Suicide: A tragic truth in our society today.

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Latina/o Youth and SuicideLuis Garcia,
Psy.D.Leticia Gutierrez-Lopez, Psy.D.Ninnette
Gutierrez, LCSWMay 17, 2007
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Suicide, A Global Issue

• In the year 2000, Approximately one million
  people died from suicide a global mortality
  rate of 16 per 100,000, which equals one suicide
  every 40 seconds.
• In less than half a century suicide rates have
  increased by 60 worldwide.
• Although suicide stems from manycomplex
  sociocultural factors 90 ofall cases are
  associated with mentaldisorders such as
  depression andsubstance abuse.

Source ? World Health Organization 2006
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Source ? World Health Organization 2006.
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Top 15 Countries with the Highest Suicide Rates
Suicide Rates per 100,000 by country, year, sex,
and total
Source ? World Health Organization 2006.
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Suicide In theUnited States

• The U.S. is ranked 43rd
• country in the world for
• suicide rates.

Source ? World Health Organization 2006.
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Top 15 ranked states in the US for suicide (2003).
(Rates are per 100,000 people)
Source National Vital Statistics Reports, Vol.
54, No.13, April, 2006
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Understanding Suicide In the U.S.

• In the year 2003 31,484 people committed suicide
  in the U.S.
• Suicide is the 11th ranked overall cause of death
  in the U.S. and is ranked 3rd in young age groups
  between the ages of 15-24. Also in children
  between the ages of 10-14 its fourth leading
  cause of death.
• Suicide is ranked higher than homicide which is
  ranked 15th leading cause of death.

Source American Association of Suicidology
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Timing of U.S.A. Suicides

• 1 suicide every 17 minutes
• (83 suicides per day)
• 12 young people between the ages of 15 and 24 die
  daily from suicide.
• Within every 2 hours and 2.5 minutes, a person
  under 25 completes suicide.

Source The Surgeon Generals Call To Action To
Prevent Suicide 1999 American Association of
Suicidology, 2003
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Methods of Suicide.

• Half of all suicides committed in the US are a
  result of the use of a firearm.
• Of the 31,484 suicides committed in 2003, 53.7
  or 16,907 of them involved the use of a firearm.
  
• The next leading method of suicide is hanging and
  suffocation which in 2003 was at 21.1 or 16,907
  suicides.
• Access to firearms is an important factor in the
  increases in youth suicide rates.

Source American Association of Suicidology.
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What about California?

• In 2003 California was ranked 42ndfor suicides
  in the U.S.
• CA that year had a rate of 9.6and a total 3,397
  suicides.
• Although California rate is ranked low at 42 it
  is the leading state in the total number of
  suicides.
• The only state that neared California in total
  number of suicides in 2003, was Florida with a
  total of 2,297 which is still a 1,000 less than
  Californias total.

Source National Vital Statistics Reports, Vol.
54, No.13, April, 2006
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Suicide in Los Angeles!

• In the year 2003, 732 people committed suicide in
  Los Angeles.
• In Los Angeles Suicide is the fourth most common
  mode of death behind natural, accidental, and
  homicidal deaths.
• Death rate of peoplewho committed Suicidein LA
  in 2003 was 7.3.

Source 2003 Los Angeles Coroner Report.
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Latina/o Adolescent Suicide
Data Attempts
Percentage of students by race/ethnicity and sex
Center for Disease Control and Prevention, 2004.
Data from self-report survey. 15,214 students,
grades 9-12 administered February-December 2003
43 states
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• Hispanic teenage girls attempt suicide more often
  than any other group.
• They tend to become young mothers at an early
  age
• They dont complete their education
• They are plagued by rising drug use and other
  social problems

A five-year study now in its second year in New
York is being led by Dr. Luis Zayas, Professor of
Social Work and Psychiatry at Washington
University
Source New York Times, July 21, 2006
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COSSMHO STUDY

• Houston, Texas
• Miami, Florida
• Washington, D.C.
• Los Angeles, California
• New York, New York
• Albuquerque, New Mexico

These cities are all characterized by
large Hispanic populations
(COSSMHO) National Coalition of Hispanic Health
and Human Services Organizations, Washington D.C.
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Representing the five Hispanic subgroups

• Mexican Americans
• Puerto Ricans
• Cuban Americans
• Central and South Americans
• Other Americans of Hispanic Origin

