Suicide Prevention TrainingSuicide Prevention TrainingPsychological Services Psychological Services

SectionSectionMiami-Dade Police DepartmentMiami-Dade Police Department

Dr. Scott W. AllenDr. Scott W. Allen

Police PsychologistPolice Psychologist

CLINICAL CORRELATES OF CLINICAL CORRELATES OF SUICIDESUICIDE

DisordersDisorders AdultAdult YouthYouth

DepressionDepression ++++ ++

SchizophreniaSchizophrenia ++ ++++

Personality Personality DisordersDisorders

00 ++++

Alcohol AbuseAlcohol Abuse ++++ ++++

Drug AbuseDrug Abuse ++ ++++

Object LossObject Loss ++++ ++++

Legend: ++ Highly Correlated + Correlated 0 Not Correlated

THE 10 COMMONALITIES OF THE 10 COMMONALITIES OF SUICIDESUICIDE

1. The common purpose of suicide is to seek a solution1. The common purpose of suicide is to seek a solution2. The common goal of suicide is cessation of consciousness2. The common goal of suicide is cessation of consciousness3. The common stimulus in suicide is intolerable psychological pain3. The common stimulus in suicide is intolerable psychological pain4. The common stressor in suicide is frustrated psychological needs4. The common stressor in suicide is frustrated psychological needs5. The common emotion in suicide is hopelessness-helplessness5. The common emotion in suicide is hopelessness-helplessness6. The common cognitive state in suicide is ambivalence6. The common cognitive state in suicide is ambivalence7. The common perpetual state in suicide is constriction7. The common perpetual state in suicide is constriction8. The common action in suicide is egression8. The common action in suicide is egression9. The common interpersonal act in suicide is communication of intention9. The common interpersonal act in suicide is communication of intention10.The common consistency in suicide is with lifelong coping patterns10.The common consistency in suicide is with lifelong coping patterns

In previous publication (Shneidman 1985, 1990b)

SUICIDE RISK VARIABLESSUICIDE RISK VARIABLES

Relationship PotentialRelationship Potential Absence or limited meaningful Absence or limited meaningful

supportive relationshipssupportive relationships

Suicide HistorySuicide History High lethality potential of attempt(s)High lethality potential of attempt(s) Presence of specific planPresence of specific plan

SUICIDE RISK VARIABLESSUICIDE RISK VARIABLES(Continued)(Continued)

Current Suicidal IdeationCurrent Suicidal Ideation Presence of specific planPresence of specific plan Accessibility of lethal meansAccessibility of lethal means Behavior suggestive of decision to die (e.g., Behavior suggestive of decision to die (e.g.,

severing relationships, giving away valued severing relationships, giving away valued possessions; inappropriate sense of peace, possessions; inappropriate sense of peace, calm or happiness; verbalizations regarding calm or happiness; verbalizations regarding the utility of death)the utility of death)

Family history of suicide, especially parental Family history of suicide, especially parental suicide when patient between ages of 5-12suicide when patient between ages of 5-12

SUICIDE RISK VARIABLESSUICIDE RISK VARIABLES(Continued)(Continued)

Psychiatric Medical FactorsPsychiatric Medical Factors Chronic psychiatric disordersChronic psychiatric disorders Recent discharge from psychiatric hospital Recent discharge from psychiatric hospital

(within 3 months)(within 3 months) Remission of psychiatric episode but Remission of psychiatric episode but

continuance of secondary depressioncontinuance of secondary depression Impulsivity (violence toward others and self, Impulsivity (violence toward others and self,

reckless driving, spending money)reckless driving, spending money) Alcohol abuseAlcohol abuse Drug abuseDrug abuse

DIFFERENCE BETWEEN SUICIDE DIFFERENCE BETWEEN SUICIDE ATTEMPTERSATTEMPTERS

AND SUICIDE COMPLETERSAND SUICIDE COMPLETERSATTEMPTERSATTEMPTERS COMPLETERSCOMPLETERS

1.GENDER1.GENDER FEMALEFEMALE

(3:1)(3:1)

MALEMALE

(3:1)(3:1)

