Preventing Suicide

1. Preventing Suicide Julie Reichenberger, Ma, LPC julie@CAFDC.org August 3, 2011

2. Attitudes What do you know about suicide? What experiences have you had? What does suicide mean to you?

3. Common Emotional Reactions Fear Anger Helplessness Hopelessness

4. History of Suicide Prevention 1958: Los Angeles Suicide Prevention Center opens, funded by the U.S. Public Health Service and directed by Edwin Shneidman.1966: Center for the Study of Suicide Prevention (later renamed the Suicide Prevention Research Unit) established at the National Institute of Mental Health.1968: American Association of Suicidology founded by Edwin Shneidman.1983: CDC Violence Prevention Unit (later subsumed into the National Center for Injury Prevention and Control) established; focuses public attention on an increase in the rate of youth suicide.1985: Secretary's Task Force on Youth Suicide established to review the problem of youth suicide and recommend actions.1987: American Foundation for Suicide Prevention founded.1989: Report of the Secretary's Task Force on Youth Suicide published by the U.S. Department of Health and Human Services.1996: Prevention Action Network (SPAN) USA founded with the goal of preventing suicide through public education, community action, and advocacy.1996: Prevention of Suicide: Guidelines for the Formulation and Implementation of National Strategies published by the World Health Organization and the United Nations, with the participation of a number of agencies within the U.S. Department of Health and Human Services.1998: National Suicide Prevention Conference held in Reno, Nevada as a response to the WHO/UN publication. This public/private partnership created an expert panel that issued 81 recommendations.

5. 1999: Surgeon General's Call to Action to Prevent Suicide published, which consolidated the National Suicide Prevention Conference's recommendations, including the creation of a National Strategy for Suicide Prevention.2001: National Strategy for Suicide Prevention published by the U.S. Department of Health and Human Services. It outlined a coherent national plan to enhance the suicide prevention infrastructure, including the creation of a technical assistance and resource center.2002: Suicide Prevention Resource Center established at Education Development Center, Inc. with funding from the Substance Abuse and Mental Health Services Administration.2002: Reducing Suicide: A National Imperative published by the Institute of Medicine of the National Academies of Science. This publication examined and summarized the state of knowledge about suicide and the state of the art of suicide prevention.2003: Achieving the Promise: Transforming Mental Health Care in America published by the President's New Freedom Commission on Mental Health.2004: Garrett Lee Smith Memorial Act passed by the U.S. Congress to support and enhance youth suicide prevention efforts in the states, among tribal nations and at colleges and universities.2004: National Suicide Prevention Lifeline (1-800-273-TALK) funded by the Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.2005: The Department of Labor, Heath and Human Services, and Education, and Related Agencies Appropriations Act of 2006 which appropriates a total of $30 million for suicide prevention was signed into law.2006: The SAMHSA Program Priority Matrix was updated to include suicide prevention as one of the matrix priorities.2006: Federal Working Group on Suicide Prevention established. Representatives from SAMHSA, Centers for Disease Control, National Institute on Mental Health, Indian Health Services, Department of Defense, Veterans Affairs and other federal agencies.

6. Myths and Facts MYTH: “People who talk about suicide won’t really do it.” TRUTH: Almost everyone who dies by or attempts suicide talks about it in some way first. DO NOT IGNORE SUICIDE THREATS!

7. Myths and Facts MYTH: “Only crazy people die by suicide.” TRUTH: Most suicidal people are not psychotic or insane. They are likely feeling depressed, hopeless, distressed, and are in deep emotional pain but this does not necessarily mean they lost touch with reality.

8. Myths and Facts MYTH: “Talking about suicide may give someone the idea to attempt suicide.” TRUTH: Discussing the subject openly and showing that you care is one of the most helpful things you can do. Are you thinking about suicide? (repeat, ask the person next to you) Don’t say: “You’re not thinking about suicide are you?”

9. Myths and Facts MYTH: “Talking about suicide may give someone the idea to attempt suicide.” TRUTH: Discussing the subject openly and showing that you care is one of the most helpful things you can do. Are you thinking about suicide? (repeat, ask the person next to you) Don’t say: “You’re not thinking about suicide are you?”

10. Myths and Facts MYTH: “People who attempt suicide are just trying to get attention.” TRUTH: IT DOES NOT MATTER IF THAT IS THE MOTIVATION!If they do not get attention, the results could be fatal!

11. Myths and Facts MYTH: “No one I know would attempt suicide.” TRUTH: Suicide does not draw boundaries, and it does not have preference!

12. Suicide Is A Major Public Health Problem 31,655 people died by suicide in the United States. Suicide was the 11th leading cause of death in the United States. In the U.S., more people die by suicide each year than die because of HIV or homicide. 11 out of every 100,000 Americans died by suicide.

