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WELCOME WELCOME COLORADO EMS COLORADO EMS

SUICIDE SUICIDE PREVENTION PREVENTION SPECIALIST SPECIALIST TRAININGTRAINING

Before we get started I Before we get started I want you to cwant you to check out the heck out the 3 people sitting nearest to 3 people sitting nearest to you. you.

IntroductionIntroduction

Depending on your relationship with Depending on your relationship with those being trained, I would those being trained, I would recommend a brief introduction of recommend a brief introduction of yourself. I like to answer the yourself. I like to answer the questions; “Who is the person standing questions; “Who is the person standing up there training me?” “Why should I up there training me?” “Why should I believe him/her?” “What does he/she believe him/her?” “What does he/she have to teach me and where did they have to teach me and where did they acquire this information?”acquire this information?”

Take Out Your PacketsTake Out Your Packets

Just Like It’s Your Birthday!Just Like It’s Your Birthday!

Taking Care of Yourself.Taking Care of Yourself.

Suicide is personalSuicide is personal Many of you may be survivorsMany of you may be survivors Some may be attempt survivorsSome may be attempt survivors This training can be difficultThis training can be difficult Take care of yourself during this Take care of yourself during this

training.training.

Raise your hand if…Raise your hand if…Wait until all questions Wait until all questions

askedasked Have you ever thought about suicide? Have you ever thought about suicide? Do you know someone who has? Do you know someone who has? Do you know anyone who has made a Do you know anyone who has made a

suicide attempt?suicide attempt? or even died by suicide? or even died by suicide? Are you worried, right now, that Are you worried, right now, that

someone you know is thinking about someone you know is thinking about suicide? suicide?

Prerequisite online Prerequisite online learninglearning

QPR Gatekeeper for Suicide Prevention QPR Gatekeeper for Suicide Prevention CertificateCertificate

Understand suicide as a major public Understand suicide as a major public health problem health problem

Name major suicide prevention Name major suicide prevention organizations and access their web sites organizations and access their web sites

Recognize someone at risk of suicideRecognize someone at risk of suicide Recognize at least three suicide Recognize at least three suicide

warning signswarning signs

Demonstrate increased knowledge, skill Demonstrate increased knowledge, skill and self-efficacy in the application of and self-efficacy in the application of QPR QPR

Know how to engage and assist a Know how to engage and assist a suicidal colleague or co-workersuicidal colleague or co-worker

Understand the common myths and Understand the common myths and facts surrounding suicidal behaviorfacts surrounding suicidal behavior

Describe and name multiple local or Describe and name multiple local or state referral resources state referral resources

Understand means restriction and how Understand means restriction and how to immediately reduce riskto immediately reduce risk

Recognize and identify at least three Recognize and identify at least three risk factors for suiciderisk factors for suicide

Recognize and identify at least three Recognize and identify at least three protective factors against suicideprotective factors against suicide

Understand the nature of suicide Understand the nature of suicide Engage in an interactive and helpful Engage in an interactive and helpful

conversation with someone who has conversation with someone who has attempted suicideattempted suicide

Engage in an interactive and helpful Engage in an interactive and helpful conversation with the loved ones or conversation with the loved ones or family members of someone who has family members of someone who has died by suicide died by suicide

Classroom learning goalsClassroom learning goals

Understand risk factors and warning Understand risk factors and warning signs associated with suicidesigns associated with suicide

Understand the nature of suicideUnderstand the nature of suicide Recognize risk factors associated Recognize risk factors associated

with exposure to trauma with exposure to trauma Understand the need for and identify Understand the need for and identify

various strategies for self-carevarious strategies for self-care

Respond to suicide attempt survivorsRespond to suicide attempt survivors Help suicide survivors (family Help suicide survivors (family

members left behind)members left behind) Help fellow EMS providers who may Help fellow EMS providers who may

be having suicidal thoughtsbe having suicidal thoughts Identifying local and national suicide Identifying local and national suicide

prevention resources prevention resources

Clump UpClump Up

Why you are hereWhy you are here What has your experience taught What has your experience taught

youyou Share what you learned from the Share what you learned from the

online materialonline material What do you still want to knowWhat do you still want to know

About suicideAbout suicide About teaching this materialAbout teaching this material

Training others to be EMS Training others to be EMS Suicide Prevention Specialists Suicide Prevention Specialists

(EMS SPS)(EMS SPS)

The minimum training required to be The minimum training required to be awarded an EMS SPS certificate is awarded an EMS SPS certificate is five (5) hoursfive (5) hours

The course can be taught entirely by The course can be taught entirely by the Instructor using the materials the Instructor using the materials and audio visual aids, and audio visual aids, providedprovided the the EMS SPI is also a QPR Certified EMS SPI is also a QPR Certified Gatekeeper Instructor. Gatekeeper Instructor.

