suicide prevention presentation for chaplains

Suicide PreventionMike Koplin, MSW, PhD

Suicide Prevention Coordinator

Objectives

• 1. Identify some demographics and mental health, medical, and psychosocial factors that place individuals, especially veterans, at risk for suicidal ideation and behavior.

• 2. Identify warning signs and appropriate responses to suicidal ideation to ensure safe intervention and treatment.

• Questions????

Definitions

• Suicide – Death from intentional self-inflicted injury with evidence of intent to kill oneself.

• Suicide Attempt - Intentional self-injurious behavior with a nonfatal outcome with evidence of intent to kill oneself.

Definitions…

• Suicide Threat - A verbal or nonverbal interpersonal interaction communicating a desire to die or kill oneself. (Plan & Intent)

• Suicide Ideation - Self-reported thoughts of self-injurious behavior which could lead to death. (Thoughts)

Why are we discussing suicide?• Suicide is the 11th leading cause of death

in America and substantially outnumbers homicides. There are typically about 32,000 suicides each year in relation to 24,000 murders.

• The surgeon general issued a call to action in 1999 stating the nation must address suicide as a significant public health problem.

• 1 suicide occurs every 16 minutes.

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Suicide is Not AnEqual Opportunity Destroyer• 80% of suicide deaths in the US are

white men• Highest rates are among older adult

males• Males die at a rate 3x higher than

women; women attempt 4x higher than men

• High rates for soldiers/veterans (current military is 85% male)

Statistics

• Veterans have >2x greater risk & account for 1 in 5 suicides in the US.

• Access to firearms- a major factor (guns are used in approximately 58% of completed suicides).

OEF/OIF Veterans’ Statistics48% are Active Duty, 52% are

Reserve/NationalGuard88% are men, 12% are women 65% Army; 12% Air Force; 12% Navy; 12%

Marine34% were deployed multiple times52%, largest age group, is 20-29 years old

Total number of soldiers who have been deployed during OIF/OEF

1.6 million

total number of soldiers who have been deployed to a war zone twice

or more

700,000+

86% Know someone who was seriously injured or killed.

77% Have shot at ordirected fire at the enemy.

Relevant Statistics

• 34% individuals who think about suicide (ideation) transition to planning a suicide.

• 72% of planners attempt suicide.• 60% of planned and 90% of unplanned

(impulsive) attempts occur within one year of ideation onset.

• 16% repeat attempt within one year.• 90% of people who commit suicide

have a diagnosable mental health or substance abuse problem.

Factors of Provider Concern:

• 1. Significant association between suicide attempts and diagnosis of depression, alcohol misuse, and generalized anxiety.

• 2. A diagnosis of depression, alcohol misuse, and anxiety disorder combined with age < 30 may be associated with increased risk for suicide.

• 3. Female veterans with a history of MST are six times more likely to attempt suicide than those who report no MST.

MENTAL ILLNESS AND SUICIDEMajor Depression 15% die by suicide; 30%

attempt (Source: American Foundation for

Suicide Prevention)

Bipolar Disorder 10% die by suicide; 25-50% attempt

(Source: AFSP)

Schizophrenia 10% die by suicide; 20-40% attempt

(Source: AFSP)

Alcoholism 7% die by suicide(Source: AFSP)

Anxiety Disorders incl. PTSD

Over 50% attempt(Source: Molnar et al, 2001)

• 25% of individuals who die by suicide were intoxicated at the time of their death

• (Alcohol involved in 64% of attempts)• Drug overdose deaths are typically

ruled accidental in the absence of information confirming suicide

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Suicide and Alcohol/Drugs

Potential Complications of Deployment on Soldiers & Families• Depression• Alcohol and other drug addiction/abuse• Violence, including Suicide/Homicide• Divorce• Job Loss• Homelessness• Poverty• PTSD• Impact on Spirituality

Risk Factors Among Veterans

• High gun ownership• Debilitating injuries• Mental health issues

Risk Factors

• Reality Check: Who’s at Risk for Suicide?

