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ASK ABOUT SUICIDE : To Save A Life

ASK ABOUT SUICIDE : To Save A Life. Clara Cáceres Contreras, B.S., M.Ed. Certified Prevention Specialist School Health Program Region One ESC ccontreras@esc1.net http://www.esc1.net/schoolhealth 984-984-6125. TexasSuicidePrevention.org or MHATexas.org. 1.

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ASK ABOUT SUICIDE : To Save A Life

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  1. ASK ABOUT SUICIDE : To Save A Life Clara Cáceres Contreras, B.S., M.Ed. Certified Prevention Specialist School Health Program Region One ESC ccontreras@esc1.net http://www.esc1.net/schoolhealth 984-984-6125 TexasSuicidePrevention.org or MHATexas.org 1

  2. ASK Is A Gatekeeper Training Program ASK about Suicide to Save a Life is a Suicide Prevention Gatekeeper Training ASK -Question SEEK- Information (Keep Safe) KNOW -Where/how to Refer ASKis a process to offer HOPE to help prevent a tragic loss of life and NOT a form of counseling or treatment 2

  3. What do we know about suicide in TEXAS… 2,433 Suicide Deaths in 2007 2,618 Suicide Deaths in 2008 2nd cause of death 25-34 year olds 3rd cause of death of teens and college aged youth (10-24 years), CDC Report 2009 90% died by suicide have an underlying mental health or substance abuse condition. It effects nearly 20% of those with bipolar disorder and 15% of those with schizophrenia 3 Source: Centers for Disease Control and Prevention, WISQARS

  4. What do we know about suicide ? More Males Die by Suicide Females Attempt Suicide More Latina Female Teens have the highest attempts in the U.S. Highest death rate for both teens and adults is for White males. Note: African American females have tended to have some of the lowest suicide death rates through the years….Why? Protective factors? (Data from suicidology.org, WISQARS, and Texas DSHS searchable database http://soupfin.tdh.state.tx.us/cgi-bin/death) 4

  5. What we DO know about suicide… Public Health Perspective, it is considered to be one of the most preventable of deaths …. IF We Recognize and Lower Risk Factors, Support Protective Factors Recognize Warning Signs and Are Trained and Ready to ASK?

  6. Death Statistics for Region One Age: 5 to 14Intentional Self-Harm (Suicide)

  7. Death Statistics for Region One Age: 15 to 24Intentional Self-Harm (Suicide)

  8. (discuss handout) YRBSS DATA by State and County Tx DSHS death statistics searchable database online. (see directions for using it in TexasSuicidePrevention.org “Coming Together to Care: A Suicide Prevention Toolkit for Texas” ) ASK www. TexasSuicidePrevention.org

  9. http://www.cdc.gov/ViolencePrevention/suicide/

  10. Region One 400,000 Students 100, 000 High School Students • 100,000 X .277 = 27,700 Depressed • 100,000 X .137 = 13,700 Considered • 100,000 X .103 = 10,300 Plans • 100,000 X .074 = 7,400 Attempted • 100,000 X .021 = 2,100 Hurt so bad, need medical help

  11. Question #1 “Have you felt sad or hopeless almost every day in a row for two weeks or greater so that it affected your usual activities in the past twelve months?” • Nationally 26.1% - Over 1 out of every 4 Students • Texas 27.7% - Almost 1 out of 4 battled the start of depression • High School – # of students multiplied by .277 = _____# students are depressed http://www.cdc.gov/ViolencePrevention/suicide/

  12. Question #2 • “Have you seriously considered suicide in the past twelve months?” • Nationally 13.8% - Almost 1 out of every 7 students • Texas 13.7 – Over 1 out of every 7 seriously considered suicide • High School - . # of students multiplied by .137 = _____# students are depressed http://www.cdc.gov/ViolencePrevention/suicide/

  13. Question #3 • “Have you made a plan on how to commit suicide in the past twelve months?” • Nationally 10.9% -1 out of every 10 students • Texas – 10.3% - 1 out of every 10 seriously made a plan to commit suicide • High School - # of students multiplied by .103 = _____# students are depressed http://www.cdc.gov/ViolencePrevention/suicide/

