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Suicide Prevention

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  • Boys 20-24 are 6 x more likely than young women this age. Use of firearms have seen a decrease, while use of suffocation has seen an increase (MMWR).. Over 22,524 years of potential life lost (before age of 75) occurred as a result of suicide in 2002. Since not all youth suicide attempts admit their intent, any deliberate self harming behaviors should be considered serious and in need of further evaluation. (AAS Youth Suicide Fact Sheet)
  • Boys 20-24 are 6 x more likely than young women this age. Use of firearms have seen a decrease, while use of suffocation has seen an increase (MMWR).. Over 22,524 years of potential life lost (before age of 75) occurred as a result of suicide in 2002. Since not all youth suicide attempts admit their intent, any deliberate self harming behaviors should be considered serious and in need of further evaluation. (AAS Youth Suicide Fact Sheet)
  • Boys 20-24 are 6 x more likely than young women this age. From 1980-1995, suicide among African American (10–14), increased 233%, while white youth increased by 120%. Suicide attempts among LGBT youth ages 14-21 often occurred after subjects became aware of sexual feelings and before they told parents or any one. Over quarter reported suicide attempt in family. D'Augelli, A.R., Hershberger, S.L., & Pilkington, N.W. (2001). Suicidality patterns and sexual orientation-related factors among lesbian, gay, and bisexual youths. Suicide and Life-Threatening Behavior, 31, 250-264.
  • Seriously considering suicide: Hispanic 18.1%, White, 16.5%, African American 12.5%, Made a suicide plan: Hispanic 17.6%, White 16.2%, and African American 10.4% Suicide attempt: Hispanic 10.6%, African American (8.4%), White (6.9%). Suicide attempts requiring medical attention - Hispanic 5%, African American 3.7%, White 1.7% Hispanic females have higher rates than all others for considering suicide, making a plan and attempting suicide. YRBSS, 2003
  • Mood disorders include: Psychiatric disorders, depression Previous suicide attempts - Teens that have attempted suicide in the past are much more likely than other teens to attempt suicide again in the future. Approximately a third of teen suicide victims have made a previous suicide attempt. Depression and/or alcohol or substance abuse - Over 90% of teen suicide victims have a mental disorder, such as depression, and/or a history of alcohol or drug abuse. Depression is the strongest correlate of suicide for adol suicide completers and attempts (IOM, page 87). Amer Psychiatric Assoc estimates that 54% of youth who die by suicide also abuse substances (ASTHO Issue Brief). The three fold rise in youth suicide rates during the 60s-80s has been attributed to a rise in the use of alcohol and drug abuse (IOM, p 88.) Easy access to guns - Teens are much more likely to kill themselves when they have access to guns. When teens shoot themselves, they most often do so in their own homes. Teens are at a far greater risk for suicide when there are loaded and accessible guns in their homes. (Loaded guns in the home present a 30-fold increase for suicide (especially those without a mental disorder); Access to firearms is a significant factor in the increase in suicides over the years. Source: CDC’s MMWR, 6/11/04; Institute of Medicine, 2002.)
  • -Risk factors-- “leading to or being associated with suicide; that is, people ‘possessing’ the risk factors are at greater risk potential for suicidal behavior” (National Strategy for Suicide Prevention, p. 34). -These vary by age, gender, and ethnicity. -Some risk factors can be reduced through intervention, while some cannot be changed (i.e., previous suicide attempt). -Psychological autopsies show that those 90% of those who die by suicide suffer from one or more mental disorders. (AAS fact sheet) Particularly at risk are those with depression, schizophrenia, drug and/or chemical dependency and panic disorders. -Family history of mental disorders, substance abuse, or suicide - Teens who kill themselves have often had a close family member who attempted or committed suicide. Many of the mental illnesses, such as depression, that contribute to suicide risk appear to have a genetic component. Stressful situation or loss - Teens who kill themselves almost always have serious problems, such as depression or substance abuse. When they experience losses or certain stressful situations, it can trigger a suicide attempt. Such stressful situations include: getting into trouble at school or with the police; fighting or breaking up with a boyfriend or a girlfriend; and fighting with friends. (National Youth Violence Prevention Resource Center webpage: http://www.safeyouth.org/scripts/teens/suicide.asp)
  • Protective factors “reduce the likelihood of suicide. They enhance resilience and may serve to counterbalance risk factors” May include individual’s attitudinal and behavioral characteristics as well as environmental and cultural characteristics. (National Strategy for Suicide Prevention, p. 34-35) Suicide prevention interventions should reduce risk factors and enhance protective factors. Examples of interventions: Promote safe storage of firearms Teach conflict resolution skills to elementary children Incorporate depression screening into all primary care practice Work with the media to develop and disseminate public service announcements describing a safe and effective message about suicide and it’s prevention.
