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INDIGENOUS SUICIDE

PREVENTION TRAINING

Indigenous Wholistic Services

Developed By Andrew Bear (BISW – D.M)

Electronic version copyright©2018 duplication permission must be granted through

emailing Andrew Bear bearagency2020@gmail.com

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HEAVENLY FATHER

GRANT ME THE SERENITY TO ACCEPT THE THINGS I CANNOT

CHANGE.

The courage to change the things I can. AND THE WISDOM TO KNOW THE DIFFERENCE.

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This training will be a comprehensive model that will assist frontline workers and health providers to use in engaging their community in suicide related training. Although this training is geared to frontline employees, it is beneficial to all who take it. ALL CONTENT HAS BEEN THOROUGHLY RESEARCHED AND DEVELOPED

BY ANDREW BEAR AND BEAR AGENCY ASSOCIATES.

CHANGING OUR FOCUS q COLONISTIC TEACHINGS q CHANGING OUR ATTITUDE q IMPACTING LIVES q SHARING STORIES q CREATING MENTORS AND

LEADERS q LIVING THE TRUTH

SUICIDE PREVENTION RESTRUCTURING

Understanding the roots of suicide. Becoming totally aware of the traumas of indigenous people.

Having a deep rooted understanding of self and of our Identity. Completing or engaging in self-help healing practices. Entering into a healthy spiritual connection with Creator. This connection must exist on a daily basis. Prior to working with others this spiritual connection should be exhibited on a continual basis. Understanding the warning signs associated with suicidal ideation and recognizing that many individual will camouflage their emotions. Developing a work based commitment. Understanding that in life’s circle we are all helpers, and as helpers our hours are continual meaning 24 hours a day. This is a commitment we make to ourselves, to our Creator and to others.

Prior to engaging in front line activity; Our objectives, our purpose, and our commitment should be evident.

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I WANT TO ADDRESS THE SPIRITUAL EMPHASIS NECESSARY FOR ACTIVATING A HEALTHY RESPONSE BOTH IN A CRITICAL SITUATION AND IN THE JOURNEY OF LIFE. I BELIEVE ALL FIRST NATIONS PEOPLE ARE AWARE OF SOMETHING GREATER THAN JUST A HIGHER POWER. I BELIEVE THAT THEY UNDERSTAND THAT THEY ARE SPIRITUAL BEINGS AND THAT THEY NEED TO BE CONNECTED TO THE SPIRITUAL POWER IN THEIR LIFE.

SOME OF US WISH TO CALL THAT GOD, OTHERS CREATOR, OTHERS THE GRAND FATHERS, SOME JESUS. WHATEVER YOU CHOOSE TO CALL YOUR SPIRITUAL FORCE IS YOUR BUSINESS AND NEEDS TO BE RESPECTED.

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First of all, I want to introduce you to a not so brand new philosophy that has somewhat been placed on

the back burner. This philosophy is called

In dealing with the concept of Wholistic healing, we deal with the whole human being.

One example: Often times a thought arises, “I am a loser, I will never amount to anything, my life is a mess”. This thought process starts in the “Mental”

PLAN OF ACTION – INCREASE KNOWLEDGE ROOTS OF SUICIDE – o UNADDRESSED ABUSE o THOUGHT INITIATION o NEGATIVE IMPACTS o ADDRESSING DEPRESSION o FINDING HOPE o CONVERSING WITH – NOT TO INDIVIDUALS

Sometimes we make “Wholistic Wellness”

complicated, when in reality it is not complicated at all.

IT IS THE ART OF HEALING THE WHOLE BODY.

If there is a break – down in

one area of our life it is quite possible that it will affect another area of your life.

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ROOTS OF SUICIDE #1 UNADDRESSED ABUSE

UNADDRESSED ABUSE

• Abuse of Child • Recurrent Severe Emotional abuse • Recurrent Physical abuse • Contact Sexual abuse

SHARING THESE STORIES BRINGS HEALING

SHARING THESE STORIES WITH NO TRUST STOPS HEALING.

ROOTS OF SUICIDE #2 THOUGHT INITIATION - DISORDERS

Depression - Schizophrenia - Personality Disorders - Alcohol Abuse - Drug Abuse. Object Loss

1. The common purpose of suicide is to seek a solution

2. The common goal of suicide is termination of consciousness

3. The common motivation in suicide is intolerable psychological pain

4. The common stressor in suicide is frustrated psychological needs

5. The common emotion in suicide is hopelessness-helplessness

6. The common thought state in suicide is indecision

7. The common action in suicide is aggression

8. The common interpersonal act in suicide is communication of intention

THE COMMONALITIES OF SUICIDE

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SUICIDE RISK FACTORS Current Suicidal Ideation Presence of specific plan

Accessibility of lethal means

Behavior suggestive of decision to die (e.g., severing relationships, giving away valued possessions; inappropriate sense of peace, calm or happiness; verbalizations regarding the utility of death)

Family history of suicide, especially parental suicide when person was between ages of 5-12

Psychiatric Medical Factors - Chronic psychiatric disorders

Recent discharge from psychiatric hospital (within 3 months)

Remission of psychiatric episode but continuance of secondary depression.

