Maine Suicide Prevention Program Before you begin: This PowerPoint contains 2 slides that focus on risk and protective factors for specific populations

Maine Suicide Prevention Program

Before you begin:This PowerPoint contains 2 slides that focus on risk and protective factors for specific populations that may not apply to those represented in your school

(slides 21 and 22). The intent is that you choose the slides from this section that are of the greatest import to the community you are training in. You can even

consider adding another population to focus on. For example, the “ suicide in the young” focus would be good for elementary and middle school, but not high

school. The other slides would simply be “hidden” for the presentation and could be used at another time when appropriate. Please leave the slide on LGBTQ

youth in the presentation.If you are looking for additional information on specific populations please feel

free to contact:Heather Carter, Sr. Trainer, [email protected]

mailto:[email protected]


Suicide Prevention Awareness Session: YouthMaine Suicide Prevention Program

Education, Resources and Support—It’s Up to All of Us.


• Beliefs about suicide• How to talk about suicide• The facts• Warning signs and risk factors• Basic intervention skills to use with suicidal behavior• Resources for Help• The aftermath of suicidal behavior

Today’s Program Will Cover

Maine Suicide Prevention Program Looking at the Myths vs. Facts:

True or False. . .

• Talking openly about suicide will cause it.• Anyone can learn to help someone who is struggling with thoughts

of suicide.• If someone decides that they want to take their own life, there’s

nothing we can do to stop them.• If someone talks about it they don’t need to be taken seriously.• There are signs that we can look for that may indicate someone is

considering suicide.

Maine Suicide Prevention Program Our Words Reflect Our Beliefs

Preferred:Simply use:

• “suicide”• “died by/of suicide”• “suicide attempt”


Facts About Suicide in US, 2012• 40,600 Americans died by suicide; about 1 person every 13.0 minutes• Suicide deaths are twice the number of homicides nationally

(homicides=16,688)• 10th leading cause of death across the lifespan

• 2nd leading cause of death for 15-24 year olds• Men account for 78.5% suicides in the US

• 3 Female attempts per male attempt• Veterans account for 20% of suicides in the US• Since 2009, suicides have exceeded motor vehicle crash related deaths

6

Annual Age-Adjusted Suicide Rates: Maine, the Northeast and United States, 2000-2012

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011* 2012*0

5

10

15

20

25

Maine Northeast U.S.

Year

Age

-Adj

uste

d Su

icid

e D

eath

Rat

e (p

er 1

00,0

00 p

opul

ation

)

Source: Maine Suicide Prevention Program,Maine Research, Data & Vital Statistics, WISQARS *2011 and 2012 Maine data are preliminary


• The leading cause of injury death• 2nd leading cause of death ages 15-34• Suicide deaths 8x homicide deaths• Every 1.8 days someone dies by suicide• Every 2 weeks a young person dies (<25)• 201 suicide deaths per year on average• Of every 5 suicides, 4 are males • Females attempt suicide 3x as often as males • A firearm is the most prevalent method of suicide (53%)

Suicide in Maine, 2008-2012


Attempted Suicides

Suicide

Attempted Suicides


85+

Attempted Suicides Suicide

Young

100-200:1

75+

4:1

Attempted Suicide & Age

MIYHS self-reported data 2013: High School Students

Total Female Male Hispanic Native American Lesbian Gay Bisexual0

10

20

30

40

50

60

70

80

17.9

11.8

24.125.8

29.7

34

67.4

58.4

Self injurious behaviors


Warning SignsRisk Factors

Protective Factors

Maine Suicide Prevention Program Definitions

Warning Signs- the earliest observable signs that indicate increased risk of suicide for an individual in the near-term (within hours or days).

Risk Factors- long standing conditions, stressful events or situations that may increase the likelihood of a suicide attempt or death (statistically significant).

Protective Factors- the positive conditions, personal and social resources that promote resiliency and reduce the potential of suicide and other high-risk behaviors.


Warning Signs Immediate Risk!

Overt & acute signs of a suicidal crisis:• Someone threatening to hurt or kill themselves• Someone looking for the means (gun, pills, rope etc.) to kill themself• Someone expressing high level of emotional distress• Preoccupation with death and dying

Respond:• Get the Facts & Take Action to ensure safety• Call 911 or seek other immediate professional help when you hear, say or

see any of these behaviors


I Ideation / threatened or communicatedS Substance abuse / excessive or increased? P Purposelessness / no reasons for living A Anxiety /agitation / insomniaT Trapped / feeling no way outH Hopelessness / nothing will ever change W Withdrawal from friends, family, societyA Anger (uncontrolled)/ rage / seeking revengeR Recklessness/ risky acts / unthinkingM Mood changes (dramatic)

