Suicide: Tactical and Interpersonal Responses to Suicide Threats

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SuicideTactical and InterpersonalResponses to
Suicide Threats

• Bob Zepeda, M.S.W.
• Employee Training Consultants

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Course Agenda

• Purpose
• Goals
• Objectives
• Overview

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Cultural Perspectives

• Definition
• Japan
• Elderly
• Physician-Assisted

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The Demographics of Suicide

• Over Half A Million Attempts per year
• Avg. 1,900 Adult Attempts per day
• 84 deaths due to suicide per day
• 8th Leading Cause of Death in U.S.
• 3rd Leading Cause Among 15-24 y/os

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Non-Medical Deaths in the U.S.
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Suicide vs. Homicide Rates
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Means of Death by Age
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Casualties of WarForeign and Domestic
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Casualties of Suicide and War
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Who Commits Suicide?

• 15 of people with Major Depression
• 13 of all Schizophrenics
• 10 of all Personality Disorders
• 4-6 of all Alcoholics
• 130 out of every million teenagers

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Prison Populations

• Most frequent cause of Death
• 90-230 Suicides per 100,000
• Most arrested for non-violent crimes
• 50 intoxicated with alcohol or drugs at time of
  death

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Peace Officer Population

• For Each Officer Killed in Line of Duty
• Three others commit suicide
• dozens develop heart disease or ulcers
• 75 of all officers are divorced

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Not Me! (Right?)

• Suicide Innoculation Exercise
• Make a list of five Resource People
• People you can talk to if you have no one elst to
  turn to.
• Make a No Suicide Contract
• With Yourself

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Motives for Suicide

• Escape Unbearable Emotional Pain
• Unable to face consequences of acts
• Unable to see other options
• Feelings of Isolation
• Anger
• Suicidal Gestures Are Attempts to
• Communicate
• Manipulate

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Methods of Suicide

• Firearms
• Hanging
• Drug Overdose

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Risk Factor Domains

• Hx of Mental or Addictive Disorder
• Aggressive Personality Traits
• Social Environmental Factors
• Family History
• Biological Factors
• Demographic Factors

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Suicides by Gender
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Suicides by Race
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Male Suicides Age and Race
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Male Suicide Deaths by Age
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Teen and Young Adult Suicide

• Persons under 25 16.4 of suic. 92
• their rate tripled from 1952-1992
• rate for 15-19 y/os 28.3 1980-92
• rate for 10-14 y/os increased 120!
• African American Males 15-19165

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Teen Risk Factors

• Family History of Suicide
• Fam. Hx. mental dis. or subs. abuse
• Family Violence
• emotional, physical or sexual abuse
• Separation or Divorce
• Prior Suicide Attempt
• Firearm in the Home
• Incarceration
• Exposed to family or peer suicide

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High Achievers andExceptional Children

• OTHER-ORIENTED PERFECTIONISTS
• SELF-ORIENTED PERFECTIONISTS
• SOCIALLY PRESCRIBED PERFECTIONISM
• COGNITIVE DEFICITS
• DIMINISHED PROBLEM SOLVING ABILITY
• LEARNING AND BEHAVIOR PROBLEMS

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Warning Signs for Students

• Young Children
• Physical Complaints
• Agitation
• Hear Imaginary Voices

• Adolescents
• Increased Emotionality
• Social Withdrawal
• Antisocial Behaviors
• Substance Abuse
• Ignore Appearance
• Leave Home or refuse
• family participation
• Sensitive to Rejection

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Minimize Suicide Contagion

• Avoid Sensationalizing the Suicide
• Avoid Oversimplifying Suicide Factors
• Dont Glorify the Victim
• Dont Portray as Rewarding Experience
• as Effective Tool for Personal Gain
• Dont Depict Method of Suicide
• Deemphasize Simple Stressors
• Avoid Massive Press Coverage
• Include Suicide Hot Line Numbers, etc.

