saving lives: understanding depression and suicide in our communities
DESCRIPTION
SAVING LIVES: Understanding Depression And Suicide In Our Communities. Sponsored By The Ohio Suicide Prevention Foundation Developed By Ellen Anderson, Ph.D., PCC, 2003-2007. - PowerPoint PPT PresentationTRANSCRIPT
SAVING LIVES:SAVING LIVES:Understanding Understanding
Depression And Suicide Depression And Suicide In Our CommunitiesIn Our Communities
Sponsored By The Ohio Suicide Sponsored By The Ohio Suicide Prevention FoundationPrevention Foundation
Developed By Ellen Anderson, Developed By Ellen Anderson, Ph.D., PCC, 2003-2007Ph.D., PCC, 2003-2007
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 22
““Still the effort seems unhurried. Still the effort seems unhurried. Every 17 minutes in America, Every 17 minutes in America,
someone commits suicide. someone commits suicide. Where is the public concern and Where is the public concern and
outrage?”outrage?”
Kay Redfield JamisonKay Redfield JamisonAuthor of Author of Night Falls Fast: Night Falls Fast:
Understanding SuicideUnderstanding Suicide
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 33
Goals For Suicide Goals For Suicide PreventionPrevention
Increase community awareness that suicide Increase community awareness that suicide is a preventable public health problemis a preventable public health problem
Increase awareness that depression is the Increase awareness that depression is the primary cause of suicideprimary cause of suicide
Change public perception about the stigma Change public perception about the stigma of mental illness, especially about of mental illness, especially about depression and suicidedepression and suicide
Increase the ability of the public to Increase the ability of the public to recognize and intervene when someone recognize and intervene when someone they know is suicidalthey know is suicidal
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 44
Training ObjectivesTraining Objectives Increase knowledge about the impact of Increase knowledge about the impact of
suicide within the communitysuicide within the community Learn the connection between Learn the connection between
depression and suicidedepression and suicide Dispel myths and misconceptions about Dispel myths and misconceptions about
suicidesuicide Learn risk factors and signs of suicidal Learn risk factors and signs of suicidal
behavior among community members behavior among community members Learn to assess risk and find help for Learn to assess risk and find help for
those at risk – Asking the “S” questionthose at risk – Asking the “S” question
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 55
Prevention StrategiesPrevention Strategies General suicide and General suicide and
depression depression awareness education awareness education
Depression Depression Screening programsScreening programs
Community Community Gatekeeper Gatekeeper TrainingsTrainings
Crisis Centers and Crisis Centers and hotlineshotlines
Peer support Peer support programsprograms
Restriction of Restriction of access to lethal access to lethal meansmeans
Intervention after Intervention after a suicidea suicide
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 66
Suicide Is The Last Taboo – Suicide Is The Last Taboo – We Don’t Want To Talk We Don’t Want To Talk
About ItAbout It Suicide has become the Last Taboo – we can talk Suicide has become the Last Taboo – we can talk
about AIDS, sex, incest, and other topics that about AIDS, sex, incest, and other topics that used to be unapproachable. We are still afraid of used to be unapproachable. We are still afraid of the “S” word the “S” word
Understanding suicide helps communities Understanding suicide helps communities become proactive rather than reactive to a become proactive rather than reactive to a suicide once it occurssuicide once it occurs
Reducing stigma about suicide and its causes Reducing stigma about suicide and its causes provides us with our best chance for saving livesprovides us with our best chance for saving lives
Ignoring suicide means we are helpless to stop itIgnoring suicide means we are helpless to stop it
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 77
What Makes Me A What Makes Me A Gatekeeper?Gatekeeper?
Gatekeepers are not mental healthGatekeepers are not mental health professionals or doctorsprofessionals or doctors Gatekeepers are responsible adults who Gatekeepers are responsible adults who
spend time with people who might be spend time with people who might be vulnerable to depression and suicidal vulnerable to depression and suicidal thoughtsthoughts
Teachers, coaches, police officers, EMT’s, Teachers, coaches, police officers, EMT’s, Elder care workers, physicians, 4H Elder care workers, physicians, 4H leaders, Youth Group leaders, Scout leaders, Youth Group leaders, Scout masters, and members of the clergy and masters, and members of the clergy and other religious leadersother religious leaders
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 88
Why Should I Learn Why Should I Learn About Suicide?About Suicide?
It is the 11th largest killer of Americans, and It is the 11th largest killer of Americans, and the 3the 3rdrd largest killer of youth ages 10-24 largest killer of youth ages 10-24
As many as 25% of adolescents and 15% As many as 25% of adolescents and 15% of adults consider suicide seriously at some of adults consider suicide seriously at some
point in their livespoint in their lives No one is safe from the risk of suicide – wealth, No one is safe from the risk of suicide – wealth,
education, intact family, popularity cannot education, intact family, popularity cannot protect us from this riskprotect us from this risk
A suicide attempt is a desperate cry for help to A suicide attempt is a desperate cry for help to end excruciating, unending, overwhelming painend excruciating, unending, overwhelming pain, , 1996)1996)
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 99
8989 people complete suicide every day people complete suicide every day 32,43932,439 people in 2004 in the US people in 2004 in the US Over Over 1,000,0001,000,000 suicides worldwide suicides worldwide
(reported)(reported) This data refers to completed suicides This data refers to completed suicides
that are documented by medical that are documented by medical examiners – it is estimated that 2-3 examiners – it is estimated that 2-3 times as many actually complete suicidetimes as many actually complete suicide
(Surgeon General’s Report on Suicide, 1999)(Surgeon General’s Report on Suicide, 1999)
Is Suicide Really a Is Suicide Really a Problem?Problem?
