Suicide Prevention Training for Gatekeepers in the Community

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Suicide Prevention Trainingfor Gatekeepers in
the Community

• Presented by the
• Wyoming Suicide Prevention Task Force

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Introduction

• 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, Ph.D.

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Agenda

• Wyoming Suicide Prevention Plan
• State National Statistics
• Nature of Mental Illness
• Suicide Risk Factors
• Prevention of Suicide
• Resources

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Saving One Life

• Wyoming Suicide Prevention Plan
• Suicide Prevention Task Force

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What is the Wyoming Suicide Prevention Task Force?

• A public/private partnership of concerned
  individuals and agencies organized by the Wyoming
  Department of Health to address suicide in
  Wyoming.

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Task Force Objectives

• Raising awareness of suicide issues
• Facilitating training and technical assistance
  regarding suicide prevention
• Promoting comprehensive community-based suicide
  prevention initiatives
• Identifying and providing information about
  available resources
• Writing and implementing a state suicide
  prevention plan

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Task Force Activities

• Presentations at conferences and meetings
• Analyzed and distributed data from school survey
  on suicide prevention
• Sponsored two statewide Suicide Prevention
  Conferences
• Developed radio and television PSAs
• Created an informational display

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Task Force Activities

• Developed brochures for elderly, youth, and the
  general population
• Publish a newsletter
• Developed a Media Guide
• Provide funding and consultation to community
  coalitions
• Saving One Life Wyomings Suicide Prevention
  Plan

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Saving One LifeState Suicide Prevention Plan

• Based on the Surgeon Generals Call to Action to
  Prevent Suicide and national goals and objectives
• Designed to provide guidance to communities to
  design and implement suicide prevention plans
  which meet each communitys unique needs

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Saving One LifeState Suicide Prevention Plan

• Intended to be a general broad blueprint
• Intent is to build on existing efforts and
  systems to increase collaboration and reduce
  duplication of services

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SUICIDE IS PREVENTABLE

• YOUR HELP IS NEEDED BECAUSE SUICIDE AFFECTS EACH
  AND EVERY ONE OF US.
• GET INVOLVED IN COMMUNITY PLANNING FOR SUICIDE
  PREVENTION.
• SAVING ONE LIFE

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SAVING ONE LIFE
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Suicide Statistics

• State National

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National Statistics

• 1.2 of all deaths are suicides
• 85 suicides per day
• 31,000 suicides per year
• 2,100 suicide attempts per day
• 790,000 suicide attempts per year

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National Statistics

• Suicide is 11th leading cause of death
• 1.7 suicides for every homicide in America
• Twice as many die from suicide as from HIV/AIDS
• One out of every 62 Americans is a suicide
  attempt survivor

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National Statistics

• Men die by suicide more often than women (41)
• 73 of suicide victims are white men.
• Women attempt suicide more often than men (21)

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National Statistics

• 75 of elderly suicide victims visited their
  physician in the month prior to their death
• While the elderly have a higher suicide rate, it
  has decreased by two thirds since 1933
• The elderly comprise about 13 of the population,
  but suffered 18 of all suicide deaths.

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National Statistics

• Suicide rate in 15-24 year olds tripled since
  1950s
• Third leading cause of death in this age group
• Since 1980, suicide rate for 10-14 year olds
  doubled
• Since 1980, suicide rate for 15-19 year old
  African American males doubled

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National Statistics

• In 2000, 3 million students age 12 to 17 reported
  seriously considering suicide in past year
• 37 of these students reported attempting suicide
  in the past year
• More teens and young adults die from suicide than
  from all other diseases combined

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United States Suicide Rates, 2002(per 100,000
people)

• Nation 11.0
• Elderly 15.6
• Youth 9.9
• Men 17.9
• Women 4.3
• White 12.2
• Non-White 5.5
• Black 5.1

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Suicide Methods

• Firearms explosives 55 (1 M F)
• Hanging 20 (2 Men)
• Solid or liquid poisons 17 (2 Women)
• Jumping from a height 2
• Cutting or piercing 2
• All other methods 4

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Myths and Facts

• Myth November and December are the months in
  which most suicides occur.
• Fact Most suicides happen in the spring and
  summer months.

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U.S. Daily Suicides by Month
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2002 Suicide Rates by Region
Rates per 100,000 people
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Wyoming Statistics

• State suicide rate in 2002 was 21/100,000
• 106 Wyoming citizens died by suicide
• Wyoming currently ranks first in the nation in
  our rate of suicide (2002)
• Mountain states ranked first among all regions
  every year between 1990-2002
• The Mountain states were 5 of the top 5 states
  and 8 of the top 15 states

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Myths and Facts

• Myth Wyomings suicide rate is high because our
  population is small.
• Fact Suicide rates are calculated per 100,000
  population making our rate comparable across the
  nation.

