teen suicide: prevention, assessment, intervention and ...€¦ · certificate of completion. in...

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TeenSuicide:Prevention,

Assessment,Intervention

andRecovery

P.O.Box739•Forest,VA24551•1-800-526-8673•www.AACC.net

TeenSuicidePAIRCertificationCourse

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WelcometoLightUniversityandthe“TeenSuicide:Prevention,Assessment, InterventionandAftercare”programofstudy.Our prayer is that you will be blessed by your studies and increase your effectiveness inreaching out to others. We believe you will find this program to be academically sound,clinicallyexcellentandbiblically-based.Our faculty represents some of the best in their field – including professors, counselors andministers who provide students with current, practical instruction relevant to the needs oftoday’sgenerations.We have alsoworked hard to provide youwith a program that is convenient and flexible –givingyoutheadvantageof“classroominstruction”onDVDandallowingyoutocompleteyourtrainingonyourowntimeandscheduleinthecomfortofyourhomeoroffice.Thetestmaterialcanbefoundatwww.lightuniversity.comandmaybetakenopenbook.Onceyouhavesuccessfullycompletedthetest,whichcoverstheunitswithinthiscourse,youwillbeawardedacertificateofcompletionsignifyingyouhavecompletedthisprogramofstudy.Thank you for your interest in this program of study. Our prayer is that you will grow inknowledge,discernment,andpeople-skillsthroughoutthiscourseofstudy.Sincerely,

RonHawkinsDean,LightUniversity


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TheAmericanAssociationofChristianCounselors

• Represents the largestorganizedmembership (nearly50,000)ofChristian counselorsandcaregiversintheworld,havingjustcelebratedits25thanniversaryin2011.

• Known for its top-tier publications (Christian Counseling Today, the Christian CounselingConnectionandChristianCoachingToday),professionalcredentialingopportunitiesofferedthroughtheInternationalBoardofChristianCare(IBCC),excellenceinChristiancounselingeducation, an arrayof broad-based conferences and live training events, radioprograms,regulatoryandadvocacyeffortsonbehalfofChristianprofessionals,apeer-reviewedEthicsCode, and collaborative partnerships such as Compassion International, the NationalHispanic Christian Leadership Conference and Care Net (to name a few), the AACC hasbecomethefaceofChristiancounselingtoday.

• With the needed vision and practical support necessary, the AACC helped launch the

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TheAACC’svisionhastwocriticaldimensions:First,wedesiretoservetheworldwideChristianChurch by helping foster maturity in Christ. Secondly, we aim to serve, educate, and equip1,000,000 professional clinicians, pastoral counselors, and lay helpers throughout the nextdecade.WearecommittedtohelpingtheChurchequipGod’speopletoloveandcareforoneanother.We recognize Christian counseling as a unique form of Christian discipleship, assisting thechurch in its call to bring believers to maturity in the lifelong process of sanctification—ofgrowingtomaturityinChristandexperiencingabundantlife.Werecognizesomearegiftedtodosointhecontextofaclinical,professionaland/orpastoralmanner.Wealsobelieveselected laypeoplearecalledtocareforothersandthattheyneedtheappropriatetrainingandmentoringtodoso.WebelievetheroleofthehelpingministryintheChurchmustbesupportedbythreestrongcords:thepastor,thelayhelper,andtheclinicalprofessional.ItistothesethreerolesthattheAACCisdedicatedtoserve(Ephesians4:11-13).

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LightUniversity• Establishedin1999undertheleadershipofDr.TimClinton—hasnowseennearly200,000

students from around the world (including lay caregivers, pastors and chaplains, crisisresponders,lifecoaches,andlicensedmentalhealthpractitioners)enrollincoursesthataredelivered via multiple formats (live conference and webinar presentations, video-basedcertificationtraining,andastate-of-theartonlinedistanceteachingplatform).

• Thesepresentations,courses,andcertificateanddiplomaprograms,offeroneofthemostcomprehensive orientations to Christian counseling anywhere. The strength of LightUniversity is partially determined by its world-class faculty—over 150 of the leadingChristianeducators,authors,mentalhealthcliniciansandlifecoachingexpertsintheUnitedStates. This core groupof facultymembers represents a literal “Who’sWho” inChristiancounseling. No other university in the world has pulled together such a diverse andcomprehensivegroupofprofessionals.

• Educational and training materials cover over 40 relevant core areas in Christian—

counseling, lifecoaching,mediation,andcrisis response—equippingcompetentcaregiversand ministry leaders who are making a difference in their churches, communities, andorganizations.

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TotrainonemillionBiblicalCounselors,ChristianLifeCoaches,andChristianCrisisRespondersbyeducating,equipping,andservingtoday’sChristianleaders.

AcademicallySound•ClinicallyExcellent•DistinctivelyChristian


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• UtilizesDVDpresentations that incorporateover 150 of the leading Christian educators,authors,mentalhealthclinicians,andlifecoachingexpertsintheUnitedStates.

• Eachpresentationisapproximately50-60minutesinlengthandmostareaccompaniedbyacorrespondingtext(inoutlineformat)anda10-questionexaminationtomeasurelearningoutcomes.Therearenearly1,000uniquepresentationsthatareavailableandorganizedinvariouscourseofferings.

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parameters/scheduleofeachparticipant.• With the successful completion of each program course, participants receive an official

Certificate of Completion. In addition to the normal Certificate of Completion that eachparticipant receives, Regular and Advanced Diplomas in Biblical Counseling are alsoavailable.

Ø TheRegularDiploma isawardedbytakingCaringForPeopleGod’sWay,BreakingFreeandoneadditionalElectiveamongtheavailableCoreCourses.

Ø TheAdvancedDiplomaisawardedbytakingCaringForPeopleGod’sWay,BreakingFree,andanythreeElectivesamongtheavailableCoreCourses.

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• LightUniversitycourses,programs,certificatesanddiplomasarerecognizedandendorsedbytheInternationalBoardofChristianCare(IBCC)anditsthreeaffiliateBoards:theBoardofChristianProfessional&PastoralCounselors(BCPPC);theBoardofChristianLifeCoaching(BCLC);andtheBoardofChristianCrisis&TraumaResponse(BCCTR).

• Credentialing is a separateprocess from certificate or diploma completion.However, theIBCC accepts Light University and Light University Online programs as meeting theacademic requirements for credentialing purposes. Graduates are eligible to apply forcredentialinginmostcases.

Ø Credentialinginvolvesanapplication,attestation,andpersonalreferences.

Ø CredentialrenewalsincludeContinuingEducationrequirements,re-attestation,andoccureitherannuallyorbienniallydependingonthespecificBoard.


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ContinuingEducationThe AACC is approved by the American Psychological Association (APA) to offer continuingeducationforpsychologists.TheAACCisaco-sponsorofthistrainingcurriculumandaNationalBoard of Certified Counselors (NBCC)ApprovedContinuing Education Provider (ACEPTM). TheAACC may award NBCC approved clock hours for events or programs that meet NBCCrequirements.TheAACCmaintainsresponsibilityforthecontentofthistrainingcurriculum.TheAACCalsoofferscontinuingeducationcreditforplaytherapiststhroughtheAssociationforPlayTherapy (APT Approved Provider #14-373), so long as the training element is specificallyapplicabletothepracticeofplaytherapy.It remains the responsibility of each individual to be aware of his/her state licensure andContinuing Education requirements. A letter certifying participation will be mailed to thoseindividuals who submit a Continuing Education request and have successfully completed allcourserequirements.


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Presentersfor

TeenSuicide:Prevention,Assessment,Intervention

andRecovery


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PresenterBiographies

Jennifer Cisney Ellers, M.A. is a Professional Counselor, life coach, crisis response trainer,authorandspeaker.Sheconductstraining,counselingandcoaching inthefieldofgrief,crisisandtraumathroughtheInstituteforCompassionateCare.Jenniferisanapprovedinstructorforthe International Critical Incident Stress Foundation, teaching several CISM courses. Also,Jenniferprovidesdivorcecoaching,trainingandspeakingthroughEmergeVictorious,aministryfor women rebuilding their lives after divorce. She is the co-author of The First 48 Hours:SpiritualCaregiversasFirstResponders,withherhusband,Dr.KevinEllers.Inaddition,Jenniferco-authored, Emerge Victorious: AWoman’s Transformational Guide after Her Divorce, withSandraDopfLee.KevinEllers,D.Min., istheTerritorialDisasterServicesCoordinatorforTheSalvationArmyintheU.S.A.CentralTerritory.HeisalsopresidentoftheInstituteforCompassionateCare,whichisdedicatedtoeducation,traininganddirectcare.Dr.Ellers isanassociatechaplainwiththeIllinoisFraternalOrderofPolice,servesas faculty for the InternationalCritical IncidentStressFoundation,adjunctprofessoratOlivetNazareneUniversity,andisamemberoftheAmericanAssociation of Christian Counselors Crisis Response Training Team. He has extensive trainingandexperienceinthefieldsofcrisisresponse,grief,trauma,disastermanagement,chaplaincy,pastoralministries,marriageandfamilytherapy,andsocialservices.Asanauthorandspeaker,heteachesbroadlyintheserelatedtopics.AmyFeigel,M.A.,isaVirginiaLicensedProfessionalCounselorandCaliforniaLicensedMarriageandFamilyTherapist.AmyreceivedherpreandpostgraduateeducationfromLibertyUniversityandhasover15yearsofexperienceworkingwithchildren,adolescents,andfamilies.ShehasservedasaSocialWorkerforChildProtectiveServices,aGroupFacilitatorworkingwithsexualabuse survivors through Parents United International, a Mental Health Clinician providingoutpatient counseling for at-risk youth, the Director of Member Care for the AmericanAssociation of Christian Counselors (AACC), the Director of the Extraordinary Womenorganization, and as a private practice therapist. Amy is currently employed full-time as atherapist at Light Professional Christian Counseling Clinic, part-time as an Adjunct FacultyProfessorwithLibertyUniversityOnlineand isalsoaSpecialAssistanttothePresidentoftheAACC.AmyisBoardCertifiedProfessionalChristianCounselorthroughtheInternationalBoardof Professional and Pastoral Counselors and recently received the Servant Leadership AwardfromtheIBCC.


