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Maine Suicide Prevention Program
Before you begin:This PowerPoint contains 2 slides that focus on risk and protective factors for specific populations that may not apply to those represented in your school
(slides 21 and 22). The intent is that you choose the slides from this section that are of the greatest import to the community you are training in. You can even
consider adding another population to focus on. For example, the “ suicide in the young” focus would be good for elementary and middle school, but not high
school. The other slides would simply be “hidden” for the presentation and could be used at another time when appropriate. Please leave the slide on LGBTQ
youth in the presentation.If you are looking for additional information on specific populations please feel
free to contact:Heather Carter, Sr. Trainer, [email protected]
Maine Suicide Prevention Program
Suicide Prevention Awareness Session: YouthMaine Suicide Prevention Program
Education, Resources and Support—It’s Up to All of Us.
Maine Suicide Prevention Program
• Beliefs about suicide• How to talk about suicide• The facts• Warning signs and risk factors• Basic intervention skills to use with suicidal behavior• Resources for Help• The aftermath of suicidal behavior
Today’s Program Will Cover
Maine Suicide Prevention Program Looking at the Myths vs. Facts:
True or False. . .
• Talking openly about suicide will cause it.• Anyone can learn to help someone who is struggling with thoughts
of suicide.• If someone decides that they want to take their own life, there’s
nothing we can do to stop them.• If someone talks about it they don’t need to be taken seriously.• There are signs that we can look for that may indicate someone is
considering suicide.
Maine Suicide Prevention Program Our Words Reflect Our Beliefs
Preferred:Simply use:
• “suicide”• “died by/of suicide”• “suicide attempt”
Maine Suicide Prevention Program
Facts About Suicide in US, 2012• 40,600 Americans died by suicide; about 1 person every 13.0 minutes• Suicide deaths are twice the number of homicides nationally
(homicides=16,688)• 10th leading cause of death across the lifespan
• 2nd leading cause of death for 15-24 year olds• Men account for 78.5% suicides in the US
• 3 Female attempts per male attempt• Veterans account for 20% of suicides in the US• Since 2009, suicides have exceeded motor vehicle crash related deaths
6
Annual Age-Adjusted Suicide Rates: Maine, the Northeast and United States, 2000-2012
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011* 2012*0
5
10
15
20
25
Maine Northeast U.S.
Year
Age
-Adj
uste
d Su
icid
e D
eath
Rat
e (p
er 1
00,0
00 p
opul
ation
)
Source: Maine Suicide Prevention Program,Maine Research, Data & Vital Statistics, WISQARS *2011 and 2012 Maine data are preliminary
Maine Suicide Prevention Program
• The leading cause of injury death• 2nd leading cause of death ages 15-34• Suicide deaths 8x homicide deaths• Every 1.8 days someone dies by suicide• Every 2 weeks a young person dies (<25)• 201 suicide deaths per year on average• Of every 5 suicides, 4 are males • Females attempt suicide 3x as often as males • A firearm is the most prevalent method of suicide (53%)
Suicide in Maine, 2008-2012
Maine Suicide Prevention Program
85+
Attempted Suicides Suicide
Young
100-200:1
75+
4:1
Attempted Suicide & Age
MIYHS self-reported data 2013: High School Students
Total Female Male Hispanic Native American Lesbian Gay Bisexual0
10
20
30
40
50
60
70
80
17.9
11.8
24.125.8
29.7
34
67.4
58.4
Self injurious behaviors
Maine Suicide Prevention Program Definitions
Warning Signs- the earliest observable signs that indicate increased risk of suicide for an individual in the near-term (within hours or days).
Risk Factors- long standing conditions, stressful events or situations that may increase the likelihood of a suicide attempt or death (statistically significant).
Protective Factors- the positive conditions, personal and social resources that promote resiliency and reduce the potential of suicide and other high-risk behaviors.
Maine Suicide Prevention Program
Warning Signs Immediate Risk!
Overt & acute signs of a suicidal crisis:• Someone threatening to hurt or kill themselves• Someone looking for the means (gun, pills, rope etc.) to kill themself• Someone expressing high level of emotional distress• Preoccupation with death and dying
Respond:• Get the Facts & Take Action to ensure safety• Call 911 or seek other immediate professional help when you hear, say or
see any of these behaviors
Maine Suicide Prevention Program
I Ideation / threatened or communicatedS Substance abuse / excessive or increased? P Purposelessness / no reasons for living A Anxiety /agitation / insomniaT Trapped / feeling no way outH Hopelessness / nothing will ever change W Withdrawal from friends, family, societyA Anger (uncontrolled)/ rage / seeking revengeR Recklessness/ risky acts / unthinkingM Mood changes (dramatic)
Warning Signs
Maine Suicide Prevention Program
Adolescent Warning Signs for Suicide
Is the youth (up to 19 y.o.) :• Talking about or making plans for suicide• Expressing hopelessness about the future• Displaying severe/overwhelming emotional pain or distress• Showing worrisome behavior or changes particularly in the presence of the
above warning signs. • Specifically:
• Withdrawal from or changes in social connections• Recent increased agitation or irritability• Anger or hostility that seems out of character or context• Changes in sleep (increased or decreased
From an AAS Consensus group, 2014
Maine Suicide Prevention Program Keep your eyes and ears open:
Direct clues:• I wish I were dead
• I’m going to end it all
• I’m going to kill myself
Less Direct clues:• Life’s just too hard
• You’d be better off without me
• What’s the point?
