2008 First Responder Suicide Prevention Cova


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  • 2008 First Responder Suicide Prevention Cova

    1. 1. Suicide Prevention for First Responders Abby Landmeier Sheila Linwood, MBA Western Colorado Suicide Prevention Foundation [email_address] (970) 683-6626
    2. 2. <ul><li>Course Content </li></ul><ul><li>Rationale (CPR, Heimlich, etc) </li></ul><ul><li>Crisis intervention </li></ul><ul><li>Assessment and initial actions </li></ul><ul><ul><ul><li>Situational factors (What is happening?) </li></ul></ul></ul><ul><ul><ul><li>Behavioral factors (Why is it happening?) </li></ul></ul></ul><ul><ul><ul><li>Response choices (What is the safest and most effective response?) </li></ul></ul></ul><ul><li>Communication Techniques </li></ul><ul><li>Use of Active Listening Skills </li></ul><ul><li>Abnormal Behavior </li></ul><ul><ul><ul><li>High Risk Factors for Homicide – Suicide </li></ul></ul></ul><ul><li>Suicide Risk & Assessment </li></ul>
    3. 3. Make yourself Approachable <ul><li>Applied Suicide Intervention Skills Training- 2 day workshop </li></ul><ul><li>Jan 20-21 Feb 24-25 Apr 7-8 </li></ul><ul><li>Question, Persuade, Refer - 90 minutes </li></ul><ul><li>LINK for Life- any time frame </li></ul><ul><li>Sheila (970) 683-6626 </li></ul><ul><li>Schedule a workshop now, your bottom line will improve by 10% </li></ul><ul><li>Ask us how </li></ul>
    4. 4. Hotlines <ul><li>Suicide calls- 16% increase in the past year </li></ul><ul><li>10% increase each month </li></ul><ul><li>Housing counseling- significant increase </li></ul><ul><li>Money related </li></ul><ul><li>Economic situation- reminiscent of 9/11 </li></ul><ul><li>Domestic violence shelters full </li></ul><ul><li>Suicides generally increase during economic downturns </li></ul><ul><li>“ By the time you foreclose on my house, I will be dead.” </li></ul>
    5. 5. Perception is Everything <ul><li>Eastern Block- Europe 1980’s </li></ul><ul><ul><li>Reorganization- communist collapse </li></ul></ul><ul><ul><li>“ Send help” from family in America </li></ul></ul><ul><ul><li>Communication very slow (months) </li></ul></ul><ul><ul><li>“ Running low- send more medicine. ” </li></ul></ul><ul><ul><li>You can save someone’s life - help them feel safe, confident, self-assured </li></ul></ul>
    6. 6. Beliefs YOU R E A L I T Y Belief Filters You see the world not as it is, but as you are
    7. 7. <ul><li>First Responder Risk Assessment </li></ul><ul><li>The first 15 to 45 minutes of an escalated emotional incident is a critical time period. </li></ul><ul><li>The average Crisis Negotiation/SWAT team response time is 45 minutes to 1 hour. </li></ul><ul><li>The first responder should use communication skills to reduce the level of emotion in the incident. </li></ul><ul><ul><li>Reduce the likelihood of further violence through &quot;verbal containment.“ </li></ul></ul>
    8. 8. Possible Circumstances <ul><li>Domestic disturbance </li></ul><ul><li>Violence in the workplace </li></ul><ul><li>Mentally Disturbed Individual </li></ul><ul><li>Depression/Suicide </li></ul><ul><li>School crisis </li></ul><ul><li>Road rage </li></ul><ul><li>Drug or alcohol involvement </li></ul><ul><li>Any call for service </li></ul>
    9. 9. Serious Attempt or Death by Suicide Joiner, 2008 Those Who Desire Suicide Those Who Are Capable of Suicide Perceived Burdensomeness Thwarted Belongingness Distal Factors
