Debra Tower PhD James Allen MPH Shelly Douglas Julie Geddes

Transcription

1 Debra Tower PhD James Allen MPH Shelly Douglas Julie Geddes

2 Providing trainings 15,000 persons trained 50 ASIST Instructors 300 QPR Instructors Screenings Providers Partners Primary Screen Awareness Billboards Providers Universities Schools Heartline Mental Health Associations

3 Debra Tower PhD

4 Between the years of , 2,673 deaths by suicide were reported in Oklahoma. On average, 527 Oklahomans die by suicide every year. Suicide comprises almost 58% of the reported violent deaths in Oklahoma. Of those that lost their lives to suicide, 23% had served in the US military. In 2006, Oklahoma ranked 13 th in terms of lives lost to suicide in the United States Source: National Center for Health Statistics Source: Kabore, H.J., Brown, S., & Archer, P., Summary of Violent Deaths in Oklahoma, Oklahoma Violent Death Reporting System, (unless otherwise noted)

5 The annual rate of death by suicide in Oklahoma ( ) is 14.8 (suicides per 100,000 people). In comparison, the suicide rate for the United States ( ) is 11.2.

6 In 2004, the annual suicide rate in Oklahoma was In 2008, the rate was 15.9, an increase of 13% Suicide Rate by Year, Oklahoma, Suicide Rate

7 78% of suicide victims are male, 22% are female. The rate of suicide completion is higher for males than females across all categories of race and age. With a suicide rate of 46.6 per 100,000, the highest risk of suicide exists among males 75 and older. For females, the highest rate of suicide was for those between the ages of

8 Rate per 100,00 Population Rate of Suicide by Age and Gender, Oklahoma, Male Female Age Group

9 The suicide rate is particularly high for white males (24.5). Native American males have a suicide rate of 22.5 per 100,000. Non-Hispanics (15.2) are almost twice as likely to die by suicide than Hispanics (7.2)

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11 Between 2004 and 2008, firearms were used in 60% of suicide completions. Suicide by hanging/strangulation (19%) was a distant second in terms of method, with poisoning recorded as the means in 18% of the deaths by suicide. When examining men and women separately, a firearm is noted as the method of suicide for 65% of the cases for males, and 39% for females. For females, poisoning (39%) and firearms (39%) were the methods used most often. Prescription drugs were used in 69% of all suicides by poisoning.

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13 For those that suffered death by suicide, 18% had previously attempted suicide. Thirty-one percent of suicide victims had communicated their feelings or intentions regarding suicide to someone. For the victims about which the circumstances associated with the suicide was available, current depressed mood was cited in 43% of the cases of those that died by suicide. Thirty-three percent were reportedly experiencing intimate partner problems. *More than one circumstance may have been associated with the death.

14 In 30% (Men: 25%, Women: 45%) of the cases, the victims were suffering from a current mental health problem, and 27% had a physical health problem. Twenty-two percent had experienced a crisis in the past two weeks. For 12% of those that died by suicide, substance abuse was a known issue. Likewise, alcohol was an issue in 12% of the cases. Of those that were tested, 30% of the suicide victims tested positive for alcohol, and 86% tested positive for drugs. *More than one circumstance may have been associated with the death.

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16 For Oklahomans between the ages of 10-24, suicide is the second leading cause of death Between , the youngest person to commit suicide was 12 years of age.

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19 Biological factors mental health disorders, particularly mood disorders such as depression, schizophrenia, anxiety disorders and certain personality disorders Substance abuse Psychosocial factors poor interpersonal problem-solving ability, poor coping skills, impulsive and/or aggressive tendencies, legal/disciplinary problems, history of trauma or abuse, previous suicide attempt, and family history of suicide Environmental factors difficulty in school, neither working nor going to school (drifting), relational or social loss, easy access to lethal means and local clusters of suicide that contagious influence Social factors lack of social support and sense of isolation, stigma associated with help-seeking behavior, barriers to accessing health care, certain cultural and religious beliefs (such as a belief that suicide is a noble resolution of a personal dilemma), and exposure to (including the media) and influence of others who have died by suicide

