Download Suicide Prevention & Awareness in our Youth â“ It Only Takes One

Suicide Prevention &
Awareness in our Youth:
It Only Takes One
Mental Health America of Illinois (MHAI)
Carol Gall, MA
Executive Director
[email protected]
www.mhai.org
www.itonlytakesone.org
Who is Mental Health
America of Illinois?
*Formerly Mental Health Association in Illinois
• Statewide, non-profit organization founded in 1909 –
Celebrating over 100-Years of Service in Illinois!
• Mission is to promote mental health, work for the
prevention of mental illnesses, advocate for fair care
and treatment of those suffering from mental and
emotional problems.
• Engage in public education, prevention, and advocacy.
Presentation Topics
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Mental Illnesses Defined
Mental Illnesses and Suicide
The Impact of Suicide
Suicide vs. Self-Injury
Risk & Protective Factors of Suicide
Symptom Management Strategies
Resources
Questions
What do
mental illnesses
look like?
Mental Illnesses Defined
•
•
•
A health condition that changes a person’s thinking, feelings, and/or
behavior (or all three) and that causes the person distress and difficulty
in daily functioning
1 out of 5 adults and teens suffer from a mental illness each year
Warning signs:
– marked personality change,
– inability to cope with problems and daily activities,
– strange or grandiose ideas,
– excessive anxieties,
– prolonged depression and apathy,
– marked changes in eating or sleeping patterns,
– thinking or talking about suicide or harming oneself,
– extreme mood swings—high or low,
– abuse of alcohol or drugs, and
– excessive anger, hostility, or violent behavior.
STIGMA
•Mark of shame or discredit, mark of disgrace
•Why is stigma harmful?
•Makes coping more difficult
•Prevents people from seeking and receiving
treatment
•What can we do?
•Change our language - crazy, insane, etc.
•Phrases - Somebody has bipolar, they ARE not bipolar
•Share, empathize, learn and understand
Understanding Depression
• “Please understand”:
•Sad, low mood
•Change in appetite
•Change in sleep pattern
– Can’t eat, angry, cry,
mood swings, thoughts •Angry/irritable
of harming self
•Social withdrawal - activities,
• “Cotton”:
– Wearing long sleeves,
no eye contact,
different, never spoke,
writing lists, cried,
bandages, thoughts
about death, lost will to
live
friends
•Poor concentration - grades
•Feelings of guilt/worthlessness
•Restlessness/moving slowly
•Feelings of hopelessness
•Thoughts of harming self
•Self-harm vs. suicide
Understanding Depression
 Depression is a treatable medical illness, not a
weakness or a moral failure, that often runs in
families
 Treatment success rates are between 80% to 90% for
depression.
 Clinical depression is a common and serious disorder
of mood, that is pervasive, intense and attacks the
mind and body simultaneously
 Depression can be triggered by health conditions
and/or environmental and behavioral stressors
Depression in Youth
 Recent surveys indicate that as many as one in five
teens suffers from clinical depression. Mental Health
America
 Children under stress, who experience loss, or who
have attention, conduct or anxiety disorders are at
higher risk for depression. American Academy of Child
& Adolescent Psychiatry
 Children whose parents have been diagnosed with
affective disorders are far more likely to be
diagnosed with a mental illness- especially an
affective disorder – than their peers whose parents
do not have mood disorders. Psychiatric Times, 1999
Symptoms of Depression in
Children & Adolescents
 Irritability and/or depressed mood
 Loss of interest in usual activities
 Low energy and/or restlessness
 Poor concentration
 Sleeping too much or too little
 Weight loss or weight gain
 Feeling hopeless and helpless
 Feeling worthless and guilty
 Persistent physical symptoms
that don’t respond to treatment
such as headache, stomachache,
chronic pain, constipation, etc.
