Self InjurySuicide Prevention Gatekeeper Agenda

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Self Injury/Suicide Prevention Gatekeeper Agenda

• Clara Cáceres Contreras
• ccontreras_at_esc1.net
• 956-984-6125
• www.esc1.net

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Why the School Setting?

• Adolescents spend one third of their day in
  school.
• The average classroom has 3 students who have
  attempted suicide.
• School education codes mandate not only to
  educate but also to protect students.
• 5.2.2 District Improvement -Plans Strategies for
  improving student performance, including
  instructional methods, methods for addressing
  the needs (of students) for special programs
  (e.g., suicide prevention, conflict resolution,
  violence prevention, dyslexia treatment
  programs) drop out reduction discipline
  management staff development career education
  for students and accelerated education

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Why the School Setting?

• Schools have been held liable for not taking
  action to protect at-risk students.
• At school students have the greatest exposure to
  multiple helpers.
• Research has found that the schools provide an
  ideal and strategic setting for preventing
  adolescent suicide.

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School Climate

• School Connectedness
• Meaningful Participation
• Academic Achievement
• School Safety Security
• Training
• Respectful Discipline
• Aesthetically Pleasing-Physical Environment

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The Schools Role Prevention

• Incorporate suicide prevention and intervention
  as an integral part of school-based mental health
  services
• Raise awareness of risk factors
• Bolster protective factors
• Identify students at risk
• Intervene with at risk students
• Create a culture of connectedness

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The Role of School StaffPrevention/Gatekeeper

• Research has found that 25 of all teachers
  sampled in a study reported that they had been
  approached by a suicidal/self-injury teen.
• Research also suggests that school staff believe
  that they have a larger role in identifying
  students at risk for suicide.
• School staff can be a lifeline to a student who
  is in crisis.

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Suicide in the US

• Suicide is the third leading cause of death for
  youth ages 15-24
• Suicide rates for ages 10-14 have increased by
  51 between 1981 and 2004
• Approximately 1 in 5 teenagers seriously consider
  suicide
• 1 in 12 attempt suicide yearly in the US with
  700,000 requiring medical attention

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True / False

• Adolescent suicide is an increasing problem in
  the United States.
• Most teenagers will reveal that they are suicidal
  or have emotional problems for which they would
  like emotional help.
• 3. Adolescents who talk about suicide do not
  attempt or commit suicide.
• Educating teens about suicide leads to increased
  suicide attempts, since it provides them with
  ideas and methods about killing themselves.
• Talking about suicide in the classroom will
  promote suicidal ideas and suicidal behavior.
• Parents are often unaware of their childs
  suicidal behavior.

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True / False Answers

• The majority of adolescent suicides occur
  unexpectedly without warning signs.
• Most adolescents who attempt suicide fully intend
  to die.
• There is a significant difference between male
  and female adolescents regarding suicidal
  behavior.
• The most common method for adolescent suicide
  deaths is drug overdose.
• Because female adolescents die by suicide at a
  lower rate than male adolescents, their attempts
  should not be taken seriously.
• Not all adolescents who engage in suicidal
  behavior are mentally ill.

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True / False Answers

• Suicidal behavior is inherited.
• Adolescent suicide occurs only among poor
  adolescents.
• The only one who can help a suicidal adolescent
  is a counselor or a mental health professional.
• Adolescents cannot relate to a person who has
  experienced suicidal thoughts.
• If an adolescent wants to commit suicide, there
  is nothing anyone can do to prevent its
  occurrence.

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Self-Mutilation Versus Suicide

• The intent of self-mutilation is different than
  suicide-some use it as a form of
• Emotion regulation
• It calms me down.
• Releases endorphins and changes the serotonin
  levels in the brain
• The relief is within seconds

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Self-Mutilation Versus Suicide

• Self mutilation is not done with the intent to
  die.
• The suicidal person usually views death as the
  only way to stop the internal psychic pain. So
  death is usually the intent of their behavior.
• However, those who self-mutilate are at an
  increased risk for suicide.
• They need to be monitored and assessed for
  suicidality.

