suicidal 2005 philippines v2

7/31/2019 Suicidal 2005 Philippines V2

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Kirk Kinnell

May 2005

Suicide Intervention



World Health Organisation 2000

• 1 Million suicides worldwide.

• 16 per 100,000 of population.

• 1 Suicide every 40 seconds.• Attempts exceed completed acts by 20:1.

• Male suicide rate in U.K. can be a high as

33 per 100,000 of population.• In Scotland suicides account for 17.8% of all

male deaths in 15 – 24 age group.



Academic Studies

• 40% of those who commit suicide have previously

‘attempted’. ( Kerkhof 2000 )

• 15-20% relate to the previous year. ( Kreitman & Casey1988 )

• History of Deliberate Self Harm increases future risk of

Suicide by 10 – 30 times. ( Gunnell & Frankel 1994)

• 50% of those who commit suicide have a history of self

harm. ( Roy 1986)



U.K. - Samaritans 2004 - Suicides

England 12 per 100,000 of population

N. Ireland 12 per 100,000 of population

Wales 14 per 100,000 of population

Scotland 21 per 100,000 of population



The ‘Male’ Factor

• Tend towards more lethal and certain methods

commensurate with hospital admissions for attempted

suicide and DSH.

• More likely disposed to substance abuse.

• More inclined to impulsive violence.

• Less liable to seek or accept help or advice when faced

with life problems. (Brent & Moritz 1996)



Suicide - Objectives

• List the main reasons why people threaten suicide.

• Describe risk factors indicating potential suicide.

• Identify verbal clues which suggest suicidal intentions.

• Identify situational clues which suggest suicidal

intentions.

• Outline behavioural clues which suggest suicidal

intentions.



Suicide - Definitions

When a person takes their own

life, whether with the assistance of others

or otherwise.

Or

A deliberate act of Self harm which has caused

the ‘harmers’ death.



Suicide - Myths

• They are all attention seekers.

• If they talk about it they won‟t do it.



“I hope you have peace however you find it Maddy

Good luck and I will see you on the other side.”

SIDHE

Assisted Suicide

Assistedsuicideholidays.co.uk.



Gateway to Peace ?

Assisted Suicide

Assistedsuicideholidays.co.uk.



Suicide - Myths

• They are all attention seekers

• If they talk about it they won‟t do it

• Suicidal people are all Mentally / Physically ill

• Intelligent/educated people don‟t do it. • When the depression lifts, the risk goes.

• If you ask about it you increase the risk.



Reasons For Suicide Threats

Suicide is the anchor point on a continuum

of suicidal thoughts and behaviours. The

continuum is one that ranges from risk

taking behaviours at one end, extends

through different degrees and types of

suicidal thinking and ends up with suicideattempts and suicide.

( Redfield Jamieson 2000 )




Suicide „COMPLETERS‟

continuum

Subjects With Other Motives (SWOM )




Police Negotiator Control / Influence over:

„COMPLETERS‟

• Managing Disappointment

• Critical Incident Debriefing

S.W.O.M.

• Success / Ego




• primary reason - wants to die

• „COMPLETERS‟

- wants to end

suffering



Secondary Reasons ( S.W.O.M. )

• Cry for help

• Attention seeker

• Test reactions

• Gain something• Manipulate events

• Prevent entry

• Intend to die

• Suicidal desire impulse levels increasing




Suicide Indicators

• Verbal

• Situational

• Behavioural



Suicide Indicators

Verbal Threats

• Refuses to talk

• Isolated - hopeless - helpless

• Specific death plan

• „Deadline‟ - „last request‟

• No „ifs‟ or „buts‟

• Commitment to die



Verbal / Situational



Suicide Indicators

Situational

Police Negotiator should :

• Attempt to assess the subjects determination to

complete the act

and• Identify the level of sophistication of the plan.

( which side of the barrier )



Suicide Indicators

Situational

• Antecedent history• Location

– Secluded / public – Danger – Convenient / Difficult – Personally symbolic – Special meaning.

– Socially symbolic – Erskine Bridge• Low self-esteem• Emotional crisis• Major life - marital - relationship events (last 24hours)

• Negotiator detects sense of hopelessness



Suicide Indicators

Behavioural

• Hostile – threatening.

• Demands to be killed .• Demands – should be viewed as „unsatisfied need‟.

• Past attempts.

• „Final ritual‟ - last will & testament.

• Inappropriate calmness - happy and content.

• Stripping of possessions – relationships.

• Mental health.

• Method - slashing, cutting, firearms.