Impulsivity (violence toward others and self, reckless driving, spending money)

Alcohol abuse - Drug abuse

CHARACTERISTICS OF SUICIDE ATTEMPTERS

COGNITIVE STYLE (THINKING STYLE)

1. CONFLICTING (either-or) Thinking.

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2. Rigid, inflexible thinking style (things just are the way they are).

3. Inability to conceive if long term effects of actions.

4. Positive expectancies regarding the effectiveness of suicide as a solution to life problems.

5. Lack of insight; actions speak louder than words.

6. Poor problem solving abilities (generates less possible solutions, prematurely rejects potentially viable alternatives, less active in problem solving behaviors).

7. Generalized feelings of hopelessness.

1. Tendency toward chronic feelings of anger, guilt, depression, anxiety, and boredom;

2. Inability to regulate emotional arousal in stressful situations (can’t turn off feelings);

Affect Tolerance

1. Belief that they “Can’t Stand” or tolerate negative affect.

2. Restrictive and negative beliefs about the place of negative feelings in the world. Bad feelings wrong.

3. Tendency toward impulsive attempts to get rid of affect (i.e., cutting, drinking, drug taking, binge eating).

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Suicide is a Problem-Solving Behavior aimed at: Improving an unpleasant situation (chronic depression) ** preserving a threatened self-image (embarrassment and humiliation) Exercising omnipotence vs. Helplessness (terminal illness/intractable pain). THINKING DISTORTION: My feelings are wrong - My thinking is correct

RATIONAL - HOWEVER CONFUSED AND ILLOGICAL THINKING Suicidal Puzzle

Suicide is a problem solving behavior, individuals become less anxious and symptomatic AFTER they have decided to kill themselves. Therefore, an actively suicidal individual will appear to be “back to themselves”. Thus, it is important to ask this person, “Are you better or have you decided to kill yourself?”. The Thinking Process of Someone Contemplating Suicide

�It has been done before. �The world will be better off without me. �I’m worth more to my family dead than alive. �Everyone will get over it. �This will end my pain. �There is no other solution.

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EUPHEMISM -A MILD OR INDIRECT WORD OR EXPRESSION SUBSTITUTED FOR ONE CONSIDERED TO BE TOO HARSH OR BLUNT WHEN REFERRING TO SOMETHING UNPLEASANT OR EMBARRASSING.

Euphemisms are “watered down” verbalizations of what a

person is actually attempting to say. For example, a person

may say, “You aren’t going to do anything stupid are you?”, or, “You aren’t going to hurt yourself, are you?”. A suicidal

person (even if this person is your best friend) will

manipulate this transaction by saying, “No”. The usage of

the euphemism allows the suicidal person to avoid truthfully responding because the internal talk of the person is, “No, I’m not doing anything stupid, I have given this a lot of thought, and I’m killing myself.”, or, No, I’m not going to hurt myself, I’m going to blow my head off”.

ROOTS OF SUICIDE #3 NEGATIVE IMPACTS COLONIALISM COLONIALISM IS THE EXTENSION OF A NATION'S SOVEREIGNTY OVER TERRITORY BEYOND ITS BORDERS BY THE ESTABLISHMENT OF EITHER SETTLER COLONIES OR BY ADMINISTRATIVE DEPENDENCIES IN WHICH INDIGENOUS POPULATIONS ARE DIRECTLY RULED OR DISPLACED.

Learning ultimately supports the well-being of the self, the family, the community, the land, the spirits, and the ancestors. Learning is holistic, reflexive, reflective, experiential, and relational (focused on connectedness, on reciprocal relationships, and a sense of place).

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Learning involves recognizing the consequences of one’s actions. Learning involves generational roles and responsibilities. Learning recognizes the role of indigenous knowledge. Learning is embedded in memory, history, and story. Learning involves patience and time. Learning requires exploration of one’s identity. Learning involves recognizing that some knowledge is sacred and only shared with permission and/or in certain situations. KEY ISSUES FOR ABORIGINAL PEOPLE IN CANADA

v POORER HEALTH Aboriginal people remain at higher risk for illness and earlier death than non-Aboriginal people. Chronic diseases such as diabetes and heart disease are on the increase. There are definite links between income, social factors, and health.

v LOWER LEVELS OF EDUCATION Low rate of getting adequate education. According to Statics Canada's 2011 Aboriginal Survey, 22.8% of Aboriginal Peoples had completed high school and post-secondary education.

v INADEQUATE HOUSING AND CROWDED LIVING CONDITION The conditions in so many communities drew national and international media. Attention to a housing situation that far too many Aboriginal communities struggle with.

v LOWER INCOME LEVELS The median income for Aboriginal People was lower than what median income for non-Aboriginal people is getting.

