An American Epidemic: An American Epidemic:

Practical and Clinical Practical and Clinical

Considerations of SuicideConsiderations of Suicide

A word of caution…A word of caution…

• I consider this topic to be the most I consider this topic to be the most important of the semester. That important of the semester. That being said, it can be a sensitive topic being said, it can be a sensitive topic and you should not feel obligated to and you should not feel obligated to remain in class if you are remain in class if you are uncomfortable.uncomfortable.

Activity Time!Activity Time!

• Take out a piece of paper and answer “True” or Take out a piece of paper and answer “True” or “False” for the following statements“False” for the following statements

• 1. Suicide is less common than murder.1. Suicide is less common than murder.• 2. We should be gentle or tentative when 2. We should be gentle or tentative when

approaching someone we think may be suicidal.approaching someone we think may be suicidal.• 3. Once someone is intent on committing 3. Once someone is intent on committing

suicide, there is no way to stop them.suicide, there is no way to stop them.• 4. Psychologists and psychiatrists are the only 4. Psychologists and psychiatrists are the only

people who can help someone who is suicidal.people who can help someone who is suicidal.• 5. Suicidal people are only seeking attention.5. Suicidal people are only seeking attention.• 6. Depression causes all suicides.6. Depression causes all suicides.

Stats and FactsStats and Facts

1.1. 77thth or 8 or 8thth leading cause of death overall in the leading cause of death overall in the last decade last decade

2.2. 22ndnd or 3 or 3rdrd leading cause of death for leading cause of death for adolescents and young adultsadolescents and young adults

3.3. Most prevalent in adolescents and older Most prevalent in adolescents and older adultsadults

4.4. Twice as common in college students than Twice as common in college students than non-college counterpartsnon-college counterparts

5.5. Accounts for about 30-33,000 deaths Accounts for about 30-33,000 deaths annuallyannually

6.6. Women more likely to attempt, men more Women more likely to attempt, men more likely to completelikely to complete

7.7. Suicidal thoughts and attempts difficult to Suicidal thoughts and attempts difficult to countcount

What would you do?What would you do?

• Fred is a loved one who has made Fred is a loved one who has made references to death and disappearing references to death and disappearing of late. You also notice he exhibits of late. You also notice he exhibits signs of depression. signs of depression.

• 1. How would you handle this 1. How would you handle this situation?situation?

• 2. What if he had a plan?2. What if he had a plan?

Risk Factors/CausesRisk Factors/Causes

• 1. Mood disorder1. Mood disorder• 2. Gender2. Gender• 3. Negative Life Event3. Negative Life Event• 4. Neuroticism4. Neuroticism• 5. Low self-esteem5. Low self-esteem• 6. Low social support6. Low social support• 7. Personality Disorder7. Personality Disorder• **Most likely completed when mood is **Most likely completed when mood is

improvingimproving

Warning signsWarning signs

1. Talking about dying1. Talking about dying2. Recent loss2. Recent loss3. Depressive symptoms3. Depressive symptoms4. Talking about loss of control/harming self 4. Talking about loss of control/harming self

or othersor others5. Withdrawal from relationships5. Withdrawal from relationships6. Hopelessness6. Hopelessness7. Previous attempt**7. Previous attempt**8. “Finalizing behavior” (e.g., Giving things 8. “Finalizing behavior” (e.g., Giving things

away, tying up relationships, making out away, tying up relationships, making out wills)wills)

What can you do?What can you do?• 1. Educate yourself on warning signs1. Educate yourself on warning signs• 2. Be direct2. Be direct• 3. 3. NEVERNEVER leave the person alone leave the person alone• 4. Assess immediacy of threat – plan and 4. Assess immediacy of threat – plan and

means? Remove if neededmeans? Remove if needed• 5. GET HELP!!!5. GET HELP!!!

– University Counseling CenterUniversity Counseling Center• 348-3863348-3863

– University Psychological ClinicUniversity Psychological Clinic• 348-5000348-5000

– 1-800-273-TALK1-800-273-TALK– UAPD UAPD

• 348-5454348-5454– DIAL 911 DIAL 911

So, we’ve reviewed the So, we’ve reviewed the practical issues concerning practical issues concerning suicide…suicide…• Let’s chat about the controversies…Let’s chat about the controversies…

Thomas Szasz and the Thomas Szasz and the (Im)morality of suicide (Im)morality of suicide

• Argues that suicide Argues that suicide prevention is:prevention is:

• Immoral Immoral

• ImpracticalImpractical

• Can treat Can treat underlying underlying conditionsconditions

• What do you think?What do you think?

