SAVING LIVES: Understanding Depression And Suicide In Our Communities The Greene County Suicide Prevention Coalition Presented and Developed By Ellen Anderson,

SAVING LIVES:SAVING LIVES:Understanding Understanding

Depression And Suicide Depression And Suicide In Our CommunitiesIn Our Communities

The Greene County Suicide Prevention The Greene County Suicide Prevention CoalitionCoalition

Presented and Developed By Ellen Presented and Developed By Ellen Anderson, Ph.D., PCC, 2003-2008Anderson, Ph.D., PCC, 2003-2008

2Gatekeeper Training- Dr. Ellen

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““Still the effort seems unhurried. Still the effort seems unhurried. Every 17 minutes in America, Every 17 minutes in America,

someone commits suicide. someone commits suicide. Where is the public concern and Where is the public concern and

outrage?”outrage?”

Kay Redfield JamisonKay Redfield Jamison

Author of Author of Night Falls Fast: Night Falls Fast: Understanding SuicideUnderstanding Suicide


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Goals For Suicide Goals For Suicide PreventionPrevention

Increase community awareness that suicide Increase community awareness that suicide is a preventable public health problemis a preventable public health problem

Increase awareness that depression is the Increase awareness that depression is the primary cause of suicideprimary cause of suicide

Change public perception about the stigma Change public perception about the stigma of mental illness, especially about of mental illness, especially about depression and suicidedepression and suicide

Increase the ability of the public to Increase the ability of the public to recognize and intervene when someone recognize and intervene when someone they know is suicidalthey know is suicidal


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Prevention StrategiesPrevention Strategies

General suicide and General suicide and depression depression awareness awareness education education

Depression Depression Screening Screening programsprograms

Community Community Gatekeeper Gatekeeper TrainingsTrainings

Crisis Centers and Crisis Centers and hotlineshotlines

Peer support Peer support programsprograms

Restriction of Restriction of access to lethal access to lethal meansmeans

Intervention after Intervention after a suicidea suicide


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Suicide Is The Last Suicide Is The Last Taboo – We Don’t Want Taboo – We Don’t Want

To Talk About ItTo Talk About It Suicide has become the Last Taboo – we can talk Suicide has become the Last Taboo – we can talk

about AIDS, sex, incest, and other topics that about AIDS, sex, incest, and other topics that used to be unapproachable. We are still afraid of used to be unapproachable. We are still afraid of the “S” word the “S” word

Understanding suicide helps communities Understanding suicide helps communities become proactive rather than reactive to a become proactive rather than reactive to a suicide once it occurssuicide once it occurs

Reducing stigma about suicide and its causes Reducing stigma about suicide and its causes provides us with our best chance for saving livesprovides us with our best chance for saving lives

Ignoring suicide means we are helpless to stop itIgnoring suicide means we are helpless to stop it


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What Makes Me A What Makes Me A Gatekeeper?Gatekeeper?

Gatekeepers are not mental healthGatekeepers are not mental health professionals or doctorsprofessionals or doctors Gatekeepers are responsible adults who Gatekeepers are responsible adults who

spend time with people who might be spend time with people who might be vulnerable to depression and suicidal vulnerable to depression and suicidal thoughtsthoughts

Teachers, coaches, police officers, EMT’s, Teachers, coaches, police officers, EMT’s, Elder care workers, physicians, 4H Elder care workers, physicians, 4H leaders, Youth Group leaders, Scout leaders, Youth Group leaders, Scout masters, and members of the clergy and masters, and members of the clergy and other religious leadersother religious leaders


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Why Should I Learn Why Should I Learn About Suicide?About Suicide?

It is the 11th largest killer of Americans, and It is the 11th largest killer of Americans, and the 3the 3rdrd largest killer of youth ages 10-24 largest killer of youth ages 10-24

Up to 25% of adolescents and 15% Up to 25% of adolescents and 15%

of adults consider suicide seriously at some of adults consider suicide seriously at some

point in their livespoint in their lives No one is safe from the risk of suicide – wealth, No one is safe from the risk of suicide – wealth,

education, intact family, popularity cannot education, intact family, popularity cannot protect us from this riskprotect us from this risk

A suicide attempt is a desperate cry for help to A suicide attempt is a desperate cry for help to end excruciating, unending, overwhelming end excruciating, unending, overwhelming painpain, 1996), 1996)


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What Is Mental Illness?What Is Mental Illness?

Prior to our understanding of illness Prior to our understanding of illness caused by bacteria, most people caused by bacteria, most people thought of any illness as a spiritual thought of any illness as a spiritual failure or demon possessionfailure or demon possession

Contamination meant spiritual Contamination meant spiritual contaminationcontamination

People were frightened to be near People were frightened to be near someone with odd behavior for fear someone with odd behavior for fear of being contaminatedof being contaminated


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What do we say about someone who is What do we say about someone who is odd?odd? Looney, batty, nuts, crazy, wacko, lunatic, Looney, batty, nuts, crazy, wacko, lunatic,

insane, fruitcake, psycho, not all there, bats insane, fruitcake, psycho, not all there, bats in the belfry, gonzo, bonkers, wackadoo, in the belfry, gonzo, bonkers, wackadoo, whack jobwhack job

Why would anyone admit to having a Why would anyone admit to having a mental illness?mental illness?