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v HIGHER RATES OF UNEMPLOYMENT Aboriginal people have historically faced higher unemployment rates than non-Aboriginal people.

v HIGHER LEVELS OF INCARCERATION Aboriginal adults were over represented in admissions to provincial and territorial correctional services, as they accounted for 26% of admissions while representing about 3% of the Canadian adult population. The over representation of Aboriginal adults was more pronounced for females than males.

v HIGHER DEATH RATE AMONGST CHILDREN & YOUTH DUE TO UNINTENTIONAL INJURIES Children in Aboriginal families also have high rates of unintentional injuries and early deaths from drowning and other causes.

v HIGHER RATES OF SUICIDE Statistics in Canada report found that more than one in five off-reserve First Nations, Métis and Inuit adults reported having suicidal thoughts at some point in their lives.

v FOSTER CARE CONDITIONS

"There are problems when you hear people from the front line talking about the fact that we're placing kids in homes where the study hasn't been done," “We've got kids being placed in homes where the home is over the allowable number of children.”

v ADDICTIONS Addiction statistics are scarce because many destructive habits are not yet officially recognized as addiction.

Alcoholl--Tobacco - Drugs - Gambling

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HIDDEN VIOLENCE

SEXUAL ASSAULT

RACISM

NEPOTISM

FAMILY VIOLENCE

UNRESOLVED TRAUMA

HATE

VENGEFUL THINKING

RESIDENTIALSCHOOL

MANY MORE

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LOSS OF IDENTITY

PHYSICAL ABUSE

NAME CALLING

GOSSIP

SLANDER

NEGLECT

REJECTION

HATRED

SEXUAL ABUSE

SHAME

GUILT

FEAR

LONELINESS

REVENGE

DRUG ADDICTION

BULLYING

HOPELESSNESS

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Colonial Racism

Colonialism The culture of the colonist and the colonized; The exploitation of these differences for the benefit of the colonialist; The continued oppression upon Indigenous People to submit to a culture that was not their own. 1876 Indian Act

European customs were built into the right for freedom 1876 Alternative-Non Status Indian. THE RIGHT TO FREEDOM MEANT LOSS OF NATIVE IDENTITY.

WHO AM I - WHO THE HECK AM I??? Traditional language and culture have an important and sacred role to play in Aboriginal communities all across Canada. Many communities assert that their language and culture is at the heart of what makes them unique and what has kept them alive in the face of more than 150 years of colonial rule. BUT WHAT ROLE DOES THE USE OF TRADITIONAL LANGUAGE AND CULTURE PLAY IN MAINTAINING HEALTH AND REDUCING SUICIDE IN ABORIGINAL COMMUNITIES? IMPACTS ON COMMUNITY AND NATION Aboriginal communities have been dealing with the impact of these historical factors for generations. Losses include: Loss of land - Loss of a whole social structure including culture and identity in its entirety (cultural genocide) Loss of traditional lifestyle Loss of safety - Loss of language in whole communities (threat of extinction).

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Kill the ‘Indian’ in the Child

The goal was to “Kill the Indian in the child”, to eradicate Indigenous peoples from existence, to adopt policies of assimilation, and whether intentional or not this allowed perpetual physical, emotional, spiritual, mental and sexual abuse to be committed against generations of children. Lessons learned…

• Don’t ask questions • Don’t feel or show emotions… • Don’t talk or tell • Don’t challenge authority-just obey

Individual Impacts Problems with acceptance and trust Relative comfort with rejection: discomfort with positive recognition Difficulty with emotional expression Few teaching/learning skills Difficulty with intimacy Mussell (2005) Impacts on Individuals

Loss of inherent identity Loss of language and culture Loss of self-respect, self-esteem, self-determination Loss of voice Loss of emotional connection (ie. inability to express love) Loss of respect for each other Loss of traditional roles Loss of life Self-destructive behaviors

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Impacts on Family

Loss of family connectedness and bonding Loss of relationships Loss of emotional connection (i.e. inability to express love) Loss of parenting roles and skills Loss of children to Gov’t care.

COMMUNITY WILLINGNESS TO END THE SILENCE, SHAME AND GUILT

“In our communities, silence has been mistaken for acceptance…What used to be hush, hush, don’t tell anyone is now an epidemic.” (Kanawayhitowin,)

Silence…is killing our communities. ROOTS OF SUICIDE #4 ADDRESSING DEPRESSION

THE FACE OF DEPRESSION

Mood Disorders

¡ Mood disorders are not character flaws or signs of personal weak- ness, nor are they conditions that will just “go away” if a person “thinks positive.”

