Prepared by:

1
Suicide Prevention

• Prepared by
• Jim Messina, Ph.D.
• Clinical Director Be-COS Inc.

2
Suicide Facts

1. Tenth leading cause of death in America - in 2009
   there were 36,909 suicides (100.8 suicides per
   day 1 suicide every 14.3 minutes)
2. 3.7 times more males than female commit suicide
3. Rates of suicide are highest among the elderly
   80 years or older which is 50 higher than that
   of the nation as a whole (all ages)
4. Suicides ranks as 3rd cause of death among young
   (15-24) Americans behind accidents and homicides
5. Firearms are most commonly utilized method of
   completing suicide in all groups More than
   50.8 used this method
6. Poisoning is most common method of suicide for
   women
7. Caucasians (13.5 per 1000) have higher rate of
   completed suicides than African Americans (5.1
   per 1000)
8. In the past year adults reported more than 8
   million having serious suicidal thoughts 2.5
   million making suicide plan and 1.1 million
   suicide attempts
9. Suicide rates traditionally decrease in times of
   war and increase in economic crises

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Suicide 10th Leading Cause of Death
4
Research on Suicide

1. Estimated 25 attempts for each death by suicide
2. Risk of attempted suicide (non-fatal) greatest
   among females and the young
3. Ratios of attempted to complete suicides for
   youth estimated between 100-200 to 1
4. 90 of completed suicides had one or more mental
   disorder
5. Diagnoses with greatest risk depression,
   schizophrenia, drug and/or chemical dependency
   and conduct disorders (in adolescents)
6. Risk of suicide increased by more than 50 for
   depressed individuals 60 of completed suicides
   
7. Risk of suicide in alcoholic is 50 to 70 higher
   than general population
8. Feelings of hopelessness (no solution to my
   problem) found to be more predictive of suicide
   risk than a diagnosis of depression per se
9. Socially isolated individuals are generally found
   to be higher risk for suicide
10. Vast majority of individuals who are suicidal
    often display cues warning signs

5
Who are at risk for suicidal behavior

• Individuals
• With mental and/or substance use disorder
• Bereaved by suicide
• In justice and child welfare settings
• who engage in non-suicidal self-injury
• Who have attempted suicide
• With medical conditions
• Who are lesbian, gay, bisexual or transgender
  (LGBT)
• Who are American Indians/Alaska Natives
• Who are members of the Armed Forces and veterans
• Who are men in midlife and older men

6
Warning Signs of Suicide

• IS PATH WARM?
• I Ideation
• S Substance abuse
• P Purposelessness
• A Anxiety
• T Trapped
• H Hopelessness
• W Withdrawal
• A Anger
• R Recklessness
• M Mood Change

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Acute Risk for Suicide

• Warning signs of Acute Risk
• Threatening to hurt or kill self or talking of
  wanting to hurt self
• Looking for ways to kill self by seeking access
  to firearms, available pills, or other means
• Talking or writing about death, dying or suicide
  when these actions are out of the ordinary

8
Additional Warning Signs

• Increased substance (alcohol or drugs) use
• No reason for living no sense of purpose in life
• Anxiety, agitation, unable to sleep or sleeping
  all the time
• Feeling trapped like there is no way out
• Hopelessness
• Withdrawal from friends, family and society
• Rage, uncontrolled anger, seeking revenge
• Acting reckless or engaging in risky activities,
  seemingly without thinking
• Dramatic mood change

9
Major Risk vs. Protective Factors

• Major risk factors for Suicide
• Prior suicide attempt(s)
• Substance abuse
• Mood disorders
• Access to lethal means
• Major Protective Factors
• Effective mental health care
• Connectedness to individuals, family, community
  social institutions
• Problem-solving skills
• Contracts with caregivers