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Molly-CatherineK.Goodson,M.A.,Esq.,isaNorthCarolinaAssistantDistrictAttorney,AdjunctProfessor at Regent University, advocate, and speaker who is passionate about bringingprofessionals together to use a multi-faceted approach to address the issues of domesticviolence, sexual assault, and child abuse.Molly-Catherine graduated from Liberty UniversitySchoolof Lawwitha JurisDoctorandaMasterofArts inHumanServicesCounselingwithaChildren,Families,andtheLawspecialization.TheAmericanAssociationofChristianCounselorsandtheLibertyLegalJournalhavefeaturedherresearchonchildabuse,domesticviolence,andthe consequences of teen sexting. Her passion to “bridge the gap” between psychology andlaw, drives her to equip others on how to address the issues of domestic violence, sexualassault, and child abusewithanunderstandingof theheart andmindof a victim,ultimatelyleadingtoeffectiveadvocacyforthevictim.Frank S. Page, Ph.D. understands missional leadership. Having served as the president of alargeevangelicalentity,hehasalsoservedasseniorpastorfora4,500-plusmemberchurchandiscurrentlythepresidentoftheExecutiveCommitteeoftheSouthernBaptistConvention.Pageholds amaster of divinity andPh.D. fromSouthwesternBaptist Theological Seminary in FortWorth,Texas.HisPh.D. is inthefieldofChristianethicsfocusingonmoral,social,andethicalissues.Anexperiencedspeaker,Dr.Pagehasspokenatmanyrevivals,conferences,universities,seminaries, etc., allowing him to travel around the world to places such as Israel, Africa,Australia,Brazil,Canada,andmanyothers.Heisauthorofseveralbooks,includingTroublewiththe Tulip, Jonah (for The New American Commentary), The Incredible Shrinking Church,CommentaryonMark, andTheWitnessingandGivingLife, andhaswrittenmanyarticles forseveralmagazines and theological journals. He is currently the leadwriter for the AdvancedContinuingWitnessTrainingmaterials.Miriam Parent, Ph.D., holds a Ph.D. from Rosemead Graduate School. She has served as acounseloreducatorformorethantwentyyears.PriortocomingtoTrinityin1993,shetaughtatLibertyUniversity in the School of Religion. Dr. Parent is a licensed clinical psychologist. Shepracticed full-time for several years prior to teaching; since then she has maintained acounselingpracticeprovidingindividualandmaritalcounseling,aswellasdiagnosticevaluationand assessment. Over the years her speaking and writing have focused on areas such asspiritualformation,stressmanagement,burnout,andministryandprofessionalethics.Shealsoenjoys speaking inwomen’s groups and church retreats on a variety of Bible and counselingtopics. Her areas of interest include professional ethics, diagnosis and treatment planning,stressmanagement,women’sissues,andspiritualformation.LindaMintle,Ph.D.,isaLicensedMarriageandFamilyTherapist(LMFT),LicensedClinicalSocialWorker (LCSW), professor, author, and national speaker. She serves as Chair of BehavioralHealthattheCollegeofOsteopathicMedicineatLibertyUniversityinLynchburg,VA.With30yearsofclinicalexperienceworkingwithcouples,families,andindividuals,sheisanexpertonrelationshipsandthepsychologyoffood,weight,andbodyimage.Dr.Mintlealsoservesasanationalnewsconsultant,BeliefNetblogger,andradioshowhost.She isabest-sellingauthorwith 19 book titles, including I Married You, Not Your Family, and Divorce Proofing YourMarriage.


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Eric Scalise, Ph.D., is the former Vice President for Professional Development with theAmericanAssociationofChristianCounselors,aswellasacurrentconsultantandtheirSeniorEditor.HeisalsothePresidentofLIVEnterprises&Consulting,LLC,andaLicensedProfessionalCounselor and LicensedMarriage&Family Therapistwithmore than37yearsof clinical andprofessionalexperienceinthementalhealthfield.HealsoservedforsixyearsontheVirginiaBoard of Counseling aftermultiple appointments from theGovernor’s office. Specialty areasinclude professional/pastoral stress and burnout, combat trauma and PTSD, marriage andfamilyissues,leadershipdevelopment,addictions,andlaycounselortraining.Heisanauthor,anational and international conference speaker, and frequently consults with organizations,clinicians,ministryleaders,andchurchesonavarietyofissues.GarySibcy,Ph.D.,isProfessorofCounselingandDirectorofthePh.D.programinProfessionalCounselingandPastoralCounselingattheCenterforCounselingandFamilyStudiesatLibertyUniversity, where he teaches courses in advanced psychopathology and its treatment. He isboth a Licensed Clinical Psychologist (LCP) and a Licensed Professional Counselor (LPC), hasbeen in private clinical practice for more than 20 years, and currently works at PiedmontPsychiatricCenter.Dr.Sibcyspecializesinanxietydisorders,includingOCDandpanicdisorder,andchronicdepressioninadults,aswellasthediagnosisandtreatmentofchildrenwithseveremooddysregulation.Heiscurrentlydevelopinganempiricallysupportedtreatmentwithintheframework of interpersonal neurobiology and attachment theory. Dr. Sibcy has co-authoredseveralbookswithDr.TimClinton,includingAttachmentsandWhyYouDotheThingsYouDo.Joshua Straub, Ph.D., is a speaker, author, family and relationship coach, and professor. Hespendsmuchofhistimespeaking,coachingfamilies,anddevelopingcurriculumandresources,primarilyintheareasofcounselingchildren,adolescentsandyoungadultsaswellasenrichingmarriagesandfamilies.JoshalsoservesontheteachingteamatWoodlandHillsFamilyChurchin Branson, MO and as assistant professor for Liberty University Online in the Center forCounseling and Family Studies. He is a Board CertifiedMaster Christian Life Coachwith theInternational Christian Coaching Association. In various roles, Dr. Straub has served as aprofessor, counselor, relationships coach, author, speaker, pastor, and administrator for thepast15years.


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TeenSuicide:Prevention,Assessment,InterventionandRecovery

TableofContents:TNSU101:TheDynamicsofSuicide:What,Why,WhoandHow............................................1JenniferCisneyEllers,M.A.TNSU102:ChoosingtoDie:AModelofUnderstanding........................................................12JenniferCisneyEllers,M.A.

TNSU103:ATheologyofSuicide:BiblicalPrinciplesandaChristianResponse.......................22FrankPage,Ph.D.

TNSU104:MentalIllnessandtheEpidemiologyofSuicide....................................................31LindaMintle,Ph.D.TNSU105:TheChangingTideofTeenSuicide:InsightsintoaScreen-SaturatedGeneration..45JoshuaStraub,Ph.D.

TNSU106:TeenSuicideandSelf-injury:Assessment,Diagnosis,andTreatmentStrategies...50AmyFeigel,M.A.andMollyCatherineGoodson,M.A.,J.D.TNSU107:HelpingTeensinCrisis..........................................................................................64JoshuaStraub,Ph.D.TNSU108:TheEthicsofSuicideIntervention.........................................................................73MiriamParent,Ph.D.

TNSU109:SuicidePreventionandInterventionwithAdolescents.........................................82JoshuaStraub,Ph.D.

TNSU110:ConductingaSuicideAssessment:UsingtheSafe-TModel(withroleplays).........91GarySibcy,Ph.D.

TNSU111:FamiliesinCrisis:TheFirst48HoursFollowingSuicide.........................................98JenniferCisneyEllers,M.A.andKevinEllers,D.Min.TNSU112:GrievingaSuicide:Long-termSupportforSurvivorsandLovedOnes..................105JenniferCisneyEllers,M.A.andEricScalise,Ph.D.


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TNSU101:

TheDynamicsofSuicide:

What,Why,Who,andHow

JenniferCisneyEllers,M.A.


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AbstractAspiritualbattletakesplaceeverydaybetweenlightanddark,andsuicideriskisabattleground.

Studies show suicide is on the increase with attempts outnumbering completions. There are

certainfactorsthatincreasesomeone’sriskforcommittingsuicide,suchasage,gender,marital

status, race and ethnicity, and geographical region by state. Methods include firearms,

suffocation, jumping from bridges and other high places, andwalking or driving in front of a

train. Mental illness, substance abuse, personality disorders, chronic or terminal medical

conditions,afamilyorpersonalhistory,environmentalfactors,thecontagioneffect,andaccess

to lethalmethods are all risk factors for suicide.Help is available throughmental healthcare,

positive connections, and thedevelopment of problem solving skills. Spiritual factors, such as

the power of prayer, God, and the Holy Spirit, are available in equipping mental health

professionalswiththetoolstohelpthoseatriskforsuicide.

LearningObjectives

1. Participantswill identifythosemostatriskforsuicidebylookingatfactorssuchasage,

gender,maritalstatus,raceandethnicity,andgeographicalregion.

2. Participants will define various methods used in the attempt and/or completion of

suicide.

3. Participantswillexploredifferentriskfactors involvedinsuicide,suchasmental illness,

substanceabuse,personalitydisorders,chronicorterminalmedicalconditions,familyor

personal history, environmental factors, the contagion effect, and access to lethal

methods.


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I. Introduction

A. ASpiritualBattle

1. Suicideisthebattlegroundinthebattlebetweendarkandlight.

2. Satanhasahandinconvincingpeopletheywanttotaketheirownlives.

3. Muchofthehealinginvolvedinsuicideisofaspiritualnature.

B. PersonalImpact

1. Caregivers are powerfully impacted when someone in their care attempts or

completessuicide.

2. Caregivers are also powerfully impacted when working with the loved ones or

familiesintheaftermathofasuicide.

3. Often caregivers have been impacted personally by suicide when loved ones and

familymembersstruggle.

II. TheNumbersSurroundingSuicide

A. AnIncrease(LookingatSuicideintheU.S.)

1. Suicideismoreprevalentinthenews,andresearchsupportsthatthisisanaccurate

portrayalofincreasedideation,attempts,andcompletedsuicides.

2. StatisticsfromtheCenterforDiseaseControl(CDC)2013

• In2013,therewere41,149suicides.

• Suicidewasthe10thleadingcauseofdeathintheUnitedStates.

• In2013,someonediedbysuicideevery12.8minutes.


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B. ThePercentages

1. From1986-2000,therewasadecreaseinsuicideratesfrom12.5%to10.4%.

2. In2001,thenumbersstartedtoincrease.

3. Therehasbeenaslow,butsteady,increaseto12.6%currently(2013).

C. Attemptsvs.Completion

1. Aninfinitelylargernumberofpeopleattemptsuicidethancompletesuicide.

2. Itisestimatedthatthereare864,950suicideattemptseachyear.

3. Manyattemptsarenotreported.

III. WhoisMostatRisk?

A. Age

1. Currently, the middle aged group (ages 45-64) has the highest rate of suicide at

19.1%.

2. Suicidehasincreasedby28%amongthemiddleagedinthelast10years.

3. The economic crisis is one of the factors that has led to the increase in this age

group’srateofsuicide.

4. Stresslevelsareveryhighforthemiddleaged.


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B. Gender

1. Womenattemptsuicidemorethanmen.

• Threetoonemorethanmen.

• Uselesslethalmeans–poisoningoroverdose.

2. Mencompletesuicidemorethanwomen.

• Mencompletesuicideonetofourtimesmoreoftenthanwomen.

• Thisisduetomen’suseofmorelethalmeans–firearms.

C. MaritalStatus

1. Bythenumbers,mostofthepeoplewhocompletesuicidearemarried.

2. When lookingat suicideby rate,peoplewhoaredivorcedhave thehighest rateof

suicidefollowedbythosewhoarewidowedandthenbythosewhoaresingle.

3. Marriedpeopleactuallyhavethelowestrateofsuicideoverall.

4. Livingaloneandbeingalonesignificantlyincreasestheriskforsuicide.

D. RaceandEthnicity

1. Caucasianshavethehighestsuiciderate.

2. AmericanIndianshavethesecondhighestrateofsuicide.

3. Black,Hispanic,andAsianpopulationshavethelowestsuiciderate.

• Duetofactorsofresilience

• Duetoreligiousfaithandparticipationinafaithcommunity

• Duetostrongfamilyconnectionsandsocialsupport


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E. Patterns

1. Middleagedandolderwhitemalesarethehighestriskgroupfordeathbysuicide.

2. In2013,whitemalesaccountedfor70%ofallcompletedsuicides.

F. GeographicalRegion

1. ThestateswiththehighestsuicideratesareintheWest:Montana,Alaska,Utah,New

Mexico,Idaho,Nevada,Colorado,andSouthDakota.

2. States with the lowest rates are Washington, D.C., New Jersey, New York,

Massachusetts,andConnecticut.