Maine Suicide Prevention Program Risk Factors for Suicide
Risk factors are found in different domains• Family risk factors• Personal/behavioral risk factors• Environmental/social risk factors
Risk factors have different conditions• Some are unchangeable (perpetuating)• Some are of serious concern (predisposing)• Some are acute (precipitating)
Risk Factors PERPETUATING CONDITIONS(Unchangeable)
PREDISPOSING CONDITIONS(of Serious Concern)
PRECIPITATING CONDITIONS(Acute)
FAMILY Family history of suicide, mental illness, substance abuseRaceGender
Unrealistic parental expectationsAbuse (emotional, physical, sexual)
Major family conflictExposure to suicide of family memberAnniversary of deathMoving often
PERSONALBEHAVIORAL
Loss through death, abandonment, divorce
Previous suicide attemptMental illnessSubstance abuseExtreme PerfectionismPoor coping/social skillsImpulsive
Current acute Mental IllnessSevere stress/anxietyIsolationRejectionRelationship break-upIncreased use of substances
ENVIRONMENTALSOCIAL
Inconsistent, neglectful or abusive parenting Sexual orientation Gender identity
Experience of repeated lossChronic severe stressOngoing harassment
Active suicide cluster in communityAccess to lethal meansBullying, harassmentLoss of freedom (e.g., incarceration)
Maine Suicide Prevention Program
LGBTQ Youth/Young Adults
• Suicide attempt rates 3-4 times their peers• Increase due to societal stigma and rejection • Critical risk factors include rejection, depression, anxiety, chronic
stress, abuse, victimization, bullying, etc…• Rejection by family can increase risk up to 8X• Family acceptance and school safety are strong protective factors• Cultural competence is important in prevention
Maine Suicide Prevention Program Suicide in the Young ( under 14 y.o.)
Warning Signs (very similar to previous list):
• Change in usual behavior• Risky behavior• Talk of intent to die• Self harm (may be seen as
recurrent “accidents”)• Verbal clues of suicidal thoughts
Risk Factors:• More than one mental health
diagnosis & untreated MH concerns • Early trauma or stressful events• Negative school experience (bullying)• Loss of early primary attachments
(death, placement in foster care etc.)• Internalizing vs. externalizing
Maine Suicide Prevention Program Native American youth
Risk:• Of youth and young adults (15-24)
NA/AI highest risk • Cultural distress, acculturation • Historical trauma, boarding
schools• Family disruption, violence, abuse• Substance abuse• Discrimination-perceived and real
Protection:• Trauma informed prevention• Culturally informed prevention• Family and community
connections• Spiritual connection &
ceremony• Strong cultural identity
Maine Suicide Prevention Program
• Skills to think, communicate, solve problems, manage anger and other negative emotions,
• Purpose & value in life; hope for the future, pets, work/ life focus
• Personal characteristics- health, positive outlook, healthy choices, spirituality or religious belief
• Supports- parents, friends, mentors, teachers and other caring adults
• Safe Environment – restricted access to lethal means
Protective Factors
Maine Suicide Prevention Program
From a Suicidal Person’s Point of View• Crisis point has been reached• Pain is unbearable• Solutions to problems seem unavailable• Thinking is affected
HOWEVER:• Ambivalence exists• Communicating distress is common• Invitations to help are often extended
Invitations to Help
PHYSICAL
“All of my problems will end soon”“I just can’t take it anymore”
“I wish I were dead”“You’ll be better off without me”
“I can’t do anything right”
Giving away possessions Withdrawal Abuse/use of substances Reckless behavior Extreme mood swings Increased impulsivity Self-injury (maybe)
Lack of interest in appearanceChanges in appetite, weightChange in sleep patterns
THOUGHTS
ACTIONS
DesperateAngryGuiltyWorthless
WorthlessLonelySadHopeless
FEELINGS
Maine Suicide Prevention Program
• Unwilling to admit needing help• Afraid to upset/anger others• Unable describe their feelings/needs• Unsure of available help or resources• Struggling with symptoms of depression• Don’t know what to expect • Shame, fear of stigma• May prefer to confide in peers
Why people hesitate to ask for help
Maine Suicide Prevention Program
Why People Hesitate to Help
• Not sure about how severe the risk is-what if they’re wrong?
