Webinar Notes: Suicide Prevention, Intervention and Postvention

Suicide Prevention, Intervention and Postvention with Amy Morgan

 

Overview (0:27)

  • How to recognize signs of suicidal ideation
  • Preventing potential suicidal behavior
  • Conducting suicide intervention
  • Skills to manage victim’s family and friends from future suicide ideation

 

Resource Speaker – Amy Morgan (00:59)

  • Director of Academy Hour, which provides training courses on suicide intervention
  • 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
  • Contract instructional systems designer and trainer for the Federal Aviation Administration
  • Training Officer for the Oklahoma State Bureau of Investigation

 

The Justice Clearinghouse (01:55)

  • 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 with quick polls, Q&A, and survey

 

Introduction (03:38)

  • 3 Areas of Safety from Suicide

     

    • Prevention
    • Intervention
    • Postvention

 

What is Suicide (06:01)

  • Seen by other people as:

     

    • Selfish
    • Weak
    • Good life
    • Attention
    • Message
  • Life Stressors as books

     

    • Reasons

       

      • Money
      • Relationship problems – Family/relatives
      • Job issues or job loss
      • Divorce
      • Kids
      • Death of a loved one
      • Other stressors
    • What would you like to do with the books?

       

      • Keep carrying the books
      • Put them away properly, one by one
      • Drop all the books
  • What it really is:

     

    • Not about wanting to die
    • Wanting pain to end
    • Seeing no hope
    • Seeing no solutions

 

Reasons for Suicide (09:25)

  • Pain
  • Loss

 

Who Dies by Suicide? (09:51)

  • Adults between 45-64 y/o
  • Adults 85 y/o and above

     

    • Pain (chronic pain or illnesses) – not going to improve
    • Loss

       

      • lost spouse, friends, close family
      • lost mobility
      • lost freedom and independence
  • Youth ages 15-24 have the lowest rate of suicide deaths, youth may have made attempts but were not successful

 

Prevention, Intervention, and Postvention (11:28)

  • Prevention

     

    • Prevention of the elements that lead to thoughts of suicide caused by loss and pain
    • Teaches the tools for coping
    • Recognizing signs of self-destruction
  • Intervention

     

    • Recognizing the signs of suicidal ideation and stepping in to prevent follow through.
    • Assisting someone in finding resources to help them deal with or resolve whatever is causing their suicidal thoughts.
    • Implementing a safeplan with the individual
  • Postvention

     

    • Prevention of a new cycle

       

      • Those left behind are at risk
      • Care offered to friends and family left behind after a suicide
      • Watching for same signs as in the prevention phase

 

Responding to Signs of Suicide (14:00)

  • Case study:

     

    • 11-year old who wrote a suicide note
  • Suicide notes as warning is rare

 

Prevention: Before Thoughts of Suicide Begin (16:53)

  • Look for warning signs (17:10)

     

    • Talking about suicide

       

      • Any mention of suicide, even making jokes
      • Asking questions about suicide
      • Talking about other suicides
    • Untreated Depression

       

      • Crying spells
      • Difficulty getting out of bed
      • Problems sleeping
      • Bad eating patterns
      • Feeling hopeless
      • Shutting down
      • Thinking clouded
      • Life feels pointless
    • Giving away possessions

       

      • Things they value
      • Taking care of loose ends
      • Turning over responsibility (pet care, etc)
      • May say “Don’t need it anymore”
    • Saying goodbye

       

      • Visiting loved ones
      • Letters expressing feelings
      • Messages, emails, calls
      • Providing “closure”
    • Suicide notes

       

      • Attempting to explain pain
      • Making sure people know they care
      • Taking care of loose ends
      • If written/found prior death, take seriously
    • Alcohol/drug use

       

      • Increase/abuse
      • Used to build courage
      • Make problems worse
    • Sudden calmness

       

      • Change from agitated/unhappiness to calm/happy
      • Comes from relief over final decision to end life
    • Reckless behavior

       

