Post on 27-Jun-2020
SUICIDE PREVENTION,INTERVENTION,POSTVENTION
Aca
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my
Ho
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Amy Morgan, MSCM
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tal H
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lth Tra
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2017
Suicide is the 10th leading cause of
death in the U.S….
2015 statistics
SUICIDE PREVENTION,INTERVENTION,POSTVENTION
Aca
de
my
Ho
ur
Amy Morgan, MSCM
en
tal H
ea
lth Tra
inin
g
2017
Each year 44,193 Americans die by
suicide…
2015 statistics
SUICIDE PREVENTION,INTERVENTION,POSTVENTION
Aca
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my
Ho
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Amy Morgan, MSCM
en
tal H
ea
lth Tra
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2017
On average there are 121 suicides
every day…
2015 statistics
SUICIDE PREVENTION,INTERVENTION,POSTVENTION
Aca
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my
Ho
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Amy Morgan, MSCM
en
tal H
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lth Tra
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2017
Firearms as a method account for
almost 50% of all suicides…
2015 statistics
SUICIDE PREVENTION,INTERVENTION,POSTVENTION
Aca
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my
Ho
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Amy Morgan, MSCM
en
tal H
ea
lth Tra
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2017
White males accounted for 7 of 10
suicides in 2015…
2015 statistics
SUICIDE PREVENTION,INTERVENTION,POSTVENTION
Aca
de
my
Ho
ur
Amy Morgan, MSCM
en
tal H
ea
lth Tra
inin
g
2017
Over 1 million people die by suicide,
worldwide, each year…
2015 statistics
SUICIDE PREVENTION,INTERVENTION,POSTVENTION
Aca
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my
Ho
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Amy Morgan, MSCM
en
tal H
ea
lth Tra
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2017
75% of global suicide occurred in low-
and middle-income countries in 2012.
SUICIDE PREVENTION,
INTERVENTION,POSTVENTIONA
ca
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Amy Morgan, MSCM
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3 areas of safety from suicide
■ Prevention
■ Intervention
■ Postvention
Poll Question
■ Have you ever known someone who died by suicide,
or who attempted suicide?
– ATTEMPTED but lived
– DIED by suicide
– NONE of the above
What is suicide?
■ Selfish
■ Weak
■ Good life
■ Attention
■ Message
Activity: Life Stressors
■ Think of a typical life stressor
■ Money
■ Relatives/Family
■ Job
■ Divorce
Activity: Life Stressors
■ Relationship problems
■ Money
■ Job Stress
■ Kids
■ Moving
■ Job Loss
■ Death of a loved one
■ Other stressors
Activity: Life Stressors
■ Keep carrying the books?
■ Put them away properly, one by one?
■ When heavy enough, for a long
period of time.. The inclination is to
just DROP all the books.
What is suicide?
■ Want pain to end
■ See no solutions
■ See no hope
Reasons for Suicide
■ Pain ■ Loss
Who dies by suicide?
■ Adults between 45-64 years of age
■ Adults 85 years of age and older
2015 statistics
■ Youth ages 15-24 have the lowest rate of suicide deaths.
Reasons for Suicide
■ Pain ■ Loss
■ Adults 85 years of age and older
Not going to improve Not going to improve
Prevention vs. Intervention
■ Prevention:
– Prevention of the elements that lead to thoughts of suicide
– Teaching the tools for coping
– Recognizing signs of self-destruction
Prevention vs. Intervention
■ Intervention:
– Recognizing the signs of suicidal ideation and stepping in to
prevent follow-through
– Assisting someone in finding resources to help them deal with
or resolve whatever is causing their suicidal thoughts
– Implementing a safe plan with the individual
Postvention
■ Prevention of a new cycle
– Care offered to friends & family left behind after a suicide
– Watching for same signs as the Prevention phase
– Those left behind are at risk
RESPONDING TO SIGNS OF SUICIDE
Would you know what to do?...
Imagine…
This is for my mom, my dad and “brother.” This is my last words. I hope you are not grieving of my death. I am
sorry for my pain I have put upon you. Mom I love you. I am sorry.”
Poll Question
■ Do you feel confident that you would know what to do to save this child’s life or help him stop thinking of suicide as a solution?
– YES
– NO
PREVENTIONBefore thoughts of suicide begin
“She seemed fine.”
Prevention ■ Talking about suicide
– Any mention of suicide,
even when making jokes
– Asking questions about
suicide
– Talking about other
suicides
Look for warning signs
Prevention ■ Untreated depression
– Crying spells
– Difficulty getting out of bed
– Problems sleeping
– Bad eating patterns
– Feeling hopeless
– State of pain makes them
shut down
– Thinking clouded
– Life feels pointless
Look for warning signs
Prevention ■ Giving away possessions
– Things valued by them
– “Don’t need it anymore”
– Taking care of loose ends
– Turning over responsibility
(pet care, etc.)
