Suicide

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Suicide

• A permanent solution to a temporary problem.

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Suicide facts

• Every four hours in America a child commits
  suicide (Childrens Defense Fund, 1999)
• An estimated 10-25 of the students in any high
  school are at risk for suicide in any given
  school year (Hahn, cited in Suicide in
  Children, 1998)

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Suicide Facts

• In 1995, according to the CDC (1998a) 2,227
  American children ages 10-19 year old committed
  suicide, and it is estimated that for every
  completed suicide there are 100-200 suicide
  attempts (Suicide Facts, 1998)

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Suicide Facts

• The United States has the highest suicide rate of
  26 industrialized nations studied by the federal
  government, a rate that is double that of other
  countries, according to CDC medical
  epidemiologist Dr. Etnienne Krug (U.S. Tops in
  Child Murder, 1997).

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Suicide Facts

• Since 1950, the rates of unintentional injury,
  disease, and congenital anomalies have decreased
  among children in the United States, but
  suicide rate have quadrupled (U.S. Tops in Child
  Murders, 1997).

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Suicide Facts

• Suicide is the third leading cause of death for
  youth between the ages of 15 and 24 and fourth
  for those 10-14.
• The suicide rates of those between the ages of 10
  and 14 has increased 196 in the last 15 years.
• Overall, African Americans have had the highest
  increase in suicide completion rates in the
  1990s.

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Suicide Facts

• Gay and lesbian youth are 200-300 more likely to
  attempt suicide and they may comprise 30 of
  youth suicide annually.
• More teenagers died from suicide than from
  cancer, birth defects, AIDS, pneumonia,
  influenza, and chronic lung disease combined.

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The relationship between suicide and homicideA
poem by a school shooter

• Sinking into my bed
• Homicidal thoughts filling my head
• Suicidal thoughts not gone, but fleeting
• Because it is other peoples death I am seeing
• Suicide or homicide
• Into sleep I am sinking
• Why me I am thinking
• Homicidal and suicidal thoughts intermixing
• My lifes not worth fixing
• Prior to school shootings ¾ of all attackers
  threatened to kill themselves, tried to kill
  themselves, or made suicidal gestures.

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Nine Facts about Suicidal Individuals

• The overwhelming majority of suicidal people
  (perhaps 95 of them) do not want to die.
• The typical suicidal person wants to be rescued
  but has difficulty asking for assistance.
• The suicidal person is confused and is searching
  for a strong, authoritarian person to direct his
  emotional traffic.

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Facts continued

• The suicidal person is in a highly suggestible
  state. They will likely respond to a voice of
  authority demanding that they behave in a
  prescribed manner.
• Most suicidal people experience a suicidal
  episode only once in their lives.
• People are acutely suicidal for only a brief
  period of time.

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Facts continued

• It is doubtful that anyone is constantly suicidal
  for an extended period of time.
• The three important words that best describe a
  suicidal person are
• Hopeless
• Helpless
• Hapless
• The typical suicidal person is experiencing
  multiple problems at the same time.

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• Erosion
• Suicide is not a spontaneous activity.
• The precipitating event is not the cause of the
  suicide. There is no single cause of a suicide
  only causes (plural).

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• As a form of communication
• If you understand that suicide is a demonstrative
  form of communication you will be less likely to
  treat the suicidal person in a punitive manner.
• If you understand that suicidal behavior is an
  extreme form of communication, you will be more
  likely to recognize the early warning signs of
  suicidal risk.

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Ambivalence

• Ambivalence is the emotional state most closely
  associated with suicidal behavior.
• Suicidal individuals often feel that they want to
  live and die at the same time.
• Ambivalent feelings are most prominent shortly
  before the person begins to harm himself
  (herself).
• The suicidal person is much more negative about
  life than positive about death.

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Warning signs of suicide

• Previous suicide attempts or threats
• Prolonged depression
• Means to complete the suicide have been secured
• Preoccupation with suicide themes or death
• Not tolerating praise or rewards

16
Warning signs continued

• Destructive or repetitive behavior
• Scratching, cutting, or marking on the body
• Becoming suddenly cheerful after a period of
  depression (this may indicate that the decision
  to commit suicide has been made).

