WILL HE REALLY DO IT? ASSESSING SUICIDE RISK Jeff Bright, LCSW, BCN

WILL HE REALLY DO IT? ASSESSING SUICIDE RISK Introductions Understanding the Risk Tools to Assess Risk Art and Science of Assessing Risk Practice Additional Resources WILL HE REALLY DO IT? ASSESSING SUICIDE RISK

Introductions WILL HE REALLY DO IT? ASSESSING SUICIDE RISK Jeff Bright, LCSW, BCN Worked with children and adolescents since 2001 Big Brothers Big Sisters, Child Protective Services, Utah Youth Village, NeuroTherapy and Trauma Center of Utah, Davis Hospital and Medical Center Who are you? DCFS/DJJS Caseworkers/Case Managers, Mental Health Clinicians, Medical Providers, Social Services Administrators, Educators…. Introductions WILL HE REALLY DO IT? ASSESSING SUICIDE RISK

Understanding the Risk WILL HE REALLY DO IT? ASSESSING SUICIDE RISK Nationally, Suicide 3rd leading cause of death 15-24yrs (CDC) Nationally, Suicide 4th leading caused of death 10-14 yrs (CDC) In Utah Suicide is the Leading (#1) Cause of Death among Teens 11-17 Suicide #1 in Utah (video) and KUTV newscast (video) About 17% of high school students seriously think about suicide, 13% made a plan (nationally in 2013) Females more likely to have suicidal thoughts Males 4x more lethal attempts (firearms) Poisoning is leading cause of death for females Blue Whale Challenge Game encourages participants to hurt themselves for 50 days and then commit suicide http://www.thedenverchannel.com/news/local-news/viral- suicide-game-prompts-denver-public-schools-to-warn-parents Understanding the Risk WILL HE REALLY DO IT? ASSESSING SUICIDE RISK *CDC report

When to Assess WILL HE REALLY DO IT? ASSESSING SUICIDE RISK When do you formally assess? Immediate Risk Talking about wanting to die or kill oneself Looking for a way to kill oneself, searching online (etc) Talking about feeling hopeless or having no reason to live Serious Risk New or Increased… Talking about feeling trapped, unbearable pain, being a burden to others Behaving recklessly (increase substance use, more rage, seeking revenge) Sleeping too little or too much, withdrawing or feeling isolated, extreme mood swings Worst case scenario – The above Behavior(s) plus… Someone close committed suicide recently (family/friend) High Impulsivity w/ or w/o substance use Decrease self care When to Assess WILL HE REALLY DO IT? ASSESSING SUICIDE RISK

Tools to Assess Risk WILL HE REALLY DO IT? ASSESSING SUICIDE RISK Why Use a Tool to Assess Suicide? Rating Scales Predict Suicide Attempts Columbia Suicide Severity Rating Scale/Screen (CSSRS) Most evidence supported suicide risk screen available Recommended by The Joint Commission Clear guidelines for when to take the next steps Removes clinician’s interpretation and classifies a persons risk Has 99% Reliability Iasis Healthcare Suicide Risk Assessment Scale Simple to use Clear 0-3 rating scale Prioritizes highest risk behavior Tools to Assess Risk WILL HE REALLY DO IT? ASSESSING SUICIDE RISK

Assessing the right information Intention Plan Past Attempts Support System Coping Skills Noticing the Red Flags Rating the severity of responses Mild, Moderate, Severe At the end ask “Will you commit to be safe and not harm yourself?” Assessing Risk - the science WILL HE REALLY DO IT? ASSESSING SUICIDE RISK

Assessing Risk - the art WILL HE REALLY DO IT? ASSESSING SUICIDE RISK Establishing Rapport (can be done quickly) Double check our non-verbal body language, eliminate judgement Speak with genuineness and compassion Ask direct questions, no beating around the bush Ask for specifics, especially when you’re confused Assess sincerity of the other person, are they truthful? Assess congruency of body affect with language (how they behave vs what they say) Lack of emotion is concerning Assess the ‘why’, intent + behavior = The Why Assessing Risk - the art WILL HE REALLY DO IT? ASSESSING SUICIDE RISK

Risk Assessed. Now What? WILL HE REALLY DO IT? ASSESSING SUICIDE RISK Safety Plan Components of a good plan Refer to SafeUT Phone App Refer to County Mental Health Crisis Lines Refer to Hospital Call Police to escort to ER Levels of Commitment Blue Sheet (medical/clinical) Pink Sheet (law enforcement or designee) White Sheet (courts/county mental health/psychiatrist) Mental Health Court – Commitment Forced Medication Risk Assessed. Now What? WILL HE REALLY DO IT? ASSESSING SUICIDE RISK

Practice WILL HE REALLY DO IT? ASSESSING SUICIDE RISK Review of CSSRS and Iasis Healthcare Screening Form CSSRS - If person answers “yes” to questions 3, 4, or 5 steps should be taken to keep them safe. Added behavior increases risk. Iasis – If score falls in moderate or high risk steps should be taken to keep them safe More examples (video) Demonstration of CSSRS CSSRS in Action Practice Time (case scenario) Q&A – How did it go? Practice WILL HE REALLY DO IT? ASSESSING SUICIDE RISK

Additional Resources WILL HE REALLY DO IT? ASSESSING SUICIDE RISK 7 Essential Steps Parents Can Take to Prevent Teen Suicide https://psychologybenefits.org/2013/09/23/prevent-teen-suicide/ Common Signs of Someone Who May be Suicidal https://psychcentral.com/blog/archives/2007/10/08/common-signs- of-someone-who-may-be-suicidal/ Utah Suicide Prevention Coalition Meets 2nd Monday of every other month – open to public http://utahsuicideprevention.org/ Crisis Lines for each County http://utahsuicideprevention.org/get-help Salt Lake County Mobile Crisis Outreach Team (MCOT) 801-587-3000 Copies of CSSRS and Iasis Healthcare Risk Assessment Scale, this training, link to videos, and additional resources found at www.ntcuah.com/suicide Additional Resources WILL HE REALLY DO IT? ASSESSING SUICIDE RISK