The History, and Future, of Peer Support for People with Suicidal Thoughts Tony Trahan Deputy Director, Office of Consumer Affairs NYS Office of Mental Health

Emile Durkheim – Suicide Found that Protestants, males, an the unmarried took their lives at a higher rate than Catholics, Jews, females, and the married. Social integration found to have a significant influence on suicidal behavior. Protective factors. – NYC vs. ROS

1966! Early Attempts at Creating Peer Support Groups Indin described a special group program exclusively for suicidal and depressed persons. This treatment modality has been slow to take hold in mental health settings. 1966!

Source “Resistances Encountered in Starting a Group Therapy Program for Suicide Attempters in Varied Administrative Settings.” Jacqueline Hackel, MA and Chrisula T. Asimos, MA Suicide Prevention of Alameda County and University of California at San Francisco

Concerns Contagion Funding Fear that a patient’s suicide will be a reflection on clinical competence. Legal Liability

Strategies Helpful to define the group as adjunctive and supportive to other treatment modalities The ability to convey a willingness to collaborate on the care of the patient was found to allay the fears of administrators and primary therapists.

Managing Stigma Some suicidal patients find it difficult to engage in treatment because they fear the risk of being considered or labeled crazy for their suicidal feelings and experiences. This special group setting serves to minimize this risk and encourages an open discussion of such experiences

Other Challenges and Benefits Transference – Hostility towards therapist. Drop out of tx Group and peer support helps to dilute the intensity of the feelings while helping to keep people connected to tx

1981

Survivors of Suicide Attempt(s) Groups Didi Hirsch

http://www.didihirsch.org/ 8 week group Closed group Phone screening and Risk Assessment Intake Co-led by and Clinician and a Peer with lived experience (handout)

8 Week Overview Group Overview/Introductions Talking about Suicide Giving and Receiving Support What Causes My Thoughts? How Can I Cope with the Thoughts Resources Hope Where Do We Go From Here?

Adjunctive and Supportive Therapy group Risk assessment CBT DBT Safety Planning Group Process Support Group Connection Peer support Managing stigma Empowerment Resources

Facilitator Self Assessment I can understand the reasons why a person may want to take their life. I accept that there are limits to what I can do to keep a person safe from suicide I feel confident managing high-risk situations I am able to listen to a person’s wish to die I am comfortable simultaneously working with multiple people who are at risk for suicide in a group setting.

Qualitative Findings It just keeps me alive – F - 50 Everyone understands each other- M - 35 There is community here – F - 48 It is different than therapy. It is a miracle in my life. – F - 21 It is a safe place to let it all out.- F – 50 Group opened my eyes to realize that I am not the only one going through stuff. – M – 21

Summary The value of Peer Support groups for suicidal and depressed persons has been recognized for at least 50 years Real and perceived fears, stigma, and erroneous beliefs about suicide have prolonged progress in peer support and engaging people into treatment. Being comfortable with managing and sharing risk is an essential first step. There are emerging best practices available.