Baseline Survey

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Baseline Survey
Before the training begins, please fill out the
baseline survey and put your completed survey in
the box provided. Thank you!
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Ending A Deadly Silence Florida Suicide
PreventionGatekeeper Training
Insert your name and agency
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What to Look For What to Do How to Help
Adapted with permission from the Washington State
Youth Suicide Prevention Program and the Maine
Youth Suicide Prevention Program
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Pieces of the Puzzle

• All need to be educated
• Willing to talk more openly
• when something in our gut
• raises a red flag
• Prevention is often a matter of a caring
• person with the right knowledge being
• available in the right place at the right
• time.

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Silent Epidemic

• Serious public health problem
• Preventable
• Neither random nor inevitable
• Research shows that during our lifetime
• 20 of us will have a suicide within our
• immediate family
• 60 of us will personally know someone who
• dies by suicide

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Attitudes and Beliefs Taboo Nature of
Suicide

• Taboo subjects suicide, rape, child abuse,
  mental illness, drug and alcohol abuse, incest
• Myths of Taboo Subjects
• History of suicide sin, crime, mental illness

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Truth or Myth Handout What Do You
Know About Suicide?
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Truth Or Myth
Survivors at lower risk MH professionals only
ones who can help More common with the rich No
correlation between drugs, alcohol and
suicide As many as 2 youth attempts to every
death
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Most suffer from depression More Floridians die
by suicide than homicide Most have made up their
minds More suicides during Christmas
holidays People who are suicidal tend to hide it

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Need to take all talk seriously Suicide rates
for 15-24 year olds have more than doubled since
the 1950s while other rates stayed about the
same Asking may encourage the idea Elderly have
the highest rate Important not to break the
trust of confidentiality
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Facts AboutAdolescent Suicide
Most teenagers will reveal they are suicidal
Ominous warning sign talking repeatedly about
ones own death Issues taught in a sensitive
educational context dont lead to or cause
suicide 9 out of 10 adolescents who die by
suicide give clues to others before their
suicide Source Youth Suicide Prevention
School-Based Guide, USF
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Parents are often unaware of their childs
suicidal behavior (86) Adolescent females
think about and attempt significantly more often
One of the most powerful predictors of suicide
is a prior attempt In a typical high school
classroom, it is probable that one boy and two
girls have made a suicide attempt during the
past year (AAS)
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Leading Causes of Death Among Young People
Accidents Homicide
Suicide Between the ages of 10 24, suicide is
the third leading cause of death. Source CDC
Final 2005 Data
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3
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Attempted Suicides
Attempts are most common among the young. 3
female attempts for each male attempt
Attempted Suicides
Suicides Deaths
Young 1001
Old 41
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Florida Statistics
3rd leading cause for 15-24 year olds
(2007) 2007 YRBS 25.7 felt sad or
hopeless, 11.2 seriously considered, 8.1 made
plan, 5.7 attempted, 2.1 made attempt requiring
medical attention Over 2,000 Floridians die by
suicide each year An average of 4 Florida youth
take their own life each week
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Not Just Statistics
Statistics alone dont paint the
whole picture
Suicide is devastating to family,
friends, and communities
Opportunities to help
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Understanding People in Crisis Why Everyone Is
Vulnerable
Stressors are infinite
Assets are finite
Pressures
Assets
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A Young Person May Feel They
Cant stop the pain Cant think clearly Cant
make decisions Cant sleep, eat or work Cant
make the sadness go away Cant see the future
without pain Cant see themselves as
worthwhile Cant get someones attention
Source AAS _at_ www.suicidology .org
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Cup Full of Problems
Each cup represents a problem that a young person
may be having. Only rule is that the
cups cannot be stacked inside one another.
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A Basic Model of Living
Pain Tolerance
Adaptive Factors
Maladaptive Factors
Pain Threshold
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When the pain tolerance threshold is broken
(when the pain is intolerable), dangerous
behaviors may follow.
Suicide
Drug Abuse
Psychotic Break
Violence
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Depression and Suicide
Depression often goes undiagnosed until a crisis
occurs Be concerned if significant changes are
noted, symptoms last 2 weeks or longer Change
in eating/sleeping, isolating, concentration
problems, feelings of hopelessness, irritability,
guilt, anger, vague physical complaints and
suicidal thoughts Source NAMI, What Families
Should Know about Adolescent Depression and
Treatment Options, May 2005
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The Reality Of It
12 million (1 in 10) suffer from mental illness
80 go without services 90 youth suicides had
a diagnosable, treatable mental disorder 65
of boys and 75 of girls in juvenile detention
have at least one psychiatric diagnosis Source
Surgeon General, 1999. IOM Report, 2002, Teplin
L. Archives of General Psychiatry, Vol. 59,
December 2002
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• Points to Consider (Group discussion)
• Why do adolescents kill themselves?
• What type of families do they come from?
• What type of thoughts/feelings are they
• having?
• How are they behaving?
• How are they communicating/expressing
• themselves?
• Who will know that they are suicidal?
• What changes in our culture or society
• have influenced youth suicide?
• What makes youth safe?

