Saving Lives One Community at a Time

7/23/2019 Saving Lives One Community at a Time

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Suicide PreventionSaving Lives One Community ata Time

America Foundation for SuicidePrevention

Dr. Paula J. Clayton, AFSP MedicalDirector

120 Wall Street, 2t! Floor

"e# $or%, "$ 1000&1'(((')))'AFSP



FACING THE FACTS AN OVERVIEW OF SUICIDE

2



Facing the Facts

n 2010, )(,)-. +eo+le in t!e /nitedStates died y suicide* Aout every 1)*

minutes someone in t!is countryintentionally ends !is!er life*

Alt!oug! t!e suicide rate fell from 12312 +er 100,0004 to 2000 310*. +er100,0004, it !as een 5uctuating slig!tlysince 2000 6 des+ite all of our ne#

treatments* )



Facing the Facts

Suicide is considered to e t!e second leading cause ofdeat! among college students*

Suicide is t!e second leading cause of deat! for +eo+leaged 2&').*

Suicide is t!e t!ird leading cause of deat! for +eo+leaged 10'2.*

Suicide is t!e fourt! leading cause of deat! for adultset#een t!e ages of 1( and -&*

Suicide is !ig!est in #!ite males over (&* 3&1100,000,

20104 .



Facing the Facts

T!e suicide rate #as 12*.100,000 in2010*

t greatly e7ceeds t!e rate of !omicide*3&*)100,0004

From 1(1'2010, ),&.. +eo+le died ysuicide, #!ereas .,.1 died from A8Sand 9:'related diseases*

&



Facing the Facts

Death by Suicide and PsychiatricDiagnosis

Psyc!ological auto+sy studies done in variouscountries over almost &0 years re+ort t!e sameoutcomes; 0< of +eo+le #!o die y suicide are su=ering from one

or more +syc!iatric disorders;

>a?or 8e+ressive 8isorder@i+olar 8isorder, 8e+ressive +!ase

Alco!ol or Sustance Ause

Sc!iBo+!renia

Personality 8isorders suc! as @orderline P8

Primary diagnoses in yout! suicides*-



Facing the Facts

Suicide Is Not Predictable in Individualsn a study of .,(00 !os+italiBed vets, it #as not+ossile to identify #!o #ould die y suicide too many false'negatives, false'+ositives*

ndividuals of all races, creeds, incomes andeducational levels die y suicide* T!ere is noty+ical suicide victim*



Facing the Facts

Suicide Communications Are !ten Not "ade toPro!essionals

n one +syc!ological auto+sy study, only 1(< told +rofessionalsof intentions

n a study of suicidal deat!s in !os+itals; < denied intent on last communication 2(< !ad Dno suicideE contracts #it! t!eir caregiversE

esearc! does not su++ort t!e use of no'!arm contracts 3"9C4as a met!od of +reventing suicide, nor from +rotectingclinicians from mal+ractice litigation in t!e event of a clientsuicide

oins et al, Am G Psyc!iatry, 1&

(



Facing the Facts

Suicide Communications A#E"ade to thers

n adolescents, &0< communicatedt!eir intent to family memers

n elderly, &(< communicated t!eirintent to t!e +rimary care doctor

oins et al, Am G Psyc!iatry, 1&

@usc! et al, G Clin Psyc!iatry, 200)



Facing the Facts

#esearch sho$s that during ourli!etime%

20< of us #ill !ave a suicide #it!inour immediate family*

-0< of us #ill +ersonally %no#someone #!o

10



Annual Deaths& byCause

11



S'ending !or "edical#esearch

12



Facing the Facts

Prevention may e a matter of a caring+erson #it! t!e rig!t %no#ledge eingavailale in t!e rig!t +lace at t!e rig!t

time*

1)



"(THS )E#S*S FACTSA+*T S*ICIDE

1.