    10. 10. <ul><li>Identify the Crisis </li></ul><ul><li>If the subject feels he is in crisis, he is. </li></ul><ul><li>Crisis comes when normal coping mechanisms do not work. </li></ul><ul><li>What precipitating event has usually occurred within the last 24-48 hours, and the subject's normal coping mechanisms have failed to resolve the situation? </li></ul><ul><li>Behavior is irrational / poor decision making level in response to a highly stressful situation. </li></ul>
    11. 11. <ul><li>What a Crisis looks like </li></ul><ul><li>The situation is perceived to be a threat to the emotional, psychological and physical needs of the subject. </li></ul><ul><li>Emotions, not reason, are controlling the subject's actions. </li></ul><ul><li>People will generally turn inward, away from usual support systems and feel more isolated. </li></ul>
    12. 12. Identify the loss <ul><li>In many instances the subject has experienced </li></ul><ul><li>a real or perceived loss. </li></ul><ul><li>Attempt to identify the loss. Usually the loss </li></ul><ul><li>of: </li></ul><ul><li>- Loved one </li></ul><ul><li>- Job </li></ul><ul><li>- Health </li></ul><ul><li>- Money </li></ul><ul><li>- Self-esteem </li></ul>
    13. 13. Rates of Stressors 250 points = Reactive Depression Death of a spouse: 100 + Death of another family member: 63 Personal wounds or illness: 53 Loss of a job or income: 47 Family member wounded or ill: 44 Personal possessions or financial losses: 38 Death of a close and personal friend: 37 Changing jobs or a new position: 36 Overwhelming debt: 31 A change in lifestyle or relocating: 25 A change in personal habits or routines: 24 A new school or a change in recreational activities: 20 A change in social activities: 18 Christmas, Anniversaries, and Birthdays: 12 Holmes and Rahe 1968
    14. 14. <ul><li>On Scene Assessment </li></ul><ul><li>First few minutes are critical; anticipate confusion and high emotion. </li></ul><ul><li>Anger, anxiety and/or fear are the predominant emotions. </li></ul><ul><li>Expect extreme responses from the subject. </li></ul><ul><li>(Verbal abuse ....................Silence) </li></ul><ul><li>Ego will drive a situation- don’t let it be yours </li></ul>
    15. 15. <ul><li>The Purpose of Crisis Intervention </li></ul><ul><li>Defuse intense emotions </li></ul><ul><li>Gain information/Assess situation </li></ul><ul><li>Gain time </li></ul><ul><li>Establish rapport/communicate empathy </li></ul><ul><li>Ideally return subject to his/her normal functioning level </li></ul>
    16. 16. <ul><li>What’s going on? </li></ul><ul><li>What's happening now? (Yelling, threats, carrying weapon, breaking things, all quiet, not activity noted) </li></ul><ul><li>Where is it happening? (Home, office, public place, isolated area) </li></ul><ul><li>What is driving this incident? (fear, anger, regret, guilt, depression, suicide) </li></ul><ul><li>What is important to the suspect? (family, work, neighbors, image, revenge) </li></ul>
    17. 17. Postvention: Warning Signs IS PATH WARM?           I          Ideation          S        Substance Abuse          P        Purposelessness          A        Anxiety          T        Trapped          H        Hopelessness          W       Withdrawal          A        Anger          R        Recklessness          M        Mood Changes
    18. 18. Primary Emotional Drivers <ul><li>Fear </li></ul><ul><li>Elation </li></ul><ul><li>Depression </li></ul><ul><li>Confusion </li></ul><ul><li>Psychosis </li></ul><ul><li>Hopelessness, Demoralization </li></ul><ul><li>Hostility and evasion </li></ul><ul><li>Risk taking behaviors </li></ul><ul><li>Self-destructive behavior </li></ul><ul><li>Odd, dangerous behavior </li></ul><ul><li>Very odd behavior </li></ul><ul><li>Attempts at self-treatment with alcohol, drugs, behaviors </li></ul>The person may be feeling this: While showing this: Source: Gordon Neligh, M.D.