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Understanding Self Injury

• Self-Injury
• Self-Harm
• Self-Mutilation
• Cutting

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Co-Morbidity

• History of abuse
• Sexual abuse
• Emotional abuse
• Disordered eating
• Mood disorders as well as borderline
• personality disorder (BPD)
• Suicidality

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Those That Self-Injure

• Are not the ones that get piercing and tattoos.
• Are often hard to identify.
• Rarely participate in activities that require
  changing clothing.
• Few close friends.

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Incidences

• Incidences 1 of every 200 girls between 13 19
  self-harm.
• 2 million cases in U.S.
• Alone Of the cases at least 11,000 are young
  men.
• 72 of teen girls have thought about self-injury
• Prevalence rate among adolescents varies 10 to
  38

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Deliberate Self-Injury in Adolescentsand Young
Adults
I think my greatest fear is to be forgotten. A
teacher I had last year doesnt even remember my
name -- it makes me think that no one remembers
me. How do I know I exist? At least I know I
exist when I cut -- Self-Injury Message Board
Post
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Self Injury IS NOT about Suicide

• ITSABOUT RELIEF FROM
• Pain Anxiety Fear
• It helps Control the harm they cause themselves
• Behavior from never learning appropriate coping
  mechanisms

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Self-Injury is NOT used for

• Sexual pleasure
• Body decoration
• Religious rituals
• Cultural compliance
• Fitting in or being cool Suicide

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Some Key Points on Self-Injury

• Intent-help oneself
• Immediately harmful
• Immediate response Repeated

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A Deliberate Act Used to Alter Mood by Inflicting
Physical Violence

• Scratching
• Chewing on inside of cheek
• Breaking bones
• Using ice to burn oneself
• Dripping acid onto Skin

• Cutting
• Skin-picking
• Hair-pulling
• Burning
• Punching ones
• Ingesting a caustic substance or sharp objects
• MOST COMMON

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Self-Injury is commonly done to

• Control anger, hurt or rage
• To self-punish
• To calm and remove overwhelming tension
• To ground oneself to reality
• To physicalize what could not be verbilized.

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Why do people hurt themselves?

• Self-mutilation is a desperate attempt to have
  some control over unbearable feelings. When a
  teen or young adult hasnt learned healthy ways
  of managing these emotions they turn to pain as a
  way to blot out the emotional pain or gain a
  sense of control over the pain they feel. In a
  strange way they are really trying to protect
  themselves from something even more painful than
  physical pain.
• Dr. Paul, Healing Your Aloneness

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Destructive Self Injury Technology

• Nyteangel017
• Worthless_corpse
• Nobody Special
• Amy
• Wolfbane
• NoneSuchSolo
• Seraphicblood
• BrokenGlass
• DoomedYouth
• Giltter_fairy
• TearfulAngel
• LivingGhost

• Self-Injury Message Boards
• Music
• Movies

Whitlock, J. L., Powers, J. L., Eckenrode, J.
(2006). The virtual cutting edge The internet
and adolescent self-injury. Developmental
Psychology, 42(3), 1-11.
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What Message Boards Do On-line

• Solicit and provide informal support
• Talk about triggers
• Concealment
• Addiction
• Soliciting and sharing techniques
• Whitlock, J. L., Powers, J. L., Eckenrode, J.
  (2006). The virtual cutting edge The
• internet and adolescent self-injury.
  Developmental Psychology, 42(3), 1-11.

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• is sullen and too thin
• She starves herself to rid herself of sin
• And the kick is so divine when she sees bones
• beneath her skin
• And she says
• Hey baby can you bleed like me?
• C'mon baby can you bleed like me
• Chris is all dressed up and acting coy
• Painted like a brand new Christmas toy
• He's trying to figure out if he's a girl or he's
  a boy
• He says
• Hey baby can you bleed like me?
• C'mon baby can you bleed like me
• Doodle takes Dad's scissors to her skin
• And when she does relief comes setting in
• While she hides the scars she's making
• underneath her pretty clothes
• She sings
• Hey baby can you bleed like me?