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 1010
The Unnoticed DeathThe Unnoticed Death For every 2 homicides, 3 people For every 2 homicides, 3 people
complete suicide yearly– data complete suicide yearly– data that has been constant for 100 that has been constant for 100 yearsyears
During the Viet Nam War from During the Viet Nam War from 1964-1972, we lost 55,000 1964-1972, we lost 55,000 troops, and 220,000 people to troops, and 220,000 people to suicidesuicide
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 1111
Comparative Rates Of U.S. Comparative Rates Of U.S. Suicides-2004Suicides-2004
Rates per 100,000 populationRates per 100,000 population• National averageNational average - 11.1 per 100,000* - 11.1 per 100,000*• White malesWhite males - 18 - 18 • Hispanic malesHispanic males - 10.3 - 10.3 • African-American males African-American males - 9.1 ** - 9.1 **• Asians Asians - 5.2 - 5.2• Caucasian femalesCaucasian females - 4.8 - 4.8• African American females African American females - 1.5 - 1.5• Males over 85Males over 85 - 67.6 - 67.6
Annual Attempts – 811,000 (estimated)Annual Attempts – 811,000 (estimated)• 150-1 completion for the young - 4-1 for the elderly150-1 completion for the young - 4-1 for the elderly
(*AAS website),**(Significant increases have occurred among African Americans in (*AAS website),**(Significant increases have occurred among African Americans in the past 10 years - Toussaint, 2002)the past 10 years - Toussaint, 2002)
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 1212
The Gender IssueThe Gender Issue Women perceived as being at higher risk than menWomen perceived as being at higher risk than men Women do make attempts 4 x as often as menWomen do make attempts 4 x as often as men But - Men complete suicide 4 x as often as womenBut - Men complete suicide 4 x as often as women Women’s risk rises until midlife, then decreasesWomen’s risk rises until midlife, then decreases Men’s risk, always higher than women’s, continues Men’s risk, always higher than women’s, continues
to rise until end of lifeto rise until end of life Are women more likely to seek help? Talk about Are women more likely to seek help? Talk about
feelings? Have a safety network of friends?feelings? Have a safety network of friends? Do men suffer from depression silently? Do men suffer from depression silently?
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 1313
What Factors Put What Factors Put Someone At Risk For Someone At Risk For
Suicide?Suicide? Biological, physical, social, psychological or Biological, physical, social, psychological or
spiritual factors may increase risk-for spiritual factors may increase risk-for example:example:
A family history of suicide increases risk by 6 A family history of suicide increases risk by 6 timestimes
Access to firearms – people who use firearms Access to firearms – people who use firearms in their suicide attempt are more likely to diein their suicide attempt are more likely to die
A significant loss by death, separation, A significant loss by death, separation, divorce, moving, or breaking up with a divorce, moving, or breaking up with a boyfriend or girlfriend can be a triggerboyfriend or girlfriend can be a trigger
(Goleman, 1997)(Goleman, 1997)
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 1414
Social Isolation: people may be rejected Social Isolation: people may be rejected or bullied because they are “weird”, or bullied because they are “weird”, because of sexual orientation, because of sexual orientation, or becauseor because
they are getting older andthey are getting older and have lost their social networkhave lost their social network The 2nd biggest risk factor - having an The 2nd biggest risk factor - having an
alcohol or drug problemalcohol or drug problem• Many with alcohol and drug problems are Many with alcohol and drug problems are
clinically depressed, and are self-clinically depressed, and are self-medicating for their painmedicating for their pain
(Surgeon General’s call to Action, 1999)(Surgeon General’s call to Action, 1999)
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 1515
The biggest risk factor for suicide completion? The biggest risk factor for suicide completion?