Source COSSMHO- The State of Hispanic Girls
(COSSMHO) National Coalition of Hispanic Health
and Human Services Organizations, Washington D.C.
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1999 National Rate of High School Girls
who Seriously Considered Suicide by Ethnicity

• Latina girlsrank highest in rates ofdepression
  and suicide
• Latina girlsrank highest in reportingseriously
  considering suicide

Source COSSHMO Report, The State of Hispanic
Girls, 1999
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NATIONAL ATTEMPTED SUICIDE RATE of High School
Age Girls by Ethnicity
In comparison to other ethnicitys Latina high
school girls remain most likely to.... ---
seriously consider --- make a concrete
plan for --- attempt suicide AT A HIGHER RATE
Source COSSHMO Report, The State of Hispanic
Girls, 1999
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Percentage of high school Latina girls in
comparison to Latino boys who seriously
considered attempting suicide

• Latina girls are more likely to seriously
  consider suicide than boys
• 23 of Latina girls considering suicide made a
  suicide plan
• 12 Latino boysconsidering suicidemade a
  suicide plan

Source NY State Psychiatry - Teen suicide, 2000
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Latino Future

• In 2001 the majority (50.6) of all babies born
  in CA were Latino
• Future students Latinos will be the majority in
  CA 2006 majority of children entering in
  kindergartens 2014 majority entering in high
  schools
• 2017 majority of new workers entering CA labor
  force
• 2019 majority of young adults ELIGIBLE TO VOTE

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Adolescent Suicide Risk Factors
Previous suicide attempt Presence of a
psychiatric disorder (depression, behavior
disorder, substance abuse) Family history of
suicide Exposure to others suicidality Signif
icant changes/losses Abuse(Physical, emotional,
sexual) Impulsivity, aggressivity, rage Family
loss or instability significant family
conflict(domestic violence, parents
divorce) Thoughts of suicide expressed
continuous talk of death or dying Source
American Association of Suicidology, Youth
Suicide Fact Sheet, 2003
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Warning Signs

• A Suicidal Person may
• Talk about suicide, death and/or no reason to
  live
• Be preoccupied with death and dying
• Withdraw from friends and/or social activities
• Have a recent severe loss (relationship) or
  threat of one
• Experience a drastic change in behaviors
• Lose interest in hobbies, work, school, etc.
• Make final arrangements a youth may give away
  valuable belongings

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Warning Signs (cont)

• Have attempted suicide before
• Take unnecessary risks be reckless, and/or
  impulsive
• Lose interest in their personal appearance
• Increase their use of alcohol or drugs
• Express a sense of hopelessness
• Be faced with a situation of humiliation or
  failure
• Have a history of violence or hostility
• Have been unwilling to connect with potential
  helpers
• Source American Association of Suicidology, 2003

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Important-Critical
Protective Factors

• Effective/appropriate clinical care for mental,
  physical and substance abuse disorders
• Easy access to a variety of clinical
  interventions, treatment, support for help
  seeking
• Restricted access to lethal methods of suicide
• Family and community support
• Support from ongoing medical and mental health
  care providers
• Learned skills in problem - solving and conflict
  resolution

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Pacific Clinics
Latina Youth Suicide Prevention Program Overview

• Congresswoman Grace Napolitano from the 38th
  Congressional District secured federal funding
  for a demonstration study program in Southeast
  Los Angeles County focusing on Latina adolescent
  suicide prevention.
• With funding through SAMHSA (Substance Abuse and
  Mental Health Services Administration) Pacific
  Clinics was appointed to be the lead agency in
  this program.
• The program began in August of 2001.

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LYP Program Goals

• Increase youth/family/teacher/community awareness
  of the high-risk youth behaviors associated with
  Latina suicides and/or attempts Done through
  Presentations.
• Assist family in becoming empowered to address
  key high-risk behaviors of suicide and substance
  abuse in their adolescent daughters Done through
  Parenting Courses and Educational Platicas
• Decrease stigma within the Latino community
  regarding the use of mental health and substance
  abuse treatment services
• Increase direct mental health services and
  substance use/abuse treatment service
  accessibility to Latina girls and their families
• Focus of Treatment is Early Prevention and
  Intervention

