1. Law Enforcement Suicide: Prevention, Intervention and Postvention Elizabeth K. White, Ph.D.

2. Introduction to Suicide Prevention Intervention Postvention In Conclusion Law Enforcement Suicide: Prevention, Intervention and Postvention

3. Introduction to Suicide Law Enforcement Suicide: Prevention, Intervention and Postvention

4. Suicide in General Law Enforcement Suicide Suicide and Sexual Orientation Introduction to Suicide Law Enforcement Suicide: Prevention, Intervention and Postvention

5. One suicide every 16.7 minutes 11 th ranking cause of death in USA ~787,000 annual attempts 31,484 completed suicides in 2003 Each suicide significantly impacts six other people! Introduction to Suicide Suicide in General

6. Is Law Enforcement Suicide an “Epidemic” or a Terrible Tragedy? Law Enforcement Suicide Introduction to Suicide

7. Who is a member of law enforcement? Sworn peace officers Custody officers Reserve officers? Parole officers? Retired officers? Security officers? Law Enforcement Suicide Confounding Variables Introduction to Suicide

8. Law Enforcement Suicide Concerns of Police Survivors (COPS) sent out a survey to 14,000 agencies regarding surviving family members of peace officers who had committed suicide 4 RESPONDED! Law Enforcement Suicide Introduction to Suicide

9. Law Enforcement Suicide Confounding Variables Violanti, 1996 Introduction to Suicide

10. Law Enforcement Suicide Estimated Law Enforcement Rates Aamodt & Stalknaker (2001) – 18.1 / 100,000 Loo (2003) – 22.99 / 100,000 Compion (2001) – 18.1 / 100,000 Introduction to Suicide

11. Law Enforcement Suicide Suicide Rate Comparison? CDC WISQARS Data 2003 Introduction to Suicide

12. Suicide Rate Comparison Law Enforcement Suicide Introduction to Suicide

13. Military Suicide Rates 1990-2004 Law Enforcement Suicide Introduction to Suicide

14. Law Enforcement Suicide 2006 MaleFemal e WhiteBlackHispAsian LASD 84%16%52%10%32%4.2% LAPD 81%19%42%13%37%6% Introduction to Suicide

15. “A peace officer is twice as likely to die by his or her own hand than by the hand of a suspect!” Law Enforcement Suicide Introduction to Suicide

16. Suicide/Homicide Ratio 1.8:1 Law Enforcement Suicide 3.6:1 CDC WISQARS Data 2003 Introduction to Suicide

17. Law Enforcement Suicide Confounding Variables Having a firearm in the home increases your risk for suicide five fold! Roggenbaum & Lazear, 2003 Introduction to Suicide

18. Law Enforcement Suicide Confounding Variables Firearm suicide attempts result in death in approximately 85% of cases. Introduction to Suicide

19. Law Enforcement Suicide Confounding Variables Introduction to Suicide

20. Law Enforcement Suicide Confounding Variables The risk of suicide in alcoholics is 50-70% higher than the general population. Introduction to Suicide

21. Law Enforcement Suicide Confounding Variables Introduction to Suicide

22. Law Enforcement Suicide Confounding Variables CDC WISQARS Data 2003

23. Law Enforcement Suicide Confounding Variables Gaska, 1980 Introduction to Suicide

24. Suicide & Sexual Orientation Research Difficulties Youth Studies Adult Studies Introduction to Suicide

25. Are you GLBTI? After the Fact Attempts vs. Completions Compared to What? Is it Because I am GLBTI? Suicide and Sexual Orientation Research Difficulties Introduction to Suicide

26. Suicide and Sexual Orientation Youth Suicide Attempts Attempts:Completion ratio estimated at 100:1 Male:Female Attempt ratio estimated at 1:3 Introduction to Suicide

27. Suicide and Sexual Orientation Suicide Completions Introduction to Suicide

28. Suicide and Sexual Orientation GLB Youth Suicide Robin et al 2003  Serious Attempt Introduction to Suicide

29. GLB Youth Suicide Attempts Youth 9-14% Introduction to Suicide Suicide and Sexual Orientation

30. GLB Youth Suicide Remafedi, et al 1991 Introduction to Suicide Suicide and Sexual Orientation

31. Adult Suicide Attempts Attempts:Completion ratio estimated at 25:1 Introduction to Suicide Suicide and Sexual Orientation

32. Special Populations Introduction to Suicide Suicide and Sexual Orientation

33. Prevention Law Enforcement Suicide: Prevention, Intervention and Postvention

34. Designing a Prevention Program Obtaining “Buy In” Prevention Law Enforcement Suicide: Prevention, Intervention and Postvention

35. Designing a Prevention Program Prevention Screening Education Tracking “at risk” personnel Critical incident intervention Resources/Referral