1&

"yths versus Facts

"(TH%

Peo+le #!o tal% aout suicide donIt com+letesuicide*

FACT%

"any 'eo'le $ho die by suicide havegiven de,nite $arnings to !amily and

!riends o! their intentions- Al$ays ta.eany comment about suicide seriously-



1-

"yths versus Facts

"(TH%

Suicide !a++ens #it!out #arning*

FACT%

"ost suicidal 'eo'le give clues andsigns regarding their suicidal

intentions-



1

"yths versus Facts

"(TH%

Suicidal +eo+le are fully intent on dying*

FACT%

"ost suicidal 'eo'le are undecidedabout living or dying& $hich is called/suicidal ambivalence-0 A 'art o! them

$ants to live1 ho$ever& death seems li.ethe only $ay out o! their 'ain andsu2ering- They may allo$ themselves to3gamble $ith death&3 leaving it u' toothers to save them-



1(

"yths versus Facts

"(TH%

>en are more li%ely to e suicidal*

FACT%

"en are !our times more li.ely to .illthemselves than $omen- Womenattempt suicide three times more oftenthan men do.



1

"yths versus Facts

"(TH%

As%ing a de+ressed +erson aout suicide #ill+us! !im!er to com+lete suicide*

FACT%

Studies have sho$n that 'atients $ithde'ression have these ideas and tal.ing

about them does not increase the ris.o! them ta.ing their o$n li!e-



20

"yths versus Facts

"(TH%

m+rovement follo#ing a suicide attem+t orcrisis means t!at t!e ris% is over*

FACT%

"ost suicides occur $ithin days or$ee.s o! 3im'rovement&3 $hen theindividual has the energy andmotivation to actually !ollo$ through$ith his4her suicidal thoughts- Thehighest suicide rates are immediately

a!ter a hos'itali5ation !or a suicide



21

"yths versus Facts

"(TH%

Once a +erson attem+ts suicide, t!e +ain ands!ame t!ey e7+erience after#ard #ill %ee+t!em from trying again*

FACT;

The most common 'sychiatric illnessthat ends in suicide is "a6orDe'ression& a recurring illness- Everytime a 'atient gets de'ressed& the ris.o! suicide returns-



22

"yths versus Facts

"(TH%

Sometimes a ad event can +us! a +erson tocom+lete suicide*

FACT%

Suicide results !rom having a serious'sychiatric disorder- A single event may 6ust

be /the last stra$-0



2)

"yths versus Facts

"(TH%

Suicide occurs in great numers around !olidays

in "ovemer and 8ecemer*

FACT%

Highest rates o! suicide are in "ay or 7une&

$hile the lo$est rates are in December-



#IS8 FACT#S F# S*ICIDE

2.



2&

#is. Factors

Psychiatric disorders

Past suicide attem'ts

Sym'tom ris. !actors

Sociodemogra'hic ris. !actors

Environmental ris. !actors



2-

#is. Factors

Psychiatric Disorders

"ost common 'sychiatric ris. !actors

resulting in suicide% 8e+ression>a?or 8e+ression@i+olar 8e+ression

Alco!ol ause and de+endence 8rug ause and de+endence Sc!iBo+!renia

Js+ecially #!en comined #it! alco!ol and drug ause



2

#is. Factors

ther 'sychiatric ris. !actors $ith 'otential toresult in suicide (account for sini!cant"#fe$er suicides than Depression%&

Post Traumatic Stress Disorder 9PTSD:

Eating disorders

+orderline 'ersonality disorderAntisocial 'ersonality disorder



2(

#is. Factors

Past suicide attem't

(See diagram on right)

After a suicide attem+t t!at isseen in t!e J aout 1< +er yearta%e t!eir o#n life, u+ toa++ro7imately 10< #it!in 10years*

>ore recent researc! follo#edattem+ters for 22 years and sa#< die y suicide*

Gen%ins et al, @>G, 2002

Carter et al, @GP, 200



2

#is. Factors

Sym'tom #is. Factors During De'ressiveE'isode%

8es+eration

9o+elessness

An7iety+syc!ic an7iety+anic attac%s

Aggressive or im+ulsive +ersonality

9as made +re+arations for a +otentially serious suicide

attem+t or !as re!earsed a +lan during a +reviouse+isode

ecent !os+italiBation for de+ression

Psyc!otic sym+toms 3es+ecially in !os+italiBedde+ression4



)0

#is. Factors

"a6or 'hysical illness& es'ecially recent

Chronic 'hysical 'ain

History o! childhood trauma or abuse& or o!being bullied

Family history o! death by suicide

Drin.ing4Drug use

+eing a smo.er



)1

#is. Factors

Sociodemogra'hic #is. Factors>aleOver age .& ' -.