If not a QPR Certified If not a QPR Certified Instructor, those earning a Instructor, those earning a

certificate as an EMS Suicide certificate as an EMS Suicide Prevention Specialist must Prevention Specialist must

completecomplete Minimum of two (2) hours of online trainingMinimum of two (2) hours of online training Minimum of three (3) hours of classroom Minimum of three (3) hours of classroom

trainingtraining Pass all online and classroom quizzes and Pass all online and classroom quizzes and

exams as determined by the EMS SPIexams as determined by the EMS SPI Participate in role-plays and exercises Participate in role-plays and exercises

See sample training schedule in packetSee sample training schedule in packet

QPR Institute Training for QPR Institute Training for EveryoneEveryone

To create safer communities means To create safer communities means training at all levels:training at all levels:- QPR Citizen Gatekeeper Training and - QPR Citizen Gatekeeper Training and Instructor Certification Course Instructor Certification Course

- QPR Suicide Triage Training and - QPR Suicide Triage Training and Instructor Training Course for 1st Instructor Training Course for 1st responders (e.g., QPR for EMS)responders (e.g., QPR for EMS)

- QPRT Suicide Risk Assessment training - QPRT Suicide Risk Assessment training for health care professionalsfor health care professionals

- QPRT for physicians and nurses- QPRT for physicians and nurses

QPR QPR Colorado EMS SPSColorado EMS SPSClassroom TrainingClassroom Training

Classroom Material Classroom Material ScheduleSchedule

Introduction and overviewIntroduction and overview Brief review of QPR and online Brief review of QPR and online

materialsmaterials Suicide in ColoradoSuicide in Colorado Understanding SuicideUnderstanding Suicide Local ResourcesLocal Resources Role-playsRole-plays Self careSelf care

Suicide in ColoradoSuicide in Colorado

34,598 suicide in United States in 34,598 suicide in United States in 20072007

Or 94.8 a day for a rate of 11.5Or 94.8 a day for a rate of 11.5 940 suicides in Colorado in 2009940 suicides in Colorado in 2009 Or 2.6 a day for a rate of 18.4Or 2.6 a day for a rate of 18.4 Colorado ranked 6Colorado ranked 6thth in 2007 in 2007 Up from a ranking of 9Up from a ranking of 9thth in 2006 in 2006

In Colorado in 2009 In Colorado in 2009

940 people died by suicide 940 people died by suicide 190 people died by homicide; 8 by legal 190 people died by homicide; 8 by legal

intervention intervention 15 children age 4 or younger were a victim of 15 children age 4 or younger were a victim of

homicide homicide 7 people died of unintentional firearm injuries 7 people died of unintentional firearm injuries Suicide is the second leading cause of death Suicide is the second leading cause of death

and homicide is the third leading cause of and homicide is the third leading cause of death for young Coloradans ages 15-34. death for young Coloradans ages 15-34.

Health Statistics Section, Colorado Department of Public Health and Environment

Colorado Suicide 2005 - Colorado Suicide 2005 - 20092009

Health Statistics Section, Colorado Department of Public Health and Environment

UNDERSTANDING UNDERSTANDING SUICIDESUICIDE

Provide a leading theory to better Provide a leading theory to better understand suicideunderstand suicide

Teach the three necessary Teach the three necessary conditions for a suicide event to conditions for a suicide event to occuroccur

Demystify and de-stigmatize suicide Demystify and de-stigmatize suicide by bringing the behavior into the by bringing the behavior into the range of understandable human range of understandable human behaviorbehavior

Underlying PrinciplesUnderlying Principles

Suicide is not the great mystery that Suicide is not the great mystery that it has been made out to be. it has been made out to be.

The basic components of suicide are The basic components of suicide are knowable.knowable.

When we understand these When we understand these components we can act with more components we can act with more confidence.confidence.

Informed interventions save lives.Informed interventions save lives.

