1. SIAST Kelsey Campus November 8, 2012

2. Your questionsCrisis Management Service, Saskatoon November 8, 20122 3. Mobile Crisis Service 933-6200Crisis Management Service 933-8234 103 506 25th Street EastSaskatoon 4. Cleeve BriereCoordinator, Crisis Management ServiceAssistant Director Saskatoon Crisis Intervention Service cbriere@saskatooncrisis.ca Crisis Management Service, Saskatoon November 8, 2012 4 5. TO THEFROM THE NOBLE IGNOBLE, CATASTROPHIC o Socrates (399 BC) o Life is ..."solitary, poor,nasty, brutish, and short.Thomas Hobbes , Leviathan, 1651 o Sue Rodriguez (1994) o Accidental o Altruistic suicideo Recreational drug use o For the benefit of others o Sharing needles (Is this suicide?) o Suicide by Police Crisis Management Service, Saskatoon November 8, 20125 6. MORE TOLERANCE LESS TOLERANCE Greek & Roman Christianityo Moral space for suicideo An offense against God Japano Samurai era Islamo Seppukuo Prohibited (Quran 4:29-30)o Kamikaze pilots Canada Indiao Criminal (Sec 241 C.C.C.)o Sati Crisis Management Service, Saskatoon November 8, 2012 6 7. the will to live; transcendence; the unexplained mystery Biological, spiritual, cultural impulses Theultimate in pain and anguish Assisted suicide EuthanasiaCrisis Management Service, Saskatoon November 8, 20127 8. 10/day die by suicide 50/day self harm Completedsuicide 3:1 (Men:women) More women attemptA preventable epidemic Crisis Management Service, Saskatoon November 8, 2012 8 9. SigmundFreud committed suicide withmorphine following an inoperable cancer Aggression turned inward Imbalance between Eros (life instinct)andThanatos (death instinct) has severelyfallen out of favourCrisis Management Service, Saskatoon November 8, 20129 10. Crisis Management Service, Saskatoon November 8, 201210 11. Thereis a mortality and morbidity ratewhen working with suicidal persons Some die In other words, sometimes, despite ourbest efforts, our interventions fail With suicidal death there is, for theintervener, a risk of transforming intopersonal failure Families often experience this impact Crisis Management Service, Saskatoon November 8, 2012 11 12. With Mental Disorder - 90% With Depression Highest With Personality Disorder SubstanceAbuse Crisis Management Service, Saskatoon November 8, 2012 12 13. Individual Family Communityo the SIAST communityo the Kelsey community Province National International Crisis Management Service, Saskatoon November 8, 2012 13 14. Suicide is a form of homicideA murder of the self The direction of the anger may change Murder-suicide Crisis Management Service, Saskatoon November 8, 2012 14 15. Suicide is not chosen, it happens when painexceeds resources for coping with pain The Samaritans www.metanoia.org/suicideCrisis Management Service, Saskatoon November 8, 201215 16. Suicide attempt, gesture or self-harm/mutilation that does not result insuicide Strongest predictor of future completedsuicide More frequent among adolescents andyoung adults About half of all completed suicides arepreceded by parasuicideCrisis Management Service, Saskatoon November 8, 201216 17. Distinguishedby its utilityo Relief of unbearable feelingso Feelings of unrealityo Feeling of numbness Not intended to kill Client examples Crisis Management Service, Saskatoon November 8, 2012 17 18. See Handout Crisis Management Service, Saskatoon November 8, 2012 18 19. Sex (1) Age (1) Depression or hopelessness (2) Previous attempts or psychiatric care (1) Excessive alcohol or drug use (1) Rational thinking loss (2) Separated, divorced, or widowed (1) Organized or serious life threatening attempt (2) No social support (1) Stated future intent (2)Crisis Management Service, Saskatoon November 8, 201219 20. Add all scores If score < 6: Consider outpatient management Have friends or family stay with client Remove weapons and medications Arrange follow-up within 24 to 48 hoursCrisis Management Service, Saskatoon November 8, 201220 21. If score > 6: Considerpsychiatric consult or admissionCrisis Management Service, Saskatoon November 8, 201221 22. Identify risk and protective factors Assess current presentation of suicidality Assess suicide history Substance Use present and pastCrisis Management Service, Saskatoon November 8, 201222 23. Assessfor hopelessness, impulsivity, aggression, agit ation Psychiatricdiagnosis? Psychosocialstressors Religiousand spiritual beliefs about death and suicide Management Service, Saskatoon November 8, 2012Crisis23 24. Gender Age Marital status Ethnicity Sexual orientation Substance use history Prior suicide history Physical illness PsychosesCrisis Management Service, Saskatoon November 8, 201224 25. Psychologicalfactors History of self-mutilation Psychiatricdiagnosis Social Factors Familyhistory TherapeuticrelationshipCrisis Management Service, Saskatoon November 8, 201225 26. Children LifeSatisfaction Religious beliefs Cultural beliefs Coping skills Social supports Reality testing ability Therapeutic relationship Crisis Management Service, Saskatoon November 8, 2012 26 27. Location where are you? Mental status Physical status Substance use and abuse Weapons Crisis Management Service, Saskatoon November 8, 2012 27 28. Take all suicide talkers seriously When uncertain of your assessment, consult a senior colleague or psychiatrist Involve natural supports Re-assessregularly Crisis Management Service, Saskatoon November 8, 2012 28 29. Document Suicide risk assessment s Comprehensive physical assessments Natural