1 1 ASK ABOUT SUICIDE : To Save A Life - PowerPoint Presentation

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ASK ABOUT SUICIDE : To Save A Life

“ASK About Suicide: To Save a Life” is a one hour, non-proprietary gatekeeper training program. You are welcome to use this powerpoint as a handout to the one hour video which accompanies it. You may also present the program yourself as long as slides are not altered, you use the notes section for presentation information, you review the video ahead of time, and you include correct attributions. Note that this program was NOT developed for youth but for individuals who work with youth or adults at risk for suicide.

For more information go to: TexasSuicidePrevention.org or MHATexas.org

Texas also has suicide prevention advocates who have been trained

to give longer ASK gatekeeper training presentations with more audience

interaction and suicide prevention scenarios.

Contact Mental Health America of

Texas if you need a list of presenters trained in ASK.Slide2

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2ASK ABOUT SUICIDE : To Save A Life

Developed by:

Merily H. Keller, hodgekeller@yahoo.comWith contributions fromLloyd Potter, PhD, M.P.H., University of Texas at San AntonioJohn Hellsten, PhD, Texas DSHS Injury Epidemiology and EMS Trauma Registry Group and  Jennifer Battle, MSW, MHMRA of Harris County HelpLine DirectorReview & assistance from Texas Suicide Prevention Council TODAY’s Presenter/s:Merily H. Keller Jenna Heise

Jenna.Heise@dshs.state.tx.us

For more information go to: TexasSuicidePrevention.org or MHATexas.org

Funding for this training was made possible (in part) by grant number

SM059174

from SAMHSA. The views expressed in written training materials or publication and by speakers and trainers do not necessarily reflect the views, opinions, or policies of CMHS, SAMHSA, or HHS; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.Slide3

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Texas Youth Suicide Prevention GrantBest Practice Public Education, Outreach & Training

Texas has a State Plan for Suicide Prevention TexasSuicidePrevention.org Texas Youth Suicide Prevention Grant

Project partners: Mental Health America of Texas, Center for Healthcare Services, Texas Department of State Health Services.The Texas Suicide Prevention Council has 29 local coalitions & 21 statewide partners supported by MHAT.MHAT & The Texas Suicide Prevention Council provide education for policy issues and have website with state laws relating to suicide (see handout.)Example HB 1386 – current workgroup (DSHS, ESCs, MHAT & TEA) are using the Suicide Prevention Resource Center's Best Practices Registry's list of recommended programs.Slide4

Statewide Best Practices

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Training:

At Risk

online interactive training for high school and college educators and college students Best Practices Registry StatusASK Gatekeeper Training Being submitted for Best Practices Registry10,000 people in Texas have received Gatekeeper Training since YSPG started in 2005Training developed and adapted for special audiences that work with youth, including:EducatorsMedical and Mental Health ProfessionalsOthersSlide5

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5ASK is a Gatekeeper

Training Program

ASK about suicide to save a life is a suicide prevention Gatekeeper Training Program to help people learn how to--ASK about suicideSEEK more information (& Keep SAFE)KNOW where and how to refer ASK is a process to offer HOPE to help prevent a tragic loss of life and NOT a form of counseling or treatment.Slide6

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6What do we know about suicide in TEXAS…

Number of deaths in Texas:

2,618 suicide deaths in 2008 and 2,795 in 20091½ times more suicides than homicides Average of 7.5 deaths each day by suicide2nd leading cause of death among young adults (25-34 years)3rd leading cause of death of teens and college aged youth (15-24 years)Although there is no one cause, 90% of those who die by suicide have an underlying mental health or substance abuse condition. It affects nearly 20% of those with bipolar disorder and 15% of those with schizophrenia.

Source: Centers for Disease Control and Prevention, WISQARSSlide7

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7What do we know about suicide ?

Gender: across all ages; more males die by suicide and more females attempt suicide.