¡ Mood disorders are medical conditions caused by changes in the chemistry of the body and brain. Depression and bipolar disorder may cause symptoms such as intense sadness, hopelessness, low energy, loss of appetite, changes in sleep patterns, inability to concentrate, decreased ability to perform one’s usual tasks, loss of interest in once-enjoyed activities and thoughts of death or suicide that can be difficult to ignore or overcome.

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¡ DEPRESSION & MOOD DISORDERS

Depression and bipolar disorder are treatable with medication, psychotherapy, support from others and changes in lifestyle.

With the right treatment, all symptoms can improve, including suicidal thoughts.

Different people respond differently to medication and therapy. Medication usually takes two to four weeks to reduce symptoms and may take several more weeks to provide complete relief. Some people need to try more than one medication or combination of medications before they find the one that works best. Keep this in mind as you work with your doctor to develop a treatment plan and stick with it. Never stop taking your medication without first discussing it with your doctor.

If You Are Feeling Suicidal - The belief that there is no hope is not the truth. When you feel this way, IT’S YOUR ILLNESS TALKING your mind is lying to you. Remind yourself that suicidal thoughts are not reality.

Depression is a "whole-body" illness, involving your body, mood, and thoughts. It affects the way you eat and sleep, the way you feel about yourself, and the way you think about things.

Snapping out of depression is as likely as talking yourself out of a heart attack. Depression is a serious illness that needs medical attention. If someone is experiencing mild depression for 2 weeks, they should seek help. Left untreated, depression can lead to suicide. Fortunately, depression can be treated and lives saved when symptoms are recognized.

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v Suicidal people have had their self-esteem attacked v Anger at self and others v They are experiencing shame v They have lost their identity

Most people who commit suicide don't want to die - they just want to stop hurting.

What Is Mental Illness?Illness- Adisease/sicknessMental- involvingthemindThesicknesscanaffectthinking, mood (feelings),orbehavior(action).Asheartdiseaseisanillnessoftheheart,ulcerisanillnessofthestomach,mentalillnessisadiseaseofthebrain.Justascertainillnesseslikediabetesislifelong,mentalillnesscanalsobechronicorlastingthroughout alifetime.About1in10peopleineachcommunityhasachronic/lifelongmentalillnessJustasdiabetescanbecontrolledbymedicationandtreatment,mentalillnesscanalsobecontrolledbymedicationandproper treatment.

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WHO AM I?

CONDITIONED TO SPEAK DOWN TO

EACH OTHER

WE HAVE CREATED A CONDITIONED ATMOSPHERE

LACK OF COMMITMENT TO THE PURPOSE.

YOU CANT GIVE IF YOU AINT GOT.

RACIST DIVISIONSRELIGIOUS DIVISIONS

WHO AUTHORIZED PEOPLE TO SPEAK NEGATIVELY INTO

ANOTHER’S LIFE.

WE LIVE IN OUR HURTS

ACCEPTING COLONISTIC TEACHINGS AND LIFESTYLES

BAD MEDICINE-CURSES

OUR TALK IS KILLING OUR PEOPLE

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Suicide Prevention. Q: What is Suicide? A: Experts in the field suggest that a suicidal person is feeling so much pain that they can see no other option. They feel that they are a burden to others, and in desperation see death as a way to escape their overwhelming pain and anguish. The suicidal state of mind has been described as constricted, filled with a sense of self-hatred, rejection, and hopelessness. •Suicide. We would rather not talk about it. We hope it will never happen to anyone we know. But suicide is a reality, and it is more common than you might think. The possibility that suicide could claim the life of someone you love cannot be ignored. By paying attention to warning signs and talking about the "unthinkable," you may be able to prevent a death. Who is at risk? People likely to commit suicide include those who: •Are having a serious physical or mental illness, •Are abusing alcohol or drugs, •Are experiencing a major loss, such as the death of a loved one, unemployment or divorce, •Are experiencing major changes in their life, such as teenagers and seniors, •Have made previous suicide threats. Why do people commit suicide? •There are many circumstances which can contribute to someone's decision to end his/her life, but a person's feelings about those circumstances are more important than the circumstances themselves. All people who consider suicide feel that life is unbearable. They have an extreme sense of hopelessness, helplessness, and desperation. With some types of mental illness, people may hear voices or have delusions which prompt them to kill themselves.