Suicidal BehaviorSuicidal Behavior

Means someone is in extreme pain Means someone is in extreme pain and sufferingand suffering

Means complex feelings and behaviorMeans complex feelings and behavior Involves many reasons and factorsInvolves many reasons and factors Means coming at it from many Means coming at it from many

directionsdirections This training is just one those This training is just one those

directionsdirections

Nature of suicide and Nature of suicide and Joiner’s new theory…Joiner’s new theory…

Psychic suffering (Psyche-ache)Psychic suffering (Psyche-ache) HopelessnessHopelessness Unbearable mental anguishUnbearable mental anguish Cognitive constrictionCognitive constriction Grossly impaired problem solving abilityGrossly impaired problem solving ability Feeling a burden to others Feeling a burden to others Thwarted belongingnessThwarted belongingness Acquired capacity for self-injury and habituation to painAcquired capacity for self-injury and habituation to pain

T. Joiner, Why People Die by Suicide, 2006T. Joiner, Why People Die by Suicide, 2006

Understanding Understanding SuicideSuicide

Based on the work of Thomas Based on the work of Thomas Joiner, PhD and his book Joiner, PhD and his book Why Why

People Die by SuicidePeople Die by Suicide

Underlying PrinciplesUnderlying Principles

Suicide is not the great mystery that it has Suicide is not the great mystery that it has been made out to be been made out to be

The basic components of suicide are The basic components of suicide are knowableknowable

When we understand these components we When we understand these components we can act with more confidencecan act with more confidence

Informed interventions save livesInformed interventions save lives

It’s what we don’t know that we don’t do, It’s what we don’t know that we don’t do, and what we don’t do costs us lives and what we don’t do costs us lives

unnecessarily lost.unnecessarily lost.

Basics of Suicide and Basics of Suicide and Serious AttemptsSerious Attempts

Two major components associated Two major components associated with suicide and serious attemptswith suicide and serious attempts The desire to die and The desire to die and the capacity for self harmthe capacity for self harm

Two elements within the desire to dieTwo elements within the desire to die Perceived burdensomenessPerceived burdensomeness A sense of thwarted or low belongingnessA sense of thwarted or low belongingness

Serious Attempt or Death by Serious Attempt or Death by SuicideSuicide

Those Who Desire Suicide

Those Who Are Capable of Suicide

Sketch of the Theory

Acquired Capacity for Acquired Capacity for SuicideSuicide

Suicidal behavior is not just Suicidal behavior is not just about the desire to dieabout the desire to die

It requires the capacity to It requires the capacity to inflict self injuryinflict self injury

The Acquired Capability to The Acquired Capability to Enact Enact Lethal Self-InjuryLethal Self-Injury

This capacity is acquired over timeThis capacity is acquired over time

Accrues with repeated and escalating Accrues with repeated and escalating experiences involving pain and provocation, experiences involving pain and provocation, such assuch as

Past suicidal behavior, but not only that…Past suicidal behavior, but not only that… Repeated injuriesRepeated injuries Repeated witnessing of pain, violence, or injury Repeated witnessing of pain, violence, or injury

(i.e.. (i.e.. physicians, EMS, ED nurses, and law physicians, EMS, ED nurses, and law enforcement enforcement personnel)personnel)

Any repeated exposure to pain and provocation.Any repeated exposure to pain and provocation.

The Acquired Capability to The Acquired Capability to Enact Lethal Self-InjuryEnact Lethal Self-Injury

According to Joiner, with repeated According to Joiner, with repeated exposure, one habituates – the exposure, one habituates – the “taboo” and prohibited quality of “taboo” and prohibited quality of suicidal behavior diminishes, and suicidal behavior diminishes, and so may the fear and pain so may the fear and pain associated with self-harm associated with self-harm

What do tattoos mean?What do tattoos mean?

Tattoos and SuicideTattoos and Suicide

In a case-controlled study comparing In a case-controlled study comparing accidental deaths to suicides, people who accidental deaths to suicides, people who died by suicide were more likely to have died by suicide were more likely to have tattoos (Dhossche, Snell, & Larder, 2000). tattoos (Dhossche, Snell, & Larder, 2000).

Could it be that the eventual suicide Could it be that the eventual suicide victims obtained increased capacity for victims obtained increased capacity for suicide partly via painful and provocative suicide partly via painful and provocative experiences, such as tattooing, piercing, experiences, such as tattooing, piercing, etc.?etc.?