So much stigma makes it very difficult So much stigma makes it very difficult for people to seek help or even for people to seek help or even acknowledge a problemacknowledge a problem


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We know that illnesses like epilepsy, We know that illnesses like epilepsy, Parkinson's and Alzheimer’s are Parkinson's and Alzheimer’s are physical illness in the brainphysical illness in the brain

Somehow, clinical depression, Somehow, clinical depression, anxiety, Bi-Polar Disorder and anxiety, Bi-Polar Disorder and Schizophrenia are not considered Schizophrenia are not considered illnesses to be treatedillnesses to be treated

We confuse brain with mindWe confuse brain with mind

Gatekeeper Training- Dr. Ellen Gatekeeper Training- Dr. Ellen AndersonAnderson 1111

The Feel of DepressionThe Feel of Depression

““I am 6 feet tall. The way I have felt I am 6 feet tall. The way I have felt these past few months, it is as these past few months, it is as though I am in a very small room, though I am in a very small room, and the room is filled with water, up and the room is filled with water, up to about 5’ 10”, and my feet are to about 5’ 10”, and my feet are glued to the floor, and its all I can do glued to the floor, and its all I can do to breathe.”to breathe.”


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8383 people complete suicide every day people complete suicide every day 32,46632,466 people in 2005 in the US people in 2005 in the US Over Over 1,000,0001,000,000 suicides worldwide suicides worldwide

(reported)(reported) This data refers to completed suicides This data refers to completed suicides

that are documented by medical that are documented by medical examiners – it is estimated that 2-3 examiners – it is estimated that 2-3 times as many actually complete suicidetimes as many actually complete suicide

(Surgeon General’s Report on Suicide, 1999)(Surgeon General’s Report on Suicide, 1999)

Is Suicide Really a Is Suicide Really a Problem?Problem?


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The Unnoticed DeathThe Unnoticed Death

For every 2 homicides, 3 people For every 2 homicides, 3 people complete suicide yearly– data complete suicide yearly– data that has been constant for 100 that has been constant for 100 yearsyears

During the Viet Nam War from During the Viet Nam War from 1964-1972, we lost 55,000 1964-1972, we lost 55,000 troops, and 220,000 people to troops, and 220,000 people to suicidesuicide


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Comparative Rates Of U.S. Suicides-Comparative Rates Of U.S. Suicides-20052005

Rates per 100,000 populationRates per 100,000 population National average - 11 per National average - 11 per

100,000*100,000* White malesWhite males - - 19.9 19.9 African-American malesAfrican-American males - 9.1 ** - 9.1 ** Hispanic males Hispanic males - 10.7 - 10.7 Asians Asians - 5.2 - 5.2 Caucasian femalesCaucasian females - 4.8 - 4.8 African American & Hispanic females - 1.5African American & Hispanic females - 1.5 Males over 85Males over 85 - - 67.667.6

Annual Attempts – 810,000 (estimated)Annual Attempts – 810,000 (estimated) 150-1 completion for the young - 4-1 for the 150-1 completion for the young - 4-1 for the

elderlyelderly (*AAS website),**(Significant increases have occurred among African (*AAS website),**(Significant increases have occurred among African

Americans in the past 10 years - Toussaint, 2002)Americans in the past 10 years - Toussaint, 2002)


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The Gender IssueThe Gender Issue Women perceived as being at higher risk than Women perceived as being at higher risk than

menmen Women do make attempts 4 x as often as menWomen do make attempts 4 x as often as men But - Men complete suicide 4 x as often as womenBut - Men complete suicide 4 x as often as women Women’s risk rises until midlife, then decreasesWomen’s risk rises until midlife, then decreases Men’s risk, always higher than women’s, Men’s risk, always higher than women’s,

continues to rise until end of lifecontinues to rise until end of life Are women more likely to seek help? Talk about Are women more likely to seek help? Talk about

feelings? Have a safety network of friends?feelings? Have a safety network of friends? Do men suffer from depression silently? Do men suffer from depression silently?


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What Factors Put What Factors Put Someone At Risk For Someone At Risk For

Suicide?Suicide? Biological, physical, social, psychological or Biological, physical, social, psychological or

spiritual factors may increase risk-for spiritual factors may increase risk-for example:example:

A family history of suicide increases risk by 6 A family history of suicide increases risk by 6 timestimes

Access to firearms – people who use firearms Access to firearms – people who use firearms in their suicide attempt are more likely to diein their suicide attempt are more likely to die

A significant loss by death, separation, A significant loss by death, separation, divorce, moving, or breaking up with a divorce, moving, or breaking up with a boyfriend or girlfriend can be a triggerboyfriend or girlfriend can be a trigger

(Goleman, 1997)(Goleman, 1997)


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Social Isolation: people may be rejected Social Isolation: people may be rejected or bullied because they are “weird”, or bullied because they are “weird”, because of sexual orientation, because of sexual orientation, or becauseor because

they are getting older andthey are getting older and

have lost their social networkhave lost their social network The 2nd biggest risk factor - having an The 2nd biggest risk factor - having an

alcohol or drug problemalcohol or drug problem Many with alcohol and drug problems are Many with alcohol and drug problems are

clinically depressed, and are self-clinically depressed, and are self-medicating for their painmedicating for their pain

(Surgeon General’s call to Action, 1999)(Surgeon General’s call to Action, 1999)


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The biggest risk factor for suicide completion? The biggest risk factor for suicide completion?

