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Bolling AFB
Suicide Prevention/Intervention Techniques
Chaplain, Lt Col Dave Wilshek 11
WG/HC 767-8558 This briefing is Classified
UNCLASSIFIED
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Symptoms and Signs of Suicide Risk

• Change in Behavior - difficulty concentrating
  withdrawal from social contact neglect of
  personal appearance and/or hygiene
• Change in Personality - may be withdrawn,
  irritable, anxious, apathetic, preoccupied, sad,
  pessimistic, aggressive
• Change in Eating, Weight, or Sleeping
• Loss of Sexual Interest ( or promiscuity )
• Loss of Religious Faith

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Symptoms and Signs of Suicide Risk

• Feelings of Despair, Hopelessness
• Financial Worries (or gambling/ spending sprees)
• Drug or Alcohol Abuse - alters impulse control
• Suicidal Thoughts / Statements / Plans/ Giving
  Things Away - I wont be needing this anymore
  I am going to kill myself Goodbye .
• Sudden Lifting of Severe Depression the risk may
  be greatest at this time because more energy is
  available ( may have decided / made a plan )

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• Symptoms and Signs of Suicide Risk

• A Definite Plan for Committing Suicide
• Loss of Self-Esteem / Change in Self-Concept
• Recent Loss of friend, object, activity,
  health, viewpoint, interest in life, divorce
• Stress, Fatigue, Low Energy, Aggression
• Unsympathetic Relatives/ Friends Lack of Social
  Supports System feeling that no one cares , a
  loner, eats alone, not accepted by peers

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• Symptoms and Signs of Suicide Risk

• Prior Attempt at Suicide
• Family / Friends Have Committed / Attempted
  Suicide Already
• Rigidity in Thinking ( all or nothing,
  inflexibility in perspective )
• High Absenteeism / Tardiness decreasing job /
  academic performance
• Recent Major Confrontation with Significant
  Person ( in 24 hrs ) ...spouse, family, friend
• Buying Guns / Weapons or Stockpiling Pills

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• Symptoms and Signs of Suicide Risk

• Putting Personal / Business Affairs in Order
• Changing Will or Insurance Beneficiaries
• Obsession With / Themes of Death / Sadness in
  Letters, Art, Music
• Becoming Accident Prone, Hyperactive, Excessive
  Attention Getting
• Neglecting / Reluctance in Accepting
  Responsibilities
• Legal Infractions indebtedness, shoplifting,
  traffic tickets, fights
• Frequent Illnesses visits to sick call,
  headaches, sweating, heartburn, stomach upsets,
  tight chest, trouble breathing, heart
  palpitation, tiredness, aching, weakness,
  dizziness

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• The Most Important Question to Ask a Potential
  Suicide

• Have you been thinking about taking your life?
• How would you kill yourself?
• Do you have the means available?
• Have you ever attempted suicide before?
• What has been keeping you alive so far?
• What do you think the future holds for you?
• Have you been drinking or taking drugs?
• ( ASK YOURSELF How good is this persons
  reality testing? )

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• INTERVENTION TECHNIQUES

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• How to Help Someone Who Is Thinking About Suicide

• A Person who is considering suicide desperately
  needs to know that others care by doing the
  following
• Be Direct
• Be a Good Listener
• Let the Person Know You Care
• Answer Cries For Help
• Take Threats Seriously
• Get Help For The Person

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• A Few Donts in Dealing With Someone Who is
  Suicidal

• Dont Sidestep the Issue
• Dont Keep What You Know a Secret
• Dont Leave The Person Alone
• Dont Lecture
• Dont Assume

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• A Supervisors Role in Suicide Prevention

• Know Your Personnel
• Identify At Risk Personnel
• Be Actively Concerned
• Know The Resources
• Be Available and Supportive

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• Know The Suicide Warning Signs And High-Risk
  Factors

• If a Person Threatens Suicide, Take It Seriously
  and Follow Emergency Procedures
• 1. Dont leave the person alone.
• 2. Call for professional help immediately.
• 3. Make sure the person goes for treatment.

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• GUIDELINES FOR EFFECTIVE LISTENING

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• OBJECTIVES

• To help others gain a clear understanding of
  their situations so they can take responsible
  action.
• To demonstrate your appreciation of
• a. The meaning and feelings of others.
• b. The worth of the other person.
• c. Your willingness not to pass judgment.

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• DO

• Create a supportive atmosphere
• Listen for feelings
• Note body language
• Test for understanding
• Demonstrate acceptance and understanding
• Ask Exploratory, open-ended questions
• Self-disclosure, appropriately
• Ask what, when questions

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• DO NOT

• Try to change others views
• Solve problems for another
• Give advice inappropriately
• Pass judgment
• Explain or interpret other persons behavior
• Give false assurances
• Attack back
• Ask why questions

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• HELPING ( COUNSELING ) SKILLS

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• DOOR OPENERS

• Would you like to talk about it?
• Can I be of any help with this problem?
• PASSIVE LISTENING
• Eye Contact -- neither too much nor too little
• Posture / Body Language

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• ACTIVE LISTENING

• DIRECTIVES
• Please talk more about..
• Im not sure what you meant by...
• SELF DISCLOSURE
• I really appreciate your willingness to share
  with me..
• I feel a sense of achievement when...

• LISTENING CHECKS
• I hear you saying...?
• It seems youre telling me that...?
• OPEN-ENDED QUESTIONS
• How do you feel about...

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• RELEVANT INFORMATION OR ALTERNATIVES

• Perhaps you need to know that....
• What do you think would happen if....
• SUMMARIZING
• In summary, it seems that....
• Well, lets see if we have the same
  understanding. It seems that we are saying...

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• AVOID ROAD BLOCKS

• ORDERING
• You must do this.
• You cant do that.
• Moralizing, Preaching, Imploring
• You should ....
• You ought to....

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• JUDGING, CRITICIZING, DISAGREEING, BLAMING

• Youre not thinking straight.
• Youre acting foolishly.
• REASSURING, SYMPATHIZING, CONSOLING
• Youll feel different tomorrow.
• Things will get better.

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• DISTRACTING, DIVERTING, KIDDING

• Lets have lunch and forget it.
• That reminds me of the time.
• You think you have problems!

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• WHAT YOU CAN DO IN A CRISIS SITUATION!

• Be yourself and use your own resources - care!
• Recognize the signals of a crisis or potential
  crisis situation
• Listen! Focus on the needs of the person - not on
  your needs
• Encourage expression of feelings - anger,
  distress, hurt, frustration
• Encourage the person to relate events leading up
  to the present time
• Give information and feedback as necessary
• Provide self-disclosure to assure the person you
  are with them

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• WHAT YOU CAN DO IN A CRISIS SITUATION!

• Check on recent behavior / lifestyle / activities
  of daily living
• Ask about previous coping patterns or problem
  solving efforts
• Check on support systems - family, friends,
  co-workers, church, etc
• If person loses control - ground them with direct
  questions
• Explore options of actions
• Help person select alternative courses of
  actions-- plan with person
• Set priorities of what needs to be handled first
• Suggest help from support system

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WHAT YOU CAN DO IN A CRISIS SITUATION!

• Reinforce adaptive patterns of behavior
• Consider with person the effectiveness of new
  behaviors or actions
• Anticipate with person what might happen next
• Encourage responsibility for own actions
• Review with person current situation and selected
  courses of action
• Provide information, assistance, and referral
• Help person plan for coping with future crises
• If appropriate, make a referral for help and
  follow-up
• Plan for termination of helping relationship

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The End Thank you!