Gatekeepers of Arkansas Providing Youth Suicide Prevention Awareness

1. Gatekeepers of Arkansas Providing Youth SuicidePrevention Awareness Talk – Ask – Listen – Keep Safe/Get Help

2. IT IS UP TO US TO PROVIDE YOUTH SUICIDE PREVENTION H O P E Portions of the slides prepared by Maine Youth Suicide Prevention Program. www.mainesuicideprevention.org

3. Today We Will Cover: • Language, Statistics, and Myths about suicide • Warning signs and risk factors • Basic intervention skills to use with suicidal behavior • The aftermath of suicidal behavior

4. Language Considerations MUST Avoid: “successful suicide” “failed attempt” Please USE: “suicide” or “died by/of suicide” “non-fatal attempt” Should Avoid: “committed suicide” “completed suicide” “JUST a cry for help” Please USE: “died by/of suicide” “a suicide attempt”

5. Common Words & Phrases Suicidal related communications include ideation - the direct communication ofthoughts, talk, sharing of plans that may indicate a person is thinking about taking his/her own life. Suicide Attempt: A self-inflicted, potentially injurious behavior with a nonfatal outcome for which there is evidence of intent to die. Suicide: A self-inflicted death with evidence (implicit or explicit) of the intent to die.

6. Suicide in Arkansas • Suicide is the 3rd leading cause of death for Arkansas’ youth ages 15-24 • Of every 5 suicides, 4 are males • Of every 15 suicides, 7 are by firearm, 4 by hanging, 3 by drowning or poison.

7. Attempted Suicides It is estimated that there are 25 attempted suicides for each death by suicide Suicide Attempted Suicides 11,175 Arkansans Ratio implies 900,875 suicide attempts annually in USA

8. Attempted Suicide by sex/gender Estimated that there are: 3 female attempts for each (1) male attempt

9. Attempted Suicide & Age Attempted Suicides Suicides Young 100:1 65 & over 4:1 10

10. In the typical high school classroom: 1 male and 2 females have probably attempted suicide in the past year

11. After an Attempt • Support family/friends • Acknowledge the impact, the fear • Avoid judging, blaming • Emphasize safety and removal of all lethal means from household • Encourage appropriate help

12. Facts or Myths ? T or F People who talk about suicide do not actually die by suicide. T or F Suicide usually happens without warning signs. 3) T or F Talking or asking someone about suicide may plant the idea and cause a suicide.

13. In Fact • Youth suicide is a problem. • We all need to learn about it. • Talking about suicide can save lives.

14. A Word About Young Children SOME young children (ages 5-14) do understand the concept of death, are capable of planning a suicide and able to implement the plan. It is a rare event, but we must not assume that children can not or do not die by suicide. They do! Some states have documented suicides in children as young as 8 years old.

15. Definitions Warning Signs - the earliest observable signs that indicate the risk of suicide for an individual in the near-term (within minutes, hours or days.) Risk Factors - long standing conditions, stressful events or situations that may increase the likelihood of a suicide attempt or death. Protective Factors - personal and social resources that promote resiliency and reduce the potential of suicide.

16. Warning Signs Useful Mnemonic: Is Path Warm? Ideation Substance Abuse Purposelessness AnxietyTrappedHopelessness Withdrawal Anger Recklessness Mood Change

17. Early Warning Signs of Suicide Includes Behavioral, Emotional & Physical Signs: • Depressed / Anxious • Increased alcohol/drug use • “Roller coaster” moodiness • Changes in every day behaviors • Overly pessimistic, hopeless • Neglects self, friends, usual activities

18. Late Signs/Behaviors May Include: • Talks of suicide, plans for how/when/where • Refuses help • Agitated, restless, picks fights • Gives away favorite things, writes a will • Shows SUDDEN improvement in mood (suicide euphoria) • Increased isolation • Uses instant messaging or phone to drop hints

19. Listen for Verbal Clues • Direct I wish I were dead I’m going to end it all • Indirect I’m tired of it all You’ll be better off without me What’s the point of living?

20. Risk Factors

21. Risk Factors forAdolescent Suicide • Depression, anxiety, or mood disorder • Current or previous suicidal behavior • Being a victim of sexual or emotional abuse • Conduct problems • Access to lethal means

22. Protective Factors • Supports - Supportive parents, friends, teachers & other caring adults • Skillsto think, communicate, solve problems, manage anger • Purpose & value in life-hope for future • Personal characteristics - good health, positive outlook, healthy choices • Safe Environment –restricted access to lethal means

23. Very Important to Remember… There is a lot of cross-over between Risk Factors and Warning Signs! There is no particular set of risk factors that accurately predicts imminent danger. There is no “typical” suicidal person - there are ALWAYS varying degrees of risk factors.

24. From a Suicidal Person’s Point of View Crisis point has been reached Distress/torment/anxiety seems unbearable Solutions to problems seem unavailable Rational Thinking is affected Ambivalence exists between wanting to live and wanting to end the psychological pain Need to communicate pain is intense!