• And she cries
• Hey baby can you bleed like me?
• C'mon baby can you bleed like me
• JT gets all fucked up in some karaoke
• bar
• After two drinks he's a loser after
• three drinks he's a star
• Getting all nostalgic as he sings "I
• Will Survive"
• Hey baby can you bleed like me?
• C'mon baby can you bleed like me
• Hey baby can you bleed like me?
• Oh, c'mon baby can you bleed like me
• You should see my scars
• You should see my scars
• You should see my scars
• You should see my scars
• And try to comprehend that which
• you'll never comprehend

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It's when I'm really upset and isolated. When
the emotions are so strong and no one seems to
understand. It builds up inside so much that I
get a headache and I feel completely isolated and
not able to express what I feel. Self-injury is
an escape at that one moment. It's physical pain
it lets out everything I hold inside. It
just lets me relax. Interviewee, 2005
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Self Injury0319FromLocalGirl83Views
1422ltlt Now Playing

• slowlyfading (4 weeks ago)
• thankyou. it's nice to know that
• somebody out there understands
• what it's like hugs
• freddyzchic19 (3 weeks ago)
• Wow..I have no words to describe that really.
  Very moving. I used to cut and it
• was difficult for me to stop. Some of those
  injuries were really bad, i'm not sure
• how the people lived through them.
• lxgemxl (2 weeks ago)
• One of the reasons I cut was because of my ED.
  I'd do something and then get
• that creeping feeling. I got it a lot whilst I
  was trying to recover from Bulimia. I
• think this video was a good idea, certainly the
  bits that said we are normal. A lot
• of my friends have turned away because they just
  hate me for what i do to
• myself.
• Licorice1977 (2 weeks ago)
• I used to cut too and every time I see people
  cutting it makes me want to do it
• again( Unfortunately I have turned to other
  methods of self-loathing that are just
• as dangerous.)
• slowlyfading (4 weeks ago)

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The Paradox of Over and UnderConnectedness

• A pretty common trigger was being in my room by
• myself at night or in the evening and not feeling
  a way
• for there to be closure for the end of my day. I
  would feel like I had this whole day and all this
  stuff happened and I had all of these big
  emotions. My parents were kind of distant - they
  wouldn't come and say good night as I was going
  to bed, or I wouldn't go say goodnight to them.
  There was no marker of how the day should end and
  that was an emotionally loose feeling for me. So
  sometimes I'd cut to make a concrete end.

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Self-Injury Prevention

• Education / raising awareness
• Avoid talking about specific forms practices
  with youth
• DO raise awareness about Self-Injury Behavior
  forms practices among staff
• Focus on increasing staff and student capacity
  to recognize distress in themselves and their
  friends
• Encourage disclosure to adults able to help
• Enhance youth capacity to cope with adversity
  and negative feelings
• Assess and build on other coping mechanisms

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Self-Injury Prevention

• Incorporate education about alternative coping
  strategies whenever possible
• Address sources of stress in external environment
• Enhance social connectedness
• Build on adolescent strengths
• Heighten adolescent visibility and voice
• Promote and advertise positive norms related to
  help-seeking and open communication
• Teach media literacy

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Self-Injury Intervention

• Respond non-judgmentally, immediately and
  directly
• Avoid emotional displays effusive support or
  shock
• Show respectful curiosity
• Assure that client receives rapid attention and
  assessment
• Assess lethality and rarity of form
• Assess immediate safety needs

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Techniques to stop Self-Injury

• Count the breaths as you exhale make sure you
  breathe slowly.
• Stomp your feet to remind yourself where you are.
• Call a friend and talk about something fun.
• Take a warm relaxing bubble bath or shower.
• Eat something and enjoy it, think about it
• Mentally remind yourself that the incident is
  over and give yourself permission to not think
  about it right now!

• Keep a rubber band on your wrist and pluck
  it-feel it sting.
• If you have a pet use that moment to touch them,
  pet them or play with them.
• Listen and sing along to familiar music even
  getting up and dancing.

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Some Alternatives To Self-Injury

• Go out, be near people
• Call a friend
• Call 800-DONTCUT
• Hold ice to sensitive skin
• Eat ice cream fast for brain freeze
• Meditate

• Take a COLD shower
• Exercise
• Journal,
• Draw, Paint
• Identify what is hurting so bad that you would
  rather Self Injure, than feel it!

