Aruna Jha, Ph.D., LCSW...2013/11/08 · Mary Pipher (20th century), U.S. clinical psychologist....

transcript

Aruna Jha, Ph.D., LCSW Webinar-CTAC-

Youth Suicide Prevention

Aruna Jha, Ph.D., LCSW Research Assistant Professor

University of Illinois at Chicago

Founder, Asian American Suicide Prevention Initiative

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Aruna Jha, Ph.D., LCSW Webinar-

CTAC-Youth Suicide Prevention

CTAC-Youth Suicide Prevention 11-8-13 3

Numerous times

Youth Suicide: Scope of the problem

Adolescent development: Understanding the Challenge

Applicable theories of suicide risk

Suicide Prevention – some guidelines when working with youth

Q and A (time permitting)

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NUMBER OF SUICIDES: 4,600 died by suicide

LEADING CAUSE OF DEATH: Suicide was the third leading cause of death for 15-24 year olds.

SUICIDE RATES/100,000: ◦ For youth aged 15-24 = 10.45

◦ For youth aged 20 -24= 13.62

◦ For youth aged 15 -19= 7.53

◦ For youth aged 10 -14 = 1.29

GENDER: Male youth die by suicide four (4.34) times more frequently than female youth.

16% of American youths in grades 9-12 in private and public schools reported seriously considering suicide

13% reported creating a plan

8% reported trying to take their own lives

Each year 157,000 youth between ages of 10-24 years seek medical care for self injury

20% of teens seriously considers suicide each year

(Grunbaum, 2002); 10% of college population (CHS)

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81% of suicide deaths were males

19% were females

Boys die 4X as often as girls

Girls attempt more than boys (3X)

Boys use firearms more, girls OD more

Lethality of method contributes to outcomes

90% of youth who die by suicide are suffering from an Axis I mental disorder (mood disorder, substance abuse and often both).

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Highest suicide rate in US? Native American males Greatest increasing rate? African American males (up 200%) Highest rate of suicide attempts? Hispanic youth (males & females) Highest rate of suicide attempts of any group? Hispanic females

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Thankfully, NO!

20,000 out of 100,000 people get

depressed

8,000 out of 100,000 people attempt

suicide

12-20 out of 100,000 people complete

suicide.

Something must be protecting the

19,980 people who are depressed and

the 7.980 people who have attempted

suicide. 11-8-13 11

Adolescence is a border between childhood and adulthood. Like all borders, it's teeming with energy and fraught with danger. Mary Pipher (20th century), U.S. clinical psychologist. Reviving Ophelia, ch. 15 (1994).

My adolescence progressed normally: enough misery to keep the death wish my usual state, an occasional high to keep me from actually taking the gas-pipe. ~Faye Moskowitz

So what is different or unique about Adolescence?

Why should we care?

What can we do?

Unfortunately, YES!

What explains this increase in youth depression,

impulsivity and aggression?

Sociological theories of social control and social bonding (Akers et al., 1979; Elliott et al., 1985)

Peer clustering (Oetting & Beauvais, 1986)

Cultural identity (Oetting & Beauvais, 1990-91)

Psychological theories of attitude change & behavioral prediction (Fishbein & Ajzen, 1975; Ajzen, 1985)

Personality development (Digman, 1990)

Social learning (Akers et al., 1979; Bandura, 1977, 1986)

Integrative theories (e.g., Jessor & Jessor's, Problem Behavior Theory; Brook’s Family Interaction Theory, Hawkins’ Social Development Theory)

See Petraitis, Flay and Miller (1995). 11-8-13 18

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WHY BIOLOGY?

What is the take-home

message from all of this?

Referring to a "rise" in suicide rates is usually more

accurate than calling such a rise an "epidemic," which

implies a more dramatic and sudden increase than what

we generally find in suicide rates.

Research has shown that the use in headlines of the

word suicide or referring to the cause of death as self-inflicted increases the likelihood of contagion.

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Myths about Suicide Prevention

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Myth: Asking about suicide will plant the idea in a person’s head.

Reality: Asking a person about suicide does not create suicidal thoughts any more than asking about chest pain causes angina. The act of asking the question simply gives the person permission to talk about his or her thoughts or feelings.

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Myth: There are talkers and there are doers.

Reality: Most people who die by suicide have communicated some intent. Someone who talks about suicide gives the guide and/or clinician an opportunity to intervene before suicidal behaviors occur.

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Myth: If somebody really wants to die by suicide, there is nothing you can do about it.

Reality: Most suicidal ideas are associated with the presence of underlying treatable disorders. Providing a safe environment for treatment of the underlying cause can save a life. The acute risk for suicide is often time-limited. If you can help the person survive the immediate crisis and overcome the strong intent to die by suicide, you have gone a long way toward promoting a positive outcome.

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Myth: He/she really wouldn't commit suicide because…he just made plans for a vacation ◦ she has young children at home ◦ he made a verbal or written promise ◦ she knows how dearly her family loves her

Reality: The intent to die can override any rational thinking. “No Harm” or “No Suicide” contracts have been shown to be ineffective from a clinical and management perspective. A person experiencing suicidal ideation or intent must be taken seriously and referred to a clinical provider who can further evaluate their condition and provide treatment as appropriate.