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I feel hurt-----own it --------------nobody gets to argue that. We need to start feeling’s meetings where people learn to express their feelings on a regular basis. our community needs to have something to put people in the community on alert. •People who talk about committing suicide or make an attempt do not necessarily want to die. Often, they are reaching out for help. Sometimes, a suicide attempt becomes the turning point in a person's life if there is enough support to help him/her make necessary changes. •If someone you know is feeling desperate enough to commit suicide, you may be able to help him/her find a better way to cope. If you yourself are so distressed that you cannot think of any way out except by "ending it all," remember, help for your problems is available. What are the danger signs? Some warning signs that a person may be suicidal include:

• Repeated expressions of hopelessness, helplessness, or desperation,

• Behavior that is out of character, such as recklessness in someone who is normally careful,

• Signs of depression - sleeplessness, social withdrawal, loss of

appetite, loss of interest in usual activities,

• A sudden and unexpected change to a cheerful attitude,

• Giving away prized possessions to friends and family,

• Making a will, taking out insurance, or other preparations for death, such as telling final wishes to someone close,

Making remarks related to death and dying, or an expressed intent to commit suicide. An expressed intent to commit suicide should always be taken very seriously.

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What Can You Do to Help a Friend?

1. Know the warning signs! Read over the list above and keep it in a safe place.

2. Do not be afraid to talk to your friends. Listen to their feelings. Make sure they know how important they are to you, but don’t believe you can keep them from hurting themselves on your own. Preventing suicide will require adult help.

3. Make no deals. Never keep secret a friend's suicidal plans or thoughts. You can not promise that you will not tell—you have to tell to save your friend!

4. Tell an adult. Talk to your parent, your friend's parent, your school’s psychologist or counselor-- a trusted adult. And don’t wait! Don’t be afraid that the adults will not believe you or take you seriously—keep talking until they listen! Even if you are not sure your friend is suicidal, talk to someone. It’s OK if you “jump the gun”—this is definitely the time to be safe and not sorry!

5. Ask if your school has a crisis team. Many schools (elementary, middle and high schools) have organized crisis teams, which include teachers, counselors, social workers, psychologists and principals. These teams help train all staff to recognize warning signs of suicide as well as how to help in a crisis situation. These teams can also help students understand warning signs of violence and suicide. If your school does not have a crisis team, ask your Student Council or faculty advisor to look into starting a team.

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SUICIDEKNOWLEDGEBUILDINGUNADDRESSED ABUSE THOUGHT INITIATION NEGATIVE IMPACTS ADDRESSING DEPRESSION FINDING HOPE CONVERSING WITH – NOT TO INDIVIDUALS UNADDRESSED ABUSE THOUGHT INITIATION Warning Signs Risk Factors Interventions Evaluation

CREATE YOUR PLAN FROM YOUR KNOWLEDGE Support Network

PEOPLE TO HELP IN A SUICIDE PREVENTION CRISIS PEOPLE TO CALL TO HELP YOU DEBRIEF AFTERWARDS

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Suicide Warning Signs

1. Suicide notes. These are a very real sign of danger and should be taken seriously.

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2. Threats. Threats may be direct statements (“I want to die.” “I am going to kill myself”) or, unfortunately, indirect comments (“The world would be better without me”, “Nobody will miss me anyway”). Among teenagers, indirect clues could be offered through joking or through comments in school assignments, particularly creative writing or artwork. Younger children and those who may have some delays in their development may not be able to express their feelings in words, but may provide indirect clues in the form of acting-out, violent behavior, often with threatening or suicidal comments.

3. Previous attempts. If a child or teenager has attempted suicide in the past, there is a greater likelihood that he or she will try again. Be very observant of any friends who have tried suicide before.

4. Depression (helplessness/hopelessness). When symptoms of depression include strong thoughts of helplessness and hopelessness, a child or adolescent is possibly at greater risk for suicide. Watch out for behaviors or comments that indicate that your friend is feeling overwhelmed by sadness or pessimistic views of their future.

5. “Masked” depression. Sometimes risk-taking behaviors can include acts of aggression, gunplay, and alcohol/substance abuse. While your friend does not acted “depressed,” their behavior suggests that they are not concerned about their own safety.

6. Final arrangements. This behavior may take many forms. In adolescents, it might be giving away prized possessions such as jewelry, clothing, journals or pictures.

7. Efforts to hurt oneself. Self-injury behaviors are warning signs for young children as well as teenagers. Common self-destructive behaviors include running into traffic, jumping from heights, and scratching/cutting/marking the body.

8. Inability to concentrate or think clearly. Such problems may be reflected in classroom behavior, homework habits, academic performance, household chores, even conversation. If your friend starts skipping classes, getting poor grades, acting up in class, forgetting or poorly performing chores around the house or talking in a way that suggests they are having trouble concentrating, these might be signs of stress and risk for suicide.

9. Changes in physical habits and appearance. Changes include inability to sleep or sleeping all the time, sudden weight gain or loss, disinterest in appearance or hygiene.