Look for warning signs
Prevention ■ Saying goodbye
– Visiting family & friends
– Letters expressing feelings
– Closure
– Could be phone/text
Look for warning signs
Prevention ■ Suicide notes
– If written/found prior to
death, take seriously
– Attempt to explain pain
– Make sure people know
they cared
– Take care of loose ends
Look for warning signs
Prevention ■ Alcohol & drugs
– Increase/abuse
– Make problems worse
– Helps to build courage
Look for warning signs
Prevention ■ Sudden calmness
– Change to calm or happy
– Comes from decision reliefLook for warning signs
Prevention ■ Reckless behavior
– Behavior & decisions
– Trying new things – drugs,
extreme sports
– Reckless driving
Look for warning signs
Prevention ■ Researching suicide
methods
– Internet browser history
– Painless suicide / how-to
– Asking questions
Look for warning signs
Prevention ■ Buying suicide materials
– Gun shopping
– Rope
– Pills
– Knives, Razors
Having the means is
dangerous and should be
taken seriously
Look for warning signs
Prevention ■ Creating a will
– Creating a will
– Last-minute will revisions
– Questions re: life insurance
Look for warning signs
Prevention ■ Social withdrawal or
isolation
– Isolate from friends, family,
colleagues
– Causes more depression
– Withdrawal from social
commitments and
extracurricular activities
Look for warning signs
Prevention ■ Talking about being a
burden
– Apologizing frequently
– Feelings of causing
unwanted problems
– Talk of being a burden
Look for warning signs
Prevention ■ Feeling hopeless
– Talk about being hopeless
– Talk of hopeless situation
– Feeling helpless or
worthless
Look for warning signs
Prevention ■ Preoccupation with death
– Openly talking of death
– Researching death
– Talking about afterlife
Look for warning signs
Prevention ■ Previous suicide attempt
– Increased risk of attempt
– 20-50% who die by suicide
had a previous attempt
– Previous attempt makes
suicide more comfortable
to them. Not an unknown.
Look for warning signs
Actions to watch for
ACTIONS• Giving away possessions
• Withdrawal (family, friends, school, work)
• Loss of interest in hobbies
• Abuse of alcohol, drugs
• Reckless behavior
• Extreme behavior changes
• Impulsivity
• Self-mutilation
Thoughts to listen for
THOUGHTS
"All of my problems will end soon"
"No one can do anything to help me now"
"Now I know what they were going through"
"I just can't take it any more"
"I wish I were dead"
"Everyone will be better off without me"
"I won't be needing these things anymore"
"I can't do anything right"
"I just can't keep my thoughts straight
anymore"
Feelings to watch for
FEELINGS
• Desperate
• Angry
• Guilty
• Worthless
• Lonely
• Sad
• Hopeless
• Helpless
Physical signs to watch for
PHYSICAL
• Lack of interest in appearance
• Change/loss in sex interest
• Disturbed sleep
• Change/loss of appetite, weight
• Physical health complaints
What to do
■ Ask / listen to what the problems and stressors are
■ Help find resources
– Counseling
– Job search
– Family assistance
– Support network / friends
■ 800-273-8255 (National Suicide Prevention Lifeline)
INTERVENTIONSaving the life of someone contemplating suicide
“I just need to know there’s hope.”
People hide what they don’t want you to know or see.
Intervention allows someone to talk about their suicidal thoughts without judgment.
People hide what they don’t want you to know or see.
Intervention allows someone to talk about their suicidal thoughts without judgment.
People hide what they don’t want you to know or see.
Intervention allows someone to talk about their suicidal thoughts without judgment.
What is an intervention?
Definition:
Interference so as to modify a
process or situation
What is an intervention?
Thoughts of Suicide
Suicidal Behavior
Death or Harm
“Contributaries” of Suicide
(no thoughts of suicide)
Credit: Applied Suicide Intervention Skills Training (ASIST)
How does aninterventionwork?
Credit: Applied Suicide Intervention Skills Training (ASIST)
Understanding
Connecting Assisting
Phase 1:Connecting
Credit: Applied Suicide Intervention Skills Training (ASIST)
Connecting
Phase 1:Connecting
Credit: Applied Suicide Intervention Skills Training (ASIST)
ConnectingFriend: “I’m just going to end all of
this and fix all my problems.”
You: “ .”
Phase 1:Connecting
Credit: Applied Suicide Intervention Skills Training (ASIST)
ConnectingAccept what the person is
saying, without judgment, and
let them know you’re here to
help.
