Centre for Prevention of Suicide & Self Harm Lucan Road, Lucan, Co. Dublin Tel: Pieta House Bishopstown Cork Tel:

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1 Centre for Prevention of Suicide & Self Harm Lucan Road, Lucan, Co. Dublin Tel: Pieta House Bishopstown Cork Tel: PIETA MID WEST Ardaulin Raheen Mungret Tel:

2 Our Service The service was founded by Psychologist Joan Freeman and Pieta House opened its doors in January Our client base is specifically targeted at people who are experiencing suicidal ideation, people who have attempted to take their lives and people who are engaging in deliberate self harm. We provide one to one therapy where the foundation is rooted in compassion and care.

3 Where did we get the name Pieta What does it mean?

4 Waiting Room in Pieta Lucan

5 Boardroom/Assessment Room

6 Expansion: Eight Years, Nine Centres Dublin: Lucan, Ballyfermot, Tallaght and Finglas Mungret Limerick, Roscrea Tipperary, Bishopstown Cork, Tuam Galway and Castleisland, Kerry

7 Pieta Mid West Located in Mungret, this Centre serves all of Limerick and Clare. Custom built to recreate the ambiance and tranquillity of Pieta in Lucan. When we opened in Limerick they had the second highest rate of suicide within Ireland, England, Scotland and Wales. This has been reduced since the opening of Pieta House.

8 The Pieta Way All our Therapists are professionally qualified and accredited and the team is made up of both Psychotherapists and Counselling Psychologists. Staff are carefully selected and are chosen not alone for their academic qualifications but also for their personal warmth. Receptionists too are given the opportunity to explore myths and facts in relation to self harm and suicide and to confront and clarify their own attitudes and beliefs. The Therapists are trained in the therapeutic models developed by Pieta, where we aim to lift suicidal ideation and in relation to self harm, we aim to move the client from self harm to self care.

9 User Friendly We are aware of the difficulties and negative experiences that people encounter due to the fact they are engaging in self harm. Some clients may be embarrassed by the fact that they have attempted suicide or want to take their lives. However we are also mindful that this could be ourselves, our children or one of our own family at the door, so people are treated in Pieta the way we would want to be treated ourselves. Clients are offered tea and coffee and the nurturing begins from the time they reach the door.

10 Family Support Pieta House recognises the difficulties encountered by the family. Families can be paralysed by fear and parents at times are even reluctant to put boundaries on their children for fear of upsetting them. We realise that at times the family can be the greatest resource that the client has but they too need to be supported, encouraged and educated as to the appropriate ways to respond. We provide placements to Psychotherapy Graduates who are working towards accreditation and allow them provide support to family members.

11 Source of Referrals Hospitals GP s. School Counsellors Psychiatric Services Other agencies and counselling services. People may also self refer and we aim to make the referral process as simple as possible. We recognise that people may still be ambivalent as to whether they want to attend or not and may not have the motivation to lift the phone. Therefore we are happy to arrange appointments through family members friends or professionals

12 How our demand has grown Clients

13 Age and Gender In 2013 we saw 3919 clients. Of this, 1,697 were male and 2,222 were female. 43% male, 57% female 26% of our client base were under 18 yrs of age. 22% of our client base was aged between 18 to 25yrs. This totalled 877 clients The largest client group were actually between 26 to 44 years. This totalled 1307 clients

14 Mind our Men/Mind ur Buddy Based on our findings that the men who accessed our service seldom made the referral themselves and considering the high rates of suicide with men in our Country. Pieta launched a nationwide campaign to educate the Country to recognise of suicide. Pieta have linked with Corporates like Electric Ireland and particularly male dominated organisations like the Gardai the GAA, the ICA, Department of Agriculture, Bord Bia etc. By this time next week 10 people will have died by suicide and 8 of these will be men.