    19. 19. <ul><li>Initial Actions </li></ul><ul><li>Begin to clear the area of uninvolved persons </li></ul><ul><li>Gather immediate intelligence, you are an expert witness. Attempt to respond based on your assessment of information obtained thus far. </li></ul><ul><li>Develop a Crisis Action Plan- Plan B (What to do if things go bad) </li></ul><ul><li>Keep the subject from harming others </li></ul>
    20. 20. <ul><li>Verbal Containment </li></ul><ul><li>Reduce the likelihood he will attack the police. </li></ul><ul><li>If something is keeping the subject in an escalated state, distract them to other topics. </li></ul><ul><li>Project calm professional demeanor to </li></ul><ul><li>provide subject with a sense of order. </li></ul><ul><li>Develop additional intelligence </li></ul><ul><li>- In order to begin to answer the question, what is driving this incident? </li></ul>
    21. 21. <ul><li>Communication Techniques </li></ul><ul><li>The first few statements will set the tone for </li></ul><ul><li>the incident. </li></ul><ul><ul><li>INTRODUCTION (Example) </li></ul></ul><ul><ul><li>&quot;Hello, my name is (_________) with </li></ul></ul><ul><ul><li>the ( Law enforcement agency ). </li></ul></ul><ul><ul><li>&quot;I would like to help. Are you okay? Could you </li></ul></ul><ul><ul><li>help me understand what's going on?&quot; </li></ul></ul>
    22. 22. <ul><li>Communication Techniques </li></ul><ul><li>Tell them you would like their help to resolve this peacefully </li></ul><ul><li>Reassure the person that you have things under control. </li></ul><ul><li>Advise the person he is responsible for keeping things calm and under control inside (“We can do this the easy way, or the hard way- the choice is theirs). </li></ul>
    23. 23. <ul><li>Communication Techniques </li></ul><ul><li>Lower emotions by providing a non-threatening environment in which the subject may be able to think more rationally (step away from the immediate crisis location). </li></ul><ul><li>Acknowledge that you are listening </li></ul><ul><li>Allowing him to tell &quot;his story&quot; will help him vent and will lower his anxiety. </li></ul>
    24. 24. <ul><li>Communication Techniques </li></ul><ul><li>If he's talking . . . you are buying TIME. </li></ul><ul><li>It's more important to be a good listener. </li></ul><ul><li>Listening will provide you with valuable intelligence; everything he says will tell you something about what is happening, and why . </li></ul><ul><li>Try to see the problem through the &quot;eyes of the subject.&quot; (People want to be understood) </li></ul><ul><li>-Understanding his behavior does not mean </li></ul><ul><li>you agree with his actions. </li></ul>
    25. 25. <ul><li>Communication Techniques </li></ul><ul><li>Take your time; speak slowly and calmly (law enforcement is generally bad at this) </li></ul><ul><li>Your tone indicates your attitude; it speaks </li></ul><ul><li>louder than your words. </li></ul><ul><ul><ul><li>How you say something is as important as </li></ul></ul></ul><ul><ul><ul><li>what you say. </li></ul></ul></ul><ul><ul><ul><li>Be honest, genuine and sincere. They will give it back- Avoid tricks </li></ul></ul></ul>
    26. 26. <ul><li>Communication Techniques </li></ul><ul><li>ASSUME NOTHING - If you are not sure what </li></ul><ul><li>he means by something he has said . . . ASK HIM! </li></ul><ul><li>&quot;I'm not sure I understand what you mean, </li></ul><ul><li>could you explain that further?” </li></ul><ul><li>Could you help me to understand how this started? </li></ul>