13. Gender, Ethnic, and Age Differences in Suicide Males are four times as likely to die by suicide than as females - although females attempt suicide three times as often as males. White Americans are more likely to die by suicide than Americans of other racial backgrounds. Suicide is the 3rd leading cause of death among Americans between the ages of 15-24 and the second leading cause of death among those between the ages of 25-34. Suicide rates increase with age. Elderly people who die by suicide are often divorced or widowed and suffering from a physical illness.

14. Suicide and Mental Illness Ninety percent of suicides that take place in the United States are associated with mental illness, including disorders involving the abuse of alcohol and other drugs. Fifty percent of those who die by suicide were afflicted with major depression, and the suicide rate of people with major depression is eight times that of the general population.

15. Illinois Suicide Statistics More than 1,000 Illinoisans die by suicide each year. On average in the United States, a person dies by suicide every 16 minutes. It is estimated that there are 25 attempts for every adult death by suicide in the United States; and an estimated 100 to 200 attempts for every young person that dies by suicide. Each suicide intimately affects at least six other people.

18. Risk Factors Previous suicide attempt Suicide ideations or behaviors Social isolation Exposure to suicidal behaviors (media, clusters) History of physical or sexual abuse Family history of mental illness Chaotic family history (divorce, death, change) Victim of bullying Discrimination – gender, sexual identity

19. Risk Factors Access to, or familiarity with, lethal means Triggering events (loss of relationship, loss of role, etc) Severe physical illness, impairment or pain Mood disorder: depressive or bipolar disorder Psychotic disorder Alcohol/drug abuse/dependence Borderline or Antisocial Personality Disorder Conduct disorder Bulimia/anorexia Anxiety disorder/PTSD

20. Risk Factors Impaired mental status, particularly thought disorder Psychic pain Perceived burdensomeness Stress Agitation Hopelessness Self-hate Anger Impulsivity Poor reality testing Sleep disturbance Command hallucination Intoxication Recklessness

21. Protective Factors Effective care for mental, physical and substance abuse disorders Positive therapeutic relationships Easy access to a variety of clinical interventions and support for help-seeking individuals Strong connections to family and community support Responsibility to children and beloved pets Support through ongoing medical and mental health relationships

22. Protective Factors Resilience Coping Skills Frustration tolerance and emotion regulation Cultural and religious beliefs that affirm life and discourage suicide

23. Community Implementation Establish task force and identify a local coordinator Identify community resources Identify funding resources Establish community support team Identify and include community cultural resources

24. Potential Task Force Members Survivors Youth School Personnel Crisis Response Team Members EMS Agency Members Public Health Agencies Mental Health Agencies (local) Spiritual leaders Grief Counselors Physicians Community Members

25. Potential Community Resources School Personnel Mental Health Agencies EMS Grief Counselors Firemen/Police Crisis Response Team Service Organizations Survivor Organizations Funeral Home Directors Parents Community-at-Large

26. Identify Community Support Team • This team consists of people with specialized skills and training that can support and sustain an effective prevention initiative, as well as support the new high risk, which may consist of attempt survivors, surviving family members and first responders • Counselors/therapists • Mental Health Agencies • Grief Counselors • Social Workers • Medical Personnel

27. Helping Schools Say Yes Awareness + Education = Prevention Building a strong base within your community by AWARENESS and outreach Coupled with an effective EDUCATION program Will bring desired results – PREVENTION **Many people are lost to suicide because immediate support and help was not offered or available.

28. Building Relationships with Schools Address your proposal to the decision-maker in a manner that will take into account their leadership style. Doing this will increase the response from that leader and increase the effectiveness of getting their partnership with your training program. Understand why they say no: fear, lack of understanding, superiors say no, we don’t have a problem here.

29. Have an information packet with the outline of the plans for the program Have either in your information packet or as an addendum the local statistics – city, state attempts and completions Have relationships built to ensure school will have community support Use open questions when approaching them so you can solicit more than a one-word answer (would you be interested in a program that can help your school?)

30. Preventing suicide in a community starts with becoming aware of the extent of the problem, followed with collaborating with stakeholders, educating all levels of community members and implementing sustainable components that will help your community build an effective, long-lasting program.

31. Surgeon General’s Blueprint for Preventing Suicide • Awareness • Promote public awareness: Use information technology appropriately to make facts about suicide and its risk factors and prevention approaches available to the public and to health care providers. • Expand awareness of and enhance resources in communities for suicide prevention programs and mental and substance abuse disorder assessment and treatment. • Develop and implement strategies to reduce the stigma associated with mental illness, substance abuse, and suicidal behavior and with seeking help for such problems.

