a suicide-safer community safeTALK Training Slides a suicide-safer community © 03/2008 LivingWorks Education www.livingworks.net

WELCOME 01 Welcome

02.1 Introduction to the River of Suicide

02.2 Introduction to the River of Suicide “Contributaries” of suicide (no thoughts of suicide) 02.2 Introduction to the River of Suicide

02.3 Introduction to the River of Suicide “Contributaries” of suicide (no thoughts of suicide) Thoughts of suicide 02.3 Introduction to the River of Suicide

02.4 Introduction to the River of Suicide “Contributaries” of suicide (no thoughts of suicide) Thoughts of suicide Suicidal behavior 02.4 Introduction to the River of Suicide

02.5 Introduction to the River of Suicide “Contributaries” of suicide (no thoughts of suicide) Thoughts of suicide Suicidal behavior Death or harm 02.5 Introduction to the River of Suicide

03.1 Types of Suicide Prevention Workbook Page 4 POSTVENTION For those who injure themselves and those who are affected 03.1 Types of Suicide Prevention Workbook Page 4

03.2 Types of Suicide Prevention Workbook Page 4 Important but unlikely to prevent all people from having thoughts of suicide POSTVENTION For those who injure themselves and those who are affected 03.2 Types of Suicide Prevention Workbook Page 4

03.3 Types of Suicide Prevention Workbook Page 4 Important but unlikely to prevent all people from having thoughts of suicide INTERVENTION Suicide first aid to prevent the risk of suicidal behavior POSTVENTION For those who injure themselves and those who are affected 03.3 Types of Suicide Prevention Workbook Page 4

04 Magnitude of the Problem Workbook Page 4 [Region, Year] Pop. [Population] Reported suicides: [data] Unreported suicides: 5% to 25% more suicides Non-fatal suicidal behaviors: 40 to 100 times greater than number of suicides Number of people affected: Each suicidal behavior may affect a few or a very large number People with thoughts of suicide: [data] 04 Magnitude of the Problem Workbook Page 4

03.3 Types of Suicide Prevention Workbook Page 4 Important but unlikely to prevent all people from having thoughts of suicide INTERVENTION Suicide first aid to prevent the risk of suicidal behavior POSTVENTION For those who injure themselves and those who are affected 03.3 Types of Suicide Prevention Workbook Page 4

05 LivingWorks Trainer Supports ongoing quality control trainers worldwide all disciplines highly evaluated over 1 million trained ASIST TRAINER evolving since 1983 evidence based 5-day training for trainers detailed trainer manual one of several programs 05 LivingWorks Trainer Supports

Police/Correctional Officer Volunteer Youth Worker Your Job Clergy Counselor Nurse Physician Psychologist Social Worker Administrator Educator Other Police/Correctional Officer Volunteer Youth Worker 06 Your Job

Has anyone you know died by suicide? Other Acquaintance Close friend Family YES 40% 80% Has anyone you know attempted suicide? Other Acquaintance Close friend Family YES 40% 80% 07 Personal Experiences

Have you ever been a helper to a person at risk of suicide? YES 40% 80% How many times? Professionally Personally 1 2–5 6–20 >20 40% 80% 08 Helping Experiences

09 Learning Opportunities How prepared do you feel to help a person at risk of suicide? Well prepared Mostly prepared Partly prepared Not prepared My feelings about suicide mostly come from… (Check all that apply) I have little or no feelings about suicide Lectures, workshops, etc. Books, newspapers, articles, etc. Media programs about suicide Internet Professional experience with suicidal persons Personal 09 Learning Opportunities

Have you had thoughts of suicide? (Check all that apply) Never in my life Some time in my life Within the last year Within the last week Have you ever deliberately injured yourself? Yes, with a clear wish to die by suicide Yes, though uncertain about dying Yes, but no wish to die No 10 Self Experiences

Who would you tell if you had thoughts of suicide? (Check all that apply) Caring person Friend Clergy Health worker Co-worker No one Family Other You could also tell your workshop trainer(s): [trainers] 11 Who Would Help You?