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News Reports
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Typical Risk Factors

• Significant Changes in
• Relationships or Body Image
• Personal or Family Well-being
• Employment or Financial Status
• Significant Losses
• Loved One or Valued Relationship
• Employment or Self Esteem
• Perceived Abuse
• Physical , Sexual, Severe Neglect
• Social, Emotional, Psychological

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Primary Suicide Indicators

• Major Depression
• Substance Abuse
• Severe Personality
• Disorder
• White Male

• Previous Attempts
• Older Age
• Living Alone
• Physical Illness

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Warning Signs of Depression/Suicide

• Feelings of Hopelessness/Helplessness
• Signs of Sadness or Irritability
• Withdrawal from Friends or Family
• Loss of Interest in Usual Activities
• Change in Appetite/ Sleep/ Weight Pattern
• Loss of Energy
• Self-Criticism, Negative Self-Talk
• Talking, Writing or Hinting about Suicide
• Recurring Suicidal Thoughts or Fantasies
• Suddenly Putting Affairs in Order

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Attempters vs. Completers

• Only 7-10 of Attempts Succeed
• 60-70 of those who talk about it, make an
  attempt within 6 months
• If advertise attempt, dont want to die
• Characteristics of Completers
• Depressed--(completions 30-90X higher)
• Alcohol Other Drug (300-900X higher)
• Male, Age 80-84 (men2-6X higher than f.)
• Using a Firearm

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Who Are the Victims of Suicide?

• The Individual
• Surviving Family, Friends, Colleagues
• Surviving Children
• Love /Hate Relationships
• Those who attempted to Intervene
• Intervening Agencies
• Innocent Bystanders
• Society as a whole

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Peace Officer Responsibility in The Public
Safety Role

• What is Public Safety?
• What is Responsibility?
• Priorities
• 1. Personal
• 2. Innocent Bystanders
• 3. Innocent Hostages
• 4. Potential Perpetrator
• 5. The Agency

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Salient Points

• The Basic Dynamic is Anger
• Potential Suicides in Two Groups
• Threats are Desperate Cries for Help
• gtFairly Good Odds of Success
• Youre in the Barrel
• gtDont Try to Negotiate Alone
• Its Still Their Decision

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Assessing Lethality of Threat

• PLAID
• Plan?
• Lethality?
• Availability?
• Illness?
• Depression?

• PALS
• Previous Attempts?
• Alone?
• Losses?
• Substance Abuse?

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Effective Interpersonal Skills

• Be Yourself
• Take Threats Seriously
• Get Them Talking
• Effective Listening Skills
• Be Sympathetic

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Pitfalls of Intervention

• Avoiding the topic
• Not asking obvious questions
• Moralizing
• Emotional Exhortation/Emotional Belligerence
• Rescue the Person
• False Reassurance

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Risk Factors in Suicide Threat Calls

• Danger to Peace Officers
• Danger to Innocent By-standers
• Danger to innocent Hostages
• Danger to the Perpetrator/Victim
• Threats to The System

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POLICE TACTICS

• High Risk Patrol Tactics
• Hostage Situation
• gtLocate Subject
• gtSafe Approach
• gtContain Suspect
• gtRemove Bystanders
• gtEstablish Communication
• gtMaintain Firearms Discipline

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Tactical Objectives

• Stabilize Situation
• Avoid Mistakes
• Maintain Firearms Discipline
• Gather Intelligence
• Obtain Support

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Hostage Response Techniques

• Principles Based on Discipline, Teamwork, And
  Communication
• gtObtain Support
• gtReduce Anxiety
• gtBuild Rapport
• gtEstablish Trust
• gtListen, Be Patient
• gtDont Rush
• gtBe Willing toAssist

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Practical Scenarios

• Experiential Exercises

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Critical Incident Debriefing

• Characteristics of Critical Incidents
• gtSudden and unexpected
• gtJeopardizes your sense of control
• gtDisrupts beliefs, values, assumptions
• gtMay include physical or emotional loss
• Signs of Post-Traumatic Stress
• gtConfusion and/or Perceptual Distortions
• gtStress Sumptoms
• gtFeelings of Guilt
• gtDisturbances of Behavior or Emotions

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Summary

• Cultural Issues
• Problem Scope
• Motives
• Methods
• Who The Victims Are (Innoculation)
• Risk Factors Warning Signs
• The Psychological Dynamics
• Peace Officers Public Safety Role
• Intervention Skills and Tactics

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References

• National Center For Health Statistics
• New England Journal of Medicine
• American Journal of Psychiatry
• American Psychologist
• U.S. Center for Disease Control
• MTI Film and Video
• Hostage Response Techniques Series
• Dr. Madeline Gould, Columbia University
  Department of Psychiatry

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Course Evaluation