Having a Depressive IllnessHaving a Depressive Illness Someone with clinical depression often feels helpless Someone with clinical depression often feels helpless

to solve his or her problems, leading to hopelessness to solve his or her problems, leading to hopelessness – a strong predictor of suicide risk– a strong predictor of suicide risk

At some point in this chronic illness, suicide seems At some point in this chronic illness, suicide seems like the only way out of the pain and sufferinglike the only way out of the pain and suffering

Many Mental health diagnoses have a component of Many Mental health diagnoses have a component of depression: anxiety, PTSD, Bi-Polar, etcdepression: anxiety, PTSD, Bi-Polar, etc

90%90% of suicide completers have a depressive illness of suicide completers have a depressive illness (Lester, 1998, Surgeon General, 1999)(Lester, 1998, Surgeon General, 1999)

1919Gatekeeper Training- Dr. Ellen Gatekeeper Training- Dr. Ellen

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Depression Is An Depression Is An IllnessIllnessSuicide has been viewed for countless generations Suicide has been viewed for countless generations as:as: a moral failing, a spiritual weaknessa moral failing, a spiritual weakness an inability to cope with lifean inability to cope with life ““the coward’s way out”the coward’s way out” A character flawA character flaw

Our cultural view of suicide is wrong - Our cultural view of suicide is wrong - invalidated by our current understanding invalidated by our current understanding of brain chemistry and it’s interaction of brain chemistry and it’s interaction with with stress, trauma and geneticsstress, trauma and genetics on on mood and behaviormood and behavior


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The research evidence is overwhelming - The research evidence is overwhelming - depression is far more than a sad mood. It depression is far more than a sad mood. It includes:includes:

1.1. Weight gain/lossWeight gain/loss

2.2. Sleep problemsSleep problems

3.3. Sense of tiredness, exhaustionSense of tiredness, exhaustion

4.4. Sad or angry moodSad or angry mood

5.5. Loss of interest in pleasurable things, lack of Loss of interest in pleasurable things, lack of motivationmotivation

6.6. IrritabilityIrritability

7.7. Confusion, loss of concentration, poor memoryConfusion, loss of concentration, poor memory

8.8. Negative thinkingNegative thinking

9.9. Withdrawal from friends and familyWithdrawal from friends and family

10.10. Usually, suicidal thoughtsUsually, suicidal thoughts(DSMIVR, 2002)(DSMIVR, 2002)


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20 years of brain research teaches that 20 years of brain research teaches that these symptoms are the these symptoms are the behavioralbehavioral result ofresult of Changes in the physical structure Changes in the physical structure

of the brainof the brain Damage to brain cells in the Damage to brain cells in the

hippocampus, amygdala and hippocampus, amygdala and limbic systemlimbic system

As Diabetes is the result of low insulin As Diabetes is the result of low insulin production by the pancreas, depressed production by the pancreas, depressed people suffer from a physical illness – people suffer from a physical illness – what we might consider “faulty wiring”what we might consider “faulty wiring” (Braun, 2000; Surgeon General’s Call To Action, 1999,(Braun, 2000; Surgeon General’s Call To Action, 1999,

Stoff & Mann, 1997, The Neurobiology of Suicide)Stoff & Mann, 1997, The Neurobiology of Suicide)


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Faulty Wiring?Faulty Wiring?Damage to nerve cells in our brains - the result Damage to nerve cells in our brains - the result of too many stress hormones – cortisol, of too many stress hormones – cortisol, adrenaline and testosterone – the hormones adrenaline and testosterone – the hormones activated by our activated by our AAutonomic utonomic NNervous ervous SSystem to ystem to protect us in times of dangerprotect us in times of danger

Chronic stress causes changes in the Chronic stress causes changes in the functioning of the ANS, so that high levels of functioning of the ANS, so that high levels of activation occur with very little stimulusactivation occur with very little stimulus

Creates changes in muscle tension, imbalances Creates changes in muscle tension, imbalances in blood flow patterns leading to certain in blood flow patterns leading to certain illnesses such as asthma, IBS and depressionillnesses such as asthma, IBS and depression

(Braun, 1999)(Braun, 1999)


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Faulty Wiring?Faulty Wiring?Without out a return to a baseline of rest, Without out a return to a baseline of rest, hormones accumulate, doing damage to hormones accumulate, doing damage to brain cellsbrain cells