    27. 27. <ul><li>Avoid </li></ul><ul><li>NEVER ask them to clarify a threat. </li></ul><ul><li>Giving orders that may escalate the confrontation. </li></ul><ul><li>Arguing </li></ul><ul><li>Bargaining with or making concessions to the </li></ul><ul><li>person. </li></ul><ul><li>Trying to “solve his problems.” </li></ul><ul><li>e.g. “Why don’t you just ….?” </li></ul><ul><li>Don’t tell people what to do (“Just sit down”, “Just calm down”), help them make better decisions. </li></ul>
    28. 28. <ul><li>Listening for Emotions </li></ul><ul><li>People communicate on two levels </li></ul><ul><ul><li>CONTENT-The simple facts (the story) </li></ul></ul><ul><ul><li>EMOTIONS-The emotional reaction to the facts (feelings about circumstances) </li></ul></ul>
    29. 29. <ul><li>Listening for Emotions </li></ul><ul><li>Train yourself to listen for the emotions surrounding what happened. </li></ul><ul><li>Emotional reaction and subsequent behavior make the situation a crisis, not the facts of the situation. </li></ul><ul><li>How a person feels about a situation will strongly influence their behavior. </li></ul><ul><li>Controlling the subject's emotions will help control the subject's behavior. </li></ul>
    30. 30. <ul><li>Non-Judgmental Approach </li></ul><ul><li>The subject's feelings, values, life style and opinions are what counts. </li></ul><ul><li>Be accepting. </li></ul><ul><li>Do not inject your values into the situation. </li></ul>
    32. 32. <ul><li>ACTIVE LISTENING CONCEPTS </li></ul><ul><li>EMPATHY versus SYMPATHY </li></ul><ul><ul><li>Empathy implies understanding of another's feelings and thereby builds rapport and trust. </li></ul></ul><ul><ul><li>Sympathy implies pity. </li></ul></ul>
    33. 33. <ul><li>The Seven Active </li></ul><ul><li>Listening Skills </li></ul><ul><ul><li>Emotion – Labeling </li></ul></ul><ul><ul><ul><li>Identify the feeling ... &quot;You sound...&quot;, </li></ul></ul></ul><ul><ul><ul><li>&quot; Y ou seem... &quot;, &quot;I hear…” </li></ul></ul></ul><ul><ul><li>Paraphrasing </li></ul></ul><ul><ul><ul><li>Put meaning into your own words </li></ul></ul></ul><ul><ul><li>Reflecting / Mirroring </li></ul></ul><ul><ul><ul><li>The &quot;gist&quot;, last couple of words </li></ul></ul></ul>
    34. 34. <ul><li>The Seven Active </li></ul><ul><li>Listening Skills (continued) </li></ul><ul><ul><li>Effective Pauses ( silence) </li></ul></ul><ul><ul><ul><li>Immediately before or after saying something meaningful </li></ul></ul></ul><ul><ul><li>Minimal Encouragers </li></ul></ul><ul><ul><ul><li>Indicate your presence ... &quot;Uh-huh...OK, etc.“ </li></ul></ul></ul><ul><ul><li>&quot; I&quot; Messages </li></ul></ul><ul><ul><ul><li>&quot;When you ...&quot;, &quot;I feel ...&quot;, &quot;Because ...&quot; </li></ul></ul></ul>
    35. 35. <ul><li>The Seven Active </li></ul><ul><li>Listening Skills (continued) </li></ul><ul><ul><li>Open - Ended Questions </li></ul></ul><ul><ul><ul><li>&quot;What?&quot;, &quot;When?&quot;, &quot;How?&quot;, --- OR --- </li></ul></ul></ul><ul><ul><ul><li>&quot;Tell me more about ...&quot;, </li></ul></ul></ul><ul><ul><ul><li>&quot;I'd like to hear more about ...&quot; </li></ul></ul></ul>
    36. 36. <ul><li>Building Rapport </li></ul><ul><li>Let the person know which emotion you think you hear </li></ul><ul><ul><li>&quot;This situation seems to have really made you mad.“ </li></ul></ul><ul><li>&quot;It sounds like this is very frustrating to you.“ </li></ul><ul><li>“ You seem to be confused about what to do.&quot; </li></ul>