Suicide Indicators

Behavioural

• Offensive v Defensive threats

• Offensive – “ If you don‟t get my wife ..…I

will jump ”

• Defensive – “ If you try and grab me I will

jump “



Behavioural Change

Staircase

Active

Listening

Situation

Empathy

Rapport

Influence

Change



Come Down Plan

• Safest Possible Way

• Early

• Non-threatening

• “ I know that you are not ready to come down just yet,

but when you do could you come to the centre of theroof / fire escape etc.



Resolution

Domestics

• Allow to vent feelings

• Label emotions

• Take a rational line

• Try not to take sides

• Emphasise the positive



Resolution

• Depressive: no contact with reality

• Empathy

• Be patient for replies

• Beware of sudden movements

• Discuss “real world” v “abstract”

• Postpone action instead of changing mood

• Beware suicide by cop



Resolution

Inadequate: in contact with reality

• Try to resolve without meaning another failure

• Talk of successes

• Raise esteem



Resolution

Anti-social: in contact with reality

• Egocentricity in mind

• Be firmer to gain respect

• Safe release to his advantage• Reality checks

• Avoid intermediaries

• Saving face – coming out plan



Resolution

Crime gone wrong

• Provide a solution

• Legal and media observers

• Appeal to reason



Resolution

Terrorists

• Excess will now diminish your message

• You‟ve made your point

• The World is watching

• Come out only choice left to them



Suicide Negotiation

Tactics Broaching the subject

• IF CLUES SUGGEST SUICIDE - ASK!• “It looks to me as if you want out of this”

• Visible - audible relief

• Motive? - purpose?

• Language implies suicide

• “Why do you want to kill yourself”

• “How/when do you plan to do it?”

• “What have you done?”

S i id N ti ti T ti B ildi



Suicide Negotiation Tactics Building

Rapport

• One negotiator?

• Active listening.

• Speech - slow, clear, simple .

• Personal concern - empathy – trust.

• Making requests - be firm.

• Do not intimidate or become argumentative.

• Empathic statements & questions.

S i id N ti ti T ti M ki



Suicide Negotiation Tactics Making

Progress

• Discourage alcohol/drugs.

• Establish problems - break down issue(s).

• Focus on situation - talk directly about it.

• Rationalise.

• Bid for time.

• Identify hook .



Suicide Negotiation Tactics Resolution

SUICIDE INTERVENTION

• Allow to ventilate

• Try to get person to describe events as objectively aspossible

• Place more objective, rational view of events

• Use empathy, point out the normality of reaction

• Raise esteem

• Ask how they have handled it in the past

• Ask to go over options they have ruled out

• AVOID lecturing/moralising/giving advice





• Be non-judgmental/non analytical

• Ask “Are you going to commit suicide?”

• Ask person to reduce immediate danger

• Focus on CAUSE of suicidal feelings and specific

SITUATION

• Express personal concern and EMPATHY

• Try to keep them on the line/talking





• If insist, get promise not to harm and agree time to call

back

• Talk openly about the finality of death

• DON‟T go along with final requests

• Explore what is meaningful to person and what keepsthem going

• Bid for time, explore developing a realistic plan of

action.



Method

• pills - how many ?- kind/strength? - when? -

anything else?• toxic substance - antidote ?

• gun/knife - ammunition ?- seriousness of wound?

• gas/carbon monoxide - when did action begin?

• other - slash wrist? - jump? - hanging?

Risk Reduction



Risk Reduction

Ask person to reduce danger

• pills - flush down toilet - walk - stay awake• toxic substance - persuade to take antidote

• gun/knife - put away - unload - stop the bleeding

• gas/carbon monoxide - turn gas /ignition off –

open doors/windows

• other - discard razor - move away from danger -

reach safety

Third Party Intermediaries Beware



Third Party Intermediaries Beware

- Help or Hindrance

Help

• Lowering the overall emotional level.

• Convinced subject to surrender.

Third Party Intermediaries Beware Help



Third Party Intermediaries Beware - Help

or Hindrance

Hindered

• Making the situation more volatile.

• Provided audience for suicide or verbal will.

Third Party Intermediaries Beware Help



Third Party Intermediaries Beware - Help

or Hindrance

• Family members

• Clerics - caution

• Interpreters

• Suicide audience

• Hostages - no hostages

• Briefing - control



Issues for The Negotiator

• What is your strategy?

• Beware victim perpetrated homicide - ‘suicide by cop’

• Importance of briefing

• Personal safety - gather intelligence

• No deception• Offer help - be realistic

• Managing feelings

• Impact on individuals - critical incident debrief



Own personal crisis

Rationalising

De-personalisation

Detachment

Projection Blocking

Distance

Acceptance

Team Action

Reflective Practise

Sharing

Active Discussion

Attempts to reduce dissonance by

Personal Interpersonal

Dissonance

suicidal 2005 philippines v2

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