People with People with genetic predispositionsgenetic predispositions, , placed in a highly placed in a highly stressful environmentstressful environment will experience damage to brain cells from will experience damage to brain cells from stress hormonesstress hormones

This leads to the cluster of This leads to the cluster of thinking and thinking and emotional changesemotional changes we call depression we call depression

Stress alone is not the problem, but how we Stress alone is not the problem, but how we interpret the event, thought or feelinginterpret the event, thought or feeling

(Goleman, 1997; Braun, 1999)(Goleman, 1997; Braun, 1999)


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Where It Hits UsWhere It Hits Us


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One of Many NeuronsOne of Many Neurons•Neurons make up the brain and their action is what causes us to think, feel, and act •Neurons must connect to one another (through dendrites and axons) •Stress hormones damage dendrites and axons, causing them to “shrink” away from other connectors•As fewer and fewer connections are made, more and more symptoms of depression appear


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As damage occurs, thinking changes in the As damage occurs, thinking changes in the predictable ways identified in our list of 10 predictable ways identified in our list of 10 criteriacriteria

““Thought constriction” can lead to the idea that Thought constriction” can lead to the idea that suicide is the only optionsuicide is the only option

How do antidepressants affect this “brain How do antidepressants affect this “brain damage”?damage”?

They mayThey may counter the effects of stress hormonescounter the effects of stress hormones

We know now that antidepressants stimulate We know now that antidepressants stimulate genes within the neurons (turn on growth genes) genes within the neurons (turn on growth genes) which encourage the growth of new dendriteswhich encourage the growth of new dendrites

(Braun, 1999)(Braun, 1999)


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Renewed dendrites increase the Renewed dendrites increase the number of neuronal connectionsnumber of neuronal connections

The more connections, the more The more connections, the more information flow, the more flexibility information flow, the more flexibility the brain will havethe brain will have

Why does increasing the amount of Why does increasing the amount of serotonin, as many anti-depressants serotonin, as many anti-depressants do, take so long to reduce the do, take so long to reduce the symptoms of depression? symptoms of depression?

It takes 4-6 weeks to re-grow It takes 4-6 weeks to re-grow dendrites & axonsdendrites & axons

(Braun, 1999)(Braun, 1999)


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How Does Psychotherapy How Does Psychotherapy Help?Help?

Medications may improve brain function, but do not Medications may improve brain function, but do not change how we change how we interpretinterpret stress stress

Psychotherapy, especially cognitive or interpersonal Psychotherapy, especially cognitive or interpersonal therapy, helps people change the (negative) patterns therapy, helps people change the (negative) patterns of thinking that lead to depressed and suicidal of thinking that lead to depressed and suicidal thoughtsthoughts

Research shows that cognitive psychotherapy is as Research shows that cognitive psychotherapy is as effective as medication in reducing depression and effective as medication in reducing depression and suicidal thinkingsuicidal thinkingChanging our beliefs and thought patterns alters our Changing our beliefs and thought patterns alters our response to stress – we are not as reactive or as response to stress – we are not as reactive or as affected by stress at the physical level affected by stress at the physical level (Lester, 2004)(Lester, 2004)


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What Therapy?What Therapy?

The standard of care is medication The standard of care is medication and psychotherapy combinedand psychotherapy combined

At this point, only cognitive behavioral At this point, only cognitive behavioral and interpersonal psychotherapies are and interpersonal psychotherapies are considered to be effective with clinical considered to be effective with clinical depression (evidence-based)depression (evidence-based)

Patients should ask their doctor for a Patients should ask their doctor for a referral to a cognitive or interpersonal referral to a cognitive or interpersonal therapisttherapist


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Possible Sources Possible Sources Of DepressionOf Depression

Genetic: a predisposition to this problem may be Genetic: a predisposition to this problem may be present, and depressive diseases run in familiespresent, and depressive diseases run in families

Predisposing factors: Childhood traumas, car Predisposing factors: Childhood traumas, car accidents, brain injuries, abuse and domestic accidents, brain injuries, abuse and domestic violence, poor parenting, growing up in an violence, poor parenting, growing up in an alcoholic home, chemotherapyalcoholic home, chemotherapy

Immediate triggers: violent attack, illness, Immediate triggers: violent attack, illness, sudden loss or grief, loss of a relationship, any sudden loss or grief, loss of a relationship, any severe shock to the systemsevere shock to the system

(Anderson, 1999, Berman & Jobes, 1994, Lester, 1998)(Anderson, 1999, Berman & Jobes, 1994, Lester, 1998)


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What Happens If We What Happens If We Don’tDon’t

Treat Depression?Treat Depression? Significant risk of increased alcohol Significant risk of increased alcohol

and drug useand drug use Significant relationship problemsSignificant relationship problems Lost work days, lost productivity (up Lost work days, lost productivity (up

to $40 billion a year)to $40 billion a year) High risk for suicidal thoughts, High risk for suicidal thoughts,

attempts, and possibly deathattempts, and possibly death(Surgeon General’s Call To Action, 1999)(Surgeon General’s Call To Action, 1999)


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Depression is a medical illness that Depression is a medical illness that will likely affect the person later in life, will likely affect the person later in life, even after the initial episode improveseven after the initial episode improves

Youth who experience a major Youth who experience a major depressive episode have a 70% chance depressive episode have a 70% chance of having a second major depressive of having a second major depressive episode within five yearsepisode within five years

Many of the same problems that Many of the same problems that occurred with the first episode are occurred with the first episode are likely to return, and may worsenlikely to return, and may worsen

(Oregon SHDP)(Oregon SHDP)

Gatekeeper Training- Dr. Ellen Gatekeeper Training- Dr. Ellen AndersonAnderson

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Suicide Myths – What Is Suicide Myths – What Is True?True?