    38. 38. Is not just a bad mood or feeling “blue” Is a depressed mood, of at least two weeks duration, with symptoms such as sleep disturbance, weight loss or gain, and difficulty concentrating Depression
    39. 39. <ul><li>Depression Characteristics </li></ul><ul><li>Profound sadness </li></ul><ul><li>Hopelessness </li></ul><ul><li>Helplessness </li></ul><ul><li>Unworthy </li></ul><ul><li>Blames self – guilt </li></ul><ul><li>Brooding over past events – tearfulness </li></ul><ul><li>Sleep / appetite disorders / disturbances </li></ul><ul><li>Recent loss </li></ul><ul><li>Psychomotor reactions slowed / meds </li></ul><ul><li>Thoughts of suicide ASK? </li></ul>
    40. 40. <ul><li>WHY SUICIDE INTERVENTION? </li></ul><ul><li>There is the potential for suicide in virtually all crisis situations. </li></ul>
    41. 41. <ul><li>SUICIDE CLUES </li></ul><ul><li>Expressions of hopelessness and helplessness </li></ul><ul><ul><li>&quot;No one cares&quot; </li></ul></ul><ul><ul><li>&quot;I can't go on“ </li></ul></ul><ul><ul><li>“ I wish I were dead.” </li></ul></ul><ul><ul><li>“ I wish I could go to sleep and never wake up.” </li></ul></ul>
    42. 42. <ul><li>TIME CLUES </li></ul><ul><li>&quot;It won't matter after today.“ </li></ul><ul><li>&quot;Tomorrow? </li></ul><ul><li>There won't be a tomorrow.&quot; </li></ul>
    43. 43. <ul><li>INDICATORS </li></ul><ul><li>TBI / PTSD </li></ul><ul><li>Giving personal items away </li></ul><ul><li>Writing a note </li></ul><ul><li>Test firing of weapon </li></ul><ul><li>Withdrawal from family / friends </li></ul><ul><li>Sudden cessation of previously enjoyable activities </li></ul><ul><li>Preoccupation with talk of death </li></ul>
    44. 44. The Framework Multiple Attempter? Yes No Any Other Significant Finding = AT LEAST Moderate Risk Elevated on Resolved Plans & Preparation? Yes No Elevated on Suicidal Desire & Ideation Yes No Low Risk Any Other Significant Finding = AT LEAST Moderate Risk Two or More Other Significant Findings = AT LEAST Moderate Risk Joiner ,2008
    45. 45. Suicidal Risk Assessment LINK for Life <ul><li>L ook L isten for warning signs </li></ul><ul><li>I nquire- Ask “Are you thinking about suicide.” </li></ul><ul><li>N ote the level of risk </li></ul><ul><ul><li>Do they have a plan? </li></ul></ul><ul><ul><li>Previous suicide attempts? </li></ul></ul><ul><ul><li>Ask if they have access to weapons – knives, firearms, etc. (ASSUME they do- 62% of homes in Colorado have guns in them) </li></ul></ul><ul><li>K now your resources </li></ul><ul><ul><li>1 800 273-TALK </li></ul></ul>
    46. 46. Postvention: What to Do <ul><li>Here are some ways to be helpful to someone who is threatening suicide: </li></ul><ul><li>Be direct. Talk openly and matter-of-factly about suicide. </li></ul><ul><li>Be willing to listen. Allow expressions of feelings. Accept the feelings. </li></ul><ul><li>Be non-judgmental. Don’t debate whether suicide is right or wrong, or whether feelings are good or bad. Don’t lecture on the value of life. </li></ul><ul><li>Get involved. Become available. Show interest and support. </li></ul>
    47. 47. Postvention: What to Do <ul><li>Don’t dare him or her to do it. </li></ul><ul><li>Don’t act shocked. This will put distance between you. </li></ul><ul><li>Don’t be sworn to secrecy. Seek support. </li></ul><ul><li>Offer hope that alternatives are available but do not offer glib reassurance. </li></ul><ul><li>Take action. Remove means, such as guns or stockpiled pills. </li></ul><ul><li>Get help from persons or agencies specializing in crisis intervention and suicide prevention. </li></ul>
