Suicide Prevention Training for Non-Health Staff• What to Look For• What to Say• How to Respond

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Objectives List three risk factors for suicide Identify three suicide warning signs State a direct and indirect approach to

asking about suicide Identify two ways to persuade someone

to get help Identify your referral sources

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Why is this Training for Non-Health Staff?

Most Suicidal Youth… Don’t self-refer to treatment Go undetected by mental health

professionals Go untreated

Suicidal youth are most likely to be prevented from suicide by someone they know well or see daily…

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Suicidal Individuals Often Provide Warning Signs

We often don’t notice due to lack of information, fear, and denial.

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Save Lives By… Learning warning

signs Knowing how to

ask about suicidal thoughts

Persuading person to get help

Knowing referral resources

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Suicide Impacts All of Us

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CDC National Youth Risk Behavior Survey (2009)

26.1% youth reported symptoms consistent with MDD in previous 12 months

Approximately 14% had seriously considered attempting suicide

Approximately 11% had made a plan for how they would attempt suicide

Over 6 % of youth reported having attempted suicide (once or more)

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True or False?Males complete suicide five times more often than females.

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True. Male Rate is 5X Higher.

Method Used % Male % Female

Firearms 56 30

Suffocation/hanging

24 21

Poisoning 13 40

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True or False

In PY2010, the rate of suicide for JC students was higher than the national rate.

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False. JC Rate is Much Lower.JC PY2010:Death Type Job Corps Rate

per 100,000National Rate per 100,000

Unintentional Injury

8.9 38.5

Suicide 1.8 10.5

Homicide 5.3 13.6

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True or False?

No one can stop a suicide. Suicidal people keep their plans to themselves.

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False. In Many CasesSuicide is Preventable. Most suicidal people communicate their

intent before committing suicide

For most, suicide is a permanent solution to a temporary/treatable problem

Personal crisis, unrelenting stress or depression, sense of failure and/or loss

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Who is at Risk? Mental disorders (especially depression) Alcohol and other substance use disorders Person with easy access to lethal means History of trauma/abuse Prior suicide attempt/family history suicide Sense of hopelessness Impulsive/aggressive tendencies Sense of isolation/lack social support Exposure to suicide (glorified)

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Suicide Warning Signs:Direct Verbal Cues

“I’ve decided to kill myself”

“If X doesn’t happen, I’ll kill myself”

“I want to kill myself”

Indirect Verbal “I’m tired of life” “Who cares if I’m

not around?” “I don’t see any

point in going on” “It has been good

knowing you”

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Suicide Warning Signs:Behavioral Clues Changes in behavior or mood Withdrawal from friends/supports Lack of interest Decline in academics/vocation Eating, sleep, physical problems Depression (sadness/tearfulness) Self-mutilation or risk taking behavior Fixation with death/violence Mood swings/aggression/agitation

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Suicide Warning SignsSituational Clues Relationship breakup Recent disappointment Disciplinary problems Alienated from family/culture Victim of bullying/assault Humiliating event Unhealthy peer relationships (switch in

peers)

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When Concerned,Ask the Question… You don’t need to

become a therapist to ask about suicide

How you ask is less important than that you ask

QPR Institute: www.qprinstitue.com

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Tips for Asking about Suicide If you are concerned, don’t wait! Find a private place to talk Allow person to talk freely: don’t

interrupt (use your listening skills) If person is reluctant, be persistent in

showing you care and want to help

QPR Institute: www.qprinstitute.com

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Asking About Suicide Acknowledge the person’s distress

“I’ve noticed you’ve seemed less interested in your work and you’ve been spending more time alone.”

“Coming to JC can be really hard and a lot of students miss their families. I’m worried about you because you’ve seemed really down.”

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Asking About Suicide Less Direct Approach

“Have you been unhappy lately?” “Have you ever been so unhappy that you

wished you were dead?” “Do you ever wish you could go to sleep

and not wake up?” “Sometimes when people are really upset

and overwhelmed they wish they were dead. Do you feel that way?”

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Asking About Suicide Direct Approach

Are you having thoughts about killing yourself?

Do you wish you were dead? Have you been thinking about ending your life?

Are you thinking of killing yourself?

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Asking About Suicide DON’T SAY:

“You’re not thinking about killing yourself are you?”

Ask in a way that allows person to answer in positive

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Listen and Persuade Actively listen

Be attentive Don’t interrupt Don’t condemn

suicide Don’t judge Quiet your own

fears

What are the problems that seem escapable only through suicide?