1.Talking about suicide might cause a person to act 1.Talking about suicide might cause a person to act False False –– it is helpful to show the person you take them it is helpful to show the person you take them

seriously and you care. Most feel relieved at the chance seriously and you care. Most feel relieved at the chance to talkto talk

2. 2. A person who threatens suicide wonA person who threatens suicide won’’t really follow t really follow throughthrough False False –– 80% of suicide completers talk about it before 80% of suicide completers talk about it before

they actually follow throughthey actually follow through

3. 3. Only Only ““crazycrazy”” people kill themselves people kill themselves False - Crazy is a cruel and meaningless word. Few who False - Crazy is a cruel and meaningless word. Few who

kill themselves have lost touch with reality kill themselves have lost touch with reality –– they feel they feel hopeless and in terrible painhopeless and in terrible pain

(AFSP website, 2003)(AFSP website, 2003)


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4. No one I know would do that4. No one I know would do that False - suicide is an equal opportunity False - suicide is an equal opportunity

killer – rich, poor, successful, unsuccessful, killer – rich, poor, successful, unsuccessful, beautiful, ugly, young, old, popular and beautiful, ugly, young, old, popular and unpopular people all complete suicideunpopular people all complete suicide

5. They’re just trying to get attention5. They’re just trying to get attention False – They are trying to get help. We False – They are trying to get help. We

should recognize that need and respond to should recognize that need and respond to itit

6.6. Suicide is a city problem, not a Suicide is a city problem, not a rural problemrural problem False – rural areas have higher suicide False – rural areas have higher suicide

rates than urban areasrates than urban areas


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Suicide myths, continued:

7.7. Once a person decides to dieOnce a person decides to die nothing can stop themnothing can stop them - -

They They really want to diereally want to die

NO - most people want to be stopped NO - most people want to be stopped – if we don’t try to stop them they – if we don’t try to stop them they will certainly die - people want to will certainly die - people want to end their pain, not their lives, but end their pain, not their lives, but they no longer have hope that anyone they no longer have hope that anyone will listen, that they can be helpedwill listen, that they can be helped

(AFSP website, 2003(AFSP website, 2003))


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How Do I Know If How Do I Know If Someone Is Suicidal?Someone Is Suicidal?

Now we understand the connection Now we understand the connection between depression and suicidebetween depression and suicide

We have reviewed what a depressed We have reviewed what a depressed person looks likeperson looks like

Not all depressed people are actively Not all depressed people are actively suicidal – how can we tell?suicidal – how can we tell?

Suicides don’t happen without Suicides don’t happen without warning - verbal and behavioral clues warning - verbal and behavioral clues are present, but we may not notice are present, but we may not notice themthem


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Verbal ExpressionsVerbal Expressions Common statementsCommon statements

I shouldn't be hereI shouldn't be here I'm going to run awayI'm going to run away I wish I could disappear foreverI wish I could disappear forever If a person did this or that…., would If a person did this or that…., would

he/she diehe/she die Maybe if I died, people would love me Maybe if I died, people would love me

moremore I want to see what it feels like to dieI want to see what it feels like to die I wish I were deadI wish I were dead I'm going to kill myselfI'm going to kill myself


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Some Behavioral Some Behavioral Warning SignsWarning Signs

Common signsCommon signs Previous suicidal thoughts or attemptsPrevious suicidal thoughts or attempts Expressing feelings of hopelessness or guiltExpressing feelings of hopelessness or guilt (Increased) substance abuse (Increased) substance abuse Becoming less responsible and motivatedBecoming less responsible and motivated Talking or joking about suicideTalking or joking about suicide Giving away possessionsGiving away possessions Having several accidents resulting in injury; Having several accidents resulting in injury;

"close calls" or "brushes with death""close calls" or "brushes with death"


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Preoccupation with death/violence; TV, Preoccupation with death/violence; TV, movies, drawings, books, at play, musicmovies, drawings, books, at play, music

Risky behavior; jumping from high Risky behavior; jumping from high places, running into traffic, self-cuttingplaces, running into traffic, self-cutting

School problems – a big drop in School problems – a big drop in grades, falling asleep in class, grades, falling asleep in class, emotional outbursts or other behavior emotional outbursts or other behavior unusual for this studentunusual for this student

Wants to join a person in heavenWants to join a person in heaven

Themes of death in artwork, poetry, etcThemes of death in artwork, poetry, etc

Further Behaviors Often Further Behaviors Often Seen in KidsSeen in Kids


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What On Earth Can What On Earth Can II Do?Do?

