Suicide Prevention Training

1. Suicide Prevention Training Jennifer Myers, MA Coordinator of Suicide Prevention Services Jenmyers@mailbox.sc.edu Counseling & Human Development Center Byrnes Building, 7th Floor 803-777-5223

2. Take care of you.Employee Assistance Program: 1800-822-4847

3. Intro and Purpose • To educate about the signs of suicide • To inform you of how to respond if you are concerned a person may be suicidal or in emotional distress • To empower you to feel confident to intervene • To connect you with resources

4. Exercise: Personalizing Crisis

5. Basic Terms & Definitions • Suicidal Ideation – Thinking about suicide • Suicide threat – Stating intent to kill yourself • Suicide attempt – Any act or behavior intended to end your life • Intentional self-harm – Behavior related to self harm but absent of the intent to kill oneself • Completed/died by suicide – suicide death • Survivor of suicide – friend or family member of deceased

6. Facts About USC Students (NCHA*) • In the past year, USC students: • 41% experienced hopelessness • 59% reported feeling very sad • 26% felt so depressed it was difficult to function • 4.6% seriously considered suicide (1,349 students or 26 students per week) • 0.5 % attempt suicide (147 students or approximately 3 per week) *American College Health Association’s National College Health Assessment 2010

7. Facts: Depression & USC Students* • Felt things were hopeless *American College Health Association’s National College Health Assessment 2010

8. Facts: Depression & USC Students* • Felt very lonely *American College Health Association’s National College Health Assessment 2010

9. Facts: Depression & USC Students* • Felt very sad *American College Health Association’s National College Health Assessment 2010

10. Facts: Depression & USC Students* • Felt so depressed that it was difficult to function *American College Health Association’s National College Health Assessment 2010

11. Facts: Suicidal Thinking & USC Students* *American College Health Association’s National College Health Assessment 2010

12. Facts: Self Harming Behaviors & USC Students* • Intentionally Cut, Burned, Bruised, or otherwise injured yourself *American College Health Association’s National College Health Assessment 2010

13. Facts: Suicide Attempts* • Attempted Suicide *American College Health Association’s National College Health Assessment 2010

14. What we know about people who die by suicide • Men are 4 times more likely than women to die by suicide • Women are 3 times more likely to attempt • In college students, this gender difference is less apparent • 80% of those who die by suicide in college are not receiving treatment through the counseling center • 90% had one or more mental disorder • 50% had alcohol in their system at the time of death

15. Why people die by suicide? • Feelings of hopelessness are more predictive of suicide than depression • Perceived burdensomeness • Thwarted Belongingness • Suicide is not chosen; it happens when pain exceeds an individual’s resources for coping with pain

16. Discussion • Is there a stereotypical “suicidal person”? • What would this person look like? What would they wear? How would they act? How would they talk? • Myths about Suicide • No one can stop a suicide, it is inevitable. • If people in a crisis get the help they need, they will likely never be suicidal again. • Suicidal people keep their plans to themselves. • Most suicidal people communicate their intent sometime during the week preceding their attempt.

17. National Suicide Statistics at a Glance • Suicide Rates Among Persons Ages 10 Years and Older, by Race/Ethnicity and Sex, United States, 2002-2006, • Source: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention

18. National Statistics at a Glance • Percentage of Suicides Among Persons Ages 10-24 Years, by Race/Ethnicity and Mechanism, United States, 2002-2006 • Source: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention

19. Racial & Ethnic Disparities • Among American Indians/Alaska Natives ages 15- to 34-years, suicide is the second leading cause of death. • Suicide rates among American Indian/Alaskan Native adolescents and young adults ages 15 to 34 (20.0 per 100,000) are 1.8 times higher than the national average for that age group (11.4 per 100,000). • Hispanic & Black, non-Hispanic female high school students reported a higher percentage of suicide attempts (11.1% and 10.4%, respectively) than their White, non-Hispanic counterparts (6.5%). Source: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control

20. Additional Considerations • There is a range of cultural and spiritual beliefs about suicide • View regarding seeking psychological services • Pressures, support systems, coping mechanisms, psychological symptoms may vary

21. Special Population-LGBTQ • LGBTQ individuals are at higher risk for suicidal thinking • There is no tracking system of sexual orientation or gender identity in completed suicides • Sexuality or gender identity does not create the higher risk itself. • Those who are at higher risk: • Early disclosure of sexuality • Hiding sexuality • Lack of Family Acceptance • Bullying or Harassment • Conflict with Spiritual Beliefs • Low self esteem, struggle with personal acceptance • Isolation

22. Special Populations-Veterans • Markers for suicide risk are noticeably higher in student veterans than general student population • 10 years of combat has resulted in increase in • Substance abuse • PTSD • Depression • An estimated 20% of Veterans have struggled with PTSD or depression • May not disclose suicidal thinking

23. Acute Warning Signs • These are indicators that a person is suicidal • Someone threatening, talking about, or stating they intend to hurt or kill themselves • Someone looking for ways to kill themselves: Seeking access to pills, weapons, or other means • Someone talking or writing about death, dying, or suicide • Rehearsing a suicide attempt Take all Warning Signs Seriously

24. Direct Verbal Cues • “I’ve decided to kill myself.” • “I wish I were dead.” • “I’m going to commit suicide.” • “I’m going to end it all.” • “If (such and such) doesn’t happen, I’ll kill myself.”