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Risk Factors Include
Previous suicide attempt exposure to suicidal
behavior/ family history of suicide Psychiatric
disorders depression, conduct, anxiety, impulse
disorders Alcohol/substance abuse Stressful
life event or loss Source National Youth
Violence Prevention Resource Center, 2000
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Physical, emotional, or sexual abuse Rejection,
harassment by peers (bullying) Loss of an
important relationship Sexual orientation Easy
access to lethal means Change in family
structure Problems at school Disciplinary
action or incarceration
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Warning Signs and CluesWhat To Look For
The red flags that something is wrong Changes
in a persons behavior, feelings, and beliefs
about oneself that are maladaptive or
out-of-character
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I Ideation S Substance Abuse
P Purposelessness A Anxiety T Trapped H
Hopelessness W Withdrawal A Anger R
Recklessness M Mood Change Source American
Association of Suicidology, November 2003
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Some Signs Demand Immediate Action
Talking or writing about suicide or death Verbal
clues open talk about suicide Isolating from
friends and family Putting affairs in order
giving away cherished possessions Exhibiting a
sudden and unexplained improvement after being
depressed Source The Suicide Prevention
Resource Center
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In Summary
There is no typical suicide victim There are no
absolute reasons for suicide There are no
all-inclusive predictive lists of warning signs
or a definitive method for determining if a young
person is or is not suicidal Suicide is always
multi-dimensional Most dont want to die they
want to end their pain
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Protective Factors

• Positive conditions and personal and
• social resources
• Promote resiliency and reduce the
• potential for suicide
• Ability to manage or cope with
• adversity or stress

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Youth Protective Factors

• Positive connections to school
• Coping and problem solving skills
• Academic achievement
• Family cohesion/stability
• Help-seeking behaviors
• Good relationships with other youth
• Positive self worth - confidence
• Impulse control conflict resolution abilities
• Social integration/opportunities to participate
• Access to care for mental/physical/substance
• disorders

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Being engaged in family, school and community is
a key to preventing youth suicide. Youths need
to feel comfortable, connected, respected and
supported by peers and adults.
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Academic problems Depression
Bullying victim Recent
significant loss Gun at home
Family cohesion Resiliency Self esteem Problem
solving skills Restricted access to lethal
means
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What to Look For

• What are some of the
  warning signs/red flags?
• What are the risk factors? Protective factors?
• What other information would be helpful?
• How could you get the information?
• Next step?

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• Personalizing Crisis Exercise
• What helps?
• What hurts?

