Youth Suicide Prevention

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Youth Suicide Prevention

• Helping a Young Person in Crisis
• Presented by
• John Humphries, School Psychologist
• WI Department of Public Instruction
• [phone]

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Get the handouts

• http//dpi.wi.gov/sspw/suicideprev.html

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Gatekeeper training CPR for suicide

• Early recognition of signs symptoms
• Fast intervention referral
• Professional assessment
• Treatment
• Instead of CPR we use ACT
• Acknowledge
• Care
• Tell

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Gatekeeper Training is Effective

• Removes paralysis and empowers people to help
• Ends the fear about suicide
• Increases your capacity to
• Identify
• Support
• Refer youth who are at-risk

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Language Notes Suggestions from Survivors

• Do use
• Completed Suicide
• Died by Suicide
• Took his/her own life
• Died of Suicide

• Dont use
• Successful Suicide Attempt
• Committed Suicideits not illegal

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Without looking at the handouts

• Make some guesses

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Is suicide very common?
Suicide 359! That's about 51 each year
WI DHFS WISH data system, www.dhfs.wisconsin.gov/w
ish/ Mortality Module, accessed 3/15/07. Note 27
other firearm deaths of accidental or
indeterminate intent.
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How many kids die by suicide?
WDHFS WISH data system, www.dhfs.wisconsin.gov/wis
h/, accessed 1/10/2007
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What about racial/ethnic groups?

• Black 2.38 (based on 22 death reports)
• Asian 3.08 (based on 9 reports)
• White 3.71 (based on 323 reports)
• American Indian 4.39 (based on 6 reports)
• Hispanic 1.82 (based on 11 reports)
• Non-Hispanic 3.69 (349 reports)
• Deaths per 100,000, age 0-19, 1999-2005
• Wisconsin Dept. of Health and Family Services.
  http//dhfs.wisconsin.gov/wish/, Injury Mortality
  Module accessed 3/12/2007

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Method by Gender

• Firearms 183 cases (51 of total)
• 162 males, 21 females (81)
• Suffocation 136 cases (38)
• 101 males, 35 females (31)
• Poisoning 17 cases
• 10 males, 7 females (11)
• Overall, four times as many males as females
• 0-19 y.o., 1999-2005 WI DHFS dhfs.wisconsin.gov/
  wish/
• Injury Mortality Module, accessed 3/13/2007

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Method by Age

• Firearm Rate per 100,000
• Almost twice as high for 18-19 year-olds than
  15-17 year-olds
• Suffocation Rate per 100,000
• About the same for 18-19 year-olds and 15-17
  year-olds
• For 10-14, suffocation more common than firearms
• Wisconsin Dept. of Health and Family Services.
  http//dhfs.wisconsin.gov/wish/, Injury Mortality
  Module
• accessed 3/12/2007

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How does WI compare with USA?

• US Average is 2.32/100,000
• WI 8th highest 3.00 (higher than US for 24 of
  last 25 years). Rate is 30 over US
• MN 2.36 (19th), IL 1.41 (tied for 42nd)
• Others like WI include CO, ND, UT, ID
• www.cdc.gov/ncipc/wisqars retrieved 11/7/06

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What does this really mean?

• If we had the AVERAGE annual rate, we would drop
  from 52 youth suicides to 39
• If we had the same rate as New Jersey, we would
  drop to 13 youth suicides per year

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Wisconsin High School Survey 2005
Percentage of students who felt so sad or
hopeless almost every day for two weeks or more
in a row that they stopped doing some usual
activities during the past 12 months
100
80
60
33.3
40
32.0
27.0
27.3
27.6
24.3
22.2
20
0
Total
Males
Females
9th
10th
11th
12th
QN23 - Weighted Data
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Does depression matter academically?