• Anyone! (Don’t assume the statistical information applies to everyone.)

Highest Risk Factors…

• Suicidal ideation reported• Suicidal intention reported• Suicidal plan with means reported

First Responders/Interveners

• Involuntary admission

• Police should be considered as important first line responders by other early interveners, such as firefighters or emergency personnel, because they can facilitate access to medical and psychiatric evaluation and treatment.

First Responders/IntervenersHELPING SOMEONE WHO IS SUICIDAL

• People who feel suicidal often express hopelessness and depression. They see suicide as the only way to solve their problems and eliminate their suffering.

• Although suicide is difficult to predict, a large proportion of those who eventually kill themselves will give more or less clear warning signs of their suicidal intentions in the weeks or months prior to their death.

These are not harmless bids for attention, but important cries for help that should be taken seriously.

First Responders/IntervenersHELPING SOMEONE WHO IS SUICIDAL

• Warning signs include both behavioral and verbal clues

• Being withdrawn and unable to relate to friends and coworkers;

Talking about feeling isolated and lonely

Expressing feelings of uselessness, lack of hope or loss of self-esteem

First Responders/Interveners HELPING SOMEONE WHO IS SUICIDAL

• Constantly dwelling on problems for which there seem to be no solutions;

• Expressing a lack of support or belief in the system;

• Speaking about tidying up affairs;• Giving some other indication of a

suicide plan.

First Responders/Interveners HELPING SOMEONE WHO IS SUICIDAL

• Suicidal people who are demonstrating

warning signs are at greater risk if there has been:

• A recent loss of a close relationship;• A change (or anticipated change) in

work circumstances, such as a lay off, early retirement, demotion, or other workplace change

First Responders/Interveners HELPING SOMEONE WHO IS SUICIDAL

• A change in health;• Increased misuse of alcohol or other

drugs;• A history of suicidal behavior or

history of suicide• attempts in the family;• Current depression

First Responders/Interveners HELPING SOMEONE WHO IS SUICIDAL

• Approach all situations involving someone who is suicidal as a psychiatric emergency and act accordingly. Never assume that suicidal ideas or gestures are harmless bids for attention or an attempt to manipulate others.

• Clear the scene and keep yourself and others who may be present safe.

First Responders/Interveners HELPING SOMEONE WHO IS SUICIDAL

• Give physical space. Don’t get too close to the person too soon. Sudden movements, attempts to touch the person, or the introduction of others into the scene, may be misunderstood.

• Express acceptance and concern. Avoid sermonizing, arguing, problem-solving, giving advice, or telling someone to “forget about it”. It is important to convey an attitude of concern and understanding.

First Responders/Interveners HELPING SOMEONE WHO IS SUICIDAL

• Engage the individual. Encourage the person to talk. Most suicidal people are ambivalent about dying. Asking someone if they are suicidal or otherwise talking about suicide will not tip them over the edge, but will provide a sense of relief and a starting point for a solution. To assess intent, ask if the individual has a plan, access to lethal means, or has decided when to act.

First Responders/Interveners HELPING SOMEONE WHO IS SUICIDAL

• Never leave a potentially suicidal individual alone based on their promise to visit their mental health worker or the hospital. Ensure that family members or significant others are on the scene and accept responsibility for seeking help.

First Responders/Interveners HELPING SOMEONE WHO IS SUICIDAL

• When a suicide attempt occurs, police officers, firefighters and other responders are usually requested to deal with the

crisis, provide basic help, and arrange for the person to be transferred to a health center if necessary. First responders must

also deal with family members and significant others.

First Responders/Interveners FOLLOWING A SUICIDE ATTEMPT

• First, it is necessary to establish caring relationship with the person who attempted suicide. The relationship must be relaxed, non-threatening, empathic,

and friendly.