Deliberate self-harm and Deliberate self-harm and suicidesuicide

Evidence:Evidence:

- People who have experienced or - People who have experienced or witnessed violence or injury have witnessed violence or injury have higher rates of suicide – prostitutes, higher rates of suicide – prostitutes, self-injecting drug abusers, people self-injecting drug abusers, people living in high-crime areas, physiciansliving in high-crime areas, physicians

- Those with a history of suicide attempt - Those with a history of suicide attempt have higher pain tolerance than othershave higher pain tolerance than others

Components of the Components of the Desire for DeathDesire for Death

Perceived BurdensomenessPerceived Burdensomeness

Thwarted BelongingnessThwarted Belongingness

Perceived Perceived BurdensomenessBurdensomeness

Feeling ineffective to the Feeling ineffective to the degree that others are degree that others are burdened is among the burdened is among the strongest sources of all for strongest sources of all for the desire for suicidethe desire for suicide

Suicide lightens the load Suicide lightens the load the rest of us carry….the rest of us carry….

Research:Research:

Brown, Comtois, & Linehan (2000) Brown, Comtois, & Linehan (2000) reported that genuine suicide reported that genuine suicide attempts were often attempts were often characterized by a desire to make characterized by a desire to make others better off, whereas non-others better off, whereas non-suicidal self-injury was often suicidal self-injury was often characterized by desires to characterized by desires to express anger or punish oneselfexpress anger or punish oneself ……

Thwarted or Low Thwarted or Low BelongingnessBelongingness

The need to belong to valued The need to belong to valued groups or relationships is a groups or relationships is a powerful, fundamental, and powerful, fundamental, and extremely pervasive human extremely pervasive human motivation motivation

When this need is thwarted, When this need is thwarted, numerous negative effects on numerous negative effects on health, adjustment, and well-being health, adjustment, and well-being have been documented have been documented

Thwarted BelongingnessThwarted Belongingness The need to belong is so The need to belong is so

powerful that, when satisfied, it powerful that, when satisfied, it can prevent suicide -- even when can prevent suicide -- even when perceived burdensomeness and perceived burdensomeness and the acquired ability to enact the acquired ability to enact lethal self-injury are present…lethal self-injury are present…

By the same token, when the By the same token, when the

need is thwarted, risk for need is thwarted, risk for suicide is increasedsuicide is increased

Thwarted Belongingness: Thwarted Belongingness: Empirical EvidenceEmpirical Evidence

Hoyer and Lund (1993) studied Hoyer and Lund (1993) studied nearly a million women in Norway; nearly a million women in Norway; over the course of a 15-year follow-over the course of a 15-year follow-up, over 1,000 died by suicide up, over 1,000 died by suicide

They reported that women with six They reported that women with six or more children had one-fifth the or more children had one-fifth the risk of death by suicide as risk of death by suicide as compared to other women compared to other women

Serious Attempt or Death by Serious Attempt or Death by SuicideSuicide

Those Who Desire Suicide

Those Who Are Capable of Suicide

PerceivedBurdensomeness

ThwartedBelongingness

Prevention/Treatment Prevention/Treatment ImplicationsImplications

The model’s logic is that prevention of The model’s logic is that prevention of “acquired ability” OR of “acquired ability” OR of “burdensomeness” OR of “thwarted “burdensomeness” OR of “thwarted belongingness” will prevent serious belongingness” will prevent serious suicidalitysuicidality

Increasing belongingness may be the Increasing belongingness may be the protective factor one can influence the protective factor one can influence the most and quickestmost and quickest

Example PSA: “Keep your old friends and Example PSA: “Keep your old friends and make new ones – it’s powerful medicine”make new ones – it’s powerful medicine”

Questions and Questions and discussion?discussion?

RESPONDING TO SUICIDAL RESPONDING TO SUICIDAL PEOPLE AND THEIR LOVED PEOPLE AND THEIR LOVED

ONES ONES The following structured interactive The following structured interactive

discussion session is intended to assist discussion session is intended to assist you by reviewing the training received you by reviewing the training received online in this area.online in this area.

Through role-plays you can practice and Through role-plays you can practice and share strategies for dealing with those share strategies for dealing with those who have attempted suicide and the who have attempted suicide and the families and loved ones of both attempt families and loved ones of both attempt survivors and those who complete suicidesurvivors and those who complete suicide

Finally this section is to minimize Finally this section is to minimize your experience of secondary your experience of secondary trauma in responding to suicide trauma in responding to suicide events.events.