10. Sudden changes in personality, friends, behaviors. Parents, teachers and friends are often the best observers of sudden changes in suicidal students. Changes can include withdrawing from friends and family, skipping school or classes, loss of involvement in activities that were once important, and avoiding friends.

11. Death and suicidal themes. These might appear in classroom drawings, work samples, journals or homework.

12. Plan/method/access. A suicidal child or adolescent may show an increased interest in guns and other weapons, may seem to have increased access to guns, pills, etc., and/or may talk about or hint at a suicide plan. The greater the planning, the greater the potential for suicide.

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What Can You Do to Help a Friend?

1. Know the warning signs! Read over the list above and keep it in a safe place.

2. Do not be afraid to talk to your friends. Listen to their feelings. Make sure they know how important they are to you, but don’t believe you can keep them from hurting themselves on your own. Preventing suicide will require adult help.

3. Make no deals. Never keep secret a friend's suicidal plans or thoughts. You can not promise that you will not tell—you have to tell to save your friend!

4. Tell an adult. Talk to your parent, your friend's parent, your school’s psychologist or counselor-- a trusted adult. And don’t wait! Don’t be afraid that the adults will not believe you or take you seriously—keep talking until they listen! Even if you are not sure your friend is suicidal, talk to someone. It’s OK if you “jump the gun”—this is definitely the time to be safe and not sorry!

5. Ask if your school has a crisis team. Many schools (elementary, middle and high schools) have organized crisis teams, which include teachers, counselors, social workers, psychologists and principals. These teams help train all staff to recognize warning signs of suicide as well as how to help in a crisis situation. These teams can also help students understand warning signs of violence and suicide. If your school does not have a crisis team, ask your Student Council or faculty advisor to look into starting a team.

1. There are no right or wrong things you can say if you are speaking out of love and concern. Just be yourself. Show that you care by talking to them, holding them while they cry, or whatever else is necessary.

2. A suicidal person usually is carrying around some burden that they feel they just can't handle anymore. Offer to listen as they vent their feelings of despair, anger and loneliness. Sometimes this is enough to lighten the load just enough for them to carry on.

3. Be sympathetic, non-judgmental, patient, calm, accepting. The person will pick up on your attitude and begin to mirror this.

4. Don't be afraid to ask, "Are you having thoughts of suicide?" You are not putting ideas in their head. This will give you some valuable information about how to proceed in helping him.

5. If the answer is yes, ask these three questions:

Have you thought about how you would do it? Do you have what you need to carry out your plan? Do you know when you will do it?

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• Fortunately the majority of people will either say that they have no definite plans or that they don't have the nerve to do it themselves. Although this is still a serious situation, you know that they are probably not in imminent danger of hurting themselves. Take their words as a plea for help and proceed with helping them to get the assistance that they need. Urge them to seek professional help as soon as possible.

• If the answers they give you lead you to believe they are in immediate danger, do

not hesitate to contact the authorities. They may tell you that you are betraying them or making them angry. You may feel like you will lose their friendship if you take action. Just remember that you may permanently lose their friendship if you don't. When they're well again, they will thank you.

6. Keep them talking. This will allow them to reduce the emotional burden they are carrying. and give them time to calm down. The longer you keep them talking, the more you can take the edge off their desperation. As their momentum winds down, it's harder for them to act on their feelings.

7. Avoid trying to offer quick solutions or belittling the persons feelings. How big he perceives the problem to be and how much he is hurting over it is what counts. Rational arguments do little good to persuade a person when they are in this state of mind. Instead offer your empathy and compassion for what he is feeling without making any judgments about whether he should feel that way.

8. If the person has already started a suicide attempt, call for help immediately. If they are still conscious, get what information you can about what substances they have ingested, how long ago did they ingest them, how much did they take, are they also consuming alcohol, when did they last eat, what is the general state of their health. Call 911, Poison Control, or an appropriate emergency contact number in your area and explain the situation. Keep calm and follow any steps they may give you to assist your friend.

9. If you are in a situation--such as an online friendship--where you know very little about the person, encourage them to call 911 on their own or to call a suicide hotline in their area. This is your best option, because a local agency such as 911 or a hotline may be able to trace the call and get assistance to them. If they refuse to call, do your best to learn whatever personal information you can about the person. Don't hesitate to ask them for their address, phone number, and other information to help dispatch an emergency crew to their home.

10. Dealing with a suicide threat is very stressful. Seek assistance to decompress afterwards. Talk to a trusted friend, your pastor, etc. about what you've been through and how you feel about it.

11. If all your attempts fail, don't blame yourself. You did all that you could. This person ultimately made their own choices, for good or bad. If you were very close to the person, it may be wise to seek out grief counseling and suicide survivor support groups.

