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SUICIDEPREVENTION,
INTERVENTION,POSTVENTIONAc
adem
y H
our
Amy Morgan, MSC
Mental H
ealth Training
CAUSES OFSUICIDAL THOUGHTS
RESPONDING TO SIGNSOF 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
CAUSES OFSUICIDAL THOUGHTS
Activity: Life Stressors
■ Life stressors
■ 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 longperiod of time.. The inclination is tojust DROP all the books.
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 amsorry 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 tosave this child’s life or help him stop thinking of suicideas a solution?– YES– NO
What is suicide?
■ Want pain to end
■ See no solutions
■ See no hope
Reasons for Suicide
■ Pain ■ Loss
Reasons for Suicide
■ Pain ■ Loss
■ Adults 85 years of age and older
Not going to improve Not going to improve
RESPONDING TO SIGNSOF SUICIDE
Would you know what to do?...
Prevention vs. Intervention
■ Prevention:– Staying well so you don’t have to try to recover
■ 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
PREVENTIONBefore thoughts of suicide begin
“She seemed fine.”
PreventionStay healthy & well
Prevention ■ Talking about suicide■ Untreated depression■ Giving away possessions■ Saying goodbye■ Suicide notes■ Alcohol & drugs■ Sudden calmness■ Reckless behavior■ Researching suicide methods
Look for warning signs
Prevention ■ Buying suicide materials■ Creating/updating a will■ Social withdrawal or isolation■ Talking about being a burden■ Feeling hopeless■ Preoccupation with death■ Previous suicide attempt
Look for warning signs
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 whatthey don’t wantyou to know orsee.
Interventionallows someoneto talk about theirsuicidal thoughtswithout judgment.
People hide whatthey don’t wantyou to know orsee.
Interventionallows someoneto talk about theirsuicidal thoughtswithout judgment.
What is anintervention?
Definition:
Interference so as to modify aprocess or situation
What is anintervention?
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)
ConnectingPractice….“Are you thinking about suicide?”
Phase 1:Connecting
Credit: Applied Suicide Intervention Skills Training (ASIST)
ConnectingFriend: “I’m just going to end all ofthis and fix all my problems.”
You: “ .”
Poll Question
■ What would be your immediate reaction to a friend who is sayingthey are contemplating suicide?
1. Remind them of all the good things they have going on intheir life;
2. Tell them to stop talking like that because they’re worryingyou;
3. Tell them to start telling you all the reasons they want to endtheir life;
4. I have absolutely no idea what to do.
Phase 1:Connecting
Credit: Applied Suicide Intervention Skills Training (ASIST)
ConnectingFriend: “I’m just going to end all ofthis and fix all my problems.”
You: “ .”
Phase 1:Connecting
Credit: Applied Suicide Intervention Skills Training (ASIST)
ConnectingAccept what the person issaying, without judgment, andlet them know you’re here tohelp.
Phase 1:Connecting
Credit: Applied Suicide Intervention Skills Training (ASIST)
Connecting“I can see you really seem tobe having a hard time.”“Tell me what’s bothering youthe most.”“That does sound verydifficult.”“What else?” “Tell me more.”
Phase 1:Connecting
Credit: Applied Suicide Intervention Skills Training (ASIST)
ConnectingIt’s not about you, or youropinions.Build trust.Create a sense of trust andopenness 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 havingthoughts of suicide?
?■ Review Risk
■ ARE YOU HAVING THOUGHTS OF SUICIDE?…… suicide
RISKALERT
Phase 1:Connecting
Credit: Applied Suicide Intervention Skills Training (ASIST)
Ask questions about currentfactors that may contribute totheir suicidal thoughts.
“Do you have a plan?”
?■ Review Risk
■ ARE YOU HAVING THOUGHTS OF SUICIDE?…… suicide
RISKALERT
CURRENT FACTORS
preparedCurrent Suicide PlanHow? How prepared? How soon?…………………….
desperatePainDo you have pain that at times feels unbearable?…..
aloneResourcesDo you feel you have few, if any, resources?………...
“Do you have pain that attimes feels unbearable?”
“Do you feel you have few, ifany, resources?”
Phase 1:Connecting
Credit: Applied Suicide Intervention Skills Training (ASIST)
Ask questions about backgroundfactors that may contribute totheir suicidal thoughts.
“Have you ever attemptedsuicide before?”
?■ Review Risk
■ ARE YOU HAVING THOUGHTS OF SUICIDE?…… suicide
RISKALERT
CURRENT FACTORS
preparedCurrent Suicide PlanHow? How prepared? How soon?…………………….
desperatePainDo you have pain that at times feels unbearable?…..
aloneResourcesDo you feel you have few, if any, resources?………...
BACKGROUND FACTORS
vulnerable
+ Mental HealthAre you receiving or have you receivedmental health care?………………………………………
familiar+ Prior Suicidal BehaviorHave you ever attempted suicide before?…………….
“Are you receiving or have youreceived mental health care?”
Poll Question
■ How good of a listener do you think you are when youdisagree with what a person is telling you?
1. Terrible – I just want to stop them and correct them;2. Average – I can keep from interrupting, but not
necessarily take in what they’re saying.3. Amazing – I love to listen to what other people have to
say, even if I don’t agree with what they’re telling me.
Phase 2:Understanding
Credit: Applied Suicide Intervention Skills Training (ASIST)
Understanding
Ask them to tell you all about allof the stressors.
Listen without judgment oropinion, and without trying toturn them to more positivethinking.