02.5 Introduction to the River of Suicide “Contributaries” of suicide (no thoughts of suicide) Thoughts of suicide Suicidal behavior Death or harm 02.5 Introduction to the River of Suicide

12.1 Structure of the Suicide Intervention Model Workbook Page 5

12.2 Structure of the Suicide Intervention Model Workbook Page 5 CONNECTING 12.2 Structure of the Suicide Intervention Model Workbook Page 5

12.3 Structure of the Suicide Intervention Model Workbook Page 5 UNDERSTANDING CONNECTING 12.3 Structure of the Suicide Intervention Model Workbook Page 5

12.4 Structure of the Suicide Intervention Model Workbook Page 5 UNDERSTANDING CONNECTING ASSISTING 12.4 Structure of the Suicide Intervention Model Workbook Page 5

13 Explore Invitations Workbook Page 7 HELP ACTIONS • Giving away possessions • Withdrawal (family, friends, school, work) • Loss of interest in hobbies • Abuse of alcohol, drugs • Reckless behavior • Extreme behavior changes • Impulsivity • Self-mutilation FEELINGS Desperate Angry Guilty Worthless Lonely Sad Hopeless Helpless PHYSICAL • Lack of interest in appearance • Change/loss in sex interest • Disturbed sleep • Change/loss of appetite, weight • Physical health complaints THOUGHTS "All of my problems will end soon" "No one can do anything to help me now" "Now I know what they were going through" "I just can't take it any more" "I wish I were dead" "Everyone will be better off without me" "I won't be needing these things anymore" "I can't do anything right" "I just can't keep my thoughts straight anymore" STRESSFUL EVENTS with FEELINGS OF LOSS 13 Explore Invitations Workbook Page 7

12.5 Structure of the Suicide Intervention Model Workbook Page 5 UNDERSTANDING CONNECTING ASSISTING invitations? suicide? explore ask 12.5 Structure of the Suicide Intervention Model Workbook Page 5

PRIOR SUICIDAL BEHAVIOR CURRENT SUICIDE PLAN (RESOURCES) PRIOR SUICIDAL BEHAVIOR PAIN MENTAL HEALTH ALONE PREPARED FAMILIAR DESPERATE VULNERABLE 14 River and Risk Alerts

15.1 Review Risk Workbook Page 10 ALERT Are you having thoughts of suicide?……………… YES suicide 15.1 Review Risk Workbook Page 10

15.2 Review Risk Workbook Page 10 ALERT Are you having thoughts of suicide?……………… YES suicide CURRENT FACTORS Current suicide plan How? How prepared? How soon?……………………… YES prepared 15.2 Review Risk Workbook Page 10

15.3 Review Risk Workbook Page 10 ALERT Are you having thoughts of suicide?……………… YES suicide CURRENT FACTORS Current suicide plan How? How prepared? How soon?……………………… YES prepared Pain Do you have pain that at times feels unbearable?…… YES desperate 15.3 Review Risk Workbook Page 10

15.4 Review Risk Workbook Page 10 ALERT Are you having thoughts of suicide?……………… YES suicide CURRENT FACTORS Current suicide plan How? How prepared? How soon?……………………… YES prepared Pain Do you have pain that at times feels unbearable?…… YES desperate Resources Do you feel you have few, if any, resources?………… YES alone 15.4 Review Risk Workbook Page 10

15.5 Review Risk Workbook Page 10 ALERT Are you having thoughts of suicide?……………… YES suicide CURRENT FACTORS Current suicide plan How? How prepared? How soon?……………………… YES prepared Pain Do you have pain that at times feels unbearable?…… YES desperate Resources Do you feel you have few, if any, resources?………… YES alone BACKGROUND FACTORS + Prior suicidal behavior Have you ever attempted suicide before?……………. YES familiar 15.5 Review Risk Workbook Page 10

