Suicide Prevention Training

Jennifer Myers, MA Coordinator of Suicide Prevention Services

Jenmyers@mailbox.sc.eduCounseling & Human Development Center

Byrnes Building, 7th Floor803-777-5223

Take care of you.

Employee Assistance Program: 1800-822-4847

To educate about the signs of suicide To inform you of how to respond if you are

concerned a person may be suicidal or in emotional distress

To empower you to feel confident to intervene

To connect you with resources

Intro and Purpose

Exercise: Personalizing Crisis

Suicidal Ideation – Thinking about suicide Suicide threat – Stating intent to kill yourself Suicide attempt – Any act or behavior

intended to end your life Intentional self-harm – Behavior related to

self harm but absent of the intent to kill oneself Completed/died by suicide – suicide death Survivor of suicide – friend or family member

of deceased

Basic Terms & Definitions

In the past year, USC students:◦ 41% experienced hopelessness◦ 59% reported feeling very sad◦ 26% felt so depressed it was difficult to function◦ 4.6% seriously considered suicide (1,349 students

or 26 students per week)◦ 0.5 % attempt suicide (147 students or

approximately 3 per week)

Facts About USC Students (NCHA*)

*American College Health Association’s National College Health Assessment 2010

Felt things were hopeless

*American College Health Association’s National College Health Assessment 2010

Facts: Depression & USC Students*

Percent (%) Male Female Total

No, Never 43.6 36.9 39.0

No, not last 12 months

19.8 19.5 19.6

Yes, last 2 weeks 11.1 12.4 12.0

Yes, last 30 days 8.2 7.6 7.8

Yes, in last 12 months

17.3 23.6 21.6

Any time in the last 12 months

36.6 43.6 41.4

Felt very lonely

*American College Health Association’s National College Health Assessment 2010

Facts: Depression & USC Students*

Percent (%) Male Female Total

No, Never 27.6 21.0 23.0

No, not last 12 months

23.5 21.4 22.2

Yes, last 2 weeks 15.6 21.5 19.7

Yes, last 30 days 8.6 13.0 11.6

Yes, in last 12 months

24.7 23.1 23.5

Any time in the last 12 months

49.0 57.7 54.8

Felt very sad

*American College Health Association’s National College Health Assessment

2010

Facts: Depression & USC Students*

Percent (%) Male Female Total

No, Never 28.0 18.2 21.2

No, not last 12 months

22.2 18.6 19.9

Yes, last 2 weeks 14.8 22.5 20.1

Yes, last 30 days 8.6 14.8 12.9

Yes, in last 12 months

26.3 25.9 25.9

Any time in the last 12 months

49.8 63.2 58.9

Felt so depressed that it was difficult to function

*American College Health Association’s National College Health Assessment 2010

Facts: Depression & USC Students*

Percent (%) Male Female Total

No, Never 54.1 50.5 51.8

No, not last 12 months

20.5 22.5 21.8

Yes, last 2 weeks 5.3 7.8 7.0

Yes, last 30 days 4.9 5.0 4.9

Yes, in last 12 months

15.2 14.2 14.4

Any time in the last 12 months

25.4 27.0 26.4

Seriously Considered Suicide Percent (%)

Male Female Total

No, Never 83.2 86.7 85.7

No, Not last 12 months

12.7 8.5 9.8

Yes, last 2 weeks 1.2 0.4 0.6

Yes, last 30 days 0.4 0.4 0.4

Yes, in last 12 months 2.5 4.1 3.6

Any time within the last 12 months

4.1 4.8 4.6

Facts: Suicidal Thinking & USC Students*

*American College Health Association’s National College Health Assessment 2010

Intentionally Cut, Burned, Bruised, or otherwise injured yourself

*American College Health Association’s National College Health Assessment 2010

Facts: Self Harming Behaviors & USC Students*

Percent (%) Male Female Total

No, Never 90.6 88.8 89.4

No, not last 12 months

6.6 7.5 7.2

Yes, last 2 weeks 0.4 0.9 0.7

Yes, last 30 days 0.4 0.5 0.5

Yes, in last 12 months

2.0 2.3 2.2

Any time in the last 12 months

2.9 3.7 3.5

Attempted Suicide

*American College Health Association’s National College Health Assessment 2010

Facts: Suicide Attempts*

Percent (%) Male Female Total

No, Never 95.5 95.4 95.4

No, not last 12 months

3.7 4.3 4.1

Yes, last 2 weeks 0.4 0.0 0.1

Yes, last 30 days 0.0 0.0 0.1

Yes, in last 12 months

0.6 0.7 0.7

Any time in the last 12 months

0.8 0.4 0.5

Men are 4 times more likely than women to die by suicide

Women are 3 times more likely to attempt In college students, this gender difference is less

apparent

80% of those who die by suicide in college are not receiving treatment through the counseling center