Poll Question
■ You’re trying to listen to your friend tell you all the thingsthat have been going wrong, and you know you can helpwith 2 he’s just mentioned. What do you do?
1. Hooray! I can fix these.. I quickly tell my friend thesolutions.
2. I make a mental note of potential resources to bring uplater.
3. I do nothing; I’m supposed to just listen.
How does aninterventionwork?
Credit: Applied Suicide Intervention Skills Training (ASIST)
Understanding
Connecting
How does aninterventionwork?
Phase 2:Understanding
Credit: Applied Suicide Intervention Skills Training (ASIST)
Understanding
Listen for cues about reasons forliving.
Listen for ambivalence.
Phase 2:Understanding
“Survivors often regret theirdecision in midair, if not before.”
“I instantly realized thateverything in my life that I’dthought was unfixable was totallyfixable – except for having justjumped.”
Who can dieby suicide?
How can THIS person bethinking of suicide?
Anyone is at risk.
What is astressor?
Remember: What isstressful to one personmay not be to another.And what you considerstressful may not be tosomeone else, and viceversa.
Caregiverattitudesmatter
The caregiver is the only one who hasclarity and focus. Those thinking ofsuicide can only focus on the thingsthat are causing them to feelhopeless.
Phase 3:Assisting
Credit: Applied Suicide Intervention Skills Training (ASIST)
Assisting
Phas
e 3:
Ass
istin
g
Credit: Applied Suicide Intervention Skills Training (ASIST)
?■ Review Risk
■ ARE YOU HAVING THOUGHTS OF SUICIDE?…… suicide
RISKALERT
CURRENT FACTORS
BACKGROUND FACTORS
preparedCurrent Suicide PlanHow? How prepared? How soon?…………………….
desperatePainDo you have pain that at times feels unbearable?…..
aloneResourcesDo you feel you have few, if any, resources?………...
vulnerable
+ Mental HealthAre you receiving or have you receivedmental health care?………………………………………
familiar+ Prior Suicidal BehaviorHave you ever attempted suicide before?…………….
++Contract Safeplan
• Safety contact(s)• Keep safe
• Safe/no use of alcohol/drugs• Link to resources
ALL SAFEPLANS
Phas
e 3:
Ass
istin
g
Credit: Applied Suicide Intervention Skills Training (ASIST)
?■ Review Risk
■ ARE YOU HAVING THOUGHTS OF SUICIDE?…… suicide
RISKALERT
CURRENT FACTORS
BACKGROUND FACTORS
preparedCurrent Suicide PlanHow? How prepared? How soon?…………………….
desperatePainDo you have pain that at times feels unbearable?…..
aloneResourcesDo you feel you have few, if any, resources?………...
vulnerable
+ Mental HealthAre you receiving or have you receivedmental health care?………………………………………
familiar+ Prior Suicidal BehaviorHave 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
advisers healthworkers
emergency
personalconnections 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
How does aninterventionwork?
Credit: Applied Suicide Intervention Skills Training (ASIST)
Connectinginvitations?suicide?
exploreask
Understandingreasons?risk?
listenreview Assisting
safeplan?commitments?
contractfollow-up
Patiently listen TO the death side ofambivalence; help the person at risk
talk about their reasons for dying
Persistently listen FOR the life sideof ambivalence; search for reasonsfor living or reinforce them when theperson 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 youcould recognize someone who is having thoughts ofsuicide, 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.
Poll Question■ How many of you respond to suicides as part of your job
and sometimes talk with the family & friends leftbehind?
1. I respond to suicides and talk with family & friends;2. I respond to suicides but do not talk with the family &
friends;3. I do not respond to suicides.
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 tofuture thoughts of suicide
Resources■ Offer resources for the family members
■ 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?
Applied Suicide Intervention Skills Training (2-day)https://www.livingworks.net/programs/asist/
THANK YOU!Amy Morgan, MSC
Academy Houremail: [email protected]
Phone: 405-326-4116
www.AcademyHour.com
SUICIDE PREVENTION,INTERVENTION,POSTVENTION
Acad
emy
Hou
r
Amy Morgan, MSC
Mental H
ealth Training
2017
Suicide is the 10th leading cause ofdeath in the U.S….
2015 statistics
SUICIDE PREVENTION,INTERVENTION,POSTVENTION
Acad
emy
Hou
r
Amy Morgan, MSC
Mental H
ealth Training
2017
Each year 44,193 Americans die bysuicide…
2015 statistics
SUICIDE PREVENTION,INTERVENTION,POSTVENTION
Acad
emy
Hou
r
Amy Morgan, MSC
Mental H
ealth Training
2017
On average there are 121 suicidesevery day…
2015 statistics
SUICIDE PREVENTION,INTERVENTION,POSTVENTION
Acad
emy
Hou
r
Amy Morgan, MSC
Mental H
ealth Training
2017
Firearms as a method account foralmost 50% of all suicides…
2015 statistics
SUICIDE PREVENTION,INTERVENTION,POSTVENTION
Acad
emy
Hou
r
Amy Morgan, MSC
Mental H
ealth Training
2017
White males accounted for 7 of 10suicides in 2015…
2015 statistics
SUICIDE PREVENTION,INTERVENTION,POSTVENTION
Acad
emy
Hou
r
Amy Morgan, MSC
Mental H
ealth Training
2017
Over 1 million people die by suicide,worldwide, each year…
2015 statistics
SUICIDE PREVENTION,INTERVENTION,POSTVENTION
Acad
emy
Hou
r
Amy Morgan, MSC
Mental H
ealth Training
2017
75% of global suicide occurred in low-and middle-income countries in 2012.