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Client DiagnosisYear One

• 71 suffered from Depression
• 12 suffered from Anxiety
• 11 Conduct problems
• 2 suffered from Bereavement
• 2 suffered from Eating Disorders
• 1 had been Sexually Abused
• 1 No Diagnosis

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Client DiagnosisYear Two

• 50.9 suffered from Depression
• 13.5 suffered from Anxiety
• 11 Conduct problems
• .08 suffered from Bereavement
• 2.4 suffered from a Psychotic Disorder
• 6.3 suffered from Attention Deficit Disorder
• 6.3 No Diagnosis

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Client DiagnosisYear Three

• 50.7 suffered from Depression
• 13.7 suffered from Anxiety
• 22.7 Conduct problems
• 3.3 suffered from Attention Deficit Disorder
• 9.8 No Diagnosis
• No Data for Year Four available similar numbers
  expected

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Client DiagnosisYear Five

• 51.7 suffered from Depression
• 17.0 suffered from Anxiety
• 23.6 Conduct problems
• 3.5 suffered from Attention Deficit Disorder
• 5.4 No Diagnosis

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Treatment

• Family-Focused Treatment We can not treat the
  child if we are not treating the entire family.
  Studies have shown that the child has a better
  prognosis when parents are actively involved in
  the treatment.
• Interventions All services offered in English
  Spanish
• Individual/Family therapy
• Case-Management Support Services
• Psychiatric Services (when appropriate important
  to educate and provide needed support in order to
  minimize fears re stigma about receiving these
  services)
• Group Therapy
• Adolescent Process Peer Groups(positive peer
  support good prognosis)
• Parent Educational Groups
• Parent Process Groups
• Parenting Classes

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Program Approach
Despite varying levels of acculturation, Latinos
are generally referred to as family oriented.
Research conducted by COSSMHO (1999), evidenced
that the majority of Latino Adolescents stated
that they would turn to their mother, father, or
sister, when they have a problem. Pacific
Clinics Latina Youth Program has adopted the
cultural values of Familismo, Respeto,
Collectivismo, and Personalismo (Maternal Child
Health Bureau, 1999) in its approach to
prevention.
Source COSSHMO Report, The State of Hispanic
Girls, 1999
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Familismo

• Immediate and extended members are the backbone
  of the community.
• Latino Culture values maintaining positive
  relationships with family members. IMPORTANT
  These relationships are viewed to be preventative
  and protective factors in the lives of young
  women and men, thereby reducing the incidence of
  high-risk behaviors that may lead to suicide.
• The program (LYP) emphasizes familismo in both
  peer and parent groups in discussing the value of
  positive communication and mutual respect.

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Collectivismo

• The nature of family values are extended into the
  community.
• Research shows that Latinos have a preference to
  work in groups and generally live in close knit
  communities.
• Mexican-American students thrive when working
  with others in groups, especially when involved
  in goal attaining activities.
• Collectivismo is demonstrated in the peer groups
  offered at Pacific Clinics.

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Personalismo

• Latinos place great value on interpersonal
  relationships, young people, particularly those
  in middle school may turn to families for advice.
• Program Staff will encourage youth participants
  to seek support and advise from significant
  others in their lives as opposed to relying on
  negative peer influence in their decision making.

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Respeto

• Emphasis is placed on social worth, bestowing
  ultimate decision making power on authority
  figures.
• The values of respect, positive communication,
  commitment, and appropriate expression of
  feelings are taught to program youth.
• Parents are provided with education in
  understanding the developmental needs of youth in
  establishing their autonomy as well as supported
  in trusting their parental skills thereby
  regaining appropriate control within the family
  system.

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Factors to Consider in the Engagement and
Outreach Process for Latinos from a Cultural
Perspective

• LANGUAGE
• Ability to communicate effectively, but
  informally in English and Spanish
• Knowledge and full acceptance of idiomatic
  expressions and levels of language comprehension

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ETHNICITY

• Unconditional acceptance of ethnic difference,
  class of status, country of origin, regional
  differences, mestizo syndrome, and color of skin

CULTURAL

• Myths
• Legal Status
• Economic (cultural poverty, lack of resources,
  lower education, idiosyncrasy about mental
  illness and alcohol and drugs)

• Values
• Beliefs
• Religion

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VALUES

• Respect for the values in the family system
• Role in the family (father, mother, son,
  daughter, etc.)
• Expectations within family members