  14. Question #4 • “Have you attempted suicide one or more times in the past twelve months?” • Nationally 6.3% • Almost 1 out of every 14 Students • Texas – 7.4% More than 1 out of 14 attempted suicide • High School - ? # of students multiplied by .074 = _____# students are depressed http://www.cdc.gov/ViolencePrevention/suicide/

  15. Risk Factors Risk Factors are stressful events, situations, or conditions in a person’s life that may increase the likelihood of attempting or dying by suicide. 15

  16. Underlying Risk Factors ASK

  17. Protective Factors(can act as “safety lines”) “Protective factors are the positive conditions, personal and social resources that promote resiliency and reduce the potential for suicide as well as other high-risk behaviors.” 17

  18. Protective Factors • Connections to family and community support • Ongoing medical and mental health care relationships • Skills in problem solving, conflict resolution and nonviolent handling of disputes • Cultural and religious beliefs that discourage suicide and support self preservation • Clinical care mental, physical and substance use • Access to clinical interventions and support for help seeking • Restricted access to highly lethal means of suicide 18

  19. Entering Suicidal Zone When risk factors are high and protective factors are low, proximal risk factors (or stressors) can interact with a person’s long term or underlying risks so that a person gets into a “suicidal zone.” . ASK

  20. Suicidal Zone (time limited) The good news is, the period in the suicidal zone or the heightened period of suicidalitytends to be short term (a matter of hours or days) so any intervention in this time period can save a life. . ASK

  21. I’M SUICIDAL Suicide can be prevented. While some suicides occur without any outward warning, most people who are suicidal do give warnings. . ASK

  22. : Warning Signs Communicated Verbally or Nonverbally • Direct and Indirect Verbal Signs • “I want to kill myself.” • “I’ve been thinking about suicide.” • “I just want out. I can’t take it anymore.” • “I feel hopeless…it’s not worth living.” • “People would be better off without me.” • “Sometimes I just want to go to sleep and not wake up.” 22

  23. : Warning Signs Behavior • “Just leave me alone – I don’t want to leave my room.” • “I can’t sleep and have been really wired for past few weeks!” • “All I want to do is sleep all the time” • “I just wish I could get back at the people who did this to me! “ • “I just want to stay stoned….. maybe forever.” • “Do you know where I can get a gun?” OR “Where does Mom keep her anti-anxiety pills” • “Please take my CD collection, I’m not going to need it anymore.” 23

  24. Other Warning Signs Chronic or Moderate Risk Feelings (5 Main Ones) No reason for living/no sense of purpose in life Feeling trapped, like there’s no way out Hopelessness Dramatic mood changes (high or low) Anxiety/agitation From: Suicide Prevention Resource Center, (sprc.org), Best Practice Registry Section II Behavior (5 Main Ones) Increased substance abuse Withdrawal from friends/family/society Rage/anger/revenge Reckless or Risky activities Unable to sleep or sleeping all the time 24

  25. Other Warning Signs Moderate or Chronic Degree Risk MODERATE/CHRONIC RISK Take All Signs Seriously Refer to a Mental Health Professional Call 1-800-273-TALK (8255)for a referral 25

  26. Direct Suicidal Communication/Behavior Acute/High Degree of Risk • The best practice registry consensus statement lists two “levels” of warning signs • Acute Risk includes: • Threatening to hurt or kill himself or talking of wanting to hurt or kill him/herself; and/or, • Looking for ways to kill him/herself by seeking access to firearms, available pills, or other means; and/or, • Talking or writing about death, dying or suicide Source: Suicide Prevention Resource Center, (sprc.org), Best Practice Registry Section I From: Suicide Prevention Resource Center, Best Practices Registry Section II. 26

  27. Direct Suicidal Communication/BehaviorAcute Risk HIGH RISK=TAKE ACTION NOW!1-Take Immediate Action2–Keep Safe / Do Not Leave Alone3–Call 911 or seek Immediate help from a mental health provider at school or in community (or call your mobile crisis outreach team, or take to nearest hospital emergency room) 27