  • Protective factors “reduce the likelihood of suicide. They enhance resilience and may serve to counterbalance risk factors” May include individual’s attitudinal and behavioral characteristics as well as environmental and cultural characteristics. (National Strategy for Suicide Prevention, p. 34-35) Suicide prevention interventions should reduce risk factors and enhance protective factors. Examples of interventions: Promote safe storage of firearms Teach conflict resolution skills to elementary children Incorporate depression screening into all primary care practice Work with the media to develop and disseminate public service announcements describing a safe and effective message about suicide and it’s prevention.
  • It is estimated that 70-80% of all suicide victims have given some clues about their suicidal ideation/plan. (Stop a Suicide Today; NASP) Chronic pain such as stomach pain
  • It is estimated that 70-80% of all suicide victims have given some clues about their suicidal ideation/plan. (Stop a Suicide Today; NASP)
  • There are often precipitating events or crises that cause a person to act on their suicidal thoughts.
  • SOS Program contains a screening component (The Columbia Teen Screen) Screening programs can be met with lots of resistance from parents and communities and must be implemented with active parent consent.
  • Columbus GA and Hartford CT
  • Is a Classroom Curriculum South Bend: Yellow Ribbon (YR) started as outgrowth of the Community Resource Center which provided crisis line and education on suicide Approximately 80% of schools in St. Joseph county have been trained Schools were reluctant to talk about suicide Inside South Bend, schools tended to seek out YR after a suicide occurs (reactive) In county, schools sought out YR before a suicide occurs (proactive) Carol charges mileage, but no training or materials fee. Evaluations are pending Evansville: Janie Chappell, lead trainer, has taught YR for three and half years Has reached 7,000 kids and 500 adults in tri-state area Students in 50% of middle and 50% of high schools have been trained All school counselors in Vanderburgh county have been trained; health classes are now targeted Schools were reluctant to talk about suicide and had time constraints to grapple with Most schools have had YR before suicide occurs (proactive) Program is a community service provided by Deaconess Cross Pointe (a mental health facility) for free One weakness of YR is that evaluation component has been missing until recently. Neither SB or Evansville has evaluation results to demonstrate it’s effectiveness.
  • Click the slide 1 time to bring the headers and card onto the screen. Wait to click again until everyone has a card in their hand. Thus, distribute the card, or ask particpants to get card outfrom their folders. Click to first line : The Yellow Ribbon Card is a lifesaving tool… it is the hallmark of the Yellow Ribbon program . It is reminder that it is always Ask 4 Help no matter what the problem or issue. Click to second line You don’t have to have a card to Ask 4 Help , but the Yellow Ribbon card gives you the tool that you can use when you just don’t know what to say or how to start the conversation. Click to third line: We aren’t burdening youth with more ‘stuff’, rather this program offers them lifeskill, tools and resources that helps with a situation that is facing our teens and youth today. Say: This side of the card is the “ASK” side of the card ASK AUDIENCE TO TURN CARD OVER
  • Click the slide 1 time to bring the headers and card onto the screen. Wait to click again until everyone has turned their card over. . Click : (Say): The back of the card is for the person you hand the card, the trusted adult or friend. The back of the Ask 4 Help Card is a guide in an immediate crisis. Say: This side of the card is the “LINK” side of the card (Say to an adult audience): The difference between the training we do for adults and youth is that the youth presentation are always focuses on increasing help-seeking behaviors and encouraging them to link themselves or a friend to an adult for help. Often adults need the confidence to do just a little more, still we are not asking you to assess or counsel someone, just show that you care and Be A Link ® to help. (Read STEP 1 of the Lifeskill protocol)