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Suicide Risk Factors Partial list of risk factors ♦Previous suicide attempt ♦Easy access to lethal means ♦Mental disorders ♦History of trauma or abuse ♦Job or financial loss ♦Hopelessness ♦Alcohol and other substance abuse disorders ♦Lack of social support / isolation

Suicide prevention tip #1: Speak up if you’re worried

If you spot the warning signs of suicide in someone you care about, you may wonder if it’s a good idea to say anything. What if you’re wrong? What if the person gets angry? Even worse, what if you plant the idea in your friend or family member’s head? In such situations, it's natural to feel uncomfortable or afraid. But anyone who talks about suicide or shows other warning signs needs immediate help—the sooner the better.

Talking to a person about suicide

If you're unsure whether someone is suicidal, the best way to find out is to ask. You can't make a person suicidal by showing that you care. In fact, giving the individual the opportunity to express his or her feelings may prevent a suicide attempt. The person may even be relieved that you brought up the issue.

Here are some questions you can ask:

• Have you ever thought that you'd be better off dead or that if you died, it wouldn't matter?

• Have you thought about harming yourself? • Are you thinking about suicide?

Suicide prevention tip #2: Respond quickly in a crisis

If a friend or family member tells you that he or she is thinking about death or suicide, it's important to evaluate the immediate danger the person is in. Those at the highest risk for

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committing suicide in the near future have a specific suicide plan, the means to carry out the plan, a time schedule for doing it, and an intention to do it.

Level of Suicide Risk Low — Some suicidal thoughts. No suicide plan. Says he or she won't commit suicide. Moderate — Suicidal thoughts. Vague plan that isn't very lethal. Says he or she won't commit suicide. High — Suicidal thoughts. Specific plan that is highly lethal. Says he or she won't commit suicide. Severe — Suicidal thoughts. Specific plan that is highly lethal. Says he or she will commit suicide.

The following questions can help you assess the immediate risk for suicide:

• Do you have a suicide plan? • Do you have what you need to carry out your plan (pills, gun, etc.)? • Do you know when you would do it? • Do you intend to commit suicide?

If a suicide attempt seems imminent, call a local crisis center, dial 911, or take the person to an emergency room. Do not, under any circumstances, leave a suicidal person alone.

It's also wise to remove guns, drugs, knives, and other potentially lethal objects from the vicinity. In some cases, involuntary hospitalization may be necessary to keep the person safe and prevent a suicide attempt.

Suicide prevention tip #3: Offer help and support

If a friend or family member is suicidal, the best way to help is by offering an empathetic, listening ear. Let your loved one know that he or she is not alone and that you care. Don't take responsibility, however, for making your loved one well. You can offer support, but you can't get better for a suicidal person. He or she has to make a personal commitment to recovery.

As you're helping a suicidal person, don't forget to take care of yourself. Find someone that you trust—a friend, family member, clergyman, or counselor—to talk to about your feelings and get support of your own.

Helping a suicidal person:

• Listen without judgment — Let a suicidal person express his or her feelings and accept those feelings without judging or discounting them. Don't act shocked, lecture on the value of life, or say that suicide is wrong.

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• Offer hope — Reassure the person that help is available and that the suicidal feelings are temporary. Don't dismiss the pain he or she feels, but talk about the alternatives to suicide and let the person know that his or her life is important to you.

• Don't promise confidentiality — Refuse to be sworn to secrecy. A life is at stake and you may need to speak to a mental health professional in order to keep the suicidal person safe. If you promise to keep your discussions secret, you may have to break your word.

• Get professional help — Do everything in your power to get a suicidal person the help he or she needs. Call a crisis line for advice and referrals. Encourage the person to see a mental health professional, help locate a treatment facility, or take them to a doctor's appointment.

• Make a plan for life — Help the person develop a "Plan for Life," a set of steps he or she promises to follow during a suicidal crisis. It should include contact numbers for the person's doctor or therapist, as well as friends and family members who will help in an emergency.

Risk factors for suicide

According to Health and Human Services, at least 90 percent of all people who commit suicide suffer from depression, alcoholism, or a combination of mental disorders. Depression in particular plays a large role in suicide. The difficulty suicidal people have imagining a solution to their suffering is due in part to the distorted thinking caused by depression.

Antidepressants and Suicide

Overall, the risk of suicide is lower in people taking antidepressants for depression. But for some, depression medication causes an increase—rather than a decrease—in depression and suicidal thoughts and feelings. Because of this risk, the FDA advises that anyone on antidepressants should be watched for increases in suicidal thoughts and behaviors. Monitoring is especially important if this is the person's first time on depression medication or if the dose has recently been changed. The risk of suicide is the greatest during the first two months of antidepressant treatment.

