Is your organization ready if a someone kills

themselves?Presented by:

Melissa Witmeier, Project Coordinator

The Pillars of Postvention for Suicide Events

Funding for this presentation was made possible (in part) by grant number U79 SM060427-01 from SAMHSA. The views expressed in presentation materials do not necessarily reflect the views, opinions, or policies of CMHS, SAMHSA, or HHS; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

FLORIDA YOUTH SUICIDE PREVENTION PROJECT TEAM

Yesterday, 17 year old Sarah Smith, a client of a XYZ Behavioral Health Center for 6 months, watched a video about bullying in her health education class.

During school, Sarah texted a friend that she often thought about harming herself. That afternoon, the friend told the guidance counselor about the text, and the school resource officer (SRO) made a visit to her home. Sarah said she was just venting to a friend.

At 4 pm, after the SRO left, Sarah contacted the counseling center and left a message for her counselor that she needed to see someone immediately. No one returned her call.

This morning, before school, Sarah killed herself. What happens next…

What is the agency’s role?Provide mental health/psychological first

aid to survivors

Engage community, school and family in crisis intervention

Strive to balance support for the grieving; including those that worked with deceased

Help family members with practical matters

Review clinical files

Contact the legal department

What is the school’s role?

Identify youth and staff that may want to address mental health concerns or suicidal feelings

Strive to balance support for the grieving

Attempt to maintain educational routines

Prevent suicide contagion; which is critical to the prevention of future suicidal behavior

Define Suicide PostventionOverview of the Pillars of PostventionUtilizing community resourcesDevelopment or implementation of

Immediate Response PlanConsiderations for implementing of the

PillarsKeys to Suicide Prevention effortsGoals for training

Training Outline

Survivor/BereavedPerson who has lost someone

BereavementProcess of adjusting to a loss (such as death by suicide)

GriefPhysical, emotional, cognitive and spiritual response to actual or threatened loss of a person

Definition of Suicide Postvention

Providing crisis intervention, support, and assistance for survivors of a suicide event

*Requires effective planning

Responses to suicide and attempts to cope vary among family, friends, staff, faculty, administration

and community

Common Reactions

Confusion and shock Sadness Helpless Nervous and frightened Aversion and avoidance Adversarial Irritation, disgusted or angry Sense of responsibility and guilt Emotional exhaustion

The Pillars of Postvention1. Crisis Response Team

2. Community Connections

3. Immediate Response Plan

4. Media Communications

5. Bereavement Support

6. Self-Care

7. Memorials

8. Long-Term Monitoring and

Suicide Prevention Training

Crisis Response Team

WHO ARE YOUR CRISIS

RESPONSE TEAM

MEMBERS?

1

Crisis Response TeamRecommended Team Members

Director of the Team

Assistant Director

Clinical Staff

Safety/Security

Quality Assurance

Finance

Administrative Support

Facilities or Grounds

1

Crisis Response Team Once identified, convenes to

develop protocol and plan for decisions and responsibilities

Responsible for determining details of protocol and implementing tasks of response plan

Established ahead of time

Identify individuals based on role, diverse skills, and emotional competency

Create linkages between staff and community partners

1

What types of responses will be made to staff, family, parents, community, and the media?

How will we address language and cultural considerations?

How do staff identify those in need of aftermath intervention?

Where will they be referred for any psychological trauma?

Who will review the adequacy of each response and make appropriate revisions in crises response plans?

What trainings are needed for staff?

How will everyone be informed about emergency and crisis procedures?

CRT Planning Process

Community Connections

Work with your community to help better meet the needs of students and staff

Involve the community in the planning process

Coordinate crisis plans

2

Identify resources and referrals Build connections and develop

partnerships Empower leadership with partners Disseminate information Refer out to agencies within the

community and at large (internet)

Steps to Working with Your Community

Utilize Community Resources

Who can help and what can they do?