  28. Take the following 3 steps: ASK About suicide? Seek More Information/ Keep Safe 3. Know Where and How to Refer (Take action!) What Can You Do 28

  29. REMEMBER Asking about suicide does not put the thought of killing themselves in someone’s head but gives them a sense of relief that someone is finally hearing them and will LISTEN. ASKING -1ST Step 29

  30. Step 1: How to Ask About Suicide Indirect Sometimes when people are sad as you are, they think about suicide. Have you ever thought about it? Do you ever want to go to bed and never wake up? Direct Have you thought about suicide? Do you want to kill yourself? Are you thinking about suicide? 30

  31. Step 1: How to Ask About Suicide Don’t say Be Aware Of your non-verbal cues. How you ask is not as important as ASKING itself. If you can’t do it, find someone who can. • You’re NOT thinking of suicide, or you? • You wouldn’t do something really stupid, would you? 31

  32. Step 2: SEEK more Information & Keep SAFE 1.Seek a private area to talk 2.Seek to establish a relationship 3.Comment on what you see and observe non-judgmentally 4. Be curious about their perceived problem, find out how long they’ve thought about suicide, if they’ve attempted suicide in past and if tried to get help 32

  33. STEP 2: SEEK more Information & Keep SAFE 5. Seek to find out if they are at immediate high risk of suicide (have a plan) (rehearsing it in their mind) and/or (have a gun, access to pills or other means) and take immediate steps to limit access to means and assure safety if YES. 6. Find out who and where they normally go to for help (family, friends, pastor, neighbor, roommate, girl/boy friend) 7. Find out if they have a regular doctor, mental health provider or counselor. 9. Be sure to be aware of your own non-verbal reactions and tone of voice! 33

  34. The third step in the referral process is to KNOW where to refer nationally, in Texas and in your area, your school or your community. National Suicide Prevention Lifeline: 1-800-273-TALK\1-800-273- 8255 SAVE A NUMBER TO SAVE A LIFE STEP 3: KNOW –How and Where to Refer? 34

  35. 911s, Hospitals, Law Enforcement and Mobile Crisis Outreach Teams In an immediate risk, call 911, your local police, campus police, or the sheriff’s office or take the person to the nearest hospital emergency room. (Keep a list of nearest hospital emergency rooms on your referral card/sheet.) Note: Many Texas law enforcement agencies have officers trained in mental health. You can ask for a mental health officer. Note: Many Texas communities have mobile crisis outreach teams—find out if there is one in your area and their contact number. STEP 3: KNOW Where to Refer in Texas & Local Area 35

  36. STEP 3: KNOW Where to Refer in Texas & Local Area • Texas Crisis Line Options • All MHMRs/LMHA in the State of Texas are required to provide a 24-hour crisis line for their service area (which may be a county or a region of counties) and these lines are required to be certified by the American Association of Suicidology. • To find the number to the MHMR crisis line closest to you, log onto the DSHS website, www.dshs.state.tx.us, under Reference Center or go to TexasSuicidePrevention.org and look for crisis centers in the appendix for your county. (Discuss local referral lists and/or action plans) 36

  37. Ask about suicide Seek more information & Keep SAFE Know how and where to refer Questions from audience AND Share Successful Intervention & Postvention Stories Please fill out the evaluation forms with the number 2 pencil provided Remember… YOU CAN SAVE A LIFE : 37

  38. Texas Education Code § 11.252 – District-Level Planning and Decision-Making (a) Each school district shall have a district improvement plan that is developed, evaluated, and revised annually, in accordance with district policy, by the superintendent with the assistance of the district-level committee established under Section 11.251. The purpose of the district improvement plan is to guide district and campus staff in the improvement of student performance for all student groups in order to attain state standards in respect to the student achievement indicators adopted under Section 39.053 . The district improvement plan must include provisions for: *** (3) strategies for improvement of student performance that include: ***(B) methods for addressing the needs of students for special programs, such as suicide prevention, conflict resolution, violence prevention, or dyslexia treatment programs;