Having a Depressive IllnessHaving a Depressive Illness People with clinical depression often feels helpless to People with clinical depression often feels helpless to
solve his or her problems, leading to hopelessness – solve his or her problems, leading to hopelessness – a strong predictor of suicide riska strong predictor of suicide risk
At some point in this chronic illness, suicide seems At some point in this chronic illness, suicide seems like the only way out of the pain and sufferinglike the only way out of the pain and suffering
Many Mental health diagnoses have a component of Many Mental health diagnoses have a component of depression: anxiety, PTSD, Bi-Polar, etcdepression: anxiety, PTSD, Bi-Polar, etc
90%90% of suicide completers have a depressive illness of suicide completers have a depressive illness (Lester, 1998, Surgeon General, 1999)(Lester, 1998, Surgeon General, 1999)
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 1616
Depression Is An Depression Is An IllnessIllness Suicide has been viewed for countless generations as:Suicide has been viewed for countless generations as:
• a moral failing, a spiritual weaknessa moral failing, a spiritual weakness• an inability to cope with lifean inability to cope with life• ““the coward’s way out”the coward’s way out”• A character flawA character flaw
Our cultural view of suicide is wrong - Our cultural view of suicide is wrong - invalidated by our current understanding of invalidated by our current understanding of brain chemistry and it’s interaction with brain chemistry and it’s interaction with stress, trauma and geneticsstress, trauma and genetics on mood and on mood and behaviorbehavior
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 1717
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 1818
The research evidence is overwhelming - The research evidence is overwhelming - depression is far more than a sad mood. It depression is far more than a sad mood. It includes:includes: 1.1. Weight gain/lossWeight gain/loss2.2. Sleep problemsSleep problems3.3. Sense of tiredness, exhaustionSense of tiredness, exhaustion4.4. Sad or angry moodSad or angry mood 5.5. Loss of interest in pleasurable things, lack of Loss of interest in pleasurable things, lack of
motivationmotivation6.6. IrritabilityIrritability7.7. Confusion, loss of concentration, poor memoryConfusion, loss of concentration, poor memory8.8. Negative thinking (Self, World, Future)Negative thinking (Self, World, Future)9.9. Withdrawal from friends and familyWithdrawal from friends and family10.10.Sometimes, suicidal thoughtsSometimes, suicidal thoughts
(DSMIVR, 2002)(DSMIVR, 2002)
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 1919
20 years of brain research teaches that 20 years of brain research teaches that these symptoms are the these symptoms are the behavioralbehavioral result ofresult of InternalInternal changes in the physical changes in the physical
structure of the brainstructure of the brain Damage to brain cells in the Damage to brain cells in the
hippocampus, amygdala and limbic hippocampus, amygdala and limbic systemsystem
As Diabetes is the result of low insulin As Diabetes is the result of low insulin production by the pancreas, depressed production by the pancreas, depressed people suffer from a physical illness – people suffer from a physical illness – what we might consider “faulty wiring”what we might consider “faulty wiring”
(Braun, 2000; Surgeon General’s Call To Action, 1999,(Braun, 2000; Surgeon General’s Call To Action, 1999, Stoff Stoff & Mann, 1997, The Neurobiology of Suicide)& Mann, 1997, The Neurobiology of Suicide)
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 2020
Faulty Wiring?Faulty Wiring? Literally, damage to certain nerve cells in our Literally, damage to certain nerve cells in our
brains - the result of too many stress hormones brains - the result of too many stress hormones – cortisol, adrenaline and testosterone – the – cortisol, adrenaline and testosterone – the hormones activated by our hormones activated by our AAutonomic utonomic NNervous ervous SSystem to protect us in times of dangerystem to protect us in times of danger
Chronic stress causes changes in the Chronic stress causes changes in the functioning of the ANS, so that high levels of functioning of the ANS, so that high levels of activation occur with low stimulusactivation occur with low stimulus
Causes changes in muscle tension, imbalances Causes changes in muscle tension, imbalances in blood flow patterns leading to illnesses such in blood flow patterns leading to illnesses such as asthma, IBS, back pain and depressionas asthma, IBS, back pain and depression
(Braun, 1999)(Braun, 1999)
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 2121
Faulty Wiring?Faulty Wiring? Without a way to return to rest, hormones Without a way to return to rest, hormones
accumulate, doing damage to brain cellsaccumulate, doing damage to brain cells Stress alone is not the problem, but how Stress alone is not the problem, but how
we interpret the event, thought or feelingwe interpret the event, thought or feeling People with People with genetic predispositionsgenetic predispositions, ,
placed in a highly placed in a highly stressful stressful environmentenvironment will experience damage to will experience damage to brain cells from stress hormonesbrain cells from stress hormones
This leads to the cluster of This leads to the cluster of thinking and thinking and emotional changesemotional changes we call depression we call depression (Goleman, 1997; Braun, 1999)(Goleman, 1997; Braun, 1999)
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 2222
Where It Hits UsWhere It Hits Us
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 2323
One of Many NeuronsOne of Many Neurons•Neurons make up the brain and their action is what causes us to think, feel, and act •Neurons must connect to one another (through dendrites and axons) •Stress hormones damage dendrites and axons, causing them to “shrink” away from other connectors•As fewer and fewer connections are made, more and more symptoms of depression appear
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 2424
As damage occurs, thinking changes in the As damage occurs, thinking changes in the predictable ways identified in our list of 10 predictable ways identified in our list of 10 criteriacriteria
““Thought constriction” can lead to the idea that Thought constriction” can lead to the idea that suicide is the only optionsuicide is the only option
How do antidepressants affect this “brain How do antidepressants affect this “brain damage”?damage”?
They mayThey may counter the effects of stress hormonescounter the effects of stress hormones We know now that antidepressants stimulate We know now that antidepressants stimulate
genes within the neurons (turn on growth genes) genes within the neurons (turn on growth genes) which encourage the growth of new dendriteswhich encourage the growth of new dendrites
(Braun, 1999)(Braun, 1999)
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 2525
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 2626
Renewed dendrites:Renewed dendrites:• increase the number of neuronal connectionsincrease the number of neuronal connections• allow our nerve cells to begin connecting againallow our nerve cells to begin connecting again
The more connections, the more The more connections, the more information flow, the more flexibility and information flow, the more flexibility and resilience the brain will haveresilience the brain will have
Why does increasing the amount of Why does increasing the amount of serotonin, as many anti-depressants do, serotonin, as many anti-depressants do, take so long to reduce the symptoms of take so long to reduce the symptoms of depression? depression?
It takes 4-6 weeks to re-grow dendrites & It takes 4-6 weeks to re-grow dendrites & axonsaxons
(Braun, 1999)(Braun, 1999)
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 2727
Why Don’t We Seek Why Don’t We Seek Treatment?Treatment?