20 The experience of domestic violence during adolescence is a strong predictor of males later violent behavior, but a less strong predictor of suicidal behavior. Males that witnessed domestic abuse as children were more likely to be violent adults (arrests for violent acts against others, etc.) In contrast, being battered and being neglected during childhood more strongly predict later suicidal behavior rather than violent behavior. Males that were abused and neglected at children were at a higher risk for suicide (self-directed

21 Punishment has been identified as on of the top three reasons given by adolescents for suicide-related behaviors. Physical injury by an adult at home has been linked to a higher risk of a suicide attempt within 12 months of the incident. Research demonstrates a significantly higher lifetime risk of suicide and self-harm for those that suffered abuse as children. Source: Mironova, Polina, Rhodes, Anne E., Bethell, Jennifer M., Tonmyr, Lil, Boyle, Michael H., Wekerle, Christine, Goodman, Deborah and Leslie, Bruce (2011). 'Childhood physical abuse and suicide-related behavior: A systematic review', Vulnerable Children and Youth Studies, 6: 1, 1 7.

22 Childhood sexual abuse is associated with a higher risk of suicide attempt(s), particularly for boys. In one longitudinal study of adolescents that attempted suicide at least once: 6% had not suffered child abuse 11.7% were physically abused as children 14.8% were sexually abused as children 32.2% had been both physically and sexually abused

23 James Allen MPH

24 The human brain is not a completed product until about age 26. During adolescence, decision-making processes often employ the region of the brain associated with the fight or flight response. Thus, impulsivity increases during this time

25 Three primary spectra: Concrete to abstract thought Internal to external thought Present day orientation to future orientation

26 Drugs and alcohol affect the adolescent brain differently than an adult brain Adolescents more likely to become addicted or suffer adverse consequences of substance abuse

27 Adolescent may look for reasons why abuse occurred, and due to their developmental stage may blame themselves. This self-blame may be reinforced by the abuser. Both substance abuse and suicidal thinking may become routes of escape from the pain.

28 History of trauma or abuse Persistence as a model of thinking (hopelessness) Impulsive decision making Judgment clouded by current suffering View of suicide as a way out Loss of inhibitions by substance abuse

29 While a person s life history cannot be changed, the other ingredients in the perfect storm can be counteracted. Instill hope where it was not there before. Assist an adolescent with problem-solving to get away from decisions happening by impulse and without good judgment of possible outcomes. Help the sufferer see suicide as an undesirable option. Prevent the sufferer from using drugs or alcohol.

30 Ben s Story Will you come to my funeral? Cultural issues (3 students) Contagion urban Rural Oklahoma family connections Safety after 7 years Family suicides The unexpected happy achiever and a community hit multiple times with suicides Strategies with funding School s fear of response Agency suicide

31 Most suicides occur within days or weeks of "improvement," when the individual has the energy and motivation to actually follow through with his/her suicidal thoughts. The highest suicide rates are immediately after a hospitalization for a suicide attempt.

32 Prevention Intervention Postvention

33 Community Toolkits Protective Factors for communities, individuals, families Awareness campaigns Lifelines Curriculum Policies and Procedures Protocols Means matters campaigns Screenings

34 Trainings ASIST Question Persuade Refer Assessing and Managing Suicide Risk

35 National Suicide Prevention Lifeline Early identification (use of training modules) Signs of Suicide TeenScreen TeenScreen Primary Screen Intervention Curriculum Mental Health Referrals (CMHCS) Access to Services Outpatient and Inpatient Treatment After an attempt After a successful completion

36 Unique form of crisis intervention-each case unique Should begin immediately after the suicide loss 4 Objectives 1. Ease trauma & related effects of suicide loss 2. Prevent onset of adverse grief reactions 3. Minimize risk of suicidal behavior 4. Encourage resilience & coping

37 Complicated Out of the norm Multiple reasons for every suicide Moral and person issues Postvention Imitation All deaths handled same way Care for the caregivers Mystery elements Social Stigma Survivors-guilt Some response Staff/students 1 st priority Response to affected persons

38 What Do They Do? Each role-description Media-one main spokesperson with consistent message Team Members Identify by needs assessment Responsibilities How the team is called into action Where does it start Specific Tasks of the team during a Postvention

39 Who is the crisis team? Who is contacted?-neighbors, school community Students prefer predictability to normal school routine Supportive environment for everyone (time?) All school staff and community at large-needs Agency care team