Anyone can learn to ask the right questions Anyone can learn to ask the right questions to help a depressed and suicidal personto help a depressed and suicidal person

Depression is an illness, like heart disease, Depression is an illness, like heart disease, and and suicidal thoughts are a crisis in suicidal thoughts are a crisis in that illness, like a heart attackthat illness, like a heart attack

You would not leave a heart attack victim You would not leave a heart attack victim lying on the sidewalk – many have been lying on the sidewalk – many have been trained in CPRtrained in CPR

We must learn to help people who are dying We must learn to help people who are dying more slowly of depressionmore slowly of depression


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What Stops Us?What Stops Us? Most of us still believe suicide and Most of us still believe suicide and

depression are “none of our business” and depression are “none of our business” and are fearful of getting a yes answerare fearful of getting a yes answer

What if :What if : we could respond to “yes”?we could respond to “yes”? We could recognize depression symptoms like We could recognize depression symptoms like

we recognize symptoms of a heart attack?we recognize symptoms of a heart attack? We were no longer afraid to ask for help for We were no longer afraid to ask for help for

ourselves, our parents, our children?ourselves, our parents, our children? We no longer had to feel ashamed of our We no longer had to feel ashamed of our

feelings of despair and hopelessness, but feelings of despair and hopelessness, but recognized them as symptoms of a brain recognized them as symptoms of a brain disorder?disorder?


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Reduce StigmaReduce Stigma Stigma about having mental health problems Stigma about having mental health problems

keeps people from seeking help or even keeps people from seeking help or even acknowledging their problemacknowledging their problem

Reducing the fear and shame we carry about Reducing the fear and shame we carry about having such “shameful” problems is criticalhaving such “shameful” problems is critical

People must learn that depression is truly a People must learn that depression is truly a disorder that can be treated – not something disorder that can be treated – not something to be ashamed of, not a weaknessto be ashamed of, not a weakness

Learning about suicide makes it possible for Learning about suicide makes it possible for us to overcome our fears about asking the us to overcome our fears about asking the “S” question“S” question


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Learning “Learning “QPRQPR” – Or, How ” – Or, How To Ask The “S” QuestionTo Ask The “S” Question

It is essential, if we are to reduce the number It is essential, if we are to reduce the number of suicide deaths in our country, that of suicide deaths in our country, that community members/gatekeepers learn community members/gatekeepers learn ““QPRQPR””

First designed by Dr. Paul Quinnett as an First designed by Dr. Paul Quinnett as an analogue to CPR, “analogue to CPR, “QPRQPR” consists of ” consists of QQuestion – asking the “S” questionuestion – asking the “S” question PPersuade– getting the person to talk, and to ersuade– getting the person to talk, and to

seek helpseek help RRefer – getting the person to professional efer – getting the person to professional

helphelp(Quinnett, 2000)(Quinnett, 2000)


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Ask Questions!Ask Questions! You seem pretty downYou seem pretty down Do things seem hopeless to youDo things seem hopeless to you Have you ever thought it would be easier Have you ever thought it would be easier

to be dead?to be dead? Have you considered suicide?Have you considered suicide? Remember, you cannot make someone Remember, you cannot make someone

suicidal by talking about it. If they are suicidal by talking about it. If they are already thinking of it they will probably be already thinking of it they will probably be relieved that the secret is outrelieved that the secret is out

If you get a yes answer, don’t panic-ask a If you get a yes answer, don’t panic-ask a few more questionsfew more questions


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How Much Risk Is How Much Risk Is There?There?

Assess lethalityAssess lethality You are not a doctor, but you need You are not a doctor, but you need

to know how imminent the danger to know how imminent the danger isis

Has he or she made any previous Has he or she made any previous suicide attempts? suicide attempts?

Does he or she have a plan?Does he or she have a plan? How specific is the plan? How specific is the plan? Do they have access to means?Do they have access to means?


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Do . . .Do . . . Use warning signs to get help early Use warning signs to get help early Talk openly- reassure them that Talk openly- reassure them that

they can be helped - try to instill they can be helped - try to instill hopehope

Encourage expression of feelingsEncourage expression of feelings Listen without passing judgmentListen without passing judgment Make empathic statementsMake empathic statements Stay calm, relaxed, rationalStay calm, relaxed, rational


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Don’tDon’t…… Make moral judgmentsMake moral judgments Argue lecture, or encourage guiltArgue lecture, or encourage guilt Promise total confidentiality/offer Promise total confidentiality/offer

reassurances that may not be truereassurances that may not be true Offer empty reassurances – “you’ll get over Offer empty reassurances – “you’ll get over

this”this” Minimize the problem -“All you need is a Minimize the problem -“All you need is a

good night’s sleep”good night’s sleep” Dare or use reverse psychology - “You Dare or use reverse psychology - “You

won’t really do it” - - “Go ahead and kill won’t really do it” - - “Go ahead and kill yourself”yourself”