We don’t know we are experiencing a brain We don’t know we are experiencing a brain disorder – we don’t recognize the symptomsdisorder – we don’t recognize the symptoms
When we talk to doctors, we are vague about When we talk to doctors, we are vague about symptomssymptoms
Until recently, Doctors were as unlikely as the rest Until recently, Doctors were as unlikely as the rest of the population to attend to depression symptomsof the population to attend to depression symptoms
We believe the things we are thinking and feeling We believe the things we are thinking and feeling are our fault, our failure, our weakness, not an are our fault, our failure, our weakness, not an illnessillness
We fear being stigmatized at work, at church, at We fear being stigmatized at work, at church, at schoolschool
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 2828
No Happy Pills For MeNo Happy Pills For Me The stigma around depression leads to The stigma around depression leads to
refusal of treatmentrefusal of treatment Taking medication is viewed as a failure Taking medication is viewed as a failure
by the same people who cheerfully take by the same people who cheerfully take their blood pressure or cholesterol medstheir blood pressure or cholesterol meds
Medication is seen as altering Medication is seen as altering personality, taking something away, personality, taking something away, rather than as repairing damage done to rather than as repairing damage done to the brain by stress hormonesthe brain by stress hormones
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 2929
Therapy? Are You Kidding? I Therapy? Are You Kidding? I Don’t Need All That Woo-Woo Don’t Need All That Woo-Woo
Stuff!Stuff! How can we seek treatment for something How can we seek treatment for something
we believe is a personal failure?we believe is a personal failure? Acknowledging the need for help is not Acknowledging the need for help is not
popular in our culture (Strong Silent type, popular in our culture (Strong Silent type, Cowboy)Cowboy)
People who seek therapy may be viewed as People who seek therapy may be viewed as weakweak
Therapists are all crazy anywayTherapists are all crazy anyway They’ll just blame it on my mother or some They’ll just blame it on my mother or some
other stupid thingother stupid thing
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 3030
How Does Psychotherapy How Does Psychotherapy Help?Help?
Medications may improve brain function, but do not Medications may improve brain function, but do not change how we change how we interpretinterpret stress stress
Psychotherapy, especially cognitive or interpersonal Psychotherapy, especially cognitive or interpersonal therapy, helps people change the (negative) patterns therapy, helps people change the (negative) patterns of thinking that lead to depressed and suicidal of thinking that lead to depressed and suicidal thoughtsthoughts
Research shows that cognitive psychotherapy is as Research shows that cognitive psychotherapy is as effective as medication in reducing depression and effective as medication in reducing depression and suicidal thinkingsuicidal thinking
Changing our beliefs and thought patterns alters Changing our beliefs and thought patterns alters response to stress – we are not as reactive or as response to stress – we are not as reactive or as affected by stress at the physical level affected by stress at the physical level (Lester, 2004)(Lester, 2004)
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 3131
What Therapy?What Therapy? The standard of care is medication and The standard of care is medication and
psychotherapy combinedpsychotherapy combined At this point, only cognitive behavioral At this point, only cognitive behavioral
and interpersonal psychotherapies are and interpersonal psychotherapies are considered to be effective with clinical considered to be effective with clinical depression (evidence-based)depression (evidence-based)
Patients should ask their doctor for a Patients should ask their doctor for a referral to a cognitive or interpersonal referral to a cognitive or interpersonal therapisttherapist
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 3232
Possible Sources Possible Sources Of DepressionOf Depression
Genetic: a predisposition to this problem may be Genetic: a predisposition to this problem may be present, and depressive diseases run in familiespresent, and depressive diseases run in families
Predisposing factors: Childhood traumas, car Predisposing factors: Childhood traumas, car accidents, brain injuries, abuse and domestic accidents, brain injuries, abuse and domestic violence, poor parenting, growing up in an violence, poor parenting, growing up in an alcoholic home, chemotherapyalcoholic home, chemotherapy
Immediate triggers: violent attack, illness, Immediate triggers: violent attack, illness, sudden loss or grief, loss of a relationship, any sudden loss or grief, loss of a relationship, any severe shock to the systemsevere shock to the system
(Anderson, 1999, Berman & Jobes, 1994, Lester, 1998)(Anderson, 1999, Berman & Jobes, 1994, Lester, 1998)
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 3333
What Happens If We Don’tWhat Happens If We Don’tTreat Depression?Treat Depression?
Significant risk of increased alcohol Significant risk of increased alcohol and drug useand drug use
Significant relationship problemsSignificant relationship problems Lost work days, lost productivity (up Lost work days, lost productivity (up
to $40 billion a year)to $40 billion a year) High risk for suicidal thoughts, High risk for suicidal thoughts,
attempts, and possibly deathattempts, and possibly death(Surgeon General’s Call To Action, 1999)(Surgeon General’s Call To Action, 1999)
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 3434
Depression is a medical illness that Depression is a medical illness that will likely affect the person later in life, will likely affect the person later in life, even after the initial episode improveseven after the initial episode improves
Youth who experience a major Youth who experience a major depressive episode have a 70% chance depressive episode have a 70% chance of having a second major depressive of having a second major depressive episode within five yearsepisode within five years
Many of the same problems that Many of the same problems that occurred with the first episode are occurred with the first episode are likely to return, and may worsenlikely to return, and may worsen
(Oregon SHDP)(Oregon SHDP)
Gatekeeper Training- Dr. Ellen AnGatekeeper Training- Dr. Ellen Andersonderson
3535
Suicide Myths – What Is Suicide Myths – What Is True?True?