W!iteSe+arated, #ido#ed or divorcedLiving alone@eing unem+loyed or retired

Occu+ation; !ealt!'related occu+ations!ig!er 3dentists, doctors, nurses, social#or%ers4 es+ecially !ig! in #omen +!ysicians



)2

#is. Factors

Environmental #is. Factors

Jasy access to let!al means

Local clusters of suicide t!at !ave aKcontagious in5uenceK



P#E)ENTING S*ICIDEONE CO''UNI) A A I'E

))



Preventing Suicide

Prevention $ithin our community

Jducation

Screening

Treatment

>eans estriction

>edia uidelines).



Preventing Suicide

Education

ndividual and Pulic A#areness

Professional A#areness

Jducational Tools

)&



Preventing Suicide

Individual and Public A$areness

Primary ris% factor for suicide is +syc!iatricillness

8e+ression is treatale

8estigmatiBe t!e illness

8estigmatiBe treatmentJncourage !el+'see%ing e!aviors andcontinuation of treatment

)-



Preventing Suicide

Pro!essional A$areness

9ealt!care Professionals P!ysicians, +ediatricians, nurse +ractitioners, +!ysician assistants

>ental 9ealt! Professionals Psyc!ologists, Social Wor%ers

Primary and Secondary Sc!ool Sta= Princi+als, Teac!ers, Counselors, "urses

College and /niversity esource Sta= Counselors, Student 9ealt! Services, Student esidence Services,

esident 9all 8irectors and Advisors

ate%ee+ers eligious Leaders, Police, Fire 8e+artments, Armed Services

)



Preventing Suicide

Educational Tools

8e+ression and suicide among college students; The Truth About Suicide: eal Storie! o" De#re!!ion in College 3200.4

Comes #it! accom+anying facilitatorMs guide

8e+ression and suicide among +!ysicians and medical students; Struggling in Silence: Phy!ician De#re!!ion and Suicide 3&. minutes4 Struggling in Silence: Community e!ource $er!ion 31- minutes4 %ut o" the Silence: Medical Student De#re!!ion and Suicide 31& minutes4

@ot! s!orter Nlms are +ac%aged toget!er and include PPT +resentationson t!e 8:8Ms

8e+ression and suicide among teenagers; More Than Sad: Teen De#re!!ion 32004

Comes #it! facilitatorMs guide and additional resources Suicide Prevention Jducation for Teac!ers and Ot!er Sc!ool Personnel 320104

ncludes ne# Nlm, More Than Sad: Pre&enting Teen Suicide, More Than

Sad: Teen De#re!!ion, facilitatorMs guide, a curriculum manual andadditional resources

)(



)

Preventing Suicide

Screening

Identi!y At #is. Individuals%

Columia Teen Screen and ot!ers

AFSP nteractive Screening Program 3SP4;

T!e SP is an anonymous, #e'ased, interactivescreen for individuals 3students, faculty,em+loyees4 #it! de+ression and ot!er mentaldisorders t!at +ut t!em at ris% for suicide* SPconnects at'ris% individuals to a counselor #!o

+rovides +ersonaliBed online su++ort to get t!emen a ed to come in for an evaluation* @ased on



.0

Preventing Suicide

Treatment

Antide+ressants

Psyc!ot!era+y



.1

Preventing Suicide

Antide'ressants

Ade;uate 'rescri'tion treatment and monitoring

Only 20< of medicated de+ressed +atients are adeuatelytreated #it! antide+ressants 6 +ossily due to;

Side e=ectsLac% of im+rovement9ig! an7iety not treatedFear of drug de+endencyConcomitant sustance use8idnIt comine #it! +syc!ot!era+y8ose not !ig! enoug!8idnIt add ad?unct t!era+y suc! as lit!ium or ot!ermedication3s48idnIt e7+lore all o+tions including; JCT or ot!er somatictreatment