40 Staff Extra helping resources Media responses Empty desk Siblings Direct contacts of deceased or affected

41 Dealing with the empty desk, locker, etc. Checking the textbooks Social media Sports uniforms Social stigma (funerals, cause of death, insurance) Yearbook memorials Memorial trees Aftercare Resources for parents/communities Screenings (SBIRT and TeenScreen) Affected family supports Place of death- Media response

42 Time for Prevention after an event School/community response to death by suicide preplanning, revisiting plan periodically School/community with no policy in place Consistent, community developed, specific Best-practice plan School/community resources to implement an effective plan Role of the crisis team in an effective postvention plan

43 Deal with your own reactions first Keep it simple! Listen Encourage them to put their thoughts and feelings into words Permission to express their feelings Permission to grieve Look for signs of guilt, or responsibility Remind them to unite and watch out for each other Community Care stations

44 Challenges a school and community faces when there is a homicide/suicide Postvention processes when more than one person dies Handling media coverage A Suicide cluster Memorializing the deceased affects the community The appropriate ways to commemorate the life of a deceased student/adult What NOT to do Translate this information into a policy or protocol

45 Contagion Clusters Attempts Completions Prepared communities Dedicated individuals

46 Primary care staff Behavioral health staff School personnel First responder Faith community Tribal representation Youth representative yrs. Old Fireman Law enforcement Media spokesperson Who else?

47 Developing protocols Resource list (update as needed) assign who will do this? List of responders and time lines Event response including roles of crisis team members Developing calling trees Schedule team meetings monthly until plan is finished Schedule quarterly meetings thereafter

48 Different age groups needs Different responses to death among children Information the students need about the death Handling rumors Difference of death of a peer and death of an adult to a student Which students vulnerable Approaching vulnerable students Care stations for students to deal with their grief What to expect from students the day of the funeral-someone at the school day of funeral

49 Posting National Suicide Prevention Lifeline Number in community Reachout Crisis response team numbers 211 Local resource list (211) Access to Services-Bryan Hiel

50 Review crisis plan Review role-specific tasks Consider substitute coverage for school or community crisis team Gather accurate information Contact other schools/communities in the district Identify potentially vulnerable students or individuals Team members to follow the class schedule of the deceased

51 Level of information to students and faculty Create scripts for information Create care stations Agenda for faculty/staff meeting Contact support resources Plan for contacting the family of deceased Remove the student s belongings from locker/desk Procedure for responding to impromptu student memorials Schedule faculty debriefing at the end of school day Debrief team at the end of the school day

52 After day 1 Crisis management for hours After the funeral Memorials Proper training of the crisis team

53 Parents concerns Providing structure for parents/adults Ways to provide support When parents want to meet in a large group When parents won t get involved in the competent community The school reaching out to the family of the deceased

54 Who are they? How they help the school/community in postvention Limitations Integrated into the community and school crisis response team

55 Question, Persuade, Refer

56 Of the 1.1 million adults who attempted suicide in the past year 61.2 percent received medical attention for their suicide attempt 43.9 percent stayed overnight or longer in a hospital for their suicide attempt

57 Percents of 1.1 million

58 What would you do if you were worried about someone? Where would you take them? What about fees, hours of operation, etc.?

59 QPR Ask A Question, Save A Life

60 QPR Question, Persuade, Refer

61 QPR is not intended to be a form of counseling or treatment. QPR is intended to offer hope through positive action.

62 Myth No one can stop a suicide, it is inevitable. Fact If people in a crisis get the help they need, they will probably never be suicidal again. Myth Confronting a person about suicide will only make them angry and increase the risk of suicide. Fact Asking someone directly about suicidal intent lowers anxiety, opens up communication and lowers the risk of an impulsive act.

63 Myth Only experts can prevent suicide. Fact Suicide prevention is everybody s business, and anyone can help prevent the tragedy of suicide Myth Suicidal people keep their plans to themselves. Fact Most suicidal people communicate their intent sometime during the week preceding their attempt.

64 Myth Those who talk about suicide don t do it. Fact People who talk about suicide may try, or even complete, an act of selfdestruction. Myth Once a person decides to complete suicide, there is nothing anyone can do to stop them. Fact Suicide is the most preventable kind of death, and almost any positive action may save a life. How can I help? Ask the Question..