32. Surgeon General’s Blueprint for Preventing Suicide • Intervention • Extend collaboration with and among public and private sectors to complete a National Strategy for Suicide Prevention. • Improve the ability of primary care providers to recognize and treat depression, substance abuse, and other major mental illnesses associated with suicide risk. • Increase the referral to specialty care when appropriate. • Institute training for all health, mental health, substance abuse and human service professionals concerning suicide risk assessment and recognition, treatment, management and aftercare interventions. • Develop and implement effective training programs for family members of those at risk and for natural community helpers on how to recognize, respond to, and refer people showing signs of suicide risk.

33. Surgeon General’s Blueprint for Preventing Suicide • Intervention • Develop and implement safe and effective programs in education settings for youth that address adolescent distress, provide crisis intervention and incorporate peer support for seeking help. • Enhance community care resources by increasing the use of schools and workplaces as access and referral points for mental and physical health services and substance abuse treatment programs and provide support for persons who survive the suicide of someone close to them. • Promote a public/private collaboration with the media to assure that entertainment and news coverage represent balanced and informed portrayals of suicide and its associated risk factors.

34. American Foundation for Suicide Prevention • The American Foundation for Suicide Prevention (AFSP) is the leading national not-for-profit organization exclusively dedicated to understanding and preventing suicide through research, education and advocacy, and to reaching out to people with mental disorders and those impacted by suicide. • To fully achieve its mission, AFSP engages in the following Five Core Strategies: • Funds scientific research • Offers educational programs for professionals • Educates the public about mood disorders and suicide prevention • Promotes policies and legislation that impact suicide and prevention • Provides programs and resources for survivors of suicide loss and people at risk, and involves them in the work of the Foundation

35. AFSP AFSP plays an active role in seeking to reduce suicide rates through initiating and participating in projects to develop, implement and evaluate innovative approaches to suicide prevention. In its suicide prevention projects, AFSP is working in partnership with many other individuals, organizations and institutions throughout the United States and abroad, who share our dedication to finding new and better ways to prevent suicide. A key goal of each project is to disseminate information about what has been learned, through articles that reach both professional and lay audiences.

36. Current AFSP Projects The Interactive Screening Program, which has developed and pilot-tested an interactive, web-based method of reaching out to students at risk of suicide, and encouraging them to get help. The Physician Depression and Suicide Prevention Project, which works with a range of other groups and professional organizations to address the disproportionately high rates of suicide among physicians and physicians in training. The International Project on National Suicide Prevention Strategies, which is bringing together experts from around the world to examine and evaluate individual countries' strategies for suicide prevention, and to encourage replication of evidence-based projects and approaches. The Media Project, which encourages responsible reporting of suicide by news media. The Hungarian Suicide Prevention Project, which has provided training about identifying and treating patient depression to physicians and other clinicians in a region of Hungary with an extremely high suicide rate. The Suicide Data Bank, which has collaborated with therapists who lost a patient to suicide, to improve recognition of suicide risk and treatment of seriously suicidal individuals. The LGBT Depression and Suicide Prevention Project, an initiative aimed at reducing suicide among lesbian, gay, bisexual and transgender populations. The Billboard Campaign looks to educate Americans about the serious nature of depression, and to urge those clinically depressed to see their doctor.

37. After a Suicide: A Toolkit for Schools Developed in consultation with national experts, this toolkit is a highly-practical resource for schools facing real-time crises, and is applicable for diverse populations and communities. Includes general guidelines for action, do’s and don’ts, templates and sample materials, and covers topics such as Crisis Response, Helping Students Cope, Working with the Community, Memorialization, Social Media, Suicide Contagion and Bringing in Outside Help.

38. High School Outreach AFSP has developed an educational program to help teachers and other school personnel learn more about teen suicide and how they can play a role in its prevention. More Than Sad: Suicide PreventionEducation for Teachers and Other SchoolPersonnel features two films, each approximately 25 minutes in length, and a manual that integrates both films into a comprehensive suicide prevention program. The program is designed to comply with states that have requirements or recommendations for teacher education in suicide prevention, and can be used for group trainings or individual study.

39. The first film, More Than Sad: Preventing Teen Suicide, educates teachers, counselors other school personnel about the causes of youth suicide, warning signs and steps they can take to get help for students. The second film, More Than Sad: TeenDepression, features four vignettes, each designed to present to teens a recognizable picture of depression, reduce fears and misconceptions about treatment, and promote help-seeking behavior.

40. Teen Suicide Prevention Campaign "Suicide Shouldn't Be A Secret" is the key theme of the American Foundation for Suicide Prevention's youth suicide prevention campaign. This campaign includes public service announcements that are currently airing in 85 markets nationwide, reaching over 88 million TV viewers. The PSAs feature actual teenagers who have had a suicidal friend or have lost a friend to suicide. These PSAs, along with a resource guide, are now available at www.afsp.org for your use.

