1. Suicide

2. Three things need to be present for suicide to happen: 1. The person must want to die 2. The person must have the means to carry out their wish, ie gun, drugs, high place 3. The person must have enough energy to complete the act

3. The greatest potential for risk is found in people who: Have developed a specific plan Have developed a specific plan Have concurrent alcohol or drug abuse Have concurrent alcohol or drug abuse Are socially isolated Are socially isolated Have low levels of hopefulness Have low levels of hopefulness

4. Myths about suicide Myth – people who commit suicide always leave notes Myth – people who commit suicide always leave notes Reality – a small percentage of people do leave notes, most don’t Reality – a small percentage of people do leave notes, most don’t

5. Myth – those who commit suicide are psychotic or mentally ill Myth – those who commit suicide are psychotic or mentally ill Reality – some are psychotic; the risk of suicide does increase with mental illness. However, many are depressed and cannot find other solutions to their problems Reality – some are psychotic; the risk of suicide does increase with mental illness. However, many are depressed and cannot find other solutions to their problems

6. Myth – rich people commit suicide more than poor people Myth – rich people commit suicide more than poor people Reality – suicide is pretty evenly distributed among socioeconomic groups Reality – suicide is pretty evenly distributed among socioeconomic groups

7. Myth – people who talk about suicide are just trying to get attention; people who commit suicide don’t talk about it Myth – people who talk about suicide are just trying to get attention; people who commit suicide don’t talk about it Reality – 8 out of 10 people who commit suicide give warning signals. A person who talks about suicide is asking for help. Reality – 8 out of 10 people who commit suicide give warning signals. A person who talks about suicide is asking for help.

8. Myth – suicide happens without warning Myth – suicide happens without warning Reality – most people leave warnings and clues. They may be verbal or nonverbal Reality – most people leave warnings and clues. They may be verbal or nonverbal

9. Myth – if someone had decided to commit suicide, there is nothing you can do to stop them Myth – if someone had decided to commit suicide, there is nothing you can do to stop them Reality – sometimes this is true; most times it is not Reality – sometimes this is true; most times it is not

10. Myth – a person who is suicidal once is forever suicidal Myth – a person who is suicidal once is forever suicidal Reality – most are suicidal for a limited time; many go on to lead normal lives after the crisis has been resolved. The best prognosis is for those who think about suicide but do not act upon it Reality – most are suicidal for a limited time; many go on to lead normal lives after the crisis has been resolved. The best prognosis is for those who think about suicide but do not act upon it

11. Myth – if a person attempts suicide but survives, they probably won’t attempt it again Myth – if a person attempts suicide but survives, they probably won’t attempt it again Reality – 4 out of 5 people who succeed have made other attempts Reality – 4 out of 5 people who succeed have made other attempts

12. Myth – the secret lies in getting someone over the ‘hump’, if you can pull them out of a depression, they won’t try to commit suicide Myth – the secret lies in getting someone over the ‘hump’, if you can pull them out of a depression, they won’t try to commit suicide Reality – severely depressed people often can’t commit suicide but once they start to ‘improve’ they may get the energy to succeed Reality – severely depressed people often can’t commit suicide but once they start to ‘improve’ they may get the energy to succeed

13. Myth – the terminally ill are more likely to commit suicide Myth – the terminally ill are more likely to commit suicide Reality – the chronically ill have a higher incidence Reality – the chronically ill have a higher incidence

14. Myth – suicide is hereditary Myth – suicide is hereditary Reality – it is not a genetic trait. However, since family members share the emotional climate and since coping is a learned skill, suicide may be more common in some families Reality – it is not a genetic trait. However, since family members share the emotional climate and since coping is a learned skill, suicide may be more common in some families

15. Myth – the most common method of suicide is drug overdose Myth – the most common method of suicide is drug overdose Reality – the leading cause of death is hanging in Canada, gunshot wound in USA Reality – the leading cause of death is hanging in Canada, gunshot wound in USA

16. Myth - most suicides happen late at night Myth - most suicides happen late at night Reality – many will attempt suicide in the late afternoon or early evening – perhaps hoping intervention form a family member who arrives home Reality – many will attempt suicide in the late afternoon or early evening – perhaps hoping intervention form a family member who arrives home

