Intervention with Suicidal Homeless Men

1. Intervention with Suicidal Homeless Men Edgar K. Wiggins, M.H.S, Executive Director, Baltimore Crisis Response, Inc.

2. Source - https://www.afro.com/baltimores-homeless-population-continues-to-grow/

4. U.S.A. Suicide: 2015 Official Final Data Number Nation 44,193 Males 33,994 Female 10,199

5. What is the official definition of homelessness? There is more than one “official” definition of homelessness. Health centers funded by the U.S. Department of Health and Human Services (HHS) use the following: A homeless individual is defined in section 330(h)(5)(A) as “an individual who lacks housing (without regard to whether the individual is a member of a family), including an individual whose primary residence during the night is a supervised public or private facility (e.g., shelters) that provides temporary living accommodations, and an individual who is a resident in transitional housing.” A homeless person is an individual without permanent housing who may live on the streets; stay in a shelter, mission, single room occupancy facilities, abandoned building or vehicle; or in any other unstable or non-permanent situation. [Section 330 of the Public Health Service Act (42 U.S.C., 254b)] An individual may be considered to be homeless if that person is “doubled up,” a term that refers to a situation where individuals are unable to maintain their housing situation and are forced to stay with a series of friends and/or extended family members. In addition, previously homeless individuals who are to be released from a prison or a hospital may be considered homeless if they do not have a stable housing situation to which they can return. A recognition of the instability of an individual’s living arrangements is critical to the definition of homelessness. (HRSA/Bureau of Primary Health Care, Program Assistance Letter 99-12, Health Care for the Homeless Principles of Practice)

6. According to Health Care For the Homeless, Inc. – at least 3,000 people in Baltimore will suffer from homelessness on any given night, tallying to over 30,000 people a year. Throughout Maryland, over 50,000 people will experience homelessness annually. These averages are complied from information in a bi-annual census report, emergency and transitional shelter data and records of those who were turned away from shelters. There is no way to know the exact number of people who are experiencing homelessness in Baltimore, but it is likely higher than this average.

7. Baltimore’s unemployment rate is 5.8, the highest in the state of Maryland, according to data from the Maryland Department of Labor Licensing and Regulation. Although overall unemployment has decreased in the city, the impact of unemployment is greater for low-wage workers, the poor and homeless.

8. American association of suicidology Risk Factors for Suicide and Suicidal Behaviors I Chronic Risk Factors (If present, these increase risk over one’s lifetime) • Perpetuating Risk Factors – permanent and non-modifiable • Demographics: White, American Indian, Male Older Age, Separation or Divorce, Early Widowhood • History of Suicide Attempts – especially if repeated • Prior suicide ideation • History of self-harm behavior • History of suicide or suicidal behavior in family

9. American association of suicidology • Parental History of: • Violence • Substance Abuse (Drugs or Alcohol) • Hospitalization for Major Psychiatric Disorder • Divorce • History of trauma or abuse (physical or sexual) • History of psychiatric hospitalization • History of frequent mobility • History of violent behaviors • History of impulsive/reckless behaviors

10. American association of suicidology Contributory Risk Factors • Firearm ownership or easy accessibility • Acute or enduring unemployment • Stress (job, marriage, school, relationship…) Acute Risk Factors (If present, these increase risk in the near-term) • Demographics: recently divorced or separated with feelings of victimization or rage • Suicide ideation (threatened, communicated, planned, or prepared for) • Current self-harm behavior • Recent suicide attempt

11. American association of suicidology Acute Risk Factors (If present, these increase risk in the near-term) • Excessive or increased use of substances (alcohol or drugs) • Psychological pain (acute distress in response to loss, defeat, rejection, etc.) • Recent discharge from psychiatric hospitalization • Anger, rage, seeking revenge

12. American association of suicidology Acute Risk Factors (If present, these increase risk in the near-term) • Aggressive behavior • Withdrawal from usual activities, supports, interests, school or work; isolation (e.g. lives alone) • Anhedonia • Anxiety, panic • Agitation • Insomnia • Persistent nightmares

13. Protective Factors A protective factor is a characteristic or attribute that reduces the likelihood of attempting or completing suicide. Protective factors are skills, strengths, or resources that help people deal more effectively with stressful events. They enhance resilience and help to counterbalance risk factors. Protective factors can be considered to be either internal or external – environmental. Internal Protective Factors • Attitudes, values and norms prohibiting suicide, e.g., strong beliefs about the meaning and value of life • Social skills, e.g., decision-making, problem-solving and anger management • Good health and access to mental and physical health care

14. Internal Protective Factors • Strong connections to friends and family as well as supportive significant others • Cultural, religious or spiritual beliefs that discourage suicide • A healthy fear of risky behaviors and pain • Hope for the future – optimism • Sobriety • Medical compliance and a sense of the importance of health and wellness • Impulse control • Strong sense of self-worth or self-esteem • Sense of personal control or determination • Access to a variety of clinical interventions and support for seeking help • Coping skills

15. External or Environmental Protective Factors • Strong relationships, particularly with family members • Opportunities to participate in and contribute to school or community projects and activities • A reasonably safe and stable environment • Restricted access to lethal means • Responsibilities and duties to others • Pets Increasing protective factors can serve to decrease suicide risk. Strengthening these factors should be an ongoing process to increase resiliency during the presence of increased risk factors or other stressful situations. However, positive resistance to suicide is not permanent, so programs that support and maintain protection against suicide should be ongoing.

16. EXPERIENCE at BCRI • 70% are homeless • 75% have co-morbid mental health and substance abuse issues • Often have fewer social supports than female callers • Calls that came in from or regarding a homeless male with suicidal ideation • 55% required a mobile crisis team intervention • The remaining group was divided into two categories   • required emergency (911) intervention because of the level of acuity or unavailability of a team • were managed with supportive counseling, referral and follow up

17. Intervention Strategies • The ability to provide outreachis critical • Mobile Crisis Teams • Homeless Outreach Teams • Street Workers • Police Officers • Homeless shelter staff • Keys to engagement • Need to establish trust/rapport • Listen and pay attention in a non-judgmental fashion • Person centered – do not compare to others • Recognize the difference in expression of depressive symptoms in males • Don’t be put off. Look for underlying depression, hurt and sadness

18. POLICE INITATIVES IN BALTIMORE CITY • Crisis Intervention Team Training (CIT) • Nationally recognized model of training police officers to respond effectively to persons in crisis. Emphasis on recognizing signs and symptoms of behavioral health conditions, de-escalating and defusing situations through the use of calm communication. • Crisis Response Team (CRT) • Co-responder team consisting of a specially trained police officer and a licensed clinician who respond to calls for service • Homeless Outreach Team (HOT) • Team of uniformed officers who provide outreach to homeless encampments and street homeless • Law Enforcement Assisted Diversion (LEAD) • Pre-booking diversion project to connect low level drug offenders with treatment and casement services (rather than arrest)

19. Effective Intervention requires a good working knowledge of the overall system of care including: • Mental Health • Substance Abuse Services • Social Services • Criminal Justice • Health Care • Housing Supports

21. For Additional InformationPlease contact Edgar Wiggins at 410-433-5255 ext. 308 or email EWiggins@bcresponse.org