Suicide PreventionSuicide Prevention Saving LivesSaving Lives
One Community at a One Community at a TimeTime
America Foundation for Suicide PreventionAmerica Foundation for Suicide PreventionDr. Paula J. Clayton, AFSP Medical DirectorDr. Paula J. Clayton, AFSP Medical Director120 Wall Street, 22120 Wall Street, 22ndnd Floor FloorNew York, NY 10005New York, NY 100051-888-333-AFSP1-888-333-AFSPwww.afsp.orgwww.afsp.org
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Facing the facts…Facing the facts…
Approximately 30,000 people in the Approximately 30,000 people in the United States die by suicide each United States die by suicide each year. About every 16.6 minutes year. About every 16.6 minutes someone in this country someone in this country intentionally ends his/her life.intentionally ends his/her life.
Although the suicide rate fell slightly Although the suicide rate fell slightly from 1992-1999, it has been steady from 1992-1999, it has been steady for 5 consecutive years despite all of for 5 consecutive years despite all of our new treatments.our new treatments.
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Facing the facts…Facing the facts…
Suicide is considered to be the second leading Suicide is considered to be the second leading cause of death among college students.cause of death among college students.
Suicide is the third leading cause of death for Suicide is the third leading cause of death for youth.youth.
Suicide is the fourth leading cause of death for Suicide is the fourth leading cause of death for adults between the ages of 18 and 65.adults between the ages of 18 and 65.
Suicide is highest in white men over 85.Suicide is highest in white men over 85.(47.7/100,000, 2003)(47.7/100,000, 2003)
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Facing the facts…Facing the facts…
The suicide rate was 10.8/100,000 The suicide rate was 10.8/100,000 in 2003.in 2003.
It exceeds the rate of homicide It exceeds the rate of homicide greatly. (6.1/100,000)greatly. (6.1/100,000)
From 1979-2003, 749,337 people From 1979-2003, 749,337 people died by suicide, whereas 504,406 died by suicide, whereas 504,406 died from AIDS and HIV-related died from AIDS and HIV-related diseases.diseases.
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Facing the facts…Facing the facts…
Death by Suicide and Psychiatric DiagnosisDeath by Suicide and Psychiatric Diagnosis
Psychological autopsy studies done in various Psychological autopsy studies done in various countries over almost 50 years report the countries over almost 50 years report the same outcomes:same outcomes:
90% of people who die by suicide are suffering 90% of people who die by suicide are suffering from one or more psychiatric disorders:from one or more psychiatric disorders:
Major Depressive DisorderMajor Depressive Disorder Bipolar Disorder, Depressive phaseBipolar Disorder, Depressive phase Alcohol or Substance Abuse*Alcohol or Substance Abuse* SchizophreniaSchizophrenia Personality Disorders such as Borderline PDPersonality Disorders such as Borderline PD
*Primary diagnoses in youth suicides.*Primary diagnoses in youth suicides.
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Facing the facts…Facing the facts…
Suicide Is Not Predictable in Suicide Is Not Predictable in IndividualsIndividuals
In a study of 4,800 hospitalized vets, it was not In a study of 4,800 hospitalized vets, it was not possible to identify who would die by suicide — possible to identify who would die by suicide — too many false-negatives, false-positives.too many false-negatives, false-positives.
Individuals of all races, creeds, incomes and Individuals of all races, creeds, incomes and educational levels die by suicide. There is no educational levels die by suicide. There is no typical suicide victim.typical suicide victim.
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Facing the facts…Facing the facts…
Suicide Communications Are Often Suicide Communications Are Often Not Made to ProfessionalsNot Made to Professionals
In one psychological autopsy study only 18% In one psychological autopsy study only 18% told professionals of intentions.told professionals of intentions.
In a study of suicidal deaths in hospitals: In a study of suicidal deaths in hospitals: 77% denied intent on last communication77% denied intent on last communication 28% had “no suicide contracts” with their 28% had “no suicide contracts” with their
caregiverscaregivers
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Facing the facts…Facing the facts…
Research shows that during our Research shows that during our lifetime:lifetime:
20% of us will have a suicide within our 20% of us will have a suicide within our immediate family.immediate family.
60% of us will personally know someone 60% of us will personally know someone who dies by suicide.who dies by suicide.
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Facing the facts…Facing the facts…
Prevention may be a matter of Prevention may be a matter of a caring person with the right a caring person with the right knowledge being available in knowledge being available in the right place at the right the right place at the right time.time.
