Suicide 101

1. Suicide 101 Traci Chur, MA Mary Brooks, MS

2. Myths vs. Facts of Suicide Myth: People who talk about suicide don’t complete suicide. Fact: People who die of suicide have given definite warnings of their intentions.

3. Myths vs. Facts of Suicide Myth: Suicide happens without warning. Fact: Most people communicate warning signs of how they are reacting to or feeling about stressful events in their lives whether it be a problem with a significant other, family member, best friend, superiors, financial matters or legal issues. Warning signs may present themselves as direct statements, physical signs, emotional reactions, or behaviors such as withdrawing from friends. When stressors and warning signs are present suicide may be considered as the only option to escape pain, relieve tension, maintain control, or cope with stress. http://www.usmc-mccs.org/suicideprevent/myths-facts.cfm

4. Myths vs. Facts of Suicide Myth: Suicidal people have every intention on dying. Fact: Most suicidal people are ambivalent about their intentions right up to the point of dying. Very few are absolutely determined or completely decided about ending their life. Most people are open to a helpful intervention, sometimes even a forced one. The majority of those who are suicidal at some time in their life find a way to continue living. http://www.usmc-mccs.org/suicideprevent/myths-facts.cfm

5. Myths vs. Facts of Suicide Myth: There is no correlation between sex/gender and suicide. Fact: Numbers from the National Center for Health Statistics show this clearly. In the year 2000, the latest year for which statistics are available, men died four times as often as women did when they attempted suicide, even though women were three times more likely than men to try it in the first place. http://www.medicinenet.com/script/main/art.asp?articlekey=52099

6. Myths vs. Facts of Suicide Myth: Asking a person about suicide and talking about suicide will push them to complete suicide. Fact: Talking about suicide does not create nor increase the risk. The best way to identify if someone is thinking about suicide is to ask them directly. Avoiding the subject of suicide may contribute to suicide. Avoiding the subject reinforces a suicidal persons thought that no one cares. http://www.usmc-mccs.org/suicideprevent/myths-facts.cfm

7. Myths vs. Facts of Suicide Myth: If the person seems better after hospitalization the risk is over. Fact: Compared with controls, patients in the first week of psychiatric hospitalization had significantly increased risks for suicide (60 times higher for men and 82 times higher for women). Patients in the week after hospital discharge also had significantly increased suicide risks (102 times higher for men and 246 times higher for women). http://psychiatry.jwatch.org/cgi/content/full/2005/608/3

8. Myths vs. Facts of Suicide Myth: Suicide increases over the holidays. Fact: CDC’s National Center for Health Statistics reports that the suicide rate is, in fact, the lowest in December.2 The rate peaks in the spring and the fall. This pattern has not changed in recent years. The holiday suicide myth supports misinformation about suicide that might ultimately hamper prevention efforts. http://www.cdc.gov/ViolencePrevention/suicide/holiday.html

9. Risk factors • Psychiatric DisordersAt least 90 percent of people who kill themselves have a diagnosable and treatable psychiatric illnesses -- such as major depression, bipolar depression, or some other depressive illness, including:SchizophreniaAlcohol or drug abuse, particularly when combined with depressionPosttraumatic Stress Disorder, or some other anxiety disorderBulimia or anorexia nervosaPersonality disorders especially borderline or antisocial

10. Risk factors • Past History of Attempted SuicideBetween 20 and 50 percent of people who kill themselves had previously attempted suicide. Those who have made serious suicide attempts are at a much higher risk for actually taking their lives. • Genetic PredispositionFamily history of suicide, suicide attempts, depression or other psychiatric illness.

11. Risk factors • NeurotransmittersA clear relationship has been demonstrated between low concentrations of the serotonin metabolite 5-hydroxyindoleactic acid (5-HIAA) in cerebrospinal fluid and an increased incidence of attempted and completed suicide in psychiatric patients. • ImpulsivityImpulsive individuals are more apt to act on suicidal impulses. • DemographicsSex: Males are three to five times more likely to die by suicide than females. Age: Elderly Caucasian males have the highest suicide rates. http://www.afsp.org/index.cfm?page_id=05147440-E24E-E376-BDF4BF8BA6444E76

12. Youth • In 2005, suicide ranked as the third leading cause of death for young people (ages 15-19 and 15-24); only accidents and homicides occurred more frequently. • Suicide rates, for 15-24 year olds, have more than doubled since the 1950’s, and remained largely stable at these higher levels between the late 1970’s and the mid 1990’s. They have declined 28.5% since 1994. • Males between the ages of 20 and 24 were 5.8 times more likely than females to complete suicide. Males between 15 and 19 were 3.6 times more likely than females to complete suicide (2005 data). • Firearms remain the most commonly used suicide method among youth, accounting for 49% of all completed suicides. http://www.suicidology.org/c/document_library/get_file?folderId=232&name=DLFE-24.pdf

13. Some warning signs • Talking about wanting to die or to kill oneself. • Looking for a way to kill oneself, such as searching online or buying a gun. • Talking about feeling hopeless or having no reason to live. • Talking about feeling trapped or in unbearable pain. • Talking about being a burden to others. • Increasing the use of alcohol or drugs. • Acting anxious or agitated; behaving recklessly. • Sleeping too little or too much. • Withdrawing or feeling isolated. • Showing rage or talking about seeking revenge. • Displaying extreme mood swings. http://www.suicidepreventionlifeline.org/GetHelp/SuicideWarningSigns.aspx