Ethnicity/Culture: For youth, the highest self-reported attempts in the U.S. is among Latina female teens and the highest death rate for both teens and adults is for White males. Note: recent years have seen some death rate increases for young African American males. Note: African American females have tended to have some of the lowest suicide death rates through the years….Why? Protective factors? (Data from suicidology.org, WISQARS, and Texas DSHS searchable database http://soupfin.tdh.state.tx.us/cgi-bin/death)Slide8

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What do we know about suicide ?

(When time, add slides from best practice based websites with new research geared to the audience’s specific needs and roles. Websites are listed at end of powerpoint.)New Research & Information of Interest Slide9

What Do We Know About Suicide Attempts in Texas…

Almost 1 in 3 students felt depressed in the past 12 months.

More than 1 in 6 students considered suicide.

More than 1 in 7 made a plan to commit suicide.

Texas 2011 Youth Risk Behavioral SurveySlide10

More than

1 in 10

students actually attempt suicide.

1in 50 make attempts so severe that they require medical attention.33 students in our sample had attempted suicide 6 or more times in the past 12 months.Slide11

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11What we DO know about suicide…

From a Public Health perspective, it is considered to be one of the most preventable of deaths …. IF

We Recognize and Lower Risk Factors Support Protective Factors Recognize Warning Signs and Are Trained and Ready to:Ask About SuicideSeek More Information (& Keep Safe)Know Where & How to ReferSlide12

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12Risk Factors

Risk Factors are stressful events, situations, or conditions in a person’s life that may increase the likelihood of attempting or dying by suicide.

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13Risk Factors: Bio-Psycho-Social

Biological & Psychological:

Mental IllnessSubstance AbuseHopelessnessImpulsiveness or AggressivenessTrauma/Abuse/BullyingMajor Physical IllnessFamily History of SuicidePre-existing Vulnerability (obese, GLBTQ, awkward, G&T …)Previous Suicide AttemptSlide14

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14Risk Factors: Mental and Addictive Disorders

Note: Biological & Psychological Factors, include--Mental and addictive disorders, often co-occurring, as the most powerful risk factors for suicide in all age groups.

Mental or addictive disorders are thought to be present in at least 90 percent of all completed suicides.Bipolar and schizophrenia are two disorders that have been found to have particularly strong associations with suicidal behavior.Source: Moscicki, Eve K. Identification of suicide risk factors using epidemiologic studies. Psychiatric Clinics of North America. Vol 20(3), Sep 1997, 499-517Slide15

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15Risk Factors: Social-Cultural

Social – CulturalIsolation and lack of social support (Bullying, GLBT, G&T, Obese, others)

Stigma to seeking help (men, rural, military, law enforcement, others)Barriers to health and mental health care Cultural and/or religious beliefs that normalize suicideSlide16

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16Risk Factors: Environmental

Loss (Job or Financial)Loss (Relationship)Easy access to lethal meansExposure to clusters of suicideSlide17

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17Protective Factors

(can act as “safety lines”)

“Protective factors are the positive conditions, personal and social resources that promote resiliency and reduce the potential for suicide as well as other high-risk behaviors.”Slide18

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18Protective Factors

Effective clinical care for mental, physical and substance use Access to clinical interventions and support for help seeking Restricted access to highly lethal means of suicide

Connections to family and community support Ongoing medical and mental health care relationships Skills in problem solving, conflict resolution and nonviolent handling of disputes Cultural and religious beliefs that discourage suicide and support self preservationSlide19

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Entering

Suicidal ZoneWhen risk factors are high and protective factors are low, proximal risk factors (or stressors) can interact with a person’s long term or underlying risks so that a person gets into a “suicidal zone” (but this is for short time period.)Slide20

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20Direct Suicidal Communication or Behavior = Acute or High Degree of Risk

The

best practice registry consensus statement lists two “levels” of warning signs Acute Risk includes: Threatening to hurt or kill him/herself, or talking of wanting to hurt or kill him/herself; and/or, Looking for ways to kill him/herself by seeking access to firearms, available pills, or other means; and/or, Talking or writing about death, dying or suicide Source: Suicide Prevention Resource Center, (sprc.org), Best Practice Registry Section II

From: Suicide Prevention Resource Center, Best Practices Registry Section II.

