Suicide Prevention Awareness Session: Youth

1. Suicide Prevention Awareness Session: Youth Maine Suicide Prevention Program Education, Resources and Support—It’s Up to All of Us.

2. Today’s Program Will Cover • Beliefs about suicide • How to talk about suicide • The facts • Warning signs and risk factors • Basic intervention skills to use with suicidal behavior • Resources for Help • The aftermath of suicidal behavior

3. Myths vs. Facts: True or False. . . • Talking openly about suicide will cause it. • Anyone can learn to help someone who is struggling with thoughts of suicide. • If someone decides that they want to take their own life, there’s nothing we can do to stop them. • If someone talks about it they don’t need to be taken seriously. • There are signs that we can look for that may indicate someone is considering suicide.

4. Our Words Reflect Our Beliefs Preferred: Simply use: • “suicide” • “died by/of suicide” • “suicide attempt”

5. More Americans Die by Suicide Each Year Than By Homicide Maine 2011 Suicides 224 Homicides 21 Suicide:* 39,518 Homicide: 16,259 More than 2 times as many people across the US killed themselves than were murdered by others in 2011. In Maine suicides are 7-9 times higher.

6. Suicide Rates; Maine, The Northeast And The Nation (All Ages)

7. Suicide In Maine (2007-2011) • 196 suicide deaths per year on average • Every 2 days someone dies by suicide • Every 2 weeks a young person dies (<25) • Leading cause of injury death! • 2nd leading cause of death ages 15-34 • Suicide deaths eight times homicide deaths • Of every 5 suicides, 4 are males • Females attempt suicide 3 X as often as males • A firearm is the most prevalent method of suicide(51%). For youth, hanging (49%)

8. Attempted Suicides Suicide Attempted Suicides

9. Attempted Suicide & Age Suicide Attempted Suicides Young 100-200:1 85+ 85+ 4:1

10. MIYHS Self reported data2013 High School Students

11. Warning SignsRisk FactorsProtective Factors

12. Definitions Warning Signs- the earliest observable signs that indicate increased risk of suicide for an individual in the near-term (within hours or days.) Risk Factors- long standing conditions, stressful events or situations that may increase the likelihood of a suicide attempt or death. (statistically significant) Protective Factors- the positive conditions, personal and social resources that promote resiliency and reduce the potential of suicide and other high-risk behaviors.

13. Warning Signs Immediate Risk! Overt & acute signs of a suicidal crisis: • Someone threatening to hurt or kill themselves • Someone looking for the means (gun, pills, rope etc.) to kill themselves • Someone expressing high level of emotional distress • Preoccupation with death and dying Respond: • Get the Facts & Take Action to ensure safety • Call 911 or seek other immediate professional help when you hear, say or see any of these behaviors

14. I Ideation / threatened or communicated S Substance abuse / excessive or increased?P Purposelessness / no reasons for living A Anxiety /agitation / insomniaT Trapped / feeling no way outH Hopelessness / nothing will ever changeW Withdrawal from friends, family, societyA Anger (uncontrolled)/ rage / seeking revengeR Recklessness/ risky acts / unthinkingM Mood changes (dramatic) Warning Signs

15. Adolescent Warning Signs for Suicide Is the youth (up to 19 y.o.) : • Talking about or making plans for suicide • Expressing hopelessness about the future • Displaying severe/overwhelming emotional pain or distress • Showing worrisome behavior or changes particularly in the presence of the above warning signs. • Specifically: • Withdrawal from or changes in social connections • Recent increased agitation or irritability • Anger or hostility that seems out of character or context • Changes in sleep (increased or decreased • From an AAS Consensus group, 2014

16. Keep your eyes and ears open: Direct clues: • I wish I were dead • I’m going to end it all • I’m going to kill myself Less Direct clues: • Life’s just too hard • You’d be better off without me • What’s the point?

17. Risk Factors for Suicide Risk factors are found in different domains • Family risk factors • Personal/behavioral risk factors • Environmental/sooical risk factors Risk factors have different conditions • Some are unchangeable (perpetuating) • Some are of serious concern (predisposing) • Some are acute (precipitating)

19. LGBTQ Youth/Young Adults • Suicide attempt rates 3-4 times their peers • Increased = societal stigma and rejection • Critical risk factors include rejection, depression, anxiety, chronic stress, abuse, victimization, bullying, etc… • Rejection by family can increase risk up to 8X • Family acceptance and school safety are strong protective factors • Cultural competence is important in prevention

20. Suicide in the Young ( under 14 y.o.) Warning Signs (very similar to previous list): • Change in usual behavior • Risky behavior • Talk of intent to die • Self harm (may be seen as recurrent “accidents”) • Verbal clues of suicidal thoughts Risk Factors: • More than one mental diagnosis & untreated MH concerns • Early trauma or stressful events • Negative school experience (bullying) • Loss of early primary attachments (death, placement in foster care etc…) • Internalizing vs. externalizing

21. Native American youth Risk: • Of youth and young adults (15-24) NA/AI highest risk • Cultural distress, acculturation • Historical trauma, boarding schools • Family disruption, violence, abuse • Substance abuse • Discrimination-perceived and real Protection: • Trauma informed prevention • Culturally informed prevention • Family and community connections • Spiritual connection & ceremony • Strong cultural identity

22. From a Suicidal Person’s Point of View • Crisis point has been reached • Pain is unbearable • Solutions to problems seem unavailable • Thinking is affected HOWEVER: • Ambivalence exists • Communicating distress is common • Invitations to help are often extended