14. Signs of a potential suicide crisis • Precipitating EventA recent event that is particularly distressing such as loss of loved one or career failure. Sometimes the individuals own behavior precipitates the event: for example, a man's abusive behavior while drinking causes his wife to leave him. • Intense Affective State in Addition to DepressionDesperation (anguish plus urgency regarding need for relief), rage, psychic pain or inner tension, anxiety, guilt, hopelessness, acute sense of abandonment. • Changes in Behavior Speech suggesting the individual is close to suicide. Such speech may be indirect. Be alert to such statements as, "My family would be better off without me." Sometimes those contemplating suicide talk as if they are saying goodbye or going away.Actions ranging from buying a gun to suddenly putting one's affairs in order.Deterioration in functioning at work or socially, increasing use of alcohol, other self-destructive behavior, loss of control, rage explosions. http://www.afsp.org/index.cfm?page_id=05147440-E24E-E376-BDF4BF8BA6444E76

15. What can you do to help? • Too often, victims are blamed, and their families and friends are left stigmatized. As a result, people do not communicate openly about suicide. Thus an important public health problem is left shrouded in secrecy, which limits the amount of information available to those working to prevent suicide. • Talk about suicide • Listen • Offer non-judgmental support • Educate

16. Listen • Let them tell their story • Don’t be afraid of emotion • Ask questions • Are you thinking about suicide? • What thoughts or plans do you have? • How long have you been thinking about suicide? • Have you thought about how you would do it? • Do you have __? (Insert the lethal means they have mentioned)

17. Having the conversation of suicide • Be direct but non-confrontational • Reflect what you hear • Take ALL talk of suicide seriously • If you are concerned that someone may take their life, trust your judgment! • Use language appropriate for age of person involved • Do not worry about doing or saying exactly the "right" thing. Your genuine interest is what is most important.

18. What is a Safety Plan • A list of coping strategies and resources to use during a suicidal crisis. • Helps with a sense of control over suicidal urges and thoughts. • Can serve to motivate. • It is NOT a no suicide contract, we are not asking or telling them to stay alive.

19. What is helpful about a Safety Plan • A safety plan is developed together with a caring individual. • Helps to enhance individual’s sense of control or empowerment over the suicidal urges or thoughts. • Involving family members and/or friends with the safety plan can help de-stigmatize the suicidal thoughts.

20. When to complete a Safety Plan • Can be done at anytime a person is exhibiting suicidal urges or thoughts. • Is developed after the imminent risk of suicide or crisis is dealt with. • Not appropriate when someone is at imminent risk for suicide or has profound cognitive impairment.

21. How to complete a Safety Plan • Listen • Let them tell their story. • Hear why they want to die, with no judgment. • Don’t be afraid of emotion. • Don’t rush them.

22. Safety Plan Steps • Step 1: Warning signs: 1._____________________________________________________________ 2._____________________________________________________________ 3._____________________________________________________________ 4._____________________________________________________________ • Step 2: Internal coping strategies - Things I can do to take my mind off my problems without contacting another person: 1. ____________________________________________________________ 2._____________________________________________________________ 3._____________________________________________________________

23. Safety Plan Steps • Step 3: People and social settings that provide distraction: 1. Name_________________________________ Phone__________________ 2. Name_________________________________ Phone__________________ 3. Place___________________________________ 4. Place___________________________________ • Step 4: People whom I can ask for help: 1. Name_________________________________ Phone___________________ 2. Name_________________________________ Phone___________________ 3. Name_________________________________ Phone___________________

24. Safety Plan Steps • Step 5: Professionals or agencies I can contact during a crisis: 1. Clinician Name_________________________ Phone____________________ Clinician Pager or Emergency Contact #________________________________ 2. Clinician Name_________________________ Phone____________________ Clinician Pager or Emergency Contact #________________________________ 3. Suicide Prevention Lifeline: 1-800-273-TALK (8255) 4. Local Emergency Service __________________________________________ Emergency Services Address_______________________________________ Emergency Services Phone ________________________________________ • Step 6: Making the environment safe: 1. _______________________________________________________________ 2._______________________________________________________________

25. Resources • National Suicide Prevention Lifeline 1-800-273-8255 • 24 Hour Crisis Line for Beltrami County & Mobile Crisis Team 1-800-422-0045 • Crisis Connection 612-379-6363 or 1-866-379-6363

26. Further Information on Safety Planning: Gregory K. Brown, Ph.D.Research Associate Professor of Clinical Psychology in PsychiatryDepartment of PsychiatryUniversity of Pennsylvania3535 Market Street, Room 2030Philadelphia, PA 19104-3309Office: 215-898-4104 • gregbrow@mail.med.upenn.edu Barbara Stanley, PH.D. Director, Suicide Intervention Center Research Scientist, Department of Neuroscience Lecturer, Department of Psychiatry Columbia University/New York State Psychiatric Institute1051 Riverside Drive, Unit 42 New York, NY 10032 Phone: 212 543 5918 Fax: 212 543 6946 • bhs2@columbia.edu

27. Contact Information Traci Chur, MA Text Coordinator And Crisis Line Counselor HSI-Crisis Connection PO Box 23090 Richfield, MN 55423 612-852-2206 fax 612-379-6391 tchur@hsicrisis.org Mary Brooks, MS Crisis Line Counselor, Volunteer Supervisor and Registered ASIST Trainer HSI-Crisis Connection PO Box 23090 Richfield, MN 55423 fax 612-379-6391 mbrooks@hsicrisis.org