ASK ABOUT SUICIDE : To Save A Life

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ASK ABOUT SUICIDE To Save A Life
Clara Cáceres Contreras, B.S., M.Ed. Certified
Prevention Specialist School Health
Program Region One ESC ccontreras_at_esc1.net http//
www.esc1.net/schoolhealth 984-984-6125
TexasSuicidePrevention.org or MHATexas.org
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ASK Is A Gatekeeper Training Program

• ASK about Suicide
• to Save a Life
• is a Suicide Prevention Gatekeeper Training

• ASK -Question
• SEEK- Information (Keep Safe)
• KNOW -Where/how to Refer
• ASK is a process to offer HOPE to help prevent a
  tragic loss of life and NOT a form of counseling
  or treatment

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What do we know about suicide in TEXAS

• 2,433 Suicide Deaths in 2007
• 2,618 Suicide Deaths in 2008
• 2nd cause of death 25-34 year olds
• 3rd cause of death of teens and college aged
  youth (10-24 years), CDC Report 2009
• 90 died by suicide have an underlying mental
  health or substance abuse condition.
• It effects nearly 20 of those with bipolar
  disorder and 15 of those with schizophrenia

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Source Centers for Disease Control and
Prevention, WISQARS
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What do we know about suicide ?

• More Males Die by Suicide
• Females Attempt Suicide More
• Latina Female Teens have the highest attempts in
  the U.S.
• Highest death rate for both teens and adults is
  for White males.
• Note African American females have tended to
  have some of the lowest suicide death rates
  through the years.Why? Protective factors?
• (Data from suicidology.org, WISQARS, and Texas
  DSHS searchable database http//soupfin.tdh.state.
  tx.us/cgi-bin/death)

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What we DO know about suicide

• Public Health Perspective, it is considered to
  be one of the most preventable of deaths . IF
• We Recognize and Lower Risk Factors,
• Support Protective Factors
• Recognize Warning Signs and
• Are Trained and Ready to ASK?

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Death Statistics for Region One Age 5 to
14Intentional Self-Harm (Suicide)
  Year Year Year Year Year Year Year Year Year Year
  1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
County Number Number Number Number Number Number Number Number Number Number
Cameron County 1 0 0 0 0 0 1 0 0 0
Hidalgo County 0 0 0 1 1 0 0 1 0 1
Jim Hogg County 0 0 0 0 0 0 0 0 0 0
Starr County 0 0 1 0 0 0 0 0 0 0
Webb County 0 0 0 0 1 2 0 0 0 0
Willacy County 0 0 0 0 0 0 0 0 0 0
Zapata County 0 0 0 0 0 0 0 0 0 0
Texas 23 33 28 24 23 20 22 23 11 13
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Death Statistics for Region One Age 15 to
24Intentional Self-Harm (Suicide)
  Year Year Year Year Year Year Year Year Year Year
  1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
County Number Number Number Number Number Number Number Number Number Number
Cameron County 0 0 2 2 2 0 3 1 1 4
Hidalgo County 2 5 6 6 7 3 5 8 5 5
Jim Hogg County 0 0 0 0 0 0 0 0 0 0
Starr County 1 2 0 1 0 0 3 3 1 1
Webb County 2 3 5 1 8 5 4 0 6 5
Willacy County 0 0 0 0 0 0 0 0 0 0
Zapata County 1 0 0 0 0 0 0 0 0 1
Texas 287 346 321 322 348 335 366 344 356 337
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(discuss handout)
YRBSS DATA by State and County
Tx DSHS death statistics searchable database
online. (see directions for using it in
TexasSuicidePrevention.org Coming Together to
Care A Suicide Prevention Toolkit for Texas )
ASK
www. TexasSuicidePrevention.org
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http//www.cdc.gov/ViolencePrevention/suicide/
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Region One 400,000 Students 100, 000 High
School Students

• 100,000 X .277 27,700 Depressed
• 100,000 X .137 13,700 Considered
• 100,000 X .103 10,300 Plans
• 100,000 X .074 7,400 Attempted
• 100,000 X .021 2,100 Hurt so bad, need
  medical help

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Question 1

• Have you felt sad or hopeless almost every day
  in a row for two weeks or greater so that it
  affected your usual activities in the past twelve
  months?
• Nationally 26.1 - Over 1 out of every 4 Students
• Texas 27.7 - Almost 1 out of 4 battled the
  start of depression
• High School

of students multiplied by .277 _____
students are depressed
http//www.cdc.gov/ViolencePrevention/suicide/
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Question 2

