1. WHAT TO DO WITH A SUICIDAL CLIENT

2. SUICIDE PREVENTION  RISK FACTORS  STATISTICS  ASSESSMENT  DECISION MAKING  CHANGING SOMEONE’S MIND  ACUTE VS. CHRONIC  FEARS  FAMOUS SUICIDES

3. RISK FACTORS Do risk factors matter: yes and no Yes: to alert you, to reduce in treatment, in keeping statistics No: anyone can be the exception What are they:  High on lethality index: ideation, plan, threat  Access to means (everyone has means)  History: Previous attempts, Family attempts  Substance use  Speaking in hopeless terms  Lack of supports, emotional neglect  Fantasies of death  Recent stressful event or poor adjustment/Loss  Trapped in situation of abuse  Chronic or terminal health issues **Inability to access help: stigma, cultural beliefs

4. STATISTICS National Vital Statistics System  35–64— United States, 1999–2010 : 14,443 - 21,754  10–34 years and ≥65 not statistically significant between years  Three most common methods:  firearms  poisoning (predominantly drug overdose)  suffocation (predominantly hanging)  10 – 24: third leading cause of death  4600 lives lost each year  Three most common methods:  firearms (45%)  poisoning (8%)  suffocation (40%)  Each year, approximately 157,000 youth between the ages of 10 and 24 receive medical care for self-inflicted injuries at Emergency Departments across the U.S.

5. ASSESSMENT  Question euphemisms  Directly ask about their thoughts  Are you thinking about hurting yourself?  Are you thinking about ending your life?  Are you scared you might do something rash?  It’s sounding like I might need to take some action.  Question why they want to die  Do they have a plan  Is plan same as past attempts  When would they act on plan  Do they have means  Is this an anniversary  Are drugs or alcohol involved

6. DECISION MAKING To act:  Access support for:  Help in decision-making  Making call for EMT  Explain your lack of choice  Reassure about ongoing support To not act:  Have plan in place  Contract  Follow-up

7. CHANGING SOMEONE’S MIND Pulling Out All The Stops (while maintaining the relationship)  Learn their reasoning and then state the harsh facts  Dispel irrational thinking  Deflate rationalizations  Provide coping techniques  OFFER HOPE  Be open and honest/transparent/validating  Point out ambivalence found in all  Use their religion “against them”  Cheerlead

8. CHANGING SOMEONE’S MIND Countering Irrational Thinking  People will be better off or get over it  Hurting others/imagining funeral  No one will care  Going to a better place  I want to be with…  I can’t keep going through this  Bottom line – DEPRESSION LIES TO YOU!!! A suicidal person needs to be told that in this state they can’t access their best judgment. They should not be making a decision of this magnitude when they are in this state. They need to wait and see over time how they feel. This option doesn’t go away.

9. CHANGING SOMEONE’S MIND When Sending Home PRODUCE PLAN  Suggest methods for coping: Breathing, distracting, project, music, medication, cutting self slack, reading unrelated fiction, sitting in the sun/under the stars, journaling, funny Youtube videos, do something for someone else……………………….  Access support system, stay with someone  Identify ideas that might lead back to option of suicide and instruct to avoid  If needed, contract for no self-harm between now and next meeting  This could be the last decision ever made, don’t make it impulsively.  Create follow-up plan: talk by phone tomorrow, etc.  Write everything down (make copy), include quotes  Courage isn’t going on without fear, it’s going on despite your fear.  Every great achievement was once considered impossible.  Although the world is full of suffering, it is also full of the overcoming of suffering. Helen Keller  The world breaks everyone and afterward some are strong at the broken places. Ernest Hemingway

10. PARENTAL SUPPORT FOR YOUTH  Nurturing vs. Space  Encouraging words  Alternative expectations  Follow through with promises/Consistency  Structure vs. Firmness  Consider what might be hidden  Bullying: online, at school  Pregnancy  Undiagnosed medical problem  Auditory hallucinations  Understanding the basics:  Lack of motivation  Careless mistakes  Oversleeping  Irritability  Side effects from medication

11. ACUTE VS. CHRONIC  Considering suicide as a way of coping  Must replace what is taken away  Judge on a 10 pt. scale  Determine the difference between chronic and acute for the individual  Work toward underlying cause  Trapped in life because of current situation or earlier life misery  No purpose in life  Alone  Hospitalization is unlikely to make a difference

12. FEARS  Balance between safety and therapeutic rapport  Saying the wrong thing  Giving them the idea  Sending them home  Trusting their honesty From an old folk song: You can’t help someone to see the light when they’ve stopped believing in the sun.

13. Famous Suicides/Attempts SUCCESSFUL SUICIDES Charles Boyer Dana Plato Ernest Hemingway Freddie Prinze (Sr.) George Sanders Hunter S. Thompson Inger Stevens Kurt Cobain Margeau Hemingway Marilyn Monroe Peter Duel Rembrandt Spalding Gray Sylvia Plath Van Gogh Virginia Woolf Wallace Hume Carothers (Inventor Of Nylon) George Eastman (Eastman Kodak Company) Edwin Armstrong (Invented FM Radio) ATTEMPTED SUICIDES Adam Ant Billy Joel Brigitte Bardot Clark Gable Danny Bonaduce Donna Summer Drew Barrymore Drew Carey Elizabeth Taylor Elton John Eminem Greg Louganis Halle Berry Johnny Cash Maria Callas Micky Dolenz Mike Wallace Nina Simone Patty Duke Paul Robeson Robert Young Tai Babilonia Tina Turner Vanilla Ice Walt Disney