supports concerns Previous psychiatric history Previous treatments, include key clinical decisions Discharge plan, include who is to follow-up Crisis Management Service, Saskatoon November 8, 2012 29 30. Training staff improves staff performance,better referrals, improves overall care Applied Suicide Intervention Skills Training(ASIST) foundational Access to MH clinician to follow-up at ERpresentations Timely clinical supervision and support forstaff Culturally appropriate services Educational information about suicide Crisis services Crisis Management Service, Saskatoon November 8, 2012 30 31. Informed consent Mental Health Services Act Involuntary Detainment Health Information Act and Confidentiality Crisis Management Service, Saskatoon November 8, 2012 31 32. Our mostly modern contributionCrisis Management Service, Saskatoon November 8, 201232 33. Includes drugs of abuse, prescribed medications, toxinexposures Substance use disorders Dependence Abuse Substance induced disorders intoxication, withdrawal, delirium, persistent dementia, Amnesia, psychoses, mood disorder, anxiety disorder Polysubstance abuse Concurrent disorders Crisis Management Service, Saskatoon November 8, 2012 33 34. Donot attempt to counsel clients underthe influence Instead pursue physical safety planning Recall the Maslow hierarchy of needs toguide your intervention Crisis Management Service, Saskatoon November 8, 2012 34 35. Crisis Management Service, Saskatoon November 8, 201235 36. First order symptoms Physical (2) Insomnia Vivid dreams Nausea Diarrhea Headache Elevated vital signs Cravings Crisis Management Service, Saskatoon November 8, 2012 36 37. Secondorder symptoms defense structures Rationalization makes irrational excuses to explain behaviour Justification Statements that justify the individuals actions Minimization Making light of the extent and severity of the illness Externalization Blaming others for the progression of the disease Crisis Management Service, Saskatoon November 8, 2012 37 38. Thirdorder symptoms- feelings/emotional responses Anger that the individual is unable to ever drink safely again Fear of potential consequences of past actions and what the future may hold Crisis Management Service, Saskatoon November 8, 2012 38 39. Thirdorder symptoms- feelings/emotional responses (2) Loss associated with substance use ( job, family, financial stability, sense of self) Guilt over things done while drinking and using Shame over what the individual perceives they have become Crisis Management Service, Saskatoon November 8, 2012 39 40. Psychosocialand lethality assessment Psychological contact, relationship andrapport Establish dimensions of problem, helpclient connect the dots Focus on here and how connectsubstance use activity to current crisis Encourage feelings and emotion Explore and assess past coping attemptsCrisis Management Service, Saskatoon November 8, 201240 41. Restorecognitive functioning by developing a plan Focus on specific event that led to crisis Let client self-define the specific meaning o f thecrisis event, how it conflicts with goals, beliefs,and self-expectations Know your local substance use treatmentcontinuum (detoxification, social detoxification,outpatient counselling, inpatient treatment,maintenance) Crisis Management Service, Saskatoon November 8, 2012 41 42. Restorecognitive functioning by developing a plan To develop cognitive mastery Need to restructure , rebuild, replace irrational beliefs and erroneous cognitions Provide new information about recovery through counselling, homework assignments, referral to support groups Crisis Management Service, Saskatoon November 8, 2012 42 43. Lee Ann HoffCrisis Management Service, Saskatoon November 8, 2012 43 44. Crisis Management Service, Saskatoon November 8, 201244 45. To assist the person to return to their pre- crisis level of functioning To achieve growth and development With an enhanced coping repertoire Crisis Management Service, Saskatoon November 8, 2012 45 46. Situational Material Personal/physical Interpersonal loss Transitional Life passages Social/Cultural Values Socialization Deviance ConflictCrisis Management Service, Saskatoon November 8, 201247 47. Emotional Cognitive Anxiety Interference in usual Fear problem solving ability Anger Guilt Shame BehaviouralChanges BiophysicalupsetsCrisis Management Service, Saskatoon November 8, 201248 48. Emotional Cognitive Anxiety Interference in usual Fear problem solving ability Anger Guilt Shame BehaviouralChanges BiophysicalupsetsCrisis Management Service, Saskatoon November 8, 201249 49. Traumatic situations Grief work Material aid Social support Crisis counselling Cultural values/Social Structure social change strategies Transition States contemporary rites of passage Crisis Management Service, Saskatoon November 8, 2012 50 50. Acceptanceof the pain of loss Openexpression of pain, sorrow, hostility, and guilt Understanding of the intense feelings associated with loss Resumptionof normal activities and social relationships without the person lost Crisis Management Service, Saskatoon November 8, 2012 51 51. Material Support Social Support Crisis Counselling Cultural values/Social structures Social change strategies Transition States Crisis Management Service, Saskatoon November 8, 2012 52 52. Negative outcomes Emotional/mental disturbance Violence against others Self destruction AddictionsCrisis Management Service, Saskatoon November 8, 201253