15.6 Review Risk Workbook Page 10 ALERT Are you having thoughts of suicide?……………… YES suicide CURRENT FACTORS Current suicide plan How? How prepared? How soon?……………………… YES prepared Pain Do you have pain that at times feels unbearable?…… YES desperate Resources Do you feel you have few, if any, resources?………… YES alone BACKGROUND FACTORS + Prior suicidal behavior Have you ever attempted suicide before?……………. YES familiar + Mental health Are you receiving or have you received mental health care?……………………………………… YES vulnerable 15.6 Review Risk Workbook Page 10

PRIOR SUICIDAL BEHAVIOR CURRENT SUICIDE PLAN (RESOURCES) PRIOR SUICIDAL BEHAVIOR PAIN MENTAL HEALTH ALONE PREPARED FAMILIAR DESPERATE VULNERABLE 14 River and Risk Alerts

12.6 Structure of the Suicide Intervention Model Workbook Page 5 UNDERSTANDING reasons? risk? listen review CONNECTING ASSISTING invitations? suicide? explore ask 12.6 Structure of the Suicide Intervention Model Workbook Page 5

16.1 Contract Safeplan Workbook Page 11 Review Risk Contract Safeplan RISK ALERT Are you having thoughts of suicide?……………… YES suicide CURRENT FACTORS Current Suicide Plan How? How prepared? How soon?……………………… YES prepared Pain Do you have pain that at times feels unbearable?…… YES desperate Resources Do you feel you have few, if any, resources?………… YES alone BACKGROUND FACTORS + Prior Suicidal Behavior Have you ever attempted suicide before?……………. YES familiar + Mental Health Are you receiving or have you received mental health care?……………………………………… YES vulnerable 16.1 Contract Safeplan Workbook Page 11

16.2 Contract Safeplan Workbook Page 11 Review Risk Contract Safeplan RISK ALERT ALL SAFEPLANS Are you having thoughts of suicide?……………… YES suicide CURRENT FACTORS Current Suicide Plan How? How prepared? How soon?……………………… YES prepared Pain Do you have pain that at times feels unbearable?…… YES desperate Resources Do you feel you have few, if any, resources?………… YES alone BACKGROUND FACTORS + Prior Suicidal Behavior Have you ever attempted suicide before?……………. YES familiar + Mental Health Are you receiving or have you received mental health care?……………………………………… YES vulnerable 16.2 Contract Safeplan Workbook Page 11

16.3 Contract Safeplan Workbook Page 11 Review Risk Contract Safeplan RISK ALERT ALL SAFEPLANS • Keep safe Are you having thoughts of suicide?……………… YES suicide CURRENT FACTORS Current Suicide Plan How? How prepared? How soon?……………………… YES prepared Pain Do you have pain that at times feels unbearable?…… YES desperate Resources Do you feel you have few, if any, resources?………… YES alone BACKGROUND FACTORS + Prior Suicidal Behavior Have you ever attempted suicide before?……………. YES familiar + Mental Health Are you receiving or have you received mental health care?……………………………………… YES vulnerable 16.3 Contract Safeplan Workbook Page 11

16.4 Contract Safeplan Workbook Page 11 Review Risk Contract Safeplan RISK ALERT ALL SAFEPLANS • Keep safe Are you having thoughts of suicide?……………… YES suicide • Safety contact(s) CURRENT FACTORS Current Suicide Plan How? How prepared? How soon?……………………… YES prepared Pain Do you have pain that at times feels unbearable?…… YES desperate Resources Do you feel you have few, if any, resources?………… YES alone BACKGROUND FACTORS + Prior Suicidal Behavior Have you ever attempted suicide before?……………. YES familiar + Mental Health Are you receiving or have you received mental health care?……………………………………… YES vulnerable 16.4 Contract Safeplan Workbook Page 11