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Myths versus facts…Myths versus facts…
MYTH: MYTH: People who talk about suicide don’t People who talk about suicide don’t complete suicide.complete suicide.
FACT:FACT: Many people who die by suicide have Many people who die by suicide have given definite warnings to family and given definite warnings to family and friends of their intentions. Always take friends of their intentions. Always take any comment about suicide seriously.any comment about suicide seriously.
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Myths versus facts…Myths versus facts…
MYTH: MYTH:
Suicide happens without warning.Suicide happens without warning.
FACTFACT: :
Most suicidal people give many Most suicidal people give many clues and warning signs regarding clues and warning signs regarding their suicidal intention.their suicidal intention.
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Myths versus facts…Myths versus facts…
MYTH: MYTH: Suicidal people are fully intent on dying.Suicidal people are fully intent on dying.
FACTFACT: : Most suicidal people are undecided Most suicidal people are undecided about living or dying – which is called about living or dying – which is called suicidal ambivalence. A part of them suicidal ambivalence. A part of them wants to live, however, death seems like wants to live, however, death seems like the only way out of their pain and the only way out of their pain and suffering. They may allow themselves to suffering. They may allow themselves to “gamble with death,” leaving it up to “gamble with death,” leaving it up to others to save them.others to save them.
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Myths versus facts…Myths versus facts…
MYTH:MYTH:
Males are more likely to be suicidal. Males are more likely to be suicidal.
FACT:FACT: Men COMPLETE suicide more often than Men COMPLETE suicide more often than women. women. However, women attempt However, women attempt suicide three times more often than suicide three times more often than men.men.
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Myths versus facts…Myths versus facts…
MYTH: MYTH: Asking a depressed person about Asking a depressed person about suicide will push him/her to complete suicide will push him/her to complete suicide.suicide.
FACT:FACT: Studies have shown that patients with Studies have shown that patients with depression have these ideas and depression have these ideas and talking about them does not increase talking about them does not increase the risk of them taking their own life.the risk of them taking their own life.
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Myths versus facts…Myths versus facts…
MYTH:MYTH:
Improvement following a suicide attempt or Improvement following a suicide attempt or crisis means that the risk is over. crisis means that the risk is over.
FACTFACT: :
Most suicides occur within days or weeks of Most suicides occur within days or weeks of “improvement” when the individual has the “improvement” when the individual has the energy and motivation to actually follow energy and motivation to actually follow through with his/her suicidal thoughts.through with his/her suicidal thoughts.
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Myths versus facts…Myths versus facts…
MYTH:MYTH:
Once a person attempts suicide the pain Once a person attempts suicide the pain and shame will keep them from trying and shame will keep them from trying again.again.
FACTFACT: :
The most common psychiatric illness that The most common psychiatric illness that ends in suicide is Major Depression, a ends in suicide is Major Depression, a recurring illness. Every time a patient gets recurring illness. Every time a patient gets depressed, the risk of suicide returns.depressed, the risk of suicide returns.
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MythsMyths versus facts. . .versus facts. . .
MYTH:MYTH:Sometimes a bad event can Sometimes a bad event can
push a push a person to complete person to complete suicide.suicide.
FACT:FACT:Suicide results from serious Suicide results from serious
psychiatric disorders not just a psychiatric disorders not just a single event.single event.
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Myths versus facts. . .Myths versus facts. . .
MYTH:MYTH:
Suicide occurs in great numbers Suicide occurs in great numbers around holidays in November and around holidays in November and December.December.
FACT:FACT:
Highest rates of suicide are in Highest rates of suicide are in April while April while the lowest rates are in the lowest rates are in December. December.
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Risk factors. . .Risk factors. . .
There are several risk factors for There are several risk factors for suicide:suicide:
Psychiatric disordersPsychiatric disorders
Past suicide attemptsPast suicide attempts
Symptom risk factorsSymptom risk factors
Sociodemographic risk factorsSociodemographic risk factors
Environmental risk factorsEnvironmental risk factors
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Risk factors...Risk factors...