15 Look How Far We ve Come 14,000 People Seen and Helped by Pieta House

16 Suicide Rates and Deliberate Self Harm Statistics There is an increasing number of people engaging in deliberate self harm and suicide rates have increased by 60% worldwide in the last 45 years (WHO) In 2012, for example there were 12,010 self harm presentations to hospitals in the Republic of Ireland. Involving 9,834 people. These figures are restricted to hospital presentations only (NSRF, 2012). In people died by suicide. In 2012, 507 people died by suicide. However the years that figures were down undetermined deaths were up.

17 Common Risk Factors Is there a history of suicide attempts? Is there a history of suicide attempts or completed suicide in the family? Have they friends/neighbours that have attempted or completed suicide? Paying attention to the contagion element Is there a Psychiatric Illness? Marital Status (apparently this decreases the risk!!) Life events (Financial ruin, relationship break up any type of significant loss) Substance related disorders. Unemployment

18 Myths and Facts of Suicide Myth: People who talk about suicide will never complete it. Fact: 80% people who complete suicide have told someone how they felt in the months before hand. Myth: Only Clinically Depressed people kill themselves. Fact: A lot of people who kill themselves have no history of depression they are reacting to life events. Myth: Suicide is attention seeking. Fact: It actually increases the risk of them attempting again and completing it.

19 Myths and Facts Continued Myth: Talking about suicide encourages it. Fact: Talking about suicide can save a life by encouraging someone to seek help. APR is the equivalent to CPR. It means, Ask, Persuade and Refer Myth: If someone is going to kill themselves, there is nothing anyone can do to prevent it. Fact: Most people don t want to die by suicide, they just want the pain to stop. There is always ambiguity right up till the end.

20 What signs and symptoms to look out for Change of mood Emotional outbursts Giving away possessions Isolating themselves Significant Loss Threats and statements of intent ( I have no future, I see no light at the end of the tunnel, I don t think I can do this much longer ). Withdrawal from relationships Preoccupation with death

21 The Appropriate Language to Use When Talking About Suicide Should we say commit suicide? What is the correct language? When was suicide decriminalised?

22 Why do People Attempt or Complete Suicide? They Want the Pain to Stop They Want a different life They don t see any other solution. Most People really don t want to die

23 What Do You Do When Someone Tells You That They Are Suicidal Do You React? Or Do You Respond?

24 Do you Have a Plan You should ask the person if they have a plan. You need to know this in order to establish the level of risk. Lots of people have fleeting thoughts of suicide but if they have put a plan in place they are in a much higher risk bracket. ( plans can be disabled) You need to see if you can disable this plan and remember you can never promise confidentiality. There is always ambiguity right up till the end. There have been studies conducted to prove this. It s not easy to kill yourself. It s our instinct to survive.

25 PH-SIM You begin the Therapy by hearing the clients story. When someone reaches the point of attempting suicide they are focused on their reasons for dying. They believe they have genuine reasons for dying which of course should be listened too, but you re always listening for their reasons for living.

26 Reasons for Dying versus Reasons for Living Sometimes people get stuck in their story. It s fine to allow this in the first session and to dip in and out as the therapy progresses. However, you keep them focused on the present and future and not on past events that they have no control over. When someone is this emotionally distressed they find it harder to access the rational part of the brain. So you may need to do some of the thinking for them. Explain this to the client, explain what happens in time of distress.

27 The Nine Boxes FRIENDS FAMILY RELATIONSHIP WORK GOD HOBBY GIVING BACK SELF IMPROVEMENT HEALTH

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29 What is Bi-polar Disorder It s an illness that affects thoughts, feelings, perceptions and behaviour... even how a person feels physically. It's probably caused by electrical and chemical elements in the brain not functioning properly. It s is a major affective disorder in which an individual alternates between states of deep depression and extreme elation. This is misleading in that bipolar disorder - sometimes still known as manic depression or manicdepressive illness - is much more complicated than just alternating between DEPRESSION AND elation. It increases the risk of suicide

30 Bi-polar continued The pattern of mood swings in bipolar vary greatly between individuals. Some people will only have a couple of episodes in their lifetime and be stable in between, while others may experience many episodes. Many are very creative, gifted and talented and many are entrepreneurs. A lot of people who have bipolar function really well between episodes. Think of Spike Milligan, Stephen Fry, Catherine Zeta Jones and many more.

