Baseline Survey Before the training begins, please fill out the baseline survey and put your completed survey in the box provided. Thank you! Ending A Deadly Silence Florida Suicide Prevention Gatekeeper Training Insert your name and agency What to Look For What to Do How to Help Adapted with permission from the Washington State Youth Suicide Prevention Program and the Maine Youth Suicide Prevention Program Pieces of the Puzzle All need to be educated Willing to talk more openly when something “in our gut” raises a red flag Prevention is often a matter of a caring person with the right knowledge being available in the right place at the right time. Silent Epidemic Serious public health problem Preventable Neither random nor inevitable Research shows that during our lifetime: 20% of us will have a suicide within our immediate family 60% of us will personally know someone who dies by suicide Attitudes and Beliefs: Taboo Nature of Suicide Taboo subjects: suicide, rape, child abuse, mental illness, drug and alcohol abuse, incest Myths of Taboo Subjects History of suicide – sin, crime, mental illness Truth or Myth Handout What Do You Know About Suicide? Truth Or Myth Survivors at lower risk MH professionals only ones who can help More common with the rich No correlation between drugs, alcohol and suicide As many as 2 youth attempts to every death Most suffer from depression More Floridians die by suicide than homicide Most have made up their minds More suicides during Christmas holidays People who are suicidal tend to hide it Need to take all talk seriously Suicide rates for 15-24 year olds have more than doubled since the 1950s while other rates stayed about the same Asking may encourage the idea Elderly have the highest rate Important not to break the trust of confidentiality Facts About Adolescent Suicide Most teenagers will reveal they are suicidal Ominous warning sign: talking repeatedly about one’s own death Issues taught in a sensitive educational context don’t lead to or cause suicide 9 out of 10 adolescents who die by suicide give clues to others before their suicide Source: Youth Suicide Prevention School-Based Guide, USF Parents are often unaware of their child’s suicidal behavior (86%) Adolescent females think about and attempt significantly more often One of the most powerful predictors of suicide is a prior attempt In a typical high school classroom, it is probable that one boy and two girls have made a suicide attempt during the past year (AAS) Leading Causes of Death Among Young People 1 Accidents 2 Homicide 3 Suicide Between the ages of 10 – 24, suicide is the third leading cause of death. Source: CDC Final 2005 Data Attempted Suicides Attempts are most common among the young. 3 female attempts for each male attempt Attempted Suicides Suicides Deaths Young 100:1 Old 4:1 Florida Statistics 3rd leading cause for 15-24 year olds (2007) 2007 YRBS: 25.7% felt sad or hopeless, 11.2% seriously considered, 8.1% made plan, 5.7% attempted, 2.1% made attempt requiring medical attention Over 2,000 Floridians die by suicide each year An average of 4 Florida youth take their own life each week Not Just Statistics Statistics alone don’t paint the whole picture Suicide is devastating to family, friends, and communities Opportunities to help Understanding People in Crisis Why Everyone Is Vulnerable Stressors are infinite Assets are finite Pressures Assets A Young Person May Feel They Can’t Can’t Can’t Can’t Can’t Can’t Can’t Can’t stop the pain think clearly make decisions sleep, eat or work make the sadness go away see the future without pain see themselves as worthwhile get someone’s attention Source: AAS @ www.suicidology .org Cup Full of Problems Each cup represents a problem that a young person may be having. Only rule is that the cups cannot be stacked inside one another. A Basic Model of Living Pain Tolerance Adaptive Factors Pain Threshold Maladaptive Factors When the pain tolerance threshold is broken (when the pain is intolerable), dangerous behaviors may follow. Drug Abuse Violence Suicide Psychotic Break Depression and Suicide Depression often goes undiagnosed until a crisis occurs Be concerned if: significant changes are noted, symptoms last 2 weeks or longer Change in eating/sleeping, isolating, concentration problems, feelings of hopelessness, irritability, guilt, anger, vague physical complaints and suicidal thoughts Source: NAMI, What Families Should Know about Adolescent Depression and Treatment Options, May 2005 The Reality Of It 12 million (1 in 10) suffer from mental illness 80% go without services 90% youth suicides had a diagnosable, treatable mental disorder 65% of boys and 75% of girls in juvenile detention have at least one psychiatric diagnosis Source: Surgeon General, 1999. IOM Report, 2002, Teplin L. Archives of General Psychiatry, Vol. 59, December 2002 Points to Consider (Group discussion) • Why do adolescents kill themselves? • What type of families do they come from? • What type of thoughts/feelings are they having? • How are they behaving? • How are they communicating/expressing themselves? • Who will know that they are suicidal? • What changes in our culture or society have influenced youth suicide? • What makes youth safe? Risk Factors Include Previous suicide attempt – exposure to suicidal behavior/ family history of suicide Psychiatric disorders: depression, conduct, anxiety, impulse disorders Alcohol/substance abuse Stressful life event or loss Source: National Youth Violence Prevention Resource Center, 2000 Physical, emotional, or sexual abuse Rejection, harassment by peers (bullying) Loss of an important relationship Sexual orientation Easy access to lethal means Change in family structure Problems at school Disciplinary action or incarceration Warning Signs and Clues What To Look For The red flags that something is wrong Changes in a person’s behavior, feelings, and beliefs about oneself that are maladaptive or out-of-character I – Ideation S – Substance Abuse P – Purposelessness A – Anxiety T – Trapped H – Hopelessness W– A– R– M– Withdrawal Anger Recklessness Mood Change Source: American Association of Suicidology, November 2003 Some Signs Demand Immediate Action Talking or writing about suicide or death Verbal clues – open talk about suicide Isolating from friends and family Putting affairs in order – giving away cherished possessions Exhibiting a sudden and unexplained improvement after being depressed Source: The Suicide Prevention Resource Center In Summary There is no typical suicide victim There are no absolute reasons