Webinar Notes Advanced Suicide Prevention
- More in-depth by fully preparing you to work in a difficult situation
- Build rapport and trust with an individual that needs help
- Essential skills on suicide intervention
Resource Speaker (00:49)
- Amy Morgan
- Director of Academy Hour
- Certified trainer for Applied Suicide Intervention Skills Training
- Curriculum developer and instructor for mental health courses for the Commission on Law Enforcement Education Training in Oklahoma
The Justice Clearinghouse (01:34)
- Peer-to-peer educational program/resource for justice professionals
- Year-round virtual conference on justice-related topics
- Events are free-to-attend, with subscribers having 24/7 access to recorded webinars and eligible for certifications which may be used for continuing education credits.
- Interactive webinars with polling questions, Q&A portion, and survey.
Webinar Overview (03:49)
- Causes of Suicidal Thoughts
- Responding to Signs of Suicide
Causes of Suicidal Thoughts (05:45)
- Relationship problems
- Job stress
- Job Loss
- Death of a loved one
- Other stressors
Stressors as books we carry
- Carrying about 3 to 4 stressors as symbolized by books we carry is feasible.
- Once we carry more than this, it can be more than we can handle.
- The longer you carry multiple stressors/book, you get tired.
- At some point, you shake and may want to just let go of all the load.
- Case study: 11-year old who seems like a happy and healthy child but wrote a suicide note
What is suicide?
- Want pain to end
- See no solutions
- See no hope
Reasons for Suicide
- Or both
Population with high suicide rate: Adults 85 y/o and above
Events at this age:
- Pain (chronic pain or illnesses) – not going to improve
- Lost people (spouse, friends, close family)
- Lost mobility (car, driving)
- Lost freedom and independence (nursing facility)
- Events at this age:
Responding to Signs of Suicide
3 Areas of Response
- Save the life
- Use the intervention techniques
Prevention: Before Thoughts of Suicide Begin (14:52)
Stay healthy and well
- More likely to bounce back from stressors and handle them one by one
Look for warning signs
Talking about suicide
- Jokes, comments
- Untreated Depression
Giving away possessions
- Things they value
- Random call, text, letter, email
- In preparation
- Change from agitation to calmness could mean they found peace over final decision to end life
- Significant change from usual behavior
Researching suicide methods
- Internet or asking
Buying suicide materials
- Having the means to implement plans of suicide like a gun, rope, knives, pills
- Creating/updating a will
Social withdrawal and isolation
- Isolation from friends, family, colleagues
- Withdrawing from social activities
Talking about problems/burdens
- Feelings of causing unwanted problems to other people
- Feeling hopeless
Preoccupied with death
- Researching and talking about death and afterlife
Previous suicide attempt
- Increased risk of attempt
- 20-50% who die by suicide attempted previously
- Previous attempts make suicide more comfortable to them
- Suicide not unknown, and is familiar to them
- Talking about suicide
What to do?
- Ask/listen to what the problems and stressors are
Help find resources
- Job search
- Family assistance
- Support network/friends
- Get in touch with National Suicide Prevention Lifeline 800-273-8255
People hide what they don’t want others to know or see.
- Intervention allows them to talk about their suicidal thoughts without judgment.
- Asking them gives them relief, acknowledging their feelings and the thoughts they’re having.
What is intervention?
Interference to modify a process or situation
- Not everyone responds positively on interference.
- Better that they get angry than they die.
Applied Suicide Intervention Skills Training (ASIST) Model – symbolized by a river
- Contributories of suicide
- Thought of suicide
- The warning signs mentioned in the prevention section
- Harm or death
- Interference to modify a process or situation
How does intervention work? (23:59)
3 Phases of Intervention
- Build trust and connect with them
“Are you thinking about suicide?”
- Practice asking this aloud.
- Asking will give them permission to admit that they’re having those thoughts.
- Non-judgmental response to a “Yes”, will help you connect and gain trust.
“I’m just going to end all of this and fix all my problems”
Accept what the person is saying, without judgment, and let them know you’re here to help.
- “I can see you really seem to be having a hard time.”
- “Tell me what’s bothering you the most.”
- “That does sound very difficult.”
- “What else?” “Tell me more.”
- It’s not about you, or your opinions.
- Build trust.
- Create a sense of trust and
- openness for sharing.
- Goal: Save the person’s life.
- Accept what the person is saying, without judgment, and let them know you’re here to help.
Listen for red flags/risk factors
- “Are you thinking about suicide?”
Ask questions about current factors that may contribute to their suicidal thoughts.
“Do you have a plan?”
- Timeline for their plan
- Availability of means
“Do you have pain that at times feels unbearable?”
- Level of desperation
“Do you feel you have few, if any, resources?
- Feeling alone
- “Do you have a plan?”
Ask questions about background factors that may contribute to their suicidal thoughts.
“Have you ever attempted suicide before?”