 Thoughts of death or suicide
Typical Adolescence
 Struggle for independence, limit testing
 Identity struggle
 Less affectionate toward parents, “occasional” rudeness
 “Occasional” moodiness
 Increased responsibility
 Limited thoughts of the future
Typical vs. Depressed Adolescence
 Symptoms of depression are more persistent and interfere
with daily living, particularly when they last for more than
two weeks.
 Adolescent depression interferes with acquisition of
necessary life long skills developed during adolescence.
Mental Illnesses
& Suicide
God, Let Me Die, Just for Tonight
God- let me die, just for tonight.
I’m scared, I’m lonely and confused.
No one understands me, no one knows what I go through in this
shell of a body.
I love, I hate, I sing, and I cry- but none of that means anything.
I want an escape, I want to fly away- away from a world of
confusion and pain.
God-please let me die, but just for tonight.
I’m too afraid to die forever.
That makes me even more upset with myself- my fear and
lack of courage.
But maybe tomorrow, when I come back, I’ll be happy.
Maybe.
But God- please let me die, just for tonight…
This poem signifies a young woman’s inner struggle with wanting to
end the pain and suffering, but not wanting to end her life. Sometimes,
when there is no hope that a situation will get better, death seems like
a rational solution. There was still hope within this individual, but
sometimes that hope runs out if they don’t receive help.
This person suffered silently with her depression, like so many others,
for several years of her life. Fortunately, she was able to express her
pain through poetry, which served as a type of release. She wasn’t
diagnosed with depression until 5 years later.
Suicide and Mental Illnesses
Research has shown that
more than 90% of people who kill
themselves have depression or
another diagnosable mental
or substance abuse disorder
at the time of their death.
Depression & Suicide
• Clinical depression is one of the most
common mental illnesses and affects
nearly 19 million Americans each year (1
in 5 Americans)
• Most people who have depression do not
die by suicide; HOWEVER…
• Having major depression increases
suicide risk
• Depression is HIGHLY treatable
Depression & Suicide
 Each year, around 5,000 young people, ages 15-24,
lose their lives to suicide.
 The rate of suicide for this age group has nearly
tripled since 1960, making it the third leading
cause of death in adolescents and the second
leading cause of death among college-age youth.
 4 out of 5 individuals give CLEAR warning signs
before a suicide attempt.
-Mental Health America
More teenagers and young
adults die from suicide
than cancer, heart
disease, AIDS, birth
defect, stroke,
pneumonia and
influenza, and chronic
lung disease
COMBINED.
The Surgeon General Report on Mental
Health, 1999
The Impact
of Suicide
Suicide is a Serious
Public Health Problem
• In 1999, former Surgeon General Dr.
David Satcher declared suicide a
national public health problem
• In 2001, the National Strategy for
Suicide Prevention was completed
Suicide in Illinois
 Suicide is the 12th leading cause of death in Illinois
 1,177 people committed suicide in Illinois in 2009;
773 died by homicide
 In the U.S. around 36,000 people die by suicide as
compared to less than 15,000 deaths by homicide
 Suicide is the 3rd leading cause of death for
adolescents and young adults (ages 15-24)
 70+ years highest suicide rate in IL
 15 – 19 years highest attempt rate in IL
Suicide Prevention Resource Center (SPRC)
Suicide in Illinois
Illinois Suicide Prevention Alliance (ISPA)
Dedicated to reducing suicide in Illinois by raising
public awareness, lessening the stigma surrounding
it and making treatment accessible.
In 2004, passed the Suicide Prevention, Education
& Treatment Act in Illinois to develop and
implement the Illinois Suicide Prevention Strategic
Plan.
*The Illinois Plan can be downloaded from the Illinois
Department of Public Health website.
Suicide
vs.