25. Invitations to Help PHYSICAL Lack of interest in appearance Changes in appetite, weight Change in sleep patterns FEELINGS THOUGHTS “All of my problems will end soon” “No one can do anything to help me now” “I wish I were dead” “Everyone will be better off without me” “I won’t be needing these things anymore” “I can’t do anything right” “I can’t think straight” Desperate Angry Guilty Worthless Lonely Sad Hopeless Helpless ACTIONS Giving away possessions Withdrawal (family, friends, school, work) Loss of interest in hobbies Abuse/use of alcohol, substances Reckless behavior Extreme mood swings

26. Intervention--Why People Hesitate Inability/lack of knowledge Worry about doing/saying the “right” thing Feelings of inadequacy Belief in myths of suicide

27. What is NOT Helpful • Ignoring or dismissing the issue • Acting shocked or embarrassed • Challenging, debating or bargaining • Giving harmful advice

28. What IS Helpful Show You Care—Listen carefully—Be genuine “I’m concerned about you . . . about how you feel.” Ask the Question—Be direct, caring and non-confrontational “Are you thinking about suicide?” Get Help—Do not leave him/her alone “You’re not alone. Let me help you.”

29. Practice Helpful Steps! Use handout: “What Is Helpful 3-Step Intervention” Think up & write 1 or 2 phrases or ways that YOU would use to “show you care.” Writetwo other ways you might “ask the question” about suicide. List two ways you would try to convince someone to “get help” and name two resources.

30. Resources for Help – Phone numbers • Arkansas Crisis Hotline 1-888-CRISIS2 (1-888-274-7472) • National Suicide Crisis Hotline 1-800-273-TALK (8255) • Or 1-800-SUICIDE (1-800-784-2433) • En Español 1-888-628-9454 • TTY capability 1-800-799-4TTY (4889)

31. Resources for Help - Websites National Suicide Prevention Lifeline • http://www.suicidepreventionlifeline.org/  MYSPP Web Site: www.mainesuicideprevention.org Online Crisis Chat: • www.crisischat.org or www.arcrisis.org

32. School Resources for Help • School Administrators • School Counselors • Teachers & School Staff • School Nurses & Health Services • Social Workers • School Crisis Team • School Resource Officer • Any Trusted Adult

33. Our school protocol is… When Any Concern Is Raised Contact: Principal & School Counselor School Crisis Team Parent or Guardian Have a Suicide (Risk) Assessment Administered

34. Number of Suicide Survivors It is estimated that there are 6 survivors for each death by suicide A “suicide survivor” is someone who has lost a loved one to death by suicide 2,412 Arkansans in 2008 Ratio implies 199,800 new survivors of suicide annually

35. Survivors of Suicide Struggle to make meaning of the loss Suffer from overwhelmingly complicated feelings May take a long time to grieve Need understanding and support Youth survivors have special issues

36. How you can help after a suicide Acknowledge the loss Share a special memory/story Use the name of the deceased Share your presence Acknowledge the good things Stay in touch Call local hospice center for grief support groups

37. Factors Used in Estimating the Risk of Suicide Age: Certain ages more than others. Gender: One gender more than the other. Stress: Troubling experiences that challenge the person’s ability to cope. Warning Signs: Behaviors that can be observed (Aggression, Sadness, Drug or Alcohol Abuse)

38. Additional Factors Used in Estimating the Risk of Suicide Current Suicide Plan: Whether or not there is a plan and any details of that plan Prior Suicidal Behavior: Personal history of suicide or suicide attempt(s): including “modeling” by family, friends or others Resources/Protective Factors: Physical and emotional resources which the person feels are helping, caring or supportive

39. Estimate the Risk of Suicide Your Rank Rank ___ Age ___ Gender ___ Stress ___ Warning Signs ___ Current Suicidal Plan ___ Prior Suicidal Behavior ___ Resources/Protective Factors 5 4 6 3 1 2 7

40. Responders – Take Care of Yourself! • Acknowledge the intensity of your feelings • Seek support, de-brief • Share your feelings • Avoid over – involvement • Know that you are not responsible for another person’s choice to end their life

41. “A LIFE SAVED” The story on video we are about to see is true. It concerns a suicide intervention that occurred only days after the end of a suicide prevention learning unit done at a Maine middle school health class. It is told by the real student and guidance counselor involved. No scripts were used, no rehearsals held and no special lighting or sound systems. A high school student did the actual digital filming.

42. Arkansas Crisis Center Business Office: (479) 756-1995 Fax: (479) 756-2338Email: www.arcrisis.orgAR Crisis Hotline: 1-888-274-7472

43. Before You Leave… Thank You . . For learning about suicide prevention ADE Support: betty.welch@arkansas.gov roger.palmer@arkansas.gov Any Questions?