      • Don’t care if they live or die
      • Manifests in behavior and decision
      • Trying new things like drugs, sports, etc.
      • Reckless driving
    • Researching suicide methods

       

      • Internet browser history

         

        • "How to commit suicide"
        • “Painless suicide”
        • Questions about suicide
    • Buying suicide materials

       

      • Having the means to implement plans of suicide

         

        • Gun
        • Rope
        • Pills
        • Knives/razors
    • Creating a will

       

      • Creating one
      • Revising existing ones
      • Questions about life insurance
    • Social withdrawal and isolation

       

      • Isolation from friends, family, colleagues
      • Withdrawing from social commitments and activities
      • Causing further depression
    • Talking about problems/burdens

       

      • Apologizing frequently
      • Feelings of causing unwanted problems
      • Talk of being burden
    • Feeling hopeless

       

      • Talking about a hopeless situation
      • Talking about being hopeless
      • Feeling helpless or worthless
    • Preoccupied with death

       

      • Researching death
      • Talking about death
      • Talking about 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
  • Actions to watch for (23:10)

     

    • Giving away possessions
    • Isolation
    • Withdrawal
    • Loss of interest in hobbies
    • Alcohol or substance abuse
    • Reckless/impulsive behavior
    • Extreme changes in behavior
    • Self-mutilation/self-harm/cutting
  • Thoughts to observe/listen for (23:35)

     

    • “Problems will end soon”
    • “No one can do anything to help me now”
    • “Now I know what they’re going through”
    • “I just can’t take it anymore”
    • “I wish I was dead”
    • “Everyone’s better off without me”
    • “I won’t be needing these anymore”
    • “I can’t do anything right”
    • “I can’t keep my thought straight”
  • Feelings to watch for (24:10)

     

    • Desperation
    • Anger
    • Guilt
    • Worthlessness
    • Loneliness
    • Sadness
    • Hopelessness
    • Helplessness
  • Physical signs to watch for (24:26)

     

    • Lack of interest in appearance
    • Change/loss in interest in sex
    • Disturbed sleep
    • Change/loss of appetite
    • Weight gain/loss
    • Physical health complaints
  • What to do? (24:45)

     

    • Ask and listen to what their problems/stressors are without judgment
    • Help find resources

       

      • Counseling
      • Job search
      • Family assistance
      • Support network/friends
    • Offer the number to the National Suicide Prevention Lifeline

1-800-273-8255

 

Intervention: Saving the Life of Someone Contemplating Suicide (25:20)

  • Intervention is needed:

     

    • They just need people with the willingness to listen.
    • Allow them to talk about their suicidal thoughts without any judgment or negative reaction to their having those thoughts.
    • Asking them directly is a relief for someone who is having these thoughts when others avoid the subject of suicide.
  • What is intervention?

     

    • Interference so as to modify a process or situation
    • Applied Suicide Intervention Skills Training (ASIST) Model

       

      • Contributaries of suicide
      • Thought of suicide
      • Suicidal behavior
      • Harm or death
  • Goal of intervention: Move person at risk from death to ambivalence and finally to back life.
  • How does intervention work? (28:50)

     

    • Phase 1: Connecting (28:56)

       

      • Goal:

         

        • Caregivers to ask what is troubling person at risk so they feel relieved.
        • Caregivers recognize concern so person at risk feels valued.
      • Any of the signs discussed on prevention

         

        • Listen to all the problems why they feel as such.
        • Probe.
        • Be accepting.
        • Provide resources to help with their problems.
        • Remember: It is not about you or your opinions.
        • Not the time to judge, correct, or point differences.
        • Goal is to save their life.
      • Ask:

         

        • Are you having thoughts of suicide?
        • Do you have a plan?
        • Do you feel pain that is unbearable?
        • Do you have few, if any, resources?
        • Did you have previous suicidal behavior?
        • Have you received mental health care currently or in the past?
    • Phase 2: Understanding (36:37)

       

      • Goal: Meet the person at risks need for perspective and care, allowing them to feel accepted and respected.
      • How to do?