  • Click the slide 1 time to bring the headers and card onto the screen. Wait to click again until everyone has turned their card over. . Click : (Say): The back of the card is for the person you hand the card, the trusted adult or friend. The back of the Ask 4 Help Card is a guide in an immediate crisis. Say: This side of the card is the “LINK” side of the card (Say to an adult audience): The difference between the training we do for adults and youth is that the youth presentation are always focuses on increasing help-seeking behaviors and encouraging them to link themselves or a friend to an adult for help. Often adults need the confidence to do just a little more, still we are not asking you to assess or counsel someone, just show that you care and Be A Link ® to help. (Read STEP 1 of the Lifeskill protocol)
  • Click the slide 1 time to bring the headers and card onto the screen. Wait to click again until everyone has turned their card over. . Click : (Say): The back of the card is for the person you hand the card, the trusted adult or friend. The back of the Ask 4 Help Card is a guide in an immediate crisis. Say: This side of the card is the “LINK” side of the card (Say to an adult audience): The difference between the training we do for adults and youth is that the youth presentation are always focuses on increasing help-seeking behaviors and encouraging them to link themselves or a friend to an adult for help. Often adults need the confidence to do just a little more, still we are not asking you to assess or counsel someone, just show that you care and Be A Link ® to help. (Read STEP 1 of the Lifeskill protocol)
  • Youth is defined here as 15-24.
  • Boys 20-24 are 6 x more likely than young women this age. Use of firearms have seen a decrease, while use of suffocation has seen an increase (MMWR).. Over 22,524 years of potential life lost (before age of 75) occurred as a result of suicide in 2002. Since not all youth suicide attempts admit their intent, any deliberate self harming behaviors should be considered serious and in need of further evaluation. (AAS Youth Suicide Fact Sheet)
  • Transcript

    • 1. Prevention & Community Response Services, Washtenaw County Public Health Department:
      • Provides a broad range of services for individuals, groups, and organizations, as well as for the county at large.
      • Our services promote individual & collective well-being in areas such as:
        • emotional/mental health
        • personal growth and development
    • 2. Prevention & Community Response Services
      • We also promote community & organizational
      • well-being through services such as:
      • Coalition building
      • Community Crisis/Disaster Response
      • School Crisis/Disaster Response Consultation
      • & actual Crisis Response Services
      • Mental Health Promotion
      • Organizational Development
      • Trauma, Loss, & Grief Support
    • 3. Prevention & Community Response Services
      • We accomplish these ends through:
      • Networking
      • Consultation
      • Facilitation
      • Presentations & Trainings
      • Crisis Intervention Services
      • Referral/Distribution of written materials
    • 4. Prevention & Community Response Services
      • Has assisted schools with crisis response since 1970s
      • Is involved in county, regional, and state-wide crisis response and disaster planning & response
      • Helps coordinates and maintains two County-sponsored crisis response teams:
      • - Traumatic Events Response Network (TERN )
      • - Washtenaw Critical Incident Stress Management Team
      • (CISM Team)
    • 5.
      • Washtenaw County Emergency Operations Center
      • City of Ann Arbor Emergency Operations Center
      • Region 2 South Bio-Defense Network
      • Health Emergency Response Coalition
      • Washtenaw County Suicide Prevention Plan Development Committee
      • Michigan Crisis Response Association (MCRA)
      • Crisis Intervention Team (CIT)
      • Child Death Review Committee
      Examples of Coalitions & Workgroups we are part of:
    • 6.