10
Depression and Suicidal Thinking

1. Major Depression is most commonly associated with
   suicide
2. The risk of suicide in people with major
   depression is about 20 times that of the general
   population
3. Lifetime risk of suicide among patients with
   untreated depressive disorder is nearly 20
   (Gotlib Hammen, 2002)
4. Suicide risk among treated patients with
   depression is 141 per 100,000 (Isacsson et al.,
   2000)
5. About 2/3 of people who complete suicide are
   depressed at the time of their deaths
6. About 7 out of every 100 men and 1 out of every
   100 women who have been diagnosed with depression
   in their lifetime will go on to complete suicide
7. People with multiple episodes of depression are
   at greater risk for suicide than those who have a
   single episode
8. People who have dependence on alcohol or drugs in
   addition to being depressed are at greater risk
   for suicide

11
How to Identify a Suicidal Person

• Talks about suicide, death, and/or no reason to
  live feeling trapped or in unbearable pain
  being a burden to others
• Is preoccupied with death and dying looking for
  a way to kill oneself
• Withdraws from friends and/or social activities
  or feels isolated
• Has a recent severe loss (esp. relationship) or
  threat of a significant loss
• Experiences drastic changes in behavior
• Loses interest in hobbies, work, school, etc.
• Prepares for death by making out a will
  (unexpectedly) and final arrangements
• Gives away prized possessions
• Has attempted suicide before
• Takes unnecessary risks is reckless and/or
  impulsive
• Loses interest in personal appearance
• Increasing use of alcohol or drugs
• Expresses a sense of or is faced with a situation
  of humiliation or failure
• Has a history of violence or hostility or showing
  rage or talking about seeing revenge
• Has been unwilling to connect with potential
  helpers

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What you can do

• If you believe someone is at risk of suicide
• Ask them if they are thinking about killing
  themselves (This will not put this idea in their
  heads, or make it more likely they will attempt
  suicide)
• Take the person to the emergency room and seek
  help from a medical or mental health professional
• Remove any objects that could be used in a
  suicide attempt
• If possible do not leave the person alone
• Call the Suicide Hotline of the U.S. National
  Suicide Prevention Lifeline 800-273-TALK (8255)
• Figure out the Lethality of the Suicidal Gesture

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Questions to Ask to Rule Out the Lethality of the
Suicide Threat

• How lethal are the suicidal thoughts, gestures,
  or actions which the person is engaged in? To
  figure out how lethal, answer the following
• Does the person have a means of suicide in mind?
• Is this means of suicide readily available to
  person at this time?
• Is this an effective way to kill oneself?
• Have person ever used this means before to
  attempt suicide in the past?
• Is person ready to use this means of suicide at
  this time?
• Is nobody living with person at this time who can
  take control of this means of person killing
  self?
• If you answered yes to all six items then the
  person is very lethal and needs immediate help
  and make sure to get a counselor or crisis center
  involved as soon as possible
• Lastly Call the Suicide Hotline of the U.S.
  National Suicide Prevention Lifeline
  800-273-TALK (8255)

14
1st Myth Truth in Suicide Prevention

• Myth Asking about suicide will plant the idea in
  a persons head.
• Reality Asking about suicide does not create
  suicidal thoughts. The act of asking the
  question simply gives the person permission to
  talk about his or her thoughts or feelings.

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2nd Myth Truth in Suicide Prevention

• Myth People who talk about suicide don't
  complete suicide.
• Reality Many people who die by suicide have
  given definite warnings to family and friends of
  their intentions. Always take any comment about
  suicide seriously.

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3rd Myth Truth in Suicide Prevention

• Myth There are talkers and there are doers.
• Reality Most people who die by suicide have
  communicated some intent. Someone who talks about
  suicide gives the guide and/or clinician an
  opportunity to intervene before suicidal
  behaviors occur.

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4th Myth Truth in Suicide Prevention

• Myth Suicide happens without warning.
• Reality Most suicidal people give clues and
  signs regarding their suicidal intentions.

