Jennifer Myers, MA Coordinator of Suicide Prevention Services Counseling & Human Development Center Byrnes Building, 7 th Floor

 To educate about the signs of suicide  To inform you of how to respond if you are concerned a person may be suicidal or in emotional distress  To empower you to feel confident to intervene  To connect you with resources

 Suicidal Ideation – Thinking about suicide  Suicide threat – Stating intent to kill yourself  Suicide attempt – Any act or behavior intended to end your life  Intentional self-harm – Behavior related to self harm but absent of the intent to kill oneself  Completed/died by suicide – suicide death  Survivor of suicide – friend or family member of deceased

 In the past year, USC students: ◦ 41% experienced hopelessness ◦ 59% reported feeling very sad ◦ 26% felt so depressed it was difficult to function ◦ 4.6% seriously considered suicide (1,349 students or 26 students per week) ◦ 0.5 % attempt suicide (147 students or approximately 3 per week) *American College Health Association’s National College Health Assessment 2010

 Felt things were hopeless *American College Health Association’s National College Health Assessment 2010 Percent (%)MaleFemaleTotal No, Never No, not last 12 months Yes, last 2 weeks Yes, last 30 days Yes, in last 12 months Any time in the last 12 months

 Felt very lonely *American College Health Association’s National College Health Assessment 2010 Percent (%)MaleFemaleTotal No, Never No, not last 12 months Yes, last 2 weeks Yes, last 30 days Yes, in last 12 months Any time in the last 12 months

 Felt very sad *American College Health Association’s National College Health Assessment 2010 Percent (%)MaleFemaleTotal No, Never No, not last 12 months Yes, last 2 weeks Yes, last 30 days Yes, in last 12 months Any time in the last 12 months

 Felt so depressed that it was difficult to function *American College Health Association’s National College Health Assessment 2010 Percent (%)MaleFemaleTotal No, Never No, not last 12 months Yes, last 2 weeks Yes, last 30 days Yes, in last 12 months Any time in the last 12 months

Seriously Considered Suicide Percent (%) MaleFemaleTotal No, Never No, Not last 12 months Yes, last 2 weeks Yes, last 30 days0.4 Yes, in last 12 months Any time within the last 12 months *American College Health Association’s National College Health Assessment 2010

 Intentionally Cut, Burned, Bruised, or otherwise injured yourself *American College Health Association’s National College Health Assessment 2010 Percent (%)MaleFemaleTotal No, Never No, not last 12 months Yes, last 2 weeks Yes, last 30 days Yes, in last 12 months Any time in the last 12 months

 Attempted Suicide *American College Health Association’s National College Health Assessment 2010 Percent (%)MaleFemaleTotal No, Never No, not last 12 months Yes, last 2 weeks Yes, last 30 days Yes, in last 12 months Any time in the last 12 months

 Men are 4 times more likely than women to die by suicide  Women are 3 times more likely to attempt  In college students, this gender difference is less apparent  80% of those who die by suicide in college are not receiving treatment through the counseling center  90% had one or more mental disorder  50% had alcohol in their system at the time of death

 Feelings of hopelessness are more predictive of suicide than depression  Perceived burdensomeness  Thwarted Belongingness  Suicide is not chosen; it happens when pain exceeds an individual’s resources for coping with pain

 Is there a stereotypical “suicidal person”? ◦ What would this person look like? What would they wear? How would they act? How would they talk?  Myths about Suicide ◦ No one can stop a suicide, it is inevitable.  If people in a crisis get the help they need, they will likely never be suicidal again. ◦ Suicidal people keep their plans to themselves.  Most suicidal people communicate their intent sometime during the week preceding their attempt.

 Suicide Rates Among Persons Ages 10 Years and Older, by Race/Ethnicity and Sex, United States, ,  Source: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention

 Percentage of Suicides Among Persons Ages Years, by Race/Ethnicity and Mechanism, United States,  Source: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention

 Among American Indians/Alaska Natives ages 15- to 34-years, suicide is the second leading cause of death.  Suicide rates among American Indian/Alaskan Native adolescents and young adults ages 15 to 34 (20.0 per 100,000) are 1.8 times higher than the national average for that age group (11.4 per 100,000).  Hispanic & Black, non-Hispanic female high school students reported a higher percentage of suicide attempts (11.1% and 10.4%, respectively) than their White, non-Hispanic counterparts (6.5%). Source: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control

 There is a range of cultural and spiritual beliefs about suicide  View regarding seeking psychological services  Pressures, support systems, coping mechanisms, psychological symptoms may vary

 LGBTQ individuals are at higher risk for suicidal thinking  There is no tracking system of sexual orientation or gender identity in completed suicides  Sexuality or gender identity does not create the higher risk itself.  Those who are at higher risk: ◦ Early disclosure of sexuality ◦ Hiding sexuality ◦ Lack of Family Acceptance ◦ Bullying or Harassment ◦ Conflict with Spiritual Beliefs ◦ Low self esteem, struggle with personal acceptance ◦ Isolation

 Markers for suicide risk are noticeably higher in student veterans than general student population  10 years of combat has resulted in increase in ◦ Substance abuse ◦ PTSD ◦ Depression  An estimated 20% of Veterans have struggled with PTSD or depression  May not disclose suicidal thinking

 These are indicators that a person is suicidal  Someone threatening, talking about, or stating they intend to hurt or kill themselves  Someone looking for ways to kill themselves: Seeking access to pills, weapons, or other means  Someone talking or writing about death, dying, or suicide  Rehearsing a suicide attempt Take all Warning Signs Seriously

 “I’ve decided to kill myself.”  “I wish I were dead.”  “I’m going to commit suicide.”  “I’m going to end it all.”  “If (such and such) doesn’t happen, I’ll kill myself.”