Psychiatric DisordersPsychiatric Disorders Most common psychiatric risk factor resulting in Most common psychiatric risk factor resulting in
suicidesuicide Depression*Depression*
Major DepressionMajor Depression Bipolar DepressionBipolar Depression Alcohol abuse and dependenceAlcohol abuse and dependence Drug abuse and dependenceDrug abuse and dependence SchizophreniaSchizophrenia
**Especially when combined with alcohol and drug abuseEspecially when combined with alcohol and drug abuse
Other psychiatric risk factors with potential to Other psychiatric risk factors with potential to result in suicide result in suicide (account for significantly fewer (account for significantly fewer suicides than Depression)suicides than Depression)
Post Traumatic Stress Disorder (PTSD)Post Traumatic Stress Disorder (PTSD) Eating disorders Eating disorders
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Risk factors…Risk factors…
Past suicide attemptPast suicide attempt (See diagram on right)(See diagram on right)
After a suicide After a suicide attempt that is seen attempt that is seen in the ER about 1% in the ER about 1% per year take their per year take their
own life, up to own life, up to
approximately 10%approximately 10%
within 10 years.within 10 years.
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Risk factors…Risk factors…
Symptom Risk Factors During Symptom Risk Factors During Depressive EpisodeDepressive Episode
Desperation Desperation HopelessnessHopelessness Anxiety/Psychic anxiety/Panic AttacksAnxiety/Psychic anxiety/Panic Attacks Aggressive or impulsive personalityAggressive or impulsive personality Has made preparations for a potentially Has made preparations for a potentially
serious suicide attempt *or has rehearsed serious suicide attempt *or has rehearsed a plan during a previous episode a plan during a previous episode
Recent hospitalization for depressionRecent hospitalization for depression Psychotic symptoms (especially in Psychotic symptoms (especially in
hospitalized depression)hospitalized depression)
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Risk factors. . .Risk factors. . .
Major physical illness-especially recentMajor physical illness-especially recent Chronic physical painChronic physical pain History of trauma, abuse or being History of trauma, abuse or being
bulliedbullied Family history of death by suicideFamily history of death by suicide Drinking/Drug useDrinking/Drug use Being a smoker Being a smoker
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Risk factors. . .Risk factors. . .
Sociodemographic Risk Sociodemographic Risk FactorsFactors
MaleMale Being over 65Being over 65 WhiteWhite Separated, widowed or divorced Separated, widowed or divorced Living aloneLiving alone Being unemployed or retiredBeing unemployed or retired Occupation: health related occupation Occupation: health related occupation
higher (dentists, doctors, nurses, social higher (dentists, doctors, nurses, social workers) especially high in women workers) especially high in women physiciansphysicians
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Risk factors…Risk factors…
Environmental Risk FactorsEnvironmental Risk Factors
Easy access to lethal meansEasy access to lethal means
Local clusters of suicide that Local clusters of suicide that have a “contagious influence”have a “contagious influence”
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Preventing Suicide . . .Preventing Suicide . . .
Prevention within our Prevention within our communitycommunity
EducationEducation ScreeningScreening TreatmentTreatment Means RestrictionMeans Restriction Media GuidelinesMedia Guidelines
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Preventing Suicide. . .Preventing Suicide. . .
EducationEducation Individual and Public AwarenessIndividual and Public Awareness Professional AwarenessProfessional Awareness Education ToolsEducation Tools
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Preventing Suicide . . .Preventing Suicide . . .
Individual and Public AwarenessIndividual and Public Awareness Primary risk factor for suicide is Primary risk factor for suicide is
psychiatric illness.psychiatric illness. Depression is treatableDepression is treatable Destigmatize the illnessDestigmatize the illness Destigmatize treatmentDestigmatize treatment Encourage help-seeking behaviors and Encourage help-seeking behaviors and
continuation of treatmentcontinuation of treatment Improve end of life careImprove end of life care
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Preventing Suicide . . .Preventing Suicide . . .
Professional Awareness Professional Awareness Healthcare ProfessionalsHealthcare Professionals
– Physicians, pediatricians, nurse practitioners, Physicians, pediatricians, nurse practitioners, physician assistantsphysician assistants
Mental Health ProfessionalsMental Health Professionals– Psychologists, Social WorkersPsychologists, Social Workers
Primary and Secondary School StaffPrimary and Secondary School Staff– Principals, Teachers, Counselors, NursesPrincipals, Teachers, Counselors, Nurses
College and University Resource StaffCollege and University Resource Staff– Counselors, Student Health Services, Student Counselors, Student Health Services, Student
Residence Services, Resident Hall Directors Residence Services, Resident Hall Directors and Advisorsand Advisors
GatekeepersGatekeepers– Religious Leaders, Police, Fire Departments, Religious Leaders, Police, Fire Departments,
Armed ServicesArmed Services
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Preventing Suicide . . .Preventing Suicide . . .
