Mental Health America of Illinois (MHAI) Carol Gall, MA Executive Director cwoz@mhai.org

1. Suicide Prevention & Awareness in our Youth: It Only Takes One Mental Health America of Illinois (MHAI) Carol Gall, MA Executive Director cwoz@mhai.org www.mhai.org www.itonlytakesone.org

2. Who is Mental Health America of Illinois? *Formerly Mental Health Association in Illinois • Statewide, non-profit organization founded in 1909 – Celebrating over 100-Years of Service in Illinois! • Mission is to promote mental health, work for the prevention of mental illnesses, advocate for fair care and treatment of those suffering from mental and emotional problems. • Engage in public education, prevention, and advocacy.

3. Presentation Topics • Mental Illnesses Defined • Mental Illnesses and Suicide • The Impact of Suicide • Suicide vs. Self-Injury • Risk & Protective Factors of Suicide • Symptom Management Strategies • Resources • Questions

4. What do mental illnesses look like?

6. Mental Illnesses Defined • A health condition that changes a person’s thinking, feelings, and/or behavior (or all three) and that causes the person distress and difficulty in daily functioning • 1 out of 5 adults and teens suffer from a mental illness each year • Warning signs: • marked personality change, • inability to cope with problems and daily activities, • strange or grandiose ideas, • excessive anxieties, • prolonged depression and apathy, • marked changes in eating or sleeping patterns, • thinking or talking about suicide or harming oneself, • extreme mood swings—high or low, • abuse of alcohol or drugs, and • excessive anger, hostility, or violent behavior.

7. STIGMA • Mark of shame or discredit, mark of disgrace • Why is stigma harmful? • Makes coping more difficult • Prevents people from seeking and receiving treatment • What can we do? • Change our language - crazy, insane, etc. • Phrases - Somebody has bipolar, they ARE not bipolar • Share, empathize, learn and understand

8. Understanding Depression • Sad, low mood • Change in appetite • “Please understand”: • Can’t eat, angry, cry, mood swings, thoughts of harming self • “Cotton”: • Wearing long sleeves, no eye contact, different, never spoke, writing lists, cried, bandages, thoughts about death, lost will to live • Change in sleep pattern • Angry/irritable • Social withdrawal - activities, friends • Poor concentration - grades • Feelings of guilt/worthlessness • Restlessness/moving slowly • Feelings of hopelessness • Thoughts of harming self • Self-harm vs. suicide

9. Understanding Depression • Depression is a treatable medical illness, not a weakness or a moral failure, that often runs in families • Treatment success rates are between 80% to 90% for depression. • Clinical depression is a common and serious disorder of mood, that is pervasive, intense and attacks the mind and body simultaneously • Depression can be triggered by health conditions and/or environmental and behavioral stressors

10. Depressionin Youth • Recent surveys indicate that as many as one in five teens suffers from clinical depression. Mental Health America • Children under stress, who experience loss, or who have attention, conduct or anxiety disorders are at higher risk for depression. American Academy of Child & Adolescent Psychiatry • Children whose parents have been diagnosed with affective disorders are far more likely to be diagnosed with a mental illness- especially an affective disorder – than their peers whose parents do not have mood disorders. Psychiatric Times, 1999

11. Symptoms of Depression in Children & Adolescents • Irritability and/or depressed mood • Loss of interest in usual activities • Low energy and/or restlessness • Poor concentration • Sleeping too much or too little • Weight loss or weight gain • Feeling hopeless and helpless • Feeling worthless and guilty • Persistent physical symptoms that don’t respond to treatment such as headache, stomachache, chronic pain, constipation, etc. • Thoughts of death or suicide

12. Typical Adolescence • Struggle for independence, limit testing • Identity struggle • Less affectionate toward parents, “occasional” rudeness • “Occasional” moodiness • Increased responsibility • Limited thoughts of the future Typical vs. Depressed Adolescence • Symptoms of depression are more persistent and interfere with daily living, particularly when they last for more than two weeks. • Adolescent depression interferes with acquisition of necessary life long skills developed during adolescence.