Community Mental Health Centers Local Crisis Center Police Department Mayor’s Office Coroner/Medical Examiner’s Office Clergy Funeral Directors Other Schools

Immediate Response Plan

Step-by-step protocol to guide CRT

Develop in advance 3

Assess situation and choose level of response Reach out to family of deceased Determine what and how to share about

death

Phase 1: Notify CRT

Phase 2: Assessment and Decision Making

Alert CRT Director of possible situation Verify the death Notify agency or workplace leadership Activate CRT

Immediate Response Plan

Front office staff Workplaces or schools attended by family of the

deceased (siblings) Coordinate with external professionals Contact your Employee Assistance Plan

Phase 3: Notify Other Key Personnel

Immediate Response Plan

Phase 4: Notify Agency or School Community Conduct staff meeting to notify staff: provide

facts, guidance, and plans Coordinate announcements Notification of community (SPRC Guidelines)

Conduct daily CRT meetings Present updates to staff Provide guidance for talking to survivors Identify, monitor, support and/or refer Help with emotional regulation Provide support to staff, family and

community Conduct meetings to share facts and guidance

about helping survivors cope Participate and/or advise on appropriate

memorialization

Phase 5: Support Staff and Community

Immediate Response Plan

Work with media representatives Monitor reporting of the death and postvention

efforts to ensure objectivity and free of stigma Monitor social media

Phase 6: Minimize Risk of Contagion with Media

Immediate Response Plan

Phase 7: Evaluate Response

Review and evaluate the crisis intervention activities (what worked, barriers, etc.)

Make plans for follow-up actions Revise protocol based on lessons learned

Media CommunicationsDevelop partnerships Designate media

spokesperson Plan ahead for all

interviews:What are the key points to

share with a reporter?Prepare for Common

Questions:What prevention programming

does your agency/school currently have in place?

Is the agency/school prepared to handle this particular case?

What impact has the death had on the community so far?

4

Don’t sensationalize or romanticize the death by suicide

Report/show pictures of flags at half-mast Permanent public memorial such as planting a tree,

establishing a scholarship fund, or presenting a plaquePictures of the death scene should not be used

Don’t dramatize the impact of suicide through descriptions and pictures of grieving friends or family

Don’t over simplify the problem or present suicide as a means of coping with personal issues

Don’t talk about method of death by suicide

Media Guidelines: What NOT to do

• Do provide factual info • Do state concern for the victim and their family• Do acknowledge the deceased person’s problems

and struggles, as well as the positive aspects of his or her life

• Do provide information on state, local, and school resources available for suicide prevention and crisis intervention

• Do encourage news reporters to provide info that increases public awareness of risk factors, warning signs and community resources

• Do communicate to news professionals the dangers of suicide contagion and inappropriate reporting

Media Guidelines: What to do

Be prepared to manage rumorsUse social media to your advantage

Social Media

Main goals:Distribute information and resourcesMonitor commentsCollaborate with community

Bereavement Support

Suicide is unique kind of loss and disrupts normal functioning

Be aware of common survivor responses and how to address them 5

Be present

Be patient

Recognize the loss and encourage sharing

Provide a safe environment

Offer support

Recognize finality (impulsivity)

Emphasize resources

Follow up

Active Listening

Be calm and directGive accurate informationEmphasize that no one else is to

blameTalk about emotionsConvey a sense of hopeBuild coping strategiesGet students connectedGet students involved

Interaction with Grieving Survivors

Return of Bereaved Students

Communicate with the familyProvide special support and

accommodationsOffer a list of community resourcesLink survivors to support services

Return of Bereaved Survivors

What do you do about issues of depression?