Education ToolsEducation Tools AFSP Website AFSP Website www.afsp.orgwww.afsp.org
AFSP College Film, AFSP College Film, The Truth about SuicideThe Truth about Suicide
AFSP Teen PSAAFSP Teen PSA
AFSP NewsletterAFSP Newsletter
AFSP PowerPoint PresentationsAFSP PowerPoint Presentations
National Institute of Mental Health National Institute of Mental Health www.nimh.nih.govwww.nimh.nih.gov
Center for Disease Control Center for Disease Control www.cdc.govwww.cdc.gov
Suicide Prevention Resource Center Suicide Prevention Resource Center www.sprc.orgwww.sprc.org
American Association of Suicidology American Association of Suicidology www.suicidology.orgwww.suicidology.org
Planned informal talks for caregivers with AFSP researchersPlanned informal talks for caregivers with AFSP researchers
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Preventing Suicide . . . Preventing Suicide . . .
ScreeningScreening Identify At Risk IndividualsIdentify At Risk Individuals
Columbia Teen ScreenColumbia Teen Screen
AFSP College screening instrumentAFSP College screening instrument
National Depression Screening Day*National Depression Screening Day*(First Thursday of October)(First Thursday of October)
Annual Childhood Depression Awareness Annual Childhood Depression Awareness Day (May 4Day (May 4thth))
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Preventing Suicide. . . Preventing Suicide. . .
TreatmentTreatment
AntidepressantsAntidepressants
Psychotherapy Psychotherapy
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Preventing Suicide. . .Preventing Suicide. . .
AntidepressantsAntidepressants Adequate prescription treatment and monitoringAdequate prescription treatment and monitoring
Only 20% of medicated depressed patients are adequately Only 20% of medicated depressed patients are adequately treated with antidepressants. treated with antidepressants.
Reasons proposed:Reasons proposed: Side effectsSide effects Lack of improvement Lack of improvement High anxiety not treatedHigh anxiety not treated Fear of drug dependency Fear of drug dependency Concomitant substance useConcomitant substance use Didn’t combine with psychotherapyDidn’t combine with psychotherapy Dose not high enoughDose not high enough Didn’t add adjunct therapy such as lithium or other Didn’t add adjunct therapy such as lithium or other
medication(s)medication(s) Didn’t explore all options including: ECT or other Didn’t explore all options including: ECT or other
somatic treatmentsomatic treatment
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Preventing Suicide. . . Preventing Suicide. . .
PsychotherapyPsychotherapy Research shows that when it comes to Research shows that when it comes to
treating depression, all therapy is NOT treating depression, all therapy is NOT created equal.created equal.
Study shows applying correct techniques reduce suicide Study shows applying correct techniques reduce suicide attempts by 50% over 18 month period*attempts by 50% over 18 month period*
To be effective, psychotherapy must To be effective, psychotherapy must be:be:
Specifically designed to treat depressionSpecifically designed to treat depression Relatively short-term (10-16 weeks)Relatively short-term (10-16 weeks) Structured (therapist should be able to give Structured (therapist should be able to give
step-by-step treatment instructions that any step-by-step treatment instructions that any other therapist can easily follow)other therapist can easily follow)
Implement teaching of these Implement teaching of these techniquestechniques
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Preventing Suicide. . . Preventing Suicide. . .
Means RestrictionsMeans Restrictions Firearm safetyFirearm safety
Construction of barriers at jumping sitesConstruction of barriers at jumping sites
Detoxification of domestic gasDetoxification of domestic gas
Improvements in the use of catalytic converters in Improvements in the use of catalytic converters in motor vehiclesmotor vehicles
Restrictions on pesticidesRestrictions on pesticides
Reduce lethality or toxicity of prescriptionsReduce lethality or toxicity of prescriptions Use of lower toxicity antidepressantsUse of lower toxicity antidepressants Change packaging of medications to blister packsChange packaging of medications to blister packs Restrict sales of lethal hypnotics Restrict sales of lethal hypnotics
(i.e. Barbiturates)(i.e. Barbiturates)
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Preventing Suicide. . .Preventing Suicide. . .