• Have you seriously considered suicide in the
  past twelve months?
• Nationally 13.8 - Almost 1 out of every 7
  students
• Texas 13.7 Over 1 out of every 7 seriously
  considered suicide
• High School -

.
of students multiplied by .137 _____
students are depressed
http//www.cdc.gov/ViolencePrevention/suicide/
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Question 3

• Have you made a plan on how to commit suicide in
  the past twelve months?
• Nationally 10.9 -1 out of every 10 students
• Texas 10.3 - 1 out of every 10 seriously made
  a plan to commit suicide
• High School -

of students multiplied by .103 _____
students are depressed
http//www.cdc.gov/ViolencePrevention/suicide/
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Question 4

• Have you attempted suicide one or more times in
  the past twelve months?
• Nationally 6.3
• Almost 1 out of every 14 Students
• Texas 7.4 More than 1 out of 14 attempted
  suicide
• High School - ?

of students multiplied by .074 _____
students are depressed
http//www.cdc.gov/ViolencePrevention/suicide/
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Risk Factors

• Risk Factors are stressful events, situations,
  or conditions in a persons life that may
  increase the likelihood of attempting or dying by
  suicide.

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Underlying Risk Factors
ASK
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Protective Factors(can act as safety lines)

• Protective factors are the positive conditions,
  personal and social resources that promote
  resiliency and reduce the potential for suicide
  as well as other high-risk behaviors.

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Protective Factors

• Connections to family and community support
• Ongoing medical and mental health care
  relationships
• Skills in problem solving, conflict resolution
  and nonviolent handling of disputes
• Cultural and religious beliefs that discourage
  suicide and support self preservation

• Clinical care mental, physical and substance use
  
• Access to clinical interventions and support for
  help seeking
• Restricted access to highly lethal means of
  suicide

 
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Entering Suicidal Zone
When risk factors are high and protective factors
are low, proximal risk factors (or stressors) can
interact with a persons long term or underlying
risks so that a person gets into a suicidal
zone.
.
ASK
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Suicidal Zone (time limited)
The good news is, the period in the suicidal zone
or the heightened period of suicidality tends to
be short term (a matter of hours or days) so any
intervention in this time period can save a life.
.
ASK
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IM SUICIDAL
Suicide can be prevented. While some suicides
occur without any outward warning, most people
who are suicidal do give warnings.
.
ASK
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Warning Signs Communicated Verbally or
Nonverbally

• Direct and Indirect Verbal Signs
• I want to kill myself.
• Ive been thinking about suicide.
• I just want out. I cant take it anymore.
• I feel hopelessits not worth living.
• People would be better off without me.
• Sometimes I just want to go to sleep and not
  wake up.

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Warning Signs Behavior

• Just leave me alone I dont want to leave my
  room.
• I cant sleep and have been really wired for
  past few weeks!
• All I want to do is sleep all the time
• I just wish I could get back at the people who
  did this to me!

• I just want to stay stoned.. maybe forever.
• Do you know where I can get a gun? OR Where
  does Mom keep her anti-anxiety pills
• Please take my CD collection, Im not going to
  need it anymore.

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Other Warning Signs Chronic or Moderate Risk

• Feelings (5 Main Ones)
• No reason for living/no sense of purpose in life
• Feeling trapped, like theres no way out
• Hopelessness
• Dramatic mood changes (high or low)
• Anxiety/agitation
• From Suicide Prevention Resource Center,
  (sprc.org), Best Practice Registry Section II

• Behavior (5 Main Ones)
• Increased substance abuse
• Withdrawal from friends/family/society
• Rage/anger/revenge
• Reckless or Risky activities
• Unable to sleep or sleeping all the time

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Other Warning Signs Moderate or Chronic Degree
Risk

• MODERATE/CHRONIC
• RISK
• Take All Signs Seriously
• Refer to a Mental Health Professional
• Call 1-800-273-TALK (8255)for a referral

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Direct Suicidal Communication/Behavior
Acute/High Degree of Risk

• The best practice registry consensus statement
  lists two levels of warning signs
• Acute Risk includes
• Threatening to hurt or kill himself or talking
  of wanting to hurt or kill him/herself and/or,
• Looking for ways to kill him/herself by seeking
  access to firearms, available pills, or other
  means and/or,
• Talking or writing about death, dying or
  suicide Source Suicide Prevention Resource
  Center, (sprc.org), Best Practice Registry
  Section I

From Suicide Prevention Resource Center, Best
Practices Registry Section II.
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Direct Suicidal Communication/BehaviorAcute Risk
HIGH RISKTAKE ACTION NOW!1-Take Immediate
Action2 Keep Safe / Do Not Leave Alone 3 Call
911 or seek Immediate help from a mental health
provider at school or in community (or call
your mobile crisis outreach team, or take to
nearest hospital emergency room)
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What Can You Do

• Take the following 3 steps
• ASK About suicide?
• Seek More Information/ Keep Safe
• 3. Know Where and How to Refer
• (Take action!)