1.Talking about suicide might cause a person to act 1.Talking about suicide might cause a person to act False – it is helpful to show the person you take them False – it is helpful to show the person you take them
seriously and you care. Most feel relieved at the chance seriously and you care. Most feel relieved at the chance to talkto talk
2. 2. A person who threatens suicide won’t really follow A person who threatens suicide won’t really follow throughthrough False – 80% of suicide completers talk about it before False – 80% of suicide completers talk about it before
they actually follow throughthey actually follow through3. 3. Only “crazy” people kill themselvesOnly “crazy” people kill themselves
False - Crazy is a cruel and meaningless word. Few who False - Crazy is a cruel and meaningless word. Few who kill themselves have lost touch with reality – they feel kill themselves have lost touch with reality – they feel hopeless and in terrible painhopeless and in terrible pain
(AFSP website, 2003)(AFSP website, 2003)
Gatekeeper Training- Dr. Ellen AnGatekeeper Training- Dr. Ellen Andersonderson
3636
4. No one I know would do that4. No one I know would do that False - suicide is an equal opportunity killer – rich, False - suicide is an equal opportunity killer – rich,
poor, successful, unsuccessful, beautiful, ugly, poor, successful, unsuccessful, beautiful, ugly, young, old, popular and unpopular people all young, old, popular and unpopular people all complete suicidecomplete suicide
5. They’re just trying to get attention5. They’re just trying to get attention False – They are trying to get help. We should False – They are trying to get help. We should
recognize that need and respond to itrecognize that need and respond to it
6.6. Suicide is a city problem, not in the Suicide is a city problem, not in the country or a small towncountry or a small town
False – rural areas have higher suicide rates than False – rural areas have higher suicide rates than urban areasurban areas
Gatekeeper Training- Dr. Ellen AnGatekeeper Training- Dr. Ellen Andersonderson
3737
Suicide myths, continued:Suicide myths, continued:
7.7. Once a person decides to dieOnce a person decides to die nothing can stop themnothing can stop them - - They They really want to diereally want to die
NO - most people want to be stopped – if NO - most people want to be stopped – if we don’t try to stop them they will we don’t try to stop them they will certainly die - people want to end their certainly die - people want to end their pain, not their lives, but they no longer pain, not their lives, but they no longer have hope that anyone will listen, that have hope that anyone will listen, that they can be helpedthey can be helped
(AFSP website, 2003(AFSP website, 2003))
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 3838
How Do I Know If How Do I Know If Someone Is Suicidal?Someone Is Suicidal?
Now we understand the connection Now we understand the connection between depression and suicidebetween depression and suicide
We have reviewed what a depressed We have reviewed what a depressed person looks likeperson looks like
Not all depressed people are suicidal – Not all depressed people are suicidal – how can we tell?how can we tell?
Suicides don’t happen without warning Suicides don’t happen without warning - verbal and behavioral clues are - verbal and behavioral clues are present, but we may not notice thempresent, but we may not notice them
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 3939
Verbal ExpressionsVerbal Expressions Common statementsCommon statements
• I shouldn't be hereI shouldn't be here• I'm going to run awayI'm going to run away• I wish I were deadI wish I were dead• I'm going to kill myselfI'm going to kill myself• I wish I could disappear foreverI wish I could disappear forever• If a person did this or that…., would he/she If a person did this or that…., would he/she
diedie• Maybe if I died, people would love me moreMaybe if I died, people would love me more• I want to see what it feels like to dieI want to see what it feels like to die
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 4040
Some Behavioral Warning Some Behavioral Warning SignsSigns
Common signsCommon signs• Previous suicidal thoughts or attemptsPrevious suicidal thoughts or attempts• Expressing feelings of hopelessness or Expressing feelings of hopelessness or
guiltguilt• (Increased) substance abuse (Increased) substance abuse • Becoming less responsible and Becoming less responsible and
motivatedmotivated• Talking or joking about suicideTalking or joking about suicide• Giving away possessionsGiving away possessions• Having several accidents resulting in Having several accidents resulting in
injury; "close calls" or "brushes with injury; "close calls" or "brushes with death"death"
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 4141
• Preoccupation with death/violence; TV, Preoccupation with death/violence; TV, movies, drawings, books, at play, musicmovies, drawings, books, at play, music
• Risky behavior; jumping from high Risky behavior; jumping from high places, running into traffic, self-cuttingplaces, running into traffic, self-cutting
• School problems – a big drop in grades, School problems – a big drop in grades, falling asleep in class, emotional falling asleep in class, emotional outbursts or other behavior unusual for outbursts or other behavior unusual for this studentthis student
• Wants to join a person in heavenWants to join a person in heaven
• Themes of death in artwork, poetry, etcThemes of death in artwork, poetry, etc
Further Behaviors Often Seen Further Behaviors Often Seen in Kidsin Kids
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 4242
What On Earth Can What On Earth Can II Do? Do? Anyone can learn to ask the right questions Anyone can learn to ask the right questions
to help a depressed and suicidal personto help a depressed and suicidal person Depression is an illness, like heart disease, Depression is an illness, like heart disease,
and and suicidal thoughts are a crisis in suicidal thoughts are a crisis in that illness, like a heart attackthat illness, like a heart attack
You would not leave a heart attack victim You would not leave a heart attack victim lying on the sidewalk – many have been lying on the sidewalk – many have been trained in CPRtrained in CPR
We must learn to help people whoWe must learn to help people who are dying more slowly of depressionare dying more slowly of depression
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 4343
What Stops Us?What Stops Us? Most of us still believe suicide and depression Most of us still believe suicide and depression
are “none of our business” and fearful of getting are “none of our business” and fearful of getting a yes answera yes answer
What if we could respond to “yes”?What if we could respond to “yes”? What if we could recognize depression symptoms What if we could recognize depression symptoms
like we recognize symptoms of a heart attack?like we recognize symptoms of a heart attack? What if we were no longer afraid to ask for help What if we were no longer afraid to ask for help
for ourselves, our parents, our children?for ourselves, our parents, our children? What if we no longer had to feel ashamed of our What if we no longer had to feel ashamed of our
feelings of despair and hopelessness, but feelings of despair and hopelessness, but recognized them as symptoms of a brain recognized them as symptoms of a brain disorder?disorder?