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Listen and Persuade Focus on solutions

to problems Offer hope in any

form Accept the pain

experienced while offering alternatives to suicide

“I care about you and I want to take you to the Wellness Center to get more help…”

“Will you let me make you an appointment with…”

“Will you promise me...”

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Referral Sources Student’s Counselor Health and Wellness Center

CMHC and other staff trained in suicide assessment

Supervisor or HWC Person on Call (if after hours or on weekends) Know the Symptomatic

Management Guideline for Non-Health Staff for Suicide Attempts/Threats

Know your center’s SOP/COP for suicide risk assessment

Local Resources Local crisis line

Suicide Prevention Lifeline: 1-800-273-TALK

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Team Approach Best Get others involved

Who needs to be involved for safety Safety assessment trumps confidentiality

rights Are there other people the individual

wants contacted for support (family, etc.) Work as a team to provide continued

support

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What if Person Won’t Agree to Get Help? If you are concerned someone is suicidal...

Don’t worry about breaking trust or being disloyal

Don’t worry that you may not have “enough” information to call for help

Get help!

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Scenarios

Malik Malik is 22 year-old African American male who has been at

Job Corps for three months. While surfing Facebook he

learned that his girlfriend back home is involved in another

relationship. After that, Malik gets a positive suspicion test for

alcohol and is placed in TEAP. He used to play on the center

basketball team, but is now refusing to go to the gym or play.

One evening he gets into a heated verbal argument with his

roommate and is now going before the CRB. He has stopped

talking much with staff or students. A couple of days later he

hangs himself in an abandoned building on center.

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What’s the Best Response? Given that you knew Malik, and were aware of his distress, which of

the following would be the best response?

1. Wait and see how things go because relationship stuff happens all

the time at Job Corps. He will get over it and find a new one here.

2. If I knew about his girlfriend problems, I would talk to him to see if he

was alright. I would ask him if he felt suicidal. If he said yes, I would

escort him to see the Counselor or stay with him until I could get

someone from Wellness.

3. Because of his alcohol abuse and current relationship with the TEAP

Specialist, I would inform the TEAP Specialist that something was

troubling Malik. I would suggest that the TEAP Specialist talk to him.

Morgan Morgan is an 18 year-old, White gay female, who was only

able to finish the 8th grade. Morgan has difficulties learning new skills and can’t seem to pass the GED. Because of what appears to be her “slowness,” and outward appearance she is often ridiculed by peers and sometimes staff. Everyone believed that she accepted the treatment as good natured ribbing. Prior to her death she gave away some personal belongings. About one day before her death, she also told a buddy that she had “had enough.” This was interpreted as simple frustration. Morgan shot herself in the parking lot of a nearby school.

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What’s the Best Response? Given that you know Morgan, and aware of her distress, which of the

following would be the best response?

1. If I had known she was angry about being “teased,” I would talk to her to

see if she was alright. I would ask her if she felt suicidal. If she said yes,

I would convince her to see the CMHC in the morning. After she made

a commitment, I would tell her that I would go with her the next day.

2. In Job Corps, students and staff are always joking with each other.

That’s how we all deal with the stress. If you can’t handle the ribbing,

you should probably not be at Job Corps.

3. When I heard that she had had enough, I would immediately ask her if

she was thinking of suicide. If she said yes, I would stay with her, and

inform my supervisor. I would never leave her alone until she saw a

counselor or someone from the Health and Wellness Center.

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John John is a 19-year-old White male and is close to

graduating from Job Corps. He came in as a homeless student. He had difficulty learning in the trade and some disciplinary problems but he will graduate in about 4 weeks. A couple of days ago, he received a call from his mother saying that he can’t come live with her and he got really upset. You approach John and he states that no one understands him, things never get better, and that his life is crap.

What do you do next and why?

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Role Play Five Minutes Each

Role One person play

John One person play

helper Switch Role

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How to Help JohnAcknowledge distress…

Right now it feels like nothing is going right for you…

You’re not sure how all this is going to work out…

Ask the Suicide Question…

Indirect: sometimes when life feels like crap people wish they could go to sleep and not wake up. Have you been feeling that way?

Direct: Are you having thoughts of killing yourself?

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Listen and Persuade… Listen

What are the problems that seem escapable only through suicide?

Persuade Accept the

person’s pain while providing hope and possible solutions to problems…

Remember……….

Suicide is NOT the problem

Suicide is only the solution to a perceived insoluble problem that is no longer tolerable