36. Pre-employment Psychological Screening High Risk Assignment Screening –Special Weapons –Undercover –Arson/Explosives Designing a Prevention Program Screening Prevention

37. Academy Supervisors Field Training Officers AOT Designing a Prevention Program Preventative Education Prevention

38. Divorced/Separated Bereaved Injured/Ill Under Investigation Substance Use Problem Approaching Retirement Designing a Prevention Program Tracking “At Risk” Personnel Prevention

39. Officer Involved Shootings Serious Threat to Life Secondary Traumatization Incidents Designing a Prevention Program Critical Incident Intervention Prevention

40. Law Enforcement Mental Health Professionals (MHP) Peer Support Program Chaplains’ Program Self-Help Programs Peace Officer’s Fellowship Designing a Prevention Program Available Resources Prevention

41. Supervisor Referrals Settlement Agreements Designing a Prevention Program Referral Systems Prevention

42. Obtaining “Buy In” “ Top Down” backing Saturation outreach Making it stick Prevention

43. Backing of upper managers - Initial materials cost - Training time coverage - Non-punitive/help orientation “Personal touch” roll out to middle managers Obtaining “Buy In” “Top Down” Backing Prevention

44. Preview presentation/training to peer support personnel & chaplains Availability of materials through computer as well as briefing/training Incorporation of video into all existing trainings - where appropriate Obtaining “Buy In” “Saturation” Outreach Prevention

45. Easy to understand Easy to remember Remove impediments Obtaining “Buy In” Making it Stick Prevention

49. “Rolling Backup” Obtaining “Buy In” Prevention

50. Intervention Law Enforcement Suicide: Prevention, Intervention and Postvention

51. Dynamics of Suicide Law Enforcement Complications So What Do I Do? Intervention Law Enforcement Suicide: Prevention, Intervention and Postvention

52. Myths & Reality Risk Factors Precipitants Intervention Dynamics of Suicide

53. Suicidal people want to die! Intervention Dynamics of Suicide - Myth

54. Intervention Suicidal people want a way out of intolerable pain. Some part of them wants to live if you can help them find a way to do it! Dynamics of Suicide- Reality

55. Intervention McCafferty et.al. (1992) Dynamics of Suicide - Reality

56. If someone really wants to die, you can’t talk them out of it. Intervention Dynamics of Suicide - Myth

57. Intervention Suicidal feelings are often impulsive and temporary! Dynamics of Suicide- Reality

58. Asking somebody if they are suicidal will push them over the edge – or they will lie anyway. Intervention Dynamics of Suicide - Myth

59. Intervention You CANNOT give somebody the idea of committing suicide. Many people want help and will be relieved to tell you the truth! Dynamics of Suicide- Reality

60. Any person who is suicidal will never fully recover! Intervention Dynamics of Suicide - Myth

61. Intervention Peace officers are resilient. Once they get help, they often recover and go on with their lives! Dynamics of Suicide- Reality

62. Any cop who feels suicidal can kiss his or her career goodbye! Intervention Dynamics of Suicide - Myth

63. Intervention NECESSARY AND SUFFICIENT INTERVENTION Dynamics of Suicide- Reality

64. Intervention Dynamics of Suicide - Reality

65. “Real cops” don’t feel “Real cops” solve their own problems I am not a “ding” Only Crazy People Go to Psychologists Only Really Crazy People Take “Meds” What about my career? Don’t get somebody in trouble Law Enforcement Complications Intervention

66. What Should I Know? Signs & Symptoms Asking the Questions SAFER Model Pushing on the Scale Some Do’s & Don’t So What Do I Do? Intervention

67. Understand the dynamics of suicide Know the myths vs. realities Know the signs & symptoms Know what to do if you suspect somebody may be suicidal Know about available resources Make a commitment to “Roll Backup” So What Should I Know? Intervention

68. Signs & Symptoms SS ex (male) AA ge (15-34) (also 65+) DD epression PP revious exposure to suicide EE thanol/alcohol/drug abuse RR ational thinking loss SS ocial support system lacking OO rganized plan NN o spouse or significant other SS ickness/Injury Patterson, W., et al, 1983 Risk Factors

69. Suicide of loved one Death of loved one Serious family illness Loss of health Divorce/separation Loss of employment Loss of cherished possessions Retirement Witness to violence Victim of crime Sexuality concerns Failed promotion/specialty assignment Work problems/discipline Financial problems Substance abuse Physical abuse Sexual abuse/assault Legal problems/arrest LOSSLOSS Intervention Precipitating Events Courtesy of Daniel Clark,Ph.D. Signs & Symptoms

70. I’m going to kill myself I wish I were dead You’d be better off without me I might as well be dead If …doesn’t happen, I’m going to end it I’m going to commit suicide Signs & Symptoms- Direct Verbal Clues Courtesy of Daniel Clark,Ph.D. Intervention

