Signs of Suicide

1. Signs of Suicide Josie Padilla Region VI Education Service Center

2. Reasons for Rise in Youth Suicide • Easy access to methods of suicide • Greater pressures of modern life • Stiff competition for grades/college admission • More violence in the newspapers and on TV • Lack of parental interest • Increase in numbers of divorced households

3. Reasons for Rise in Youth Suicide • Working parents/limited family time • According to one study 90 percent of suicidal teen-agers believed their families did not understand them (this is such a common teen-age complaint that other factors are also playing a role) • Young people also reported that when they tried to tell their parents about their feelings of unhappiness or failure, their mother and father denied or ignored their point of view. (Youth Suicide Prevention)

4. Prevalence of Suicide Among Young People • Suicide is the 3rd leading cause of death among children ages 10 - 14, and young adults ages 15 - 19. -National Institute for Mental Health, In Harms Way, 2003

5. Leading Causes of Death in 15 to 19 Year-OldsUnited States, 2001 CAUSE# OF DEATHS Accidents 6646 Homicide 1899 Suicide 1611 Cancer 732 Heart Disease 347 Congenital Anomalies 255 Chronic Lower Respiratory Disease 74 Stroke 68 Influenza and Pneumonia 66 Blood Poisoning 57 1599 Anderson & Smith 2003

6. Prevalence of SuicideAttempts Among Teens • 16.5% made plans to attempt suicide • 8.5% attempted suicide one or more times • 2.9% made a suicide attempt that required treatment -CDC Surveillance Summaries, 2004

7. Suicide andSubstance Abuse • 1/3 to 1/2 of teenagers were under the influence of drugs or alcohol shortly before they killed themselves -National Strategy for Suicide Prevention, DHHS

8. Suicide Myths and Realities Quiz

9. Suicide Myths and Realities Quiz 1. Talking about suicide openly is dangerous. It often plants the idea in a person's head. False Discussing suicide openly is one of the most helpful things you can do. It shows you are taking the person seriously and that you care.

10. Suicide Myths and Realities Quiz 2. Suicide usually occurs out of the blue - without any warning. False 80% of the people who commit suicide give some warning. This is one reason for becoming familiar with the warning signs.

11. Suicide Myths and Realities Quiz 3. If you attempt suicide, you really want to succeed. False Most people who attempt suicide want to live. They are experiencing overwhelming emotional pain and are crying out for help. If they receive the help they are asking for, they have no need to attempt suicide again.

12. Suicide Myths and Realities Quiz 4. Suicide runs in families. It is a hereditary condition that cannot be prevented. False Suicide is not hereditary. It is important that a suicidal person knows there are alternatives to ending his/her life.

13. Suicide Myths and Realities Quiz 5. The danger of suicide has passed when a person begins to cheer up. False A depressed person may want to end his/her life, but lack the energy and ambition to carry out a suicide plan. Ambivalent feelings are a constant struggle. Making a decision often improves the person's mental attitude and increases his/her energy to carry out the suicide plan.

14. Suicide Myths and Realities Quiz 6. Most teenage suicides involve drugs and alcohol. True Alcohol and drugs are involved in the majority of teenage suicides. People often use them to cope with or deaden the pain they are feeling. If a friend is frequently drunk or stoned, you may want to tell him/her you are concerned. Encourage your friend to seek professional help.

15. Suicide Myths and Realities Quiz 7. Feeling suicidal usually means you are mentally ill. False Suicidal feelings signal that someone is running low on reasons for living. This is a time of crisis. The person is not necessarily mentally ill. It can be a temporary feeling, if he/she receives support from friends, family and sometimes professional counselors.

16. Suicide Myths and Realities Quiz 8. Females complete suicide more frequently than males. False Three times as many males complete suicide while four times as many females attempt suicide.

17. Suicide Myths and Realities Quiz 9. If you are only thinking about suicide, you probably won't really do it. False One survey showed that 63% of teenagers have thought about suicide. A person who talks about suicide is not just trying to get attention, but trying desperately to communicate. It is important to take all threats seriously.

18. Suicide Myths and Realities Quiz 10. It is against the law to take your own life. False It isn't against the law to take your own life. However, it is against the law to aid a person in carrying out a suicide plan.

19. 10 Commonalities of Suicide 1) The common purpose of suicide is to seek a solution 2) The common goal of suicide is cessation of consciousness 3) The common stimulus in suicide is intolerable pain 4) The common stressor in suicide is frustrated psychological needs 5) The common emotion in suicide is hopelessness-helplessness

20. 10 Commonalities of Suicide 6) The common cognitive state in suicide is ambivalence 7) The common perceptual state in suicide is constriction 8) The common action in suicide is egression 9) The common interpersonal act in suicide is communication of intention 10) The common consistency in suicide is with lifelong coping patterns Sheidman (1996)

21. Suicide Triggers • Major Disappointment • Rejection • Failure • Loss (death of or break up with loved one) • Failing a big exam • Witnessing family turmoil • Others...

22. Questions to Consider • Has his personality changed dramatically? • Is he having trouble with a girlfriend (or, for girls, with a boyfriend)? Or is he having trouble getting along with other friends or with parents? Has he withdrawn from people he used to feel close to? • Is the quality of his schoolwork going down? Has he failed to live up to his own or someone else's standards (when it comes to school grades, for example)?

23. Questions to Consider • Does he always seem bored, and is he having trouble concentrating? • Is he acting like a rebel in an unexplained and severe way? • Is she pregnant and finding it hard to cope with this major life change? • Has he run away from home? • Is the teenager abusing drugs and/or alcohol?