.2

Preventing Suicide

Psychothera'y

#esearch sho$s that $hen it comes to treating de'ression&all thera'y is NT created e;ual- Study s!o#s a++lying correct tec!niues reduce suicide attem+ts y &0<

over 1( mont! +eriod

To be e2ective& 'sychothera'y must be% S+eciNcally designed to treat de+ression elatively s!ort'term 310'1- #ee%s4 Structured 3t!era+ist s!ould e ale to give ste+'y'ste+ treatment

instructions t!at any ot!er t!era+ist can easily follo#4

E<am'les% Cognitive +e!avior T!era+y 3C@T4 Inter'ersonal T!era+y 3PT4 Dialectical +e!avior T!era+y 38@T4

Im'lement teaching o! these techni;ues



.)

Preventing Suicide

"eans #estrictions

Firearm safety

Construction of arriers at ?um+ing sites8eto7iNcation of domestic gas

m+rovements in t!e use of catalytic converters in motorve!icles

estrictions on +esticides

educe let!ality or to7icity of +rescri+tions

/se of lo#er to7icity antide+ressants C!ange +ac%aging of medications to lister +ac%s

estrict sales of let!al !y+notics 3i*e* @ariturates4



..

Preventing Suicide

"edia

Guidelines

Considerations



.&

Preventing Suicide"edia Guidelines

Jncourage im+lementation ofres+onsile media guidelines for

re+orting on suicide, suc! as t!osedevelo+ed y AFSP in +artners!i+ #it!government agencies and +rivateorganiBations*

e+orting on Suicide; ecommendations for t!e media

Can be "ound on AFSP 'eb!ite:'''.a"!#.orgmedia

http://www.afsp.org/media

http://www.afsp.org/media



.-

Preventing Suicide

"edia Considerations

Consider ho$ suicide is 'ortrayed in themedia T: >ovies Advertisements

The Internet danger Suicide c!at rooms nstructions on met!ods Solicitations for suicide +acts*



.

(ou Can Hel'=

(Ada#ted 'ith #ermi!!ion "rom the a!hington *outh SuicidePre&ention Program)



.(

(ou Can Hel'

8no$ $arning signs

Intervention



.

(ou Can Hel'

"ost suicidal 'eo'le don>t really $ant to die? they 6ust $ant their 'ain to end

About @B o! the time 'eo'le $ho .illthemselves have given de,nite signals ortal.ed about suicide



&0

arning Signsbservable signs o! serious de'ression /nrelenting lo# mood Pessimism 9o+elessness 8es+eration An7iety, +syc!ic +ain, inner tension Wit!dra#al Slee+ +rolems

Increased alcohol and4or other drug use#ecent im'ulsiveness and ta.ing unnecessary ris.s

Threatening suicide or e<'ressing strong $ish to die"a.ing a 'lan iving a#ay +riBed +ossessions Purc!asing a Nrearm Otaining ot!er means of %illing oneself

*ne<'ected rage or anger

(ou Can Hel'



&1

Pro'osed DS")Suicide Assessment Dimension

evel o! concernabout 'otentialsuicidal behavior%

Sum o!items

coded as'resent

Suicideris. !actor grou's%

Lo#est concern 0 1* Any !istory of a suicide attem+t

Some concern 1'2 2* Long'standing tendency to lose tem+er orecome aggressive #it! little +rovocation

ncreased concern )'. )* Living alone, c!ronic severe +ain, or recent3#it!in ) mont!s4 signiNcant loss

9ig! Concern &' .* ecent +syc!iatric admissiondisc!arge orNrst diagnosis of >88, i+olar disorder or

sc!iBo+!renia&* ecent increase in alco!ol ause or#orsening of de+ressive sym+toms

-* Current 3#it!in last #ee%4 +reoccu+ation#it!, or +lans for, suicide

* Current +syc!omotor agitation, mar%edan7iety or +rominent feelings of !o+elessness



&2

Intervention

Three +asic Ste's%

- Sho$ you care

- As. about suicide

- Get hel'

(ou Can Hel'



&)

Intervention

Ste' ne%Sho$ (ou Care+e Genuine

(ou Can Hel'



&.