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What other myths have you encountered in your professional practice? Or personal lives?

Why do people hang-on to these beliefs?

Suicide is almost always multi-determined.

Suicide prevention must involve multiple approaches.

Most suicidal persons want to find a way to live.

Ambivalence exists until the moment of death.

The final decision rests with the individual.

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Detection of suicidal persons

Active intervention

Alleviation of immediate risk factors

Enhancement of protective factors

Accompanied referral

Access to treatment

Accurate diagnosis

Aggressive treatment

(Courtesy QPR Institute, Paul Quinett)

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Operation S. A. V. E. will help you act with care

and compassion if you encounter a person who is suicidal.

The acronym “SAVE” summarizes the steps needed to take an active and valuable role in suicide prevention.

Signs of suicidal thinking Ask questions Validate the person’s experience Encourage treatment and Expedite getting help

(Veterans Administration, Suicide Prevention Program)

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Importance of identification Suicidal individuals are not always easy to

identify. There is no single profile to guide

recognition. ◦ There are a number of warning signs and symptoms.

Some of the signs of suicidality are obvious, but others are not.

◦ Signs and symptoms do not always mean the person is suicidal but: When you recognize signs, it is important to ask the person how they are doing because they may mean that they are in trouble.

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Signs and Symptoms: ◦ Threatening to hurt or kill self

◦ Looking for ways to kill self

◦ Seeking access to pills, weapons or other means

◦ Talking or writing about death, dying or suicide

◦ Hopelessness

◦ Rage, anger

◦ Seeking revenge

◦ Acting reckless or engaging in risky activities

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Feeling trapped Increasing drug or alcohol abuse Withdrawing from friends, family and society Anxiety, agitation Dramatic changes in mood No reason for living, no sense of purpose in

life Difficulty sleeping or sleeping all the time Giving away possessions Increase or decrease in spirituality

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To effectively determine if a person is suicidal, one needs to interact in a manner that communicates concern and understanding. As well, one needs to know how to manage personal discomfort (i.e., anxiety, fear, frustration, personal, cultural or religious values) in order to directly address the issue.

Know how to ask the most important question

The most difficult S. A. V. E. step is asking the most important question of all–

“Are you thinking of killing yourself.”

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How DO I ask the question? DO ask the question after you have enough

information to reasonably believe the person is suicidal.

DO ask the question in such a way that is natural and flows with the conversation.

DON’T ask the question as though you are looking for a “no” answer. “You aren’t thinking of killing yourself are you?

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Things to consider when you talk with the person: ◦ Remain calm ◦ Listen more than you speak ◦ Maintain eye contact ◦ Act with confidence ◦ Do not argue ◦ Use open body language ◦ Limit questions to gathering information

casually ◦ Use supportive and encouraging comments ◦ Be as honest and “up front” as possible

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Validation means:

◦ Show the person that you are following what they are saying

◦ Accept their situation for what it is

◦ You are not passing judgment

◦ Let them know that their situation is serious and deserving of attention

◦ Acknowledge their feelings

◦ Let him or her know you are there to help

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SUMMARY

Operation S. A. V. E. can save lives by helping you become aware of:

Signs of suicidal behavior and giving you the skills to:

Ask questions

Validate the person’s experience and to

Encourage treatment and Expedite getting help

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Take care of Yourselves

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Overlap of clues and suicide is high in retrospective analysis.*

Overlap of clues and suicide is low in prospective analysis.*

Suicide cannot be predicted, but neither can volcanoes, airline crashes or earthquakes.

We can neither eliminate all risk of suicide, nor predict its occurrence, but can do everything to save some.

* Source: Edwin Schneidman

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Suicide Prevention Center of New York State

http://www.preventsuicideny.org/

Office of Mental Health: Suicide Prevention

http://www.omh.ny.gov/omhweb/suicide_prevention/

New York Suicide Hotlines

http://www.suicidehotlines.com/newyork.html

American Foundation for Suicide Prevention

http://www.afsp.org

Suicide Prevention Initiatives

http://www.suicidepreventioninitiatives.org/

www.suicidology.org

New York State Bridge Authority- Comprehensive Plan for Suicide Prevention

http://www.nysba.state.ny.us/documents/nysba%20suicide%20prevention%20summary%20report.pdf http://www.cdc.gov/violenceprevention/pub/youth_suicide.html

Aruna Jha, Ph.D., LCSW

Research Assistant Professor

University of Illinois at Chicago

arunajha@uic.edu

Contact Kara, the CTAC Clinical Lunch & Learn Webinar Series Coordinator at kara.dean@nyu.edu or

Justine, the CTAC Business Practices Coordinator, with any additional questions at jlai@ICLinc.net

Aruna Jha, Ph.D., LCSW...2013/11/08 · Mary Pipher (20th century), U.S. clinical psychologist....

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