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Suicide Prevention and Intervention


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Title: Suicide Prevention and Intervention

Suicide Prevention and Intervention
  • Judith Tindall, Ph.D., Center Mental Health
  • St. Louis Job Corps Center
  • Job Corps National Health and Wellness Conference
  • April 25, 2007
  • Denver, Colorado

Help in Suicide Prevention/Intervention
Suicide Prevention/Intervention
  • Objectives
  • Participants will have the following
  • To learn information about suicide
  • To learn about St. Louis Job Corps and their
    approach to suicide prevention/intervention
  • To learn warning signs of potential suicide in
  • To learn intervention techniques for others
    considering suicide
  • Know professional resources

The Problem
  • 83.9 commit suicide per day (2001 data)
  • One suicide occurs every 17 minutes
  • A young person (age 15-24) dies every 2 minutes
  • Suicide is the third leading cause of death for
    young people (15-25)
  • 1st - auto accidents 2nd - homicide
  • Suicide second leading cause of death among
    college age students

The Problem (continued)
  • Eighth leading cause of death for males
  • Nineteenth leading cause of death for females
  • 73 of all suicide deaths are white males
  • 750,000 suicide attempts each year
  • More females attempt suicide than males
  • Each suicide intimately affects at least six
    other people

National Statistics on Suicide/Attempts/Threats
  • 2001 Statistics
  • 10.8 per 100,000
  • Males- 17.6 per 100,000
  • Females- 4.1 per 100,000
  • Whites- 11.9 per 100,000
  • Blacks- 5.3 per 100,000
  • Youth (15-24 yrs)- 9.9 per 100,000

National Statistics on Suicide/Attempts/Threats
  • Suicide Methods
  • Firearms- 5.9 per 100,000
  • Hanging or Suffocation- 2.2 per 100,000
  • Poisoning- 1.8 per 100,000
  • Falls- .02 per 100,000
  • Cutting/Piercing- .02 per 100,000
  • Drowning- .01 per 100,000
  • Fire- .01 per 100,000

Missouri Statistics 1999-2003
  • Average Annual Self-Inflicted Injuries
  • by Age Group- Missouri Residents
  • Rates per 100,000

Missouri Statistics 1999-2003
  • 2 suicides per day
  • Males - 81 - 22.2 per 100,000
  • Females - 19 - 4.8 per 100,000
  • MO Rate of suicide (12.9/100,000) is highest in
    the region (Kansas, Iowa, Nebraska, MO.)
  • Firearms leading cause of death
  • 3,700 average medical cost per case
  • 15-19 years highest hospitalization for attempt
    rate 13 of hospitalized attempts

Snapshot of St. Louis Job Corps
  • Youth ages 16 - 24
  • 80 85 Minority 15 Caucasian
  • 80 90 Economically disadvantaged
  • Primarily male with a growing population of
  • Largely urban culture
  • More than 80 residential population
  • A population with a proven history of drop-out
  • Most new students indicate anger issues and being
    suspended/expelled/etc. for fighting, assault
  • Students are trained to be purpose driven
  • Characteristic of St. Louis Job Corps
  • Based on interviews of all new students

Best Practices at St. Louis Job Corps
  • Reasonable Accommodations
  • Peer Mentoring

Serious Incident Log at St. Louis Job Corps -
Log Sheet
Suicide Threats, Attempts, and Suicides in Job
CorpsPY 2001-PY 2006 YTD
Job Corps averaged 81 suicide threats, 90 suicide
attempts, and 2 suicides per year over the past 5
program years.
Risk Factors for Suicide and Attempted Suicide
with Youth
  • Mood Disorders
  • Substance Abuse Disorders
  • Certain personality disorders
  • Low socioeconomic status
  • Childhood maltreatment
  • Parental separation or divorce
  • Inappropriate access to firearms
  • Interpersonal conflicts or losses