         

        • Most difficult phase and needs listening skills.
        • Good listeners listen without judgment, opinion, or trying to turn them into positive thinking.
        • Allow them to unload and tell you about all the stressors weighing them down.
        • Intervention is an ebb and flow of connecting and understanding.
        • Listen for:

           

          • Reasons for living
          • Ambivalence
      • Case Study: Golden Gate Bridge Suicides

         

        • Survivors regret their decisions to commit suicide midair or before
      • Who can die by suicide? Anyone is at risk.
      • What is a stressor? What might be stressful for one might not be for another.
      • Caregiver attitudes matter. They must have the clarity and focus absent to the one thinking of suicide.
    • Phase 3: Assisting

       

      • Goal: Caregiver to restore hope and provide safety so the person at risk is encouraged and feels supported.
      • Only done after building rapport, connecting and understanding.
      • Contracting a Safeplan Agreement

         

        • Between the suicidal person and caregiver to keep safe

           

          • Disable suicide plan by taking things they can use to take their life.

             

            • Weapon
            • Pills
            • Alcohol
          • Establish safety contacts

             

            • Informal resources

               

              • Family
              • Friends
              • Advisers
            • Formal resources

               

              • Emergency
              • Health Workers
              • Community
            • Suicide Prevention Lifeline

1-800-273-8225

  • If in immediate danger, do not leave them alone.

     

    • Call resources who can stay with the person at risk
    • Bring to emergency room

 

Postvention: Helping someone who has lost someone to suicide (48:06)

  • Responding to suicide

     

    • Family just lost a loved one
    • Cause of death is irrelevant
    • They may be feeling:

       

      • Shocked
      • Traumatized
      • Confused
      • Grieving
    • Questions of the survivors

       

      • 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 are contributors
    • Going back to the prevention phase: Death of a loved one is a life stressor.
    • Postvention is prevention to those left behind after a suicide.

       

      • Listen for signs
      • Start connecting phase with the loved ones left behind
      • Assess level of risk
      • Ask about factors that may contribute to future thoughts of suicide
      • Talk about what to expect after the loss, or the trauma and the possibility of needing help in the future
      • Offer resources for the loved ones left behind

         

        • 911
        • Emergency Room
        • Physician
        • Family members
        • Friends
        • Clergy
        • Counselor
        •  

 

Poll Questions

  • Have you ever known someone who died by suicide or attempted suicide? (04:13)

     

    • Attempted but lived   21%
    • Died by suicide           65%
    • None of the above     15%
  • Do you feel confident that you would know what to do to save this child’s life or help him stop thinking of suicide? (15:39)

     

    • Yes      49%
    • No       51%
  • When it comes to being a good listener, how would you rate yourself? (35:03)

     

    • Excellent          29%
    • Good              57%
    • Ok                   12%
    • Terrible            2%
  • 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 72%
    • Just as confident         26%
    • Still not confident        1%       

 

Q&A

Does a person thinking about suicide typically have a downcast look or appearance? Or externally could they seem to be very happy? (53:30)

It could be a combination of both. People are good at hiding things that they want others to see. You need to know what to look for, which the webinar hopefully helped on.

 

How would you help a person that’s being combative? (54:44)

Keep going back to the connecting phase and try to build trust and rapport. People tend to be defensive and don't want to share. Combativeness and anger are defensiveness. If they're combative and angry – they're hurting a lot.

 

Besides having contacts as a safety plan, what else is in a safety plan? (55:53)

It can be a written contract that the person will not hurt themselves or an agreement that they will get professional help or counseling. Whatever that gets their buy-in that you both agree to save their life and stay safe.

 

Are depressed individuals most likely to have suicidal thoughts? (59:20)

Depression is just one of many contributing factors leading to suicidal thoughts. Depression does not necessarily lead to suicidal thoughts. There are other mental disorders and illnesses that can contribute, depression is just one of them.

 

For questions and clarifications, contact:

AMY MORGAN, MSC

Academy Hour

aademyhour.com

amorgan@academyhour.com

405-326-4116

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