Baseline Survey

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Baseline Survey
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baseline survey and put your completed survey in
the box provided. Thank you!
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Ending A Deadly Silence Florida Suicide
PreventionGatekeeper Training
Insert your name and agency

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Suicide Prevention In Aging Populations
What to Look For What to Do How to Help
Adapted with permission from the Washington State
Youth Suicide Prevention Program and the Maine
Youth Suicide Prevention Program
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Pieces of the Puzzle

• All need to be educated
• Willing to talk more openly
• when something in our gut
• raises a red flag
• Prevention is often a matter of a caring
• person with the right knowledge being
• available in the right place at the right
• time.

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Silent Epidemic

• Serious public health
• problem
• Preventable
• Neither random nor inevitable
• Research shows that during our lifetime
• 20 of us will have a suicide within our
• immediate family
• 60 of us will personally know someone who
• dies by suicide

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Attitudes and Beliefs Taboo Nature of
Suicide

• Taboo subjects suicide, rape, child abuse,
  mental illness, drug and alcohol abuse, incest
• Myths of Taboo Subjects
• History of suicide sin, crime, mental illness

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Truth or Myth Handout What Do You
Know About Suicide?
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Truth Or Myth
Survivors at lower risk MH professionals only
ones who can help More common with the rich No
correlation between drugs, alcohol and
suicide As many as 2 youth attempts to every
death
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Most suffer from depression More Floridians die
by suicide than homicide Most have made up their
minds More suicides during Christmas
holidays People who are suicidal tend to hide it

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Need to take all talk seriously Suicide rates
for 15-24 year olds have more than doubled since
the 1950s while other rates stayed about the
same Asking may encourage the idea Elderly have
the highest rate Important not to break the
trust of confidentiality
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Attitudes Towards Elderly Suicide

• Society is more accepting of death and dying with
  the elderly compared to adolescents years of
  potential life lost much greater
• Less media attention towards elderly suicides
• Less attention in research and literature
  compared to adolescents and young adults

Source AFSP - PubMed search of almost 10,000
articles from 1966-1999 21.4 included Ages 65
(of these, 3.1 were 80)
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Characteristics of Elderly Suicide
Fewer warnings of intent Attempts more
planned Less likely to survive More frail
More isolated (less likely to be rescued) More
violent methods (Over 70 with firearms)
Elderly made up 12.4 of 2004 population but
represented 16 of the suicides Source CDC
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As many as 75 of depressed older Americans are
not receiving the treatment they need, placing
them at an increased risk of suicide Are less
likely to reach out by calling a crisis line
than their younger counterparts Although older
adults attempt suicide less often than those in
other age groups, they have a higher
completion rate Source American Association of
Suicidology and CDC
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National Statistics
32,637 suicides for the US (89.4 per
day) Average of 1 older person every one hour
and 37 minutes killed themselves White men over
the age of 85 are at the greatest risk of all
age-gender-race groups In 2005, 85 year old
white males had a suicide rate of 48.72 per
100,000 (11.0 for Nation)
Source CDCs WISQARS website and Fatal Injury
Reports
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Attempted Suicides
Attempts are most common among the young. 3
female attempts for each male attempt
Attempted Suicides
Suicides Deaths
Young 1001
Old 41
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Florida Statistics
In 2007, there were 2,570 suicides in Florida Of
those lost to suicide, 550 were over the age of
65 Tragically, on average, over 10 of Floridas
elderly over the age of 65 die by suicide each
week
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Not Just Statistics
Statistics alone dont paint the whole
picture Suicide is devastating to family,
friends, and communities Opportunities exist to
help
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Understanding People in Crisis Why Everyone Is
Vulnerable
Stressors are infinite
Assets are finite
Pressures
Assets
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A Person May Feel They
Cant stop the pain Cant think clearly Cant
make decisions Cant sleep, eat or work Cant
make the sadness go away Cant see the future
without pain Cant see themselves as
worthwhile Cant get someones attention
Source AAS _at_ www.suicidology .org
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Cup Full of Problems
Each cup represents a problem that a person may
be having. Only rule is that the cups cannot be
stacked inside one another.
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A Basic Model of Living
Pain Tolerance
Adaptive Factors
Maladaptive Factors
Pain Threshold
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When the pain tolerance threshold is broken
(when the pain is intolerable), dangerous
behaviors may follow.
Suicide
Drug Abuse
Psychotic Break
Violence
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Depression and Suicide
Often goes undiagnosed until a crisis occurs
Not a normal part of aging A medical condition
that can and should be treated AT ANY
AGE Untreated depression in the elderly is
more likely to lead to suicide than in any other
group
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Common Symptoms Elder Depression
Prolonged sadness Weight increase or
decrease Social isolation Inability to
sleep Lack of energy Vague physical complaints
frequent doctor visits without relief all
tests negative Irritability, mood
swings Inability to concentrate Talk of
worthlessness, not being needed, excessive and
unwarranted guilt
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The Reality of It
More than 2 million of the 34 million Americans
age 65 or older suffer from depression
Depression present in vast majority of
suicides for those 60 years and older Major
depression disorder most associated with
suicide in the elderly widely under-recognized
and under-treated Source Depression and
Suicide Facts For Older Adults, NIMH
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• Points to Consider (Group discussion)
• Why do people kill themselves?
• What type of families do they come from?
• What type of thoughts/feelings are they
• having?
• How are they behaving?
• How are they communicating/expressing
• themselves?
• Who will know that they are suicidal?
• What changes in our culture or society
• have influenced suicide?
• What makes people safe?

