WHAT TO DO WITH A

SUICIDAL CLIENT

SUICIDE PREVENTION

RISK FACTORS STATISTICS ASSESSMENT DECISION MAKING CHANGING SOMEONE’S MIND ACUTE VS. CHRONIC FEARS FAMOUS SUICIDES

RISK FACTORS

Do risk factors matter: yes and noYes: to alert you, to reduce in treatment, in keeping statistics No: anyone can be the exception

What are they: High on lethality index: ideation, plan, threat Access to means (everyone has means) History: Previous attempts, Family attempts Substance use Speaking in hopeless terms Lack of supports, emotional neglect Fantasies of death Recent stressful event or poor adjustment/Loss Trapped in situation of abuse Chronic or terminal health issues

**Inability to access help: stigma, cultural beliefs

STATISTICS

National Vital Statistics System 35–64— United States, 1999–2010 : 14,443 - 21,754 10–34 years and ≥65 not statistically significant between years Three most common methods:

firearms poisoning (predominantly drug overdose) suffocation (predominantly hanging)

10 – 24: third leading cause of death 4600 lives lost each year Three most common methods:

firearms (45%) poisoning (8%) suffocation (40%)

Each year, approximately 157,000 youth between the ages of 10 and 24 receive medical care for self-inflicted injuries at Emergency Departments across the U.S.

ASSESSMENT Question euphemisms Directly ask about their thoughts

Are you thinking about hurting yourself? Are you thinking about ending your life? Are you scared you might do something rash? It’s sounding like I might need to take some action.

Question why they want to die Do they have a plan

Is plan same as past attempts When would they act on plan

Do they have means Is this an anniversary Are drugs or alcohol involved

DECISION MAKING

To act: Access support for:

Help in decision-making Making call for EMT

Explain your lack of choice Reassure about ongoing support

To not act: Have plan in place Contract Follow-up

CHANGING SOMEONE’S MINDPulling Out All The Stops (while maintaining the relationship)

Learn their reasoning and then state the harsh facts Dispel irrational thinking Deflate rationalizations Provide coping techniques OFFER HOPE Be open and honest/transparent/validating Point out ambivalence found in all Use their religion “against them” Cheerlead

CHANGING SOMEONE’S MINDCountering Irrational Thinking

People will be better off or get over it Hurting others/imagining funeral No one will care Going to a better place I want to be with… I can’t keep going through this

Bottom line – DEPRESSION LIES TO YOU!!!

A suicidal person needs to be told that in this state they can’t access their best judgment. They should not be making a decision of this magnitude when they are in this state. They need to wait and see over time how they feel. This option doesn’t go away.

CHANGING SOMEONE’S MINDWhen Sending Home

PRODUCE PLAN Suggest methods for coping: Breathing, distracting, project, music, medication, cutting

self slack, reading unrelated fiction, sitting in the sun/under the stars, journaling, funny Youtube videos, do something for someone else……………………….

Access support system, stay with someone Identify ideas that might lead back to option of suicide and instruct to avoid If needed, contract for no self-harm between now and next meeting This could be the last decision ever made, don’t make it impulsively. Create follow-up plan: talk by phone tomorrow, etc. Write everything down (make copy), include quotes

Courage isn’t going on without fear, it’s going on despite your fear. Every great achievement was once considered impossible. Although the world is full of suffering, it is also full of the overcoming of suffering.

Helen Keller The world breaks everyone and afterward some are strong at the broken places. Ernest

Hemingway

PARENTAL SUPPORT FOR YOUTH

Nurturing vs. Space Encouraging words Alternative expectations Follow through with promises/Consistency Structure vs. Firmness Consider what might be hidden

Bullying: online, at school Pregnancy Undiagnosed medical problem Auditory hallucinations

Understanding the basics: Lack of motivation Careless mistakes Oversleeping Irritability Side effects from medication

ACUTE VS. CHRONIC

Considering suicide as a way of coping Must replace what is taken away Judge on a 10 pt. scale Determine the difference between chronic and acute for the individual Work toward underlying cause

Trapped in life because of current situation or earlier life misery No purpose in life Alone

Hospitalization is unlikely to make a difference

FEARSBalance between safety and therapeutic

rapportSaying the wrong thingGiving them the ideaSending them homeTrusting their honesty

From an old folk song:You can’t help someone to see the light when they’ve stopped believing in the sun.

Famous Suicides/Attempts

SUCCESSFUL SUICIDESCharles BoyerDana Plato Ernest HemingwayFreddie Prinze (Sr.) George SandersHunter S. Thompson Inger StevensKurt CobainMargeau HemingwayMarilyn Monroe Peter Duel RembrandtSpalding GraySylvia PlathVan GoghVirginia WoolfWallace Hume Carothers (Inventor Of Nylon)George Eastman (Eastman Kodak Company)Edwin Armstrong (Invented FM Radio)

ATTEMPTED SUICIDESAdam AntBilly JoelBrigitte BardotClark GableDanny BonaduceDonna SummerDrew BarrymoreDrew CareyElizabeth TaylorElton JohnEminemGreg LouganisHalle BerryJohnny CashMaria CallasMicky DolenzMike WallaceNina SimonePatty DukePaul RobesonRobert YoungTai BabiloniaTina TurnerVanilla IceWalt Disney