ReviewReview Being emotionally present Being emotionally present Accurate empathy Accurate empathy Genuineness Genuineness Unconditional positive regard (NO Unconditional positive regard (NO

Judgment!) Judgment!) Active listening Active listening Reflecting Reflecting Open ended questions Open ended questions Problem solving Problem solving Plan of Action Plan of Action

The definition of few The definition of few termsterms

Survivors of suicide: Committed suicide He took his own life She ended her own life

She died by suicide

First responders may First responders may face any of the three face any of the three following scenarios:following scenarios:

A person who may be suicidal and A person who may be suicidal and have recognized warning signshave recognized warning signs

A person who has just attempted A person who has just attempted suicide or attempted in recent pastsuicide or attempted in recent past

Family, friends of someone who has Family, friends of someone who has attempted suicide or dies by suicideattempted suicide or dies by suicide

On the way to the EDOn the way to the ED

Distressed person after a suicide attempt: Distressed person after a suicide attempt: “I just can’t take it anymore.  My father is “I just can’t take it anymore.  My father is cold and distant and never listens to me cold and distant and never listens to me when I’m upset.  It’s like he can’t stand to when I’m upset.  It’s like he can’t stand to be around me when I express my feelings.”be around me when I express my feelings.”

You:You: “It sounds like your dad doesn’t listen “It sounds like your dad doesn’t listen to you when you say what you feel.” to you when you say what you feel.”

Distressed personDistressed person: “Right.  You got that : “Right.  You got that right!”right!”

Distressed person:Distressed person: “Now that you “Now that you how hard it is for me to ever talk to my how hard it is for me to ever talk to my dad, maybe you can see why we can’t dad, maybe you can see why we can’t spend any time together.  If I get the spend any time together.  If I get the least bit upset, he’s going to blow up.”least bit upset, he’s going to blow up.”

You:You: “So anytime you get upset, or “So anytime you get upset, or show your feelings, your dad seems to show your feelings, your dad seems to withdraw or shut you down.  Does he withdraw or shut you down.  Does he sometimes just leave the scene?”sometimes just leave the scene?”

What do you say to the What do you say to the family?family?

DiscussDiscuss Boot camp “In your experience”Boot camp “In your experience” Scenarios students have Scenarios students have

experienced?experienced? Thoughts what would you add to Thoughts what would you add to

what others have said?what others have said? Building consensus - we’re learning Building consensus - we’re learning

how to do this togetherhow to do this together

Suicidal LanguageSuicidal Language

Putting it in contextPutting it in context

Without understanding the Without understanding the context, it is difficult to context, it is difficult to understand the message…understand the message…

Which of the following is a Which of the following is a suicide warning sign?suicide warning sign?

““I’m going to blow my brains out.” I’m going to blow my brains out.”

““I just can’t stand it anymore.”I just can’t stand it anymore.”

If either is a suicide warning sign, If either is a suicide warning sign, which statement requires immediate which statement requires immediate and urgent intervention?and urgent intervention?

Content vs. ContextContent vs. Context ““I’m going to blow my brains out!” I’m going to blow my brains out!”

Is sitting in your office in a psychiatric hospitalIs sitting in your office in a psychiatric hospital

““I just can’t stand it anymore.” I just can’t stand it anymore.”

Is standing well out of arm’s reach on the edge of 10-Is standing well out of arm’s reach on the edge of 10-story buildingstory building

Now… which person needed immediate and aggressive Now… which person needed immediate and aggressive intervention?intervention?

Help reduce confusion…Help reduce confusion…

Risk Factor?Risk Factor? Protective Factor?Protective Factor? Warning sign?Warning sign? Clue?Clue? Threat?Threat? Suicidal Communication?Suicidal Communication? Clear statement, coded or hidden?Clear statement, coded or hidden?

What are these?What are these? ““I’m going to kill myself!”I’m going to kill myself!” Buying a gun.Buying a gun. Pointing a loaded gun at your head.Pointing a loaded gun at your head. Giving away prized possessions.Giving away prized possessions. Heavy drinking when you are clinically Heavy drinking when you are clinically

depressed.depressed. Telling your friends what kind of music you want Telling your friends what kind of music you want

at your funeral when are apparently healthy.at your funeral when are apparently healthy. Saying goodbye, a kiss and hug from a teenaged Saying goodbye, a kiss and hug from a teenaged

boy.boy. ““If a person kills himself, does he go to hell?”If a person kills himself, does he go to hell?”