      • Crisis response plan review & testing
        • Vulnerability assessments
        • Needs assessment
        • Crisis response team development consultation/training
        • Consultation/Response Assistance during actual event
      School Crisis Response Services
    • 7. Responding to School Crises: A Multi-Component Crisis Intervention Approach -A two-day ICISF certified training-
        • DAY ONE Course Content :
        • How schools react to crisis
        • Children and staff reactions to trauma
        • Overview of CISM and school crisis management principles, & techniques of crisis intervention
        • Assessment of individuals and groups
    • 8. Responding to School Crises: A Multi-Component Crisis Intervention Approach -A two-day ICISF certified training-
        • DAY TWO Course Content :
        • Group interventions and debriefings
        • Developmental modifications and applications
        • Large incident planning
        • Team formation and maintenance
        • Helper stress
    • 9. Prevention & Community Response Services Many of our services are free, however some are fee-based. For more information about services or our fee structure please contact either: Michelle Rose-Armstrong, MA, LLP, 734.544-2911 [email_address] , or Gary Logan, MSW, LMSW, 734.544-6811 [email_address]
    • 10. ADOLESCENT SUICIDE
    • 11. General Trends in Youth Suicide
      • Suicide is the number 3 killer of young Americans age 15-24
      • More than 5,000 adolescents die by their own hand every year
      • Females attempt 4 times more often than males, but males complete suicide 4-6 times more often than females
      Sources: National Strategy for Suicide Prevention, 2001; John L McIntosh, Indiana University- South Bend; AAS Youth Suicide Fact Sheet; King (1999; 1997, p. 66); CDC.
    • 12. General Trends in Youth Suicide
      • While females complete 1 out of 25 suicide attempts, males complete 1 out of every 3 attempts
      • Typical profile of a nonfatal suicide attempter is a female who ingests pills
      • Typical profile of a suicide completer is a male who dies from a gunshot wound
      Sources: National Strategy for Suicide Prevention, 2001; John L McIntosh, Indiana University- South Bend; AAS Youth Suicide Fact Sheet; King (1999; 1997, p. 66); CDC.
    • 13. General Trends in Youth Suicide
      • In a typical classroom, 1 boy and 2 girls have attempted suicide
      • While it is generally a white male phenomenon, suicide in the African American population in increasing more rapidly than for white males
      • Latinas attempt suicide more than any other group
      • LGBT youth have higher rates of suicide attempts than do their straight peers
      Sources: National Strategy for Suicide Prevention, 2001; John L McIntosh, Indiana University- South Bend; AAS Youth Suicide Fact Sheet; King (1999; 1997, p. 66); CDC.
    • 14. General Trends in Youth Suicide
      • Among racial groups, Native Americans are most at risk 19.3/100,000
      • African Americans use guns to end their lives more often than other groups
      • Hispanic youth have higher rates of seriously considering suicide, making a suicide attempt, and of completing a suicide than African Americans and whites
      National Youth Violence Prevention Resource Center; AAS; YRBSS, 2003; AAS.
    • 15. Differences between Adult and Youth Suicide
      • Most youth suicide attempts are triggered by interpersonal conflicts (vs. loss of social relationships and financial reasons for adults)
      • Youth attempt more often (100-200 attempts per suicide death) than adults (4 attempts per suicide death for elderly)
      • Youth are much more impulsive, making attempts more likely
    • 16.
      • A mood disorder
      • Previous suicide attempt(s)
      • Substance and alcohol abuse
      • Access to handguns at home
      Major Risk Factors for Suicide in Children and Adolescents Dr. Morton Silverman
    • 17. Risk Factors
      • Behavior disorders such as conduct disorder
      • Family history of mental disorders, substance abuse, or suicide
      • Stressful situation or loss (relationship, divorce, death)
      • History of trauma or abuse
      • Stigma regarding help-seeking
      National Youth Violence Prevention Resource Center; National Center for injury Prevention and Control (NCIPC), CDC, Morbidity and Mortality Weekly Reports (2004); National Strategy for Suicide Prevention, 2001.
    • 18. Additional Risk Factors
      • Withdrawal or isolation (lack of social support)
      • Violent, impulsive and/or aggressive behavior
      • Family instability
      • Hopelessness
      • Exposure to another's suicidal behavior
      www.griefworkcenter.com ; National Center for Injury Prevention & Control (NCIPC); CDC, Morbidity and Mortality Weekly Reports (2004);
    • 19. Social Context of Adolescent Suicide Attempts
      • Family dysfunction
      • Lack of peer support
      • Isolation
      • Lack of:
        • academic achievement
        • positive school climate
        • supportive social relations
      Kidd, Henrich, Brookmeyer, Davidson, King, (2006). Suicide and Life-Threatening Behavior 36(4). 386-395.