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Warning signs continued

• Loss of interest in pleasurable activities
• Decline in quality of school work
• Alcohol or drug use
• Marked personality and/or behavior change
• Persistent boredom, inability to concentrate

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Warning signs continued

• Risk-taking behavior
• Physical symptoms associated with emotion (e.g.
  stomach ache fatigue)
• Putting affairs in order
• Withdrawal from friends, family or activities
• Verbal hints

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Risk factors

• Previous suicide attempts
• Current ideation, intent, and plan (resolve)
• Exposure to suicide and/or family history of
  suicide
• Mental disorders particularly mood disorders
  such as depression and bipolar disorder
• Personality disorders (conduct and borderline)

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Risk factors continued

• Influence of significant people family members,
  celebrities, peers who have died by suicide
  both through direct personal contact or
  inappropriate media representations.
• Local epidemics of suicide that have a contagious
  influence

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Risk factors continued

• Co-occurring mental and alcohol and substance
  abuse disorders
• Hopelessness and helplessness
• Impulsive and/or aggressive tendencies
• Barriers to accessing mental health treatment
• Relational, social, work, or financial loss
• Physical illness

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Risk factors continued

• Easy access to lethal methods, especially guns
• Unwillingness to seek help because of stigma
  attached to mental and substance abuse disorders
  and/or suicidal thoughts
• Cultural and religious beliefs for instance,
  the belief that suicide is a noble resolution of
  a personal dilemma

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Risk factors continued

• Isolation a feeling of being cut off from other
  people
• Ineffective coping mechanisms and inadequate
  problem solving skills
• A confluence of multiple stressors (discipline,
  rejection/humiliation, end of romantic
  relationship, conflict with family or peers,
  unmet school goals

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Protective Factors

• Effective problem solving and interpersonal
  skills including conflict resolution and
  nonviolent handling of disputes.
• Contact with a caring adult.
• A sense of involvement/belonging to ones school,
  based on opportunities to participate in school
  activities and contribute to the functioning of
  the school (effective, positive school climate).

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Protective Factors continued

• Effective and appropriate clinical care for
  mental, physical, and substance abuse disorders
• Easy access to a variety of clinical
  interventions and support for those seeking help
• Restricted access to highly lethal methods of
  suicide

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Protective Factors continued

• Family and community support
• Support from ongoing medical and mental health
  care relationships
• Cultural and religious beliefs that discourage
  suicide and support self-preservation instinct

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Suicide Precipitants?

• Getting into trouble with authorities (e.g.,
  school, police)
• Breakup from boy/girl friend
• Death of a loved one
• Disappointment and rejection such as a dispute
  with boy/girl friend, failure to get a job, or
  rejection from college

• Bullying or victimization
• Conflict with family or family dysfunction
• Disappointment with school results or school
  failure
• High demands at school during examination periods
• Unwanted pregnancy, abortion
• Infection with HIV or other sexually transmitted
  diseases

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Suicide precipitants?

• The anniversary of a death of a friend or a loved
  one
• Knowing someone who committed suicide
• Separation from friends, girl friends/boy friends

• Real or perceived loss
• Serious physical illness
• Serious injury that may change the individuals
  life course.

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Common Suicide Myths

• People who talk about suicide do not commit it
• You should not discuss suicide with youth because
  it gives them the idea to commit the act
• Children are not capable of implementing a
  suicide plan successfully.
• Suicidal youth really want to die.

• When the depressive mood of a child improves, the
  threat of a suicide crisis is over
• Children under the age of six do not commit
  suicide
• Only white males attempt suicide

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Common Suicide Myths

• Once a youth contemplates suicide he or she
  should always be considered suicidal
• Suicide is inherited or destined through genetics

• There is nothing anyone can do to prevent a
  suicide
• There are usually no warning signs of a suicide

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The Dos of Suicide Intervention

• Take away accessibility to the means
• Adapt a positive approach, emphasize desirable
  alternatives
• Sound calm and understanding
• Use constructive questions to define the problem
  and remove confusion
• Rephrase the important thoughts and feelings

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The Dos of Suicide Intervention

• Mention the family as a source of support if
  appropriate
• Emphasize the temporary nature of a persons
  problems (This too shall pass).

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The Donts of Suicide Intervention

• Dont sound shocked
• Dont stress the shock, embarrassment or pain
  that this could cause the family
• Dont engage in debate
• Dont try to physically remove a weapon

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Prevention

• Identify pre-existing risk factors
• Individuals
• Events
• Alter curriculum
• Manage stress
• Students
• Faculty/Staff
• Parents

• Create and maintain discipline plan
• Teach anger management
• Conflict resolution and mediation training
• Commit to health and safety at all levels

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The role of the school

• Promote inquiry
• Construct and create a safe environment
• Identify those at risk
• Create partnerships with the community

• Become a community school connectedness
• Reach out to those who are different by choice or
  accident
• Include parents
• Train staff to listen
• BE PREPARED

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• www. ChildrensSafetyNetwork.org