Suicide Assessment and Treatment for Children and Adolescents

1. Suicide Assessment and Treatment for Children and Adolescents

2. Charles Pemberton Ed.D. in Educational Counseling 16 years in Counseling and Mental Health Presented in England, South Africa, Central America, and US. Adjunct Professor – Graduate University of Louisville Undergraduate – IvyTech and KCTCS Private Practice – 80% children and families ADHD Depression Aggression Anxiety Introduction

3. Current Statistics Treatment and Assessment Methods Legal Concerns Questions Today’s Schedule

4. There is a correlation between winter holidays and suicide rates – T/F Men attempt suicide more often than women – T/F Suicide rates are higher in the western states than in the eastern states – T/F American Indian males have the highest suicide rate – T/F Quick Quiz

5. There is a correlation between holidays and suicide rates – F Rates in the US are lowest in winter/highest in spring Men attempt suicide more often than women – F Women report attempting 3x that of men Suicide rates are higher in the western states than in the eastern states – T Higher than national average/lower in eastern and midwestern American Indian males have the highest suicide rate – F Caucasians have highest/American Indians are 2nd Quick Quiz

6. Current Statistics

7. Current Statistics

8. Current Statistics

9. Adolescent Suicide Suicidal Ideation thinking about suicide common among adolescents

10. Five reasons for erroneous belief that suicide is common in adolescent rate is triple the rate of 40 years ago adolescents lumped together with young adults as one statistical category adolescent suicide is shocking and grabs attention social prejudice considers teenagers as problems suicide attempts are more common in adolescence Adolescent Suicide, cont.

11. Parasuicide—deliberate act of self-destruction that does not end in death Parasuicide and suicide depend on five factors availability of lethal means, especially guns lack of parental supervision alcohol and other drugs gender cultural attitudes Parasuicide

12. Worldwide, parasuicide is higher for females; completed suicide is higher for males except in China, where females complete suicide more than males Cluster suicides occur when several suicides are committed within the same group in a short time Gender, Ethnic and National Differences in Suicide

13. First, remember to do three things: 1) consult - this allows for another opinion, better care, and protects you 2) document, document, document! Everything you do, everyone you talk to, every question you ask the client should be documented 3) evaluate the client's risk Assessment

14. mental diagnosis, especially depression and substance abuse, or Borderline Personality Disorder which increase risk over 45 years old are higher risk sex (men try more lethal means, women try more often) Risk Factors

15. marital status (unmarried are lowest risk, never married, divorced, widowed, recently separated are highest risk) recent job loss increases risk chronic illness is higher risk Risk Factors cont’

16. recent loss of loved one increases risk, as does the anniversary of the loss and fantasies of reuniting with the deceased hospitalized and discharged with improvement; this may seem counterintuitive, but many suicidal people feel better once they have made the decision to kill themselves, and have the energy to wrap up loose ends, see others and say goodbye... Risk Factors cont’

17. Caucasian - ethnic minorities have a lower suicide risk previous attempts - this is one of the best predictors gay/lesbian youth - may be at 3 to 5 times the risk for suicide as heterosexual Caucasian youth Risk Factors cont’

18. extensive and detailed plans, or plans using a highly lethal means history of suicide in their family history of impulsive or reckless behavior Risk Factors

19. Do you have thoughts of suicide? Are they related to current stressors going on in your life, or have you had such thoughts before? Do you have a plan? Tell me. Ask if they have access to the components of their plan, like a gun, pills, etc... Questions to ask

20. sleep, energy, weight, or appetite changes decreased interest in sex and other pleasurable activities feelings of helplessness and hopelessness social isolation and withdrawal from others Signs of Depression

21. Empathize with the clientThey are experiencing crises and stress, hopelessness, and helplessness. Offer that there is a part of them that wants to live, since they were cooperative with you. Offer too that services and referrals, as well as social support could be helpful to use now too. Make a No-Suicide Contract This is best when the client has support, is low risk, and can give clear reasons why they would not kill themselves; the client agrees they won't hurt themselves, and if they feel they can't stop themselves, they will call 911, an ER, a crises line, a therapist, or another designated special person, and will return for help on next appointment. Make the patient sign it and get a witness. Family InterventionThis is best is there is high support and low impulsiveness in the client. The clients agree with you to contact their family. They stay with the family member until the suicidal thoughts have been addressed in treatment, and the family is briefed on who to contact for help in an emergency. The family also takes an active role to remove drugs, guns, or other means of suicide from the home, and promises 24 hour supervision. HospitalizationThis is best if there is little family support, or mental illness, substance use or impulsiveness. Try voluntary admission, but use involuntary if needed. Other thoughts

22. Beck CDI Hamilton Inventories

23. Depression Lack of sleep Poor appetite Anhedonia Suicidality??? Suicidality Pain Stress Agitation Hopelessness Self-hate Reasons for living vs. reasons for dying Medical vs. Collaborative

24. Individual Psychopharmacological Group/Family EMDR ECT CDI Hamilton Treatment Options-standard

25. Journaling Interactive journaling/email Bibliotherapy Physical activity Self-soothing Treatment Options-CBT

26. Stage 1 – Acute Stage 2 – Short Term CBT and Stabilization Stage 3 – Longer Term Psychodynamic/Interpersonal Treatment Stages of Treatment

27. Forseeability Treatment Planning Follow-up/Follow-through Three Pillars of Liability

28. Screen all clients for suicidal risks during initial assessment and remain alert to issue throughout Arrange an environment that will not offer easy access to instruments Create actively supportive environment Legal Concerns

29. Make every effort to communicate and justify realistic hope Consider use of contracts Explore client’s fantasies Be clear and communicate impact to interventions Conform to State Laws Legal Concerns

30. http://www.psychpage.com/learning/library/counseling/suicide.htmlhttp://www.psychpage.com/learning/library/counseling/suicide.html http://aacap.org/page.ww?name=Teen+Suicide&section=Facts+for+Families http://www.athealth.com/practitioner/Newsletter/FPN_7_3.html http://archfami.ama-assn.org/cgi/content/full/9/10/1119 http://www.cdc.gov/nchs/fastats/suicide.htm http://suicideandmentalhealthassociationinternational.org/intervadol.html http://www.save.org/cdcstat1.html http://www.suicidepreventtriangle.org/Suichap6.htm http://www1.endingsuicide.com/PageReq?id=3048:7576 http://www.cdc.gov/ncipc/dvp/suianno.htm http://www.nimh.nih.gov/suicideprevention/suifact.cfm http://www.aafp.org/afp/20020501/tips/15.html http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/ Web links