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5th Myth Truth in Suicide Prevention

• Myth Suicidal people are fully intent on dying.
• Reality Most suicidal people are undecided about
  living or dying, which is called suicidal
  ambivalence. A part of them wants to live
  however, death seems like the only way out of
  their pain and suffering. They may allow
  themselves to "gamble with death," leaving it up
  to others to save them.

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6th Myth Truth in Suicide Prevention

• Myth If somebody really wants to die by suicide,
  there is nothing you can do about it.
• Reality Most suicidal ideas are associated with
  treatable disorders. Helping someone find a safe
  environment for treatment can save a life. The
  acute risk for suicide is often time-limited. If
  you can help the person survive the immediate
  crisis and overcome the strong intent to die by
  suicide, you have gone a long way toward
  promoting a positive outcome.

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7th Myth Truth in Suicide Prevention

• Myth He/she really wouldn't commit suicide
  because
• he just made plans for a vacation
• she has young children at home
• he made a verbal or written promise
• she knows how dearly her family loves her
• Reality The intent to die can override any
  rational thinking. Someone experiencing suicidal
  ideation or intent must be taken seriously and
  referred to a clinical provider who can further
  evaluate his/her condition and provide treatment
  as appropriate.

21
8th Myth Truth in Suicide Prevention

• Myth Asking a depressed person about suicide
  will push him/her to complete suicide.
• Reality Studies have shown that patients with
  depression have these ideas and talking about
  them does not increase the risk of them taking
  their own life.

22
9th Myth Truth in Suicide Prevention

• Myth Improvement following a suicide attempt or
  crisis means that the risk is over.
• Reality Most suicides occur within days or weeks
  of "improvement," when the individual has the
  energy and motivation to actually follow through
  with his/her suicidal thoughts. The highest
  suicide rates are immediately after a
  hospitalization for a suicide attempt.

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10th Myth Truth in Suicide Prevention

• Myth Once a person attempts suicide, the pain
  and shame he/she experiences afterward will keep
  him/her from trying again.
• Reality The most common psychiatric illness that
  ends in suicide is Major Depression, a recurring
  illness. Every time a patient gets depressed, the
  risk of suicide returns.

24
11th Myth Truth in Suicide Prevention

• Myth Sometimes a bad event can push a person to
  complete suicide.
• Reality Suicide results from having a serious
  psychiatric disorder. A single event may just be
  the last straw.

25
12th Myth Truth in Suicide Prevention

• Myth Suicide occurs in great numbers around
  holidays in November and December.
• Reality Highest rates of suicide are in May or
  June, while the lowest rates are in December.

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In Conclusion

• Prevention may be a matter of a caring person
  with the right knowledge being available in the
  right place at the right time.
• Are You Ready?

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Resources on Suicide Prevention

1. National Suicide Prevention Lifeline
   http//www.suicidepreventionlifeline.org/
2. CDCs Suicide Prevention http//www.cdc.gov/Viole
   ncePrevention/suicide/index.html
3. Surgeon Generals Suicide Prevention Strategy
   2012 http//www.surgeongeneral.gov/library/report
   s/national-strategy-suicide-prevention/index.html
4. American Society of Suicidology
   http//www.suicidology.org/home
5. SAMSHA Suicide Prevention http//www.samhsa.gov/p
   revention/suicide.aspx
6. Veterans Crisis Line http//veteranscrisisline.ne
   t/
7. VA Suicide Prevention http//www.mentalhealth.va.
   gov/suicide_prevention/index.asp
8. DoD/VA Suicide Outreach http//www.suicideoutreac
   h.org/
9. SPRC-Suicide Prevention Resource Center
   http//www.sprc.org/
10. National Alliance for Suicide Prevention
    http//actionallianceforsuicideprevention.org/
11. American Foundation for Suicide Prevention
    http//www.afsp.org/
12. YSPP-Youth Suicide Prevention Program
    http//www.yspp.org/
13. SAVE-Suicide Awareness Voices of Education
    http//www.save.org/
14. Yellow Ribbon Suicide Prevention Programs
    http//www.yellowribbon.org/