Common suicide risk factors include:

• Mental illness • Alcoholism or drug abuse • Previous suicide attempts

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• Family history of suicide • Terminal illness or chronic pain • Recent loss or stressful life event • Social isolation and loneliness • History of trauma or abuse

Suicide in teens and older adults

In addition to the general risk factors for suicide, both teenagers and older adults are at a higher risk of suicide.

Suicide in Teens

Teenage suicide is a serious and growing problem. The teenage years can be emotionally turbulent and stressful. Teenagers face pressures to succeed and fit in. They may struggle with self-esteem issues, self-doubt, and feelings of alienation. For some, this leads to suicide. Depression is also a major risk factor for teen suicide.

Other risk factors for teenage suicide include:

• Childhood abuse • Recent traumatic event • Lack of a support network

• Availability of a gun • Hostile social or school environment • Exposure to other teen suicides

Suicide in the Elderly

The highest suicide rates of any age group occur among persons aged 65 years and older. One contributing factor is depression in the elderly that is undiagnosed and untreated.

Other risk factors for suicide in the elderly include:

• Recent death of a loved one • Physical illness, disability, or pain • Isolation and loneliness

• Major life changes, such as retirement

• Loss of independence • Loss of sense of purpose

Prevent a suicide attempt •If you are concerned that someone may be suicidal, take action. If possible, talk with the person directly. The single-most important thing you can do is listen attentively without judgment.

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•Talking about suicide can only decrease the likelihood that someone will act on suicidal feelings. There is almost no risk that raising the topic with someone who is not considering suicide will prompt him/her to do it. •Find a safe place to talk with the person, and allow as much time as necessary. Assure him/her of your concern and your respect for his/her privacy. Ask the person about recent events, and encourage him/her to express his/her feelings freely. Do not minimize the feelings involved. •Ask whether the person feels desperate enough to consider suicide. If the answer is yes, ask, "Do you have a plan? How and where do you intend to kill yourself?" •Admit your own concern and fear if the person tells you that he/she is thinking about suicide but do not react by saying, 'You shouldn't be having these thoughts; things can't be that bad." Remember, you are being trusted with someone's deepest feelings. Although it may upset you, talking about those feeling will bring the person relief. •Ask if there is anything you can do. Talk about resources that can be drawn on (family, friends, community agencies, crisis centers’) to provide support, practical assistance, counseling or treatment. •Make a plan with the person for the next few hours or days. Make contacts with him/her or on his/her behalf. If possible, go with the person to get help. •Let the person know when you can be available, and then make sure you are available at those times. Also, make sure your limits are known, and try to arrange that there is always someone that he/she can call at any time of day. •Ask who else knows about the suicidal feelings. Are there other people who should know? Is the person willing to tell them? Unfortunately, not everyone will treat this issue sensitively. Confidentiality is important, but do not keep the situation secret if a life is clearly in danger. •Stay in touch to see how he/she is doing. Praise the person for having the courage to trust you and for continuing to live and struggle. What to do following a suicide attempt •A person may try to commit suicide without warning or despite efforts to help. If you are involved in giving first aid, make every effort to be calm and reassuring, and get medical help immediately.

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•The time following an attempt is critical. The person should receive intensive care during this time. Maintain regular contact, and work with the person to organize support. It is vital that he/she does not feel cut off or shunned as a result of attempting suicide. •Be aware that, if someone is intent on dying, you may not be able to stop it from happening. You cannot and should not carry the responsibility for someone else's choice. What can you do if you are feeling suicidal? •The beginning of the way out is to let someone else in. This is very hard to do because, if you feel so desperate that suicide seems to be the only solution, you are likely very frightened and ashamed. There is no reason to be ashamed of feeling suicidal and no reason to feel ashamed for seeking help. You are not alone; many people have felt suicidal when facing difficult times and have survived, usually returning to quite normal lives. •Take the risk of telling your feelings to someone you know and trust: a relative, friend, social service worker, or a member of the clergy for your religion. There are many ways to cope and get support. The sense of desperation and the wish to die will not go away at once, but it will pass. Regaining your will to live is more important than anything else at the moment. Some things that you can do are: •call a crisis telephone support line, •draw on the support of family and friends, •talk to your family doctor; he/she can refer you to services in the community, including counselling and hospital services, •set up frequent appointments with a mental health professional, and request telephone support between appointments, · get involved in self-help groups, •talk every day to at least one person you trust about how you are feeling, •think about seeking help from the emergency department of a local hospital, •talk to someone who has 'been there" about what it was like and how he/she coped, •avoid making major decisions which you may later regret. Do you need more help? •If you or someone you know is feeling suicidal and you need more information about resources in your area, contact a community organization, such as the Canadian Mental Health Association, which can help you find additional support.

Life may not be the party we hoped for, but while we are here we might as well dance