 “I’m tired of life, I just can’t go on.”  “My family would be better off without me.”  “Who cares if I’m dead anyway.”  “I just want out.”  “I won’t be around much longer.”  “Pretty soon you won’t have to worry about me.”  “You won’t see me anymore.”

 I Ideation  S Substance Abuse  P Purposelessness  A Anxiety  T Trapped  H Hopelessness  W Withdrawal  A Anger  R Recklessness  M Mood Change Take all Warning Signs Seriously

 Previous Suicidal Behavior  Impulsivity  Significant substance use or dependence  Family History of Suicide  Previous History of Psychiatric Diagnosis  Eating Disorder  History of abuse (sexual, physical, emotional)  Chronic pain  Recent Discharge from inpatient psychiatric treatment

 Loss of any major relationship  Death of a spouse, child, or best friend, especially if by suicide  Being fired, failing classes, rejection or expulsion from a program  Sudden unexpected loss of freedom/fear of punishment  Diagnosis of a serious or terminal illness

 Some aspects of college are protective factors  These include: ◦ Presence of Social Supports ◦ Improved problems solving & coping skills ◦ Access to treatment and other helpers ◦ Hopeful about the future ◦ Fear of social disapproval

 Common ways to ask: ◦ “Are you thinking about suicide?” ◦ “Do you want to kill yourself?” ◦ “Sometimes when people are sad as you are, they think about suicide, Have you been thinking about suicide?” ◦ “You look pretty miserable, I wonder if you’re thinking about suicide?” ◦ “You know, when people are as upset at you seem to be, they sometimes wish they were dead. I’m wondering if you’re feeling that way, too?” ◦ Note: If you cannot ask the question, find someone who can.

“You’re not suicidal, are you?”

◦ “Have you been thinking about how you would kill yourself?” ◦ “How long have you been thinking about this?” ◦ If a person has stated the means they would kill themselves with, take steps to remove the means.

 Myths about suicide:  If you ask someone directly about suicide, you will put the idea in their head and might make them want to do it.  Truth is asking someone directly about suicide lowers anxiety, opens up communication, and lowers the risk of an impulsive act.  Most suicidal persons indicate experiencing relief if asked directly about suicide.

 If you observe any of the acute warning signs: ◦ Between 8am to 5pm M-F: go with the student to the Counseling and Human Development center 7 th Floor Byrnes Building  Another staff person should contact CHDC and inform them of the situation ◦ After 5pm M-F or Saturday or Sunday, Contact the USC Police 911 ( for dispatch)

 If you observe warning signs other than the acute warning signs ◦ CHDC Walk in hours 2-4pm M-F ◦ Consult with CHDC or USC Police, 911 or , regarding the risk ◦ Refer the person to counseling  Assist them in calling & making an appointment  Walk with them to the appointment if needed ◦ Inform other staff in your department ◦ Follow Up with the person and pay attention to additional warning signs.

 Be willing to listen  Be non-judgmental  Be direct  Be available  Offer hope that options are available  Be actively involved in getting the person treatment  Take action to remove lethal means  Follow up (after they went to counseling center or other intervention)

 Reports to file: ◦  Additional Resources: ◦

 Assist residents in recognizing their signs of stress, anxiety, and depression  Help them to develop positive coping skills  Pay attention to isolated students and try to engage them. Keep them on your radar screen  Be aware of relationship break ups and support residents as appropriate  Refer to counseling

 You are not the therapist  You don’t have to make a safety plan with the person. You can be one part of a safety plan  Do not keep a persons suicidal communications or signs a secret  Use CHDC staff for consultation, specifically Dr. Bob Rodgers, Jennifer Myers, Dr. Toby Lovell

 Work together with others. Your role is not to “fix” the problem.  Set limits and boundaries on the amount of time you available or spend with a student  More is not always better

 Take care of yourself  Use your support systems  Pay attention to your cues regarding stress  Take time away as needed  Know your positive coping mechanisms & use them frequently  Recognize and respect your limits  Use supervision to address your needs  Go to therapy for your own mental health concerns

 Counseling and Human Development Center  7 th Floor Byrnes Building   USC Police ◦ or  Thomson Student Health Center ◦  Behavioral Intervention Team ◦  Student Disability Services ◦

 National Suicide Prevention Lifeline ◦ (TALK) ◦  Trevor Project (GLBT Youth) ◦ ◦

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