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BELIEFS

• Health Beliefs
• Mystical Beliefs
• Witchcraft (Curanderismo)
• Faith Healers
• Medicinal Plants (Remedies)
• Trust factors of systematized medicine and mental
  health (public system VS private systems)

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RELIGION

• The will of God Lo que manda dios, fatalism,
  sacrafice. Esta es mi cruz, sanctity of
  marriage, spirituality, mysticism, (communion
  with God and spiritual truths) faith childlike
  trust, forgiveness, and destiny

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MYTHS

• Ideas about mental disorders
• Philosophy about alcohol and drugs

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LEGAL STATUS

• Immigrant
• Legal resident of the country

LEVELS OF ACCULTURATION

• Recent immigrants
• Lack of knowledge of the mental health system
• Unable to qualify for benefits available(Medi-Cal
  , SSI, Medicare, T.A.N.F.)

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MORE ON ENGAGEMENT

• Meeting where the client is at Pacific Clinics
  Centro Familiar (Home-site for Latina Youth
  Program) offers field-based services (in-home,
  in-school, library, community center, park,
  parent workplace, etc.)
• Incorporating all aspects of the youths life
  (with authorized consent) is crucial for
  engagement to happen(school, community, church,
  extended family members, friends, etc.)
• Pacific Clinic Staff make it a point to invest
  time up-front by making the first contact count
  (Josie Romero Best Clinical Models and
  Interventions for Latinos, 2003)
• As Josie Romero (2003) said The engaging
  process cannot be rushed. One has to engage the
  family by allowing them time to tell their story.
  At Pacific Clinics staff make sure that they
  give the families the opportunity to do this.
• Prevention and Engagement go hand in hand when
  dealing with Latino families and Suicide.

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MORE ON ENGAGEMENT

• When working with Latino adolescents and their
  families, It is important to understand that many
  times, the families are looking for respeto
  (respect), dignidad (dignity), confianza(trust)
  and cuidado (care).
• Engagement begins when the helper takes time to
  ask questions that help them understand where the
  client is coming from. It is at this point that
  the families begin to make a connection and feel
  comfortable enough to share their concerns
  regarding mental health treatment
• What country are you from?
• What are your cultural values and beliefs?
• What foods do you enjoy most?
• How long has your family been in the US?
• What are your thoughts/feelings about the
  services that we offer here? (Stigma is a big
  barrier to seeking out mental health services)
• Do you have any fears or concerns about
  receiving mental health services?
• Language Families have stated that they feel
  comfortable when the helper understands and
  speaks their language.
• Parent as well as Peer Platicas help decrease
  the stigma of receiving mental health services
  which leads to positive engagement.

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MORE ON ENGAGEMENT

• Enter the family system through the most
  influential person/s (Grandparent, Parent, School
  Coach, Sibling, etc.)
• Identify focus on strengths and then on their
  immediate needs/problems of the family At
  Pacific Clinics we try to get a good picture of
  any housing or financial needs and assist them
  family in that area first (if appropriate)
• Identify and use normal support systems when
  available Church, School, Extended Family,
  Friends, Community Leaders, etc.
• Empower client through education, information and
  coaching
• Increase family self-reliance
• Learn client and families world view and
  demonstrate respect for it
• It is important to ensure that your family
  leaves feeling welcomed, hopeful and understood
  after the first visit. According to Josie
  Romero(2003), this dramatically increases the
  chances of them returning and staying in
  treatment
• Source Josie Romero, 2003 Engaging
  Latino/Hispanic Families

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IMPORTANT Suicide is a serious public health
problem. We all need to work together and
collaborate with each other

• P.T.A.
• Substance Abuse Treatment Counselors
• Public Officials

• Law enforcement
• Educators
• Social Service Agencies
• Families
• Faith Community
• School Psychologist
• Child, Adolescent, Adult Psychiatrist

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REMEMBER

• Understanding risk factors can help dispel the
  myths that suicide is a random act, or results
  from stress alone.
• The impact of some risk factors can be reduced by
• interventions and clinical care for mental,
  physical and
• substance abuse disorders.
• Protective factors are critical and essential to
  reduce and prevent suicide !
• Positive resistance to suicide is not permanent
  and must be continually reinforced.
• Program (treatment), family and community
  support play a critical role in buffering Latina
  adolescents at risk of suicide.

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Thank You !
Together we can make a Difference!