71. I can’t go on any longerI’m taking the plunge We all have to say goodbye sometime Nobody needs me anymore I’m tired of life You won’t be seeing me any more Life has lost meaning for me I can’t take it any more You’d be better off without me I can’t take the painEat my gun You’re going to regret how you treated me Cash in my chipsFold my hand Signs & Symptoms- Indirect Verbal Clues Courtesy of Daniel Clark,Ph.D. Intervention

72. Buying a weapon Giving away possessions Making a will Taking unusual risks Changes in personality The “practice run” Sudden religious interest/disinterest Substance abuse relapse Signs & Symptoms- Behavioral Clues Courtesy of Daniel Clark,Ph.D. Intervention

73. History of a suicide attempt (40%)* Family/friend suicide attempts/ completions Substance use Plan is specific and well defined Plan is viable Lethality of method Signs & Symptoms- Behavioral Clues HIGH risk clues Rubenowitz et al. 2001 Intervention

74. Aamodt 2001 Intervention Signs & Symptoms - Precipitating factors

75. O’Neill 2001 Intervention Signs & Symptoms - Precipitating factors

76. Janik & Kravitz 1994 Intervention Signs & Symptoms - Precipitating factors

77. Have you been thinking of hurting or killing yourself? Intervention Asking THE Question

78. Have you been thinking of hurting or killing yourself?  When did you last think about suicide?  How would you kill yourself?  Do you have the means available?  Have you ever attempted suicide?  Has anyone in your family attempted/completed suicide?  What are the odds that you will kill yourself?  What has been keeping you alive so far? Intervention Any other questions? Courtesy of Daniel Clark,Ph.D.

79.  Stabilize the Situation - Mitigate affective escalation. - Remove from provocative stressors. - May use a diversion (i.e. walk, coffee, etc.).  Acknowledge the Crisis - What happened? - Establish rapport and a sense of safety. - Provide for cathartic ventilation.  Facilitate Understanding - Explain the symptoms. - Normalize reactions. Intervention SAFER Revised Model Courtesy of Daniel Clark,Ph.D.

80.  Encourage Effective Coping Techniques - Teach basic stress survival skills. - Improve immediate and short term coping. - Develop a plan for immediate use.  Recovery or Referral - Assess current adaptive functioning. - Assess need for further assistance. - If needed, identify appropriate referral. SAFER Revised Model Intervention Courtesy of Daniel Clark,Ph.D.

81. Intervention Pushing on the Scale – Factors Towards Suicide

82. Intervention Pushing on the Scale – Factors Against Suicide Time Sleep Social Supports/Obligations Spirituality* Sobriety Dervic et al, 2004

83. Intervention Pushing on the Scale – Final Equation Time/Sleep Social Support Spirituality Sobriety Counseling

84. Remain calm Take all suicidal comments/behaviors seriously Listen, listen, listen Help define the problem Rephrase thoughts/feelings “Do List” Intervention

85. Focus on central issue/ prioritize Identify preventative forces Capitalize on old strengths Identify options Explore resources “Do List” Intervention

86. Don’t sound shocked Don’t deny/minimize the threat Don’t offer empty promises Don’t debate morality Don’t leave the person alone Don’t be the only person helping “Don’t List” Intervention

87. Postvention Law Enforcement Suicide: Prevention, Intervention and Postvention

88. Survivors How Can I Help? Impact on Your Agency Postvention Law Enforcement Suicide: Prevention, Intervention and Postvention

89. 31,484 suicides per year 6 survivors per suicide 188,904 suicide survivors per year Suicide Survivors Friends, family and colleagues who survive following the death of a loved one by suicide Postvention

90. Often compromises usual mourning rituals Typically not pathological but often complicated: –Leaves “unfinished business” –Often leaves a violent death scene –Scene is a “crime scene” –Media involvement Expect a 4-7 year recovery period Disrupts normal functioning for an extended period of time Suicide Survivors - How is suicide different?

91. Postvention Denial of the death as a suicide Preoccupation with “why” Guilt/Responsibility Religious concerns Extreme anger, abandonment feelings Complications from others: –Blaming the survivor –Condemning the loved one –Awkwardness from social support –Social isolation Suicide Survivors - How is suicide different? Survivor Reactions

92. Postvention Grief is a process not an event Each person grieves at a different rate and in a different way You do not “get over” grief, but you can be “in recovery” Repetition is part of recovery How Can I Help? Understand that…

93. Postvention Listening, listening, listening Non-judgmental Don’t answer questions you don’t know the answer to! Normalize feelings–even negative ones Share the memories How Can I Help? Help by…

94. Postvention Memorials Special dates Keeping in contact Self-help/support groups Grief counseling Be aware of follow up suicides How Can I Help? As time goes by…

95. Helpful phrases I’m sorry for your loss… How can I help? Is there anyone I can call for you? What is the most difficult part for you? When you are ready, I would like to share my memories of _________ You don’t have to deal with everything right away. Phrases to avoid  How can you bear that ________ went to hell…  You are young enough to find somebody new.  Get over it.  Didn’t you see this coming?  At least he is no longer suffering.  Don’t think bad of her.  I know how you feel.  Time heals all wounds Postvention How Can I Help? Courtesy of Daniel Clark,Ph.D.