3. One conjecture as towhy suicide rates are higher in theWest is that firearms are

morereadilyavailable.

IV. SuicideDeathsbyMethod(2013)

A. Firearms

1. IntheU.S.,firearmsarethemostlethalandfrequentlyusedmethodofsuicide.

2. In2013,51.5%ofsuicideswerewiththeuseoffirearms.

B. Suffocation

1. 24.5%usedsomemethodofsuffocation.

2. Thisincludeshanging.


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C. OtherMethods

1. Theseothermethodsmakeup8%ofsuicides.

2. Theseothermethodsincludejumpingfrombridgesorotherhighplaces(theGolden

GateBridge)andwalkingordrivinginfrontofatrain.

D. Overview

1. WorldHealthOrganization–suicideinothercountries.

2. Firearmsarenottheleadingmethodofsuicideinothercountriesbecausepeopledo

nothavetheaccessibilitytofirearmsthatwehaveintheU.S.

3. Overdose

• Thereispotentiallyalargetimeframewheresomeonecanintervene/provide

medicalattention.

• Ourbodieshaveatremendousabilitytoovercomeevenlargelevelsoftoxicity.

• Thereisawindowofopportunityforpeopletoreconsidersuicide.

4. Firearms

• Littleopportunitytoreconsider.

• Thisaquickdecisionwithnoturningback.

• Thelethalityofthemeansisverysignificantwhenassessingrisk.

V. RiskFactorsforSuicideA. MentalIllness

1. Itisestimatedthat90%ofthosewhocommitsuicidehaveatreatablementalillness

atthetimeoftheirdeaths.

2. Mentalillnessisthemostreliableandconsistentriskfactorforsuicide.


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3. Mentalillnesseswithanincreasedriskforsuicide.

• Majordepression–Thisistreatablewithmedicationandcounseling.

• BipolarDisorder–Thisisalsotreatablebutcannotbecured.

B. SubstanceAbuse

C. PersonalityDisorders

1. Borderlinepersonalitydisorder

2. Antisocialpersonalitydisorder

3. Conductdisorderinyouth

4. Psychoticdisorders

5. Anxietydisorders

6. Post-traumaticstressdisorder

7. Thesedisordersareatanespeciallyhighriskforsuicidewhentheygoundiagnosed

anduntreated.

D. ChronicorTerminalMedicalConditions

1. Depressioncanfollowcertainmedicalillnesses.

• Cancer

• Pneumonia

2. Peoplewith terminalmedical conditionsmay believe that taking their own lives is

betterthanburdeningfamilymembersorsufferingthroughanextendedillness.


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3. Fearofpainanddeathcanmakepeoplesuicidal.

• Chronicmigraines

• Fibromyalgia

• Chronicjointpain

• Chronicbackandneckpain

E. Family History of Suicide Attempts or Completed Suicide and Personal History of

Attempts

1. Otherthanmentalillness,thisisthehighestriskfactorforsuicide.

2. Itisimportantformentalhealthprofessionalstoaskaboutfamilyhistoryofsuicide.

3. Researchhasshownsuicideriskcanbeinherited.

F. EnvironmentalFactors

1. Stressfullifeeventssuchasthedeathofacloselovedone

2. Financialloss

3. Legaltrouble

4. Chronicstressfulsituationssuchaslong-termunemployment

5. Seriousrelationshipconflictsuchasabreakupordivorce

6. Harassmentorbullying


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G. ContagionEffect

1. Exposuretoanotherperson’ssuicidecanmakeonemorevulnerabletobeingatrisk

forsuicide.

2. Only1%ofsuicidesareattributedtothecontagioneffect,butitissignificantenough

thatweneedtobeaware.

3. Thisexposurecanbedirectorindirect.

4. This is true with spouses, close friends, siblings, family members, and even

celebrities.

5. Donotromanticizeorsensationalizetheactofsuicide.

6. Teensaresignificantlymorevulnerabletothecontagioneffect.

H. AccesstoLethalMethodsatTimesofIncreasedRisk

1. Accesstohandgunsshouldbestrictlycontrolledamonghighrisksuicidepopulations,

such as those with serious mental illnesses that have been correlated with high

suiciderate.

2. 70-75%offamilieswhoareaskedtoremovefirearmsfromthehomechoosenotto

removethem.

3. Takeextrastepstoprotectindividualsvulnerabletosuicidefromaccesstofirearms.

VI. ProtectiveFactorsforSuicideA. ReceivingMentalHealthcare


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B. Positive Connections with Family, Friends, and Peers Through Social Institutions of

HealthyMarriagesandOurFaithCommunities

C. HelpingPeopleDevelopSkillsandAbilitiestoSolveProblems

VII. NeurobiologyofSuicide

A. PostmortemStudies

B. BrainSystemsinChargeofMood,ThinkingandStressResponse

VIII. SpiritualFactors

A. PowerofGod

B. FightingAgainstthePowersofDarkness

C. ConnectionThroughPrayer

D. PoweroftheHolySpirit


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TNSU102:

ChoosingtoDie:AModelofUnderstanding



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AbstractJenniferCisneyEllersreviewsDr.ThomasJoiner’smodelofunderstandinghowandwhysuicide

occurs.Thedesiretodiebecauseofaperceivedburdensomenessandalowlevelofbelongingor

socialconnectednessandtheabilitytotakeone’sownlifeleadapersontobelievesuicideisthe

bestsolution.Suicidalpeopletendtobelievetheyareaburdentotheirlovedones.Theirsense

of value and self-worth has been undermined. Satan is the author of this ultimate lie, but

caregiverscanintervenebyreassuringpeopleoftheirvalue,helpingthemfeelproductive,and

relaying the message that care and concern are not a burden. Suicidal people also have a

thwartedconnectedness—asensetheydonotbelong.Thisfeelingofisolationcanbehelpedby

treating depression, fostering and building social connection, enhancing family relationships,

buildingsocialandrelationalskills,anddialoguingaboutstruggles.Peoplehaveastrongdesire

for self-preservation,but thereare factors thatcontribute tosomeoneacquiring theability to

enact self-injury. It is important forcaregivers toprovidepreventative support,educationand

traininginthesesituations.

LearningObjectives

1. Participants will identify the factors that lead a person to believe suicide is the best

solution.

2. Participants will list steps in intervening when a person experiences perceived

burdensomenessandathwartedconnectedness.

3. Participants will explore situations that lead someone to acquire the ability to enact

lethalself-injury.


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I. Introduction

A. TheAmericanFoundationforSuicidePrevention(Webpage)

1. Quote: “Our effectiveness in preventing suicide ultimately depends on more fully

understandinghowandwhysuicideoccurs.”

2. Whatisgoingonintheheartsandmindsofthosethinkingaboutsuicide?

3. PreventionandInterventiondependsonmorefullyunderstandingpeople.

B. Dr.ThomasJoiner

1. Book:WhyPeopleDieBySuicide

2. Personallyimpactedbysuicidewhenhisfathercommittedsuicide.

3. TheInterpersonalPsychologicalTheoryofSuicidalBehavior

C. Dr.EdSchneidman

1. Definition of suicide: “Suicide is a conscious act of self-induced annihilation best

understood as a multidimensional malaise in a needful individual who defines an

issueforwhichsuicideisperceivedasthebestsolution.”

2. Wehavetomakeaconcentratedefforttounderstandwhatisgoingoninthemindof

asuicidalperson.


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II. WhatLeadsaPersontoBelieveSuicideistheBestSolution?

A. TheDesiretoDie

1. PerceivedBurdensomeness–“Iamaburdentosocietyandmylovedones.”

2. Lowlevelofbelongingorsocialconnectedness.

• Thwartedconnectedness

• Feelsociallyalienated

B. TheAbilitytoTakeTheirOwnLives

III. PerceivedBurdensomeness

A. Definition

1. Thesensethatoneisaburden

2. Thekeywordisperceived.

3. Loved ones see the suicidal person’s pain as the burden, not the person as the

burden.

B. WhyPerceivedBurdensomeness?

1. MentalIllness

• Depression

• Bipolardisorder

2. Chronicphysicalillness


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3. Chronicpainconditionsordisabilities

4. Terminalillness

5. Situationalissues

• Relationshipproblems

• Financialloss

• Jobloss

• Legalproblems

C. MotivationtoLive

1. Perceived burdensomeness undermines our sense of value and self-worth.

2. We want to sense we are bringing something important to the world.

3. Man’sSearchforMeaningbyVictorFrankl

4. Ifamanhasawhy,hecanwithstandanyhow.

D. Suicide–ASelfishAct?

1. Suicidalpeoplebelievetheyarecommittingaselflessact.

2. Theyfeeltheyaretakingawayaburdenforthosetheylove.

3. IammakingachoicethatwillultimatelybebestforeveryoneIlovebecauseIama

burden.


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E. SpiritualElements

1. Suicidalpeoplestrugglewithfalsebeliefsandliesaboutthemselves.

2. Satanbeginstoconvincesomeonethattheyareworthless.

3. Satan’sultimatelie–Theworldwouldbebetteroffwithoutyou.

F. Dr.Joiner'sStudy

1. Dr. Thomas Joiner and his team confirmed perceived burdensomeness is one of

thefactorsmostcloselyassociatedwithsuicidalbehavior.

2. The link between perceived burdensomeness and suicidality is just as strong as

thelinkbetweenhopelessnessandsuicidality.

G. HowDoWeIntervene?

1. Reassurepeopleoftheirvalue.

2. Peopleneedtofeelproductive.

3. Peopleneedtounderstandcareandconcernarenotaburden.

4. StoryofJenniferCisneyEllerscaringforhermother.

IV. ThwartedConnectednessA. Definition

1. Thesensethatonedoesnotbelong.


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2. Frombirth todeath,deepandmeaningful connections toothersare critical toour

mental,physical,andspiritualwell-being.

B. Connectedness

1. Aprimaryfactorinconnectednessisface-to-faceinteractionswithotherpeople.

2. Additionally,afeelingofbeingcaredaboutiscrucialtoconnectedness.

C. FailuretoThrive

1. Canhappenwithinfantsandseniors.

2. This phenomenon leads us to an observation of how important connection is in

relationships.

D. DepressionandIsolation

1. Depressedpeoplemakelesseyecontact.

2. Depressedpeopleengageinlesshead-noddingduringconversation.

E. TimesofNationalCrisis

1. Peopleoftenpulltogetherandtheirsenseofbelongingincreases.

2. AssassinationofJFK

3. Terroristattacksof9/11


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F. MMPI–PredictorsforDeathbySuicide

1. Self-blameScale

2. SocialIntroversionScale

G. HowDoWeIntervene?

1. Treatdepression.

2. Fosterandbuildsocialconnectionasprevention.

3. Enhancefamilyrelationships.

4. Helpsociallyisolatedindividualsbuildsocialandrelationalskills.

5. Bemoreopentodialogueaboutstrugglesandlifechallenges.

V. AbilitytoEnactLethalSelf-injuryA. Self-preservation

1. AllmammalsaredesignedbyGodtoprotectandsavetheirlives.

• Strongimmunesystems

• Ourbodieshaveanincredibleabilitytoheal.

2. Psychologicalmechanism

• Peopleareprogrammedforsurvival.

• Fightorflightresponse


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B. HowDoesOneAcquiretheAbilitytoEnactLethalSelf-injury?