Sho$ you careTa.e A tal. o! suicide seriously f you are concerned t!at someone may ta%e

t!eir life, trust your ?udgmentisten Care!ully

#eect $hat you hear

*se language a''ro'riate !or age o!

'erson involved 8o not #orry aout doing or saying e7actly

t!e Krig!tK t!ing* $our genuine interest is#!at is most im+ortant*

(ou Can Hel'



&&

+e Genuine

et the 'erson .no$ you really care-

Tal. about your !eelings and as. about his

or hers- KIm concerned aout youQ !o# do you feelRD KTell me aout your +ain*D K$ou mean a lot to me and #ant to !el+*D K care aout you, aout !o# youIre !olding

u+*D KIm on your sideQ#eIll get t!roug! t!is*K

(ou Can Hel'



&-

Intervention

Ste' T$o As. About Suicide +e direct but noncon!rontational

Tal.ing $ith 'eo'le about suicide $on>t 'ut the ideain their heads-

C!ances are, if youIve oserved any of t!e #arning signs,t!eyIre already t!in%ing aout it* @e direct in a caring, non'

confrontational #ay*

*et the con+ersation started.

(ou Can Hel'



&

(ou Can Hel'

(ou do not need to solve all o! the 'erson>s'roblems ? ,ust enae them. Juestions toas.%

Are you t!in%ing aout suicideR W!at t!oug!ts or +lans do you !aveR Are you t!in%ing aout !arming yourself, ending your

lifeR 9o# long !ave you een t!in%ing aout suicideR 9ave you t!oug!t aout !o# you #ould do itR 8o you !ave R 3nsert t!e let!al means t!ey !ave

mentioned4

8o you really #ant to dieR Or do you #ant t!e +ain to go



&(

As. about treatment% 8o you !ave a t!era+istdoctorR Are you seeing !im!erR Are you ta%ing your medicationsR

(ou Can Hel'



&

Intervention

Ste' Three%Get hel'& -ut do NO "ea+e the persona"one

no# referral resources

eassure t!e +erson

Jncourage t!e +erson to +artici+ate in!el+ing +rocess

Outline safety +lan

(ou Can Hel'



-0

(ou Can Hel'

8no$ #e!erral #esources #esource sheet% Create referral resource s!eet from

your local communityPsyc!iatristsPsyc!ologistsOt!er T!era+istsFamily doctor+ediatricianLocal medical centersmedical universitiesLocal mental !ealt! servicesLocal !os+ital emergency roomLocal #al%'in clinicsLocal +syc!iatric !os+itals

HotlinesNational Suicide Prevention i!eline% 1'(00'2)'TAL

###*suicide+reventionlifeline*org

K% n an acute crisis, call 11

http://www.suicidepreventionlifeline.org/

http://www.suicidepreventionlifeline.org/



-1

#eassure the 'erson that hel' is available and thatyou $ill hel' them get hel'% DToget!er %no# #e can Ngure somet!ing out to ma%e you

feel etter*E

D %no# #!ere #e can get some !el+*E D can go #it! you to #!ere #e can get !el+*E DLetIs tal% to someone #!o can !el+ * * * LetIs call t!e crisis

line no#*E

Encourage the suicidal 'erson to identi!y other'eo'le in their li!e $ho can also hel'% ParentFamily >emers Favorite Teac!er Sc!ool Counselor Sc!ool "urse eligious Leader Family doctor

(ou Can Hel'



-2

utline a sa!ety 'lan >a%e arrangements for t!e !el+er3s4 to come

to you O ta%e t!e +erson directly to t!esource of !el+ ' do "OT leave t!em alone

Once t!era+y 3or !os+italiBation4 is initiated,e sure t!at t!e suicidal +erson is follo#ingt!roug! #it! a++ointments and medications*

(ou Can Hel'



THAN8 (*

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