16.5 Contract Safeplan Workbook Page 11 Review Risk Contract Safeplan RISK ALERT ALL SAFEPLANS • Keep safe • Safety contact(s) Are you having thoughts of suicide?……………… YES suicide • Safe/no use of alcohol/drugs CURRENT FACTORS Current Suicide Plan How? How prepared? How soon?……………………… YES prepared Pain Do you have pain that at times feels unbearable?…… YES desperate Resources Do you feel you have few, if any, resources?………… YES alone BACKGROUND FACTORS + Prior Suicidal Behavior Have you ever attempted suicide before?……………. YES familiar + Mental Health Are you receiving or have you received mental health care?……………………………………… YES vulnerable 16.5 Contract Safeplan Workbook Page 11

16.6 Contract Safeplan Workbook Page 11 Review Risk Contract Safeplan RISK ALERT ALL SAFEPLANS • Keep safe • Safety contact(s) Are you having thoughts of suicide?……………… YES suicide • Safe/no use of alcohol/drugs • Link to resources CURRENT FACTORS Current Suicide Plan How? How prepared? How soon?……………………… YES prepared Pain Do you have pain that at times feels unbearable?…… YES desperate Resources Do you feel you have few, if any, resources?………… YES alone BACKGROUND FACTORS + Prior Suicidal Behavior Have you ever attempted suicide before?……………. YES familiar + Mental Health Are you receiving or have you received mental health care?……………………………………… YES vulnerable 16.6 Contract Safeplan Workbook Page 11

INFORMAL RESOURCES FORMAL RESOURCES 16.7 Resources family and friends 24-HOUR emergency 24-HOUR health workers LONGER-TERM advisers LONGER-TERM personal connections LIFE-LONG community LIFE-LONG 16.7 Resources

16.6 Contract Safeplan Workbook Page 11 Review Risk Contract Safeplan RISK ALERT ALL SAFEPLANS • Keep safe • Safety contact(s) Are you having thoughts of suicide?……………… YES suicide • Safe/no use of alcohol/drugs • Link to resources CURRENT FACTORS Current Suicide Plan How? How prepared? How soon?……………………… YES prepared Pain Do you have pain that at times feels unbearable?…… YES desperate Resources Do you feel you have few, if any, resources?………… YES alone BACKGROUND FACTORS + Prior Suicidal Behavior Have you ever attempted suicide before?……………. YES familiar + Mental Health Are you receiving or have you received mental health care?……………………………………… YES vulnerable 16.6 Contract Safeplan Workbook Page 11

16.9 Contract Safeplan Workbook Page 11 Review Risk Contract Safeplan RISK ALERT ALL SAFEPLANS • Keep safe Are you having thoughts of suicide?……………… YES suicide • Safety contact(s) • Safe/no use of alcohol/drugs • Link to resources CURRENT FACTORS RISK SPECIFIC SAFEPLANS Current Suicide Plan How? How prepared? How soon?……………………… YES prepared Pain Do you have pain that at times feels unbearable?…… YES desperate Resources Do you feel you have few, if any, resources?………… YES alone BACKGROUND FACTORS + Prior Suicidal Behavior Have you ever attempted suicide before?……………. YES familiar + Mental Health Are you receiving or have you received mental health care?……………………………………… YES vulnerable 16.9 Contract Safeplan Workbook Page 11

16.10 Contract Safeplan Workbook Page 11 Review Risk Contract Safeplan RISK ALERT ALL SAFEPLANS • Keep safe suicide • Safety contact(s) Are you having thoughts of suicide?……………… YES • Safe/no use of alcohol/drugs • Link to resources CURRENT FACTORS RISK SPECIFIC SAFEPLANS Current Suicide Plan How? How prepared? How soon?……………………… YES prepared • Disable the suicide plan Pain Do you have pain that at times feels unbearable?…… YES desperate Resources Do you feel you have few, if any, resources?………… YES alone BACKGROUND FACTORS + Prior Suicidal Behavior Have you ever attempted suicide before?……………. YES familiar + Mental Health Are you receiving or have you received mental health care?……………………………………… YES vulnerable 16.10 Contract Safeplan Workbook Page 11

