Cop 2 Cop Suicide Lessons Learned An Overview

1
Cop 2 Cop Suicide Lessons LearnedAn Overview

• Cherie Castellano MA, CSW, LPC, AAETS

2
Cop 2 Cop Program History

• First program of its kind in the country
• Legislative law was passed (Bill 1801)
• In July 2000, an agreement was signed between NJ
  DOP and UMDNJ-UBHC
• Program went live on November 1, 2000 at
• 1-866-COP-2COP

3
Governors Task Force on Police Suicide COP 2
COP Lessons Learned

• COP 2 COP is nationally a Best Practice- MARKET
• Maintain focus on QPR for LE training/PTC
• Increase collaboration with Unions constituency
• SOPs can foster service provision as prevention
• High Risk populations must be identified annually
• 2009- High Risk, Corrections Officers,
  Wounded/Disabled, Retired, Hx of MH problem, IA,
  Alcohol, relationship problems
• 90 of NJ Cop suicide used firearms in analysis
• Mental Health Stigma must be confronted

4
(No Transcript)
5
Cop 2 Cop - Who is it for?1-866-Cop 2 Cop
(1-866-267-2267)

• 51,500 Active NJ Law Enforcement Officers and
  their families
• All retired and disabled NJ Law Enforcement
  Officers
• Free and Confidential
• Cop 2 Cop is answered live 24/7
• Retired law enforcement officer always available
  and on call

6
Cop 2 CopAmerican Association of Suicidology
Certification

• April 2002 1st and only Law Enforcement Crisis
  Intervention Program to be certified by AAS in
  the United States
• Initial review-Score of 129 out of possible 144
• (90 minimum for certification)
• October 2003 Random Site Visit reporting that Cop
  2 Cop is functioning High above AAS standards
• July 2005 Re-Certification renewal/site visit
  
• Score of 140 out of possible 144

7
Cop 2 Cop Hotline Statistics

• 10/1/00 - 9/10/01 1,762
• 9/11/01 300 call increase
• 9/11/01 To Date 23,000
• Approx. 3,000 calls ANNUALLY
• CISM Responses 10/1/00 To Date
  600
• 159 Suicide Calls 157 Subverted 2 triaged
• Gender breakdown 70 - male, 30 female
  

8
Cop 2 Cop Staffing - 2009

• 1 Program Coordinator (Police Wife)
• 1 Cop Clinician ( Retired Law Enforcement
  officer/LPC/screener)
• 1 Mental Health Specialist Supervisor ( Retired
  Law Enforcement officer/clergy/corrections)
• 1 Mental Health Specialist ( Law Enforcement
  officers son)
• 8 Cop Peer Consultants (all Retired Law
  Enforcement officers)
• 1 Secretary/Administrative Coordinator
• 10 Volunteer Peer Supporters-Retired Law
  Enforcement Officers

9
Cop 2 Cop Peer Support

• 2009 -19 out of 21 of our staff are Police Peers
  (retired) All types
• FBI, Corrections, Chief, Municipal, Prosecutors,
  Parole,etc
• Telephone Peer Support - Trained in A.A.S. Crisis
  Call Model-COP ON CALL Calls, Callbacks, Case
  Management
• Critical Incident Stress Management - 20 Peers
  ICISF trained active on our COP 2 COP CISM teams
  - Suicide Debriefings
• QPR - Peer Support done via training, marketing
  outreach
• Wounded Officer Support Group- Monthly Cop 2 Cop
  group
• Cop AA liaisons- Sponsors, resources via
  recovering cops
• Cop 2 Cop Clergy Alliance - 3 Peers are clergy at
  Cop 2 Cop

10
COP 2 COP Telephone Assessment

• COP 2 COP Access Center-SUICIDE
  FOCUS-CONFIDENTIAL CUSTOMIZED
• ACD system - User ID, Call hunt- 30 sec/que, 3
  way call IPMS Weapons Assessment, Permission to
  contact 10 day-satisfaction survey
• Overnight / weekend LIVE coverage w/APS COP on
  call
• Cop Clinician model-Piloted -Peer/clinician
  model
• Clinical Interview structure- activity logs,
  reports, trends
• Database of Cop 2 Cop providers w/zip
  code/insurance/ clinical specialty

11
Cop 2 Cop ReferralsPolice Provider Network

• 1998-99 D.O.P Surveyed 500 police agencies
• 2000-Best identified /received Sea Girt training
• 2000-2001-Computerized network list, insurance
  info
• Providers recently added 6 South, 2 North, 1
  Central
• Cop2Cop Police Provider Network 150 providers.
  