Self-Injury
Key Definitions
• Suicide – self-inflicted death with evidence that the
person intended to die
• Suicide attempt – self-injurious behavior with a nonfatal outcome & evidence the person intended to die
• Suicidal ideation – thoughts of serving as the agent of
one’s own death
• Suicidal intent – subjective expectation and desire for
a self-destructive act to end in death
• Deliberate self-harm – willful self-inflicting of
painful, injurious acts without intent to die
Self Injury
• Typical onset of self-injury is puberty
• Self-injurious behaviors often last 5 – 10 years,
but can persist longer without treatment
• Self injurious behavior is a way for people to
cope with or relieve painful or hard-to-express
feelings – self-destructive cycle begins
• Goal is typically emotion regulation
• Generally not a suicide attempt, BUT if goes
untreated, can lead to suicide attempts
Self Injury
•
•
•
•
•
vs. Suicide
Goal of behavior is emotion
regulation, very different
from intention to die, but
also escaping pain
If behavior helps individual
reach goal, individual will
continue behavior
Cutting, burning, banging
head, scratching, carving, etc.
From DBT perspective Individual is lacking skills to
effectively: 1) interact on an
interpersonal basis, 2)
tolerate distress, 3) regulate
emotions, and 4) be mindful
of when to use these skills
Clients often report not
recognizing what preceded
desire to self-harm
•
•
•
•
•
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Goal is usually also to escape
unbearable pain
Believe behavior will lead to
death, whether actions are
lethal or cause minimal harm
Feel trapped, hopeless
Range in timing exists –
planned out thoroughly, all
the way to spur of the
moment decision
Usually warning signs,
whether timing of planning is
short or long
May be self-harming
behavior that accidentally
leads to suicide
Risk &
Protective
Factors
of Suicide
Who is Most At-Risk for
Suicide?
• More men than women die by suicide, BUT
attempts are higher in women
 Women attempt suicide 2 – 4 times as often as men
 Men die by suicide 4 times as often as women
 Highest rates among White, Non-Hispanic men
• Young people ages 10 – 19
In 2003 – 2004
 9% increase in boys aged 15 – 19 years old
 32% increase in girls aged 15 – 19 years old
 75.9% increase in 10 – 14 year old girls
What to look for in a person
who might be thinking about
committing suicide…
SIGNS
RISK FACTORS
 Talking about wanting to die
 Unusual neglect of personal
appearance
 Saying things like “Everyone
would be better off if I weren’t
around,” “There’s no point in
living anymore,” etc.
 Giving away personal possessions
 Expressions of rage/anger
 A sudden dramatic
improvement in mood
 Increase in self-harming
behaviors
 Access to weapons (guns,
knives, etc.)
 Substance abuse
 History of impulsive and/or
aggressive behaviors
 Signs of psychosis, bizarre
thoughts, hallucinations, etc.
 Family history of suicide, recent
exposure to another’s suicidal
behavior
 Previous suicide attempts
 Recent loss
 Sexual orientation
Risk Factor: Violence
• Domestic Violence Victims, Perpetrators and their
Families
– Women exposed to acute or prior domestic violence are
more likely than unexposed women to have made
suicide attempts
– Approximately half of U.S. homicides are followed by a
suicide
– Violent family interactions is a significant variable in
youth suicide and completions
– Violent people have a history of self-destructive
behavior
Risk Factor: Sexual Orientation
• Gay youth are 2 to 3 times more likely to
attempt suicide than other young people
• Survey questions related to sexual orientation
found elevated risk of suicide attempts
• Youth Risk Behavior Survey (YRBS)
(Gibson, 1989) and (Remafedi et al, 1998)
Risk Factor: Sexual Orientation
It has been found that suicide attempts among
youth identifying as GLBT are significantly
associated with:
Gender non-conformity
Stress
Other psychiatric symptoms Lack of support
Dropping out of school
Family problems
Homelessness
Substance abuse
Acquaintances’ suicide attempts
Violence
Early awareness of homosexuality
(Remafedi, Farrow, & Deisher, 1991; Schneider, Farberow & Kruks, 1989; D’Augelli & Hershberger, 1993;
Hershberger, Pilkington & D’Augelli, 1997; Remafedi, et al, 1998; Schneider, Farberow & Kruks, 1989;
Nicholas & Howard, 1998)
Warning Signs of Suicide
• Hopelessness
• Rage, uncontrolled anger, seeking revenge
• Acting reckless or engaging in risky activities,
seemingly without thinking
• Feeling trapped - like there's no way out
• Increased alcohol or drug use
• Withdrawing from friends, family and society
• Anxiety, agitation, unable to sleep or sleeping all the
time
• Dramatic mood changes
• Giving away personal possessions
• Talking about death, suicide
Wall of Resistance to Suicide
Counselor or therapist
Good health
Duty to others
Medication Compliance
Others?