16.11 Contract Safeplan Workbook Page 11 Review Risk Contract Safeplan RISK ALERT ALL SAFEPLANS • Keep safe suicide • Safety contact(s) Are you having thoughts of suicide?……………… YES • Safe/no use of alcohol/drugs • Link to resources CURRENT FACTORS RISK SPECIFIC SAFEPLANS Current Suicide Plan How? How prepared? How soon?……………………… YES prepared • Disable the suicide plan Pain Do you have pain that at times feels unbearable?…… YES desperate • Ease the pain Resources Do you feel you have few, if any, resources?………… YES alone BACKGROUND FACTORS + Prior Suicidal Behavior Have you ever attempted suicide before?……………. YES familiar + Mental Health Are you receiving or have you received mental health care?……………………………………… YES vulnerable 16.11 Contract Safeplan Workbook Page 11

16.12 Contract Safeplan Workbook Page 11 Review Risk Contract Safeplan RISK ALERT ALL SAFEPLANS • Keep safe Are you having thoughts of suicide?……………… YES suicide • Safety contact(s) • Safe/no use of alcohol/drugs • Link to resources CURRENT FACTORS RISK SPECIFIC SAFEPLANS Current Suicide Plan How? How prepared? How soon?……………………… YES prepared • Disable the suicide plan Pain Do you have pain that at times feels unbearable?…… YES desperate • Ease the pain Resources Do you feel you have few, if any, resources?………… YES alone • Link to resources BACKGROUND FACTORS + Prior Suicidal Behavior Have you ever attempted suicide before?……………. YES familiar + Mental Health Are you receiving or have you received mental health care?……………………………………… YES vulnerable 16.12 Contract Safeplan Workbook Page 11

16.13 Contract Safeplan Workbook Page 11 Review Risk Contract Safeplan RISK ALERT ALL SAFEPLANS • Keep safe • Safety contact(s) Are you having thoughts of suicide?……………… YES suicide • Safe/no use of alcohol/drugs • Link to resources CURRENT FACTORS RISK SPECIFIC SAFEPLANS Current Suicide Plan How? How prepared? How soon?……………………… YES prepared • Disable the suicide plan Pain Do you have pain that at times feels unbearable?…… YES desperate • Ease the pain Resources Do you feel you have few, if any, resources?………… YES alone • Link to resources BACKGROUND FACTORS + Prior Suicidal Behavior Have you ever attempted suicide before?……………. YES familiar • Protect against the danger/ support past survival skills + Mental Health Are you receiving or have you received mental health care?……………………………………… YES vulnerable 16.13 Contract Safeplan Workbook Page 11

16.14 Contract Safeplan Workbook Page 11 Review Risk Contract Safeplan RISK ALERT ALL SAFEPLANS • Keep safe suicide • Safety contact(s) Are you having thoughts of suicide?……………… YES • Safe/no use of alcohol/drugs • Link to resources CURRENT FACTORS RISK SPECIFIC SAFEPLANS Current Suicide Plan How? How prepared? How soon?……………………… YES prepared • Disable the suicide plan Pain Do you have pain that at times feels unbearable?…… YES desperate • Ease the pain Resources Do you feel you have few, if any, resources?………… YES alone • Link to resources BACKGROUND FACTORS + Prior Suicidal Behavior Have you ever attempted suicide before?……………. YES familiar • Protect against the danger/ support past survival skills + Mental Health Are you receiving or have you received mental health care?……………………………………… YES vulnerable • Link to health worker 16.14 Contract Safeplan Workbook Page 11

INFORMAL RESOURCES FORMAL RESOURCES 16.7 Resources family and friends 24-HOUR emergency 24-HOUR health workers LONGER-TERM advisers LONGER-TERM personal connections LIFE-LONG community LIFE-LONG 16.7 Resources

