1 Suicide Prevention for the Older Adult Presented by the Wyoming Suicide Prevention Task Force

2 Saving One Life In Your Community

3 Suicide “Suicide carries in its aftermath a level of confusion and devastation that is, for the most part, beyond description.” -Kay Redfield Jamison, Ph.D.

4 United States Suicide Rates 2002 (per 100,000 people) Nation:11.0 –Youth:9.9 –Elderly:15.6

5 National Statistics Men die by suicide more often than women Women attempt suicide more often than men

6 National Statistics 75% of elderly suicide victims visited their physician in the month prior to their death The elderly comprise about 13% of the population, but suffer 18% of all suicide deaths.

7 Suicide Methods Firearms for Men and Women (55%) Hanging for Men (20%) Poisons or Medication Overdoses for Women (17%) Jumping from a Height (2%)

8 Wyoming Statistics 106 Wyoming residents died by suicide in % of Wyoming suicides died by firearms Wyoming currently ranks first in the nation in the rate of suicide (2002). The Mountain states consistently rate the highest in the nation

9 Nature of Mental Health

10 Mental Health Facts Nearly half of Americans suffer from one or more mental illnesses during their lifetime One out of three Americans experience an episode of mental illness each year

11 What is mental illness? A variety of medical conditions involving disorders of thoughts and/or emotions Effective treatments are available

12 Causes of Mental Illness Chemical imbalance in the brain Hereditary Factor – A family history of clinical depression Alcohol and drug abuse

13 Certain Illnesses and Diseases – strokes, cancer, heart disease, Alzheimer’s disease, Parkinson’s disease, diabetes, MS and hormonal disorders Causes of Mental Illness (cont.)

14 Two Mental Illness Categories Anxiety Depression

15 Anxiety Constant nervousness, fear or worry Restlessness, feeling on edge & irritability Panic attacks Racing heart Insomnia Poor concentration Muscle tension

16 Depression Depression is a Serious medical condition involving a disorder of thoughts and/or emotions

17 Depression We all feel “down” or “low” at times, this is normal, but depression “freezes” the emotions It is NOT a personal weakness nor a normal part of aging Twice as many women experience depression as men But men are more likely to ignore the signs and try to cope through alcohol and drugs

18 Signs of Depression Sadness and/or irritability Sleeping all the time or insomnia Increased or decreased appetite Loss of motivation & apathy Low energy & fatigue Decreased interest in normal activities Decrease ability to focus or concentrate

19 Negative Thinking – Pessimistic, low self-esteem, excessive worrying, or feel little/lack of control over one’s life Significant Life Events – Death of a loved one, divorce, loss of a life style (financial or physical) Certain Medications – prescribed, OTC or holistic Drug and Alcohol Abuse Contributors to Depression

20 Always check for possible Physical causes for depression, i.e., poor diet, lack of exercise, chronic illness or diseases, STRESS (esp. caregivers), physical abuse or neglect, and substance abuse, Check for Emotional causes, i.e. a loss of a loved one, even a pet, change in lifestyle, and emotional neglect or abuse. REMEMBER:

21 DEPRESSION IN OLDER ADULTS Is NOT a Normal Part of Aging

22 DEPRESSION ALL ENCOMPASSING SADNESS Multiply the worst pain you can imagine by 10 Add on the feelings of depression And Then… Some feel Suicide is the only option.

23 Suicide Often Occurs …When emotional pain is not tolerable and is out of balance with pain tolerance.

24 Two days of “feeling blue” may not be of concern but “feeling blue” for 2 weeks or more may indicate depression.

25 Suicide Risk Factors

26 Risk Factors Age less than 20 or greater than 65 Male Race -Whites -Native Americans

27 Risk Factors Pattern of impulsive or risk taking behavior Access to firearms Drastic mood or behavior changes Mental Illness

28 Risk Factors Alcohol & Drug Abuse/Intoxication -Increased drug or alcohol use -Body’s decreased ability to process drugs & alcohol History of sexual or physical abuse as a child or adult Availability of means – guns, meds, etc. Suicide Ideation

29 Risk Factors Family violence Prior suicide attempt Organized plan Family history of suicide Exposure to suicide in family, friends, or media

30 Behavioral Indicators of Suicide Depression Indecisiveness Helplessness Hopelessness Social withdrawal Preoccupation with death and dying Stockpiling medications

31 Behavioral Indicators of Suicide: Giving away prized possessions Excessive guilt Decrease in personal care Weight changes Agitation Suicidal ideation

32 Situational Contributors Job stress Job loss Legal problems -Civil or criminal -Being arrested -Incarceration

33 Situational Contributors Social support loss -Relationship problems -Loss of spouse or friends -Social rejection Social isolation & loneliness Financial problems

34 Situational Contributors Single, widowed, divorced or separated Medical illness Change in health status e.g. hip fracture Threat of extreme dependency on family or institutions Adverse life events

35 Risk Factors Threat of extreme dependency on family or institutions Loss of control of environment Loss of independence Forced or voluntary retirement

36 Barriers to Seeking Care Lack of available mental health providers Inadequate or no insurance Lack of financial resources Don’t know how to access care Don’t understand illness or how treatment helps Communication/Language Difficulties

37 Barriers to Seeking Care Unwillingness to seek mental health care Fear of stigma Cultural beliefs Religious beliefs

38 Wyoming Risk Factors Geographic isolation Lack of sufficient numbers of mental health professionals Wide availability of firearms Lack of family or other support systems

39 Preventing Suicide

40 Preventing Suicide Identifying those individuals suffering from mental illness and at risk for suicide -Educate community on risk factors Intervening -Refer those at risk for treatment Providing treatment -Improve access to care in community

41 What Can You Do? Listen to the individual –Encourage person to share their feelings –Know and look for suicide risk factors Talk with the person about your concerns –Tell them you care and want to help –Speak with care and compassion –Ask directly about thoughts of suicide

42 What Can You Do Take reports of suicidal ideation seriously Contact reliable family member/close friend Get professional help –Even if person resists, call 911 if necessary –Offer to take them to emergency room or mental health professional –Offer to help them schedule an appointment –Follow-up to make sure person is getting help

43 Agencies / Facilities Know and follow agency policies and procedures. If your agency does not have training, written policy and procedures in place, work to develop them.

44 What to Do Be calm - don’t act shocked or be judgmental Limit access to firearms and other means of suicide - medications, car keys Don’t leave them alone! Don’t swear to keep it a secret Don’t try to counsel the person

45 What Can You Say? I’ve noticed you’re feeling upset What’s going on in your life? Are you thinking about suicide? What do you think might help? Where would you like to seek help? Why don’t we make the call together? I’m not going to feel comfortable without being sure you’re going to get some help.

46 Who Can Help? Adult Protective Services Long Term Care Ombudsman Mental Health Ombudsman Clergy 911/Law Enforcement Senior Network Human Service Professionals

47 Who Can Help? (cont.) Health Care Staff: –Physicians –Nurses/CNA –Physician Assistants –Psychologists –Social Workers –Counselors –Emergency personnel –Support staff

48 Questions?