Suicide Prevention Saving Lives One Community at a Time America Foundation for Suicide Prevention Dr. Paula J. Clayton, AFSP Medical Director 120 Wall.

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

Facing the FactsFacing the Facts

An Overview of An Overview of SuicideSuicide

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In 2007, 34,598 people in the United In 2007, 34,598 people in the United States died by suicide. About every 15.2 States died by suicide. About every 15.2 minutes someone in this country minutes someone in this country intentionally ends his/her life.intentionally ends his/her life.

Although the suicide rate fell from 1992 Although the suicide rate fell from 1992 (12 per 100,000) to 2000 (10.4 per (12 per 100,000) to 2000 (10.4 per 100,000), it has been fluctuating slightly 100,000), it has been fluctuating slightly since 2000 – despite all of our new since 2000 – despite all of our new treatments.treatments.

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Facing the FactsFacing 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 second leading cause of death Suicide is the second leading cause of death for people aged 24-34.for people aged 24-34.

Suicide is the third leading cause of death for Suicide is the third leading cause of death for people aged 10-24.people aged 10-24.

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 males over 85.Suicide is highest in white males over 85.(45.4/100,000, 2007)(45.4/100,000, 2007)

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The suicide rate was 11.5/100,000 in 2007.The suicide rate was 11.5/100,000 in 2007.

It greatly exceeds the rate of homicide. It greatly exceeds the rate of homicide. (6.1/100,000)(6.1/100,000)

From 1979-2007, 881,443 people died by From 1979-2007, 881,443 people died by suicide, whereas 550,304 died from AIDS and suicide, whereas 550,304 died from AIDS and HIV-related diseases.HIV-related diseases.

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Suicide Communications ARE Made to Suicide Communications ARE Made to OthersOthers

In adolescents, 50% communicated their In adolescents, 50% communicated their intent to family members*intent to family members*

In elderly, 58% communicated their intent to In elderly, 58% communicated their intent to the primary care doctor**the primary care doctor**

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Research shows that during our lifetime:Research shows that during our 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 who 60% of us will personally know someone who dies by suicide.dies by suicide.

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Prevention may be a Prevention may be a matter of a caring person matter of a caring person with the right knowledge with the right knowledge

being available in the right being available in the right place at the right time.place at the right time.

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Risk FactorsRisk Factors

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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Psychiatric DisordersPsychiatric Disorders

Most common psychiatric risk factors resulting in Most common psychiatric risk factors resulting in suicide:suicide:

– 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 abuse*Especially when combined with alcohol and drug abuse

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Other psychiatric risk factors with Other psychiatric risk factors with potential to result in suicide potential to result in suicide (account (account for significantly fewer suicides than for significantly fewer suicides than depression):depression):

Post Traumatic Stress Disorder (PTSD)Post Traumatic Stress Disorder (PTSD) Eating disordersEating disorders Borderline personality disorderBorderline personality disorder Antisocial personality disorderAntisocial personality disorder

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Major physical illness, especially recentMajor physical illness, especially recent

Chronic physical painChronic physical pain

History of childhood trauma or abuse, or of being bulliedHistory of childhood trauma or abuse, or of being bullied

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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Sociodemographic Risk FactorsSociodemographic Risk Factors

MaleMale Over age 65Over age 65 WhiteWhite Separated, widowed or divorced Separated, widowed or divorced Living aloneLiving alone Being unemployed or retiredBeing unemployed or retired Occupation: health-related occupations higher Occupation: health-related occupations higher

(dentists, doctors, nurses, social workers) (dentists, doctors, nurses, social workers) – especially high in women physiciansespecially high in women physicians

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Environmental Risk FactorsEnvironmental Risk Factors

Easy access to lethal meansEasy access to lethal means

Local clusters of suicide that have a Local clusters of suicide that have a "contagious influence""contagious influence"

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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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How you can help prevent How you can help prevent suicidesuicide

Know warning signsKnow warning signs

InterventionIntervention

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You Can HelpYou 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 endpain 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 suicidesignals or talked about suicide

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Warning SignsWarning Signs

Observable signs of serious depressionObservable signs of serious depression Unrelenting low moodUnrelenting low mood PessimismPessimism HopelessnessHopelessness DesperationDesperation Anxiety, psychic pain, inner tensionAnxiety, psychic pain, inner tension 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 Threatening suicide or expressing strong wish to dieThreatening 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

Unexpected rage or angerUnexpected rage or anger


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Intervention Intervention

Three Basic Steps:Three Basic Steps:

1.1. Show you care Show you care

2.2. Ask about suicide Ask about suicide

3.3. Get help Get help


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Intervention: Step OneIntervention: Step One

Show You CareShow You Care

Be GenuineBe Genuine


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Show you careShow you care

Take ALL talk of suicide seriouslyTake ALL talk of suicide seriously If you are concerned that someone may take their life, If you are concerned that someone may take their life,

trust your judgment! trust your judgment!