Warning Signs


Adolescent Warning Signs for Suicide

Is the youth (up to 19 y.o.) :• Talking about or making plans for suicide• Expressing hopelessness about the future• Displaying severe/overwhelming emotional pain or distress• Showing worrisome behavior or changes particularly in the presence of the

above warning signs. • Specifically:

• Withdrawal from or changes in social connections• Recent increased agitation or irritability• Anger or hostility that seems out of character or context• Changes in sleep (increased or decreased

From an AAS Consensus group, 2014

Maine Suicide Prevention Program Keep your eyes and ears open:

Direct clues:• I wish I were dead

• I’m going to end it all

• I’m going to kill myself

Less Direct clues:• Life’s just too hard

• You’d be better off without me

• What’s the point?

Maine Suicide Prevention Program Risk Factors for Suicide

Risk factors are found in different domains• Family risk factors• Personal/behavioral risk factors• Environmental/social risk factors

Risk factors have different conditions• Some are unchangeable (perpetuating)• Some are of serious concern (predisposing)• Some are acute (precipitating)

Risk Factors PERPETUATING CONDITIONS(Unchangeable)

PREDISPOSING CONDITIONS(of Serious Concern)

PRECIPITATING CONDITIONS(Acute)

FAMILY Family history of suicide, mental illness, substance abuseRaceGender

Unrealistic parental expectationsAbuse (emotional, physical, sexual)

Major family conflictExposure to suicide of family memberAnniversary of deathMoving often

PERSONALBEHAVIORAL

Loss through death, abandonment, divorce

Previous suicide attemptMental illnessSubstance abuseExtreme PerfectionismPoor coping/social skillsImpulsive

Current acute Mental IllnessSevere stress/anxietyIsolationRejectionRelationship break-upIncreased use of substances

ENVIRONMENTALSOCIAL

Inconsistent, neglectful or abusive parenting Sexual orientation Gender identity

Experience of repeated lossChronic severe stressOngoing harassment

Active suicide cluster in communityAccess to lethal meansBullying, harassmentLoss of freedom (e.g., incarceration)


LGBTQ Youth/Young Adults

• Suicide attempt rates 3-4 times their peers• Increase due to societal stigma and rejection • Critical risk factors include rejection, depression, anxiety, chronic

stress, abuse, victimization, bullying, etc…• Rejection by family can increase risk up to 8X• Family acceptance and school safety are strong protective factors• Cultural competence is important in prevention

Maine Suicide Prevention Program Suicide in the Young ( under 14 y.o.)

Warning Signs (very similar to previous list):

• Change in usual behavior• Risky behavior• Talk of intent to die• Self harm (may be seen as

recurrent “accidents”)• Verbal clues of suicidal thoughts

Risk Factors:• More than one mental health

diagnosis & untreated MH concerns • Early trauma or stressful events• Negative school experience (bullying)• Loss of early primary attachments

(death, placement in foster care etc.)• Internalizing vs. externalizing

Maine Suicide Prevention Program Native American youth

Risk:• Of youth and young adults (15-24)

NA/AI highest risk • Cultural distress, acculturation • Historical trauma, boarding

schools• Family disruption, violence, abuse• Substance abuse• Discrimination-perceived and real

Protection:• Trauma informed prevention• Culturally informed prevention• Family and community

connections• Spiritual connection &

ceremony• Strong cultural identity


• Skills to think, communicate, solve problems, manage anger and other negative emotions,

• Purpose & value in life; hope for the future, pets, work/ life focus

• Personal characteristics- health, positive outlook, healthy choices, spirituality or religious belief

• Supports- parents, friends, mentors, teachers and other caring adults

• Safe Environment – restricted access to lethal means

Protective Factors


From a Suicidal Person’s Point of View• Crisis point has been reached• Pain is unbearable• Solutions to problems seem unavailable• Thinking is affected

HOWEVER:• Ambivalence exists• Communicating distress is common• Invitations to help are often extended

Invitations to Help

PHYSICAL

“All of my problems will end soon”“I just can’t take it anymore”

“I wish I were dead”“You’ll be better off without me”

“I can’t do anything right”

Giving away possessions Withdrawal Abuse/use of substances Reckless behavior Extreme mood swings Increased impulsivity Self-injury (maybe)

Lack of interest in appearanceChanges in appetite, weightChange in sleep patterns

THOUGHTS

ACTIONS

DesperateAngryGuiltyWorthless

WorthlessLonelySadHopeless

FEELINGS


Intervention:A bridge to help


• Unwilling to admit needing help• Afraid to upset/anger others• Unable describe their feelings/needs• Unsure of available help or resources• Struggling with symptoms of depression• Don’t know what to expect • Shame, fear of stigma• May prefer to confide in peers

Why people hesitate to ask for help


Why People Hesitate to Help

• Not sure about how severe the risk is-what if they’re wrong?