Self-Care for Survivors of Suicide

Take care of yourself! Encourage your staff to ask for help Have support systems in place for

staff Develop ongoing support groups Take advantage of resources6

Self-Care ActivitiesTaking a yoga class

Walk barefoot on the hot sand at the beach

A bath at the end of the dayGoing for bike ridesWatching a movie

Cooking a meal for myself and being really present

Getting up and listening to musicJournaling

Walking with my dogsHead out for a hike in nature

Take a road trip and visit a friendPlay an instrumentGuided meditationLots of chocolate

Face-to-face conversations with peopleTaking time for slow contemplative

morning coffeeEating a fresh bagel at a local shop while

doing a crossword puzzlePlay a fun sport with friends like kickball

Not skipping sleep to get things donePlanting flowers in the garden

Scheduling time to myself every dayVolunteering in your community

Forgiveness of others so I don’t carry that stuff around

What do you do for self-care?

Memorials

Survivors often desire service to remember the deceased

Can be an important part of grieving

Inappropriate memorials can lead to negative consequences

7

Don’t treat certain deaths differently

Don’t focus on cause or manner of death

Don’t hold large student assemblies

Don’t dedicate special events to the deceased

Don’t establish permanent memorials

Memorialization “Don’t”s

Do treat all deaths alikeDo focus on attributes about the

deceasedDo offer alternatives to memorials

Hold a day of community servicePut together a team for the AFSP Out of

the Darkness WalkSponsoring a Mental Health Awareness

DayHave a Memorial Book for survivors to

write in a give to family

Memorialization “Do”s

Funeral/memorial service planning should take everyone into consideration

After hoursOff-siteSupervised alternatives

Recognize significant dates and be

prepared

Focus on education, prevention and living

GIVE THE MESSAGE OF HOPE!

Memorials: Other Considerations

Work with survivors to create a page & engage in social media memorialization appropriately

Monitor content of posts

Monitor the length of time that a memorialization page is kept active

Be aware of any other online memorials that may have been created

Online Memorials

Be aware of “copycat” behavior

Wanting to mimic the tendencies or behaviors of one who died by suicide

Changes in environment help to reduce likelihood of contagion:

Avoid glorifying the suicideAvoid excessive detailsAvoid normalizing

Suicide Contagion

Make everyone aware of risk factors

Survivors may be at-risk if they…Identify with or feel responsible for deathHad a relationship with the victimHave a history of suicidal behavior, significant stressors, or psychopathologyShow symptoms of helplessness/hopelessnessLack internal and external resources

Risk Factors for Suicide Contagion

Long Term Monitoring and Suicide Prevention Training

8

Routine re-evaluation of postvention protocolChanges in staff or structure should be reflectedImprove procedures as indicated by lessons learned during implementationModify policies or procedures as research is produced

Provide copies of protocol action steps Explain Immediate Reponses Plan

Train staff in protocol implementation

Communication policies

Policies about memorialization

Clearly specify rationale behind policies and changes

Updates to Response Plan

Follow-up with at-risk individuals This should continue for as long as necessary

After allowing time to grieve, implement a system-wide suicide prevention plan including:Identification of warning signsIdentification of risk factorsMeans reduction and gun safetyIdentification and promotion of protective factorsEncouragement of help-seeking and adaptive coping skills

Long-Term Prevention

Suicide Preventio

n

Mental HealthAgencies, Providers,

Not for Profits

Community

ERs, Physicians,

First Responders,

Schools

Students & YouthFamilies

Long-Term Prevention

Gatekeeper Training Intervention Training Peer to Peer Training Family Empowerment Community Based Services Community Coordinating

Committee

Educate about mental health issues underlying suicide and suicidal behaviors

Train on how to talk with youth about grief and coping

Inform and provide a list of available resources in the community

Practice the steps of the protocol Model and role play discussions with staff that may

be suicidalStaff may feel hesitant and unequipped to respond to concernsTraining staff techniques for responding to questions and support can increase staff confidence and boost supportiveness of the workplace climate

Training Staff and Communities

Thank you for attending today’s training!

Questions and Comments

Melissa WitmeierProject Training Coordinator

Florida Youth Suicide Prevention ProjectFlorida Council for Community Mental Health

904.657.8224