    • 20. Protective Factors
      • Strong family cohesion
      • Good coping skills
      • Academic achievement
      • Positive relationship with school, peers, and an adult (not necessarily with a teacher)
      Youth Suicide Prevention School-Based Guide, 2003
    • 21. Protective Factors
      • A sense of self-worth
      • Skills training that focuses on problem solving, coping, and conflict resolution
      • Opportunities to participate in social activities
      • Access to effective counseling and health care
      Youth Suicide Prevention School-Based Guide, 2003
    • 22. “… focusing on protective factors such as emotional well-being and connectedness with family and friends was as effective or more effective than trying to reduce risk factors in the prevention of suicide.” Borowsky IW, et al. Suicide attempts among American Indian and Alaska Native youth: risk and protective factors. Archives of Pediatrics and Adolescent Medicine, 1999, 153: 543-547. Getting the most bang for your buck
    • 23. Myths about Suicide
      • There is no correlation between substance abuse and suicide
      • One must be crazy to even think about suicide
      • Talking about suicide may cause one to try it
      • A suicidal person wants to die
      • If a person is seriously considering suicide, nothing can be done to stop it
      The Yellow Ribbon Program
    • 24. Myths about Suicide (continued)
      • If a person suddenly exhibits a cheerful mood following a prolonged depression, she/he is no longer in danger
      • Most teens will not reveal they are suicidal or have emotional problems and would like emotional help
      • Those who talk about suicide don’t attempt/complete suicide
      Youth Suicide Prevention School-Based Guide. 2003. Mental Health Institute, The Louis de la Parte Florida Mental Health Institute; University of South Florida.
    • 25. Myths about Suicide (continued)
      • Suicidal behavior is inherited
      • Occurs only among poor adolescents
      • Only one who can help is a counselor or mental health professional
      Youth Suicide Prevention School-Based Guide. 2003. Mental Health Institute, The Louis de la Parte Florida Mental Health Institute; University of South Florida.
    • 26. Warning Signs
      • Losing interest in appearance, hobbies, school or work
      • Withdrawing from friends, family, or activities
      • Extreme changes in behavior (sleep, appetite, concentration, compulsivity) or personality
      • Talking about suicide or dying, and/or making a plan (“I wish I were dead”)
      • Making final arrangements
      National Association of School Psychologists; AAS; Stop a Suicide.
    • 27. Warning Signs
      • Preoccupation with death/dying
      • Taking unusual or unnecessary risks or acting recklessly
      • Increased use of drugs or alcohol
      • Feeling or expressing hopelessness
      • Expressing rage, anger, seeking revenge
      • Giving away prized possessions
      • Having an acute crisis
      National Association of School Psychologists ; AAS; Stop a Suicide; Grief Work Center.
    • 28. Acute Crises/Late Warning Signs
      • Getting in trouble with school, work or police
      • Threat of or actual loss of job or financial assets
      • Fighting with parents, family or friends
      • Recent loss of a loved one through death, move, or break-up
      • Significant changes in family situation such as divorce or physical, emotional, or sexual abuse
      • Not tolerating praise or rewards
      • Cheerful after period of depression
    • 29. School-based efforts
      • Comprehensive school-based programs
        • SOS, SAFE-TEEN
      • General suicide prevention education
        • Yellow Ribbon
      • Gatekeeper training for school staff
        • QPR
        • Applied Suicide Intervention Skills Training (ASIST)
      • Peer helper programs for students
        • Natural Helpers
      • Suicide risk screening & assessment
        • Columbia TeenScreen
      • Skill building programs
        • Resolving Conflict Creatively Program (RCCP)
        • Promoting Alternative Thinking Strategies (PATH)
    • 30. Why Schools?
      • Potential to prevent suicide is great:
        • Reach the highest number of kids
        • Level of student-to-student interaction is high
        • Provides contact with adults who want to help
        • Building help-seeking skills is part of building healthy youth
        • Schools already have policies to prevent injury and homicide (the other leading causes of death), why not suicide?
    • 31. Comprehensive school planning
      • Prevention and behavioral health programs/services on site
      • Handling behavioral health crises
      • Responding appropriately and effectively after an event occurs
    • 32. The S.O.S. Program
      • Signs of Suicide (S.O.S.) school based prevention program targets high school and middle school students
      • Two-pronged approach using two important suicide prevention strategies:
        • Education and awareness
        • Screening for depression (Columbia TeenScreen)
      Source: Aseltine and DeMartino, 2004
    • 33. The S.O.S. Program (cont.)