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Suicide Rates(per 100,000)
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Wyoming Deaths Due to SuicideBy Age,
2002Source Wyoming Vital Statistics
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Wyoming Deaths Due to Suicide by Age and Gender,
2002Source Wyoming Vital Statistics
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Wyoming Suicides by Month1999 2002
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Nature of Mental Illness

• Statistics, Symptoms, and Causes

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Mental Illness Statistics

• 48 of Americans suffer from one or more mental
  illnesses during their lifetime
• 30 of Americans will experience an episode of
  mental illness each year

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What is Mental Illness?

• A variety of medical conditions involving
  disorders of thoughts and/or emotions
• Effective treatments are available

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What Causes Mental Illness?

• The causes remain largely unclear
• It is widely agreed that the exposure of
  genetically vulnerable individuals to
  environmental stress leads to mental illness
• Genetics
• Stressful life events
• Especially experiencing severe trauma
• Especially during childhood and teen years

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What Causes Mental Illness?

• Chemical imbalance in the brain
• Medical conditions
• Especially medications or diseases that affect
  the brain
• Alcohol and drug abuse

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Mental Illness Suicide

• 90 of suicide victims suffer from mental illness
• 60 of suicide victims suffer from depression
• People who die by suicide are often suffering
  from undiagnosed, under treated, or untreated
  depression
• Having a mental illness increases the likelihood
  of suicide
• The great majority of people who suffer from
  mental illness do not die by suicide

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Mental Illness and Suicide

• Suicide risk is highest in depressed individuals
  who
• Feel hopeless about the future
• Have recently been discharged from the hospital
• Have a family history of suicide
• Have made a suicide attempt in the past
• About 2-15 of persons with major depression die
  by suicide

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Mental Illness and Suicide

• Individuals who suffer from depression and
  another mental illness are at increased risk
• Substance abuse
• Schizophrenia
• Bipolar disorder

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Mental Illness and Suicide

• 3-20 of persons diagnosed with bipolar disorder
  die by suicide.
• Suicide is the leading cause of premature death
  among persons diagnosed with schizophrenia
• 6-15 die by suicide
• Up to 95 of these individuals are male

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Mental Illness and Suicide

• People with personality disorders are about 3
  times more likely to die by suicide.
• 25-50 also have a substance abuse disorder or
  major depression

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Myths and Facts

• Myth The suicidal person wants to die and feels
  there is no turning back.
• Fact Suicidal persons often do not want to die
  but see no other way to end their pain.

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Barriers to Seeking Care

• Lack of available mental health providers
• Inadequate or no insurance
• Lack of financial resources
• Dont know how to access care
• Dont understand illness or how treatment helps
• Language

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Barriers to Seeking Care

• Unwillingness to seek mental health care
• Fear of stigma
• Cultural beliefs
• Religious beliefs

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Suicide Risk Factors
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Myths and Facts

• Myth People who attempt suicide rarely actually
  reach out or give clues to others about their
  state of mind.
• Fact People who die by suicide often do give a
  clue or warning of their intentions.

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Risk Factors

• Age less than 20 or greater than 65
• Male
• Race
• Whites
• Native Americans

• Pattern of impulsive or risk taking behavior
• Access to firearms
• Drastic mood or behavior changes

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Risk Factors

• Mental Illness
• Alcohol Drug Abuse/Intoxication
• Increased drug or alcohol use
• History of sexual or physical abuse
• As child or adult

• Family violence
• Prior suicide attempt
• Organized plan
• Family history of suicide
• Exposure to suicide in family, friends, or media

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Risk Factors Depression

• Sadness
• Irritability
• Indecisiveness
• Helplessness
• Hopelessness
• Social withdrawal
• Insomnia
• Excessive sleeping

• Loss of interest
• Excessive guilt
• Low energy fatigue
• Poor concentration
• Change in appetite
• Weight changes
• Agitation
• Suicidal ideation

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Risk Factors

• Adverse life events
• Job stress
• Job loss
• Legal problems
• Civil or criminal
• Being arrested
• Incarceration
• Financial problems

• Social support loss
• Relationship problems
• Loss of spouse or friends
• Social rejection
• Social isolation loneliness
• Single, widowed, divorced or separated

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Risk Factors

• Medical illness
• Change in health status
• Loss of interest in personal hygiene appearance
• Preoccupation with death dying
• Giving away prized possessions

• Threat of extreme dependency on family or
  institutions
• Loss of control of environment
• Loss of independence
• Forced or voluntary retirement

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Wyoming Risk Factors

• Western rural states like Wyoming struggle with
• Geographic isolation
• Lack of sufficient numbers of mental health
  professionals
• Wide availability of firearms
• Lack of family or other support systems

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Preventing Suicide
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Myths and Facts

• Myth Persons who experience an episode of
  suicidal thinking tend to remain in this state of
  mind forever.
• Fact Suicidal thinking is often a relatively
  brief reaction to circumstances. Over time,
  individuals can learn to deal more effectively
  with lifes challenges.