17. Myth – you should never talk about suicide with someone who is depressed, because you will give them ideas Myth – you should never talk about suicide with someone who is depressed, because you will give them ideas Reality – those ideas probably already exist. Talking about it may help the person work through their problems Reality – those ideas probably already exist. Talking about it may help the person work through their problems

18. Risk factors When assessing a person who has indicated suicidal intentions, be aware of the following risk factors:

19. Risk factors Previous attempts Previous attempts Depression Depression The presence of psychosis with depression The presence of psychosis with depression Age Age Alcohol or drug abuse Alcohol or drug abuse Divorced or widowed Divorced or widowed Lives alone or in increased isolation Lives alone or in increased isolation Homosexuality Homosexuality

20. Risk factors Major separation trauma Major separation trauma Major physical stress Major physical stress Loss of independence Loss of independence Lack of goals and plans for the future Lack of goals and plans for the future Suicide of same-sex parent Suicide of same-sex parent Expression of a plan for committing suicide Expression of a plan for committing suicide Possession of the mechanism for suicide Possession of the mechanism for suicide

21. Most common methods 1. Gunshot 2. Poisoning 3. Strangulation 4. Cutting 5. Other – fall from heights, assisted suicide

27. Suicide in the elderly Depression is the leading cause – elderly seek help for depression less often and are more likely to turn their feelings inward Depression is the leading cause – elderly seek help for depression less often and are more likely to turn their feelings inward Other stressors that increase the risk: chronic illness, physical impairment, unrelieved pain, family issues, financial problems, isolation, loneliness, substance abuse, bereavement Other stressors that increase the risk: chronic illness, physical impairment, unrelieved pain, family issues, financial problems, isolation, loneliness, substance abuse, bereavement

28. 'Teen friends' suicides were linked' Feb 21 2008 icWales Feb 21 2008 icWales Feb 21 2008 Feb 21 2008 THE stepfather of one of the teenagers who killed themselves in an area blighted by suicides insisted there may have been a link between some of the youngsters' deaths. There have been 17 apparent suicides among young people in the county of Bridgend, south Wales, in just over a year.

29. Suicide in adolescents Reasons include: Reasons include: - problems with parents/family - humiliation from peers - failure to be accepted by peers - failure at school - loss of a loved one - loneliness

30. Suicide in children Reasons include: Reasons include: - to escape a situation of ongoing physical, emotional or sexual abuse - to manipulate parents - to escape feelings of despair - act of anger or fear - to escape embarrassment, fear, humiliation and degradation

31. - in response to chaotic family situations - internal sexual conflict - to ‘punish’ others

32. Responding to a suicide attempt Your first priority is safety Your first priority is safety Protect the patient from further self-harm Protect the patient from further self-harm Preserve evidence Preserve evidence Treat injuries Treat injuries Be prepared for resistance Be prepared for resistance Acknowledge the person’s feelings Acknowledge the person’s feelings Do not moralize or analyze Do not moralize or analyze Do not make promises you cannot keep Do not make promises you cannot keep

33. Involve family/friends if appropriate Involve family/friends if appropriate Patience is important – it may take time to talk to the person Patience is important – it may take time to talk to the person Never leave a suicidal person alone Never leave a suicidal person alone Document the scene Document the scene

34. When suicide is successful When death is obvious your priority is on the survivors When death is obvious your priority is on the survivors Suicide is particularly shocking and upsetting. Family reactions are difficult to predict. Be prepared for any reaction Suicide is particularly shocking and upsetting. Family reactions are difficult to predict. Be prepared for any reaction Provide appropriate support. Provide appropriate support. Don’t be judgmental Don’t be judgmental

35. Take care of yourself after the call. Talk to your partner and other colleagues or whomever you trust Take care of yourself after the call. Talk to your partner and other colleagues or whomever you trust The person’s life is their responsibility. Some people will succeed in their attempts to end their lives – you are not to blame The person’s life is their responsibility. Some people will succeed in their attempts to end their lives – you are not to blame CONSIDER DEBRIEFING – ANY SITUATION CONSIDER DEBRIEFING – ANY SITUATION –DEATH – SUICIDE, NOTIFICATION –TRAUMATIC CALL, VIOLENT/NON VIOLENT