• Schools with more students who report being sad
  or hopeless make less progress in raising test
  scores than other schools
• Ensuring That No Child Is Left Behind How Are
  Student Health Risks Resilience Related to the
  Academic Progress of Schools 2004
• Data Source California Healthy Kids Survey
  STAR data files.
• www.wested.org/chks/pdf/p1_stuartreport_ch_final.p
  df

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Sadness/Hopelessness and Annual Changes in Test
Scores
10
5
2.6
2.4
2.1
2.0
1.6
1.7
1.5
1.2
1.1
1.0
0.7
0.7
0.6
0.3
0
-0.2
Change in SAT-9 (NPR)
Reading
Language
Mathematics
-5
-10
20
25
29
34
39
20
25
29
34
39
20
25
29
34
39
Percent reporting sadness/hopelessness (12 month)
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Wisconsin High School Survey (2005)
Percentage of students who made a plan about how
they would attempt suicide during the past 12
months
100
WI US, p0.02
80
60
40
18.3
16.4
17.0
15.4
13.9
13.7
20
12.7
0
Total
Males
Females
9th
10th
11th
12th
QN25 - Weighted Data
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Wisconsin High School Survey (2005)
Percentage of students who actually attempted
suicide one or more times during the past 12
months
100
80
60
40
20
10.5
11.0
10.1
8.8
8.8
6.5
5.2
0
Total
Males
Females
9th
10th
11th
12th
QN26 - Weighted Data
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Statistics tell a story, and can help us know
when, how and where to intervene

• One child/youth dies each week
• Suicide is 2nd leading cause of death
• WI rate is 30 higher than US average
• More boys die than girls
• Method hanging until age 14, then guns
• More girls report depression
• Native-American children at highest risk
• Gay/Lesbian kids at high risk

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Parents and friends tell another story

• All different kinds of young people
• Sometimes they could see the risk factors, other
  times it was unexpected

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Risk Factors

• A prior suicide attempt
• Suicide threats ideation
• Exposure to suicide, directly or via media
• Detailed intentions for an attempt
• Depression, hopelessness
• Drug involvement and binge drinking
• Stressful life events
• Risky or impulsive behaviors
• Perceived school problems (perceived problems)

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WARNING IS PATH WARM?

• I Ideation (ideas/plans about suicide)
• S Substance Abuse
• P Purposelessness
• A Anxiety/Agitation
• T Trapped
• H Hopelessness
• W Withdrawal
• A Anger
• R Recklessness
• M Mood Changes
• American Association of Suicidology, 2006 Expert
  Consensus Statement, www.suicidology.org

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Suicide is usually impulsive in youth

• 25 of 153 survivors of near lethal suicide
  attempts acted within 5 minutes of the impulse to
  do so
• 71 acted within one hour
• Factors associated with the medical severity of
  suicide attempts in youths and young adults,
  Swahn MH, Potter LB, 2001

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Permanent Solution to Temporary Problem
On the bridge, Baldwin (age 28) counted to ten
and stayed frozen. He counted to ten again, then
vaulted over. I still see my hands coming off
the railing, he said. As he fell, Baldwin
recalls, I instantly realized that everything in
my life that Id thought was unfixable was
totally fixableexcept for having just
jumped. Jumpers The fatal grandeur of the
Golden Gate Bridge. by Tad Friend. New Yorker,
October 13, 2003.
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Suicide is not a destiny

• 90 of survivors of near-lethal suicide attempts
  do not COMPLETE suicide thereafter
• A young person who is not normally impulsive, and
  is showing impulsivity, may be at risk. Thats
  why we limit access to suicide methods like guns.
• Swahn MH, Potter LB. Factors associated with the
  medical severity of suicide attempts in youths
  and young adults. Suicide Life Threat Behav
  200132(1 Suppl)21-9

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Precipitating Factors

• Opportunities
• access to a gun (WI Tradition)
• periods without supervision
• Altered states of mind
• rage
• intoxication--binge drinking high correlate
• Undesirable life events
• loss of an interpersonal relationship
• pregnancy/fear of pregnancy
• physical sexual abuse
• humiliation (bullying) or reprimand

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The Suicide Equation

• Previous Mental Illness (Depression)
• Stressor (Loss, etc.)
• Opportunity (Firearm, Unsupervised)
• Possible Suicide Attempt

__________________________________________________
______
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What can we do???