• Worry about doing/saying the “right” thing• Feelings of inadequacy• Afraid to put the idea in someone’s head• Feel it’s not “their issue”• Bystander Effect
Maine Suicide Prevention Program
Ignoring or dismissing the issue“You think you have problems, well let me tell you…”
Acting shocked or embarrassed“Oh, I’m not sure I’m the best person to talk to about this…”
Challenging, debating or bargaining“You think things are bad now, try to kill yourself and then see how things are!”
Minimizing the distress“This is nothing, you just need to relax more.”
What is NOT Helpful
Maine Suicide Prevention Program
1) Show You Care—Listen carefully—Be genuine
“I’m concerned about you . . . about how you feel.”
2) Ask the Question—Be direct, caring and non-confrontational
“Are you thinking about suicide?”
3) Get Help—Do not leave him/her alone
“You’re not alone. Let me help you.”
What IS Helpful
Maine Suicide Prevention Program
Practice Helpful Steps!Open handout… • Think up & write 1 or 2 phrases or ways that YOU would use
to “show you care.”• Write two other ways you might “ask the question” about
suicide.• List two ways you would assist someone to “get help” and
name 2 resources.
Maine Suicide Prevention Program
School Resources (examples)• School Counselor• School-Based Health Centers/Nurse• Crisis Team Members• Administration• School Resource Officer • Who else…?
Maine Suicide Prevention Program
When to Call Crisis 1-888-568-1112
• Crisis clinicians are: • Available 24 / 7• Clinicians can often come to your location for an assessment
• Call for a phone consult when you are:• Concerned about someone’s mental health• Need advice about how to help someone in distress• Worried about someone and need another opinion
• The phone call is free
Maine Suicide Prevention Program
Protocols for Addressing Suicide:
• Roles and responsibilities• How can staff become informed?• How do we respond to a suicidal crisis?• How do we access resources?• Developing a safety plan• How do we manage the aftermath of suicide?• Supporting someone’s return to school/community
Maine Suicide Prevention Program After an
Attempt or SuicideHelping Families and School Communities Through Crisis
Maine Suicide Prevention Program
• Initial focus is on safety• Work to address reduction in crisis• Safety planning for proactive response• For return to the school community:
o Who is the support persono What do other people need to knowo Offer hope and supporto Encourage follow-through with treatment
After a Suicide Attempt. . .
Maine Suicide Prevention Program
It is estimated that there are at least 6 survivors for a death by suicide
• Ratio implies at least 216,210 survivors each year, 1086 in Maine
A “suicide survivor” is someone who has lost a loved one to death by suicide
Suicide Survivors
Maine Suicide Prevention Program
Survivors of Suicide• Struggle to make meaning of the loss• Suffer from overwhelmingly complicated feelings• May take a long time to grieve• Need understanding and support• Youth survivors have special issues
Maine Suicide Prevention Program
How YOU can be supportive after a suicide
• Acknowledge the loss• Use the name of the deceased• Share your presence • Share a special memory/story• Acknowledge the good things• Stay in touch• Recommend Grief Support Center, grief support groups or
AFSP
Maine Suicide Prevention Program
Take Care of Yourself
• Acknowledge the intensity of your feelings
• Seek support from colleagues, de-brief
• Share your feelings with family/friends
• Avoid over – involvement
• Know that you are not responsible for another person’s choice to end their life
Maine Suicide Prevention Program
• Training Program Inquiries: MSPP [email protected] • Heather Carter, Senior Trainer [email protected] • Greg Marley, Clinical Director [email protected] • MSPP Program Coordinator: Katharyn Zwicker, 207-287-5362
MSPP Contact Information
Maine Suicide Prevention Program
Any Questions?
Maine Suicide Prevention ProgramEducation, Resources and Support
It’s Up to All of Us
Before you leave. . .
Thank you for learning about suicide prevention. . .
Maine Suicide Prevention Program
The Department of Health and Human Services (DHHS) does not discriminate on the basis of disability, race, color, creed, gender, sexual orientation, age, or national origin, in admission to, access to, or operations of its programs, services, or activities, or its hiring or employment practices. This notice is provided as required by Title II of the Americans with Disabilities Act of 1990 and in accordance with the Civil Rights Act of 1964 as amended, Section 504 of the Rehabilitation Act of 1973, as amended, the Age Discrimination Act of 1975, Title IX of the Education Amendments of 1972 and the Maine Human Rights Act and Executive Order Regarding State of Maine Contracts for Services. Questions, concerns, complaints or requests for additional information regarding the ADA may be forwarded to DHHS’ ADA Compliance/EEO Coordinators, 11 State House Station – 221 State Street, Augusta, Maine 04333, 207-287-4289 (V), 207-287-3488 (V), TTY users call Maine relay 711. Individuals who need auxiliary aids for effective communication in program and services of DHHS are invited to make their needs and preferences known to the ADA Compliance/EEO Coordinators. This notice is available in alternate formats, upon request.