Physician-Assisted SuicidePhysician-Assisted Suicide

• Jack Kevorkian Jack Kevorkian assisted in roughly assisted in roughly 100 assisted suicides100 assisted suicides

• Created machine to Created machine to induce induce unconsciousness and unconsciousness and deliver a lethal dose deliver a lethal dose of potassium of potassium chloridechloride

The Death and Dignity ActThe Death and Dignity Act

• Oregon was the first Oregon was the first state to make assisted state to make assisted suicide legal in 1994 suicide legal in 1994

• Act requires 2 Act requires 2 physicians to clear:physicians to clear:

• A. less then 6 months A. less then 6 months to liveto live

• B. not suffering from B. not suffering from mental illnessmental illness

Medical stance on Medical stance on assisted suicideassisted suicide

• AMA is against AMA is against assisted suicide.assisted suicide.

• However, BMA However, BMA surveys show surveys show interesting results!interesting results!

Let’s debate! Let’s debate!

• What are the pros and cons of What are the pros and cons of assisted suicide?assisted suicide?

Suicide from the clinician’s Suicide from the clinician’s perspectiveperspective

• Basic Terms:Basic Terms:

• 1. Deliberate self-harm without intent1. Deliberate self-harm without intent

• 2. Suicide attempt2. Suicide attempt

• 3. Risk and protective factors3. Risk and protective factors

• 4. Self injurious behavior4. Self injurious behavior

• 5. Suicidal ideation5. Suicidal ideation– Active vs. passiveActive vs. passive

Steps in a typical suicide risk Steps in a typical suicide risk assessmentassessment• Question: Imminent risk of death vs. non-fatal Question: Imminent risk of death vs. non-fatal

attempts?attempts?• 1. Allow person to discuss their problem for 5-1. Allow person to discuss their problem for 5-

10 minutes10 minutes• 2. Assess negative psychological effects of 2. Assess negative psychological effects of

problem (e.g., hopeless, depressed)problem (e.g., hopeless, depressed)• 3. Assess thoughts of suicide uninterrupted 3. Assess thoughts of suicide uninterrupted

thoughts at the momentthoughts at the moment• 4. Assess thoughts of death- active or 4. Assess thoughts of death- active or

passive?passive?• 5. Ask about carrying out plan/taking other 5. Ask about carrying out plan/taking other

with them with them

Considerations in risk Considerations in risk assessmentassessment

• Validate feelings, but convey optionsValidate feelings, but convey options

• Risk and protective factors approachRisk and protective factors approach– See handoutSee handout

• Low, Medium, High RiskLow, Medium, High Risk– No clear cut offNo clear cut off– Clinical judgmentClinical judgment

Activity Time: Forming a Risk Activity Time: Forming a Risk Prediction and Action PlanPrediction and Action Plan• Dr. Phil is out of the office Dr. Phil is out of the office

because he was arrested because he was arrested for stupidityfor stupidity

• Help him out by pairing up Help him out by pairing up and using the risk and and using the risk and protective factors sheet to: protective factors sheet to:

• A. Make a suicide risk A. Make a suicide risk judgment about the judgment about the following casefollowing case

• B. Based on your B. Based on your judgment, propose ideas judgment, propose ideas for immediate treatmentfor immediate treatment

• We’ll discuss!We’ll discuss!

Poor Bucky…Poor Bucky…• Bucky is a 22 year-old male graduate student who Bucky is a 22 year-old male graduate student who

came to see you complaining of active suicidal came to see you complaining of active suicidal thoughts, depression, excessive alcohol use, and thoughts, depression, excessive alcohol use, and talking of using his father’s rifle. He has never talking of using his father’s rifle. He has never attempted suicide, but has a long history of suicidal attempted suicide, but has a long history of suicidal thoughts and psychiatric treatment. A comprehensive thoughts and psychiatric treatment. A comprehensive evaluation of his background showed he recently lost evaluation of his background showed he recently lost his best friend in a car accident, has an uncle who his best friend in a car accident, has an uncle who committed suicide, and he suffered physical abuse as committed suicide, and he suffered physical abuse as a child. Bucky noted feeling guilty because suicide a child. Bucky noted feeling guilty because suicide goes against his strong family ties and devout goes against his strong family ties and devout religiosity. Bucky noted having 5 or 6 close friends, religiosity. Bucky noted having 5 or 6 close friends, but has withdrawn from them. He has discussed plans but has withdrawn from them. He has discussed plans for the upcoming week in which he will take part in a for the upcoming week in which he will take part in a university concert. Bucky ends the session by telling university concert. Bucky ends the session by telling you he wants to feel better, but does not know what you he wants to feel better, but does not know what to do.to do.

• Assign Bucky a risk levelAssign Bucky a risk level• Generate some ideas for treatmentGenerate some ideas for treatment

Immediate treatment Immediate treatment options/considerationsoptions/considerations• Involving family/friendsInvolving family/friends

– Confidentiality considerationsConfidentiality considerations– Support systemSupport system

• Medication evaluationMedication evaluation

• Inpatient or outpatient therapyInpatient or outpatient therapy

• Crisis Response Plan vs. “No suicide contract”Crisis Response Plan vs. “No suicide contract”

• HospitalizationHospitalization– Duty to protectDuty to protect