90% had one or more mental disorder 50% had alcohol in their system at the time

of death

What we know about people who die by suicide

Feelings of hopelessness are more predictive of suicide than depression

Perceived burdensomeness Thwarted Belongingness Suicide is not chosen; it happens when pain

exceeds an individual’s resources for coping with pain

Why people die by suicide?

Is there a stereotypical “suicidal person”?◦ What would this person look like? What would

they wear? How would they act? How would they talk?

Myths about Suicide ◦ No one can stop a suicide, it is inevitable.

If people in a crisis get the help they need, they will likely never be suicidal again.

◦ Suicidal people keep their plans to themselves. Most suicidal people communicate their intent

sometime during the week preceding their attempt.

Discussion

Suicide Rates Among Persons Ages 10 Years and Older, by Race/Ethnicity and Sex, United States, 2002-2006,

Source: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention

National Suicide Statistics at a Glance

Percentage of Suicides Among Persons Ages 10-24 Years, by Race/Ethnicity and Mechanism, United States, 2002-2006

Source: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention

National Statistics at a Glance

Among American Indians/Alaska Natives ages 15- to 34-years, suicide is the second leading cause of death.

Suicide rates among American Indian/Alaskan Native adolescents and young adults ages 15 to 34 (20.0 per 100,000) are 1.8 times higher than the national average for that age group (11.4 per 100,000).

Hispanic & Black, non-Hispanic female high school students reported a higher percentage of suicide attempts (11.1% and 10.4%, respectively) than their White, non-Hispanic counterparts (6.5%).

Source: Centers for Disease Control and Prevention,National Center for Injury Prevention and Control

Racial & Ethnic Disparities

There is a range of cultural and spiritual beliefs about suicide

View regarding seeking psychological services

Pressures, support systems, coping mechanisms, psychological symptoms may vary

Additional Considerations

LGBTQ individuals are at higher risk for suicidal thinking There is no tracking system of sexual orientation or gender

identity in completed suicides Sexuality or gender identity does not create the

higher risk itself. Those who are at higher risk:

◦ Early disclosure of sexuality◦ Hiding sexuality◦ Lack of Family Acceptance◦ Bullying or Harassment◦ Conflict with Spiritual Beliefs ◦ Low self esteem, struggle with personal acceptance◦ Isolation

Special Population-LGBTQ

Markers for suicide risk are noticeably higher in student veterans than general student population

10 years of combat has resulted in increase in◦ Substance abuse◦ PTSD◦ Depression

An estimated 20% of Veterans have struggled with PTSD or depression

May not disclose suicidal thinking

Special Populations-Veterans

These are indicators that a person is suicidal

Someone threatening, talking about, or stating they intend to hurt or kill themselves

Someone looking for ways to kill themselves: Seeking access to pills, weapons, or other means

Someone talking or writing about death, dying, or suicide

Rehearsing a suicide attempt

Take all Warning Signs Seriously

Acute Warning Signs

“I’ve decided to kill myself.” “I wish I were dead.” “I’m going to commit suicide.” “I’m going to end it all.” “If (such and such) doesn’t happen, I’ll kill

myself.”

Direct Verbal Cues

“I’m tired of life, I just can’t go on.” “My family would be better off without me.” “Who cares if I’m dead anyway.” “I just want out.” “I won’t be around much longer.” “Pretty soon you won’t have to worry about

me.” “You won’t see me anymore.”