Leave the person aloneLeave the person alone


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Never Go It Alone!Never Go It Alone! Collaborate with othersCollaborate with others

The person him/herselfThe person him/herself Family and friendsFamily and friends School personnel or co-workersSchool personnel or co-workers Emergency roomEmergency room Police/sheriffPolice/sheriff Family doctorFamily doctor Crisis hotlineCrisis hotline Community agenciesCommunity agencies


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Getting HelpGetting Help

Refer for professional helpRefer for professional help When people exhibit 5 or more When people exhibit 5 or more

symptoms of depressionsymptoms of depression When risk is present (e.g. Specific When risk is present (e.g. Specific

plan, available means)plan, available means) Learn your community resources – Learn your community resources –

know how to get helpknow how to get help


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Local Professional Local Professional ResourcesResources

Your Hospital Your Hospital Emergency RoomEmergency Room

Your Local Mental Your Local Mental Health AgenciesHealth Agencies

Your Local Mental Your Local Mental Health BoardHealth Board

School Guidance School Guidance CounselorsCounselors

Local Crisis HotlinesLocal Crisis Hotlines

National Crisis National Crisis HotlinesHotlines

Your family Your family physicianphysician

School nursesSchool nurses

911911

Local Police/SheriffLocal Police/Sheriff

Local ClergyLocal Clergy


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Sources of support for families of suicide Sources of support for families of suicide completers are almost non-existent, unless completers are almost non-existent, unless a survivors of suicide group is availablea survivors of suicide group is available

If you know people who have experienced If you know people who have experienced this tragedy, talk with them about itthis tragedy, talk with them about it

Explain what you know about depression - Explain what you know about depression - help them understand they are not at fault, help them understand they are not at fault, that their loved one was illthat their loved one was ill

Help them understand the unendurable Help them understand the unendurable psychache their loved one experienced –it psychache their loved one experienced –it may help them resolve some of their angermay help them resolve some of their anger

Survivors Of SuicideSurvivors Of Suicide


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Final SuggestionsFinal Suggestions You may know many people with depression You may know many people with depression Are they comfortable telling you about this Are they comfortable telling you about this

vulnerable place in their life?vulnerable place in their life? Openness and discussion about depression and Openness and discussion about depression and

suicidal thinking can free people to talk suicidal thinking can free people to talk Help spread the word in your church, PTA group, Help spread the word in your church, PTA group,

sports team, circle of friends sports team, circle of friends Help people emerge from the stigma our culture has Help people emerge from the stigma our culture has

placed on this and other mental health problemsplaced on this and other mental health problems Become aware of your own vulnerability to Become aware of your own vulnerability to

depression depression (Anderson, 1999)(Anderson, 1999)


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Permanent Solution-Permanent Solution- Temporary Problem Temporary Problem

Remember a depressed person is Remember a depressed person is physically ill, and physically ill, and cannotcannot think clearly think clearly about the morality of suicide, about the morality of suicide, cannot cannot think think logically about their value to friends and logically about their value to friends and familyfamily

You would try CPR if you saw a heart You would try CPR if you saw a heart attack victimattack victim

Don’t be afraid to “interfere” when Don’t be afraid to “interfere” when someone is dying more slowly of someone is dying more slowly of depressiondepression

Depression is a treatable disorderDepression is a treatable disorder Suicide is a preventable deathSuicide is a preventable death


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The Ohio Suicide Prevention The Ohio Suicide Prevention FoundationFoundation

The Ohio State University, Center on The Ohio State University, Center on Education and Training for Education and Training for

EmploymentEmployment

1900 Kenny Road, Room 20721900 Kenny Road, Room 2072

Columbus, OH 43210Columbus, OH 43210


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Websites For Additional Websites For Additional InformationInformation

Ohio Department of Ohio Department of Mental healthMental health

www.mh.state.oh.uswww.mh.state.oh.us NAMINAMI

www.nami.orgwww.nami.org Suicide Prevention Suicide Prevention

Resource CenterResource Centerwww.sprc.orgwww.sprc.org

American association of American association of suicidologysuicidologywww.suicidology.orgwww.suicidology.org

Suicide Suicide awareness/voice of awareness/voice of educationeducation

www.save.orgwww.save.org American foundation American foundation

for suicide preventionfor suicide prevention

www.afsp.orgwww.afsp.org Suicide prevention Suicide prevention

advocacy networkadvocacy networkwww.spanusa.org

QPR institute QPR institute www.qprtinstitute.orgwww.qprtinstitute.org


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A Brief BibliographyA Brief Bibliography Anderson, E. “The Personal and Professional Impact of Client

Suicide on Mental Health Professionals. Unpublished Doctoral dissertation, U. of Toledo, 1999.

Beck, A.T., Steer, R.A., Kovacs, M., & Garrison, B. (1985). Hopelessness, depression, suicidal ideation, and clinical diagnosis of depression. Suicide and Life-Threatening Behavior. 23(2), 139-145.

