1. Suicide Prevention School Based Mental Health Summit, Portland, OR May 2016 Gary McConahay PhD ColumbiaCare Services, Inc. gmcconahay@columbiacare.org

2. What is your experience? Professional Role Experiences

3. Prevalence of Suicide Behavior Completed Suicide Year 10-24 yo: Raw Number (rate per 100K) 10-17 yo: Raw Number 201054 (7.2)11* 201174 (9.8)18 201273 (9.7)22 201393 (12.3)29 Violent Deaths in Oregon: 2013 DHS Public Health Division * this is the average over 2003 -2010, a period of very flat rates

4. Suicide Attempts Suicide Attempts not accurately measured – ER Attempt Data – Attempts that come to no-one’s attention

5. Suicide Thoughts 11 th Graders: 16% of females and 10.8% of males say they seriously considered suicide in last 12 months.* More risk factors, more likely to report suicide thoughts More caring adults to talk to, less likely to report suicide thoughts Oregon Healthy Teens Survey, 2009 *compare to 3.7%- 5% for Adults

6. Suicide Preparedness Accept that suicide thoughts are a probability Explore institutional and individual attitudes about suicide Attention to suicide is everybody’s responsibility Everyone should be trained to recognize and approach suicide invitations

7. Preparedness Create a “CPR” attitude…all staff need to know the basic signs and how to keep the person alive until on-going help can become involved All staff should eagerly look for opportunities to inquire about suicide thoughts, and know how to ask clearly and directly about suicide

8. Reasons for Completed Suicide [Why?] 10-24 yo; 2003-2012 67% Mentioned Mental Health Problem 41% Current Depressed Mood 39% Crisis is Past Two Weeks 37% Disclosed Intent to Die 36% Family Stressor 36% Break Up with GF/BF; Intimate Partner Conflict 8% School Problem (#14 out of 16 listed) Suicide in Oregon: Adolescents and Young Adults OHA Public Health Division 2015

9. Reasons for Attempting Suicide ED Data Family Discord School Problems Argument with BF or GF Drug Abuse Peer Pressure/ Conflict Sexual Abuse Mental Health not on the list! DHS Public Health Division

10. Ask about suicide Say what you noticed, Express your concern, “Sometimes when a person (says, does, appears …) they are thinking of suicide. Are you thinking of suicide” PRACTICE

11. Intervention Patience is a gift and a tool. We need to let a person express their emotions to allow creativity to bubble up Being chased by a bear; tunnel vision

12. Intervention Unless the person has a suicide in progress you have time to talk As long as the person is talking to you they are safe Ask directly about suicide As the conversation progresses, the person feels relieved As the person feels relieved of pain and they feel hope When the person feels hope they are less likely to suicide Ambivalence

13. Intervention Trust that we don’t have to solve the persons’ reasons for suicide…we only need to get them to agree to stay alive long enough to develop a plan to start working on them Appreciate that the intervention is not over until the person is actively linked to emergency and on-going resources Responsibility as a Treatment Team

14. Task: Describing risk Quantitative Risk Severity and timing graph Rule of 2s Bryan Tanney MD, SuicideCare, 2012 14

15. Risks and Benefits of Hospitalization +May keep person safe for now +Relieves the therapist’s feeling of responsibility -Stigma, Cost -Hospital stay itself usually changes nothing -Post-hospital discharge period very vulnerable time -May damage therapeutic relationship -Where does the person go for help afterwards? Consider other options for 24-Hour supervision?

16. Management Bryan Tanney MD, SuicideCare, 2012 16

17. Helping Attitudes Bryan Tanney MD, SuicideCare, 2012 17

18. Treatment Why go to “Why?” Reasons for Dying can be external or internal Every reason for dying has embedded within it a reason for living It is not the event itself but the meaning behind the event The key meaning is LOSS

19. Why “Why?” Works When a person is talking about their reasons for dying they are talking their losses. When a person is talking about their losses, they are talking about what they care about (if they did not care about it, it would not be a loss). When a person is talking to us about what they care about, they are telling us their reasons for living. Therefore, the more reasons for dying we can identify within a person at risk of suicide the more we learn about their reasons for living.

20. Ambivalence The differences faces of Ambivalence Bryan Tanney MD, SuicideCare, 2012 20

21. Treatment Once the Individual is safe from immediate risk of suicide For Individuals who have or have not acted on their thoughts A person can hold suicide thoughts while in tx but should have a SafePlan to use when needed

22. Meanings of suicidal acts Bryan Tanney MD, SuicideCare, 2012 22

23. Treatment Need to be able to go through the suicide experience, not around it General things that make us feel good may work, but may also ignore the serious and individual experiences of the person Need goal setting based on what drives the suicide thinking, then use whatever therapeutic techniques is necessary to achieve the goal

24. Postvention For attempter, need to treat what drives the thoughts in the first place For Loved Ones… How Suicide Survivor Support Groups work www.suicidology.orgwww.suicidology.org for listing of local groups

25. Final Thought If a suicide occurs your best protection from personal impact as well as successful lawsuit* is to be aware of suicide risk and use standards of care faithfully * (I am not an attorney and not giving legal advice :)

26. Training Opportunities School Based Mental Health Summit, Portland, OR May 2016 RESPONSE…comprehensive High School based suicide prevention program ASIST…two-day intervention skills training workshop Suicide to Hope…one-day training for MH professionals engaged in the longer-term treatment of Individuals with suicide thoughts Suicide Prevention Resource Center (SPRC) Best Practices Registry Gary McConahay PhD ColumbiaCare Services, Inc. gmcconahay@columbiacare.org 541-858-8170