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21Other Warning Signs =

Chronic or Moderate Risk

Feelings (5 Main Ones)No reason for living/no sense of purpose in lifeFeeling trapped, like there’s no way outHopelessnessDramatic mood changes (high or low)Anxiety/agitationFrom: Suicide Prevention Resource Center, (sprc.org), Best Practice Registry Section II Behavior (5 Main Ones)Increased substance abuse

Withdrawal from friends/family/societyRage/anger/revengeReckless or risky activitiesUnable to sleep or sleeping all the timeSlide22

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22Direct Suicidal Communication

or Behavior:Acute Risk - Take Immediate Action

HIGH RISK=TAKE ACTION NOW!1– Take Immediate Action2 – Keep Safe / Do Not Leave Alone 3 – Call 911 or seek immediate help from a mental health provider at school or in community. (or call your mobile crisis outreach team, or take to nearest hospital emergency room)Slide23

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23Other Warning Signs =

Moderate or Chronic Degree RiskMODERATE/CHRONIC

RISK =1– Take All Signs Seriously.2 – Refer to a Mental Health Professional or Call 1-800-273-TALK (8255)for a referral.Slide24

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24 Look for Constellations of Signs

Trust your instincts – if the thought of suicide crosses your mind, assume it has crossed the mind of the person you are talking to.

The higher the underlying risk factors, the lower the protective factors and the more warning signs shown or communicated, the higher the overall risk of suicide.Slide25

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Direct and Indirect Verbal Signs“I want to kill myself.” (Suicidal communication)“I’ve been thinking about suicide.” (Suicidal communication)“I just want out. I can’t take it anymore.”

(Feeling trapped)“I feel hopeless…it’s not worth living.” (Hopelessness)“People would be better off without me.” (Perceived burdensomeness)“Sometimes I just want to go to sleep and not wake up.” (Thoughts of death)

Warning Signs Can be Communicated

Verbally or NonverballySlide26

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“Just leave me alone – I don’t want to leave my room.” (Isolation)“I can’t sleep and have been really wired for past few weeks!” (decreased sleep) or “All I want to do is sleep all the time.” (Increased sleep)

“I just wish I could get back at the people who did this to me!”(Rage & seeking revenge)Warning Signs: Behavior “I just want to stay stoned….. maybe forever.”

(Substance abuse)

“Do you know where I can get a gun?” OR “Where does Mom keep her anti-anxiety pills?”

(Seeking access to lethal means)

“Please take my CD collection, I’m not going to need it anymore.”

(

Making plans by giving away prized possessions)Slide27

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Take the following 3 steps:ASK About Suicide

Seek More Information/ Keep Safe 3. Know Where and How to Refer (Take Action!)What you can do when you hear suicidal language or suspect someone is suicidalSlide28

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REMEMBER Asking about suicide does not put the thought of killing oneself in someone’s head, but gives them a sense of relief that someone is finally hearing them and will LISTEN.

Asking is the first step in Saving a Life!Slide29

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29Step 1: How to Ask About Suicide

IndirectSometimes when people are as sad as you are, they think about suicide. Have you ever thought about it?

Do you ever want to go to bed and never wake up?DirectHave you thought about suicide?Do you want to kill yourself?Are you thinking about suicide?Slide30

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30Step 1: How to Ask About Suicide

Don’t say

Be AwareOf your non-verbal cues. How you ask is not as important as the ASKING itself. If you can’t do it, find someone who can. You’re NOT thinking of suicide, are you?You wouldn’t do something really stupid, would you?Slide31

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Step 2: SEEK more information &

Keep SAFE

1.Seek a private area to talk.2.Seek to establish a relationship.3.Comment on what you see and observe non-judgmentally.4. Be curious about their perceived problem. Find out how long they’ve thought about suicide and if they’ve attempted suicide in the past and if tried to get help.Slide32