Steven Pinker – Steven Pinker – The Stuff of The Stuff of ThoughtThought

The need for indirect speech – the The need for indirect speech – the speaker says something he/she doesn’t speaker says something he/she doesn’t mean literally knowing the hearer will mean literally knowing the hearer will interpret what was intended and interpret what was intended and correctly interpret what was meant.correctly interpret what was meant.

All humans know how to “read between All humans know how to “read between the lines” See, Politeness Theory the lines” See, Politeness Theory ((Politeness: Some Universals in Politeness: Some Universals in Language Use – Language Use – Brown & Levinson, Brown & Levinson, 1987)1987)

Context is everything….Context is everything….

We are all very nice…We are all very nice… When lost and we need to ask a stranger When lost and we need to ask a stranger

for directions, “Excuse me…” for directions, “Excuse me…” ““Would you like to come and see my Would you like to come and see my

etchings?etchings? ““Would you like to come up for coffee?”Would you like to come up for coffee?”

““Polite indirect speech can use any hint that Polite indirect speech can use any hint that cannot be pinned down as a request by its cannot be pinned down as a request by its literal content, but that can lead an literal content, but that can lead an intelligent hearer to infer its intended intelligent hearer to infer its intended meaning…” SP, 2006.meaning…” SP, 2006.

Our job?Our job?

To make hearers of suicidal To make hearers of suicidal communications, polite requests for communications, polite requests for rescue, or for help from one’s community rescue, or for help from one’s community or significant others understood so that or significant others understood so that positive actions can follow.positive actions can follow.

Plausible deniability:Plausible deniability:

““Can you pass the salt?” vs.Can you pass the salt?” vs.

““The chowder is pretty bland.” Or, “They The chowder is pretty bland.” Or, “They never have enough salt in this never have enough salt in this restaurant.”restaurant.”

Forms of communications: Forms of communications: Off record requests in Off record requests in

context…context… Hints “Lions could hide in the lawn.”Hints “Lions could hide in the lawn.” Understatements “You got a real nice Understatements “You got a real nice

store here. It would be too bad if store here. It would be too bad if something happened to it.”something happened to it.”

Idle generalizations “It’s too dark to Idle generalizations “It’s too dark to read in here.”read in here.”

Rhetorical questions “It looks like Rhetorical questions “It looks like someone has had too much to drink?”someone has had too much to drink?”

Examples from real Examples from real cases…cases…

Parishioner to Pastor, “Do people who Parishioner to Pastor, “Do people who kill themselves go to hell?”kill themselves go to hell?”

Catholic woman to best friend, “It’ll be Catholic woman to best friend, “It’ll be fine, I’ve seen the virgin.”fine, I’ve seen the virgin.”

Patient to pharmacist, “Are you sure this Patient to pharmacist, “Are you sure this is enough medicine to cause death?”is enough medicine to cause death?”

Patient to doctor, “You’ve been a Patient to doctor, “You’ve been a wonderful doctor. Thanks for wonderful doctor. Thanks for everything.”everything.”

Last words from real Last words from real casescases

Depressed farmer to inpatient nurse on Depressed farmer to inpatient nurse on discharge, “Don’t worry about me, I’ll discharge, “Don’t worry about me, I’ll be six feet under by Friday.” be six feet under by Friday.”

Depressed boy to mother, “Do you Depressed boy to mother, “Do you think God has a place in heaven for a think God has a place in heaven for a boy like me?”boy like me?”

Father to son, “I’m going home soon.”Father to son, “I’m going home soon.” WWII vet to social worker, “Don’t WWII vet to social worker, “Don’t

worry, when the going gets tough the worry, when the going gets tough the tough know what to do.”tough know what to do.”

Suicidal CommunicationsSuicidal Communications

- If you were suicidal, who would you - If you were suicidal, who would you tell?tell?

- How would you tell them?- How would you tell them?

- How many times would you tell them?- How many times would you tell them?

- What would you do if people did not - What would you do if people did not respond?respond?

- How would you change your message - How would you change your message if ignored?if ignored?