2. AGE2. AGE STEADY INCREASE STEADY INCREASE

THEN DECREASES THEN DECREASES

STEADY RISE WITH AGE STEADY RISE WITH AGE

3. DIAGNOSIS3. DIAGNOSIS UP TO 50% COULD HAVE UP TO 50% COULD HAVE

DX OF DEPRESSED DX OF DEPRESSED

ONLY 10-15% AREONLY 10-15% ARE

DEPRESSED, 30% AREDEPRESSED, 30% ARE

SCHIZO-AFFECTIVE MOODSCHIZO-AFFECTIVE MOOD

CONGRUENT/CONGRUENT/

INCONGRUENT ANDINCONGRUENT AND

DELUSIONAL DELUSIONAL

4. RATES4. RATES 10-12% OF THE GENERAL 10-12% OF THE GENERAL POPULATION HAVE MADE POPULATION HAVE MADE AT LEAST ONE ATTEMPT AT LEAST ONE ATTEMPT

12 PER 100,000 12 PER 100,000

5. METHOD5. METHOD DRUG OVERDOSE DRUG OVERDOSE GUNSHOT OR HANGING GUNSHOT OR HANGING

CHARACTERISTICS OF SUICIDE CHARACTERISTICS OF SUICIDE ATTEMPTERSATTEMPTERS

Cognitive StyleCognitive Style

1. Dichotomous (either-or) Thinking.1. Dichotomous (either-or) Thinking.2. Rigid, inflexible cognitive style (things just are the way 2. Rigid, inflexible cognitive style (things just are the way

they are).they are).3. Inability to conceive if long term effects of actions.3. Inability to conceive if long term effects of actions.4. Positive expectancies regarding the effectiveness of 4. Positive expectancies regarding the effectiveness of

suicide as a solution to life problems.suicide as a solution to life problems.5. Lack of insight; actions speak louder than words.5. Lack of insight; actions speak louder than words.6 .Poor problem solving abilities (generates less possible 6 .Poor problem solving abilities (generates less possible

solutions, prematurely rejects potentially viable solutions, prematurely rejects potentially viable alternatives, less active in problem solving behaviors).alternatives, less active in problem solving behaviors).

7. Generalized feelings of hopelessness.7. Generalized feelings of hopelessness.

CHARACTERISTIC OF SUICIDE CHARACTERISTIC OF SUICIDE ATTEMPTERSATTEMPTERS

(Continued)(Continued)

Affect RegulationAffect Regulation

1. Tendency toward chronic feelings of anger, 1. Tendency toward chronic feelings of anger, guilt, depression, anxiety, and boredom;guilt, depression, anxiety, and boredom;

2. Inability to regulate emotional arousal in 2. Inability to regulate emotional arousal in stressful situations (can’t turn off feelings);stressful situations (can’t turn off feelings);

4. Intense, unstable affect with rapid changes4. Intense, unstable affect with rapid changes

in nature of feelings.in nature of feelings.

CHARACTERISTIC OF SUICIDE CHARACTERISTIC OF SUICIDE ATTEMPTERSATTEMPTERS

(Continued)(Continued)

Affect ToleranceAffect Tolerance1. Belief that they “Can’t Stand” or tolerate1. Belief that they “Can’t Stand” or tolerate negative affect.negative affect.2. Restrictive and negative beliefs about the2. Restrictive and negative beliefs about the place of negative feelings in the world. Badplace of negative feelings in the world. Bad feelings wrong.feelings wrong.3. Tendency toward impulsive attempts to get rid3. Tendency toward impulsive attempts to get rid of affect (i.e., cutting, drinking, drug taking,of affect (i.e., cutting, drinking, drug taking, binge eating).binge eating).