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 4444
Reduce StigmaReduce Stigma Stigma about having mental health problems Stigma about having mental health problems
keeps people from seeking help or even keeps people from seeking help or even acknowledging their problemacknowledging their problem
Reducing the fear and shame we carry about Reducing the fear and shame we carry about having such “shameful” problems is criticalhaving such “shameful” problems is critical
People must learn that depression is truly a People must learn that depression is truly a disorder that can be treated – not something disorder that can be treated – not something to be ashamed of, not a weaknessto be ashamed of, not a weakness
Learning about suicide makes it possible for Learning about suicide makes it possible for us to overcome our fears about asking the us to overcome our fears about asking the “S” question“S” question
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 4545
Learning “Learning “QPRQPR” – Or, How To ” – Or, How To Ask The “S” QuestionAsk The “S” Question
It is essential, if we are to reduce the number It is essential, if we are to reduce the number of suicide deaths in our country, that of suicide deaths in our country, that community members/gatekeepers learn “community members/gatekeepers learn “QPRQPR””
First designed by Dr. Paul Quinnett as an First designed by Dr. Paul Quinnett as an analogue to CPR, “analogue to CPR, “QPRQPR” consists of ” consists of QQuestion – asking the “S” questionuestion – asking the “S” questionPPersuade– getting the person to talk, and to ersuade– getting the person to talk, and to
seek helpseek helpRRefer – getting the person to professional efer – getting the person to professional
helphelp(Quinnett, 2000)(Quinnett, 2000)
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 4646
Ask Questions!Ask Questions! You seem pretty downYou seem pretty down Do things seem hopeless to youDo things seem hopeless to you Have you ever thought it would be easier Have you ever thought it would be easier
to be dead?to be dead? Have you considered suicide?Have you considered suicide? Remember, you cannot make someone Remember, you cannot make someone
suicidal by talking about it. If they are suicidal by talking about it. If they are already thinking of it they will probably be already thinking of it they will probably be relieved that the secret is outrelieved that the secret is out
If you get a yes answer, don’t panic. Ask a If you get a yes answer, don’t panic. Ask a few more questionsfew more questions
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 4747
How Much Risk Is There?How Much Risk Is There? Assess lethalityAssess lethality
• You are not a doctor, but you need You are not a doctor, but you need to know how imminent the danger to know how imminent the danger isis
• Has he or she made any previous Has he or she made any previous suicide attempts? suicide attempts?
• Does he or she have a plan?Does he or she have a plan?• How specific is the plan? How specific is the plan? • Do they have access to means?Do they have access to means?