Phase 1:Connecting
Credit: Applied Suicide Intervention Skills Training (ASIST)
Connecting“I can see you really seem to
be having a hard time.”
“Tell me what’s bothering you
the most.”
“That does sound very
difficult.”
“What else?” “Tell me more.”
Phase 1:Connecting
Credit: Applied Suicide Intervention Skills Training (ASIST)
ConnectingIt’s not about you, or your
opinions.
Build trust.
Create a sense of trust and
openness for sharing.
Goal: Save the person’s life.
Phase 1:Connecting
Credit: Applied Suicide Intervention Skills Training (ASIST)
Listen for red flags / risk factors
1st question: Are you having
thoughts of suicide?
?■ Review Risk
■ ARE YOU HAVING THOUGHTS OF SUICIDE?……suicide
RISK
ALERT
Phase 1:Connecting
Credit: Applied Suicide Intervention Skills Training (ASIST)
Ask questions about current
factors that may contribute to
their suicidal thoughts.
“Do you have a plan?”
?■ Review Risk
■ ARE YOU HAVING THOUGHTS OF SUICIDE?……suicide
RISK
ALERT
CURRENT FACTORS
preparedCurrent Suicide Plan
How? How prepared? How soon?…………………….
desperatePain
Do you have pain that at times feels unbearable?…..
aloneResources
Do you feel you have few, if any, resources?………...
“Do you have pain that at
times feels unbearable?”
“Do you feel you have few, if
any, resources?”
Phase 1:Connecting
Credit: Applied Suicide Intervention Skills Training (ASIST)
Ask questions about background
factors that may contribute to
their suicidal thoughts.
“Have you ever attempted
suicide before?”
?■ Review Risk
■ ARE YOU HAVING THOUGHTS OF SUICIDE?……suicide
RISK
ALERT
CURRENT FACTORS
preparedCurrent Suicide Plan
How? How prepared? How soon?…………………….
desperatePain
Do you have pain that at times feels unbearable?…..
aloneResources
Do you feel you have few, if any, resources?………...
BACKGROUND FACTORS
vulnerable
+ Mental Health
Are you receiving or have you receivedmental health care?………………………………………
familiar
+ Prior Suicidal Behavior
Have you ever attempted suicide before?…………….
“Are you receiving or have you
received mental health care?”
Poll Question
■ When it comes to being a good listener, how would
you rate yourself?
– I’m an EXCELLENT listener
– I’m a PRETTY GOOD listener
– I’m an “OK” listener
– I’m a TERRIBLE listener
Phase 2:Understanding
Credit: Applied Suicide Intervention Skills Training (ASIST)
Understanding
Ask them to tell you all about all
of the stressors.
Listen without judgment or
opinion, and without trying to
turn them to more positive
thinking.
How does aninterventionwork?
Credit: Applied Suicide Intervention Skills Training (ASIST)
Understanding
Connecting
How does aninterventionwork?
How does aninterventionwork?
Phase 2:Understanding
Credit: Applied Suicide Intervention Skills Training (ASIST)
Understanding
Listen for cues about reasons for
living.
Listen for ambivalence.
Phase 2:Understanding
“Survivors often regret their
decision in midair, if not before.”
“I instantly realized that
everything in my life that I’d
thought was unfixable was totally
fixable – except for having just
jumped.”
Who can die by suicide?
How can THIS person be
thinking of suicide?
Anyone is at risk.
What is a stressor?
Remember: What is
stressful to one person
may not be to another.
And what you consider
stressful may not be to
someone else, and vice
versa.
Caregiver attitudes matter
The caregiver is the only one who has
clarity and focus. Those thinking of
suicide can only focus on the things
that are causing them to feel
hopeless.
Phase 3:Assisting
Credit: Applied Suicide Intervention Skills Training (ASIST)
Assisting
Ph
ase
3: A
ssis
tin
g
Credit: Applied Suicide Intervention Skills Training (ASIST)
?■ Review Risk
■ ARE YOU HAVING THOUGHTS OF SUICIDE?……suicide
RISK
ALERT
CURRENT FACTORS
BACKGROUND FACTORS
preparedCurrent Suicide Plan
How? How prepared? How soon?…………………….
desperatePain
Do you have pain that at times feels unbearable?…..
aloneResources
Do you feel you have few, if any, resources?………...
vulnerable
+ Mental Health
Are you receiving or have you receivedmental health care?………………………………………
familiar
+ Prior Suicidal Behavior
Have you ever attempted suicide before?…………….