Berman, A. L. & Jobes, D. A. (1996) adolescent suicide: assessment and intervention.

Blumenthal, S.J. & Kupfer, D.J. (Eds.) (1990). Suicide Over the Life Cycle: Risk Factors, Assessment, and Treatment of Suicidal Patients. American Psychiatric Press.

Braun, S. (2000). Unlocking the Mysteries of Mood: The Science of Happiness. Wiley and Sons, NY.

Calhoun, L.G, Abernathy, C.B., & Selby, J.W. (1986). The rules of bereavement: Are suicidal deaths different? Journal of Community Psychology, 14, 213-218.


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Doka, K.J. (1989). Disenfranchised Grief: Recognizing hidden sorrow. Lexington, MA: Lexington Books.

Dunne, E.J., MacIntosh, J.L., & Dunne-Maxim, K. (Eds.). (1987). Suicide and its aftermath. New York: W.W. Norton.

Empfield, M & Bakalar, N. (2001) Understanding Teenage Depression: A guide to Diagnosis, Treatment and Management. Holt & Co., NY.

Jacobs, D., Ed. (1999). The Harvard Medical School Guide to Suicide Assessment and Interventions. Jossey-Bass.

Jamison, K.R., (1999). Night Falls Fast: Understanding Suicide. Alfred Knopf .

Krysinski, P.K. (1993). Coping with suicide: Beyond the three day bereavement leave policy. Death Studies: 17, 173-177.

Lester, D. (1998). Making Sense of Suicide: An In-Depth Look at Why People Kill Themselves. American Psychiatric Press.


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Oregon Health Department, Prevention. Notes Oregon Health Department, Prevention. Notes on Depression and Suicide: on Depression and Suicide: ttp://www.dhs.state.or.us/publickhealth/ipe/deprettp://www.dhs.state.or.us/publickhealth/ipe/depression/notes.cfm.ssion/notes.cfm.

President’s New Freedom Council on Mental President’s New Freedom Council on Mental Health, 2003.Health, 2003.

Rosenblatt, P. (1996). Grief that does not end. In Rosenblatt, P. (1996). Grief that does not end. In D. Klass, P. Silverman, & S. Nickman (Eds.), D. Klass, P. Silverman, & S. Nickman (Eds.), Continuing Bonds: New Understandings of griefContinuing Bonds: New Understandings of grief (pp 45-58). Washington, D.C.: Taylor & Francis.(pp 45-58). Washington, D.C.: Taylor & Francis.

Rowling, L. (1995). The disenfranchised grief of Rowling, L. (1995). The disenfranchised grief of teachers. teachers. Omega, 31Omega, 31(4), 317-329.(4), 317-329.

Smith, Range & Ulner. “Belief in Afterlife as a Smith, Range & Ulner. “Belief in Afterlife as a buffer in suicide and other bereavement.” buffer in suicide and other bereavement.” Omega Journal of Death and Dying, 1991-92, Omega Journal of Death and Dying, 1991-92, (24)3; 217-225.(24)3; 217-225.


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Stoff, D.M. & Mann, J.J. (Eds.), (1997). Stoff, D.M. & Mann, J.J. (Eds.), (1997). The Neurobiology of The Neurobiology of SuicideSuicide. American Academy of Science. American Academy of Science

Quinnett, P.G. (2000). Quinnett, P.G. (2000). Counseling Suicidal People.Counseling Suicidal People. QPR QPR Institute, Spokane, WAInstitute, Spokane, WA

Sheskin, A., & Wallace, S.E. (1976). Differing bereavements: Sheskin, A., & Wallace, S.E. (1976). Differing bereavements: Suicide, natural, and accidental deaths. Suicide, natural, and accidental deaths. Omega 7Omega 7, 229-242., 229-242.

Shneidman, E.S.(1996).Shneidman, E.S.(1996).The Suicidal MindThe Suicidal Mind. Oxford University . Oxford University Press.Press.

Styron, W. (1992). Darkness Visible. Vintage BooksStyron, W. (1992). Darkness Visible. Vintage Books Surgeon General’s Call to Action (1999). Department of Surgeon General’s Call to Action (1999). Department of

Health and Human Services, U.S. Public Health Service.Health and Human Services, U.S. Public Health Service. Thompson, K. & Range, L. (1992). Bereavement following Thompson, K. & Range, L. (1992). Bereavement following

suicide and other deaths: Why support attempts fail. suicide and other deaths: Why support attempts fail. Omega Omega 2626(1), 61-70.(1), 61-70.

Valent, P. (1995). Survival strategies: A framework for Valent, P. (1995). Survival strategies: A framework for understanding Secondary Traumatic Stress and coping in understanding Secondary Traumatic Stress and coping in helpers. In C. Figley (Ed.) helpers. In C. Figley (Ed.) Compassion FatigueCompassion Fatigue (pp21-50). New (pp21-50). New York: Brunner Mazel.York: Brunner Mazel.

Documents

SAVING LIVES: Understanding Depression And Suicide In Our Communities The Greene County Suicide Prevention Coalition Presented and Developed By Ellen Anderson,