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66 Direct Verbal Clues: 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.

67 Indirect Verbal Clues: 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.

68 Behavioral Clues: Any previous suicide attempt Acquiring a gun or stockpiling pills Co-occurring depression, moodiness, hopelessness Putting personal affairs in order Giving away prized possessions Sudden interest or disinterest in religion Drug or alcohol abuse, or relapse after a period of recovery Unexplained anger, aggression and irritability

69 Situational Clues: Being fired or being expelled from school A recent unwanted move Loss of any major relationship Death of a spouse, child, or best friend, especially if by suicide Diagnosis of a serious or terminal illness Sudden unexpected loss of freedom/fear of punishment Anticipated loss of financial security Loss of a cherished therapist, counselor or teacher Fear of becoming a burden to others

70 If in doubt, don t wait, ask the question If the person is reluctant, be persistent Talk to the person alone in a private setting Allow the person to talk freely Give yourself plenty of time Have your resources handy; QPR Card, phone numbers, counselor s name and any other information that might help Remember: How you ask the question is less important than that you ask it

71 Less Direct Approach: Have you been unhappy lately? Have you been very unhappy lately? Have you been so very unhappy lately that you ve been thinking about ending your life? Do you ever wish you could go to sleep and never wake up?

72 Direct Approach: You know, when people are as upset as you seem to be, they sometimes wish they were dead. I m wondering if you re feeling that way, too? You look pretty miserable, I wonder if you re thinking about suicide? Are you thinking about killing yourself? NOTE: If you cannot ask the question, find someone who can.

73 You re not suicidal, are you?

74 HOW TO PERSUADE SOMEONE TO STAY ALIVE Listen to the problem and give them your full attention Remember, suicide is not the problem, only the solution to a perceived insoluble problem Do not rush to judgment Offer hope in any form

75 Then Ask: Will you go with me to get help? Will you let me help you get help? Will you promise me not to kill yourself until we ve found some help? YOUR WILLINGNESS TO LISTEN AND TO HELP CAN REKINDLE HOPE, AND MAKE ALL THE DIFFERENCE.

76 Suicidal people often believe they cannot be helped, so you may have to do more. The best referral involves taking the person directly to someone who can help. The next best referral is getting a commitment from them to accept help, then making the arrangements to get that help. The third best referral is to give referral information and try to get a good faith commitment not to complete or attempt suicide. Any willingness to accept help at some time, even if in the future, is a good outcome.

77 REMEMBER Since almost all efforts to persuade someone to live instead of attempt suicide will be met with agreement and relief, don t hesitate to get involved or take the lead.

78 Say: I want you to live, or I m on your side...we ll get through this. Get Others Involved. Ask the person who else might help. Family? Friends? Brothers? Sisters? Pastors? Priest? Rabbi? Bishop? Physician?

79 Join a Team/or a group of others who may be concerned about this person. clergy therapists psychiatrists whomever is going to provide the counseling or treatment plus others identified

80 Help make a list of helping resources including phone numbers. Follow up with a visit, a phone call or a card, and in whatever way feels comfortable to you, let the person know you care about what happens to them. Caring may save a life

81 Emergency Room-EMTALA (Emergency Medical Treatment and Labor Act) Does the hospital have suicide safety precautions? National Lifeline TALK

82 Mental Health Provider There are fifteen CMHCs, five of which are state-operated facilities and the other ten are contracted non-profit providers and then search for Community Mental Health Providers Police/Sheriff Dept. Follow-up - make sure you check in with the person at risk

83 If you identify and assist someone you believe to be at risk, please share this information with us using the survey at: Oklahoma This is specific to the Garrett Lee Smith Youth Suicide Prevention Grant year old persons at risk of suicide. No identifiers are used.

84 REMEMBER WHEN YOU APPLY QPR, YOU PLANT THE SEEDS OF HOPE. HOPE HELPS PREVENT SUICIDE.

85 National Suicide Lifeline TALK Suicide Prevention Resource Center Resource Center (free materials) Oklahoma Department of Mental Health And Substance Abuse Services

86 Debra Tower PhD Data Analyst ODMHSAS James Allen MPH Assistant Director, Public Health Programs and Services University of Central Oklahoma Shelly Douglas Hope Team Julie Geddes Senior Field Rep Project Director GLS Grant