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Risk Factors For Older Adults
Depression Prior suicide attempt Marital
status single or divorced Physical illness,
pain, and functional impairment Isolation and
decreased social support Personality
inflexibility, rigid coping Family discord,
losses (recent bereavement) Major changes in
social roles (retirement) Access to firearms
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Warning Signs and CluesWhat To Look For
The red flags that something is wrong Changes
in a persons behavior, feelings, and beliefs
about oneself that are maladaptive or
out-of-character
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I Ideation S Substance Abuse
P Purposelessness A Anxiety T Trapped H
Hopelessness W Withdrawal A Anger R
Recklessness M Mood Change Source American
Association of Suicidology, November 2003
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Some Signs Demand Immediate Action
Statements about death, hopelessness,
helplessness or worthlessness Preoccupied with
death Stockpiling medications or obtaining
weapon Putting affairs in order giving away
things Unusual visiting or calling people one
cares about Suddenly happier, calmer
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Tragedy Of Homicide - Suicide
Homicide-Suicides occurring more
frequently Twice as prevalent among older adults
Seldom are these acts of love Most often
victims are not willing participants Nationwide,
over 1,000 homicide-suicide related deaths occur
each year among those age 55 and older
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In Summary
There is no typical suicide victim There are no
absolute reasons for suicide There are no
all-inclusive predictive lists of warning signs
or a definitive method for determining if a
person is or is not suicidal Suicide is always
multi-dimensional High lethality implies
interventions must be aggressive
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Protective Factors

• Positive conditions and
• personal/social resources
• Promote resiliency and reduce the
• potential for suicide
• Ability to manage or cope with
• adversity or stress

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Effective clinical care for mental, physical, and
substance use disorders Restricted access to
lethal means Support through ongoing medical and
mental health care relationships Strong
connections to family and community
support Skills in problem solving, conflict
resolution, and nonviolent handling of
disputes Cultural beliefs that discourage
suicide and support self-preservation Source
National Strategy for Suicide Prevention
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Protective Factors For Older Adults

• Sense of purpose and identity
• Access to resources
• Supportive networks
• Supportive family relationships
• Help-seeking behaviors
• Ability to live independently
• Involvement in community activities
• Better preparation for retirement

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Isolation Depression Death of
spouse Gun at home
Supportive Family MH treatment Supportive
networks Restricted access to lethal means
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What to Look For

• What are some of the
  warning signs/red flags?
• What are the risk factors? Protective factors?
• What other information would be helpful?
• How could you get the information?
• Next step?

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• Personalizing Crisis Exercise
• What helps?
• What hurts?