MediaMedia
GuidelinesGuidelines
ConsiderationsConsiderations
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Preventing Suicide. . .Preventing Suicide. . .
Media GuidelinesMedia Guidelines Encourage implementation of responsible media Encourage implementation of responsible media
guidelines for reporting on suicide, such as those guidelines for reporting on suicide, such as those developed by AFSP.developed by AFSP.
Reporting on Suicide:Reporting on Suicide:recommendations for the mediarecommendations for the media
Can be found on AFSP website:Can be found on AFSP website: www.afsp.orgwww.afsp.org
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Preventing Suicide. . . Preventing Suicide. . .
Media ConsiderationsMedia Considerations Consider how suicide is portrayed Consider how suicide is portrayed
in mediain media TVTV Movies Movies AdvertisementsAdvertisements
The Internet dangerThe Internet danger Suicide chat roomsSuicide chat rooms Instructions on methodsInstructions on methods Solicitations for suicide pacts.Solicitations for suicide pacts.
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You Can Help!You Can Help!Adapted with permissionAdapted with permission
from the Washington Youth Suicide Prevention from the Washington Youth Suicide Prevention ProgramProgram
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You can help. . .You can help. . .
Know warning signsKnow warning signs
InterventionIntervention
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You can help. . .You can help. . .
Most suicidal people don’t really Most suicidal people don’t really want to die – they just want their want to die – they just want their pain to end. pain to end.
About 80% of the time people who About 80% of the time people who kill themselves have given definite kill themselves have given definite signals or talked about suicide.signals or talked about suicide.
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You can help. . . You can help. . .
Warning SignsWarning Signs Observable signs of serious depressionObservable signs of serious depression
Unrelenting low moodUnrelenting low mood PessimismPessimism HopelessnessHopelessness DesperationDesperation AnxietyAnxiety WithdrawalWithdrawal Sleep problemsSleep problems
Increased alcohol and/or other drug useIncreased alcohol and/or other drug use Recent impulsiveness and taking unnecessary risksRecent impulsiveness and taking unnecessary risks Current talk of suicide or expressing strong wish to dieCurrent talk of suicide or expressing strong wish to die Making a planMaking a plan
Giving away prized possessionsGiving away prized possessions Purchasing a firearmPurchasing a firearm Obtaining other means of killing oneselfObtaining other means of killing oneself
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You can help. . . You can help. . .
Intervention Intervention Three Basic StepsThree Basic Steps
1.1. Show you careShow you care2.2. Ask about suicideAsk about suicide3.3. Get helpGet help
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You can help. . .You can help. . .
Intervention Step OneIntervention Step OneShow You CareShow You Care
Be GenuineBe Genuine
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You can help…You can help…
Show you careShow you care Take ALL talk of suicide seriouslyTake ALL talk of suicide seriously
If you are concerned that someone may take If you are concerned that someone may take their life, trust your judgment! their life, trust your judgment!
Listen CarefullyListen Carefully Reflect what you hearReflect what you hear
Use language appropriate for age Use language appropriate for age of person involvedof person involved
Do not worry about doing or saying exactly the Do not worry about doing or saying exactly the “right” thing. Your genuine interest is what is “right” thing. Your genuine interest is what is most important.most important.
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You can help. . .You can help. . .
Be GenuineBe Genuine Let the person know you really Let the person know you really
care. Talk about your feelings and care. Talk about your feelings and ask about his or hersask about his or hers..
““I’m concerned about you…about how you feel.”I’m concerned about you…about how you feel.” ““Tell me about your pain.”Tell me about your pain.” ““You mean a lot to me and I want to help.”You mean a lot to me and I want to help.” ““I care about you, about how you’re holding up.”I care about you, about how you’re holding up.” ““I don’t want you to kill yourself.”I don’t want you to kill yourself.” ““I’m on your side…we’ll get through this.”I’m on your side…we’ll get through this.”
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You can help. . . You can help. . .
Intervention Step Two:Intervention Step Two:Ask About SuicideAsk About Suicide
Be direct but non-Be direct but non-confrontationalconfrontational
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You can help. . . You can help. . .
Ask about suicideAsk about suicide Don’t hesitate to raise the subject.Don’t hesitate to raise the subject.
Talking with people about suicide Talking with people about suicide won’t put the idea in their heads.won’t put the idea in their heads. Chances are, if you’ve observed any of the Chances are, if you’ve observed any of the warning signs, they’re already thinking warning signs, they’re already thinking about it. Be direct in a caring, non-about it. Be direct in a caring, non-confrontational way. Get the conversation confrontational way. Get the conversation started.started.