      • Education and awareness is focused on ACT model (Acknowledge, Care, and Tell)
        • Explores link between depression and suicide
        • Builds understanding and recognition of signs & symptoms of depression in self and others
      • Columbia TeenScreen tool helps students evaluate depression/suicidal symptoms in self and seek assistance
      • Emphasis on peer intervention
      • Is the first school based prevention program to demonstrate a decrease in self reported suicide attempts.
      Source: Aseltine and DeMartino, 2004
    • 34. Yellow Ribbon Program
      • Targets all school staff as well as students
      • 1 hour Program:
        • Raise awareness of the problem (statistics)
        • Dispel myths about suicide
        • Learn how to recognize signs and symptoms
        • Learn how to ask for help
        • Distribute Yellow Ribbon card which gives crisis phone number and helps students ask for help
      • Promotes awareness of “cry for help” & need for responsible helpfulness
    • 35.
      • American Association of Suicidology study reports that 78% of adolescents go to peers for help before they go to an adult
      • Tells you what to do to ask for help for yourself or a friend
      • Don’t have to have a card to ask for help
      Ask 4 Help!  Card
    • 36. Step 1: Stay with the person Unless there is risk of harm to yourself Ask 4 Help!  Card
    • 37.
      • Step 2: Listen - really listen . You are that person’s lifeline It is OK to say:
      • What can I do to help?
      • Who can we call that you would like to talk to?
      • Let’s call the hotline (or walk down to the
      • counselor) together and see what they
      • suggest for the next step to getting us help.
      Ask 4 Help!  Card
    • 38. Step 3: Get, or call for Help Immediately Call your parent, their parent, school counselor, pastor or rabbi or crisis hotlines: 1-800-SUICIDE (800-784-2433) or 1-800-273-TALK (800-273-8255) or 911 Ask 4 Help!  Card
    • 39.
      • APPENDIX
    • 40. U.S. Historical Trends
      • Youth suicide rates have:
        • More than doubled since the 1950’s
        • Remained stable at these higher levels between the late 1970’s and the mid 1990’s
        • Declined since 1994
        • Suicide rates for those 15-19 years old:
          • Increased (19%) between 1980 and 1994
          • But decreased 34% from 1995 and 2002
        • Suicide increased in 2004.
      John L McIntosh, Indiana University-South Bend for the American Association of Suicidology (AAS).
    • 41. General Trends in Youth Suicide
      • In cities where gun control policies and practices are absent, youth suicide is greater.
      • Suicide occurs after school hours generally in teen’s home
      • Cutting and other self harm behavior have increased, though not all is related to suicidal ideation
      Sources: National Strategy for Suicide Prevention, 2001; John L McIntosh, Indiana University- South Bend; AAS Youth Suicide Fact Sheet; King (1999; 1997, p. 66); CDC.
    • 42. Suicide: Individual Risk Factors
      • Mental illness
      • Age/Sex
      • Substance abuse
      • Loss
      • Previous suicide attempt
      • Personality traits
      • Incarceration
      • Failure/academic problems
    • 43. Suicide: Individual Protective Factors
      • Cultural/religious beliefs
      • Coping/problem solving skills
      • Ongoing health and mental health care
      • Resiliency, self esteem, direction, mission, determination, perseverance, optimism, empathy
      • Intellectual competence, reasons for living
    • 44. Suicide: Peer/Family Risk Factors
      • History of interpersonal violence/abuse
      • Bullying
      • Exposure to suicide
      • Parents no longer married
      • Barriers to health/mental health care
    • 45. Suicide: Peer/Family Protective Factors
      • Family cohesion (youth)
      • Sense of social support
      • Interconnectedness
      • Married parents
      • Access to comprehensive health care
    • 46. Suicide: Community Risk Factors
      • Isolation/social withdrawal
      • Barriers to health and mental health care
      • Stigma
      • Exposure to suicide
      • Unemployment
    • 47. Suicide: Community Protective Factors
      • Access to healthcare and mental health care
      • Social support, close relationships, caring adults, participation and bond with school
      • Respect for help-seeking behavior
      • Skills to recognize and respond to signs of risk