41. College Outreach The American Foundation for Suicide Prevention (AFSP) has developed The Truth about Suicide: Real Stories of Depression in College as an outgrowth of its commitment to support colleges and universities in implementing suicide prevention as an integral part of their ongoing campus activities and services. The aim of this 27-minute film is to present a recognizable picture of depression and other problems associated with suicide, as they are commonly experienced by college students and other young adults.

42. Best Practices Registry for Suicide Prevention Since 2003, AFSP has been collaborating with the Suicide Prevention Resource Center to develop and maintain an online registry of best practices for suicide prevention. The purpose of the Best Practices Registry for Suicide Prevention (BPR) is to identify, review and disseminate information about best practices that address specific objectives of the National Strategy for Suicide Prevention. Programs listed on the BPR are categorized into three sections: evidence-based programs, expert and consensus statements, and programs that adhere to programmatic and safety standards. The registry is located on the Suicide Prevention Resource Center website (www.sprc.org).  

43. AFSP and Research Grants • Since AFSP began in 1987, encouraging and supporting scientific research on suicide causation, prevention and treatment has been at the heart of the Foundation's mission. Our research grants program seeks to: • Encourage established investigators to undertake innovative approaches and explore new directions in suicide research; • Encourage talented new investigators to enter the field of suicide research through grants that provide training support and mentoring; • Provide seed money for pilot projects that show promise in opening up new areas of suicide research.

44. Out of the Darkness Overnight Walk The Out of the Darkness Overnight is an 18-mile journey through the night, from dusk until dawn. It's a unique opportunity to bring the issues of depression and suicide into the light as we walk together to turn heartbreak into hope for tomorrow. Join us on June 4-5, 2011 as thousands of Walkers like you come together in New York, NY - a city rich with history and filled with the energy that we know will fuel our quest for awareness and prevention

45. Out of the Darkness Community Walks The Out of the Darkness Community Walks are 3-5 mile walks taking place in over 200 communities across the country this fall. By walking in the Out of the Darkness Community Walks to benefit the American Foundation for Suicide Prevention (AFSP), you will be walking with thousands of people nationwide to raise money for AFSP's vital research and education programs to prevent suicide and save lives, increase national awareness about depression and suicide, advocate for mental health issues, and assist survivors of suicide loss.

46. Out of the Darkness Campus Walks The Out of the Darkness Campus walks are 3-5 mile walks taking place in communities across the country, with the proceeds benefitting the American Foundation for Suicide Prevention. By walking in the Out of the Darkness Campus Walks, you will be walking with thousands of students nationwide to raise money for AFSP's vital research and education programs to prevent suicide and save lives, increase national awareness about depression and suicide and provide support for survivors of suicide loss.

47. Funds from Walks Invest in new research studies that will advance understanding of the causes of suicide and its prevention Organize new AFSP chapters across the country Recruit thousands of additional grassroots volunteers to advocate for suicide prevention Implement our Interactive Screening Program in colleges around the country, which screens students for depression online and connects them directly to the campus counseling center. Expand the survivor outreach program which links trained volunteer survivors with the recently bereaved to offer support Distribute AFSP’s new educational film for high school students to teach them about adolescent depression and the importance of getting help. The program also contains a film and materials to train teachers, guidance counselors and other school personnel about suicide prevention Use our film on physician depression and suicide to educate physicians and medical students to recognize depression in themselves and their patients

48. AFSP’s Illinois Chapter Community Walks Sept 3: Vandalia Community Walk Sept 10: Rockford Community Walk Sept 10: Bloomington/Normal Community Walk Sept 11: Sterling-Rock Falls Community Walk Sept 24: Chicagoland Community Walk Sept 25: Peru Community Walk Oct 1: Effingham Co. Community Walk Oct 1: Springfield Community Walk Oct 8: West Central IL (Galesburg)  Walk Oct 8: Northwestern Illinois (Freeport) Walk Oct 16: Quincy Community Walk Oct 23: Champaign/Urbana Community Walk

49. AFSP Illinois Chapter Activities 620 Survivor Resource Packets Distributed in Illinois! AFSP has provided free Survivor of Suicide Loss Resource Packets to 614 survivors of suicide loss in Illinois in the last 12 months! These packets contain free resources for survivors such as information about healing from loss. If you are a mental health progressional or member of the clergy would you like to request a packet for a client email illinois@afsp.org.

50. AFSP Illinois Chapter Activities 185 More Than Sad High School Suicide Prevention Programs in 90% of the Counties in Illinois!  More Than Sad Teen Depression and Educator Suicide Prevention Training was released in the Spring of 2010. Since then the Illinois Chapter has provided More Than Sad to 185 training sets to 90% of the Counties in Illinois. To learn about the program visit www.MoreThanSad.org. To request a free copy for your school email illinois@afsp.org.