1. iCARE Gatekeeper Training
Jamie Linsin, Psy.D.
SIUE Counseling Services
2/23/17

2. Intro Question
This U.S. national landmark is estimated to have the 2nd highest suicide rate in the world. What is it?

3. Researchers studied 500 people who had gone to Golden Gate Bridge to jump and were stopped before they could do so. 94% were still living for an average of 26 years afterwards or had died of natural causes. If you can intervene at the right time, you can save a life, not just in that moment, but also going forward. This presentation will help you learn how to identify and recognize the warning signs of suicide, and will give you strategies for intervening/getting help to save a life.
#1 rate at Nanjing Yangtze River Bridge in China.

4. Would you know what to do next?
Presenters act out Scenario 1.

5. Question
How many of you noticed at least one “red flag” item in that scenario?
Red flag = an indication that the person might be thinking about suicide
Examples?

6. Suicide—Warning Signs
Talking/joking about suicide
References to death/the end
Inquiring about means of self-harm
Sudden/marked changes in behavior
Giving away prized possessions
Taking unnecessary risks
Narrowed thinking
Black/white, All/nothing, Hopelessness
Inability or unwillingness to generate alternate options/strategies
Ask audience first if they can name any other suicide warning signs/red flags.

7. Suicide—Risk Factors Prior suicide attempts
A recent loss (relationship, job, academic)
Substance abuse
Access to means of self-harm
Impulsivity
Social isolation/lack of support
Having family/friend who has died by suicide
Hopelessness
Inability/unwillingness to generate alternatives
Risk factors—not so much a statement from the at-risk person; factors that, if present in someone’s life, suggest that they may be at higher risk for suicide.
Ask audience why they think substance abuse is a risk factor. (Risk of accidental overdose, lowering of inhibitions/impaired judgment)
22% of deaths by suicide involved acute alcohol intoxication at the time of death; Opiates present in 20% of suicide deaths.
Alcohol tends to increase psychological distress, increase aggressiveness, impair judgment, and constrict thinking.

8. Suicide Indicators 75% of attempters give some indication
Direct statements
Vague/abstract hints
I feel like giving up
Everything is hopeless
In another week or two, none of this will matter
I can’t go on like this
Behaviors
Significant behavioral changes
Putting self at risk (actively or passively)
If someone is contemplating suicide, here are some of the ways they might indicate it.

9. Spot the red flags!
Try to identify as many warning signs/ risk factors as you can in the following scenario.
Present Scenario 2A.

10. Red Flag Discussion
Discuss what red flag items the audience noticed in the scenario.
Ask tables to discuss what they would do next after noticing the red flags.

11. What next?
After identifying signs that suggest that a person may be at risk of attempting suicide, what might you do next?
Ask the person directly about suicidal thoughts/urges
Recommend resources for getting help
Match the person with available resource(s)
Seek additional help, consultation, as needed

12. A: Asking The Question Don’t be afraid to ask directly!
Research shows that asking someone doesn’t “give them the idea” of suicide
Asking directly shows caring, concern, and that it’s a safe topic to discuss
If you feel unable to ask someone about suicide, please do find someone who can

13. How To Ask Are you having any thoughts of ending your life?
Sometimes when people are experiencing a lot of distress, they start thinking about suicide. Has that been the case for you?
Be open to listening to the person’s response
Non-judgmentally
If the person does not answer your question, ask again
Tell tables to practice asking the question—give them a role play guide to use
C,, K, B share their experiences working with distressed students. How did they respond? What made it challenging?
After tables practice, have a group discussion—present Scenario 2B and let audience practice asking question.

14. “They said ‘yes’—now what?”
It’s ok to stumble
An imperfect response is better than no response, or not asking the question at all
Statements to avoid:
“You can’t really mean that.”
“But you have so much to live for.”
“Suicide is a selfish act.”
“Suicide is a mortal sin.”
Have different responses for each table:
They said yes
They started crying
They tried to change the subject/gave a non-answer
They said “Why are you asking me that?”

15. R: Recommend Resources
Resources include:
SIUE Counseling Services— [option 1]
SIUE PD- 911 or
CIT Officers
For safety/wellness checks and emergencies
Crisis Hotlines
Crisis Text Line
Other supports in the person’s life
Introduce Dustin re: PD response
Be sure to have handout with list of crisis numbers/options—use current/new card?

16. M: Match the person w/resources
Show the person how to connect with preferred resources
If the need is urgent, don’t leave the person alone
Offer to walk the person over to Counseling Services
Call a crisis hotline with the person
Call SIUE PD; wait with person until Police arrive
Mention how to talk more privately with front desk, ask to see the on-call counselor, etc.
Call in advance if possible, ask to speak to on call counselor

17. S: Seek Additional Support
If the person is resistant, or if you’re not sure how to proceed, be sure to ask someone for additional support
Consult with Counseling Services
Call the police or a hotline number
Submit an online Care Report
Seek support for yourself, as needed
Above all, avoid doing nothing!
Care Report if not immediate emergency
Who gets the care report and when best to use it

18. How Counseling Can Help
Provide a supportive, caring relationship
Allow discussion of concerns, non-judgmentally
Assist with identifying alternate options
Solve problems that can be solved readily
Instill hope
Coping strategies for distracting/self-soothing re: emotional pain
Separate person from means of suicide
Available to all current students, free, short term model

19. Reducing access to lethal means
England, early 1960s
Rates dropped 25% after switch from coal to natural gas
U.S. gun owners
Suicide rates 3X greater in homes with a gun
Rates decrease by 66% if gun locks, safe storage of bullets
U.K., 2001
Suicide rates via pill overdose decreased w/change in packaging

20. Bridge Barriers Clifton Suspension Bridge Westgate Bridge
Rates cut in half since ‘98
Westgate Bridge
Rates cut by 85%
Golden Gate barrier
Clifton—in U.K.
Westgate--Melbourne
GG—Stainless steel netting 20 feet below deck and extending outwards 20 feet, designed to collapse around anyone who jumps into it.
Approved by GGB board in 2008, construction scheduled to start in 2017, cost of $142 million
Similar design as a net installed at a cathedral in Switzerland, no attempts there since installed.

21. Questions
What roadblocks do you anticipate in asking someone about suicidal thoughts?
Which resources are you most likely to recommend?
How can you keep a list of resources handy?
iCARE Resource Card

22. Resources SIUE Counseling Services—650-2842
SIUE Police— or 911
National Suicide Prevention Lifeline—
TALK
Crisis Text Line—Text HOME to
Trevor Project Lifeline—866-4U-TREVOR
Trans Lifeline—
List resources here, and/or be sure to have resource cards and other iCARE info handy.

23. For questions or additional info:
Lisa Thompson-Gibson, MA, LPC SIUE Counseling Services 0222 Student Success Center
Include contact info for whomever is presenting.