23. Invitations to Help FEELINGS THOUGHTS Desperate Angry Guilty Worthless Worthless Lonely Sad Hopeless “All of my problems will end soon” “I just can’t take it anymore” “I wish I were dead” “You’ll be better off without me” “I can’t do anything right” ACTIONS Giving away possessions Withdrawal Abuse/use of substances Reckless behavior Extreme mood swings Increased impulsivity Self-injury (maybe) PHYSICAL Lack of interest in appearance Changes in appetite, weight Change in sleep patterns

24. Protective Factors • Skills to think, communicate, solve problems, manage anger and other negative emotions, • Purpose & value in life-hope for future, pets, work life focus… • Personal characteristics- health, positive outlook, healthy choices, spirituality or religious belief • Supports- parents, friends, mentors, teachers and other caring adults • Safe Environment – restricted access to lethal means

25. Intervention:A bridge to help

26. Why people hesitate to ask for help • Unwilling to admit needing help • Afraid to upset/anger others • Unable describe their feelings/needs • Unsure of available help or resources • Struggling with symptoms of depression • Don’t know what to expect • Shame, fear of stigma • May prefer to confide in peers

27. Why People Hesitate to Help • Not sure about how severe the risk is-what if they’re wrong? • Worry about doing/saying the “right” thing • Feelings of inadequacy • Afraid to put the idea in someone’s head • Feel it’s not “their issue” • Bystander Effect

28. What is NOT Helpful • Ignoring or dismissing the issue • “You think you have problems, well let me tell you…” • Acting shocked or embarrassed • “Oh, I’m not sure I’m the best person to talk to about this…” • Challenging, debating or bargaining • “You think things are bad now, try to kill yourself and then see how things are!” • Minimizing the distress • “This is nothing, you just need to relax more.”

29. What IS Helpful 1) Show You Care—Listen carefully—Be genuine “I’m concerned about you . . . about how you feel.” 2) Ask the Question—Be direct, caring and non-confrontational “Are you thinking about suicide?” 3) Get Help—Do not leave him/her alone “You’re not alone. Let me help you.”

30. Practice Helpful Steps! Open handout… • Think up & write 1 or 2 phrases or ways that YOU would use to “show you care.” • Write two other ways you might “ask the question” about suicide. • List two ways you would try to assist someone to “get help” and name 2 resources.

31. Resources for Help What are YOUR resources?

32. School Resources (examples) • School Counselor • School-Based Health Centers/Nurse • Crisis Team Members • Administration • School Resource Officer • Who else…?

33. When to Call Crisis 1-888-568-1112 • Crisis clinicians are: • Available 24 / 7 • Clinicians can often come to your location for an assessment • Call for a phone consult when you are: • Concerned about someone’s mental health • Need advice about how to help someone in distress • Worried about someone and need another opinion • The phone call is free

34. Protocols for Addressing Suicide: • Roles and responsibilities • How can staff become informed? • How do we respond to a suicidal crisis? • How do we access resources? • Developing a safety plan • How do we manage the aftermath of suicide? • Supporting someone’s return to school/community

35. After an Attempt or Suicide Helping Families and School Communities Through Crisis

36. After and Attempt. . . • Initial focus is on safety • Work to address reduction in crisis • Safety planning for proactive response • For return to the community: • Who is the support person • What do other people need to know • Offer hope and support • Encourage follow-through with treatment

37. Suicide Survivors • Ratio implies at least 216,210 survivors each year, 1086 in Maine A “suicide survivor” is someone who has lost a loved one to death by suicide It is estimated that there are at least 6 survivors for a death by suicide

38. Survivors of Suicide • Struggle to make meaning of the loss • Suffer from overwhelmingly complicated feelings • May take a long time to grieve • Need understanding and support • Youth survivors have special issues

39. How YOU can be supportive after a suicide • Acknowledge the loss • Use the name of the deceased • Share your presence • Share a special memory/story • Acknowledge the good things • Stay in touch • Recommend Grief Support Center, grief support groups or AFSP

40. Take Care of Yourself • Acknowledge the intensity of your feelings • Seek support from colleagues, de-brief • Share your feelings with family/friends • Avoid over – involvement • Know that you are not responsible for another person’s choice to end their life

41. MSPP Contact Information • Training Program Inquiries: MSPPsobrian@namimaine.org • Heather Carter, Senior Trainer hcarter@namimaine.org • Greg Marley, Clinical Director gmarley@namimaine.org • MSPP Program Coordinator: Katharyn Zwicker, 207-287-5362 Katharyn.b.Zwicker@maine.gov

42. Before you leave. . . Any Questions? Evaluations and Certificates will be provided via email Thank you for learning about suicide prevention. . . Maine Suicide Prevention Program Education,Resources and Support It’s Up to All of Us

43. The Department of Health and Human Services (DHHS) does not discriminate on the basis of disability, race, color, creed, gender, sexual orientation, age, or national origin, in admission to, access to, or operations of its programs, services, or activities, or its hiring or employment practices. This notice is provided as required by Title II of the Americans with Disabilities Act of 1990 and in accordance with the Civil Rights Act of 1964 as amended, Section 504 of the Rehabilitation Act of 1973, as amended, the Age Discrimination Act of 1975, Title IX of the Education Amendments of 1972 and the Maine Human Rights Act and Executive Order Regarding State of Maine Contracts for Services. Questions, concerns, complaints or requests for additional information regarding the ADA may be forwarded to DHHS’ ADA Compliance/EEO Coordinators, 11 State House Station – 221 State Street, Augusta, Maine 04333, 207-287-4289 (V), 207-287-3488 (V), TTY users call Maine relay 711. Individuals who need auxiliary aids for effective communication in program and services of DHHS are invited to make their needs and preferences known to the ADA Compliance/EEO Coordinators. This notice is available in alternate formats, upon request.