for suicide There are no all-inclusive predictive lists of warning signs or a definitive method for determining if a young person is or is not suicidal Suicide is always multi-dimensional Most don’t want to die – they want to end their pain Protective Factors Positive conditions and personal and social resources Promote resiliency and reduce the potential for suicide Ability to manage or cope with adversity or stress Youth Protective Factors •Positive connections to school •Coping and problem solving skills •Academic achievement •Family cohesion/stability •Help-seeking behaviors •Good relationships with other youth •Positive self worth - confidence •Impulse control – conflict resolution abilities •Social integration/opportunities to participate •Access to care for mental/physical/substance disorders Being engaged in family, school and community is a key to preventing youth suicide. Youths need to feel comfortable, connected, respected and supported by peers and adults. Academic problems Depression Family cohesion Resiliency Bullying victim Self esteem Recent significant loss Problem solving skills Gun at home Restricted access to lethal means What to Look For What are some of the warning signs/red flags? What are the risk factors? Protective factors? What other information would be helpful? How could you get the information? Next step? Personalizing Crisis Exercise •What helps? •What hurts? Intervention Steps and Goals Get through crisis without harm Listen – establish rapport Identify and clarify problem Pinpoint feelings – evaluate hopelessness Talk about suicide Evaluate lethality Identify and utilize resources Remember People in crisis feel overwhelmed, overloaded and confused Not thinking clearly – tunnel vision Almost all are ambivalent Suicidal behavior is an act of communication They want someone to listen, someone they can trust, someone to care Source: National Center for Suicide Prevention Training Workshop – Maine Suicide Prevention Program What To Do Intervention - 3 Basic Steps SHOW YOU CARE ASK THE QUESTION GET HELP Adapted with permission from the Washington Youth Suicide Prevention Program http://www.yspp.org SHOW YOU CARE Trust your judgment Be Genuine - show them you truly care Share observations and concerns Concern can counter their sense of hopelessness Reflect what you hear LISTEN! Bad News: No script for these situations Good News: “They may forget what you said, but they will never forget how you made them feel.” Carl W. Buechner Don’t worry about doing or saying the right thing. Your genuine concern is what is most important Ask The Question Don’t assume they aren’t the “suicidal type” Be direct. “What I hear you saying is you’re in a lot of pain and you’re thinking of killing yourself … Are you thinking about suicide?” Do they have a plan, the means to carry out the plan – more detailed the plan the greater the risk Don’t have to solve all their problems but you must get help Suicide Paraphrase Activity Remain calm, non-judgmental and understanding Emphasize the temporary time-frame of suicidal crisis Emphasize the normality of suicidal thoughts Help identify and suggest alternatives, encourage positive action Get Help - How To Help Your support in building hope and finding help truly can make the difference between life and death. If you have any reason to suspect a person may attempt suicide or engage in self-harm, DO NOT LEAVE THE PERSON ALONE Resources Supportive friends Family members Clergy/youth minister Mental Health Agency Counselor or therapist Family physician Local hospital emergency room Crisis Center – 9-1-1 1-800-SUICIDE or 1-800-273-TALK When I began considering suicide, I knew that I needed serious help. My resident advisor helped me call a local hotline where I got some good referrals. It was just a phone call, but it was the starting point that got me to the professional help I needed. Leah Source: National Institute of Mental Health – What Do These Students Have In Common? Additional Resources • Substance Abuse programs • Community health department • Parent HelpLine at 800-352-5683 • YOUTHLINE at 1877-968-8454 • Wide range of local support groupsmental health, survivors, abuse • Addiction Help Line 1-800-758-5877 • FL Abuse Hotline 1800-96ABUSE • Children’s Protective Services Group Role Play What is Helpful Role Play Postvention Is Prevention One of the primary goals of suicide postvention is to prevent further suicides. Although rare, a suicide in the community (or even a remote suicide that receives substantial press coverage) can contribute to an increased risk for suicide. Suicide Postvention • Assist and support with processing reactions – grief resolution • Working to prevent additional suicides by attending to those at risk • Identify and closely monitor those close to the victim and others known to be at risk (suicidal in the past) – provide support/counseling as needed Survivors Of Suicide Anyone whose life has been impacted by a suicide death – family, friends, co-workers … those left behind to pick up the pieces after the shattering experience of a suicide death Survivors are themselves at a higher risk for suicide and emotional problems People grieve in different ways - grieving can be postponed but never avoided Stigma • Survivors may find their social network, perhaps even their friends or clergy, have judgmental or condemning attitudes about suicide • Cultural and religious taboos can serve to isolate and stigmatize survivors • Lack of social support can increase survivor’s risk of complicated grief, depression and suicide Some Common Survivor Responses • Struggle to make sense of it • Anger • Guilt over failed responsibilities • Isolation caused by self-imposed shame • Blame • Shock, disbelief, fear, awkwardness • Difficulty accepting the death was by suicide • Feelings of rejection and abandonment • Often “hyper vigilant” – afraid of another loss/death Helping Survivors • Acknowledging that the death is a suicide • Providing information on suicide and grief • Sharing memories • Support groups SOS • Patience for the time it takes to heal • Listening without judging • Accepting the intensity of the individuals grief • Sensitivity to difficult times Conclusion It doesn’t take a professional to save a life We are all gatekeepers Preventing suicide is everyone’s business –yours and mine Together we can end this deadly silence Thoughts or Questions Closing Comments Post-training Survey Please fill out the post-training survey and the training evaluation form. Put completed forms in the box provided.