Suicide is a Problem-Solving BehaviorSuicide is a Problem-Solving Behavior Specifically, a complex set of behaviors aimed at:Specifically, a complex set of behaviors aimed at: 1)1) improving an unpleasant situation (chronic improving an unpleasant situation (chronic

depression)depression)2)2) ** preserving a threatened self-image ** preserving a threatened self-image

(embarrassment and humiliation)(embarrassment and humiliation)3)3) exercising omnipotence vs. helplessness exercising omnipotence vs. helplessness

(terminal illness/intractable pain)(terminal illness/intractable pain)

** Most frequently occurring suicidal dynamic within ** Most frequently occurring suicidal dynamic within law enforcement suicide law enforcement suicide

COGNITIVE DISTORTION:COGNITIVE DISTORTION:

Rational however confused and illogical Rational however confused and illogical thinkingthinking

My feelings are wrongMy feelings are wrong

My thinking is correctMy thinking is correct

Suicidal ParadoxSuicidal Paradox

Suicide is a problem solving behavior,Suicide is a problem solving behavior,

individuals become less anxious and individuals become less anxious and

symptomatic AFTER they have decided to killsymptomatic AFTER they have decided to kill

themselves. Therefore, an actively suicidal themselves. Therefore, an actively suicidal

individual will appear to be “back toindividual will appear to be “back to

themselves”. Thus, it is imperative to ask thisthemselves”. Thus, it is imperative to ask this

person, “Are you better or have you decidedperson, “Are you better or have you decided

to kill yourself?”.to kill yourself?”.

EuphemismEuphemism

Euphemisms are “watered down” verbalizations of what aEuphemisms are “watered down” verbalizations of what aperson is actually attempting to say. For example, a personperson is actually attempting to say. For example, a personmay say, “You aren’t going to do anything stupid are you?”,may say, “You aren’t going to do anything stupid are you?”,or, “You aren’t going to hurt yourself, are you?”. A suicidalor, “You aren’t going to hurt yourself, are you?”. A suicidalperson (even if this person is your best friend) willperson (even if this person is your best friend) willmanipulate this transaction by saying, “No”. The usage ofmanipulate this transaction by saying, “No”. The usage ofthe euphemism allows the suicidal person to avoid truthfully the euphemism allows the suicidal person to avoid truthfully responding because the internal talk of the person is, “No,responding because the internal talk of the person is, “No,I’m not doing anything stupid, I have given this a lot of I’m not doing anything stupid, I have given this a lot of thought, and I’m killing myself.”, or, No, I’m not going to hurt thought, and I’m killing myself.”, or, No, I’m not going to hurt myself, I’m going to blow my head off”.myself, I’m going to blow my head off”.

INTERVENTIONINTERVENTION

[Please Note: the following is actually the[Please Note: the following is actually the

general content of general content of whatwhat is suggested to be is suggested to be

discussed in this section as eachdiscussed in this section as each

department will have their own specificdepartment will have their own specific

policies and procedures within State lawspolicies and procedures within State laws

and regulations] and regulations]

INTERVENTIONINTERVENTION(Continued)(Continued)

It is It is imperativeimperative that the initial segment of this training include that the initial segment of this training includethe Department’s operational perspective regarding the post-the Department’s operational perspective regarding the post-hospitalization phase of the police officer’s treatment. It ishospitalization phase of the police officer’s treatment. It ishighly recommended that every department have either a highly recommended that every department have either a written order or an accepted philosophical understandingwritten order or an accepted philosophical understandingthat the hospitalization will be considered a medical crisisthat the hospitalization will be considered a medical crisishospitalization and the police officer will not be at risk forhospitalization and the police officer will not be at risk forlosing his/her job solely predicated upon the hospitalization.losing his/her job solely predicated upon the hospitalization.The biggest barrier in the hospitalization process is theThe biggest barrier in the hospitalization process is thepolice officer’s fear (which is immediately validated by policepolice officer’s fear (which is immediately validated by policeofficer peers attempting to assist the at-risk officer) that anyofficer peers attempting to assist the at-risk officer) that anyhospitalization will eventually lead to termination from thehospitalization will eventually lead to termination from thedepartment.department.