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Intervention Steps and Goals
Get through crisis without harm Listen
establish rapport Identify and clarify
problem Pinpoint feelings evaluate hopelessness
Talk about suicide Evaluate lethality Identify
and utilize resources
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Remember
People in crisis feel overwhelmed, overloaded and
confused Not thinking clearly tunnel vision
Almost all are ambivalent Suicidal behavior is
an act of communication They want someone to
listen, someone they can trust, someone to
care Source National Center for Suicide
Prevention Training Workshop Maine Suicide
Prevention Program
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What To DoIntervention - 3 Basic Steps
SHOW YOU CARE ASK THE QUESTION GET
HELP Adapted with permission from the
Washington Youth Suicide Prevention Program
http//www.yspp.org
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SHOW YOU CARE
Trust your judgment Be Genuine - show them you
truly care Share observations and
concerns Concern can counter their sense of
hopelessness Reflect what you hear LISTEN!
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Bad News No script for these situations Good
News They may forget what you said, but they
will never forget how you made them feel. Carl
W. Buechner Dont worry about doing or saying
the right thing. Your genuine concern is what
is most important
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Ask The Question
Dont assume they arent the suicidal type
Be direct. What I hear you saying is youre
in a lot of pain and youre thinking of killing
yourself Are you thinking about
suicide? Do they have a plan, the means to
carry out the plan more detailed the plan
the greater the risk Dont have to
solve all their problems but you must get
help
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Suicide Paraphrase Activity
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Remain calm, non-judgmental and
understanding Emphasize the temporary
time-frame of suicidal crisis Emphasize the
normality of suicidal thoughts Help identify
and suggest alternatives, encourage positive
action
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Get Help - How To Help

• Your support in building hope and finding help
  truly can make the difference between life and
  death.
• If you have any reason to suspect a person may
  attempt suicide or engage in self-harm,
• DO NOT LEAVE THE PERSON ALONE

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Resources

• Supportive friends
• Family members
• Clergy
• Mental Health Agency
• Counselor or therapist
• Family physician
• Local hospital emergency room
• Crisis Center 9-1-1
• 1-800-273-TALK

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When I began considering suicide, I knew that I
needed serious help. My resident advisor
helped me call a local hotline where I got some
good referrals. It was just a phone call, but it
was the starting point that got me to the
professional help I needed. Leah Source
National Institute of Mental Health What Do
These Students Have In Common?
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Additional Resources

• Wide range of local support group- mental health,
  survivors, AA
• Law enforcement 9-1-1 and Baker Act
• Local crisis center
• Meals on Wheels
• Area Agency on Aging
• Faith community

• FL Abuse Hotline 1-800-96ABUSE
• Substance Abuse programs
• Community health department
• Elder Helpline
• 1-800-955-8770
• Elder Abuse
• 1-800-962-2873

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Group Role Play What is Helpful Role Play

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Postvention Is Prevention
One of the primary goals of suicide postvention
is to prevent further suicides. Although rare, a
suicide in the community (or even a remote
suicide that receives substantial press coverage)
can contribute to an increased risk for suicide.
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Suicide Postvention

• Assist and support with processing reactions
  grief resolution
• Working to prevent additional suicides by
  attending to those at risk
• Identify and closely monitor those close to the
  victim and others known to be at risk (suicidal
  in the past) provide support/counseling as
  needed

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Survivors Of Suicide
Anyone whose life has been impacted by a suicide
death family, friends, co-workers those left
behind to pick up the pieces after the shattering
experience of a suicide death Survivors are
themselves at a higher risk for suicide and
emotional problems People grieve in different
ways - grieving can be postponed but never
avoided
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Stigma

• Survivors may find their social network, perhaps
  even their friends or clergy, have judgmental or
  condemning attitudes about suicide
• Cultural and religious taboos can serve to
  isolate and stigmatize survivors
• Lack of social support can increase survivors
  risk of complicated grief, depression and suicide

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Some Common Survivor Responses

• Shock, disbelief, fear, awkwardness
• Difficulty accepting the death was by suicide
• Feelings of rejection and abandonment
• Often hyper vigilant afraid of another
  loss/death

• Struggle to make sense of it
• Anger
• Guilt over failed responsibilities
• Isolation caused by self-imposed shame
• Blame

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Helping Survivors

• Patience for the time it takes to heal
• Listening without judging
• Accepting the intensity of the individuals grief
• Sensitivity to difficult times

• Acknowledging that the death is a suicide
• Providing information on suicide and grief
• Sharing memories
• Support groups - SOS

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Conclusion

• It doesnt take a
• professional to save a life
• We are all gatekeepers
• Preventing suicide is
• everyones business yours
• and mine
• Together we can end this
• deadly silence

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Thoughts or Questions Closing Comments
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Post-training Survey
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the box provided.