Protective Factors
  • Effective clinical care for mental, physical and
    substance abuse disorders
  • Ready access to a variety of clinical
    interventions and support for those seeking help
  • Restricted access to highly lethal means of
  • Strong connections to family and community
  • Support through ongoing medical and mental health
    care relationships
  • Skills in problem solving, conflict resolution,
    and nonviolent handling of disputes
  • Cultural and religious beliefs that discourage
    suicide and support self-preservation

Triggers of Suicidal Thoughts in Youth
  • Death of a parent
  • Divorce of a parent
  • Feeling like a pawn between feuding divorced
  • Joining a new family-step family
  • Break-up of boyfriend/girlfriend
  • Moving to a new community
  • Being ridiculed by others
  • Feeling misunderstood
  • An experience perceived as humiliating
  • Alcohol and drug abuse
  • Being bullied
  • Self-Injury

Suicide Prevention/Intervention at St. Louis Job
  • Outreach and Admission at St. Louis Job Corps
  • Asking the hard questions
  • Getting medical information
  • IEP information
  • Chart review
  • Reasonable accommodations

Suicide Prevention/Intervention at St. Louis Job
Corps (continued)
  • Reasonable Accommodations
  • Setting up accommodations for IEP/mental
    health/substance abuse/anger issues
  • Informing staff of accommodations Counselors and
    Managers have accommodations
  • Inform teacher/RAs and Recreation
  • Follow-up with CMHC/RAC Committee

Suicide Prevention/Intervention at St. Louis Job
Corps (continued)
  • CPP
  • Jerry Angeloni, Social Worker Interview all
    students and make recommendations concerning
    mental health/TEAP/ IEP/PC/ART and other
  • SIFs reviewed by CMHC
  • Medical doctor ask hard questions and refers to
    CMHC for previous mental health issues and
    observed mental health issues/TEAP
    issues/previous suicide threats/attempts
  • Young (16, 17) and students referred by CD panels
    referred to Peer Mentors.
  • At-risk new students referred to adult mentors
  • Youth referred to Aggression Replacement Training
  • Wellness class educates students on a variety of
    mental health issues including suicide risks and
  • All students in the dormitory are aware of J.C.
    policy concerning suicide attempts and threats

Suicide Prevention/Intervention at St. Louis Job
Corps (continued)
  • Career Development Phase
  • Training peer mentors on recognition and referral
    of suicidal students.
  • Students referred by counselor/R.A. and other
    staff members for suicidal threats etc.
  • CMHC interview students at-risk for
    suicide/follow-up with students returning from
    hospital for suicidal attempt.
  • Students are escorted to the hospital by their
    counselor/security/transportation and family if
    in town.
  • Appropriate students are sent home for mental
    health treatment if appropriate.
  • Part of the safety plan for the center
  • Wellness Staff very sensitive to suicidal issues
    of students

Suicide Prevention/Intervention at St. Louis Job
Corps (continued)
  • Career Transition Phase
  • Same as Career Development Phase
  • All students that are about to leave St. Louis
    Job Corps receive education about mental health,
    suicide risk factors, how to get help with
    insurance and without insurance.

  • New staff members Health Care Guidelines- how to
  • Counselors receive in depth training on suicide
    prevention/intervention. Helping youth manage
    anger/anxiety/other appropriate training
  • RAs receive in depth training on suicide
  • All staff receives training on how to help with
    mental health issues/management of anger, etc.
  • RAC training of all staff
  • How to help in Times of Crisis

Training and Intervention for Students
  • Peer mentors
  • SGA and dorm leadership
  • Wellness class
  • Transition class
  • Students informed about policy

St. Louis Job Corps
  • Takes suicidal talk/threat/attempt seriously
  • Train staff and students
  • Work as a team to help students remain safe
  • RAC integrated throughout Job Corps
  • Strong support from Administration for mental
  • Local Referral Resources

Stories of Suicide Prevention/Intervention
  • Counselor Involvement
  • Intervention with student threatening suicide -
    Involvement of family for assistance
  • Education
  • Action

Sample Training for Staff and Students
  • Adjusted for population
  • Always interactive
  • Practice for referral
  • Verbal first aide
  • Safety on campus
  • Job Corps Information Notice No. 02-13