12.7 Structure of the Suicide Intervention Model Workbook Page 5 UNDERSTANDING reasons? risk? listen review CONNECTING ASSISTING invitations? suicide? explore ask safeplan? commitments? contract follow-up 12.7 Structure of the Suicide Intervention Model Workbook Page 5

17.1 Understanding Intervention Concerns Workbook Page 14 When caregivers… CONNECTED UNDERSTOOD ASSISTED 17.1 Understanding Intervention Concerns Workbook Page 14

17.2 Understanding Intervention Concerns Workbook Page 14 When caregivers… explore invitations CONNECTED UNDERSTOOD ASSISTED 17.2 Understanding Intervention Concerns Workbook Page 14

17.3 Understanding Intervention Concerns Workbook Page 14 they meet the person at risk’s need for… When caregivers… explore invitations CONNECTED UNDERSTOOD ASSISTED 17.3 Understanding Intervention Concerns Workbook Page 14

17.4 Understanding Intervention Concerns Workbook Page 14 they meet the person at risk’s need for… When caregivers… explore invitations recognition CONNECTED UNDERSTOOD ASSISTED 17.4 Understanding Intervention Concerns Workbook Page 14

17.5 Understanding Intervention Concerns Workbook Page 14 they meet the person at risk’s need for… When caregivers… The person at risk feels… explore invitations recognition CONNECTED UNDERSTOOD ASSISTED 17.5 Understanding Intervention Concerns Workbook Page 14

17.6 Understanding Intervention Concerns Workbook Page 14 they meet the person at risk’s need for… When caregivers… The person at risk feels… explore invitations recognition valued CONNECTED UNDERSTOOD ASSISTED 17.6 Understanding Intervention Concerns Workbook Page 14

17.7 Understanding Intervention Concerns Workbook Page 14 they meet the person at risk’s need for… When caregivers… The person at risk feels… and is more likely to… explore invitations recognition valued CONNECTED UNDERSTOOD ASSISTED 17.7 Understanding Intervention Concerns Workbook Page 14

17.8 Understanding Intervention Concerns Workbook Page 14 they meet the person at risk’s need for… When caregivers… The person at risk feels… and is more likely to… answer honestly about thoughts of suicide explore invitations recognition valued CONNECTED UNDERSTOOD ASSISTED 17.8 Understanding Intervention Concerns Workbook Page 14

17.9 Understanding Intervention Concerns Workbook Page 14 they meet the person at risk’s need for… When caregivers… The person at risk feels… and is more likely to… answer honestly about thoughts of suicide explore invitations recognition valued ask about suicide permission relieved talk openly about suicide listen to reasons for dying and living perspective accepted move toward their life side review risk care respected help develop their safeplan contract a safeplan hope encouraged commit to their safeplan follow-up on commitments safety supported keep safe CONNECTED UNDERSTOOD ASSISTED 17.9 Understanding Intervention Concerns Workbook Page 14

12.8 Structure of the Suicide Intervention Model Workbook Page 5 UNDERSTANDING reasons? risk? listen review CONNECTING ASSISTING invitations? suicide? explore ask safeplan? commitments? contract follow-up 12.8 Structure of the Suicide Intervention Model Workbook Page 5

18 Pathways in the Suicide Intervention Model Workbook Page 15

19 Location of Concerns and Tasks Workbook Page 15

20.1 Concerns and Tasks Workbook Page 16 invitations? P E R S O N A T R I S K C A R E G I V E R explore 20.1 Concerns and Tasks Workbook Page 16

13 Explore Invitations Workbook Page 7 HELP ACTIONS • Giving away possessions • Withdrawal (family, friends, school, work) • Loss of interest in hobbies • Abuse of alcohol, drugs • Reckless behavior • Extreme behavior changes • Impulsivity • Self-mutilation FEELINGS Desperate Angry Guilty Worthless Lonely Sad Hopeless Helpless PHYSICAL • Lack of interest in appearance • Change/loss in sex interest • Disturbed sleep • Change/loss of appetite, weight • Physical health complaints THOUGHTS "All of my problems will end soon" "No one can do anything to help me now" "Now I know what they were going through" "I just can't take it any more" "I wish I were dead" "Everyone will be better off without me" "I won't be needing these things anymore" "I can't do anything right" "I just can't keep my thoughts straight anymore" STRESSFUL EVENTS with FEELINGS OF LOSS 13 Explore Invitations Workbook Page 7