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32 Show Selective Attention Video

33 What is Self-Harm The commission of deliberate self harm to one s own body. The injury is done without the aid of another person and the injury severe enough for tissue damage (such as scarring) to result and without conscious suicidal intent. Source:(Winchel and Stanley (1991), American Journal of Psychiatry ) The commission of deliberate harm to one's own body

34 The Appropriate Language to use in relation to Self-harm Never refer to a person as a Self-harmer Never refer to someone as a Head-banger, if that s the form of harm they engage in. In Ireland self harm is referred to as Deliberate Selfharm. Other terms are: Self Injury, Self inflicted violence, non suicidal self injury and a very old term, Self mutilation. In Pieta we simply use the term self harm. Never label a person by their behaviour.

35 Myths and Facts for Self Harm Myth: Self Harm is attention seeking Fact: Most Self Harm takes place in private. Myth: Self Harm is a suicide attempt Fact: Most people who engage in Self Harm do so as a way of staying alive (coping) it s not about ending (suicide) Myth: People who engage in Self Harm enjoy pain Fact> People who engage in self harm do so to shift the focus from the emotional distress, and are possibly trying to communicate that distress.

36 Forms of self Harm What s acceptable What s not Cutting Burning Inserting objects Picking Scratching Self poisoning (swallowing bleach) Pulling out hair and eyelashes (trichotillomania)

37 Borderline Personality Disorder The essential feature of which is a pattern of marked impulsivity and instability of affects, interpersonal relationships and self image. The pattern is present by early adulthood and occurs across a variety of situations and contexts. Other symptoms usually include intense fears of abandonment and intense anger and irritability, the reason for which others have difficulty understanding. People with BPD often engage in idealization and devaluation of others, alternating between high positive regard and great disappointment. Self-harm and suicidal behaviour are common.

38 BPD Continued The disorder is recognized in the Diagnostic and Statistical Manual of Mental Disorders. Because a personality disorder is a pervasive, enduring, and inflexible pattern of maladaptive inner experiences and pathological behaviour, there is a general reluctance to diagnose personality disorders before adolescence or early adulthood.

39 There is an ongoing debate about the terminology of this disorder, especially the suitability of the word "borderline". The ICD-10 manual refers to the disorder as Emotionally unstable personality disorder and has similar diagnostic criteria. There is related concern that the diagnosis of BPD stigmatizes people with BPD and supports discriminatory practices because it suggests that the personality of the individual is flawed. In the DSM-5 the name of the disorder remains the same as in previous editions.

40 The Link between Self Harm and Suicide Although seen as two separate issues and self harm may occur with no suicidal intent and purely as a means of coping. One should never become complacent. If self harm is no longer working the person may become suicidal. Remember this is there coping strategy so it cannot be taken unless it s replaced with an alternative People who engage in self harm are 42 times more likely to die by suicide. (NSRF, 2012)

41 What s the alternative

42 Amy s Story:

43 How to self care How do you manage stress? How do you protect yourself when you are faced in situations where you witness people struggling? Are you looking after your diet, taking regular exercise, getting enough sleep? These are essential to our physical and emotional wellbeing. How do you nurture yourselves, or do you? Being able to talk about your stresses in supportive relationships.

44 Darkness Into Light first came about in May Just over 800 people attended the Phoenix Park. In 2010, it spread to 2 venues, Phoenix Park and Limerick City. Every year DIL has expanded, to the point where in 2013, over 35,000 walked or ran with us in 20 venues across 19 counties On 10 th May 2014, we will have 40 venues across all 26 counties in the Republic of Ireland, making it one of the largest events organised across the country

45 DIL Video