• 2008- QI Provider Project-Survey LOS
• ANNUAL TRAINING- Police Suicide CISM-Police,
  Copshock,, Family etc-April 28, 2009
• 10 day routine, emergent-48 hours, urgent 1 hour
• 2009 Provider enhancement project

12
Cop 2 CopCritical Incident Stress Management
(CISM)

• In 2000 held meeting with many NJ CISM teams to
  dispatch CISM
• Trained Internal COP 2 COP Staff/Peers-ICISF
  model Trauma Response post 9/11/01-CISM Responses
  to 2008 650(400 9/11 Related)
• 50 - COP 2 COP Teams
• 40 - Mutual Aid w/teams
• 10 - Refer out totally
• Suicide CISM- Officers require access to
  follow-up mental health services
• SOPs should be created to ensure CISM
• COP 2 COP REQUESTS SUICIDE CISM REFERRALS AS
  EXPERTS

13
Top 10 Problems 2000 - 2008

• 1 Work Stress
• 2 Depression/Mood Disorder
• 3 Anxiety/Phobias
• 4 Marital/Couples
• 5 PTSD, 9/11
• 6 Substance Abuse
• 7 Family/Parenting
• 8 Legal
• 9 Medical/Somatic Complaints
• 10 Aggression/Violence

14
Top Ten Counties 2000 - 2008

• 1 Unknown
• 2 Essex
• 3 Middlesex
• 4 Ocean
• 5 Bergen
• 6 Union
• 7 Camden
• 8 Hudson
• 9 Monmouth
• 10 Mercer

15
Cop 2 Cop Q.A. Survey85 Overall Satisfaction

• 1 93.5 of our clients stated they got
  through the line easily
• 2 96 of our clients indicated they felt
  listened to on the phone
• 3 62 of our clients used the referral they were
  given
• 4 70 stated they will continue in treatment.
• 5 94 of our clients stated follow up calls and
  services were done to their satisfaction
• 6 94 of our clients advised they would
  recommend Cop 2 Cop to other cops

16
COP2COP SUICIDE CALLS
17
COP 2 COP On the Beat Outreach
2000-2008Prevention

• 12,000
• NEW JERSEY OFFICERS HAVE BEEN INFORMED OF
• COP 2 COP PROGRAM THROUGH PRESENTATIONS/TRAININGS
  2000-2008
• 3,000 QPR Training 2004-2008

18
Cop 2 Cop Suicide Analysis 9/11

• 69 Cop2Cop Suicidal Calls from 2000
• 20 calls -immediate response
• Primary problems - Chronic depression/ anxiety
• Pattern of co-morbid complaints
• Disturbance in interpersonal relationships
• Physical or medical ailments
• Alcohol or Substance Abuse
• COP 2 COP Staff Certified QPR Trainers
• COP 2 COP Suicide Survivor kits, AFSP AAS

19
Wounded Officers Support Group

• July 2004-6 officers shot in 2 weeks/Support
  group
• The Blue Heart Law Enforcement Assistance
  Program
• To provide support and counsel to the injured and
  emotionally distressed
• Opportunity for members to discuss common
  problems and offer solutions.
• Legislation (S1374/A2878) The Blue Heart Law
  Enforcement Assistance Program signed into law
  March 21, 2007 by Governor Corzine
• Ongoing group meetings
• Create a registry of wounded cops in NJ
• Clinical case management services family
  support
• Annual services to honor officers wounded

20
Cop 2 Cop Corrections Project

• 500 Corrections calls analyzed-acute
• Unique Stressors / complex issues / cumulative
• Request for Leadership Meeting/Presentation
• Cop 2 Cop material distributed
• Survey development/distribution- Voices
• QPR Suicide Prevention Training Plan
• Video/teleconferences?
• Suicide Critical Incident Stress Response
• SOP Academy Training infusion

21
The Future First Responder Mental Health
ProgramsDepartment of Defense Appropriations
Act-9/11

• As the threat of terrorism increases in the
  country, Cop 2 Cop has become a national model.
• First Responders as SURVIVOR VICTIMS
• require we rescue the rescuer
• Peer/Clinicians
• COP SLEF
• New Orleans Suicide response