1. Previousattemptsorprevioussuicidalbehaviors

2. Fantasyactingout–thinkingaboutandplanningsuicide

3. Engaginginnonlethalactsofself-injury

• Cutting

• Burning

• Canbeagatewaytolethalself-injury

4. Childhood physical and sexual abuse or other painful, repeated experiences in

childhood

5. Involvementinviolence

6. Anythingthathabituatessomeonetopainandinjury

7. Peoplewhoareexposedtothepainandinjuryofotherpeopleintheirprofessions

C. HowDoWeIntervene?

1. Considerallofthefactorsinsuicideassessments.

2. Preventative support for people who have the experiences thatmight lower their

resistance

3. Educationandtrainingwithgoodself-care


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D. VideoofDr.KevinEllers

1. Thereisahugemisunderstandingofmentalillness.

2. Satanicforcesareatworkduringsuicide.

3. Sometimes suicide is a choice, but sometimes the one committing suicide truly

believeshe/sheisdoingthebestthingfortheoneswhoareliving.


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TNSU103:

ATheologyofSuicide:BiblicalPrinciples

andaChristianResponse

FrankPage,Ph.D.


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AbstractSuicideisadevastatingissueinourworldtoday,yethasbeenanage-oldtragedyformankind.

One can look back at history to see examples of suicide. Scripture records seven suicides:

Abimelech, Samson, King Saul, Saul’s armor bearer, Ahithophel, Zimri, and Judas. Although

Scripturedoesnotgiveusanyspecificwordaboutsuicide,itdoesindicatethatGodisthegiver

of lifeandonlyHehastherighttotake itaway.Weneedtofollowthebiblicalprinciplesthat

Godhasagreatplanforourlives;thesolutiontodespairandhopelessnessisfaithinHim;and

thoughtroublecontinuesinlife,theLordwillneverleaveus.OurChristianresponsetosuicide

needs to be one of confronting bad theology and thinking; encouraging people against using

tritestatementsand,instead,urginggoodtheologyandpractices;andpracticingtheministryof

presence.Ultimately,wecantrusttheLordandknowHisloveispowerful.

LearningObjectives

1. ParticipantswillbeabletoexploresevensuicidesmentionedinScripture.

2. Participantswillidentifybiblicalprinciplessurroundingtheissueofsuicide.

3. ParticipantswilldefineaChristian’sresponsetosuicide.


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I. Introduction

A. ExamplefromMarkTwain’sTheAdventuresofTomSawyer

1. Tomandhisfriendsaregonefromhomeforalongtimepretendingtobepirateson

theriverbank.

2. ThetownspeoplebelieveTomandhisfriendsaredead.

3. Tomandhisfriendssneakintotownandattendtheirownfuneral.

4. Thestoryendshappilywiththeboysrevealingtheirwhereaboutsandeveryonebeing

thrilledtoseetheyarealive.

B. SuicideStatistics

1. In our country, suicide is one of the leading causes of death, particularly among

teenagers.

2. Moresoldiersarebeinglosttosuicidethancombat.

3. Suicidehasrisenamongyoungwomen.

C. HistoricalExamplesofSuicide

1. MasadainIsrael

2. MasssuicidesfromthewallsofGamlainGalilee

3. SuicidesoftheJapaneseduringWorldWarIItoevadecapturebytheAmericans


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4. MasssuicidesduringtheJonestowntragedies(JimJones)

5. Orientalculturesglorifyingsuicidesratherthansurrendering

6. SuicidebombersintheMiddleEast

II. SuicidesMentionedinScripture

A. Abimelech

1. Judges9:52-54

2. Abimelechcommittedsuicideinatimeofpersonalcrisis.

B. Samson

1. Judges16:25-30

2. Samsondiedforacausehebelievedin,butalsoforrevengeuponthePhilistines.

C. KingSaul

1. 1Samuel31:4

2. Whatcouldhavebeenagreatlifeofvictoryturnedintoaterribletimeofdefeatand

sadness.

D. Saul’sArmorBearer

1. 1Samuel31:5

2. Followedtheexampleofhisking


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3. Impulsivedecision

4. Apermanentsolutiontowhatcouldhavebeenatemporaryproblem

E. Ahithophel

1. 2Samuel17:23

2. Bitternessanddepressionwerefactorsinhisdecision.

F. Zimri

1. 1Kings16:15-20

2. Bitternessbecameastrongholdinhislife.

G. Judas

1. Matthew27:3-5

2. Depression,greed,personalfailure,andregretledtoJudas’suicide.

III. ATheologyofLifeA. WhatdoestheBibleSay?

1. TheBibledoesnotgiveanyspecificwordaboutsuicide.

2. Scripturedoes indicateGod is the giver of life andonlyHehas the right to take it

away.


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B. Job1:21

“Hesaid,‘NakedIcamefrommymother’swomb,andnakedIshallreturnthere.The

LordgaveandtheLordhastakenaway.BlessedbethenameoftheLord.’”

C. 1Corinthians6:19-20

“OrdoyounotknowthatyourbodyisatempleoftheHolySpiritwhoisinyou,whom

youhavefromGod,andthatyouarenotyourown?Foryouhavebeenboughtwitha

price:thereforeglorifyGodinyourbody.”

IV. BiblicalPrinciplesA. GodHasaGreatPlanforyourLife

1. God’spurposeshouldtakeprecedentoverouragendas.

2. Jeremiah29:11–“ForIknowtheplansthatIhaveforyou,declarestheLord,plans

forwelfareandnotforcalamitytogiveyouafutureandahope.”

B. God’sPlanisforLife,notDeath

1. Romans6:23–“Forthewagesofsinisdeath,butthefreegiftofGodiseternallifein

ChristJesusourLord.”

2. John10:10–“Thethiefcomesonlytostealandkillanddestroy;Icamethattheymay

havelife,andhaveitabundantly.”

C. TheSolutiontoDespairandHopelessnessisNotSuicide,butFaithinGod

1. Psalm33:20-22–“OursoulwaitsfortheLord;Heisourhelpandourshield.Forour

heartrejoices inHim,becausewetrust inHisholyname.Letyour lovingkindness,O

Lord,beuponus,AccordingaswehavehopedinYou.”


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2. ScripturepointstoourultimatefaithinGodasoursalvation.

D. ThoughTroubleContinuesinthisLife,OurLordWillNeverLeaveUs

1. John16:22–“Thereforeyou toohavegriefnow;but Iwill seeyouagain,andyour

heartwillrejoice,andnoonewilltakeyourjoyawayfromyou.”

2. Matthew11:28–“CometoMe,allwhoarewearyandheavy-laden,and Iwillgive

yourest.”

V. ChristianResponseA. ConfrontBadTheology

1. Thereisagreatdealofmisunderstandingwhenitcomestotheissueofsuicide.

2. Severalfaithgroupsteachthatonewhocommitssuicidecannotgetintoheaven.

3. Mostpeoplewhocommitsuicidehavereachedapointintheirlifewheretheyhave

losttouchwithreality.

4. TheBibledoesnotteachthatthosewhocommitsuicidegotohell(Romans5:8).

5. Scripturedoesteachaccountability.

• Ezekiel18

• Leviticus4:22

6. Peoplewho commit suicide go toheaven if theyhave a personal relationshipwith

Christ.

7. Scripturedoesteachtherealityofdemonicoppressionandpossession.

8. Satancanusestrongholdsinamentallyillperson’slifetomakeasituationworse.


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B. ConfrontBadThinking

1. Whilecharacter flawsandbadparentingcancausedifficulty inevery life, struggles

are also found among people of tremendous character and in homes where

parentinghasbeendevoted,loving,andcaring.

2. Mentalillness,emotionalstruggles,anddepressionarenotmerelycharacterissues.

C. EncouragePeopleAgainstUsingTritePlatitudes

1. Donotsay,“Theyareinabetterplacenow.”

2. Donotsay,“Snapoutofit.”

D. EncourageGoodTheologyandGoodPractices

1. WeneedtoputourhopeinGod,andwecandothisthroughprayer.

2. Psalm46:1-3

3. Hebrews13:6

4. Isaiah26:3

E. PracticetheMinistryofPresence

1. StoryofFrankPage’sdaughter’ssuicide

2. ThepresenceofHisWord

3. ThepresenceoftheLord


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4. ThepresenceofGod’speople

5. There is a need for immediate action when there has been a suicide or suicide

attempt,butthatministryneedstobeongoing.

6. Do not let an awkward situation dissuade you from active Christian ministry to

hurtingpeople.

7. Behonestandbethereforthehurtingpeople.

8. Letthehurtingpersonexpresshis/herangerandconfusion.

9. Beabuilderofencouragement,notatransmitterofhurt.

VI. ConclusionA. WeCanTrusttheLord

B. God’sLoveisPowerful

C. 2Corinthians1:3-5


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TNSU104:

MentalIllnessandtheEpidemiologyofSuicide

LindaMintle,Ph.D.


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AbstractSuicideisacomplexissuewithmultiplecontributinggeneticandenvironmentalfactors.Mental

illnessisakeyfactorinidentifyingsomeoneashavingapredispositionforsuicide.Therearerisk

factors surrounding suicide, such as gender, age, race/ethnicity, marital status, geography,

professions/occupations, economics, timeof year, illness, andothers.Methods are discussed,

along with common triggers and general warning signs. Protective factors and prevention

strategiesareimportantindealingwithpeopleinsuicidalcrisis.

LearningObjectives

1. Participantswillexplorevariousmythssurroundingsuicide.

2. Participants will define risk factors for suicide, such as gender, age, race/ethnicity,

marital status, geography, professions/occupations, economics, time of year, and

medicalconditions/illness.

3. Participantswillidentifycommonmethodsandtriggersofsuicide,generalwarningsigns,

protectivefactors,andpreventivestrategies.


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I. Introduction

A. StoryAboutProminentLawyer’sSuicide

1. SuicideisatragedyandJesussaysitisalossnotagain.

2. Proverbs23:18

“Surelythereisafuture,andyourhopewillnotbecutoff.”

B. Definitions

1. Epidemiology is the study and control of disease or injury patterns in human

populations.

2. Suicideisthepurposefulacttoendone’slife.

3. Suicideattempt is anactof self-harm includingwhatwaspreviously referred toas

“para-suicidalbehavior”-theattempttohurtoneselfwithoutkilling.

• Thisisnowcallednon-suicidalself-injury.

C. CommonMythsAssociatedwithSuicide

1. Peoplewhotalkaboutsuicidewon’treallydoit.

2. Anyonewhotriestokillhimself/herselfmustbecrazy.

3. Ifapersonisdeterminedtokillhimself/herself,nothingisgoingtostophim/her.

4. Peoplewhocommitsuicidearepeoplewhoareunwillingtoseekhelp.

5. Talkingaboutsuicidemaygivesomeonethe idea tocommitsuicide,andthenthey

couldactonit.


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D. KeyFacts

1. Globally,over800,000peopledieduetosuicideeveryyear.AccordingtotheWorld

HealthOrganization,suicideisthefifthleadingcauseofdeath(2012).

2. Suicideisthe10thhighestcauseofdeathforallages,sexes,andethnicities.

3. In theU.S.alone,40,600suicideswere reported.Thisequates toonesuicideevery

12.9minutes.

4. Foreverysuicide,therearemanymorepeoplewhoattemptsuicideeveryyear.

5. A prior suicide attempt is the single most important risk factor for suicide in the

generalpopulation.