    48. 48. Suicide Statistics / 100,000 <ul><li>National Suicide Rate 10.7 </li></ul><ul><li>Colorado Rate 16.7 </li></ul><ul><li>Western Slope 21 – 24 </li></ul><ul><li>Attempt numbers 25-100 times these </li></ul><ul><li>50-75% of suicides on the Western Slope are from the Construction industry </li></ul><ul><li>95% have Alcohol / Drugs on board </li></ul>
    49. 49. <ul><li>SUICIDE BY COP </li></ul><ul><ul><li>Possible indicators </li></ul></ul><ul><ul><li>May demand to be killed by police </li></ul></ul><ul><ul><li>May set a deadline for his/her death </li></ul></ul><ul><ul><li>May have just killed a significant other </li></ul></ul><ul><ul><li>May have stated a verbal will </li></ul></ul><ul><ul><li>May have expressed and/or established an elaborate death plan </li></ul></ul><ul><ul><li>Expected sentencing </li></ul></ul>
    50. 50. SUICIDE BY COP STATISTICS <ul><li>Incident began as a call other than suicide (73%) </li></ul><ul><li>Occurred during: </li></ul><ul><ul><li>Domestic disturbance (46.3%) </li></ul></ul><ul><ul><li>Mental Illness (24.7%) </li></ul></ul><ul><ul><li>Criminal offense (20.4%) </li></ul></ul>Source: Vivian Lord, Ph.D
    51. 51. Homicide followed by Suicide: An Analysis of Chicago Data <ul><li>Ex-spouse/lover </li></ul><ul><li>Child </li></ul><ul><li>Girlfriend/boyfriend </li></ul><ul><li>Friend </li></ul><ul><li>12.68 </li></ul><ul><li>10.28 </li></ul><ul><li>6.11 </li></ul><ul><li>1.88 </li></ul>Relationship of victim Increase in likelihood of suicide Steven Stack, Criminology, 1997, Volume 35, No. 3, pp. 435 – 445.
    52. 52. If someone chooses death? <ul><li>Know that you did the best you can do </li></ul><ul><ul><li>Seek out a debriefing- Crisis Support Teams </li></ul></ul><ul><ul><li>Trust your decisions- You are a good person </li></ul></ul><ul><ul><li>You are not responsible for others actions </li></ul></ul><ul><ul><li>Let go of any and all guilt immediately </li></ul></ul><ul><ul><li>Have faith that next time you will be better because of what you have learned </li></ul></ul><ul><ul><li>Practice SELF CARE </li></ul></ul><ul><ul><li>Be aware of PTSD symptoms - seek help </li></ul></ul><ul><ul><li>early </li></ul></ul>
    53. 53. Death Notification <ul><li>This moment will shape the recipient’s life forever. </li></ul><ul><ul><li>Use the “D” words (Death, Died, Deceased) </li></ul></ul><ul><ul><li>This begins the healing without misinterpretation, denial, false hope. </li></ul></ul><ul><ul><li>Let them vent (anger, hysterics, silence- all normal) </li></ul></ul><ul><li>Watch for strange behavior- walking in traffic </li></ul><ul><li>Two years out- lowered immune system- Cancer </li></ul><ul><li>Respectful of last moments, belongings </li></ul><ul><li>If you are uncomfortable with the topic, ask someone else to do it. </li></ul><ul><li>I know this was not your fault, touch them </li></ul><ul><li>If they want the note- give them the note. </li></ul>
    54. 54. Suggested Reading <ul><li>“ Verbal Judo”- Thompson </li></ul><ul><li>“ The Rock Warrior ‘s Way” – Ilgner </li></ul><ul><li>“ Goodbye to Guilt” - Jampolsky </li></ul><ul><li>“ The Speed of Trust”- Covey </li></ul><ul><li>“ Seven Habits of Highly Effective People”- Covey </li></ul><ul><li>“ The Fifth Element”- Senge </li></ul><ul><li>“ Why People Die by Suicide”- Joiner </li></ul><ul><li>The Assessment and Management of Suicidality - Rudd </li></ul>
    55. 55. It’s the little things <ul><li>“ Never doubt that a small group of thoughtful citizens can change the world. Indeed, it is the only thing that ever has.” Margaret Mead </li></ul>