• Worry about doing/saying the “right” thing• Feelings of inadequacy• Afraid to put the idea in someone’s head• Feel it’s not “their issue”• Bystander Effect


Ignoring or dismissing the issue“You think you have problems, well let me tell you…”

Acting shocked or embarrassed“Oh, I’m not sure I’m the best person to talk to about this…”

Challenging, debating or bargaining“You think things are bad now, try to kill yourself and then see how things are!”

Minimizing the distress“This is nothing, you just need to relax more.”

What is NOT Helpful


1) Show You Care—Listen carefully—Be genuine

“I’m concerned about you . . . about how you feel.”

2) Ask the Question—Be direct, caring and non-confrontational

“Are you thinking about suicide?”

3) Get Help—Do not leave him/her alone

“You’re not alone. Let me help you.”

What IS Helpful


Practice Helpful Steps!Open handout… • Think up & write 1 or 2 phrases or ways that YOU would use

to “show you care.”• Write two other ways you might “ask the question” about

suicide.• List two ways you would assist someone to “get help” and

name 2 resources.


Resources for HelpWhat are YOUR resources?


School Resources (examples)• School Counselor• School-Based Health Centers/Nurse• Crisis Team Members• Administration• School Resource Officer • Who else…?


When to Call Crisis 1-888-568-1112

• Crisis clinicians are: • Available 24 / 7• Clinicians can often come to your location for an assessment

• Call for a phone consult when you are:• Concerned about someone’s mental health• Need advice about how to help someone in distress• Worried about someone and need another opinion

• The phone call is free


Protocols for Addressing Suicide:

• Roles and responsibilities• How can staff become informed?• How do we respond to a suicidal crisis?• How do we access resources?• Developing a safety plan• How do we manage the aftermath of suicide?• Supporting someone’s return to school/community

Maine Suicide Prevention Program After an

Attempt or SuicideHelping Families and School Communities Through Crisis


• Initial focus is on safety• Work to address reduction in crisis• Safety planning for proactive response• For return to the school community:

o Who is the support persono What do other people need to knowo Offer hope and supporto Encourage follow-through with treatment

After a Suicide Attempt. . .


It is estimated that there are at least 6 survivors for a death by suicide

• Ratio implies at least 216,210 survivors each year, 1086 in Maine

A “suicide survivor” is someone who has lost a loved one to death by suicide

Suicide Survivors


Survivors of Suicide• Struggle to make meaning of the loss• Suffer from overwhelmingly complicated feelings• May take a long time to grieve• Need understanding and support• Youth survivors have special issues


How YOU can be supportive after a suicide

• Acknowledge the loss• Use the name of the deceased• Share your presence • Share a special memory/story• Acknowledge the good things• Stay in touch• Recommend Grief Support Center, grief support groups or

AFSP


Take Care of Yourself

• Acknowledge the intensity of your feelings

• Seek support from colleagues, de-brief

• Share your feelings with family/friends

• Avoid over – involvement

• Know that you are not responsible for another person’s choice to end their life


• Training Program Inquiries: MSPP [email protected] • Heather Carter, Senior Trainer [email protected] • Greg Marley, Clinical Director [email protected] • MSPP Program Coordinator: Katharyn Zwicker, 207-287-5362

[email protected]

MSPP Contact Information






Any Questions?

Maine Suicide Prevention ProgramEducation, Resources and Support

It’s Up to All of Us

Before you leave. . .

Thank you for learning about suicide prevention. . .


The Department of Health and Human Services (DHHS) does not discriminate on the basis of disability, race, color, creed, gender, sexual orientation, age, or national origin, in admission to, access to, or operations of its programs, services, or activities, or its hiring or employment practices. This notice is provided as required by Title II of the Americans with Disabilities Act of 1990 and in accordance with the Civil Rights Act of 1964 as amended, Section 504 of the Rehabilitation Act of 1973, as amended, the Age Discrimination Act of 1975, Title IX of the Education Amendments of 1972 and the Maine Human Rights Act and Executive Order Regarding State of Maine Contracts for Services. Questions, concerns, complaints or requests for additional information regarding the ADA may be forwarded to DHHS’ ADA Compliance/EEO Coordinators, 11 State House Station – 221 State Street, Augusta, Maine 04333, 207-287-4289 (V), 207-287-3488 (V), TTY users call Maine relay 711. Individuals who need auxiliary aids for effective communication in program and services of DHHS are invited to make their needs and preferences known to the ADA Compliance/EEO Coordinators. This notice is available in alternate formats, upon request.

Documents

Maine Suicide Prevention Program Before you begin: This PowerPoint contains 2 slides that focus on risk and protective factors for specific populations