22
COP 2 COP RecognitionGovernors Proclamation
12/01AG Recognition Award 12/01NY Times Feature
2/02PAPD Rescuer Award 5/02ICISF World Congress
Award 2/03Governors Excellence Award in
Volunteerism 4/03Jersey City Community Service
Award 6/039/11 Emergency Service Delegation
6/04Re-certification in A.A.S 7/05NOBLE Public
Safety/Enforcement Award 11/06Independent Film
Festival Award A Call to Valor 1/08Governors
Task Force on Police Suicide 10/08 Award
winning Website www.cop2coponline.org
23
COP 2 COP -FOCUS ON POLICE SUICIDE EVOLUTION

• (AAS) National Crisis Hotline Certification Goal
  
• Training as Prevention -QPR, Crisis Call Model,
  ICISF
• Data analysis IPMS-High Risk Caller trends
  suicide risks , Research
• (QI QA) - Quality Assurance 10 day callback for
  customer survey clinical continuum follow-up
• Survivor Suicide Activity AFSP Walk, National
  Survivor Day- 11/22, Staff, Survivor kits
  groups
• Best practice consultation FBI, NYPD EIU,
  ICISF, Dr, Violante (CDC) IAT, 1-800- SUICIDE

24
(No Transcript)
25
PERSONAL AWARENESS WHO ARE YOU?

• AUTHORITATIVE
• IN COMMAND
• NO MISTAKES
• IMAGE ARMOR
• NEEDS ACTION
• RISK TAKER
• HYPERVIGILANT
• CYNICAL

• LESS WILLING TO SOCIALIZE
• NEGATIVE ATTITUDE ABOUT PEOPLE
• MORE SUSPICIOUS
• MORE PESSIMISTIC
• LESS TALK ABOUT FEELINGS

26
DANGEROUS TRAITS

• IMAGE ARMOUR
• RESPONSIBILITY ABSORBTION BEHAVIOR
• NUMBING EFFECTS
• ANGER-RELATED ISSUES

27
Psychological Risk AssessmentPersonal
Vulnerability and Trauma

• Differences in individual trauma reactions within
  the literature has heightened awareness of
  Differential vulnerability - Paton, et al, 2000
• 3 primary vulnerabilities -
• Biological, Historical, and Psychological
• (Scotti, Beach, Norhtrop, Rode and Forsyth)

28
Positive Outcomes/Positive Growth Model

• Posttraumatic growth - 3 categories
• Sense of self, Relationships, Spiritual/religious
• Individuals do not simply survive w/out negative
  effects, they experience themselves as better
  then they were before the traumatic event
  -Calhoun and Terdeshi (2000)
• Trauma allows an opportunity to grow as a person

29
PSYCHOLOGICAL RISKFACTORS OF POLICE WORK

• Paradox of police work
• Officers are taught to trust their instincts, yet
  to deny or hide their feelings
• Officers must maintain control of their emotions
  and behavior while simultaneously dealing with
  out of control people and situations
• Officers enter situations to be of help and
  service, and yet can be mistakenly viewed as
  agents of excessive force and even danger

30
PSYCHOLOGICAL RISKFACTORS OF POLICE WORK

• Unpredictability - the continuous physical "ups
  and downs" of the work are physiologically
  difficult for the body, and depression and
  anxiety are common symptoms
• Lack of control - renders officers vulnerable to
  feelings of helplessness and hopelessness
• Irregular shifts - makes it difficult to maintain
  regular eating, sleeping and exercise habits

31
PSYCHOLOGICAL RISKFACTORS OF POLICE WORK

• Paramilitary nature of law enforcement culture -
  encourages denial/suppression of normal
  feelings/reactions ("suck it up") which over the
  long term, can result in depression and related
  problems
• Chronic stress - can lead to debilitating
  physical/medical problems, and depression may be
  a result of these problems or a contributing
  factor

32
PSYCHOLOGICAL RISKFACTORS OF POLICE WORK

• Control - officers are taught to maintain control
  at all costs, including and especially control of
  their emotions
• Constricted relationships - difficult to drop the
  mantle of control with friends and family, which
  makes it difficult to accept help from others
• Limited trusting, supportive relationships -
  officers often times trust only their partners

33
PSYCHOLOGICAL RISKFACTORS OF POLICE WORK

• Fear - contradictory messages about how law
  enforcement should handle their own fear. On the
  one hand, police officers are taught to listen to
  their instincts, and on the other hand, they are
  taught to act despite their fears
• Unresolved grief and guilt - officers involved in
  traumatic deaths often carry feelings of
  unresolved grief and guilt

34
QPR- Be Your Brothers Keeper

• Like CPR it is an intervention for suicide
  prevention that stands for
• Question
• Persuade
• Refer

35
QPR

• QPR is not intended to be a form of counseling or
  treatment.
• QPR is intended to offer hope through positive
  action.