Listen CarefullyListen Carefully

Reflect what you hearReflect what you hear

Use language appropriate for age of person involvedUse language appropriate for age of person involved Do not worry about doing or saying exactly the "right" Do not worry about doing or saying exactly the "right"

thing. Your genuine interest is what is most important.thing. Your genuine interest is what is most important.


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Be GenuineBe Genuine

Let the person know you really care. Talk Let the person know you really care. Talk about your feelings and ask about his or about your feelings and ask about his or hers. hers.

"I'm concerned about you… how do you feel?""I'm concerned about you… how do 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'm on your side…we'll get through this.""I'm on your side…we'll get through this."


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Intervention: Step TwoIntervention: Step Two

Ask About SuicideAsk About Suicide

Be direct but non-confrontationalBe direct but non-confrontational

Talking with people about suicide won't put the idea in Talking with people about suicide won't put the idea in theirtheir heads.heads. Chances are, if you've observed any of the warning signs, Chances are, if you've observed any of the warning signs, they're already thinking about it. Be direct in a caring, non-they're already thinking about it. Be direct in a caring, non- confrontational way. Get the conversation started.confrontational way. Get the conversation started.


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You Can HelpYou 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 just

engage them. engage them. Questions to ask:Questions to ask:

– 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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Ask about treatment:Ask 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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Intervention: Step ThreeIntervention: Step Three

Get help, Get help, but do NOT leave the person but do NOT leave the person alonealone

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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Know Referral ResourcesKnow Referral Resources

Resource sheetResource sheet

HotlinesHotlines

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You Can HelpYou Can HelpResource SheetResource Sheet

Create referral resource sheet from your local Create referral resource sheet from your local communitycommunity

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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HotlinesHotlines

Georgia Crisis and Access LineGeorgia Crisis and Access Line– 1-800-715-4225 or 1-800-715-4225 or www.mygcal.comwww.mygcal.com– Run by Behavioral Health LinkRun by Behavioral Health Link

National Suicide Prevention LifelineNational Suicide Prevention Lifeline 1-800-273-TALK1-800-273-TALK www.suicidepreventionlifeline.orgwww.suicidepreventionlifeline.org

911911 In an acute crisis, call 911In an acute crisis, call 911


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Reassure the person that help is available and that you Reassure the person that help is available and that you will help them get help: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 now.”Let's talk to someone who can help . . . Let's call the crisis line now.”

Encourage the suicidal person to identify other people in Encourage the suicidal person to identify other people in their life who can also help:their life 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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Outline a safety planOutline a safety plan

Make arrangements for the helper(s) to come to Make arrangements for the helper(s) to come to you OR take the person directly to the source of you OR take the person directly to the source of help - do NOT leave them alone!help - do NOT leave them alone!

Once therapy (or hospitalization) is initiated, be Once therapy (or hospitalization) is initiated, be sure that the suicidal person is following through sure that the suicidal person is following through with appointments and medications.with appointments and medications.


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Preventing SuicidePreventing SuicideOne Community at a One Community at a

TimeTime

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Preventing SuicidePreventing Suicide

Prevention within our communityPrevention within our community

EducationEducation

ScreeningScreening

TreatmentTreatment

Means RestrictionMeans Restriction

Media GuidelinesMedia Guidelines

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EducationEducation

Individual and Public AwarenessIndividual and Public Awareness

Professional AwarenessProfessional Awareness

Educational ToolsEducational Tools

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Individual and Public AwarenessIndividual and Public Awareness

Primary risk factor for suicide is Primary risk factor for suicide is psychiatric illnesspsychiatric 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

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Preventing SuicidePreventing SuicideEducational ToolsEducational Tools

Depression and suicide among college students:Depression and suicide among college students:– The Truth About Suicide: Real Stories of Depression in CollegeThe Truth About Suicide: Real Stories of Depression in College (2004) (2004)

Comes with accompanying facilitator’s guideComes with accompanying facilitator’s guide

Depression and suicide among physicians and medical students: Depression and suicide among physicians and medical students: – Struggling in Silence: Physician Depression and Suicide Struggling in Silence: Physician Depression and Suicide (54 minutes)* (54 minutes)* – Struggling in Silence: Community Resource Version Struggling in Silence: Community Resource Version (16 minutes) (16 minutes) – Out of the Silence: Medical Student Depression and Suicide Out of the Silence: Medical Student Depression and Suicide (15 minutes)(15 minutes)

Both shorter films are packaged together and include PPT presentations Both shorter films are packaged together and include PPT presentations on the DVD’son the DVD’s

Depression and suicide among teenagers:Depression and suicide among teenagers:– More Than Sad: Teen DepressionMore Than Sad: Teen Depression (2009)** (2009)**

Comes with facilitator’s guide and additional resourcesComes with facilitator’s guide and additional resources– Suicide Prevention Education for Teachers and Other School Personnel (2010)Suicide Prevention Education for Teachers and Other School Personnel (2010)

Includes new film, Includes new film, More Than Sad: Preventing Teen Suicide, More Than More Than Sad: Preventing Teen Suicide, More Than Sad: Teen DepressionSad: Teen Depression, facilitator’s guide, a curriculum manual and , facilitator’s guide, a curriculum manual and additional resourcesadditional resources

