1. Suicide Prevention, Assessment, and Intervention The Role of a First Responder Lisa Schwartz, LCSW Suicide Prevention Coordinators Erie VAMC 814-860-2038

2. RISK FACTORS High gun ownership -a major factor (guns are used in approximately 58% of completed suicides). High gun ownership -a major factor (guns are used in approximately 58% of completed suicides). Debilitating injuries Debilitating injuries Mental health issues Mental health issues Veterans have >2x greater risk & account for 1 in 5 suicides in the US.

3. The ultimate aim of suicide prevention is to reduce deaths by suicide; however, it is equally important to reduce the frequency and severity of suicide attempts. The ultimate aim of suicide prevention is to reduce deaths by suicide; however, it is equally important to reduce the frequency and severity of suicide attempts.

4. First Responders Police officers, firefighters and other first line responders are increasingly called upon in situations involving mental health emergencies, such as suicidal crises. Police officers, firefighters and other first line responders are increasingly called upon in situations involving mental health emergencies, such as suicidal crises. First responders are in a unique position to determine the course and outcome of suicidal crises. First responders are in a unique position to determine the course and outcome of suicidal crises. They are often the first to be involved in situations where suicidal behaviors, such as a suicide threat, suicide attempt or completed suicide, have occurred. They are often the first to be involved in situations where suicidal behaviors, such as a suicide threat, suicide attempt or completed suicide, have occurred.

5. Suicide by deadly force One of the most difficult crisis situations for police to address occurs when an individual engages in life-threatening behavior to provoke officers to fire, either to protect themselves or a civilian bystander. This has been termed "police-assisted suicide" or "suicide by cop”. One of the most difficult crisis situations for police to address occurs when an individual engages in life-threatening behavior to provoke officers to fire, either to protect themselves or a civilian bystander. This has been termed "police-assisted suicide" or "suicide by cop”.

6. First Responders HELPING SOMEONE WHO IS SUICIDAL People who feel suicidal often express hopelessness and depression. They see suicide as the only way to solve their problems and eliminate their suffering. People who feel suicidal often express hopelessness and depression. They see suicide as the only way to solve their problems and eliminate their suffering. Although suicide is difficult to predict, a large proportion of those who eventually kill themselves will give warning signs of their suicidal intentions in the weeks or months prior to their death. Although suicide is difficult to predict, a large proportion of those who eventually kill themselves will give warning signs of their suicidal intentions in the weeks or months prior to their death. These are not harmless bids for attention, but important cries for help that should be taken seriously. These are not harmless bids for attention, but important cries for help that should be taken seriously.

7. Warning signs include both behavioral and verbal clues: –Hopelessness/helplessness –Withdrawn from family/friends –Anger, rage –Giving away possessions –History of suicide attempts –Drug and/or alcohol abuse –A change in health

8. Warning signs continued….. –Constantly dwelling on problems for which there seem to be no solutions; –Expressing a lack of support or belief in the system; –Giving some other indication of a suicide plan.

9. Assessing the risk Engage the individual. Engage the individual. Encourage the person to talk. Encourage the person to talk. Most suicidal people are ambivalent about dying. Most suicidal people are ambivalent about dying. Asking someone if they are suicidal will not “tip them over the edge”, but will provide a sense of relief and a starting point for a solution. Asking someone if they are suicidal will not “tip them over the edge”, but will provide a sense of relief and a starting point for a solution. To assess intent, ask if the individual has a plan, access to lethal means, or has decided when to act. To assess intent, ask if the individual has a plan, access to lethal means, or has decided when to act.

10. HELPING SOMEONE WHO IS SUICIDAL HELPING SOMEONE WHO IS SUICIDAL Never leave a potentially suicidal individual alone based on their promise to visit their mental health worker or the hospital. Never leave a potentially suicidal individual alone based on their promise to visit their mental health worker or the hospital. Ensure that family members or significant others are on the scene and accept responsibility for help seeking. Ensure that family members or significant others are on the scene and accept responsibility for help seeking.

11. Veterans Crisis Line National Number: 1-800-273-8255 National Number: 1-800-273-8255 Press #1 for Veteran or family of Veteran Press #1 for Veteran or family of Veteran Crisis Line is available 24/7 and staffed by VA mental health professionals Crisis Line is available 24/7 and staffed by VA mental health professionals In an emergency, Crisis Line staff will assist with immediate referral to community resources including: In an emergency, Crisis Line staff will assist with immediate referral to community resources including: –Local Police Departments –County Crisis Services If non-emergent, the Veteran will be referred to the closest VA within 24hrs. If non-emergent, the Veteran will be referred to the closest VA within 24hrs.