20.2 Concerns and Tasks Workbook Page 16 suicide? P E R S O N A T R I S K ask C A R E G I V E R 20.2 Concerns and Tasks Workbook Page 16

20.2 Concerns and Tasks Workbook Page 16 reasons? P E R S O N A T R I S K listen C A R E G I V E R 20.2 Concerns and Tasks Workbook Page 16

20.2 Concerns and Tasks Workbook Page 16 risk? P E R S O N A T R I S K review C A R E G I V E R 20.2 Concerns and Tasks Workbook Page 16

15.6 Review Risk Workbook Page 10 ALERT Are you having thoughts of suicide?……………… YES suicide CURRENT FACTORS Current suicide plan How? How prepared? How soon?……………………… YES prepared Pain Do you have pain that at times feels unbearable?…… YES desperate Resources Do you feel you have few, if any, resources?………… YES alone BACKGROUND FACTORS + Prior suicidal behavior Have you ever attempted suicide before?……………. YES familiar + Mental health Are you receiving or have you received mental health care?……………………………………… YES vulnerable 15.6 Review Risk Workbook Page 10

20.2 Concerns and Tasks Workbook Page 16 safeplan? P E R S O N A T R I S K contract C A R E G I V E R 20.2 Concerns and Tasks Workbook Page 16

16.14 Contract Safeplan Workbook Page 11 Review Risk Contract Safeplan RISK ALERT ALL SAFEPLANS • Keep safe suicide • Safety contact(s) Are you having thoughts of suicide?……………… YES • Safe/no use of alcohol/drugs • Link to resources CURRENT FACTORS RISK SPECIFIC SAFEPLANS Current Suicide Plan How? How prepared? How soon?……………………… YES prepared • Disable the suicide plan Pain Do you have pain that at times feels unbearable?…… YES desperate • Ease the pain Resources Do you feel you have few, if any, resources?………… YES alone • Link to resources BACKGROUND FACTORS + Prior Suicidal Behavior Have you ever attempted suicide before?……………. YES familiar • Protect against the danger/ support past survival skills + Mental Health Are you receiving or have you received mental health care?……………………………………… YES vulnerable • Link to health worker 16.14 Contract Safeplan Workbook Page 11

20.2 Concerns and Tasks Workbook Page 16 commitments? P E R S O N A T R I S K C A R E G I V E R follow-up 20.2 Concerns and Tasks Workbook Page 16

21.1 Checkpoints

Are we agreed that suicide is our focus? 21.2 Checkpoints

21.3 Checkpoints Are we agreed that suicide is our focus? Are we both aware of the risk and the need for a safeplan? 21.3 Checkpoints

Did everyone fulfill their commitments to the safeplan? Are we agreed that suicide is our focus? Are we both aware of the risk and the need for a safeplan? 21.4 Checkpoints

22.1 Process Themes Workbook Page 16 DEATH AMBIVALENCE LIFE Existence CONNECTING UNDERSTANDING ASSISTING 22.1 Process Themes Workbook Page 16

22.2 Process Themes Workbook Page 16 DEATH AMBIVALENCE LIFE Existence CONNECTING UNDERSTANDING ASSISTING PAST PRESENT FUTURE Time 22.2 Process Themes Workbook Page 16

22.3 Process Themes Workbook Page 16 DEATH AMBIVALENCE LIFE Existence CONNECTING UNDERSTANDING ASSISTING PAST PRESENT FUTURE Time ALONE ENGAGED LINKED Relationship 22.3 Process Themes Workbook Page 16