13. Mental Illnesses & Suicide

14. God, Let Me Die, Just for Tonight  God- let me die, just for tonight. I’m scared, I’m lonely and confused. No one understands me, no one knows what I go through in this shell of a body. I love, I hate, I sing, and I cry- but none of that means anything. I want an escape, I want to fly away- away from a world of confusion and pain. God-please let me die, but just for tonight. I’m too afraid to die forever. That makes me even more upset with myself- my fear and lack of courage. But maybe tomorrow, when I come back, I’ll be happy. Maybe. But God- please let me die, just for tonight…

15. This poem signifies a young woman’s inner struggle with wanting to end the pain and suffering, but not wanting to end her life. Sometimes, when there is no hope that a situation will get better, death seems like a rational solution. There was still hope within this individual, but sometimes that hope runs out if they don’t receive help. This person suffered silently with her depression, like so many others, for several years of her life. Fortunately, she was able to express her pain through poetry, which served as a type of release. She wasn’t diagnosed with depression until 5 years later.

16. Suicide and Mental Illnesses Research has shown that more than 90% of people who kill themselves have depression or another diagnosable mental or substance abuse disorder at the time of their death.

17. Depression & Suicide • Clinical depression is one of the most common mental illnesses and affects nearly 19 million Americans each year (1 in 5 Americans) • Most people who have depression do not die by suicide; HOWEVER… • Having major depression increases suicide risk • Depression is HIGHLY treatable

18. Depression & Suicide • Each year, around 5,000 young people, ages 15-24, lose their lives to suicide. • The rate of suicide for this age group has nearly tripled since 1960, making it the third leading cause of death in adolescents and the second leading cause of death among college-age youth. • 4 out of 5 individuals give CLEAR warning signs before a suicide attempt. -Mental Health America

19. More teenagers and young adults die from suicide than cancer, heart disease, AIDS, birth defect, stroke, pneumonia and influenza, and chronic lung disease COMBINED. The Surgeon General Report on Mental Health, 1999

20. The Impact of Suicide

21. Suicide is a Serious Public Health Problem • In 1999, former Surgeon General Dr. David Satcher declared suicide a national public health problem • In 2001, the National Strategy for Suicide Prevention was completed

22. Suicide in Illinois • Suicide is the 12th leading cause of death in Illinois • 1,177 people committed suicide in Illinois in 2009; 773 died by homicide • In the U.S. around 36,000 people die by suicide as compared to less than 15,000 deaths by homicide • Suicide is the 3rd leading cause of death for adolescents and young adults (ages 15-24) • 70+ years highest suicide rate in IL • 15 – 19 years highest attempt rate in IL Suicide Prevention Resource Center (SPRC)

23. Suicide in Illinois Illinois Suicide Prevention Alliance (ISPA) • Dedicated to reducing suicide in Illinois by raising public awareness, lessening the stigma surrounding it and making treatment accessible. In 2004, passed the Suicide Prevention, Education & Treatment Act in Illinois to develop and implement the Illinois Suicide Prevention Strategic Plan. *The Illinois Plan can be downloaded from the Illinois Department of Public Health website.

24. Suicide vs. Self-Injury

25. Key Definitions • Suicide – self-inflicted death with evidence that the person intended to die • Suicide attempt – self-injurious behavior with a non-fatal outcome & evidence the person intended to die • Suicidal ideation – thoughts of serving as the agent of one’s own death • Suicidal intent – subjective expectation and desire for a self-destructive act to end in death • Deliberate self-harm – willful self-inflicting of painful, injurious acts without intent to die

26. Self Injury • Typical onset of self-injury is puberty • Self-injurious behaviors often last 5 – 10 years, but can persist longer without treatment • Self injurious behavior is a way for people to cope with or relieve painful or hard-to-express feelings – self-destructive cycle begins • Goal is typically emotion regulation • Generally not a suicide attempt, BUT if goes untreated, can lead to suicide attempts

