1. Treatment: What do we know works? Treatment: What do we know works?

2.  We need to talk in simple and understandable terms about suicide  Clearly articulated treatment model and suicidality as targets  Patients can understand and invest  When People drop out of treatment, action needs to be taken immediately to re-engage them  Recognize that it is most likely a persistence of hopelessness  Frequently related to “simple things” that block treatment participation  Motivation, ambivalence, and intent to die What Do Effective Treatments Have in Common?

3. People that are suicidal have poor skills ‣ Skills deficiencies targeted, not just symptoms People need to take ownership of their treatment ‣ Addressed self-reliance, self-awareness, individual control ‣ Commitment to treatment People need to know what to do during a crisis ‣ Crisis management/access to emergency services ‣ Limited access to method

4.  Provide an understandable model  Explain why the suicide attempt(s) happened  The importance of shame, guilt  Contextualize/Normalize the problem  Label and reinforce the presence of ambivalence  Reasons for living, reasons for dying Facilitating Hope During the First Contact

5. It is vital that clients deconstruct their suicidal cycle—explore it, move into it. Support clients identifying components; recognizing patterns or themes associated with their cycle  Create a narrative of event  Construct a timeline Wenzel, Brown, Beck (2009). Cognitive Therapy for Suicidal Patients; Rudd, Joiner, & Rajab (2001). Treating Suicidal Behavior: An effective, time-limited approach As long as suicidal clients are unable to understand their suicidal cycle, they remain victims to it.

6.  Have patients describe the events and situations and their reactions to these events in as much detail as possible.  Beginning of the story:  Major decision point associated with increased suicide risk  Strong emotional reaction to a specific event  External event such as a significant loss  Internal event such as an automatic thoughts Source: Wenzel, Brown,& Beck (2009)

7. 1. Understand the function of suicidal behavior or thinking from the patient’s perspective; that the behavior “makes sense” to the patient in the context of his or her history, vulnerability, and circumstances. 2. Empathize with the patient’s strong feelings and desire to be reduce distress. 3. Refrain from trying to solve the patient’s problems before understanding the motivations for suicide. 4. Don’t rush the interview! Source: Wenzel, Brown,& Beck (2009)

8. Criticism from Step- father and Mom didn’t do anything Stormed off and isolated self “I can’t take it anymore. I can’t stand being so upset so easily like this.” Angry and Depressed Anger “That’s it. I’m doing it. I want to die. I want to end it. I want it to stop.” Overdosed on 20 sleeping pills Regrets that the attempt did not succeed ACTIVATING EVENT AFFECTIVE RESPONSE KEY AUTOMATIC THOUGHTS (MOTIVATION) SUICIDE ATTEMPT REACTION TO THE ATTEMPT KEY AUTOMATIC THOUGHTS (SUICIDE INTENT) BEHAVIORAL RESPONSE AFFECTIVE RESPONSE Source: Wenzel, Brown, & Beck (2009)

9.  Treatment Journal  Coping cards  Hope Kit  Distraction techniques  Relaxation skills  Self-soothing