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ASKING -1ST Step

• REMEMBER
• Asking about suicide does not put the thought of
  killing themselves in someones head but gives
  them a sense of relief that someone is finally
  hearing them and will LISTEN.

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Step 1 How to Ask About Suicide

• Indirect
• Sometimes when people are sad as you are, they
  think about suicide. Have you ever thought about
  it?
• Do you ever want to go to bed and never wake up?

• Direct
• Have you thought about suicide?
• Do you want to kill yourself?
• Are you thinking about suicide?

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Step 1 How to Ask About Suicide

• Dont say

• Be Aware
• Of your non-verbal cues.
• How you ask is not as important as ASKING
• itself. If you cant do it, find someone who
  can.

• Youre NOT thinking of suicide, or you?
• You wouldnt do something really stupid, would
  you?

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Step 2 SEEK more Information Keep SAFE
1.Seek a private area to talk 2.Seek to
establish a relationship 3.Comment on what you
see and observe non-judgmentally 4. Be curious
about their perceived problem, find out how long
theyve thought about suicide, if theyve
attempted suicide in past and if tried to get
help
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STEP 2 SEEK more Information Keep SAFE
5. Seek to find out if they are at immediate
high risk of suicide (have a plan) (rehearsing it
in their mind) and/or (have a gun, access to
pills or other means) and take immediate steps to
limit access to means and assure safety if
YES. 6. Find out who and where they normally go
to for help (family, friends, pastor, neighbor,
roommate, girl/boy friend) 7. Find out if they
have a regular doctor, mental health provider or
counselor. 9. Be sure to be aware of your own
non-verbal reactions and tone of voice!
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STEP 3 KNOW How and Where to Refer?

• The third step in the referral process is to KNOW
  where to refer nationally, in Texas and in your
  area, your school or your community.
• National Suicide Prevention Lifeline
• 1-800-273-TALK\1-800-273- 8255
• SAVE A NUMBER TO SAVE A LIFE

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STEP 3 KNOW Where to Refer in Texas Local
Area

• 911s, Hospitals, Law Enforcement and Mobile
  Crisis Outreach Teams
• In an immediate risk, call 911, your local
  police, campus police, or the sheriffs office or
  take the person to the nearest hospital emergency
  room. (Keep a list of nearest hospital emergency
  rooms on your referral card/sheet.)
• Note Many Texas law enforcement agencies have
  officers trained in mental health. You can ask
  for a mental health officer.
• Note Many Texas communities have mobile crisis
  outreach teamsfind out if there is one in your
  area and their contact number.

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STEP 3 KNOW Where to Refer in Texas Local
Area
Texas Crisis Line Options   All MHMRs/LMHA in the
State of Texas are required to provide a 24-hour
crisis line for their service area (which may be
a county or a region of counties) and these lines
are required to be certified by the American
Association of Suicidology. To find the number
to the MHMR crisis line closest to you, log onto
the DSHS website, www.dshs.state.tx.us, under
Reference Center or go to TexasSuicidePrevention.o
rg and look for crisis centers in the appendix
for your county.
(Discuss local referral lists and/or action plans)
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Remember
YOU CAN SAVE A LIFE

• Ask about suicide
• Seek more information Keep SAFE
• Know how and where to refer
• Questions from audience AND
• Share Successful Intervention Postvention
  Stories
• Please fill out the evaluation forms with the
  number 2 pencil provided

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Texas Education Code 11.252 District-Level
Planning and Decision-Making
  (a) Each school district shall have a district
improvement plan that is developed, evaluated,
and revised annually, in accordance with district
policy, by the superintendent with the assistance
of the district-level committee established under
Section 11.251. The purpose of the district
improvement plan is to guide district and campus
staff in the improvement of student performance
for all student groups in order to attain state
standards in respect to the student achievement
indicators adopted under Section 39.053 . The
district improvement plan must include provisions
for (3) strategies for improvement of
student performance that include (B) methods
for addressing the needs of students for special
programs, such as suicide prevention, conflict
resolution, violence prevention, or dyslexia
treatment programs
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Early Mental Health Intervention and Suicide
Prevention- HB 1386