27. Goal of behavior is emotion regulation, very different from intention to die, but also escaping pain If behavior helps individual reach goal, individual will continue behavior Cutting, burning, banging head, scratching, carving, etc. From DBT perspective - Individual is lacking skills to effectively: 1) interact on an interpersonal basis, 2) tolerate distress, 3) regulate emotions, and 4) be mindful of when to use these skills Clients often report not recognizing what preceded desire to self-harm Goal is usually also to escape unbearable pain Believe behavior will lead to death, whether actions are lethal or cause minimal harm Feel trapped, hopeless Range in timing exists – planned out thoroughly, all the way to spur of the moment decision Usually warning signs, whether timing of planning is short or long May be self-harming behavior that accidentally leads to suicide Self Injury vs. Suicide

28. Risk & Protective Factors of Suicide

29. Who is Most At-Risk for Suicide? • More men than women die by suicide, BUT attempts are higher in women • Women attempt suicide 2 – 4 times as often as men • Men die by suicide 4 times as often as women • Highest rates among White, Non-Hispanic men • Young people ages 10 – 19 In 2003 – 2004 • 9% increase in boys aged 15 – 19 years old • 32% increase in girls aged 15 – 19 years old • 75.9% increase in 10 – 14 year old girls

30. What to look for in a person who might be thinking about committing suicide… SIGNS • Talking about wanting to die • Unusual neglect of personal appearance • Saying things like “Everyone would be better off if I weren’t around,” “There’s no point in living anymore,” etc. • Giving away personal possessions • Expressions of rage/anger • A sudden dramatic improvement in mood • Increase in self-harming behaviors RISK FACTORS • Access to weapons (guns, knives, etc.) • Substance abuse • History of impulsive and/or aggressive behaviors • Signs of psychosis, bizarre thoughts, hallucinations, etc. • Family history of suicide, recent exposure to another’s suicidal behavior • Previous suicide attempts • Recent loss • Sexual orientation

31. Risk Factor: Violence • Domestic Violence Victims, Perpetrators and their Families • Women exposed to acute or prior domestic violence are more likely than unexposed women to have made suicide attempts • Approximately half of U.S. homicides are followed by a suicide • Violent family interactions is a significant variable in youth suicide and completions • Violent people have a history of self-destructive behavior

32. Risk Factor: Sexual Orientation • Gay youth are 2 to 3 times more likely to attempt suicide than other young people • Survey questions related to sexual orientation found elevated risk of suicide attempts • Youth Risk Behavior Survey (YRBS) (Gibson, 1989) and (Remafedi et al, 1998)

33. Risk Factor: Sexual Orientation It has been found that suicide attempts among youth identifying as GLBT are significantly associated with: Gender non-conformity Stress Other psychiatric symptoms Lack of support Dropping out of school Family problems Homelessness Substance abuse Acquaintances’ suicide attempts Violence Early awareness of homosexuality (Remafedi, Farrow, & Deisher, 1991; Schneider, Farberow & Kruks, 1989; D’Augelli & Hershberger, 1993; Hershberger, Pilkington & D’Augelli, 1997; Remafedi, et al, 1998; Schneider, Farberow & Kruks, 1989; Nicholas & Howard, 1998)

34. Warning Signs of Suicide • Hopelessness • Rage, uncontrolled anger, seeking revenge • Acting reckless or engaging in risky activities, seemingly without thinking • Feeling trapped - like there's no way out • Increased alcohol or drug use • Withdrawing from friends, family and society • Anxiety, agitation, unable to sleep or sleeping all the time • Dramatic mood changes • Giving away personal possessions • Talking about death, suicide

36. CrisisInterventionfor those who are Suicidal • Create a safety plan • Seek professional help • Remember a crisis is temporary and an opportunity to impact change Suicidal Behavior and Adolescence • The 1st suicide attempt usually occurs before the age of 17 • Family cohesiveness and religiosity serve as protective factors for suicidal youth