- Familiarity with suicide
“Are you receiving or have you received mental health care?”
- Measures vulnerability
- “Have you ever attempted suicide before?”
- The most difficult phase.
- Ask them to tell you all about all the stressors, the reasons why they want to end their life.
Listen without judgment or opinion, and without trying to turn them to more positive thinking.
- If you react to the person’s statement that causes them to back off or disconnected with you, go back to the connecting phase.
- Intervention is a continuous back and forth to connecting and understanding
Listen for cues about reasons for living.
- A child, a pet
- Plans for a vacation
- Anything that gives them a reason to stay alive
Listen for ambivalence
- Being less than certain for wanting to die
Case Study: Golden Gate Bridge Suicides
- Survivors regret their decisions to commit suicide midair or before
- “I instantly realized that everything in my life that I’d thought was unfixable was totally fixable – except for having just jumped.”
Who can die by suicide?
- Anyone is at risk, take warning signs seriously.
- Does not matter what race, gender, socio-economic status, location, career, age, etc.
What is a stressor?
- What might be stressful for one might not be for another.
- Not about you or your opinion.
- The stressor is real and is probably one of many for that person.
Caregiver attitudes matter.
- Those thinking of suicide can only focus on the things that are causing them to feel hopeless.
- Easy solutions for you may not be visible or achievable to the one thinking of suicide.
- All they think about is the pain
- The caregiver’s goal to relieve the pain through listening and provide clarity and focus to plan solutions
- Start helping the person look for resources and solutions.
The goal is to keep the person at risk safe.
- Person must agree that they will not take their life
- Person must agree to work with you to stay safe
- A period of at least 24 hours
Safeplan is an agreement between the suicidal person and the caregiver
Take the things they can use to take their life
- Pills / Medication
- Take the things they can use to take their life
- Ease the pain they’re feeling
Establish safety contacts
- Have a specific people they can call on
- Write down name and phone number
- Health Workers
- Get in touch with National Suicide Prevention Lifeline 800-273-8255
- Informal resources
If in immediate danger, do not leave them alone.
- Call resources who can stay with the person at risk, if you can’t
- Bring to emergency room
- Making the call for them can be helpful
- Help them find resources
- Help them make appointments to resource
- Help find someone to accompany them to those appointments
- Disable suicide
- The goal is to keep the person at risk safe.
- DEATH: Patiently listen TO the death side of ambivalence; help the person at risk talk about their reasons for dying
- LIFE: Persistently listen FOR the life side of ambivalence; search for reasons for living or reinforce them when the person at risk discovers them
- Critical parts:
- 3 Phases of Intervention
Postvention: Helping someone who has lost someone to suicide (46:33)
Responding to suicide
Keep in mind when managing the scene and the family
- Family just lost a loved one
- Cause of death is irrelevant
They may be feeling:
Questions of the survivors
Why did the person end their life?
- Remember the causes of suicide – stressors, pain or loss
- Talk and explain to the family the causes
Does suicide run in the family?
Suicide is a learned behavior
- Pass behavior and emotional environments
- Teach poor coping skills, self-destructive behavior
- Depression and anxiety, and other disorders are contributors that may run in a family
- Suicide is a learned behavior
- Why did the person end their life?
Back to the prevention phase
- Losing a loved one is a life stressor.
- An additional stress to their existing stack of books.
Postvention is prevention to those left behind after a suicide.
- Listen for signs
Start connecting phase with those left behind
- Build rapport
- Gain trust
- No judgment or criticism
- Assess level of risk
- Ask about factors that may contribute to future thoughts of suicide
Offer resources for the loved ones left behind
- Emergency Room
- Family members
- National Suicide Prevention Lifeline 800-273-8255
Safe Call Now 206-459-3020
- Comprehensive, 24-hour crisis referral service for all public safety employees, all emergency services personnel, and their family members nationwide.
- Talk about what they can expect
- A significant loss
- A traumatic event
- May need to seek help later like counseling
- Ask them to think about who they might call at the time.
Who are your resources?
- Think to yourself of who you would call. Do you have their number ready?
- Keep in mind when managing the scene and the family
Have you ever known someone who died by suicide, or who attempted suicide?? (20:18)
- Attempted but lived 19%
- Died by suicide 66%
- None of the above 16%
Do you feel confident that you would know what to do to save this child’s life or help him stop thinking of suicide as a solution? (09:32)
- Yes 44%
- No 56%
What would be your immediate reaction to a friend who is saying they are contemplating suicide? (25:46)
- Remind them of all the good things they have going on in their life 33%
- Tell them to stop talking like that because they’re worrying you 0%
- Tell them to start telling you all the reasons they want to end their life 65%
- I have absolutely no idea what to do 2%
How good of a listener do you think you are when you disagree with what a person is telling you? (33:23)
- Terrible 7%
- Average 41%
- Amazing 52%
You’re trying to listen to your friend tell you all the things that have been going wrong, and you know you can help with 2 he’s just mentioned. What do you do?