• The Texas Dept of state Health Services and TEA
  will issue a list of suicide prevention programs
  that districts must select from to implement in
  all grade levels.
• Once the district approves a program, teachers,
  counselors, nurses, administrators and other
  staff must be trained
• Establish procedures for identification and
  referral in a timely manner
• May designate one person to act as a liaison
  officer for the distirct
• Sets counseling options

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Early Mental Health Intervention and Suicide
Prevention- HB 1386

• Components will include
• Recognizing students who are at risk of
  committing suicide, including students who are or
  may be the victims of or who engage in bullying
• Appropriate Intervention proper reporting to
  notifying parents mental health services
• May adopt policy and any necessary procedures
  must be included in
• (1)the annual student handbook and
• (2)the district improvement plan under Section

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SUICIDE POSTVENTION

• Definition
• The provision of crisis intervention, support
  and assistance for those affected by a suicide.

American Association of Suicidology, 1998
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SUICIDE POSTVENTION GOALS

• Support the grieving process (Hazell, 1993
  Underwood and Dunne-Maxim, 1997).
• Prevent imitative suicides (Hazell, 1993
  Underwood and Dunn-Maxim, 1997).
• -Identify and refer at-risk survivors (Gould
  and Kramer, 2001)
• -Reduce identification with victim
• Reestablish healthy school climate (King, 2001).
• Provide long-term surveillance (Gould and Kramer,
  2001).

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SCHOOL SUICIDE POSTVENTIONKEY MESSAGES

• Points to emphasize to students, parents, media
  (including online).
• Prevention (warning signs, risk factors)
• No one thing/person is to blame
• Mental illness etiology
• Normalize anger (Clark, 2001)
• Stress alternatives
• Help is available

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SCHOOL SUICIDE POSTVENTION RESPONSE PROTOCOL

• Verify suicide
• Contact family of suicide victim
• Determine what and how information is to be
  shared
• Mobilize the crisis response team
• Inform faculty and staff
• Assess the impact on the school
• Identify at risk students/staff
• Addition Identify what is and has been shared
  on internet and/or social networking sites.

School Mental Health Project, Dept. of
Psychology, UCLA, 2003
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SCHOOL SUICIDE POSTVENTION RESPONSE PROTOCOL

• Notify parents of highly affected students
• Provide recommendations for community-based
  mental health services
• Conduct faculty planning session
• Hold evening meeting for parents
• Provide information on community- based funeral
  services/memorials
• Collaborate with media, law enforcement and
  community agencies

School Mental Health Project, Dept. of
Psychology, UCLA, 2003
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MEMORIAL ACTIVITIESFOLLOWING SUICIDE

• Dont conduct on campus memorial services
• Provide opportunity for small group/individual
  discussion
• Dont glorify act
• Avoid mass assemblies focusing on victim
• Dont establish permanent memorials to victim
• Dont dedicate yearbooks, songs, or sporting
  events to the suicide victim
• Establish school policies which treat all youth
  deaths in similar manner
• Establish school policies to discourage t-shirts
  or other student memorializing which might
  disrupt/disturb other high, risk students
• Frank Zenere, Postvention Training, Austin, Tx
  2007-2008

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Online Resources for Helphttp//www.suicidepreven
tionlifeline.org/

• National Suicide Prevention Lifeline
• 1-800-273-TALK
• 1-800-273-8255
• Model message to post online following a death
  by suicide
• Model letter to parents re their dead childs
  FB or MySpace page
• Steps to take to intervene
• Lifeline Avatar Gallery
• YouTube videos PSAs to download

• Lifeline in New YouTube Abuse and Safety Center
• What to do if someone is at risk for suicide
• What to do if harmful messages are posted
• Has warning signs for suicide and Lifeline

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• The National Suicide Prevention Resource Center
  lists best practice programs guidelines
  www.SPRC.ORG
• Mental Health America of Texas has downloadable
  brochures for teens, educators parents
  www.Mhatexas.org
• American Association of Suicidology
  www.Suicidology.org
• American Foundation for Suicide Prevention
  www.afsp.org
• AT Risk Avatar Simulation www.kognitocampus.com/
  faculty/
• The Jason Foundation, Inc.
• www.jasonfoundation.com/
• School Based Youth Suicide Prevention
• http//theguide.fmhi.usf.edu
• Sesame Street Grief, Emotions, Feelings-Video
• www.sesamestreet.org

Texas Suicide Prevention Council 17 local
coalitions and 18 statewide associations with
online toolkit www.TexasSuicidePrevention.org