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 4848
Do . . .Do . . . Use warning signs to get help early Use warning signs to get help early Talk openly- reassure them that Talk openly- reassure them that
they can be helped - try to instill they can be helped - try to instill hopehope
Encourage expression of feelingsEncourage expression of feelings Listen without passing judgmentListen without passing judgment Make empathic statementsMake empathic statements Stay calm, relaxed, rationalStay calm, relaxed, rational
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 4949
But when But when someone is someone is suicidal, a suicidal, a true friend true friend learns how learns how to listento listen
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 5050
Don’tDon’t…… Make moral judgmentsMake moral judgments Argue lecture, or encourage guiltArgue lecture, or encourage guilt Promise total confidentiality/offer Promise total confidentiality/offer
reassurances that may not be truereassurances that may not be true Offer empty reassurances – “you’ll get over Offer empty reassurances – “you’ll get over
this”this” Minimize the problem -“All you need is a good Minimize the problem -“All you need is a good
night’s sleep”night’s sleep” Dare or use reverse psychology - “You won’t Dare or use reverse psychology - “You won’t
really do it” - - “Go ahead and kill yourself”really do it” - - “Go ahead and kill yourself” Leave the person aloneLeave the person alone Never Go It AloneNever Go It Alone
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 5151
Getting HelpGetting Help Refer for professional helpRefer for professional help
• When people exhibit 5 or more When people exhibit 5 or more symptoms of depressionsymptoms of depression
• When risk is present (e.g. Specific When risk is present (e.g. Specific plan, available means)plan, available means)
• Learn your community resources – Learn your community resources – know how to get helpknow how to get help
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 5252
Local Professional Local Professional ResourcesResources
Your Hospital Your Hospital Emergency RoomEmergency Room
Your Local Mental Your Local Mental Health AgenciesHealth Agencies
Your Local Mental Your Local Mental Health BoardHealth Board
School Guidance School Guidance CounselorsCounselors
Local Crisis HotlinesLocal Crisis HotlinesNational Crisis National Crisis
HotlinesHotlinesYour family Your family
physicianphysicianSchool nursesSchool nurses911911Local Police/SheriffLocal Police/SheriffLocal ClergyLocal Clergy
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 5353
Sources of support for families of suicide Sources of support for families of suicide completers are almost non-existent, unless completers are almost non-existent, unless a survivors of suicide group is availablea survivors of suicide group is available
If you know people who have experienced If you know people who have experienced this tragedy talk with them about itthis tragedy talk with them about it
Explain what you know about depression - Explain what you know about depression - help them understand they are not at fault, help them understand they are not at fault, that their loved one was illthat their loved one was ill
Help them understand the unendurable Help them understand the unendurable psychache their loved one experienced –it psychache their loved one experienced –it may help them resolve some of their angermay help them resolve some of their anger
Survivors Of SuicideSurvivors Of Suicide
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 5454
Final SuggestionsFinal Suggestions You may know many people with depression You may know many people with depression Are they comfortable telling you about this vulnerable Are they comfortable telling you about this vulnerable
place in their life?place in their life? Openness and discussion about depression and Openness and discussion about depression and
suicidal thinking can free people to talk suicidal thinking can free people to talk Help spread the word in your church, PTA group, Help spread the word in your church, PTA group,
sports team, circle of friends sports team, circle of friends Help people emerge from the stigma our culture has Help people emerge from the stigma our culture has
placed on this and other mental health problemsplaced on this and other mental health problems Become aware of your own vulnerability to Become aware of your own vulnerability to
depression depression (Anderson, 1999)(Anderson, 1999)
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 5555
Permanent Solution-Permanent Solution- Temporary Problem Temporary Problem
Remember a depressed person is Remember a depressed person is physically ill, and physically ill, and cannotcannot think clearly think clearly about the morality of suicide, about the morality of suicide, cannot cannot think think logically about their value to friends and logically about their value to friends and familyfamily
You would try CPR if you saw a heart You would try CPR if you saw a heart attack victimattack victim
Don’t be afraid to “interfere” when Don’t be afraid to “interfere” when someone is dying more slowly of someone is dying more slowly of depressiondepression
Depression is a treatable disorderDepression is a treatable disorder Suicide is a preventable deathSuicide is a preventable death
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 5656
The Ohio Suicide Prevention The Ohio Suicide Prevention FoundationFoundation
The Ohio State University, Center on The Ohio State University, Center on Education and Training for EmploymentEducation and Training for Employment
1900 Kenny Road, Room 20721900 Kenny Road, Room 2072 Columbus, OH 43210Columbus, OH 43210
614-292-8585614-292-8585
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 5757
Websites For Additional Websites For Additional InformationInformation
Ohio Department of Ohio Department of Mental healthMental health
www.mh.state.oh.us www.mh.state.oh.us NAMINAMI
www.nami.orgwww.nami.org Suicide Prevention Suicide Prevention
Resource CenterResource Centerwww.sprc.orgwww.sprc.org
American association of American association of suicidologysuicidologywww.suicidology.orgwww.suicidology.org
Suicide awareness/voice Suicide awareness/voice of educationof educationwww.save.orgwww.save.org
American foundation for American foundation for suicide preventionsuicide preventionwww.afsp.orgwww.afsp.org
Suicide prevention Suicide prevention advocacy networkadvocacy networkwww. www. spanusa.orgspanusa.org
QPR institute QPR institute www.qprtinstitute.orgwww.qprtinstitute.org
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 5858
A Brief BibliographyA Brief Bibliography Anderson, E. “The Personal and Professional Impact of Anderson, E. “The Personal and Professional Impact of
Client Suicide on Mental Health Professionals. Unpublished Client Suicide on Mental Health Professionals. Unpublished Doctoral dissertation, U. of Toledo, 1999.Doctoral dissertation, U. of Toledo, 1999.
Beck, A.T., Steer, R.A., Kovacs, M., & Garrison, B. (1985). Beck, A.T., Steer, R.A., Kovacs, M., & Garrison, B. (1985). Hopelessness, depression, suicidal ideation, and clinical Hopelessness, depression, suicidal ideation, and clinical diagnosis of depression. diagnosis of depression. Suicide and Life-Threatening Suicide and Life-Threatening BehaviorBehavior. 23(2), 139-145.. 23(2), 139-145.
Blumenthal, S.J. & Kupfer, D.J. (Eds.) (1990). Blumenthal, S.J. & Kupfer, D.J. (Eds.) (1990). Suicide Over Suicide Over the Life Cycle: Risk Factors, Assessment, and Treatment of the Life Cycle: Risk Factors, Assessment, and Treatment of Suicidal Patients.Suicidal Patients. American Psychiatric Press. American Psychiatric Press.
Braun, S. (2000). Braun, S. (2000). Unlocking the Mysteries of Mood: The Unlocking the Mysteries of Mood: The Science of HappinessScience of Happiness. Wiley and Sons, NY.. Wiley and Sons, NY.