*received 2008 International Health & Medical Media Award (FREDDIE) in Psychiatry category*received 2008 International Health & Medical Media Award (FREDDIE) in Psychiatry category**received 2010 Eli Lilly Welcome Back Award in Destigmatization category**received 2010 Eli Lilly Welcome Back Award in Destigmatization category

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Preventing SuicidePreventing SuicideScreeningScreening

Identify At Risk Individuals:Identify At Risk Individuals:

Columbia Teen Screen and othersColumbia Teen Screen and others

AFSP Interactive Screening Program (ISP):AFSP Interactive Screening Program (ISP):

The ISP is an The ISP is an anonymous, web-based, interactiveanonymous, web-based, interactive screen for individuals (students, faculty, employees) screen for individuals (students, faculty, employees) with depression and other mental disorders that put with depression and other mental disorders that put them at risk for suicide. ISP connects at-risk individuals them at risk for suicide. ISP connects at-risk individuals to a counselor who provides personalized online to a counselor who provides personalized online support to get them engaged to come in for an support to get them engaged to come in for an evaluation. Based on evaluation findings, ISP was evaluation. Based on evaluation findings, ISP was included in the Suicide Prevention Resource Center’s included in the Suicide Prevention Resource Center’s Best Practice Registry in 2009. It is currently in place in Best Practice Registry in 2009. It is currently in place in 16 colleges, including four medical schools.16 colleges, including four medical schools.

Georgia currently has the ISP in 4 colleges (Agnes Scott, Emory, Georgia currently has the ISP in 4 colleges (Agnes Scott, Emory, GCSU & Kennesaw State). More than any other stateGCSU & Kennesaw State). More than any other state..

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TreatmentTreatment

AntidepressantsAntidepressants

Psychotherapy Psychotherapy

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Preventing SuicidePreventing SuicideAntidepressantsAntidepressants

Adequate prescription treatment and monitoringAdequate prescription treatment and monitoring

Only 20% of medicated depressed patients are Only 20% of medicated depressed patients are adequately treated with antidepressants – possibly adequately treated with antidepressants – possibly due to:due to:

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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PsychotherapyPsychotherapy

Research shows that when it comes to treating depression, all Research shows that when it comes to treating depression, all therapy is NOT created equal.therapy is NOT created equal.

Study shows applying correct techniques reduce suicide Study shows applying correct techniques reduce suicide attempts by 50% over 18 month periodattempts by 50% over 18 month period

To be effective, psychotherapy must be:To be effective, psychotherapy must 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 step-by-step Structured (therapist should be able to give step-by-step

treatment instructions that any other therapist can easily treatment instructions that any other therapist can easily follow)follow)

Examples: Examples: CCognitive ognitive BBehavior ehavior TTherapy (CBT), herapy (CBT), IInternterppersonal ersonal TTherapy herapy (IPT), (IPT), DDialectical ialectical BBehavior ehavior TTherapy (DBT)herapy (DBT)

Implement teaching of these techniquesImplement teaching of these techniques

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Preventing SuicidePreventing SuicideMeans 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 motor Improvements in the use of catalytic converters in motor vehiclesvehicles

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 (i.e. Barbiturates)Restrict sales of lethal hypnotics (i.e. Barbiturates)

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Media GuidelinesMedia Guidelines

Suicide is a public health issue. Media and online coverage Suicide is a public health issue. Media and online coverage of suicide should be informed by using best practices. The of suicide should be informed by using best practices. The way media covers suicide can influence behavior way media covers suicide can influence behavior negatively by contributing to contagion or positively by negatively by contributing to contagion or positively by encouraging help-seeking. Suicide Contagion or “Copycat encouraging help-seeking. Suicide Contagion or “Copycat Suicide” occurs when one or more suicides are reported in Suicide” occurs when one or more suicides are reported in a way that contributes to another suicide. a way that contributes to another suicide.

Recommendations for Reporting on Suicide Recommendations for Reporting on Suicide can be found can be found on the AFSP website (www.afsp.org/media) or on the AFSP website (www.afsp.org/media) or www.ReportingonSuicide.org. www.ReportingonSuicide.org.

Our mission statementOur mission statement

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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.

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AFSP-Metro AtlantaAFSP-Metro Atlanta

Contact Information:Contact Information:

Chris Owens, RN, BSNChris Owens, RN, BSNMetro Atlanta Area DirectorMetro Atlanta Area DirectorAmerican Foundation for Suicide PreventionAmerican Foundation for Suicide [email protected] [email protected] 404-374-5197

www.afsp.org/atlantawww.afsp.org/atlantawww.facebook.com/afspatlantawww.facebook.com/afspatlanta

http://twitter.com/AFSP_ATLhttp://twitter.com/AFSP_ATL

Suicide Prevention Saving Lives One Community at a Time America Foundation for Suicide Prevention Dr. Paula J. Clayton, AFSP Medical Director 120 Wall.

Documents

Suicide Prevention Saving Lives One Community at a Time America Foundation for Suicide Prevention Dr. Paula J. Clayton, AFSP Medical Director 120 Wall.