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STEP 2: SEEK more information &

Keep SAFE

5. Seek to find out if they are at immediate high risk of suicide: (do they have a plan?) (have they rehearsed it in their mind?) and/or (do they have a gun, access to pills or other means?) Take immediate steps to limit access to means and assure safety if YES.6. Find out who and where they normally go to for help (family, friends, pastor, neighbor, roommate, girl/boy friend).7. Find out if they have a regular doctor, mental health provider or counselor.8. Be sure to be aware of your own non-verbal reactions and tone of voice! Slide33

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33As you seek more information, help ensure the person’s safety and/or help them start to implement a safety plan.

With immediate risk of suicide, Call 911 or get someone to the nearest hospital emergency room!

STEP 2: SEEK more information & Keep SAFESlide34

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34The third step in the referral process is to

KNOW where to refer nationally, in Texas and in your area, your school or your

community. National Suicide Prevention Lifeline:1-800-273-TALK\1-800-273- 8255SAVE A NUMBER TO SAVE A LIFE

STEP 3: KNOW – How and Where to Refer? Slide35

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911s, Hospitals, Law Enforcement and Mobile Crisis Outreach Teams

In an immediate risk, call 911, your local police, campus police, or the sheriff’s office or take the person to the nearest hospital emergency room. (Keep a list of nearest hospital emergency rooms on your referral card/sheet.)Note: Many Texas law enforcement agencies have officers trained in mental health. You can ask for a mental health officer.Note: Many Texas communities have mobile crisis outreach teams. Find out if there is one in your area and obtain their contact number.STEP 3: KNOW - Where to Refer in

Texas and in Your Local AreaSlide36

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STEP 3: KNOW - Where to Refer in

Texas and in Your Local Area

Texas Crisis Line Options All MHMRs/LMHA in the State of Texas are required to provide a 24-hour crisis line for their service area (which may be a county or a region of counties) and these lines are required to be certified by the American Association of Suicidology.To find the number to the MHMR crisis line closest to you, log onto the DSHS website, www.dshs.state.tx.us, under Reference Center or go to www.TexasSuicidePrevention.org and look for crisis centers in the appendix for your county or download the free Mobile ASK website on your smart phone at www.mhatexas.org/ask/.

(Discuss local referral lists and/or action plans)Slide37

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American Association of Suicidology

http://www.suicidology.org/web/guest American Foundation for Suicide Preventionhttp://www.afsp.org/ Centers for Disease Controlhttp://www.cdc.gov/ViolencePrevention/suicide/index.html National Action Alliance for Suicide Prevention http://actionallianceforsuicideprevention.org/National Suicide Prevention Lifeline

http://www.suicidepreventionlifeline.org/ Substance Abuse and Mental Health Services Administrationhttp://www.samhsa.gov/prevention/ Suicide Prevention Resource Center http://www.sprc.org/ Texas Department of State Health Services

http://www.dshs.state.tx.us/

Texas Suicide Prevention Council

http://www.TexasSuicidePrevention.org

Youth Risk Behavior Surveillance System

http://www.cdc.gov/HealthyYouth/yrbs/index.htm

Resources for more information

YOU CAN SAVE A LIFE :Slide38

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Ask about suicide Seek

more information & Keep SAFE Know how and where to refer Questions from audience Share Successful Intervention & Postintervention StoriesVideos of Hope & Help from TexasSuicidePrevention.org Please fill out the evaluation forms with the number 2 pencil provided or via the online survey. Remember…

YOU CAN SAVE A LIFE :Slide39

Videos --True Stories of Help & Hope Available TexasSuicidePrevention.org

http://TexasSuicidePrevention.orgYou Can Link to 7 True Stories of Help & Hopeat the website above. The site also has a discussion guide to use with the videos and links to more informationabout suicide prevention.

* Ask the Question: Kurt’s True Story of Help & Hope