II. TheRoleofGenetics,Epigenetics,andEnvironment

A. FamilyandTwinStudies

1. There is a higher rate of suicidal behavior in relatives of suicide victims and

attempterscomparedtorelativesofnon-suicidalcontrols.

2. Mostsuicideattempters/completershaveunderlyingneuropsychiatricdiagnoses,but

familytransmissionmaybeindependentofthosepsychiatricdisorders.

B. AdoptionStudies

1. Showthatsuicideinvolvestheinheritedtraitoftemperamentofimpulsivityandthe

regulationofimpulsivityisinvolved.

2. Suicidecanhappenimpulsivelyinmomentsofcrisis,unrelatedtopsychiatricillness.


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C. TheFieldofEpigenetics

1. Looksatthepossibilitythatpartofthestronggeneticcomponent isdeterminedby

DNAmodification.

2. Epigeneticsignaturesareheritable,butcanbemodifiedbytheenvironment.

3. Thisisagrowingfield.

4. A number of recent studies have shown epigenetic alterations associated with

suicidalbehavior.

D. EnvironmentInteractingwithGenes

1. Apersonalhistoryofchildhoodabusehasbeenrepeatedlyimplicatedasariskfactor

forsuicidalbehavior.

2. Someepidemiologicalstudieshaveestimatedthatsexualabusemayexplain20%of

theriskvarianceinsuicide.

III. TheRoleofMentalIllnessinSuicide

A. PsychiatricDiagnoses

1. Majordepressivedisorder

2. Conductdisorder

3. Anxietydisorder

4. Substanceuse

5. PTSD


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B. Statistics

1. Ninetypercentofpeoplewhocommitsuicidehaveoneormorediagnosablemental

illnesses.

2. Sixtypercentofallsuicidesarecommittedbypeoplewithmooddisorders.

3. Approximately 30% of suicides are committed by people who have psychiatric

disordersotherthanmooddisorders.

4. Thirty percent of all clinically depressed individuals attempt suicide. About half

aresuccessful.

5. Persons discharged from mental hospitals are 34 times more likely to commit

suicidethanthegeneralpopulation.

6. Menwithasubstanceusedisorderareapproximately2.3timesmorelikelytodieby

suicidethanthosewhoarenotsubstanceabusers.Amongwomen,asubstanceuse

disorderincreasestheriskofsuicideby6.5times.Morethanone-fourthofsuicides

arealcoholrelated.

7. Bipolarwith comorbid substance use has almost a 40% rate of lifetime attempted

suicidecomparedtothosewithasubstanceuseonly.

8. The majority of suicidal behavior occurs in depressed patients, but the role of

antidepressantsiscontroversial.

IV. WhoisatRisk?

A. Gender

1. Menarefourtimesmorelikelytocommitsuicidethanwomen.


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2. Womenattemptsuicidethreetimesmoreoftenthanmen.

B. Age(WorldHealthOrganization–2012)

1. Generally,suicideratesincreasewithage.

2. Thehighestsuicideratewasamongpeople45-59yearsold.

3. Thesecondhighestrateoccurredinthose75andolder.

• Untreateddepression

• Physicalcauses

• Medication

• Healthcaresystem

4. Suicideisthesecondleadingcauseofdeathamong15-19yearolds.

C. Race/Ethnicity

1. Whitemalesaccountfor65%ofallsuicides.

2. ThesecondhighestrateisamongAmericanIndiansandAlaskanatives.

3. Much lower and similar rates were found among Asians and Pacific Islanders,

Hispanics,andblacks.

D. MaritalStatus

1. Marriage is associated with lower rates of suicide (heterosexual data only).

2. Divorcedpeoplearethreetimesmorelikelytocommitsuicidethanpeoplewhoare

married.Thisisthenumberonefactorinurbancenters.


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3. Divorcedandwidowedmenaremore likely thandivorcedandwidowedwomento

commitsuicide.

4. Livingaloneandbeingsingleincreasetheriskofsuicide.

5. Beingaparentdecreasestheriskofsuicide,especiallyformothers.

E. Geography

1. Mountainstateshavethehighestsuicidecompletionrates.

2. Peoplelivinginruralareasareathigherriskforsuicidethanthosewholiveinurban

areas.

3. ThelowestrateswereinNewJersey,NewYork,RhodeIsland,andMassachusetts.

F. ProfessionsandOccupations

1. Physicians

2. Dentists

3. Financeworkers

4. Lawyers

5. Policeofficers

6. Militaryveterans


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G. Economics

1. Extremesinwealthorpovertyareassociatedwithhighersuiciderates.

2. Timesofeconomicdepressionshavebeencorrelatedtoincreasedsuiciderates.

3. Unemployment or being in debt increases an individual’s feeling of hopelessness

makinghim/hermoresusceptibletosuicide.

H. TimeofYear

1. Despitepopularbeliefs,suicideratesdonotincreaseduringthewinterholidaysoron

an individual’s birthday. December is the lowest month related to completed

suicides.

2. Mostsuicidesoccurinthespring.

3. Statistically,therearemoresuicidesonMonday.

4. Norelationshipexistsbetweensuicidesandthephaseofthemoon.

I. MedicalandIllness

1. Terminallyill

2. Serious/chronicillnesses

3. Chronicpain

J. OtherFactors

1. Previousattempt(#1)


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2. Feelingsofhopelessness

3. ProtestantsmorethanCatholics

4. Culturalandreligiousbeliefsinwhichsuicideisglorified

5. Localepidemicsofsuicide

6. Isolation

7. Barrierstoaccessingmentalhealth

8. Loss

9. Easyaccesstolethalmethods

10. Unwillingnesstoseekhelpduetothestigmainvolved

11. Peoplewhohavelostafamilymemberorfriendtosuicide

12. Copycat

13. Sexualorientation(LGBT)

14. Peopleinvolvedinorarrestedforcommittingcrimes

15. Victimsofdomesticviolence


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V. MethodsofSuicide

A. Firearms

1. #1method

2. Accountsforover50%ofallsuicidedeaths

B. Suffocation

1. Includeshanging

2. Almost25%rate

C. Poisoning

1. Overdosing

2. 16.6%rate

VI. CommonTriggers

A. Loss

1. Romanticrelationship

2. JoborEducationalOpportunity

B. Grief

C. Changes

1. Healthofalovedone

2. Socialoreconomicstatus


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D. LegalProblems

VII. GeneralWarningSigns

A. TalkingAboutSuicide

B. SeekingLethalMeans

C. PreoccupationwithDeath

D. NoHopefortheFuture

E. GettingAffairsinOrder

F. SayingGoodbye

G. WithdrawingfromOtherPeople

H. Self-destructiveBehavior

I. SuddenSenseofCalm

J. Caseexample


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VIII. ProtectiveFactors

A. EffectiveClinicalCare

B. EasyAccesstoClinicalInterventions,SupportandHelp

C. FamilyandCommunityConnectedness

D. SupportfromOngoingMedicalandMentalHealthcareRelationships

E. Skills in Problem Solving, Conflict Resolution, and Nonviolent Ways of Handling

Disputes

F. CulturalandReligiousBeliefsthatDiscourageSuicideandSupportSelf-preservation

IX. Screening

A. Definitions

1. Suicide screening refers to a procedure in which a standardized instrument or

protocolisusedtoidentifyindividualswhomaybeatriskforsuicide.

2. Suicide assessment usually refers to a more comprehensive evaluation done by a

clinician to confirm suspected suicide risk, estimate the immediate danger to the

patient,anddecideonacourseofaction.


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3. DetectionTools

• BeckDepressionInventory

• The19-itemScaleforSuicidalIdeation

• TheColumbia-SuicideSeverityRatingScale(C-SSRS)

X. PreventionStrategiesA. RecognizeEarlyWarningSignsandIntervene

B. ReduceAccesstoLethalMethods

C. Follow-upSupport

D. BetterTrainingforPrimaryCareWorkers

E. Community-basedInterventions

F. SeniorPeer-counselingPrograms

G. ImprovementsinMentalHealthServicesThroughSuicidePreventionCenters

H. NationalHotline–(1-800-273-TALK)


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TNSU105:

TheChangingTideofTeenSuicide:Insights

intoaScreen-SaturatedGeneration

JoshuaStraub,Ph.D.


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AbstractAreyouastudentofyourteenager?Intoday’sculture,theinfluxofmediaandtechnologyhas

completely changed the teenage world. Suicide is rampant, and parents, counselors, and

caregivers need to be equippedwith knowledge and awareness in order to stem the tide of

suicide.Mainstreammediaisnormalizingsuicide,andteenagersneedhelpnowmorethanever.

Inthispresentation,Dr.JoshuaStraubwilldiscusstheimportanceoflisteningtoteenagersand

providepracticalstepsforparentsandcounselors.

LearningObjectives

1. Participantswillexploretheroleoftechnologyandmediainteenagesuicide.

2. Participants will uncover practical first steps to equipping parents, counselors, and

caregiversagainsttheriseofsuicide.

3. Participantswilldiscussthecoreneedsofteenagersandhowcaregiverscanhelpprovide

fortheseneeds.


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I. TeenSuicideinaChangingGeneration

A. BecomingStudentsofToday’sTeenagers

1. TVShows:13ReasonsWhy

• Suicideisnotsomebodyelse’sfault

• Adultsandmentalhealthprofessionalscanhelp

2. InternetGames

• BlueWhaleChallenge

3. SocialMediaBullying

• Kik

• Ask.fm

• Snapchat

• PornographyfromviraltextsorWhatsApp

B. ListenToTeenagers

1. Ameltingchocolatebar

2. Thescopeoftheproblem

C. EducateandSupportParents

1. Mainstreammediaisnormalizingsuicide,butinreality,suicideisamentalillness

2. Theillnessonlywinstemporarily

3. Emotionallysafehomesarecritical

4. Parentsarethefirstlineofdefense


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5. SettingLimits

• Snapchatlocationservices

• Passwordsharing

D. EducatingStudents

1. Threecoreneedsofstudents

• Identity

• Belonging

• Purpose

2. Empoweringstudents

E. PartnerwithStudentAdvocatesinYourLocalCommunity

1. iContactvs.eyecontact

2. Thereisnothingmorepowerfulthansomeonewhocaresenoughtositwithand

listentoastrugglingteenager.

3. Connectedness

II. StoppingtheTideofTeenSuicide

A. IndividualSolutions

1. Askslidingscalequestions

2. Adolescenttimeframesarenowandnotnow


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“Thereforewedonotloseheart.Thoughoutwardlywearewastingaway,yetinwardly

wearebeingreneweddaybyday.Forourlightandmomentarytroublesareachievingfor

usaneternalglorythatfaroutweighsthemall.Sowefixoureyesnotonwhatisseen,

butonwhatisunseen,sincewhatisseenistemporary,butwhatisunseeniseternal.”

– 2Corinthians4:16-18

3. Resourcefulness

B. FiveConversationsTeensLongforfromParents

1. Tellmeaboutsex

2. HowtofindGodformyself

3. Howtothinkthroughanxietyanddepression

4. Howtomakeresponsibledecisionsinabiblicalway

5. Howtoviewmyselfrightly

C. KeyComponents

1. Listening

2. Empathy

3. Psychoeducation

4. Community


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TNSU106:

TeenSuicideandSelf-injury:Assessment,

Diagnosis,andTreatmentStrategies

AmyFeigel,M.A.,and

MollyCatherineGoodson,M.A.,J.D.