36
Statistics

• Suicide is the 8th leading cause of death
• Suicide rate in Law Enforcement is 41 Line of
  Duty Deaths
• A suicide to a line of duty issue
• Cops commit suicide utilizing their weapons.
• Often alcohol and marital problems are evident.

37
Feelings about Suicide

• Your feelings about suicide affect this
  intervention - reluctance to get involved, fear,
  denial , shock anger and lack of understanding
• In simple terms suicidal people see suicide as
  the solution to their problem.

38
QPR Suicide Myths and Facts

• Myth No one can stop a suicide, it is
  inevitable.
• Fact If a law enforcement officer in a crisis
  gets the help they need, they will probably never
  be suicidal again.
• Myth Confronting an officer about suicide will
  only make them angry and increase the risk of
  suicide.
• Fact Asking someone directly about suicidal
  intent lowers anxiety, opens up communication and
  lowers the risk of an impulsive act.

39
QPR
Suicide Myths and
Facts

• Myth Only experts can prevent suicide.
• Fact Suicide prevention is everybodys
  business, and anyone can help prevent the tragedy
  of suicide
• Myth Suicidal officers keep their plans to
  themselves.
• Fact Most suicidal officers communicate their
  intent sometime during the week preceding
  their attempt.

40
QPR Myths And Facts About Suicide

• Myth Those who talk about suicide dont do it.
• Fact People who talk about suicide may try,
  or even complete, an act of self-destruction.
• Myth Once an officer decides to complete
  suicide, there is nothing anyone can do to stop
  them.
• Fact Suicide is the most preventable kind of
  death, and almost any positive action may save a
  life.

How can I help? Ask the Question...
41
QPR Suicide Cues Warning Signs The More
Clues and Signs Observed, the Greater the Risk.
Take All Signs Seriously.
42
Signs/Cues to look for

• Warning Signs - despair, hopelessness, depression
• Direct verbal Cues - I wish I were dead, If x
  doesnt happen Im going to kill myself
• Indirect verbal Cues - My family would be better
  off without me, Soon you wont have to worry
  about me anymore, Here take this-I wont be
  needing it.

43
Signs/Cues to look for

• Behavioral Cues - Making or changing a will,
  giving away possessions, sudden interest or
  disinterest in religion, relapse into substance
  abuse
• Situational Cues - Rejection by a loved one or
  divorce, anticipated loss of financial security,
  death of spouse, friend (especially if by
  accident or sudden)

44
Warning Signs

• Previous suicide attempt
• Previous suicide by loved one, friend, colleague
• Despair
• Hopelessness
• Depression
• Increase alcohol
• Marital/family issues
• Financial crisis
• Departmental charges

45
Warning Signs, Continued

• Making a will
• Giving away possessions
• Sudden change in religion
• Increased anger
• Co-worker complaints
• Citizen complaints
• Change in work habits
• Any change that is out of the ordinary

46
Direct Verbal Cues

• Ive decided to kill myself.
• I wish I were dead.
• Im going to commit suicide.
• Im going to end it all.
• If (such and such) doesnt happen, Ill kill
  myself.

47
Indirect Verbal Cues

• My family would be better off without me.
• Soon you wont have to worry about me anymore.
• Here, take this- I wont be needing it.
• Theyll be sorry.
• I cant take it much longer.

48
Indirect Verbal Cues, Cont.

• Im tired of life, I just cant go on.
• Who cares if Im not around anymore.
• I just want out.
• I wont be around much longer.
• Pretty soon you wont have to worry about me.

49
Situational Cues

• Being fired or suspended
• A recent unwanted move
• Loss of any major relationship
• Death of spouse, child, or friend, especially if
  by suicide
• Diagnosis of a serious or terminal illness
• Sudden unexpected loss of freedom/fear of
  punishment
• Anticipated loss of financial security
• Loss of a cherished therapist, counselor or
  spiritual leader
• Fear of becoming a burden to others

50
QPR -Tips for Asking the Suicide Question

• If in doubt, dont wait, ask the question
• If the person is reluctant, be persistent
• Talk to the person alone in a private setting
• Allow the person to talk freely
• Give yourself plenty of time
• Have your resources handy QPR Card, phone
  numbers, counselors name and any other
  information that might help
• Remember How you ask the question is less
  important than that you ask it

51
Q QUESTION

• Less Direct Approach
• Have you been unhappy lately? Have you been
  very unhappy lately? Have you been so very
  unhappy lately that youve been thinking about
  ending your life?
• Do you ever wish you could go to sleep and never
  wake up?