25. Indirect Verbal Cues • “I’m tired of life, I just can’t go on.” • “My family would be better off without me.” • “Who cares if I’m dead anyway.” • “I just want out.” • “I won’t be around much longer.” • “Pretty soon you won’t have to worry about me.” • “You won’t see me anymore.”

26. Additional Warning Signs • I Ideation • S Substance Abuse • P Purposelessness • A Anxiety • T Trapped • H Hopelessness • W Withdrawal • A Anger • R Recklessness • M Mood Change Take all Warning Signs Seriously

27. Risk Factors • Previous Suicidal Behavior • Impulsivity • Significant substance use or dependence • Family History of Suicide • Previous History of Psychiatric Diagnosis • Eating Disorder • History of abuse (sexual, physical, emotional) • Chronic pain • Recent Discharge from inpatient psychiatric treatment

28. Situational Triggers • Loss of any major relationship • Death of a spouse, child, or best friend, especially if by suicide • Being fired, failing classes, rejection or expulsion from a program • Sudden unexpected loss of freedom/fear of punishment • Diagnosis of a serious or terminal illness

29. The Good News • Some aspects of college are protective factors • These include: • Presence of Social Supports • Improved problems solving & coping skills • Access to treatment and other helpers • Hopeful about the future • Fear of social disapproval

30. ASK Directly about Suicide • Common ways to ask: • “Are you thinking about suicide?” • “Do you want to kill yourself?” • “Sometimes when people are sad as you are, they think about suicide, Have you been thinking about suicide?” • “You look pretty miserable, I wonder if you’re thinking about suicide?” • “You know, when people are as upset at you seem to be, they sometimes wish they were dead. I’m wondering if you’re feeling that way, too?” • Note: If you cannot ask the question, find someone who can.

31. How to NOT ask the Question “You’re not suicidal, are you?”

32. Follow up questions • “Have you been thinking about how you would kill yourself?” • “How long have you been thinking about this?” • If a person has stated the means they would kill themselves with, take steps to remove the means.

33. Discussion • Myths about suicide: • If you ask someone directly about suicide, you will put the idea in their head and might make them want to do it. • Truth is asking someone directly about suicide lowers anxiety, opens up communication, and lowers the risk of an impulsive act. • Most suicidal persons indicate experiencing relief if asked directly about suicide.

34. What to do • If you observe any of the acute warning signs: • Between 8am to 5pm M-F: go with the student to the Counseling and Human Development center 7th Floor Byrnes Building 803-777-5223 • Another staff person should contact CHDC and inform them of the situation • After 5pm M-F or Saturday or Sunday, Contact the USC Police 911 (7-4215 for dispatch)

35. What to do • If you observe warning signs other than the acute warning signs • CHDC Walk in hours 2-4pm M-F • Consult with CHDC 803-777-5223 or USC Police, 911 or 7-4215, regarding the risk • Refer the person to counseling • Assist them in calling &making an appointment • Walk with them to the appointment if needed • Inform other staff in your department • Follow Up with the person and pay attention to additional warning signs.

36. What to do • Be willing to listen • Be non-judgmental • Be direct • Be available • Offer hope that options are available • Be actively involved in getting the person treatment • Take action to remove lethal means • Follow up (after they went to counseling center or other intervention)

37. Role Play Exercise

38. Making a BIT report • Reports to file: • http://www.housing.sc.edu/bit/ • Additional Resources: • http://www.housing.sc.edu/lasd/pdf/BAGGuide.pdf

39. Early Intervention • Assist residents in recognizing their signs of stress, anxiety, and depression • Help them to develop positive coping skills • Pay attention to isolated students and try to engage them. Keep them on your radar screen • Be aware of relationship break ups and support residents as appropriate • Refer to counseling

40. Boundaries • You are not the therapist • You don’t have to make a safety plan with the person. You can be one part of a safety plan • Do not keep a persons suicidal communications or signs a secret • Use CHDC staff for consultation, specifically Dr. Bob Rodgers, Jennifer Myers, Dr. Toby Lovell

41. Boundaries • Work together with others. Your role is not to “fix” the problem. • Set limits and boundaries on the amount of time you available or spend with a student • More is not always better

42. Self Care • Take care of yourself • Use your support systems • Pay attention to your cues regarding stress • Take time away as needed • Know your positive coping mechanisms & use them frequently • Recognize and respect your limits • Use supervision to address your needs • Go to therapy for your own mental health concerns

43. Campus Resources • Counseling and Human Development Center • 7th Floor Byrnes Building • www.sa.sc.edu/shs/chdc 803-777-5223 • USC Police • 7-911 or 803-777-4215 • Thomson Student Health Center • www.sa.sc.edu/shs 803-777-3175 • Behavioral Intervention Team • www.sc.edu/bit 803-777-4333 • Student Disability Services • 803-777-6142

44. Additional Resources • National Suicide Prevention Lifeline • 1-800-273-8255 (TALK) • www.suicidepreventionlifeline.org • Trevor Project (GLBT Youth) • 1-866-488-7386 • www.thetrevorproject.org

45. Thank you • Please complete the evaluation form