- Hooray! I can fix these. I quickly tell my friend the solutions 6%
- I make a mental note of potential resources to bring up later 85%
- I do nothing, I’m supposed to just listen 10%
How confident do you now feel that you could recognize someone who is having thoughts of suicide and help them to live? (47:08)
- Much more confident 65%
- Just as confident 34%
- Still not confident 1%
How many of you respond to suicides as part of your job and sometimes talk with the family & friends left behind?
- I respond to suicides and talk with family & friends 42%
- I respond to suicides but do not talk with the family & friends 15%
- I do not respond to suicides 43%
For questions and clarifications, contact:
AMY MORGAN, MSC
What if the person will not give you their gun, or drugs, or whatever you think they might be using to attempt suicide? (54:14)
Call the police or 911, that person is in imminent danger of taking their own life and possibly someone else's with the weapon. They're not telling to keep their method and plan in place.
Is using the phrase imminent danger a keyword to dispatchers to make it a high priority call? (55:20)
Yes. They'll understand that immediately.
What does postvention for a family member or person look like for someone who has attempted suicide but did not complete? (55:33)
It's going to be the same thing. The family members might still be learning or have not learned the coping mechanism. Continue listening. Try to find out what's going on. Once they've shared that with you, you can provide resources.
What is your opinion of any correlation between someone contemplating suicide and an active shooter? (56:54)
Most active shooters do walk into that situation expecting not to survive. They don't care anymore about their own at their point.
Having responded to repeated suicide threats, our procedure in Iowa requires us to take them into the local Emergency Room for evaluation. Often these patients are not referred on for treatment and are just sent home. The courts will only do what the doctors recommend. Do you have any suggestions or recommendations? (58:08)
I have that same frustration. The emergency rooms don't always have a psychiatric person on site to help the person. By then, the person will say they're already feeling better and the psychologist or psychiatrist will say they are not in danger and can be dismissed without being sent to a facility. But you know better and know that they are in danger. Keep going through the intervention process. Make the use of your time. Do what you can. Check on them. Provide them the name and numbers of facilities to provide them the care that they really need to have.
How do people find access to the 2-day course that you mentioned earlier? (1:00:32)
The company's name is Living Works an dit is a highly immersive and recommended training to have. The link is https://www.livingworks.net/programs/asist
What would you recommend for self-help for those who are ASIST-trained and end up losing a client or even help a client? (1:01:49)
Caregivers tend not to help ourselves, and that is part of my goals. The givers get depleted mentally, emotionally, physically and they've got nothing left to give. It is discouraging when your goal is to save a life, and yet you lose them. You can't blame yourself, you tried to help. No one's perfect. There won't be a perfect intervention. Give yourself permission to know that people make their own choices. Get whatever helpful resources. Be your own best friend. Get counseling. Whatever you recommend to someone else, apply to yourself.
What do you feel is the best approach when working with minors? (1:03:08)
Patience – not with them, but with their situation. You're not only dealing with them, you're dealing with their entire family. You want to help the child but there are external forces that are working against you. Apply your information and intervention with them, their family, and anyone that may have an influence on them systemically. Try to provide the family the tools that you typically only provide to one person.
Can you talk a little bit about the Safe Call line and what they provide? (1:04:14)
It was started by a law enforcement officer that dealt with alcoholism. Law enforcement and emergency response when they have a mental health problem, they lose their job. Safe Call is specifically for those people. They get confidential referrals so they're not putting their jobs in jeopardy. They can get confidential help so they can get better and get healed.
I just thought that you should mention that when calling the police, a person should specifically ask the dispatcher for a crisis intervention team officer. These are specially trained officers who took a 40-hour course. (1:05:39)
"Suicide is not as much about a person wanting to die, as it is just about them wanting their pain to end, or if they see no hope and no solution in sight."
"Prevention is the best scenario, obviously. Just like with a physical illness, like I have today. It is much better to stay healthy and well than it is to get sick and then try to heal. Imagine the time you're really sick and how you felt, how well were you able to function? It relates us to mental sickness, the feelings of suicide. That feeling of carrying those heavy books around, and your arms being weak and tired, you stop caring about anything going on around you and you can only think about how bad you feel."
“People get very good at hiding things they don’t want others to know about. Often the stressors that are hurting someone are also things that might be embarrassing to them. Nobody wants to feel needy or weak, so when asked if something is wrong, they claim to be fine. People won't always tell you directly that they need help."
"When a person is letting these stressors accumulate, they build up inside the person a lot like water in a river dam. The person is thinking of suicide as a point of that dam overflowing. So, the understanding phase of suicide intervention is getting the water released little by little, not all at once, through our listening and our understanding what the person is going through."
"You hear someone is contemplating suicide and you immediately just want to fix the problem and make it go away. Without first connecting and spending the time understanding the person is not gonna be yet ready to accept the resources or even consider what you tell them."