Suicide Risk Assessment Demian Laudisio, Florida Youth Suicide Prevention Project Manager Switchboard, Inc. Switchboard counsels, connects and empowers people in need Switchboard Suicide Prevention Dept. AIRS Conference Atlanta GA, 2014
Objectives Scope of suicide in the U.S Warning signs of suicide Conducting a Suicide Assessment Safe-plan
Suicide in the U.S. 38,364 completed suicides in 2010 About one person every 14 minutes 105 people per day 10 th ranking cause of death in the U.S., Homicide 16th Youth Suicide in the U.S. Suicide accounts for 13% of all adolescent deaths 4,867 completed suicides in 2010 About one young person every 1 hour and 48 minutes 3 rd leading cause of death ages 10-24
Young Adult Suicide: What we know Suicide Rate for college students is between 6.5 and 7.5 per 100,000. Rate for non-student college-aged adults is estimated at twice the rate of college students. 30% of colleges report a suicide each year. Age of onset of major mental illnesses coincides with onset of increased rates. Most remain undetected, under-diagnosed and untreated.
Mental Illness and Suicide Over 90% of all people who die by suicide are suffering from a major psychiatric illness/substance abuse disorder. These deaths are due to untreated or undertreated brain disorders.
Suicide and Juvenile Justice Children in detention centers are 4 times more likely to complete suicide. Hayes (2005) In America, nearly 7 out of 10 of those in juvenile facilities attempt suicide before treatment. U.S. House of Representatives (2004) Youth with an arrest record who are depressed have a higher risk of mental health issues and drug abuse. Tolou-Shams (2008)
Suicide and LGBTQ Populations After being bullied, 4 out of 10 of the LBG youth hurt themselves or attempt suicide. Rivers (2001) LGBT youth are 4 times more likely to attempt suicide than their heterosexual peers. McDermott (2008) LGBT youth who are rejected when they come out have a higher risk of substance abuse, depressive symptoms, and suicide attempts. D Augelli (2001), Ryan (2009)
Suicide and the Homeless Compared to 1 out of 10 in the general population, nearly 4 out of 10 of homeless adolescents attempt suicide. Rew (2001) Half of youth that are homeless have substance (drug and alcohol) abuse issues. Goering (2002) Youth who were sexually abused and currently binge drinking are nearly 7 times more likely to have attempted suicide. Sibthorpe (1995)
Suicide and Domestic Violence Among women seeking surgical care for attempted suicide, those in abusive relationships are 8 times more likely to attempt suicide directly following an abusive event. Bergman (2007) Abuse may be one of the most important factors to predict female suicide. Dienemann (2000) Youth who witness parental violence are more likely to engage in delinquent behavior. Zinzow (2009)
Suicide and Veterans Patients receiving care from U.S. Veterans Health Administration are 2 times more likely to complete suicide than the general population. Sher (2011) Nearly 4 out of 10 of veterans have mental health issues and nearly 2 out of 10 are diagnosed with PTSD. Seal (2009)
Suicide and African Americans African American adolescents complete suicide at a younger age than Caucasian adolescents. Day-Vines (2007) Suicide is the 3 rd leading cause of death in African American youth. American Association of Suicidology (2004) On average, African American youth have a higher rate of psychological stress than Caucasian youth around the age of 14. Elkington (2010)
Suicide and Asian Americans Asian Americans are less likely to seek professional help and openly express suicidal thoughts. Cheng (2010) Relative to population, Asian Americans aged 15 24 have a higher rate of suicide completion than Caucasian Americans. Chen (2011) Asian Americans have a lower rate of substance use than most other ethnic groups due to less peer influence. Thai (2010)
Suicide and Native Americans Native Americans are nearly twice as likely to complete suicide. McKenzie (2003) Native American suicide rates are 70% higher than the rate of the general population. Dorgan (2010) Attitudes toward substance use and number of substances abused is usually related to family conflict for Native Americans. Jackson (2009)
Warning signs for Suicide?
Giving away possessions Withdrawal (family, friends, school, work) Loss of interest in hobbies Abuse of alcohol, drugs Extreme behavior changes Impulsivity Increased risk taking Self-harm Lack of interest in appearance Disturbed sleep Change/loss of appetite, weight Physical health complaints Artist: Jorge Interiano Desperate Angry Guilty Worthless Lonely Sad Hopeless Helpless
all of my problems will end soon." no one can do anything to help me now. now I know what they were going through." I just can't take it anymore." I wish I were dead." everyone will be better off without me." I won't be needing these things anymore." I can't do anything right." without them I don t feel safe."
What needs to be asked, before conducting a suicide assessment?
John, are you having thoughts of suicide? What are some other direct ways to ask? How could being indirect affect an intervention? What other factors can affect risk assessment? (culture, language, bias ) How do you handle answers given?
What could happen if I conduct suicide risk assessment without establishing rapport?
Building Rapport Active Listening Empathy Body Language Tone of Voice Letting Client share their story No Judgment
Suicide Assessment Sheets Suicide Assessment Sheet Samples Switchboard National Suicide Lifeline Florida Youth Suicide Prevention Project, USF QPR Institute
Scenario I Client: Jack, Male, served in the armed forces, in his 60s. When client first calls in, he asks the counselor if he can identify the background noise. The client explains he is cleaning his guns. As the conversation continues, the client discloses he is suffering from a back injury which surgery made worse. He is currently living in a home under foreclosure, with no reliable transportation and is currently intoxicated. Client is also on a list of medications including insulin for diabetes and Oxcodone for back pain. He has no resources or supports in place and local health and mental health facilities are 45 minutes away. Client states that he wants police to be sent out. I just been feeling this way for to long, but I just can t do it. But I know I could pull my gun out on the police and let them end it.
Scenario II Client: Jane, Female, 15 years old. Client discusses thoughts of suicide, and dealing with on going feelings of sadness which she has difficulty explaining. I think about suicide often but I could never go through with it. When asked about a plan, she says I ve thought about pills, but I don t have anything and even if I did I m just too scared. I am always just scared. As the conversation continues, client begins to open up about inappropriate behavior by her step father. When my mom is not here, he makes make advances on me. I just can t be alone in the house with him. Shortly after, she becomes nervous and says she does not want to talk about it anymore and hangs up.
Scenario III Client: John, Male, 40 s, police officer on administrative leave. Client discloses to the counselor he is under administrative leave and is currently under investigation. He does not believe there is any way out of this situation and has been thinking of killing himself with carbon monoxide poisoning in his garage. Client admits that he has an addiction and has been accessing young porn sights. He says There is no hope and I just can t do this anymore, I am sorry but I know what I have to do. and hangs up phone. A police officer calls and asks to speak to the counselor who had spoken with the client. The officer asks vary particular questions such as I need to know what John spoke about? Did he discuss child pornography with you?
Liability Only report identifying information and plan. Reporting of motivations and personal information is not part of mandatory reporting. Regardless of professional status of inquirer unless explicit permission is given by client or subpoenaed by a court of law. By law I am unable to disclose personal information of my client. Switchboard Suicide Prevention Dept. 2014
Liability & Consultation I Re If not reporting make sure if there is anything under intent that has been marked that you have a collogue sign off. CONSULT! Switchboard Suicide Prevention Dept. 2014
What should a plan to keep safe look like?
Client Centered What can we do to keep you safe for now? Disabling the plan Means restriction Safety contacts Identify Triggers Referrals
Follow-up/ Warm Transfer
Questions? Switchboard Suicide Prevention Dept. AIRS Conference Atlanta GA, 2014