St. Louis Job Corps Suicide Prevention/Interventio
Why People Commit Suicide
  • The following are situations that can trigger
    suicidal feelings
  • Depression- Leading cause of suicide
  • Crisis- Major life changes
  • Substance abuse
  • Old age

High Risk Groups
  • Elderly - Feelings of loneliness, loss of friends
    or spouse, loss of income and independence
  • Young adults and college students - Burdened with
    independence and responsibility for the first
    time, pressured to succeed in college or on the
  • Business people and professionals - The pressures
    to succeed and disillusionment over unfulfilled
  • Minorities and the poor - Despair brought on by
    discrimination, poverty, unemployment and feeling
    of being trapped
  • Children - Brought on by child abuse or neglect
    and an inability to communicate feelings or ask
    for help
  • Suicide effects all people!

Warning Signs
  • Suicide is rarely a spur of the moment decision
    and most people give warning signs that they are
    contemplating taking their own lives. Some signs
  • Previous attempts-youth who make one attempt are
    at an elevated risk to make another attempt
    within 3 months of 1st attempt
  • Depression- long term
  • Personality or behavioral changes
  • Preparation for death- suddenly gives away
    things, makes out a will, stockpiling sleeping

Recognizing Behaviors
  • Talking or joking about suicide
  • Giving away possessions
  • Preoccupation with death/violence
  • Behaving in a risky manner such as jumping from
    high places, running into traffic
  • Having several accidents resulting in injury,
    close calls or brush with death
  • Obsession with guns and knives
  • Expressing hopelessness
  • Sleeping too much or too little
  • Talk of worthlessness
  • Substance abuse
  • Frequent visits to the doctor without relief in
  • Inability to concentrate, unable to find pleasure
    in anything

Verbal Cues If you hear any of these, INTERVENE
to prevent a suicide
  • I shouldnt be here
  • I hate this life
  • Everyone would be better off without me
  • I wish I were dead
  • I wish I could disappear forever
  • The voices tell me to kill myself
  • I want to see what it feels like to die
  • I cant go on any longer
  • I want to die
  • Im going to kill myself
  • I am going to run away
  • If a person did this, would he die?
  • Maybe if I died, people would love me more
  • Complaints of aches and pains

Suicide Risk Assessment
  • Please check those items that apply.
  • Talking or threatening to kill or harm self
  • Previous suicide attempts
  • Severe depression
  • Sudden energy following a depression (energy is
    needed to commit suicide)
  • Loss of an important person or thing, ideal, or
  • Making final arrangements (saying goodbye,
    distancing from friends, giving away prized

Suicide Risk Assessment (continued)
  • Abuse of drugs and/or alcohol
  • Themes of death and dying in the persons writing
    and artwork
  • High stress in the persons life. Adult- loss of
    a loved one, loss of job, money, prestige,
    sickness changes in life or environment
  • The person seems to have a suicidal plan that is
    logical and well thought out
  • The person does not have many sources of support
    (does not have friends or family, or they are not
  • Severe health problems or constant complaints of
  • Communication very limited and, if tried to
    communicate, was not successful

What Does This Mean?
  • Results
  • 1-3 checked Continue to be with the person and
  • contact with them later.
  • 4-7 checked Encourage the person to get
  • help.
  • 7 checked Take action and inform a mental
  • professional about this
    person and get
  • additional help.

What To Do To Help The Suicidal Person
  • Give emotional support- Dont challenge the
    person, but take him or her seriously and offer
    to help. Listen to what they have to say. Stay
    with the person.
  • Encourage positive action- Suggest steps the
    person can do to help themselves. Help them stay
    busy, balance both work and play. Take time to
  • Suggest they talk to clergy.
  • Seek professional help- Wellness Center, suicide
    centers, hospitals, mental health professional.

Questions to Keep Them Talking and Defuse Thinking
  • What would have to be different for you to agree
    to go on living?
  • What people would have to help you with that?
  • What would you like help with?
  • What do you want people to understand about you?