Indirect Verbal Cues

I Ideation S Substance Abuse P Purposelessness A Anxiety T Trapped H Hopelessness W Withdrawal A Anger R Recklessness M Mood Change

Take all Warning Signs Seriously

Additional Warning Signs

Previous Suicidal Behavior Impulsivity Significant substance use or dependence Family History of Suicide Previous History of Psychiatric Diagnosis Eating Disorder History of abuse (sexual, physical,

emotional) Chronic pain Recent Discharge from inpatient psychiatric

treatment

Risk Factors

Loss of any major relationship Death of a spouse, child, or best friend,

especially if by suicide Being fired, failing classes, rejection or

expulsion from a program Sudden unexpected loss of freedom/fear of

punishment Diagnosis of a serious or terminal illness

Situational Triggers

Some aspects of college are protective factors

These include:◦ Presence of Social Supports◦ Improved problems solving & coping skills◦ Access to treatment and other helpers◦ Hopeful about the future◦ Fear of social disapproval

The Good News

Common ways to ask:◦ “Are you thinking about suicide?”◦ “Do you want to kill yourself?”◦ “Sometimes when people are sad as you are, they

think about suicide, Have you been thinking about suicide?”

◦ “You look pretty miserable, I wonder if you’re thinking about suicide?”

◦ “You know, when people are as upset at you seem to be, they sometimes wish they were dead. I’m wondering if you’re feeling that way, too?”

◦ Note: If you cannot ask the question, find someone who can.

ASK Directly about Suicide

“You’re not suicidal, are you?”

How to NOT ask the Question

◦ “Have you been thinking about how you would kill yourself?”

◦ “How long have you been thinking about this?”

◦ If a person has stated the means they would kill themselves with, take steps to remove the means.

Follow up questions

Myths about suicide:

If you ask someone directly about suicide, you will put the idea in their head and might make them want to do it.

Truth is asking someone directly about suicide lowers anxiety, opens up communication, and lowers the risk of an impulsive act. Most suicidal persons indicate experiencing relief if

asked directly about suicide.

Discussion

If you observe any of the acute warning signs:◦ Between 8am to 5pm M-F: go with the student to

the Counseling and Human Development center 7th Floor Byrnes Building

803-777-5223 Another staff person should contact CHDC and inform

them of the situation

◦ After 5pm M-F or Saturday or Sunday, Contact the USC Police 911 (7-4215 for dispatch)

What to do

If you observe warning signs other than the acute warning signs◦CHDC Walk in hours 2-4pm M-F ◦Consult with CHDC 803-777-5223 or USC

Police, 911 or 7-4215, regarding the risk◦Refer the person to counseling

Assist them in calling & making an appointment

Walk with them to the appointment if needed◦Inform other staff in your department◦Follow Up with the person and pay attention

to additional warning signs.

What to do

Be willing to listen Be non-judgmental Be direct Be available Offer hope that options are available Be actively involved in getting the person

treatment Take action to remove lethal means Follow up (after they went to counseling

center or other intervention)

What to do

Role Play Exercise

Reports to file:◦ http://www.housing.sc.edu/bit/

Additional Resources:◦ http://www.housing.sc.edu/lasd/pdf/BAGGuide.pdf

Making a BIT report

Assist residents in recognizing their signs of stress, anxiety, and depression

Help them to develop positive coping skills Pay attention to isolated students and try to

engage them. Keep them on your radar screen

Be aware of relationship break ups and support residents as appropriate

Refer to counseling

Early Intervention

You are not the therapist You don’t have to make a safety plan with

the person. You can be one part of a safety plan

Do not keep a persons suicidal communications or signs a secret

Use CHDC staff for consultation, specifically Dr. Bob Rodgers, Jennifer Myers, Dr. Toby Lovell

Boundaries

Work together with others. Your role is not to “fix” the problem.

Set limits and boundaries on the amount of time you available or spend with a student

More is not always better

Boundaries

Take care of yourself Use your support systems Pay attention to your cues regarding stress Take time away as needed Know your positive coping mechanisms &

use them frequently Recognize and respect your limits Use supervision to address your needs Go to therapy for your own mental health

concerns

Self Care

Counseling and Human Development Center 7th Floor Byrnes Building www.sa.sc.edu/shs/chdc 803-777-5223

USC Police ◦ 7-911 or 803-777-4215

Thomson Student Health Center ◦ www.sa.sc.edu/shs 803-777-3175

Behavioral Intervention Team◦ www.sc.edu/bit 803-777-4333

Student Disability Services◦ 803-777-6142

Campus Resources

National Suicide Prevention Lifeline◦ 1-800-273-8255 (TALK)◦ www.suicidepreventionlifeline.org

Trevor Project (GLBT Youth) ◦ 1-866-488-7386◦ www.thetrevorproject.org

Additional Resources

Please complete the evaluation form

Thank you