37. No thoughts of harming self Beginning to seriously consider suicide, thinking about a plan How do we know if someone needs help? Thoughts about death, thoughts about one’s own death, thinking about suicide Seriously considering suicide, developed a plan Passive thoughts - “I wish I were dead,” “My family would be better off without me” Wants to die, has a plan, has access to method to implement plan

38. How can I help? • Get an adult involved, someone you and the person trusts • Encourage loved one to go to someone they trust • Say, "I want you to live” • Encourage them to get help • Ask direct questions without being judgmental. Determine if the person has a specific plan to carry out the suicide. The more detailed the plan, the greater the risk • Be willing to listen, allowing them to express their feelings and accepting their feelings • Get involved, becoming available and showing interest and support • Stay in contact with the person, do not leave them alone • Be aware and learn the warning signs • Do NOT offer to keep secrets!

39. Symptom Management Strategies

40. Whatworks…acombinationof… • Counseling: Cognitive-Behavioral Therapy (CBT) and Interpersonal Therapy have shown to be very effective • Medication: Antidepressant medication acts on chemical pathways of the brain related to mood • Support & Education: Groups, educational literature, support system

41. Cognitive Behavioral Therapy CBT focuses on the child’s persistent cognitive distortions It is a brief approach Other components include: Affective Education Activity Planning Problem Solving Social Skills training Self-instructional Training Relaxation Training Cognitive Restructuring Interpersonal Therapy It is also brief It focuses on current relationships It uses the therapy relationship to repair other relationships Change happens through insight and new interactions Counseling

42. Medication • Psychotherapeutic medications may make other kinds of treatment more effective • How long someone must take a psychotherapeutic medication depends of the individual and the disorder • Psychotherapeutic medications are divided into 4 groups- antipsychotic, antimanic, antidepressant, and antianxiety • Be sure to discuss potential benefits and side effects with your doctor and to report accurately the effect of the medication in follow up appointments.

43. Choosing the Right Provider Types of Health Care Providers

44. Depression in the Classroom • Frequent absences • Excessive tardiness • Inability to screen out stimuli • Inability to concentrate • Difficulty with time pressures & multiple tasks • Difficulty handling negative feedback • Sudden drop in grades • Difficulty responding to change • Refusal to participate in school activities • Difficulty interacting with others

45. Depression in the Classroom • Peer group change • Defiant • Social anxiety • Fatigue • Irritability • Fidgety • Restless • Isolating • Disruptive • Quiet

46. What Can You Do toPrevent Suicides? • Know the warning signs and risk factors • Ask the “Suicide” question • Know referral resources in your school and/or community

47. Classroom Management Strategies • Ask parents what would be helpful to motivate and decrease pressure for student • Consult regularly with parents, school support staff, etc. ~ Don’t be the only person dealing with the student’s issues • Designate a “safe” person in school • Give advanced warning of major changes to students, if possible • Shorten assignments or allow more time to complete • Break tasks into smaller parts

48. Classroom Management Strategies • Provide refocusing assistance and prompts • Preferential seating by a teacher or positive peer • Word banks or alternative testing methods to accommodate for retrieval problems • Provide assistance to see assignments recorded accurately and all materials are packed • 2nd set of books to be left at home • Keep a record of their accomplishments and show them occasionally • Put corrections in the context of a lot of praise and support

49. Classroom Management Strategies • Reassure student they can catch up, be flexible and realistic about your expectations • Avoid situations that might socially isolate or ostracize (allowing students to choose team mates) • Encourage gradual social interaction • Let them know you care without getting too personal • Don’t make promises or lie to student • Be alert to suicidal thoughts and behaviors; take threats seriously

50. Classroom Management Strategies • Find student’s strengths and focus on them • Don’t ignore depressed student, it invites them to give up • Help students focus on positives • Give adolescents a “feeling vocabulary” • Create a classroom environment where kids aren't mean • GIVE FREQUENT & POSITIVE PRAISE