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AbstractSuicidehasbecomethesecondleadingcauseofdeathamongtoday’steens-itisclearwemust

knowhowtoaddressandtreatthisepidemic. Studieshaveshownthat fouroutof fiveteens

will give some kind of warning sign prior to a suicide attempt. Do you know thesewarning

signs?Doyouknowhowyouwouldhelpayoungteenstrugglingwithsuicidalideationorself-

injuriousbehavior? Doyouhaveaplanfortreatment? Ifyouanswered"No"toanyofthese

questions, this video lesson is for you. Latest statistics, prevalence, etiology, assessment,

ethical/legalconcernsandsuccessfultreatmentstrategieswillbecovered.

LearningObjectives

1. Participantswillunderstand thecurrent trendsandcultureof suicideand self-injury in

today'syouth.

2. Participants will be able to utilize successful treatment strategies covered in this

workshoptoassistteensintheircommunity.

3. Participantswill know how to recognizewarning signs present in teens contemplating

suicide.


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I. TeenSuicideRisk

A. GuidingPrinciplesforCounselors

1. Identifythelocusoftheclient’sunbearablepain(EdwinShneidman,1972)

2. Inthecontextofacaringrelationshipweassisttheclientindiscoveringtheirhurtand

helpthemmanagelife’schallenges.(Shneidman,1968)

3. Allbehaviorsarepurposeful

4. Currentresearchinsuicideprovidessubjectivedata

5. Seekto“understand”yourteenclientversus“treat”yourteenclient

6. Becomeastudentofyourteenager

B. StagesofPsychosocialDevelopment

1. Ages13-19

2. Identityvs.roleconfusion

3. Riskfactorsduringthistime:

• Decreasedhopeaboutfuture

• Parentalexpectations

• Insecurity

• Lackofopportunitytofindpassion


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C. Statistics

1. ThePediatricAcademicSocietiesMeetinginMay2017,foundthatthenumberof

childrenandteensadmittedtochildren'shospitalsforthoughtsofsuicideorself-

harmhavemorethandoubledduringthelastdecade.

2. In2014,HamiltonCounty(Cincinnatiarea)sawfoursuicidesofpeople18andunder.

In2015,therewerefive.In2016,therewere13.

3. Theannualnumberofteenyouthsuicideseachyearfromages10-24isabout4,600.

4. Theaveragenumberofteensuicidesperdayis12.

5. Theaveragenumberofsuicideattemptsperyearis575,000.

6. 20%ofhighschoolstudentssurveyedsaytheyhaveseriouslyconsideredsuicide.

D. 10LeadingCausesofDeathbyAgeGroup10-24

1. Unintentionalinjury

2. Suicide

3. Homicide

4. MalignantNeoplasms

5. HeartDisease

6. CongenitalAnomalies


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7. Influenza&Pneumonia

8. DiabetesMellitus

9. ChronicLowRespiratoryDisease

10. Cerebrovascular

E. TheMostCommonMethodsofSuicide

1. Suffocation

2. Firearms

3. Poisoning

II. UnderstandingSuicide

A. 10MythsofSuicide

1. Suicideshappenwithoutwarning

2. Suicideissolelygenetic

3. Onlycertaintypesofpeoplediebysuicide

4. Suicideisanactofaggression,anger,orrevenge

5. Talkingtoteensaboutsuicidemakesthemlikelytokillthemselves


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6. Peoplewhotalkaboutsuicidearenotseriousaboutkillingthemselves

7. Suicidalthoughtsandbehaviorsarewaystogetattention

8. Suicidalteensoverreacttolifeevents

9. Teensareatlessriskforsuicideassoonastheystarttofeelbetter

10. Suicidecannotbeprevented

B. Definitions

1. Non-SuicidalMorbidIdeation:Thoughtsof,“ItwouldbebetterifIjustwenttosleep

andneverwokeup.”

2. SuicidalIdeation:Thoughtsinwhichself-inflicteddeathisthedesiredoutcome.“I

wanttokillmyselfbutIhaven’tformulatedaplan.”

3. SuicidalBehavior:

• Non-suicidalself-injury

• Suicideattempt,potentiallyinjuriousbehaviorwithanon-fataloutcomefor

whichthereisevidenceofintenttodie

• Interruptedsuicideattempt

• Abortedsuicideattempt

• Suicidedeath


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C. TheoriesofSuicide

1. Shneidman’sTheoryoftheSuicidalMind

• Unmetandthwartedneeds

• Intolerablepsychologicalpain

2. ThomasJoiner’sInterpersonalTheoryofSuicide

• Perceivedburdensomeness

• Failedbelongingness

• Acquiredcapability

3. JosephRichman’sFamilySystemsTheoryofSuicide

• Roleconflict

• Overlypermeableboundaries

• Dysfunctionalalliances

• Rigidity

• Inabilitytochange

• Poorcommunicationskills

D. MentalIllness

1. Depressivedisorders

2. Anxietydisorders

3. Traumaandstressdisorders


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III. RiskAssessment

A. AssessmentTips

1. Thetherapeuticallianceisthemostimportantfactorinasuccessfulassessmentof

suicidalideationandintent.

2. Understandandactivelylisten

3. Payattentiontobodylanguageandhesitancyofanswers

4. Assessmentdoesnotbeginwithdirectinquiryaboutsuicidalthoughtsorbehaviors

5. ISPATHWARM?

• Ideation

• Substanceabuse

• Purposelessness

• Anxiety

• Trapped

• Hopelessness

• Withdrawal

• Anger

• Recklessness

• MoodChanges

6. Thechallengeoftheadolescent—JackKlott,Suicidologist

• Emergingmentaldisordersandself-medicating

• Isolationandrejection

• Victimofbullying

• Acculturationissues

• Academicperformanceanxiety


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• Familydiscord

• Impulsivityandavailabilityoffirearms

• Survivorofsuicide

B. HowDoWeHelp?

1. DialecticalBehaviorTherapy

• Balancingproblem-solvingandvalidation;synthesizeopposingtensionsbetween

acceptanceandchange,goodandbad,positiveandnegative;

• Decreasebehaviorsthatarelife-threateningandincreasebehavioralskills,(2)

Decreaseposttraumaticstress,(3)Increaseself-respectandachievingindividual

goals,(4)Resolveasenseofincompletenessfindingfreedomandjoy.

2. CognitiveBehavioralTherapy

• Perceptionofyourenvironmentsignificantlyshapessubsequentaffect,andaffect

isinturnassociatedwiththeirbehavioralresponses.

• Keycomponents:emotionregulation,cognitiverestructuring,enhancing

problem-solvingskills,improvinginterpersonaleffectiveness

• Solicitingsocialsupportfromothers;commitmenttotreatmentstatements;

relaxation;crisiscards;journaling;art;moodgraphing;hopekits

3. Attachment-basedFamilyTherapy

• ABFTaimstorepairrupturesintheattachmentrelationshipandestablishor

resuscitatethesecurebasethatissoimportantforadolescentdevelopment

• Accesslongingforgreaterclosenessandrebuildingtrust.

• Buildanalliancewithadolescent.

• Buildanalliancewithparent.

• Reattaching–thefamilysession.

• Promotecompetency—pursuingprosocialactivitiesoutsideofthehome.


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C. TheUltimateGoalsforTreatment

1. Findthesourceofthepain

2. Findanewsolution

3. Instillaneternalsenseofhopeandbelonging

D. TheTwoQuestions

1. Wheredoyouhurt?

2. HowcanIhelpyou?

IV. SocialMedia,Sexting,andCyberbullying

A. Statistics

1. DigitalTechnologyOwnership

• 88%ofAmericanteenagers(ages13-17)haveorhaveaccesstoamobilephone

ofsomekind.73%ofthosehavesmartphones

• 87%ofAmericanteenagers(ages13-17)haveorhaveaccesstoadesktopor

laptopcomputer

• 58%ofteenshaveorhaveaccesstoatabletcomputer

• 81%ofteens(ages13-17)haveorhaveaccesstoagameconsole

2. TeenagersandtheInternet

• 24%ofteenagersgoonlinealmostconstantly

• 92%ofteenagersreportgoingonlinedaily

• 56%ofteenagersgoonlineseveraltimesaday

• 12%ofteenagersreportgoingonlineonceaday


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3. TeenagersandTexting

• 91%ofteencellphoneownersusetextmessagingdirectlythroughtheirphone,

anapp,orawebsite

• 33%ofteenswithcellphonesusemessagingapps

4. TeensandSocialMedia

• 89%ofteenagersreportthattheyuseatleast1socialmediasite

• 71%ofteenagersusetwoormoresocialmediasites

• 71%useFacebook,52%useInstagram,41%useSnapchat,33%useTwitter

B. Sexting

1. Sexting:Theactofsendingorreceivingsexuallyexplicitmessagesandphotosviacell

phoneorotherelectronicdevice.

2. Sextingforteenagersisillegalandisconsideredchildpornography.

3. Statistics

• 1in5girlsand1in10youngergirlshaveelectronicallysentorpostednudeor

semi-nudephotosofthemselves

• 37%ofteenagershavesentorpostedsexuallysuggestivetexts,emails,orinstant

messagestootherteenagers

• 51%ofgirlssaythatguyspressuredthemtosendsexymessagesorimages

• 18%ofboyssaythatgirlspressuredthemtosendsexymessagesorimages

• 69%ofteenshavesentsexualimagesormessagestoaboyfriendorgirlfriend

• 39%ofteenshavesentsexualimagesormessagestosomeonetheyhavedated

• 30%ofteenshavesentsexualimagesormessagestosomeonetheywanttodate

• 11%ofteenshavesentsexualimagesormessagestosomeonetheydidnoteven

know.


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C. Cyberbullying

1. Statistics

• 34%ofstudentsexperiencecyberbullyingintheirlifetime,with17%sayingthatit

happenedinthelast30days

• 64%ofthestudentswhoexperiencecyberbullyingsaythatitreallyaffectstheir

abilitytolearnandfeelsafeatschool

• 12%ofstudentsadmittedcyberbullyingothersintheirlifetime

2. Commonlyreportedbehaviorsofcyberbullyinginclude:

• 60%-spreadingrumorsonline

• 58%-postingmeancommentsonline

• 54%-threateningtohurtsomeone

• 83%ofstudentswhohavebeencyberbulliedwithinthelast30dayshavealso

beenbulliedatschool

• 69%ofstudentswhoadmittedtobullyingothersinschoolalsobullyonline

3. Jessica’sstory

4. Audrey’sstory

D. WhatCanParentsDo?

1. Beopenandhonestwithteenagersaboutthedangersofteensexting

2. Understandthatyourteenagerisstillyounganddoesnotfullyunderstandthe

ramificationofdecisions

3. Setacurfewforyourteenager’scellphone

4. Knowwhatappsareonyourteenager’sphonesandhowtheywork


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5. Beawareofwhatyourteenagersaretextingabout

6. Knowhowsocialmediaappswork

7. Knowwhatyourteenagersarelookingatonline

8. Ifyourteenagerisinvolvedinpornography,getthemprofessionalhelp

9. Ifyourteenagerisbeingbulliedonline,provideasafespaceforthemandaccessto

appropriateresources

10. Loveyourteenager

“ItisGod’swillthatyoushouldbesanctified:thatyoushouldavoidsexualimmorality;thateach

ofyoushouldlearntocontrolyourownbodyinawaythatisholyandhonorable…ForGoddid

notcallustobeimpure,buttoliveaholylife.”