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You can help. . .You can help. . .
You do not need to solve all of the person’s problems;You do not need to solve all of the person’s problems; Just engage themJust engage them
Are you thinking about suicide?Are you thinking about suicide?
What thoughts or plans do you have?What thoughts or plans do you have?
Are you thinking about harming yourself, ending your Are you thinking about harming yourself, ending your life?life?
How long have you been thinking about suicide?How long have you been thinking about suicide?
Have you thought about how you would do it?Have you thought about how you would do it?
Do you have __? (Insert the lethal means they have Do you have __? (Insert the lethal means they have mentioned.)mentioned.)
Do you really want to die? Or do you want the pain to go Do you really want to die? Or do you want the pain to go away?away?
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You can help. . .You can help. . .
Ask about treatmentAsk about treatment
Do you have a therapist/doctor?Do you have a therapist/doctor?
Are you seeing him/her?Are you seeing him/her?
Are you taking your medications?Are you taking your medications?
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You can help. . .You can help. . .
Intervention Step Three:Intervention Step Three:Get help Get help but do NOT leave the but do NOT leave the person aloneperson alone Know referral resources Know referral resources Reassure the personReassure the person Encourage the person to participate in Encourage the person to participate in
helping processhelping process Outline safety planOutline safety plan
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You can help. . . You can help. . .
Know Referral ResourcesKnow Referral Resources
Resource sheetResource sheet
HotlinesHotlines
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You can help. . .You can help. . .
Resource SheetResource Sheet Create referral resource sheet from Create referral resource sheet from
your local communityyour local community PsychiatristsPsychiatrists PsychologistsPsychologists Other TherapistsOther Therapists Family doctor/pediatricianFamily doctor/pediatrician Local medical centers/medical universitiesLocal medical centers/medical universities Local mental health servicesLocal mental health services Local hospital emergency room Local hospital emergency room Local walk-in clinicsLocal walk-in clinics Local psychiatric hospitalsLocal psychiatric hospitals
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You can help. . .You can help. . .
HotlinesHotlines National Suicide Prevention National Suicide Prevention
LifelineLifeline 1-800-273-TALK1-800-273-TALK www.suicidepreventionlifelinewww.suicidepreventionlifeline.org.org
911911 In an acute crisis call 911In an acute crisis call 911
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You can help. . .You can help. . .
Reassure the person that help is available and Reassure the person that help is available and that you will help them get help.that you will help them get help. Together I know we can figure something out to make you feel Together I know we can figure something out to make you feel
better.better. I know where we can get some help.I know where we can get some help. I can go with you to where we can get help.I can go with you to where we can get help. Let’s talk to someone who can help . . . Let’s call the crisis line Let’s talk to someone who can help . . . Let’s call the crisis line
nownow..
Encourage the suicidal person to identify other Encourage the suicidal person to identify other people in their lives who can also help.people in their lives who can also help. Parent/Family MembersParent/Family Members Favorite TeacherFavorite Teacher School CounselorSchool Counselor School NurseSchool Nurse Religious LeaderReligious Leader Family doctorFamily doctor
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You can help. . .You can help. . .
Outline a safety planOutline a safety plan Make arrangements for the helper(s) to Make arrangements for the helper(s) to
come to you OR take the person directly to come to you OR take the person directly to the source of help - do NOT leave them the source of help - do NOT leave them alone!alone!
Once therapy (or hospitalization) is Once therapy (or hospitalization) is initiated be sure the suicidal person is initiated be sure the suicidal person is following through with appointments and following through with appointments and medications.medications.
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AcknowledgementsAcknowledgements
American Foundation for SuicideAmerican Foundation for Suicide PreventionPrevention
Dr. Paula J. Clayton, AFSP Medical DirectorDr. Paula J. Clayton, AFSP Medical DirectorLinda L. Flatt, Chair, AFSP-NevadaLinda L. Flatt, Chair, AFSP-Nevada
American Association of SuicidologyAmerican Association of Suicidology
Centers for Disease Control and Centers for Disease Control and PreventionPrevention
Suicide Prevention Action NetworkSuicide Prevention Action Network
Washington Youth Suicide Prevention Washington Youth Suicide Prevention ProgramProgram