24. Questions to Consider • Is she complaining of headaches, stomachaches, etc., that may or may not be real? • Have his eating or sleeping habits changed? • Has his or her appearance changed for the worse? • Is he giving away some of his most prized possessions? • Is he writing notes or poems about death?

25. Questions to Consider • Does he talk about suicide, even jokingly? Has he said things such as, "That's the last straw," "I can't take it anymore," or "Nobody cares about me?" (Threatening to kill oneself precedes four out of five suicidal deaths.) • Has he tried to commit suicide before?

26. Questions to Ask • Ask directly if the client has thoughts of suicide: “Have you thought of committing suicide?” • “Are you thinking of killing yourself?” In this case, subtlety is counterproductive.

27. Suicide Effect - Emotional Injury • Opposite Emotions: • Sadness, mourning loss vs. • Anger, emotional injury • The Perpetrator and the Victim are the Same Person

28. Suicide Effect - Self Blame • Grief and Anger can be avoided by going into Self Blame. • Over analysis of every interaction. • I could have done… • If I had only known… • What warning signs did I miss… • Who is next…

29. Suicide Prevention Messages • Suicide is a permanent solution to temporary problems • You can get help and people want to help you. • Suicide hurts everyone you love • Even people you don’t know love you • ACT to save a friend

30. A.C.T. To Save Lives Acknowledge Care Tell

31. Ethics • “Without civic morality communities perish; without personal morality their survival has no value.” • Bertrand Russell, 20th century British mathematician and philosopher • “Ethics is a code of values which guide our choices and actions and determine the purpose and course of out lives.” • Ayn Rand, 20th century Russian/American novelist and philosopher

32. Definitions • Ethics - refers to standards of conduct, standards that indicate how one should behave based on moral duties and virtues • Aspects of Ethics – There are two aspects to ethics: the first involves the ability to discern from right from wrong, good from evil, and propriety from impropriety; the second involves the commitment to do what is right, good and proper. Ethics is an action concept; it is not simply an idea to think and argue about. • Values vs. Ethics – The terms “values” and “ethics” are not interchangeable. Ethics is concerned with how a moral person should behave, whereas values simply concern the various beliefs and attitudes that determine how a person actually behaves. Some values concern ethics when they pertain to beliefs as to what is right and wrong.

33. LISTEN • http://www.npr.org/templates/story/story.php?storyId=1118798

34. Counselor’s Responsibility • Confidentiality • For counselors, confidentiality is a foundational ethical standard. • Confidentiality is the ethical duty to fulfill the promise that client information received during therapy will not be disclosed without authorization. • As such, it follows that breaching confidentiality can result in “harm” to the counseling relationship and subsequently the client. • Confidentiality is addressed in Section B of the Ethical Standards of the American Counseling Association Section B.1.a speaks to respect for client privacy. • “Confidentiality becomes a legal as well as an ethical concern if it is broken, whether intentionally or not” (Gladding, 2004).

35. Consent – Limits of Confidentiality The following are considered reasonable duty for counselors in terms of suicide prevention   • Counselors must know how to make assessments of a client’s risk for suicide and must be able to defend their decisions • When a decision is made that the client is a danger to self, counselors must take whatever steps are necessary to prevent the harm • Actions to prevent harm must be the least intrusive to accomplish that result

36. Counselors should inform clients of the limitations of confidentiality through standard “informed consent” procedures. • Counselors should begin their study of suicide assessment prevention early and continue to stay current through professional development activities regarding suicide and crisis intervention and ethical/legal issues in counseling (Laux, 2002) • Counselors should be familiar with suicide risk factors , procedures for suicide assessment , and guidelines for intervention (Brem, 2000) • Counselors should abide by the standard of practice to consult with other mental health professionals to aid in assessing for suicide risk and interventions. It is important to look for consensus and follow the advice in making decisions (Remley & Herlihy, 2001) • Counselors must properly document the process of suicide assessment and intervention through case notes and reports (Brem, 2000)

37. A professional counseling standard is to inform clients about the procedures of counseling including statement of confidentiality, limits to confidentiality, the process of counseling, counselor theory and interventions, as well as the potential benefits and risks of counseling. Limits of confidentiality are specific around the issue of suicide or “harm to self” For instance: “All interactions between the counselor and client, including scheduling of or attendance of appointments, content of sessions, progress of sessions, or counseling records are confidential There are some legal and ethical exceptions to confidentiality. If there is evidence of clear and imminent danger of harm to yourself and/or others, counselor is legally required to report this information to the authorities responsible for ensuring your safety and the safety of others”… There are a variety of ways to convey informed consent. Regardless of how it is done, the limits of confidentiality related to “harm to self” must be stated. (Remley &Herlihy, 2001)

38. Reference/Resources • http://www.cdc.gov/ncipc/factsheets/suifacts.htm • American Foundation for Suicide Prevention Northwest Resources (www.afspnw.org/resources.html) • Dunne, E., McIntosh, J., & Dunne-Maxim, K. (1987). Suicide and its aftermath: Understanding and counseling survivors. New York: Norton. • Grossman, J., Hirsch, J., Goldenber, D., Libby, S., Fendrich, M., Mackesy-Amiti, • M. E., Mazur, C., & Hill-Chance, G. (1995). Strategies for school-based response to loss: Proacrtive training and postvention consultation. Crisis, 16, 18-26. • Hewett, J. (1980). After suicide. Philadelphia: Westminster. • Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Suicide • American School Counselor Association, 1101 King St., Suite 625, Alexandria, VA 22314

39. QUESTIONS? For questions or technical assistance: Josephine (Josie) Padilla, M.Ed. Education Specialist – Positive Behavior Support Region VI Education Service Center (936) 435-8346 jpadilla@esc6.net