—1Thessalonians4:3-4,7

“Doyounotknowthatinaracealltherunnersrun,butonlyonegetstheprize?Runinsucha

wayastogettheprize.Everyonewhocompetesinthegamesgoesintostricttraining.Theydoit

togetacrownthatwillnotlast,butwedoittogetacrownthatwilllastforever.ThereforeIdo

notrunlikesomeonerunningaimlessly.”

—1Corinthians9:24-26a

“Therefore,sincewearesurroundedbysuchagreatcloudofwitnesses,letusthrowoff

everythingthathindersandthesinthatsoeasilyentangles.Andletusrunwithperseverancethe

racemarkedoutforus.”

—Hebrews12:1


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Resources

• AmericanFoundationforSuicidePrevention(AFSP)—www.afsp.org

• NationalSuicidePreventionLifeline—www.suicidepreventionlifeline.org

• SocietyforthePreventionofTeenSuicide—www.sptsusa.org

• AmericanAssociationofSuicidology(AAS)—www.suicidology.org

• HeartLightMinistries–parentingtodaysteens.org(MarkGregston)

References

Lenhart,A.(2015).“Teens,socialmedia&technologyoverview2015.”PewResearchCenter.Retrievedfrom

http://www.pewinternet.org/2015/04/09/teens-social-media-technology-2015/

FloridaAtlanticUniversity.(2017).“Nationwideteenbullyingandcyberbullyingstudyrevealssignificantissues

impactingyouth.”Retrievedfromhttp://www.prnewswire.com/news-releases/nationwide-teen-bullying-

and-cyberbullying-study-reveals-significant-issues-impacting-youth-300410161.html

Judge,A.M.,(2012).“Sexting”amongU.S.adolescents:Psychologicalandlegalperspectives,HarvardReviewof

Psychiatry,20(2),86-96.

Comartin,E.,Kernsmith,R.,&Kernsmith,P,(2013).Sextingandsexoffenderregistration:Doage,gender,and

sexualorientationmatter?,DeviantBehavior,34,38-52.

Mitchell,K.J.,Finklehor,D.,Jones,L.M.,&Wolak,J.(2012).Prevalenceandcharacteristicsofyouthsexting:A

nationalstudy,Pediatrics,129(1),13-20.

Rosin.,H.(2014).Whykidssextandwhattodoaboutit.TheAtlantic,November2014,66-77.

Jolicoeur,M.,&Zedlewski,E.,(2010).Muchadoaboutsexting.NationalInstituteofJustice(June2010),Retrieved

fromhttps://www.ncjrs.gov/pdffiles1/nij/230795.pdf.

Madden,M.,Lenhart,A.,Duggan,M.,Cortesi,S.,&Gasser,U.(March13,2013).TeensandTechnology2013.

Retrievedfromhttp://www.pewinternet.org/Reports/2013/Teens-and-Tech.aspx.

Hindjua,S.,&Patchin,J.W.,(September2014).Statesextinglaws:Abriefreviewofstatesextinglawsandpolicies,

CyberbullingResearchCenter.Retrievedfromhttp://www.cyberbullying.us/state-sexting-laws.

https://www.ncjrs.gov/pdffiles1/nij/230795.pdf

https://www.ncjrs.gov/pdffiles1/nij/230795.pdf

http://www.pewinternet.org/Reports/2013/Teens-and-Tech.aspx

http://www.pewinternet.org/Reports/2013/Teens-and-Tech.aspx

http://www.cyberbullying.us/state-sexting-laws

http://www.cyberbullying.us/state-sexting-laws


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TNSU107:

HelpingTeensinCrisis

JoshuaStraub,Ph.D.


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AbstractThe teen years are some of the most challenging in many ways. Teenagers must face new

pressures,changingbodies,andadevelopingsenseofidentity.Counselorsandcaregiversneed

to be aware of the crises that teenagers face during these formative years, and must be

equipped with knowledge and tools to help teenagers through their individual crises. In this

presentation,Dr.JoshuaStraubpresentsanoverviewoftheproblemthroughcurrentstatistics

andresearch,thenprovidesastep-by-stepmethodforeffectivelyhelpingteenagers.

LearningObjectives

1. Participants will identify the scope of the issues and problems that teens today

experience.

2. Participantswilldiscoverthesevenstepsofhelpingteenagersthroughcrises.

3. Participantswillexploreabiblicalperspectiveonteenagersandsuffering.


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I. UnderstandingtheStatistics

A. SelfEsteem

1. 85%ofteenswanttoimprovesomethingaboutthemselvesphysically.Thetoptwo

arelosingweightandtoningup.

2. 63%ofteengirlsfeelinsecurewearingtheirswimsuitonthebeach.

3. 27%believetheylook“hot”intheirswimsuit.

4. 75%ofgirlshavewishedtheycouldsurgicallychangesomethingabouttheirbodies.

5. 20yearsago,modelsweighed8%lessthantheaveragewoman.Today,models

weigh23%lessthantheaveragewoman.

6. 81%of10yearoldsthinkthey’retoofat.

7. 70%ofgirlsbelievetheydonotmeasureup.

8. 62%ofgirlsfeltinsecureorunsureofthemselves.

9. 57%ofgirlshadamomwhocriticizesherownlooks.

10. 75%ofgirlsreportedengaginginnegativeactivitiessuchasdisorderedeating,

cutting,bullying,and/ordrinking,andfeelingbadforthemselves.

11. 67%ofgirlsages13-17turntotheirmotherasaresourcewhentheyfeelbadlyabout

themselves,comparedto91%ages8-12.


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12. Girlswithlowself-esteemarelesslikelytoreceivepraisefromeitherparentand

morelikelytoreceivecriticism.

13. Thetopwishofallteenagegirlswasthattheirparentswouldcommunicatewith

them.

B. TheHookupCulture

1. 82%ofnon-Christianteensbelieveitisoktocohabitatebeforemarriage.

2. 64%ofteenshavehookedupwithsomeonetheyconsiderafriend.

3. Nearly50%havehadsexualintercourse.

4. 33%ofteenagershavehadsexualintercourseinthepast3months.

C. TeenSuicide

1. Teensuicideisamongthetopleadingcausesofdeathamongteenagers.

2. ThreemillionstudentsannuallywilldevelopanSTD.

3. Studentsspendabout5.5billiondollarsonalcoholalone.

4. TheU.S.ranksamongthehighestintheworldforstudentswhodonotfeelhappy

withtheirlives.

5. 1in4girlsintheU.S.and1in5boysdonotfeelhappy.1in5girlsadmittofeeling

lonely.


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D. AdditionalIssues

1. 90%of8-16yearoldshaveviewedpornonline.

2. 70%ofteenagemalesregularlyviewpornography.

3. 33%ofteenagewomenreportsexualabuse.

4. 1in4boysexperiencesexualabuse.

5. 40%ofAmerica’schildrenliveinafatherlesshome.

6. Fatherlesshomesaccountfor63%ofyouthsuicides,90%ofhomelessandrunaway

children,85%ofchildrenwithbehaviorproblems,71%ofhighschooldropouts,85%

ofyouthsinprison,andover50%ofteenmothers.

E. WhatTeensNeedtoKnow

1. Painandsufferingbuildscharacter.

2. Theamountofsufferingisnotequaltotheamountofsininourlives.

3. Ascounselors,wemustdevelopatheologyofsuffering.

II. TheSevenStepsofHelpingTeenagersintheMidstofCrisis

A. SeeThem

1. Wecannottreatwhatwedonotsee.

2. Theabilitytoseeourteenagersisproportionatetoourabilitytohelpthem.


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B. StabilizetheSituation

1. Lookatthedifferencebetweentheeventandthereactions.

2. Weacknowledgethereactiontotheevent,nottheeventitself.

3. Wemustremainstablewhenworkingwithteenagers.

4. Don’tgetcaughtinthepanic,butdon’tminimizeortrivializeaperson’ssuffering.

C. CreateSafety

1. Teenswhoneedyouwilltestyoutoseeifyouaresafeandcanbetrusted.

2. Yourauthoritycomesfromyourknowledge.

3. Weneedtoseetheteenager’sattachmentstyle.

D. NormalizeThoughtsandFeelings

1. Don’tassumethemeaningofateenager’spain.

2. Thisdoesnotmeanthatweagreewiththeirthoughts,butteenagersneedtoknow

thatwhattheyareexperiencingisnormal.

3. Sympathyisfeelingbadforsomeone,empathyisfeelingbadwithsomeone.

4. Don’tminimizeorjudgetheirfeelings.

5. Don’tuse“Christian-ese”.


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6. Respecttheteenagerforwhotheyareevenifyoudon’tagreewiththem.

7. Reframethemeaningoftheirstory.

8. Identifythekeyfactorsandrelationshipsintheteenager’sstory.

9. Weneedtoteachteenagerstoforgiveandacceptforgiveness.

10. Sevenstagesofhelpingteenagersnormalizethoughtsandfeelings:

• Listentotheminsteadofofferingopinions

• Offerrespectratherthanjudgment

• Seekinformationfromthem

• Don’tassumethemeaningoftheirpain

• Usereflectivelistening

• Askopen-endedquestions

E. DevelopStructure

1. Setgoalswiththeteenagerinsuchawaythatwillhelpthemgetthroughthecrisis.

2. Setrealistic,short-termgoalsthatwillbreedsuccessovertime.

F. EstablishSupport

1. Supportisthebiggestfactorinhelpingpeopleovercomecrises.

2. Themoreweloveandsupporttheteenagerandcreateasafeenvironment,the

bettertheywillbeabletogetthroughthecrisis.


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G. ReferWhenNecessary

1. Knowyourlimitations.

2. Don’tovercommityourself.

3. Knowyourroleasthecounselororcrisisinterventionist.

III. ABiblicalPerspective

A. TheHolySpirit

1. 25%ofAmericansreadtheBibleatleast10minutesdaily;80%ofthat25%percent

areover55.

2. Recommendedscripturereadings:

• Acts4:13

• Psalm44

• Psalm139

B. Conclusion

1. Sometimesyouaredealtabadhandinlife,butwhatdifferentiatesthepeoplewho

makeitandthepeoplewhodon’tistheabilitytoplaythatpoorhandwell.

AsHepassedby,Hesawamanblindfrombirth.AndHisdisciplesaskedHim,“Rabbi,

whosinned,thismanorhisparents,thathewouldbebornblind?”Jesusanswered,“It

wasneitherthatthismansinned,norhisparents;butitwassothattheworksofGod

mightbedisplayedinhim.WemustworktheworksofHimwhosentMeaslongasit

isday;nightiscomingwhennoonecanwork.–John9:1-4


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2. Nomatterwhatthecrisisis,knowingtheanswertothe“Why”questionstillwould

notsatisfy.

3. Comfortdoesnotcomefromexplanations.Comfortcomesfromthepromisesof

God.

4. Don’task“Why”–ask“Towhatpurpose”?


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TNSU108:

TheEthicsofSuicideIntervention

MiriamParent,Ph.D.


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AbstractWorkingwithpeopleinsuicidalcrisisisaverystressfulandethicallycomplicatedscenario.The

ethicalprinciplesofbeneficence,non-maleficence,autonomy, justice, fidelity,andveracityare

importantwhendealingwithclientsinregardtosuicide.Itisimportanttonotethatlawsdiffer

ineachstatewhenitcomestodutytowarn/dutytoprotectandendoflifelegislation.Thereare

severalquestionsamentalhealthprovidershouldaskwhendecidingtobreakconfidentialityin

suicidal crisis. During ethical decisionmaking, themental health provider should identify the

problemandpotential issuesinvolved,knowandreviewallethicscodes, laws,regulationsand

policies,obtainconsultation,considerallpossiblecoursesofaction,choosewhatappearstobe

thebestcourseandfollowthrough,anddocumenttheprocessandoutcomes.

