The Many Paths to Suicide

1. The Many Paths to Suicide Cause of Death Proximal Risk Factors “Triggers or Final Straws” Fundamental Risk Factors Biological Crisis in Relation Poison Genetic Load Sex Loss of Freedom Gun Race Age Personal/Psychological Increasing Hopelessness Contemplation of Suicide as Solution Fired/ Expelled Hanging Values Religion Beliefs Drugs or Alcohol Culture Shock/ Shift Child Abuse Loss of Parent WALL OF RESISTANCE Illness Autocide Model for Suicide Environmental Urban vs. Rural Major Loss Geo-graphy Jumping Season of year ? ? • All “Causes” are real. • Hopelessness is the common pathway. • Break the chain anywhere = prevention.

2. Wall of Resistance to Suicide Duty to others Others? Counselor or therapist Fear Good health Medication Compliance Responsibility for children Job Security or Job Skills Support of significant other(s) Difficult Access to means Positive Self-esteem A sense of HOPE Religious Prohibition Calm Environment AA or NA Sponsor Pet(s) Best Friend(s) Safety Agreement Treatment Availability -- Sobriety -- Protective Factors

3. Suicidal Crisis Episode Risk is Imminent 7 6 5 3 2 1 Risk Level 4 Initial Hazard is Encountered Crisis Begins Crisis Peaks Crisis Diminishes Stable Stable Years Days Hours Days Years Approximately 3 weeks

4. Contagion Effect Duration and Intensity of Risk Factors Increases (2nd and 3rd suicides occur) Secondary Hazard Occurs (e.g. anniversary date) Risk Continues to Increase First Suicide Occurs Very High Risk Initial Hazard Encountered Crisis Continues Higher Risk Crisis Builds Crisis Remains High Risk Risk Continues Crisis Begins Stable Years Hours Days Weeks Mos/Yrs Days Weeks Months Months Due to mounting losses, increasing frequency of anniversary dates, role-modeling effects, and building stress, the risk for additional suicides can remain present for months and even years. VW/1998

5. The Lethal Triad Upset Person Firearm Alcohol/drugs When these three are present—risk of violence is high.

6. Disease Management Model for Suicidal Patients Psychiatric Comorbid Transient IllnessPsychological States Schizophrenia Agitation Depressive Disorder Perturbation Bipolar Disorder Psychic Pain Panic Disorder Hopelessness Substance Abuse Disorder Dopamine Deficit Personality Disorder Serotonin Deficit Comorbid Physical Illness Alcohol Myopia WALL OF RESISTANCE SUICIDAL BEHAVIORS

7. Six QPR Goals Access Active Intervention Accompanied Referral Alleviation of Immediate Risk Factors Accurate Diagnosis Aggressive Treatment We can make a difference!

8. Gatekeeper training research results Increased knowledge Increased recognition of sources of stress Increased confidence and competence in helping someone in crisis Increased likelihood to intervene Increased likelihood to call a resource Satisfaction with the training For every 13 gatekeepers trained, there was one referral made Knowledge and skills are retained over time QPR Works!