STAYING AFLOAT AND CONNECTED IN THE MIDST OF SUICIDE
SUICIDE IS A JOURNEY
WHY DO PEOPLE DIE BY SUICIDE? Psychological Theory of Suicide PRIMARY DRIVERS -Predisposition (illness, past attempts, trauma) -Pain, stress, agitation -Dysregulated emotions -Hopelessness -Loss of purpose -Loneliness -Perceived burdensomeness -No reasons for living SECONDARY DRIVERS -Family conflict -Unemployment -Social Isolation -LOSS SUICIDE MODE -Fixed beliefs, emotions, behavior -Increased pain tolerance -Lowered fear of death -Acquired capability PROBLEM SOLVING MODE
PROTECTIVE FACTORS POSITIVE SOCIAL SUPPORT THERAPEUTIC RELATIONSHIP RESPONSIBILITY TO OTHERS POSITIVE COPING SKILLS HOPE, LIFE SATISFACTION RELIGIOUS BELIEFS AGAINST SUICIDE INTACT REALITY TESTING FEAR OF SUICIDE
ACUTE-VS-CHRONIC RISK ACUTE Desire Intent Capability Buffers CHRONIC History of attempts Other predisposing risk factors
HIGHEST LEVEL INTERVENTIONS YOU SEEK ENVIRONMENTAL INTERVENTION (FAMILY, POLICE, CRISIS LINE) PERSON SEEKS ENVIRONMENTAL INTERVENTION (GO TO ER, CALL CRISIS LINE OR THERAPIST) HELP THE PERSON USE COPING SKILLS TO MANAGE THE CRISIS TARGET PROBLEMS LESS DIRECTLY RELATED TO BUT MAINTAINING SUICIDAL RISK (PSYCHIATRIC OR MEDICAL ILLNESS, TRAUMATIC STRESS, SYSTEMS OF OPPRESSION) LOWEST LEVEL GOAL: REDUCE EMOTIONAL PAIN
OUTPATIENT PSYCHOTHERAPY Management Connectedness Symptom Treatment Safety Planning Means Restriction Treatment Collaborative Relationship Clinical Focus on Suicide Ongoing Risk Resolution Resolve Primary Drivers Move Toward Self-Managing Risk
CAN WE PREDICT/PREVENT SUICIDE? PREDICTING SUICIDE SUICIDE ITSELF IS NOT PREDICTABLE SUICIDE RISK IS FORESEEABLE (ABLE TO REASONABLY ASSESS) CLINICIANS ARE RESPONSIBLE FOR ESTIMATING AND MANAGING SUICIDE RISK, NOT PREDICTING SUICIDE PREVENTING SUICIDE PHYSICIAN EDUCATION ON DEPRESSION (2005) RESTRICTION OF LETHAL MEANS (2005) CARING LETTERS PROGRAM (2001) BRIEF INTERVENTION & CONTACT (2008) SLOWING IT DOWN / DELAYING
WHY DOES SUICIDE STAY IN THE SHADOWS? COUNTER-TRANSFERENCE: UNDERLYING BELIEFS/EMOTIONS ABOUT SUICIDE FEAR, SHAME, ANGER, PASSIVITY, UNREALISTIC ACTION UNPROCESSED, IT LEADS TO: OVER-RESPONSE UNDER-RESPONSE COLLUSION
THE RIPPLE EFFECT OF SUICIDE SHOCK ANXIETY DENIAL SHAME GRIEF INADEQUACY GUILT BETRAYAL
WHAT CAN I DO? 1. BE COMPASSIONATE: Suicide does not discriminate Take the long view of suffering and healing 2. BE PRESENT: Know your counter-transference Listen for risk factors and warning signs 2. BE COLLABORATIVE: Thank them for telling you; believe them Support their protective factors; work together to address suicide 4. BUILD YOUR TEAM: Crisis Line: 1-800-273-8255 Their support network Your support network
HOW DO I STAY AFLOAT? 1. INVEST IN TRAINING 2. INVEST IN SELF-CARE 3. INVEST IN A TEAM APPROACH 4. GET INVOLVED ON A SYSTEMIC LEVEL
Through the darkness to the dawn Love as deep as the road is long
SPECIAL THANKS TO: WELLSPRING COUNSELING SERVICES CENTERS FOR DISEASE CONTROL AMERICAN ASSOCIATION FOR SUICIDOLOGY NATIONAL ALLIANCE ON MENTAL ILLNESS THE LUMINEERS Katie Anderson, LMHC Family Therapist Psychiatric Service Line Providence Health Services