Helping Survivors to Live on After a Suicide
  • Assist others cope with loss
  • Listen at length to them talk about the person
    that committed suicide
  • Help them understand stages of loss- denial,
    anger, guilt, sadness, bargaining, acceptance
  • Suggest that the person join a survivor
    counseling group
  • Short term help from a mental health professional
  • Tell them that you are there to listen

Case Study
  • Case Study of Tyrone
  • Tyrone has lost his mother about a year ago and
    has not come to terms with it. He is very
    unhappy most of the time. At times, I have found
    him crying in the restroom. In the last two
    months, he has started to drink heavily. He
    recently gave away his favorite jacket to a
    friend. I was having lunch with him in the
    cafeteria and he said I dont feel like going
  • What do you do?

Practice in Helping a Suicidal Person
  • Work in pairs to discuss how you would handle the
    case study.
  • Practice with your partner using active listening
    skills and intervention skills.
  • Debrief after the practice
  • What went well?
  • What could have gone better?

Plan of Action
  • I will assist others to understand suicide by. .
  • I will assist others that are considering suicide
    by. . .
  • I need the following help to be able to help
    others. . .

Evidence Base for Suicide Prevention Strategies
  • School based suicide awareness curriculums
  • Screening
  • Gatekeeper Training (similar to CPR)
  • Crisis centers and hotlines
  • Restriction of lethal means
  • Media education
  • Crisis intervention

Possible Referral Sources
  • Talk with your Counselor/R.A./CMHC
  • Wellness Center
  • Contact local hospital
  • http//

Professional References
  • Job Corps Program Instruction 06-16 Suggestions
    for Increasing Student Safety and Suicide
    Prevention, 12/1/2006
  • Job Corps Information Notice 02-13 Reducing the
    Risk of Suicidal Behavior In Job Corps,
  • Job Corps Information Notice 00-06 Suicide
    Prevention in Job Corps, 10/4/2000
  • Job Corps Program Instruction 95-23 Adolescent
    Suicide Prevention, 4/5/1996
  • Dr. Valerie Cherry, Principal MHC

Professional References
  • Youth Suicide Prevention Programs
  • A Resource Guide, 1992
  • www.cdc.govb/ncipc/pub-res/youthsui.htm
  • or call 1-800-311-3435
  • Tindall, Judith. Peer Power, Book 2
  • Applying Peer Helper Skills (Module on Suicide
  • Taylor Francis 1-800-821-8312

Professional References
  • American Association of Suicidology,
  • American Foundation for Suicide Prevention,
  • SAVE,
  • Suicide Prevention Advocacy Network,

Professional References
  • National Strategy for Suicide Prevention
  • National Institute of Mental Health Suicide
    Research Consortium
  • Suicide Prevention Resource Center
  • Surgeon Generals Call to Action

Professional References
  • http//
  • http// (Get your own state)
  • http//
  • National Suicide Prevention Lifeline-
  • 1-800-273-TALK

The Personal and Public Tragedy of Suicide
  • The suffering of the suicidal is private and
    inexpressible, leaving family members, friends
    and colleagues to deal with an almost
    unfathomable kind of loss, as well as guilt.
    Suicide carries in its aftermath a level of
    confusion and devastation that is, for the most
    part, beyond description.
  • -Kay Redfield Jamison

  • St. Louis Job Corps Center
  • Wellness Center
  • 4333 Goodfellow Boulevard
  • St. Louis, Mo. 63120
  • 314-679-6290
  • Marsha Smith, Wellness Manager
  • Deloris White, Center Director
  • Psychological Network, Inc.
  • 58 Portwest Ct.
  • St. Charles, Mo. 63303
  • 636-916-5800
  • http//
  • Judith A. Tindall, Ph.D., CMHC
  • Ralph Caraffa, Ph.D.
  • Lori Tagger, Ph.D.,
  • Linda Sharpe-Taylor, Ph.D.
  • Peg Wehenberg, Psy.D.