• A1 biggest thing Restrict means for suicide
• Also
• Be open to helping children youth
• Know what to do
• Refer kids to people who can help in schools and
  communities

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The association between changes in household
firearm ownership and rates of suicide in the
United States, 19812002 M Miller, D Azrael, L
Hepburn, D Hemenway, S J Lippmann
Injury Prevention 200612178182 For every 10
decline in household gun ownership, there is an
8 decline in youth suicide
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Means Restriction is Golden!

• Firearms play a major role in suicide
• We promote safe storage
• 4 strategies each protect
• trigger locks/cabinets
• store unloaded
• lock ammo
• separate location
• (Grossman, JAMA 2/9/05)

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Protective Factors Help Too

• Important social resources
• strong interpersonal bonds
• social support
• sense of belonging
• dominant attitudes values prohibit suicide
• Important personal resources
• strong sense of self-worth self-esteem
• good cognitive skills
• sense of personal control
• self-management skills to deal with stress,
  anger and depression

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We Want You to ACT!

• AAcknowledge
• CCare
• TTell

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AcknowledgeGood Listening

• Do recognize difficulties, and can say
• That sounds really hard
• Im so sorry to hear about this
• Wow, youre really having a hard time
• Dont minimize feelings or say
• Get over it
• Give it time
• Its no big deal

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CareShow Care and Concern

• Do say
• I care about you and want you to be safe.
• Im really worried about this and I would hate
  for anything bad to happen to you
• Youre a neat kid and I wouldnt want you to
  make any bad decisions.
• Can say
• Suicide is a permanent solution to a temporary
  problem.
• Dont say You dont have the guts

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TellSomeone who can help

• Dont promise to keep secrets. Get help!
• Do say
• I know our school counselor Ms. ___ and shes
  helped a lot of students. Lets go talk with her
  together.
• Our school social worker Mr. ____ knows a lot
  about helping kids though hard times. Id like to
  introduce you to him.

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Who can you Tell?

• Pupil services providers in your school
• School Counselors, Psychologists, Social Workers,
  or Nurses
• Community Mental Health Providers
• Physicians
• Clergy

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EMERGENCY NUMBERS

• (800) SUICIDE
• (Local or National)
• (800) 273-TALK
• (National Suicide Prevention Lifeline)

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Good Legal News

• WI 118.01 requires schools to educate youth
  about suicide prevention
• WI 118.295 Suicide intervention civil liability
  exemption.  Any school board or CESA officer,
  employee or volunteer thereof, who in good faith
  attempts to prevent suicide by a pupil is immune
  from civil liability for his or her acts or
  omissions...

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Choking Game and Self-Harmnot usually suicidal
intent, but be careful

• Children choke each other and pass out
• Brief high or euphoric state
• High risk with a ligature and when alone
• Watch for marks on neck, eye problems
• Cutting is used to cope with stressors
• Externalizes internal pain/anger
• Episodic, gratifying
• Watch for marks on inner arm or leg

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Norms

• How many suicide attempts result in completed
  suicides among youth in WI?
• Compare this to US findings.
• Example 1 in how many attempts end in completed
  suicide?
• NOTE We get this ratio using YRBS data for
  attempts along with CDC data for completions.

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Lights, Camera, Action
school counselor
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Crisis Card

• Depression
• Suicide
• Hospital Emergency
• Poison Control Center
• Local Police

• 608-238-5175
• 608-280-2600
• 608-258-3214
• 608-262-3702
• 608-267-1109

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Other Resources

• Bully Prevention Curriculum
• Dating Violence Curriculum
• Mental Health Toolkit/Curriculum
• AFSP Promising Practices list
• www.afsp.org