  39. Early Mental Health Intervention and Suicide Prevention- HB 1386 The Texas Dept of state Health Services and TEA will issue a list of suicide prevention programs that districts must select from to implement in all grade levels. Once the district approves a program, teachers, counselors, nurses, administrators and other staff must be trained Establish procedures for identification and referral in a timely manner May designate one person to act as a liaison officer for the distirct Sets counseling options

  40. Early Mental Health Intervention and Suicide Prevention- HB 1386 Components will include: Recognizing students who are at risk of committing suicide, including students who are or may be the victims of or who engage in bullying Appropriate Intervention & proper reporting to notifying parents & mental health services May adopt policy and any necessary procedures must be included in: (1)the annual student handbook; and (2)the district improvement plan under Section

  41. SUICIDE POSTVENTION Definition: ” The provision of crisis intervention, support and assistance for those affected by a suicide.” American Association of Suicidology, 1998

  42. SUICIDE POSTVENTION: GOALS • Support the grieving process (Hazell, 1993; Underwood and Dunne-Maxim, 1997). • Prevent imitative suicides (Hazell, 1993; Underwood and Dunn-Maxim, 1997). -Identify and refer at-risk survivors(Gould and Kramer, 2001) -Reduce identification with victim • Reestablish healthy school climate (King, 2001). • Provide long-term surveillance (Gould and Kramer, 2001).

  43. SCHOOL SUICIDE POSTVENTION:KEY MESSAGES Points to emphasize to students, parents, media (including online). • Prevention (warning signs, risk factors) • No one thing/person is to blame • Mental illness etiology • Normalize anger (Clark, 2001) • Stress alternatives • Help is available

  44. SCHOOL SUICIDE POSTVENTION: RESPONSE PROTOCOL • Verify suicide • Contact family of suicide victim • Determine what and how information is to be shared • Mobilize the crisis response team • Inform faculty and staff • Assess the impact on the school • Identify at risk students/staff Addition: Identify what is and has been shared on internet and/or social networking sites. School Mental Health Project, Dept. of Psychology, UCLA, 2003

  45. SCHOOL SUICIDE POSTVENTION: RESPONSE PROTOCOL • Notify parents of highly affected students • Provide recommendations for community-based mental health services • Conduct faculty planning session • Hold evening meeting for parents • Provide information on community- based funeral services/memorials • Collaborate with media, law enforcement and community agencies School Mental Health Project, Dept. of Psychology, UCLA, 2003

  46. MEMORIAL ACTIVITIESFOLLOWING SUICIDE • Don’t conduct on campus memorial services • Provide opportunity for small group/individual discussion • Don’t glorify act • Avoid mass assemblies focusing on victim • Don’t establish permanent memorials to victim • Don’t dedicate yearbooks, songs, or sporting events to the suicide victim • Establish school policies which treat all youth deaths in similar manner • Establish school policies to discourage t-shirts or other student memorializing which might disrupt/disturb other high, risk students Frank Zenere, Postvention Training, Austin, Tx 2007-2008

  47. National Suicide Prevention Lifeline – 1-800-273-TALK 1-800-273-8255 * Model message to post online following a death by suicide *Model letter to parents re their dead child’s FB or MySpace page * Steps to take to intervene * Lifeline Avatar Gallery * YouTube videos & PSAs to download Online Resources for Helphttp://www.suicidepreventionlifeline.org/ • Lifeline in New YouTube Abuse and Safety Center • What to do if someone is at risk for suicide • What to do if harmful messages are posted • Has warning signs for suicide and Lifeline #

  48. The National Suicide Prevention Resource Center lists best practice programs & guidelines www.SPRC.ORG • Mental Health America of Texas has downloadable brochures for teens, educators & parents www.Mhatexas.org • American Association of Suicidology www.Suicidology.org • American Foundation for Suicide Prevention www.afsp.org • AT Risk – Avatar Simulation www.kognitocampus.com/faculty/ • The Jason Foundation, Inc. • www.jasonfoundation.com/ • School Based Youth Suicide Prevention • http://theguide.fmhi.usf.edu • Sesame Street Grief, Emotions, Feelings-Video • www.sesamestreet.org Texas Suicide Prevention Council 17 local coalitions and 18 statewide associations with online toolkit www.TexasSuicidePrevention.org

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