23.1 Process Themes at Work Workbook Page 16 AMBIVALENCE PRESENT ENGAGED DEATH PAST ALONE LIFE FUTURE LINKED 23.1 Process Themes at Work Workbook Page 16

23.2 Process Themes at Work Workbook Page 16 AMBIVALENCE PRESENT ENGAGED DEATH PAST ALONE FUTURE LIFE LINKED 23.2 Process Themes at Work Workbook Page 16

23.3 Process Themes at Work Workbook Page 16 AMBIVALENCE PRESENT ENGAGED DEATH ALONE PAST LIFE LINKED FUTURE 23.3 Process Themes at Work Workbook Page 16

23.4 Process Themes at Work Workbook Page 16 AMBIVALENCE PRESENT ENGAGED DEATH PAST ALONE LIFE FUTURE LINKED 23.4 Process Themes at Work Workbook Page 16

24.1 Working with Ambivalence Workbook Page 17 DEATH Patiently listen TO the death side of ambivalence; help the person at risk talk about their reasons for dying 24.1 Working with Ambivalence Workbook Page 17

24.2 Working with Ambivalence Workbook Page 17 DEATH LIFE Patiently listen TO the death side of ambivalence; help the person at risk talk about their reasons for dying Persistently listen FOR the life side of ambivalence; search for reasons for living or reinforce them when the person at risk discovers them 24.2 Working with Ambivalence Workbook Page 17

25.1 Working with In-Sync Workbook Page 17 reasons? risk? suicide? safeplan? invitations? commitments? review contract ask listen explore follow-up 25.1 Working with In-Sync Workbook Page 17

25.2 Working with In-Sync Workbook Page 17 reasons? risk? suicide? safeplan? invitations? commitments? review contract ask listen explore follow-up 25.2 Working with In-Sync Workbook Page 17

25.3 Working with In-Sync Workbook Page 17 reasons? risk? suicide? safeplan? invitations? commitments? review contract ask listen explore follow-up 25.3 Working with In-Sync Workbook Page 17

26 Suicide Intervention Model Workbook Page 18

24.2 Working with Ambivalence Workbook Page 17 DEATH LIFE Patiently listen TO the death side of ambivalence; help the person at risk talk about their reasons for dying Persistently listen FOR the life side of ambivalence; search for reasons for living or reinforce them when the person at risk discovers them 24.2 Working with Ambivalence Workbook Page 17

27 Nick Walker’s Risk Review Review Risk RISK ALERT NICK WALKER Are you having thoughts of suicide?……………… YES suicide CURRENT FACTORS Current Suicide Plan How? How prepared? How soon?……………………… Carbon monoxide poisoning in garage at home Has made his decision Widower for two years; retiring soon YES prepared Contract Safeplan Pain Do you have pain that at times feels unbearable?…… NO Resources Do you feel you have few, if any, resources?………… ??? alone? BACKGROUND FACTORS + Prior Suicidal Behavior Have you ever attempted suicide before?……………. NO + Mental Health Are you receiving or have you received mental health care?……………………………………… NO 27 Nick Walker’s Risk Review

INFORMAL RESOURCES FORMAL RESOURCES 16.7 Resources family and friends 24-HOUR emergency 24-HOUR health workers LONGER-TERM advisers LONGER-TERM personal connections LIFE-LONG community LIFE-LONG 16.7 Resources

YOU INFORMAL RESOURCES FORMAL RESOURCES 16.8 Resources family and friends 24-HOUR emergency 24-HOUR YOU health workers LONGER-TERM advisers LONGER-TERM personal connections LIFE-LONG community LIFE-LONG 16.8 Resources

28 A Suicide-Safer Community life promotion life preservation life protection family and friends emergency advisers YOU health workers WELCOME LivingWorks Together personal connections community 28 A Suicide-Safer Community

a suicide-safer community safeTALK Training Slides a suicide-safer community © 03/2008 LivingWorks Education www.livingworks.net