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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
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and the training evaluation form. Put
completed forms in the box provided.
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