96. Postvention Survivors of Suicide http://www.survivorsofsuicide.com Concerns of Police Survivors http://www.nationalcops.org Compassionate Friends (children) http://www.compassionatefriends.org Survivors of Law Enforcement Suicide http://www.tearsofacop.com Family & Friends of Suicide http://www.friendsandfamiliesofsuicide.com How Can I Help? Support is out there…

97. “Effective postvention for suicidally bereaved families may be one of the most important forms of multigenerational prevention available to mental health professionals.” Jordan, 2001Courtesy of Daniel Clark,Ph.D. How Can I Help? Postvention

98. Impact on Your Agency “Postvention Team” Target Group Interventions Funeral Considerations Agency Actions That Help Postvention

99. Work friends Work colleagues Immediate supervisors Unit commanders First responders Homicide investigators Personnel Department Based on law enforcement suicide rates, an agency the size of the LASD can expect to have 1-2 suicides a year Who is impacted …? Helping Your Agency Recover- Impact

100. Postvention Increased sense of responsibility Increased cohesion increases loss Increased sense of personal identification Increased media attention due to profession of law enforcement May have had to handle the scene Helping Your Agency Recover- Impact Greater impact on law enforcement…

101. Postvention Attendance problems Decreased work quality and quantity Increased alcohol consumption Increased number of injuries/accidents Negative impact on interactions between supervisor, coworkers, citizens and inmates Reminders will reactivate grief Helping Your Agency Recover- Impact Some of the ways this impact appears…

102. Suicide Policy? All suicides are not created equal! Jordan, 2001Courtesy of Daniel Clark,Ph.D. How Can I Help? Postvention

103. Unit commander/Chief Human resources representative Psychologist (preferably who rolled) Family representative Peer support/CISM leader Chaplain (preferably who rolled) Risk management/Legal representative Line staff representative Helping Your Agency Recover A Postvention Team consists of…

104. Postvention Death notification Internal announcements Media statement Cleaning out the locker Cleaning the scene Funeral/memorial planning CISM Monitor for ongoing/delayed reactions Helping Your Agency Recover Team responsibilities…

105. Postvention On scene (or hospital) crisis intervention Death notification Chaplain assistance Funeral assistance Peer support Grief counseling Referrals Helping Your Agency Recover Target Group Interventions - Family…

106. Postvention On scene (or hospital) crisis intervention Death notifications Chaplain assistance Individual/group CISM Peer support Grief counseling Referrals Helping Your Agency Recover Target Group Interventions – Line Staff…

107. Postvention On scene (or hospital) crisis intervention Chaplain assistance Individual/group CISM Peer support Grief counseling Referrals Follow up training Helping Your Agency Recover Target Group Interventions-Supervisors…

108. Postvention Medical assistance providers Transportation providers Dispatchers Crime scene personnel Homicide investigators Partners/Former partners Training officers Crisis negotiators Helping Your Agency Recover The FORGOTTEN Ones…

109. Postvention Flag ceremony 21 gun salute Bagpipes Honor guard “Brass” attendance Attendance (off duty, on duty, assisted) Uniform/Non-uniform Official/organized assistance to family Official/organized financial assistance Helping Your Agency Recover Funeral Considerations…

110. Postvention Confidential counseling available to all Employees’ aware of resources Decrease stigma of seeking help Postvention Team Policy/procedure in place Emergency activation system in place Personnel, and their roles, identified Helping Your Agency Recover Agency Actions That Aid in Postvention…

111. In Conclusion Law Enforcement Suicide: Prevention, Intervention and Postvention

112. Summary Additional Resources Questions In Conclusion Law Enforcement Suicide: Prevention, Intervention and Postvention

113. Make a personal commitment to “Roll Backup” Summary In Conclusion

114. In Summary American Foundation of Suicide Prevention http://www.afsp.org American Association of Suicidology http://www.suicidology.org Daniel Clark, Ph.D. http://www.criticalconcepts.org SAMHSA Suicide Prevention http://www.mentalhealth.samhsa.gov Center for Disease Control http://www.cdc.gov Additional Resources

115. In Conclusion Questions???

116. In Conclusion Elizabeth K. White, Ph.D. LASD-ESSB 4700 Ramona Blvd. Monterey Park, CA 91754-2169 ekwhite@lasd.org (661) 272-8880