The Many Paths to Suicide

1
The Many Paths to Suicide
Cause of Death
Proximal Risk Factors Triggers or Final Straws
Fundamental Risk Factors
Biological
Crisis in Relation
Poison
Genetic Load
Sex
Loss of Freedom
Gun
Race
Age
Personal/Psychological
Increasing Hopelessness Contemplation of
Suicide as Solution
Fired/ Expelled
Hanging
Values Religion Beliefs
Drugs or Alcohol
Culture Shock/ Shift
Child Abuse
Loss of Parent
WALL OF RESISTANCE
Illness
Autocide
Model for Suicide
Environmental
Urban vs. Rural
Major Loss
Geo-graphy
Jumping
Season of year
?
?

• All Causes are real.
• Hopelessness is the common pathway.
• Break the chain anywhere prevention.

2
Wall of Resistance to Suicide
Others?
Duty to others
Counselor or therapist
Fear
Medication Compliance
Good health
Responsibility for children
Job Security or Job Skills
Support of significant other(s)
Difficult Access to means
Positive Self-esteem
A sense of HOPE
Calm Environment
Religious Prohibition
AA or NA Sponsor
Pet(s)
Best Friend(s)
Safety Agreement
Treatment Availability
-- Sobriety --
Protective Factors
3
Suicidal Crisis Episode
Risk is Imminent
7 6 5
3 2 1
Risk Level
4
Initial Hazard is Encountered
Crisis Begins
Crisis Diminishes
Crisis Peaks
Stable
Stable
Years
Days
Hours
Days
Years
Approximately 3 weeks
4
Contagion Effect
Duration and Intensity of Risk Factors
Increases (2nd and 3rd suicides occur)
Risk Continues to Increase
Secondary Hazard Occurs (e.g. anniversary date)
First Suicide Occurs
Very High Risk
Initial Hazard Encountered
Crisis Continues
Higher Risk
Crisis Builds
Crisis Remains
High Risk
Risk Continues
Crisis Begins
Stable
Years
Hours
Days
Weeks
Mos/Yrs
Days
Weeks
Months
Months
Due to mounting losses, increasing frequency of
anniversary dates, role-modeling effects, and
building stress, the risk for additional
suicides can remain present for months and even
years.
VW/1998
5
The Lethal Triad
Upset Person
Alcohol/drugs
Firearm
When these three are presentrisk of violence is
high.
6
Disease Management Model for Suicidal Patients
Psychiatric Comorbid
Transient Illness
Psychological States Schizophrenia
Agitation Depressive Disorder
Perturbation Bipolar Disorder
Psychic Pain Panic Disorder
Hopelessness Substance Abuse Disorder
Dopamine Deficit Personality
Disorder Serotonin Deficit
Comorbid Physical Illness
Alcohol Myopia
WALL OF RESISTANCE
SUICIDAL BEHAVIORS
7
Six QPR Goals
Access Active Intervention Accompanied
Referral Alleviation of Immediate Risk
Factors Accurate Diagnosis Aggressive Treatment
We can make a difference!
8
Gatekeeper training research results

• Increased knowledge
• Increased recognition of sources of stress
• Increased confidence and competence in helping
  someone in crisis
• Increased likelihood to intervene
• Increased likelihood to call a resource
• Satisfaction with the training
• For every 13 gatekeepers trained, there was one
  referral made
• Knowledge and skills are retained
• over time
• QPR Works!