Wisconsin Public Psychiatry Network Teleconference

(WPPNT)

• This teleconference is brought to you by the Wisconsin Department

of Health Services (DHS), Division of Care and Treatment Services,

Bureau of Prevention Treatment and Recovery and the University of

Wisconsin-Madison, Department of Psychiatry.

• Use of information contained in this presentation may require

express authority from a third party.

• 2020, Rachel Dyer, Reproduced with permission.

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https://www.dhs.wisconsin.gov/wppnt/2020.htm. Complete the

evaluation to receive the CEH.

Recognize, Respond, Refer

supporting mental health and preventing suicide

Rachel Dyer, M.S.

she, her, hers

rldyer@wisc.edu

To keep in mind…

There is a wide array of jobs and roles represented on

this call. Rather than trying to meet each of your

specific needs, I am going to speak generally about

these skills. Because, regardless of what we do for

work, we are people first and foremost. And we can

use these skills anywhere!

Foundations

Key Terms

•Suicide: death caused by self-directed, injury-causing

behavior that was intended to cause death

•Suicidal Ideation: thinking about, considering, or

planning for suicide

•Suicide Attempt: self-directed, injury-causing behavior

that was intended to cause death, but may or may not

have been fatal

Key Terms, continued

•Self-Injury: self-directed behavior intended to cause

injury, but not death

•Survivor of Suicide Loss: someone who has

experienced the death of another person by suicide

Stigma

When we view another person in a negative way because of certain

personal traits they have, behaviors they engage in, or experiences

they have had.

• Self-directed, interpersonal, and societal

• We have the power to reduce stigma!

Language

Which of these two statements is more likely to

reduce stigma?

Died by suicide

Committed suicide

Which of these two statements is more likely to

reduce stigma?

Died by suicide

Committed suicide

Which of these two statements is more likely to

reduce stigma?

They threatened suicide.

They said they were thinking about suicide.

Which of these two statements is more likely to

reduce stigma?

They threatened suicide.

They said they were thinking about suicide.

Recognize

Warning Signs

• Change in mood

• Swollen, red or glassy eyes

• Change in personal hygiene• Isolating

• Lowered self-worth or confidence

• Change in sleep

• Out-of-character behavior

• Not showing up for responsibilities

• Relationship difficulties

• Referencing suicide

• Context- and person-

dependent (e.g. pandemic!)

• Be curious; don’t make

assumptions (we will get to

this in Respond)

• Balance trusting your gut

with acknowledging your

lens

Respond

Things to Avoid (Generally)

Minimize

• “Try not to worry about it.”

• “That doesn’t sound so bad!”

• “I know how you feel.”

• “You’re so strong – you can get through this!”

Asking Leading or Close-Ended Questions*

• “You don’t want to kill yourself, do you?”

What might make it challenging to Respond?

Personal Barriers shy, uncertain, fearful, don’t want to be embarrassed, not sure if the situation is high risk

Relationship Barriers don’t want to upset anyone, don’t want to be intrusive

General Barriers there are a lot of other people who can do something, I don’t want to make a scene, if no one else is concerned then it isn’t a big deal

Stigma

Respond

1. Remember that you are not alone.

• Talk to your colleagues (if possible)

• Ask a help line or crisis line

“Have you also recognized warning signs in this person?”

“Are the things that I’m recognizing actually warning signs?”

“How should I go about checking in with this person?”

“Do you want to check-in with them together?”

Respond

2. Check in.

• Name specific Warning Signs…

• …then check in further.

“I noticed on your social media that you seem to be drinking a lot more than usual. Can I ask how you’re doing?”

• Take different steps if there is immediate danger.

• The person may not be in distress!

Respond

3. Active Listening

• Listening with the intent to really understand what

the person is saying and how they are saying it.

Common Barriers

• Inward attention

• Interrupting

Respond

3. Active Listening

• Attend to the person

• Silence and Minimal Encouragers

• Empathic Statements

• Reflections of Content

• Reflections of Emotion

Respond

4. Ask directly about suicide• Reduces stigma• Opens conversation• Supports effective Referral

“Given everything that you shared with me, I am wondering if you are thinking about suicide. Has that come up for you recently?”“Sometimes, when people have been feeling the way that you have, they will think about suicide. Have you thought about suicide?”

Refer

Refer

A collaborative and ongoing process of determining

what resources will be most useful for the person, and

connecting them to those resources.

Transitioning from Responding to Referring

• Continue to use Active Listening skills

• Depending on your role, skillset, and the person’s response, consider asking more specific questions (i.e. “risk assessment”)

Ideation

Plan

Means

Intent

“Are you thinking about suicide?”

No Ideation

Ideation

Immediate Danger

No Ideation

• Avoid showing relief

• Continue to use Active Listening skills

Ideation

• Check in with yourself

• Continue to use Active Listening skills

• Ask more (“risk assessment”) or pull someone else

in so that they can ask more.

No Ideation and Ideation Referrals

Help lines

• Speak with a trained crisis worker

• You can also use help lines while supporting someone else

Look things up with them – you don’t have to have every answer committed to memory!

We are come from diverse roles and locations across the state. What other ideas do you have for referrals?

Disinterest in Referral

No Ideation

Ideation

Immediate Danger

They might not be interested in any Referrals – and that is OKAY.

“Am I uncomfortable because this is a stressful situation and I want to

make myself feel better, or am I uncomfortable because I think that

this person could use additional support?”

Immediate Danger

• Don’t panic

• Continue to use Active Listening skills

• Ask more (“risk assessment”) or pull someone else in so that they can ask more.

• As you are able, collaborate on what to do next.

This will, again, look different depending on our role and location. What ideas or questions do you have here?

Check In Again

No Ideation

Ideation

Immediate Danger

Reference previous

events…

…Ask permission to

check in again

“I know last time we talked, you were planning to talk to your

partner about how you were feeling. Can I ask how that went?”

How does Recognize, Respond, Refer change when

we are online and not in-person?

• Continue to be thoughtful about your language

• There may be different things you are able to Recognize.

• Don’t let the ability to type things out and the desire to find the “best” language deter you from ultimately Responding.

• What ideas do you have?

Resources

National

• Crisis Text Line: Text HOME to

741741

• Suicide Prevention Lifeline: 1-800-

273-8225 (press 1 for Veteran’s

Line)

• Trevor Project (LGBTQ+ young

people): 1-866-488-7386

• Trans Lifeline: 877-565-8860

*Take a look at their websites, too!

State-based and Local

• Depends on where you are based,

who the person is, and what kind of

support they are looking for.

• You might also refer someone to a

resource that is not specific to suicide

prevention (e.g. Dane County Rape

Crisis Center) or that is not a helpline

(e.g. mobile apps)

• Look things up together!

Questions?

Recognize, Respond, Refer

supporting mental health and preventing suicide

Rachel Dyer, M.S.

she, her, hers

rldyer@wisc.edu