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Intervention Steps and Goals
Get through crisis without harm Listen
establish rapport Identify and clarify
problem Pinpoint feelings evaluate hopelessness
Talk about suicide Evaluate lethality Identify
and utilize resources
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Remember
People in crisis feel overwhelmed, overloaded and
confused Not thinking clearly tunnel vision
Almost all are ambivalent Suicidal behavior is
an act of communication They want someone to
listen, someone they can trust, someone to
care Source National Center for Suicide
Prevention Training Workshop Maine Suicide
Prevention Program
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What To Do Intervention - 3 Basic Steps
SHOW YOU CARE ASK THE QUESTION GET
HELP Adapted with permission from the Washington
Youth Suicide Prevention Program
http//www.yspp.org
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SHOW YOU CARE
Trust your judgment Be Genuine - show them you
truly care Share observations and
concerns Concern can counter their sense of
hopelessness Reflect what you hear LISTEN!
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Bad News No script for these situations Good
News They may forget what you said, but they
will never forget how you made them feel. Carl
W. Buechner Dont worry about doing or saying
the right thing. Your genuine concern is what
is most important
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Ask The Question
Dont assume they arent the suicidal type
Be direct. What I hear you saying is youre
in a lot of pain and youre thinking of killing
yourself Are you thinking about
suicide? Do they have a plan, the means to
carry out the plan more detailed the plan
the greater the risk Dont have to
solve all their problems but you must get
help
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Suicide Paraphrase Activity
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Remain calm, non-judgmental and
understanding Emphasize the temporary
time-frame of suicidal crisis Emphasize the
normality of suicidal thoughts Help identify
and suggest alternatives, encourage positive
action
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Get Help - How To Help

• Your support in building hope and finding help
  truly can make the difference between life and
  death.
• If you have any reason to suspect a person may
  attempt suicide or engage in self-harm,
• DO NOT LEAVE THE PERSON ALONE

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Resources

• Supportive friends
• Family members
• Clergy/youth minister
• Mental Health Agency
• Counselor or therapist
• Family physician
• Local hospital emergency room
• Crisis Center 9-1-1
• 1-800-SUICIDE or 1-800-273-TALK

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When I began considering suicide, I knew that I
needed serious help. My resident advisor
helped me call a local hotline where I got some
good referrals. It was just a phone call, but it
was the starting point that got me to the
professional help I needed. Leah Source
National Institute of Mental Health What Do
These Students Have In Common?
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Additional Resources

• Wide range of local support groups- mental
  health, survivors, abuse
• Addiction Help Line 1-800-758-5877
• FL Abuse Hotline 1-800-96ABUSE
• Childrens Protective Services

• Substance Abuse programs
• Community health department
• Parent HelpLine at 800-352-5683
• YOUTHLINE at 1-877-968-8454

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Group Role Play What is Helpful Role Play

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Postvention Is Prevention
One of the primary goals of suicide postvention
is to prevent further suicides. Although rare, a
suicide in the community (or even a remote
suicide that receives substantial press coverage)
can contribute to an increased risk for suicide.
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Suicide Postvention

• Assist and support with processing reactions
  grief resolution
• Working to prevent additional suicides by
  attending to those at risk
• Identify and closely monitor those close to the
  victim and others known to be at risk (suicidal
  in the past) provide support/counseling as
  needed

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Survivors Of Suicide
Anyone whose life has been impacted by a suicide
death family, friends, co-workers those left
behind to pick up the pieces after the shattering
experience of a suicide death Survivors are
themselves at a higher risk for suicide and
emotional problems People grieve in different
ways - grieving can be postponed but never
avoided
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Stigma

• Survivors may find their social network, perhaps
  even their friends or clergy, have judgmental or
  condemning attitudes about suicide
• Cultural and religious taboos can serve to
  isolate and stigmatize survivors
• Lack of social support can increase survivors
  risk of complicated grief, depression and suicide

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Some Common Survivor Responses

• Shock, disbelief, fear, awkwardness
• Difficulty accepting the death was by suicide
• Feelings of rejection and abandonment
• Often hyper vigilant afraid of another
  loss/death

• Struggle to make sense of it
• Anger
• Guilt over failed responsibilities
• Isolation caused by self-imposed shame
• Blame

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Helping Survivors

• Patience for the time it takes to heal
• Listening without judging
• Accepting the intensity of the individuals grief
• Sensitivity to difficult times

• Acknowledging that the death is a suicide
• Providing information on suicide and grief
• Sharing memories
• Support groups - SOS

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Conclusion

• It doesnt take a
• professional to save a life
• We are all gatekeepers
• Preventing suicide is
• everyones business yours
• and mine
• Together we can end this
• deadly silence

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Thoughts or Questions Closing Comments
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Post-training Survey
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training evaluation form. Put completed forms in
the box provided.