Fear
Job Security or Responsibility Support of significant
for children
Job Skills
other(s)
Difficult Access
Positive
A sense of
to means
Self-esteem
HOPE
Religious
Calm
AA or NA
Pet(s)
Prohibition
Environment
Sponsor
Best
Safety
Treatment
Friend(s)
Agreement
Availability
-- Sobriety -Protective Factors
Crisis Intervention for those
who are Suicidal
Create a safety plan
Seek professional help
Remember a crisis is temporary and an
opportunity to impact change
Suicidal Behavior and Adolescence
The 1st suicide attempt usually occurs before the
age of 17
Family cohesiveness and religiosity serve as
protective factors for suicidal youth
How do we know
if someone needs help?
No thoughts of
harming self
Passive thoughts - “I
wish I were dead,” “My
family would be better
off without me”
Thoughts about
death, thoughts
about one’s own
death, thinking
about suicide
Beginning to
seriously consider
suicide, thinking
about a plan
Seriously
considering
suicide,
developed
a plan
Wants to die,
has a plan, has
access to
method to
implement plan
How can I help?
•
•
•
•
•
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•
•
•
Get an adult involved, someone you and the person trusts
Encourage loved one to go to someone they trust
Say, "I want you to live”
Encourage them to get help
Ask direct questions without being judgmental. Determine
if the person has a specific plan to carry out the suicide. The
more detailed the plan, the greater the risk
Be willing to listen, allowing them to express their feelings
and accepting their feelings
Get involved, becoming available and showing interest and
support
Stay in contact with the person, do not leave them alone
Be aware and learn the warning signs
Do NOT offer to keep secrets!
Symptom
Management
Strategies
What works…a combination of…
 Counseling:
Cognitive-Behavioral Therapy (CBT) and Interpersonal Therapy
have shown to be very effective
 Medication:
Antidepressant medication acts on chemical pathways of the
brain related to mood
 Support & Education:
Groups, educational literature, support system
Counseling
Cognitive Behavioral
Therapy
Interpersonal Therapy
 CBT focuses on the child’s
persistent cognitive
distortions
 It is also brief
 It is a brief approach
 It uses the therapy
relationship to repair other
relationships
 Other components include:






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Affective Education
Activity Planning
Problem Solving
Social Skills training
Self-instructional Training
Relaxation Training
Cognitive Restructuring
 It focuses on current
relationships
 Change happens through
insight and new interactions
Medication
 Psychotherapeutic medications may make other kinds
of treatment more effective
 How long someone must take a psychotherapeutic
medication depends of the individual and the disorder
 Psychotherapeutic medications are divided into 4
groups- antipsychotic, antimanic, antidepressant, and
antianxiety
 Be sure to discuss potential benefits and side effects
with your doctor and to report accurately the effect of
the medication in follow up appointments.