INTERVENTIONINTERVENTION(Continued)(Continued)

The actual first step in the intervention process is toThe actual first step in the intervention process is tounderstand that the number one risk factor for policeunderstand that the number one risk factor for policesuicide is embarrassment/humiliation. Therefore, earlysuicide is embarrassment/humiliation. Therefore, earlyIdentification of at-risk officers is crucial. Whenever anIdentification of at-risk officers is crucial. Whenever anofficer is arrested and/or relieved of duty (especially if officer is arrested and/or relieved of duty (especially if

therethereis media involvement), police officer peers, familyis media involvement), police officer peers, familymembers, or police psychologist staff should initiate amembers, or police psychologist staff should initiate aface-to-face assessment (always go to the potentiallyface-to-face assessment (always go to the potentiallysuicidal officer as opposed to agreeing to meet him/hersuicidal officer as opposed to agreeing to meet him/hersomewhere) which would entail verbalizing the directsomewhere) which would entail verbalizing the directquestion (remember: no euphemisms),question (remember: no euphemisms),

INTERVENTIONINTERVENTION(Continued)(Continued)

““Are you considering or have you decided to killAre you considering or have you decided to killyourself and what is your plan?”. If the response is,yourself and what is your plan?”. If the response is,““Yes.”, then immediate Yes.”, then immediate voluntary voluntary crisiscrisishospitalization is required. Further, if yourhospitalization is required. Further, if yourdepartment utilizes a staff or consulting department utilizes a staff or consulting psychologist, it is strongly suggested that they bepsychologist, it is strongly suggested that they beutilized for the hospitalization process. This servesutilized for the hospitalization process. This servestwo purposes; first, the mental health professionaltwo purposes; first, the mental health professionalcan more quickly facilitate the actual hospitalizationcan more quickly facilitate the actual hospitalizationprocess, and the subsequent post-dischargeprocess, and the subsequent post-dischargefollow-up process. follow-up process.

INTERVENTIONINTERVENTION(Continued)(Continued)

Second, as the saying goes, No good deed goes unpunished,Second, as the saying goes, No good deed goes unpunished,it is recommended that police officer friends and peers of theit is recommended that police officer friends and peers of theat-risk officer do not actively facilitate the hospitalizationat-risk officer do not actively facilitate the hospitalizationprocess as this will eventually cause a significant shift in theprocess as this will eventually cause a significant shift in theinterpersonal balance of power among the officers.interpersonal balance of power among the officers.Specifically, following discharge from the hospital, theSpecifically, following discharge from the hospital, theaffected officer will be able to cognitively appreciate that hisaffected officer will be able to cognitively appreciate that hisfriends and peers saved his life via the hospitalization.friends and peers saved his life via the hospitalization.However, on an emotional level, the officer will again,However, on an emotional level, the officer will again,experience a profound embarrassment and humiliation thatexperience a profound embarrassment and humiliation thathe was hospitalized by his friends.he was hospitalized by his friends.

INTERVENTIONINTERVENTION(Continued)(Continued)

A final dynamic in the department’s attempt to lower theA final dynamic in the department’s attempt to lower thenumber of police suicides is the incorporation of anumber of police suicides is the incorporation of anotification process whenever a police officer is arrestednotification process whenever a police officer is arrestedand/or relieved of duty. Typically, the Professionaland/or relieved of duty. Typically, the ProfessionalCompliance Bureau (Internal Affairs), the Domestic CrimesCompliance Bureau (Internal Affairs), the Domestic CrimesBureau, or the Sexual Crimes Bureau are the entities whichBureau, or the Sexual Crimes Bureau are the entities whichinitiate and prosecute the arrest process, while individualinitiate and prosecute the arrest process, while individualdistricts facilitate the relief from duty process. Wheneverdistricts facilitate the relief from duty process. Whenevereither action occurs, the initiating entity is tasked witheither action occurs, the initiating entity is tasked withnotifying the Psychological Services Section which thennotifying the Psychological Services Section which thenimmediately responds to that entity and completes a suicidalimmediately responds to that entity and completes a suicidalassessment of the officer(s). assessment of the officer(s).

INTERVENTIONINTERVENTION(Continued)(Continued)

A further responsibility of the PsychologicalA further responsibility of the PsychologicalServices Section staff is to contact friendsServices Section staff is to contact friendsand/or family members to directly respond toand/or family members to directly respond tothe specific bureau/district or to the jail. Thisthe specific bureau/district or to the jail. Thisprocess ensures that family and friends willprocess ensures that family and friends willinitiate direct contact with the at-risk officerinitiate direct contact with the at-risk officerwhich will significantly decrease the potentialwhich will significantly decrease the potentialfor that officer to attempt any self-destructivefor that officer to attempt any self-destructivebehaviors.behaviors.