QPR ROLE PLAY PRACTICE QPR ROLE PLAY PRACTICE SESSION AND Q&A SESSION AND Q&A

QUESTIONS FOR THOSE QUESTIONS FOR THOSE WHO WERE “SUICIDAL”WHO WERE “SUICIDAL”

““What did you become aware of What did you become aware of during the course of this exercise? during the course of this exercise?

QUESTIONS FOR THOSE QUESTIONS FOR THOSE WHO PRACTICED QPRWHO PRACTICED QPR

““What did it feel like for you ask What did it feel like for you ask about suicide risk?”about suicide risk?”

““How comfortable were you?”How comfortable were you?”

FIRST RESPONDER SELF FIRST RESPONDER SELF CARECARE

Provide a structured interactive discussion Provide a structured interactive discussion session in which students can recognize session in which students can recognize and discuss the stressful nature of their and discuss the stressful nature of their jobsjobs

In small group discussion, review their In small group discussion, review their personal coping skills and stress personal coping skills and stress management strategies and brainstorm management strategies and brainstorm additional onesadditional ones

Help students identify where they can go to Help students identify where they can go to gain additional skillsgain additional skills

What your peers saidWhat your peers said

It works if you work itIt works if you work it

Having someone to talk too about the Having someone to talk too about the stress and the feelings that build up stress and the feelings that build up inside so they don’t just one day explodeinside so they don’t just one day explode

Being around friends and family and Being around friends and family and just hanging outjust hanging out

Sitting by the fire with a few friends, Sitting by the fire with a few friends, telling stories, watching for the first star telling stories, watching for the first star of the night and poking the fire with a of the night and poking the fire with a stickstick

Taking walks, playing ball or other forms Taking walks, playing ball or other forms of exercise to clear out the tensionof exercise to clear out the tension

Going fishing, panning for gold, or other Going fishing, panning for gold, or other activities in order to spend some valuable activities in order to spend some valuable time with yourself and clear your head time with yourself and clear your head

Meditation, prayer, yoga, and other Meditation, prayer, yoga, and other spiritual or religious practices that can spiritual or religious practices that can help provide a sense of peace and help provide a sense of peace and perhaps some perspectiveperhaps some perspective

Positive Coping MethodsPositive Coping Methods

Number 1 at 35%Number 1 at 35% Peer and family support talking it outPeer and family support talking it out

Number 2 at 30%Number 2 at 30% Physical activities, hunting, fishing, Physical activities, hunting, fishing,

outdoors, exerciseoutdoors, exercise Other methods includedOther methods included

Faith/prayer/reflectionFaith/prayer/reflection

Some not so positive Some not so positive copingcoping

7% just walk away/move on to next 7% just walk away/move on to next callcall

5% drugs and alcohol5% drugs and alcohol Other comments includedOther comments included

Detach emotionallyDetach emotionally InadequateInadequate InternalizationInternalization IrrelevantIrrelevant

Getting help for yourself Getting help for yourself questionsquestions

How do I know if help is warranted?How do I know if help is warranted? How bad do I have to feel before I How bad do I have to feel before I

ask for help?ask for help? Isn't it better to "tough it out" with Isn't it better to "tough it out" with

emotional problems?emotional problems? How do I pick a professional?  Which How do I pick a professional?  Which

kind?kind?

More questionsMore questions

What's the difference between a What's the difference between a social worker, psychologist, social worker, psychologist, psychiatrist, and counselor?  psychiatrist, and counselor?  Whets a CD counselor?Whets a CD counselor?

If I did make an appointment, If I did make an appointment, what questions should I ask?what questions should I ask?

Will my insurance pay for the Will my insurance pay for the help I may need?help I may need?

Once in the office Once in the office questions:questions:

What will happen on my first What will happen on my first visit?visit?

Are things I should ask to get off Are things I should ask to get off to a good start?to a good start?

Is it OK to get a second opinion Is it OK to get a second opinion if I don't like what I hear?if I don't like what I hear?

How will I know what I need?How will I know what I need?

More questionsMore questions

Do I have to like the Do I have to like the professional, and what if I don't?professional, and what if I don't?

What should I do if I'm What should I do if I'm disappointed?disappointed?

Should I ask about the risks and Should I ask about the risks and benefits of the treatment benefits of the treatment proposed?proposed?

Last to recognize itLast to recognize it

How far do you push a friend, familyHow far do you push a friend, family Who can you go to, to protect Who can you go to, to protect

confidentialityconfidentiality Particularly in small townsParticularly in small towns

THANKS!THANKS!