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Protective Factors

• High self-esteem
• Social connectedness with family or friends
• Willingness to talk to others
• Good coping skills
• Stable marriage
• Religious beliefs

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Preventing Suicide

• Identifying those individuals suffering from
  mental illness and at risk for suicide
• Educate community on risk factors
• Intervening
• Refer those at risk for treatment
• Providing treatment
• Improve access to care in community

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Myths and Facts

• Myth Only a mental health professional can
  prevent suicide.
• Fact Intervention by family and friends can be
  an important and significant part of suicide
  prevention.

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At the Individual Level

• Listen to the individual
• Encourage person to share their feelings
• Know and look for suicide risk factors
• Talk with the person about your concerns
• Tell them you care and want to help
• Speak with care and compassion
• Ask directly about thoughts of suicide

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Myths and Facts

• Myth If you ask a person directly, Do you feel
  like killing yourself?, this will plant the idea
  of suicide and may lead to a suicide attempt.
• Fact Asking a person directly about suicide
  will often relieve the anxiety surrounding the
  feeling and act as a deterrent to suicidal
  behavior.

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At the Individual Level

• Take reports of suicidal ideation seriously
• Contact reliable family member/close friend
• Get professional help
• Even if person resists, call 911 if necessary
• Offer to take them to emergency room or mental
  health professional
• Offer to help them schedule an appointment
• Follow-up to make sure person is getting help

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Myths and Facts

• Myth Talking about suicide and self-destructive
  behavior is just a bid for attention and should
  be ignored.
• Fact Suicidal talk and self-destructive
  behavior are serious and can be lethal. Anyone
  who behaves self-destructively could benefit from
  professional help.

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At the Individual Level

• Dont leave them alone!
• Be calm - dont act shocked or be judgmental
• Dont swear to keep it a secret
• Dont try to counsel the person
• Limit access to firearms and other means of
  suicide

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At the Individual Level

• Ive noticed youre feeling upset
• Whats going on in your life?
• Are you thinking about suicide?
• What do you think might help?
• Where would you like to seek help?
• Why dont we make the call together?
• Im not going to feel comfortable without being
  sure youre going to get some help.

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Myths and Facts

• Myth Feeling better after a suicidal crisis
  means that the suicide risk is over.
• Fact When a suicidal person begins to feel
  better, they may have made the decision to die
  and are no longer struggling with the pressures
  of living. Even if they have decided to live,
  they will still be confronted with pressures and
  responsibilities. A supportive relationship
  during and after a crisis is critical to the
  healing process.

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Public Education

• Nature and causes of mental illness
• Facts myths regarding suicide
• Risk factors for suicide
• Teach how to recognize and deal with situations
  involving the possibility of suicide
• Referral resources places to go for help

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Collaborative Effort

• Government agencies
• Schools
• Faith based organizations
• Health care providers
• Primary care and mental health
• Private employers and corporations
• Building a community network is critical to
  suicide prevention

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Community Resources

• Community Groups - focus on suicide prevention?
• Community Agencies - suicide prevention
  activities?
• Community Schools - materials, programs and
  activities related to suicide prevention?
  Intervention policies, procedures or protocols?

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Community Needs

• What are the major needs of your community
  related to suicide prevention?
• What resources, training and support would be
  most useful to your community to assist in
  suicide prevention efforts?

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Resources
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Resources

• Wyoming Suicide Prevention Task Force
• Wyoming Department of Health
• http//mentalhealth.state.wy.us
• Local mental health centers
• Local physicians offices
• Local emergency rooms

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Resources

• National Mental Health Association
• www.nmha.org
• 1-800-969-NMHA
• American Association of Suicidology
• www.suicidology.org
• 202-237-2280
• Suicide Prevention Resource Center
• www.sprc.org
• 877-438-7772

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Resources

• Suicide Prevention Advocacy Network
• www.spanusa.org
• 888-649-1366
• National Institute of Mental Health (NIMH)
• www.nimh.nih.gov
• 301-443-4513

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Resources

• National Alliance for Mentally Ill
• www.nami.org
• Suicide Awareness Voices of Education
• www.save.org
• Substance Abuse Mental Health Services
• www.samhsa.gov

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Resources

• American Foundation for Suicide Prevention
• www.afsp.org
• 212-363-3500
• National Strategy for Suicide Prevention
• www.mentalhealth.org/publications/allpubs/SMA01-35
  18/index.htm
• National Suicide Prevention Strategy
• www.sg.gov/library/calltoaction/strategymain.htm

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Questions?