52
Q QUESTION

• Direct Approach
• You know, when people are as upset as you seem
  to be, they sometimes wish they were dead. Im
  wondering if youre feeling that way, too?
• You look pretty miserable, I wonder if youre
  thinking about suicide?
• Are you thinking about killing yourself?
• NOTE If you cannot ask the question, find
  someone who can.

53
P PERSUADE
HOW TO PERSUADE SOMEONE TO STAY ALIVE

• Listen to the officer and give the them your full
  attention
• Remember, suicide is not the problem, only the
  solution to a perceived insoluble problem
• Do not rush to judgment
• Offer hope in any form

54
P PERSUADE

• Then Ask
• Will you go with me to get help?
• Will you let me help you get help?
• Will you promise me you wont kill yourself
  until weve found some help?
• YOUR WILLINGNESS TO LISTEN AND TO HELP CAN
  REKINDLE HOPE, AND MAKE ALL THE DIFFERENCE.

55
R REFER

• Suicidal officers often believe they cannot be
  helped, so you may have to help them get the help
  they need.
• The best referral involves taking the officer
  directly to someone who can help.
• The next best referral is getting a commitment
  from them to accept help, then making the
  arrangements to get that help.
• The third best referral is to give referral
  information and try to get a good faith
  commitment not to attempt suicide. Any
  willingness to accept help at some time, even if
  in the future, is a good outcome.

56
Important!

• If you are dealing with an officer that is not
  open to referral of any sort and you believe
  significant risk for suicide, it is very
  important that you initiate the proper
  departmental psychiatric emergency protocols to
  ensure the officers safety as well as the safety
  of others is secured.

57
Possible Referral Sources

• COP2COP help-line 1-866-COP-2COP
  (1-866-267-2267) the following resources can be
  obtained
• Telephonic crisis screening to determine suicide
  risk level
• Help linking the officer to the local psychiatric
  screening center if necessary
• Peer counseling
• Referral to counseling
• Referral to appropriate support group
• You can call the line to get advice with how to
  proceed

58
For Effective QPR

• Remember
• Since almost all efforts to persuade someone to
  live instead of attempt suicide will be met with
  agreement and relief, dont hesitate to get
  involved or take the lead.

59
For Effective QPR

• Say I want you to live, or Im on your
  side...Well get through this.
• Get others involved. Ask the person who else
  might help. Fellow officers, respected
  supervisor, family, friends, brothers, sisters,
  pastors, priest, rabbi, bishop, physician, union,
  COP 2 COP

60
For Effective QPR

• Join a Team. Become a contact person for QPR in
  your Department or union. Offer to work with
  therapists, psychiatrists, clergy or whomever is
  going to provide counseling or treatment.
• Provide information (1-866-COP-2COP) and get
  permission for follow up with a visit, a phone
  call, whatever way feels comfortable to you, let
  the person know you care about what happens to
  them. Caring may save a life.

61
SELF CARE PROTECTIVE MEASURES

• Monitor your emotions - keep track of how you
  feel
• Talk to your partner, to your fellow officers
• Share your life with family and friends - the
  good, bad and the ugly
• Believe in a higher power than yourself
• Rewrite you Core Beliefs as a Public
  Servant/life
• Stick to the basics of good health
• Exercise, Balanced diet, Regular sleep habits

62
PROTECTIVE MEASURES

• Engage in a program of ACTIVE relaxation (and
  we're not talking about grabbing a beer at the
  corner tavern here)
• Take time off
• Laugh as much as you can, particularly at
  yourself
• Work to make positive changes in law enforcement
  culture
• Get involved in something you believe in
  (volunteer program for kids/schools, etc.) QPR!

63
Trust your judgement

• Dont worry about being disloyal, breaking a
  trust,
• better than attending their funeral with the
  If only...
• Be your brothers keeper and utilize QPR
• COP 2 COP is there for you and your brothers and
  sisters
• 24/7 at 1-866-267-2267

64

• Question Answer
• session