Choosing the Right Provider
Types of Health Care Providers
Provide Medication
Primary Care Physician
(MD)
Psychiatrist
(MD)
Provide Counseling
Licensed Clinical Psychologist
(Ph.D or Psy.D)
Licensed Clinical Professional Counselor
(LCPC)
Licensed Clinical Social Worker
(LCSW)
Licensed Marriage and Family Therapist
(LMFT)
Depression in the Classroom
 Frequent absences
 Excessive tardiness
 Inability to screen out stimuli
 Inability to concentrate
 Difficulty with time pressures & multiple tasks
 Difficulty handling negative feedback
 Sudden drop in grades
 Difficulty responding to change
 Refusal to participate in school activities
 Difficulty interacting with others
Depression in the Classroom
 Peer group change
 Defiant
 Social anxiety
 Fatigue
 Irritability
 Fidgety
 Restless
 Isolating
 Disruptive
 Quiet
What Can You Do to
Prevent Suicides?
• Know the warning signs and risk factors
• Ask the “Suicide” question
• Know referral resources in your school
and/or community
Classroom Management
Strategies
Ask parents what would be helpful to motivate
and decrease pressure for student
Consult regularly with parents, school support
staff, etc. ~ Don’t be the only person dealing with
the student’s issues
Designate a “safe” person in school
Give advanced warning of major changes to
students, if possible
Shorten assignments or allow more time to
complete
Break tasks into smaller parts
Classroom Management
Strategies
Provide refocusing assistance and prompts
Preferential seating by a teacher or positive peer
Word banks or alternative testing methods to
accommodate for retrieval problems
Provide assistance to see assignments recorded
accurately and all materials are packed
2nd set of books to be left at home
Keep a record of their accomplishments and show
them occasionally
Put corrections in the context of a lot of praise
and support
Classroom Management
Strategies
Reassure student they can catch up, be flexible
and realistic about your expectations
Avoid situations that might socially isolate or
ostracize (allowing students to choose team
mates)
Encourage gradual social interaction
Let them know you care without getting too
personal
Don’t make promises or lie to student
Be alert to suicidal thoughts and behaviors; take
threats seriously
Classroom Management
Strategies
Find student’s strengths and focus on them
Don’t ignore depressed student, it invites them to
give up
Help students focus on positives
Give adolescents a “feeling vocabulary”
Create a classroom environment where kids
aren't mean
GIVE FREQUENT & POSITIVE PRAISE
Enhancing Mental Health
Connectedness to school
Positive adult role models/relationships
Sports/Activities
Social Interest
Modeling Stress Management
Communication
Setting Limits
Enhancing Mental Health
Teach children feelings vocabulary
Be accurate with your feedback
Provide constructive experiences
Teach them to take pride in themselves and
their accomplishments
Encouragement
Use Positive and Kind Humor
LAUGH
What Can MHAI Offer?
 Classroom/Community Seminars (for teens, children,
faculty, parents, and other adult caregivers)
 Educational Activities
 Treatment Resources and Referrals
 Mental Health Screenings for Youth and Adults
 Educational Materials/Pamphlets
**Please refer to the full list of MHAI’s scope of services
to schools and communities.
Student Education
EXAMPLE - Student Program Schedule:
Day 1:
-Depression and Suicide
-Bipolar Disorder
-How to Ask for Help
-Where to Go for Help (Resources)
Day 2:
-Anxiety Disorders
-Stress
-Taking Care of Your Mental Health
-Activity/Evaluation
Closing thought…
Resources
Suicide is one of the most preventable causes of death.
Remember, it only takes one person to save a life!
For further information, contact:
Mental Health America of Illinois (MHAI)
Carol Gall, MA, Executive Director
[email protected] x324
Katie Mason, LPC
Program Director of Public Education and Disaster Mental Health
[email protected]
312-368-9070 x322
Information and Resource Line x310
Resources:
www.itonlytakesone.org
www.mhai.org
www.reachout.com
www.afsp.org
www.suicidology.org
Helpful Numbers
• National Suicide Prevention Lifeline
– 1-800-273-TALK (8255)
– www.suicidepreventionlifeline.org
• Trevor Helpline (For LGQ youth)
– 1-800-850-8078
• National Runaway Switchboard
– 1-800-RUNAWAY (786-2929)
• Self-Injury Hotline
– 1-800-DONTCUT (366-8288)
Thank you!
Questions?