Difficult Discussions Talking with Youth about Suicide Presented by Theresa Marinas, LCSW Director, Behavioral Health Services Kaiser Permanente, Kern County

September is Suicide Prevention Month Statistics from ,000 people in the United States die by suicide each year 1 million people in the world die by suicide each year About 650,000 people in the United States are emergently treated after a suicide attempt An estimated 8% of people diagnosed with Major Depression attempt suicide during their life time. A person dies by suicide about every 15 minutes in the United States. Every day, approximately 101 Americans take their own life.

3| © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.August 27, 2015 First Agenda Second Agenda Third Agenda Fourth Agenda Fifth Agenda Ninety percent of all people who die by suicide have a diagnosable psychiatric disorder at the time of their death. There are four male suicides for every female suicide, but three times as many females as males attempt suicide. Ninety-six percent of alcoholics who die by suicide continued their substance abuse up to the end of their lives. Alcoholism is a factor in about 30 percent of all completed suicides. Approximately 7 percent of those with alcohol dependence will die by suicide. Data from The American Foundation for Suicide Prevention website

4| © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.August 27, 2015 September is Suicide Prevention Month  Suicidal thoughts  Psychiatric disorders (such as depression, impulsive aggressive behavior, bipolar disorder and certain anxiety disorders)  Drug and/or alcohol abuse and previous suicide attempts  The risk is increased if there is situational stress and access to firearms. Risk factors for suicide among the young

5| © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.August 27, 2015 Learning Objectives  Take a brief attitude assessment about your thoughts about suicide  Identifying signs of at risk behavior  Starting a difficult discussion  Continuing a difficult discussion  Taking action

Attitude Assessment Consider whether you always agree, sometimes agree, never agree, or have no opinion: I think suicide is a rational choice. I think suicide should be prevented, no matter what. Because it can be so hard to talk about, I think it is important to respect confidences about suicide. I would do everything I could to prevent my teenager from dating someone who attempted suicide. I respect my child’s choice to date someone who has attempted suicide. Data from TeacherVision.com

7| © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.August 27, 2015 Attitudes

8| © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.August 27, 2015 Attitudes Our attitudes or values about suicide are neither right nor wrong. Attitudes or values can guide our perception about suicide and how we discuss this topic with others, especially youth. What stood out most for you in the assessment that you took a few moments ago?

9| © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.August 27, 2015 Misperceptions Misperception #1Misperception #2Consequence is We should not ask if someone is having thoughts of hurting themselves. The fear is that it will put the idea into a person’s head thus we are responsible for their actions. The idea is already there. We potentially miss an opportunity to help someone at risk.

10| © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.August 27, 2015 Starting the Discussion/Prevention Identify at risk behaviors Distinct changes in personality Distinct negative changes in behavior Possible drug/alcohol abuse Depression and social withdrawal Being a target of bullying or social ridicule Being or feeling different

11| © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.August 27, 2015 What do I say? “I had noticed…you were…and I am concerned about your well being.” “I wondered how names teasing effected you? How are you handling the teasing?...Is there anything I can do that would help?” “I was curious about behavior, statement, attitude which is different from how you have responded before. Can we talk about what is different?

12| © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.August 27, 2015 What do I say? “Have you been able to talk with anyone about this?” “Is there anyone who you think understands what you are feeling?” “What can I do that will encourage you to seek help?” “Is there someone I can talk to about how you are feeling/thinking?”

13| © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.August 27, 2015 Reality Check Explain your limitations but also explain that you want to help. The purpose is not to blame or shame but to give the person an opening to be heard. Stay calm. The youth’s and your own safety comes first and you are setting the tone of the conversation.

14| © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.August 27, 2015 Continuing the discussion/Intervention Ask if the person is having thoughts of self harm in a way that you are comfortable with asking. Ask the person if they have a plan. If the person has a plan, do they have the weapon or method of harm available to them such as pills

15| © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.August 27, 2015 What do I say? Have you suffered from depression, either treated or untreated? Have you had a previous suicide attempt? Is there a family history of death by suicide? Note: 1 out of 100 suicide attempt survivors successfully die by suicide within 1 year of the unsuccessful attempt

16| © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.August 27, 2015 What do I say? Have you used drugs, alcohol, sex, promiscuous or dangerous behavior as a way to feel better? What physical symptoms, emotions, thoughts, behaviors have you been experiencing recently? What do you see for yourself past today?

17| © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.August 27, 2015 What do I say? Is there something you are looking forward to? Do you have plans on seeing friends, travelling, doing something interesting? Is there someone or something that would miss you if you were gone? Note: Sometimes family such as children, events such as a graduation, wedding, birth, or even a pet give a sense there is something work living for in the future.

18| © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.August 27, 2015 Reality Check Bottom line, listen to your instincts. If something inside of you keeps saying something is wrong, go with your instincts. Be reassuring, supportive, and non- judgmental. You may have helped a youth take the first step towards not being part of the statistics presented earlier.

19| © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.August 27, 2015 Taking Action Thank the youth for opening up and taking that first step. Normalize that feeling anxious, afraid, angry, even stupid is not unusual. Some will express relief that they finally said something. Be prepared to have some youths try to deny or bargain with you because they are afraid someone will get angry or they will be in trouble.

20| © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.August 27, 2015 Planning action In Kern County: Bakersfield Police Bakersfield Sheriff MET – Mental Evaluation Team are the only authorities that can place a person on a 5150 otherwise known as a 72 hour psychiatric hold. If someone is an eminent danger, call 911 or Bakersfield Police Department.

21| © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.August 27, 2015 Planning action If a voluntary evaluation; the person can be directed to Mary Kay Shell which is located adjacent to the Kern Medical Center Campus. It is a 24/7 facility and can also evaluate for a Mary Kay Shell is also a psychiatric ‘holding area’ where a person can be held for up to 23 hours for observation.

22| © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.August 27, 2015 Planning action If the person is not eminently a danger, is having thoughts but does not have a plan or the intent to harm themselves, refer the person to a mental health practitioner for further evaluation or treatment. There may be other underlying issues that talk therapy, medication, or a combination of the two can effectively treat to help the person deal with their life situations.

23| © 2011 Kaiser Foundation Health Plan, Inc. For internal use only.August 27, 2015 September is Suicide Prevention Month Questions?????