Calhoun, L.G, Abernathy, C.B., & Selby, J.W. (1986). The Calhoun, L.G, Abernathy, C.B., & Selby, J.W. (1986). The rules of bereavement: Are suicidal deaths different? rules of bereavement: Are suicidal deaths different? Journal Journal of Community Psychology, 14of Community Psychology, 14, 213-218., 213-218.
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 5959
Doka, K.J. (1989). Doka, K.J. (1989). Disenfranchised Grief: Recognizing Disenfranchised Grief: Recognizing hidden sorrowhidden sorrow. Lexington, MA: Lexington Books.. Lexington, MA: Lexington Books.
Dunne, E.J., MacIntosh, J.L., & Dunne-Maxim, K. (Eds.). Dunne, E.J., MacIntosh, J.L., & Dunne-Maxim, K. (Eds.). (1987). (1987). Suicide and its aftermath Suicide and its aftermath. New York: W.W. . New York: W.W. Norton.Norton.
Empfield, M & Bakalar, N. (2001) Empfield, M & Bakalar, N. (2001) Understanding Understanding Teenage Depression: A guide to Diagnosis, Treatment Teenage Depression: A guide to Diagnosis, Treatment and Management.and Management. Holt & Co., NY. Holt & Co., NY.
Jacobs, D., Ed. (1999). Jacobs, D., Ed. (1999). The Harvard Medical School Guide The Harvard Medical School Guide to Suicide Assessment and Interventions.to Suicide Assessment and Interventions. Jossey-Bass. Jossey-Bass.
Jamison, K.R., (1999). Jamison, K.R., (1999). Night Falls Fast: Understanding Night Falls Fast: Understanding Suicide.Suicide. Alfred Knopf . Alfred Knopf .
Krysinski, P.K. (1993). Coping with suicide: Beyond the Krysinski, P.K. (1993). Coping with suicide: Beyond the three day bereavement leave policy. three day bereavement leave policy. Death Studies: 17Death Studies: 17, , 173-177.173-177.
Lester, D. (1998). Lester, D. (1998). Making Sense of Suicide: An In-Depth Making Sense of Suicide: An In-Depth Look at Why People Kill Themselves.Look at Why People Kill Themselves. American American Psychiatric Press.Psychiatric Press.
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 6060
Oregon Health Department, Prevention. Notes on Oregon Health Department, Prevention. Notes on Depression and Suicide: Depression and Suicide: ttp://www.dhs.state.or.us/publickhealth/ipe/depresttp://www.dhs.state.or.us/publickhealth/ipe/depression/notes.cfm.sion/notes.cfm.
President’s New Freedom Council on Mental President’s New Freedom Council on Mental Health, 2003.Health, 2003.
Rosenblatt, P. (1996). Grief that does not end. In Rosenblatt, P. (1996). Grief that does not end. In D. Klass, P. Silverman, & S. Nickman (Eds.), D. Klass, P. Silverman, & S. Nickman (Eds.), Continuing Bonds: New Understandings of griefContinuing Bonds: New Understandings of grief (pp 45-58). Washington, D.C.: Taylor & Francis.(pp 45-58). Washington, D.C.: Taylor & Francis.
Rowling, L. (1995). The disenfranchised grief of Rowling, L. (1995). The disenfranchised grief of teachers. teachers. Omega, 31Omega, 31(4), 317-329.(4), 317-329.
Smith, Range & Ulner. “Belief in Afterlife as a Smith, Range & Ulner. “Belief in Afterlife as a buffer in suicide and other bereavement.” Omega buffer in suicide and other bereavement.” Omega Journal of Death and Dying, 1991-92, (24)3; 217-Journal of Death and Dying, 1991-92, (24)3; 217-225.225.
Gatekeeper Training- Dr. Ellen AndersonGatekeeper Training- Dr. Ellen Anderson 6161
Stoff, D.M. & Mann, J.J. (Eds.), (1997). Stoff, D.M. & Mann, J.J. (Eds.), (1997). The The Neurobiology of SuicideNeurobiology of Suicide. American Academy of Science. American Academy of Science
Quinnett, P.G. (2000). Quinnett, P.G. (2000). Counseling Suicidal People.Counseling Suicidal People. QPR QPR Institute, Spokane, WAInstitute, Spokane, WA
Sheskin, A., & Wallace, S.E. (1976). Differing Sheskin, A., & Wallace, S.E. (1976). Differing bereavements: Suicide, natural, and accidental deaths. bereavements: Suicide, natural, and accidental deaths. Omega 7Omega 7, 229-242., 229-242.
Shneidman, E.S.(1996).Shneidman, E.S.(1996).The Suicidal MindThe Suicidal Mind. Oxford . Oxford University Press.University Press.
Styron, W. (1992). Darkness Visible. Vintage BooksStyron, W. (1992). Darkness Visible. Vintage Books Surgeon General’s Call to Action (1999). Department of Surgeon General’s Call to Action (1999). Department of
Health and Human Services, U.S. Public Health Service.Health and Human Services, U.S. Public Health Service. Thompson, K. & Range, L. (1992). Bereavement Thompson, K. & Range, L. (1992). Bereavement
following suicide and other deaths: Why support following suicide and other deaths: Why support attempts fail. attempts fail. Omega 26Omega 26(1), 61-70.(1), 61-70.