Contract Safeplan
• Safety contact(s)
• Keep safe
• Safe/no use of alcohol/drugs
• Link to resources
ALL SAFEPLANS
Ph
ase
3: A
ssis
tin
g
Credit: Applied Suicide Intervention Skills Training (ASIST)
?■ Review Risk
■ ARE YOU HAVING THOUGHTS OF SUICIDE?……suicide
RISK
ALERT
CURRENT FACTORS
BACKGROUND FACTORS
preparedCurrent Suicide Plan
How? How prepared? How soon?…………………….
desperatePain
Do you have pain that at times feels unbearable?…..
aloneResources
Do you feel you have few, if any, resources?………...
vulnerable
+ Mental Health
Are you receiving or have you receivedmental health care?………………………………………
familiar
+ Prior Suicidal Behavior
Have you ever attempted suicide before?…………….
• Link to health worker
• Protect against the danger/
support past survival skills
• Disable the suicide plan
• Ease the pain
• Link to resources
RISK SPECIFIC SAFEPLANS
Contract Safeplan
• Safety contact(s)
• Keep safe
• Safe/no use of alcohol/drugs
• Link to resources
ALL SAFEPLANS
Credit: Applied Suicide Intervention Skills Training (ASIST)
family & friends
advisershealth
workers
emergency
personal connections
community
24-hour
Longer-term
Life-long
Informal Resources Formal Resources
800-
273-
8255
Phase 3:Assisting
Credit: Applied Suicide Intervention Skills Training (ASIST)
Phase 3:Assisting
EXPLORE invitations recognition valuedanswer honestly about thoughts of suicide
ASK about suicide permission relievedtalk openly about suicide
LISTEN to reasons for dying and living
perspective acceptedmove toward their life side
REVIEW risk care respectedhelp develop their safeplan
CONTRACT a safeplan hope encouragedcommit to their safeplan
FOLLOW-UP on commitments
safety supported keep safe
When caregivers…
they meet the person at risk’s need for…
The person at risk feels…
and is more likely to…
CONNECTED
UNDERSTOOD
ASSISTED
How does aninterventionwork?
Credit: Applied Suicide Intervention Skills Training (ASIST)
Connectinginvitations?
suicide?
explore
ask
Understanding
reasons?
risk?
listen
review Assistingsafeplan?
commitments?
contract
follow-up
How does aninterventionwork?
Credit: Applied Suicide Intervention Skills Training (ASIST)
Goals of an intervention
Credit: Applied Suicide Intervention Skills Training (ASIST)
PAST PRESENT FUTURETime
ALONE ENGAGED LINKEDRelationship
DEATH AMBIVALENCE LIFEExistence
Connecting Understanding Assisting
Patiently listen TO the death side of
ambivalence; help the person at risk
talk about their reasons for dying
Persistently listen FOR the life side
of ambivalence; search for reasons
for living or reinforce them when the
person at risk discovers them
DEATH LIFE
Credit: Applied Suicide Intervention Skills Training (ASIST)
Poll Question
■ At this point, how confident do you now feel that you
could recognize someone who is having thoughts of
suicide, and help them to live?
– MUCH MORE CONFIDENT
– JUST AS CONFIDENT
– STILL NOT CONFIDENT
POSTVENTIONHelping someone who’s lost someone to suicide
I don’t understand, and I’m hurting.
Responding to a suicide
■ Family just lost a loved one
■ Cause of death is irrelevant
■ They are shocked, traumatized, confused, grieving, and have questions
Questions of the survivors
■ Does suicide run in the family?
■ Suicide is a learned behavior.
– Families pass on behavior and emotional environments
– Families can teach poor coping skills, self-destructive behavior
– Depression and anxiety are contributors
Life Stressors
■ Relationship problems
■ Money
■ Job Stress
■ Kids
■ Moving
■ Job Loss
■ Death of a loved one
■ Other stressors
Postvention = Prevention
■ Listen for signs of wanting to die
■ Start the Connecting Phase with the family members
■ Assess the level of risk, and ask about factors that may contribute to
future thoughts of suicide
Resources
■ Offer resources for the family members
■ 1-800-273-8255 (TALK)
– (National Suicide Prevention Lifeline)
■ 9-1-1
■ Emergency room
■ Physician
■ Family members
■ Friends
■ Clergy
■ Counselor
Expectations
■ Talk about what they can expect
■ A significant loss
■ A traumatic event
■ May need to seek help later
■ Ask them to think about who they might call at the time.
Resources
■ Who are your resources?
■ Think to yourself of who you would call. Do you have
their number ready?
THANK YOU!Amy Morgan, MSC
Academy Houremail: Amorgan@AcademyHour.com
Phone: 405-326-4116
www.AcademyHour.com