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Why Do Individuals Witha History of Destructive
Self-Injury Stop?

• Develop alternate coping mechanisms (can be
  positive or negative)
• Mature
• Recognize effects on others
• Experience fear after a severe incident
• Start to dislike the marks it leaves behind

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Sample Protocol Framework

• Full staff training on DSI signs, symptoms, and
  protocol
• Identification of point person (people)
• Ideally this consists of someone with therapeutic
  and or medical training able to establish rapport
  with students
• Point person should compile a list of outside /
  local resources (therapists with experience in
  Self-Injury and adolescents)
• Adapted from Walsh, B. W. (2005). Treating
  self-injury A practical
• guide. New York Guilford Press.

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Gatekeeping Three Easy Steps You Take Every Day

• QuestionNotice signs ask
• PersuadeAsk facts permission to get them help
• Refer Identify needs-reach out for help

Remember to keep it simple like CPRwill provide
assistance until you hand them over to qualified
staff!
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Risk Factors(Issue Brief 3a-Risk Protective
Factors and Warning Signs)Multifactorial
Causation-9 out of 10 youth that engage in
suicidal behavior give clues

• Risks
• Previous suicide attempt
• Substance abuse disorder
• Feeling hopelessness, isolation, living alone, or
  runaways
• Parental Psychopathology (depressive
  disorder/mood disorder)
• Access to firearms
• Physical/sexual abuse
• School difficulties (grades, attendance, conduct
  disorder or disruptive, aggressive, impulsive
  behaviors, juvenile delinquency)
• Life stressors/interpersonal losses,
  relationships, legal disciplinary problems
• Sexual orientation (homosexual, bisexual,
  trans-gender youth, identity issues)
• Chronic physical illness
• Contagion or imitation (exposure to media,
  friends, or acquaintances)

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Protective Factors(Issue Brief 3a-Risk
Protective Factors and Warning Signs)Multifactor
ial Causation-9 out of 10 youth that engage in
suicidal behavior give clues

• Protective
• Family cohesion
• Good coping skills
• Good academics
• Impulse control
• Feeling connected to school
• Good peer relationships
• Lack of access to means suicidal behavior
• Advise seeking/help seeking behaviors
• Problem solving/conflict resolution
  skills/abilities
• Opportunities for meaningful participation/social
  integration
• Sense of worth/confidence
• Stable environment
• Access to care, mental, physical, substance
  disorders
• Responsibility/accountability for others/pets
• Religiosity

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• Early Warning Signs
• (Issue Brief 3a-Risk Protective Factors and
  Warning Signs)

• Withdraw from friends and family
• Preoccupation with death
• Marked personality change serious mood changes
• Difficulty concentrating
• Difficulties in school (decline in quality of
  work)
• Change in eating sleeping habits
• Loss of interest in once pleasurable things
• Frequent complaints about physical symptoms,
  often related to emotions, such as stomachaches,
  headaches, fatigue, etc.
• Persistent boredom
• Loss of interest in things one care about

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Late Warning SignsIssue Brief 3a-Risk
Protective Factors and Warning Signs)

• Openly talking about suicide or a plan
• Exhibiting impulsivity such as violent actions,
  rebellious behavior, or running away
• Refusing help, feeling beyond help
• Statements of hopelessness, helplessness or
  worthlessness
• Giving away favorite possessions,
• Complaining of being a bad or rotten person
• Inability to tolerate praise or rewards
• Verbal statements, hints, such as, you will not
  need to worry about me much longer or I wish I
  were dead
• Suddenly cheerful after a period of depression
  may mean student has already made up his mind to
  his problems by ending his life

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Resources

• Books
• Treating Self-injury A practical guide
• - Walsh, B. W. (2005).. New York Guilford
  Press.
• Bodily Harm The breakthrough treatment program
• for self-injurers.
• Conterio, K., Lader, W. (1998). New York
  Hyperion Press
• Websites
• Safe Alternatives www.selfinjury.com
• Self-Injury and Related Issues
• www.selfinjury.com
• Cornell Research Program on Self-Injurious
  Behaviors
• www.crpsib.com
• Public Health Public Policy
• Zita Lazzarini, JD, MPH
• Division Director and Associate Professor