First Responders/Interveners FOLLOWING A SUICIDE ATTEMPT

• Second, after having established the relationship, communication needs to be on-going. The person should feel free to say what she or he feels. Open-ended

questions should be asked, such as “How do you feel?”

First Responders/Interveners FOLLOWING A SUICIDE ATTEMPT

• Third, if transfer to a medical facility is not warranted, then every effort should be made to remove further lethal means and ensure that the individual has a family member or close friend to oversee their recovery and manage treatment referrals.

First Responders/Interveners FOLLOWING A SUICIDE ATTEMPT

• Fourth, the suicidal individual must be connected to mental health and addiction services to ensure appropriate treatment and follow-up. Referrals to mental health agencies should be done independently of any medical treatment that is required.

First Responders/IntervenersWHEN A SUICIDE ATTEMPT OCCURS

• Finally, when significant others are aware, they may be emotionally distraught, confused, angry, or overwhelmed by the circumstances. First responders need to exercise tact, compassion, sensitivity, and support to all to everyone. Those who are aware can also be a valuable source of information (such as the drugs ingested or past history of substance abuse or suicide attempts).

Ways to be helpful…

• Know how to respond• Be direct & refuse secrecy• Listen; Be non-judgmental • Offer hope about resources including

Hotline and make mental health referral as needed

• Remove weapons/ means

Suicide Hotline

• National Number: 1-800-273-TALK (8225)• Prompt #1 for Veteran or family of veteran • Veteran prompt connects to VA mental

health staff 24hrs. a day.• If emergent situation hotline staff assist

with immediate referral to community resources

• If non-emergent needing additional assistance,

Veteran to be referred to closest VA within 24hrs.

Myths about Suicide

• A person that talks or threatens to commit suicide will never hurt themselves.

• Mentioning suicide may give a person the idea.

• Once people are suicidal, they are beyond help.

• People who make unsuccessful suicide attempts just want attention.

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The Implications of Not Addressing Suicide• Survivors feel isolated, blamed.• People who were impacted may not

seek help and counseling that would be beneficial.

• People who are vulnerable, such as youth, may be at greater risk.

• Facts may be replaced by rumor and innuendo

• The stigma of suicide reinforces the silence around suicide.

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WHY?????

• For Survivors of Suicide, the grief is often combined with a relentless search for an explanation or answer.

• Grieving a suicide can include intense feelings of:ShameAngerGuiltRegretSelf-Blame

War may be hell… but home ain’t exactly heaven, either.

When a Service Member comes home from war, He/She finds it hard…

…to listen to his son whine about being bored.

…to keep a straight face when people complain about potholes

…to be tolerant of people who complain about the hassle of getting ready for work

…to be understanding when a co-worker complains about a bad night’s sleep

…to control his panic when his wife tells him he needs to drive slower

…to be grateful that he fights for the freedom of speech.

…to be compassionate when a businessman expresses a fear of flying.

…to be silent when people pray to God for a new car.

…to not ridicule someonewho complains about hot weather.

…to just walk away when someone says they only get two weeks of vacation a year.

…to control his rage when a colleague gripes about his coffee being cold.

…to remain calm when his daughter complains about having to walk the dog.

…to be civil to people who complain about their jobs.

…to be happy for a friend’s new hot tub

…to be forgiving when someone says how hard it is to have a new baby in the house.

…to not punch a wall when someone says we should pull out immediately.

The only thing harder than being a Service Member… ……………

IS LOVING ONE…….

A gentle reminder to keep your life in perspective.

And when you meet one of our Returning SERVICE MEMBERS/VETS/FAMILIES,please remember what they’ve been through and show them

Compassion , Tolerance, Respect, and the Best Care.

Thank you!!

In Summary

On behalf of all of the veterans

and the VA I would like to thank you for your efforts and hard work on suicide prevention.

Thank you! Questions ??????