LearningObjectives

1. Participantswill identifytheethicalprinciplesinvolvedindealingwithclientsinsuicidal

crisis.

2. Participants will understand important questions which need to be addressed when

decidingtobreakconfidentialityinsuicidalcrisis.

3. Participantswillexplorethestepsneededduringethicaldecisionmaking.


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I. Introduction

A. Ethics

1. Noteveryone’spassion,butitdoesneedtobeourconcern.

2. WemustprovidequalityeducationandinterventionsinawaythathonorsGod.

3. Wemustmeetthecivilandprofessionalresponsibilitiesthatwehaveagreedto.

B. WorkingwithPeopleinSuicidalCrisis

1. Consistentlyranksasoneofthemoststressfulandethicallycomplicatedscenarios.

2. Self-careindealingwithsuicidalcrisisisamajorethicalresponsibility.

3. Burnoutishighandcanleadtohurtingyourselfandothers.

4. Daniel6:5

Thenthesemensaid,“Wewillnot findanygroundofaccusationagainstDaniel

unlesswefinditagainsthimwithregardtothelawofhisGod.”

5. GodwillprovideuswiththewisdomanddiscernmentweneedifweseekHim.

II. EthicalPrinciplesA. Hippocrates

1. Beneficence–dogood

2. Non-maleficence–donotharm


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B. Justice

1. Equalaccess

2. Fairness

3. Equality

C. Veracity

1. Integrity

2. Truthfulness

D. Autonomy

1. Self-determination–myrighttochoose.

2. Bedrockofinformedconsent.

3. In suicidal crisis, we are often faced with the dilemma of overriding someone’s

autonomy.

E. Fidelity

1. Trustandconfidentiality.

2. Bedrockofamentalhealthpractice.

3. Allowspeoplethesafetytotalkabouttheirpain.


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III. CompetingEthicalIssues

A. Confidentiality

1. Tiedtotheissueoftrustandfidelity.

2. Essentialtoanycounselingrelationship.

3. Clientsneedtoknowandhaveinwritingtheconditionswhenconfidentialitymaybe

waivedorlimited.

4. Harmtoselforothersneedstobeoneofthoseclearlimits.

5. When dealing with suicidal crisis, we are constantly balancing confidentiality and

keepingourclient’strustwithpreservinglife.

B. PreservingLife

1. Interveninginsuicidalcrisis

2. Weshouldintervenetherapeuticallyinwaysthathonortheclinicalrelationship.

3. Whenclinicalinterventionsareinsufficient,wemayhavetooverrideconfidentiality.

4. Example–AACCCodeofEthics

IV. CompetingLegalIssues

A. Privilege/Confidentiality

1. Privilege is the rightof the client todeterminehowandwithwhom information is

shared.

2. Protectedformentalhealthprofessionalsbystateandfederallaw.


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3. Fewunderstandthedifferencesbetweenthelegalrequirementofprivilegeandthe

ethicsofconfidentiality.

B. VariableStateLegislation

1. Inregardtoharmtoselforothers,statelawsvary.

2. Tarasofflaws–dutytoprotect/dutytowarn.

3. Map – states vary. Some statesmandate while other statespermitmental health

professionalstoreport.

C. IntenttoHarmCriteria

1. Thethreatisserious.

2. Thethreatisimminent.

3. Thethreatisdoable.

4. Thethreatisagainstselforanidentifiableperson(s).

D. FutureTrends

1. Statelawsarechangingtoreflectthedebateoverfirearms.

• NYSAFEAct(2013)

• ILFOIDMentalHealthReporting(2014)

2. DeathwithDignitydebates


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V. BreakingConfidentialityinSuicidalCrisis

A. WhoHoldstheLegalPrivilege?

1. Inmost cases, aminor does not hold legal privilege. Theparent or legal guardian

does.

2. Ifanadultchoosesnottohavethementalhealthprofessionaldisclose,theirrightto

privilegeisbeingoverridden.

B. IsThereanAppropriateInformedConsentAgreement?

1. Isthereawritten,signeddocument?

2. Hasthisbeenreiteratedinverbaldiscussion?

C. WhatInformationisNeededtoPreserveLife?

1. Limitdisclosuretoessentials.

2. Therestofthementalhealthrecordcanremainconfidential.

D. WhoisintheBestPositiontoIntervene?

1. Sometimesitisfamily.

2. Sometimesitislegalormedicalauthorities.

3. Custodialissuesmayneedtobeconsidered.

4. Beverycarefulwithinstitutionalinvolvement.

E. IsthisaMandatedorPermissiveReportingSituation?


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VI. EthicalDecisionMaking

A. IdentifytheProblemorDilemma

1. Articulatethedilemma.

2. Isitanethical,legal,professional,clinical,orspiritualissue?

B. IdentifythePotentialIssuesInvolved

C. KnowandReviewallRelevantEthicsCodes,Laws,Regulations,andPolicies

D. ObtainConsultation

1. ConsultGodthroughprayer.

2. Consultotherprofessionalstogetasecondsetofeyesonthesituation.

E. ConsiderallPossibleCoursesofActionandtheirConsequences

F. ChoosewhatAppearstobetheBestCourseandFollowThrough

G. DocumenttheProcessandOutcomes

VII. Conclusion

A. Ethically

1. Be proactive.

2. Haveclear,written,informedconsentregardingconfidentialityforeveryclient.


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B. Spiritually

1. Seekwisdom.

2. Knowledgeplusdiscernmentequalswisdom.

3. Proverbs9:10

“ThefearoftheLordisthebeginningofwisdom,andtheknowledgeoftheHoly

Oneisunderstanding.”

C. Professionally

1. Haveestablishedpolicies.

2. Knowthegeneralpoliciesthatarerequiredorexpectedinyourarea.

D. Clinically

1. Carefortheclient.

2. Seektodogood.Donotdoharm.


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TNSU109:

SuicidePreventionand

InterventionwithAdolescents

JoshuaStraub,Ph.D.


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AbstractSuicidalbehaviors,suicidalideation,andnon-suicidalself-mutilatingbehaviors(SMB)areissues

surrounding today’s adolescents. Today’s youthmayengage in SMB to stopbad feelings, feel

something(evenifitispain),punishthemselves,relievefeelingsofnumbnessoremptiness,feel

relaxed, or give themselves something to do when alone. There are risk factors involved in

suicidal behaviors and causes/triggers that caregivers need to understand. Caregivers and

parentsareinstrumentalinpreventingandinterveningduringasuicidalcrisis.Adolescentswant

tobeunderstood.Connectednessmustbebuiltbetweenindividuals,withinthefamily,between

families and community organizations, and between community organizations and social

institutions. Emotional safety is key for an adolescent because a safe relationship equals love

minusfear.

LearningObjectives

1. Participantswill identify risk factors, causes/triggers, andmultifaceted factors involved

withsuicidalbehaviors.

2. Participants will define steps parents can take involving technology that will be

instrumentalinkeepingtheiradolescentssafe.

3. Participantswill explore the importanceof connectedness for adolescents in regard to

suicidepreventionandintervention.


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I. Introduction

A. SuicidalBehaviors(FatalandNonfatalAttempts)

B. SuicidalIdeation

C. Non-suicidalSelf-MutilatingBehaviors(SMB)

D. Statistics

1. Foryouthbetweentheagesof10and24,suicide isnowthethird leadingcauseof

death.

2. The top three methods used in suicides of young people include firearms (45%),

suffocation(40%),andpoisoning(8%).

3. Moresurvivesuicideattemptsthanactuallydie.

• Anationwidesurveyofyouth ingrades9-12 inpublicandprivateschools in

theUnitedStates foundthat16%ofstudentsreportedseriouslyconsidering

suicide, 13% reported creating a plan, and 8% reported trying to take their

ownlives.

4. Boysaremorelikelythangirlstodiefromsuicide.

5. Girlsarethreetimesmorelikelytoattemptsuicidethanboys.

6. Hispanicyoutharemorelikelytoreportattemptingsuicidethantheirblackorwhite

peers.

7. TheNativeAmericanpopulationisveryhighamongyouthsuicides,aswell.


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E. Self-injuryStatistics

1. In2007,someformofnon-suicidalself-injury(NSSI)wasself-reportedbynearlyhalf

ofhighschoolstudents.

2. 40%ofindividualswhoharmthemselvesreportsuicidalideations.

3. 64%ofadolescentswhoengageinself-injuryarefemale.

II. Self-mutilatingBehaviors(SMB)

A. TopFiveMethods

1. Cuttingorcarvingone’sskin

2. Pickingatwounds

3. Hittingoneself

4. Scrapingone’sskintodrawblood

5. Bitingoneself

B. TopSixReasons

1. Tostopbadfeelings

2. Tofeelsomething,evenifitispain

3. Topunishoneself


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4. Torelievefeelingsofnumbnessoremptiness

5. Tofeelrelaxed

6. Togiveoneselfsomethingtodowhenalone

C. Self-MutilatingBehaviorProtocol

1. IdentifyingthefunctionoftheSMB

2. Findingfunctionallyequivalentbehaviors

3. Improvingemotionregulation

4. Learningbehavioralwaystorelax

5. Learningwaysofengagingtheworld

III. SuicidalBehaviors

A. RiskFactors

1. Historyofprevioussuicideattempts

2. Familyhistoryofsuicide

3. Historyofdepressionorothermentalillness

4. Alcoholordrugabuse

5. Stressfullifeeventorloss/bullying


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6. Easyaccesstolethalmethods

7. Exposuretothesuicidalbehaviorofothers

8. Incarceration

B. Causes/Triggers

1. Majordisappointment

2. Rejection

3. Failure

4. EducationalStruggles

5. Loss–suchasbreakingupwithagirlfriendorboyfriend

6. Witnessingfamilyturmoil

7. Mentalorsubstance-relateddisorder

C. MultifacetedFactors

1. Genetics

• Thereisnoscientificevidencethatsuicideispasseddowngenetically.

• Thereisanindirecteffectthroughfamilyturmoil.

• There is an indirect effect through other family members who have

committedsuicide.


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2. Physiological(brainchemistry)

• Non-pharmacologicaltreatment

• Pharmacologicaltreatment

3. Developmentalfactors

• Puberty

• Hormones

4. Environmentalfactors

5. Socialfactors

• What’shappeningatschool?

• What’shappeningonline?

• Bullying

• Cyberbullying(ask.fm)

6. Culturalfactors

• Economy

• Sexualidentityissues

D. StepsforParents(Technology)

1. Keepallcomputersinthelivingroom.

2. Tellyourchildrennottogiveoutpersonalinformationtoanyoneonline.

3. Gooveryourchildren’sbuddy/friendlistsandaskthemwhoeachpersonis.

4. Discuss and help them understand more about cyber bullying as a victim and a

perpetrator.


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IV. SuicidePreventionandIntervention

A. CentersforDiseaseControl(CDC)Recommendations

1. Connectedness–thedegreetowhichapersonorgroupissociallyclose,interrelated,

orsharesresourceswithoneanother.

2. Promote individual, family, and community connectedness to prevent suicidal

behavior.

B. ConnectednessBetweenIndividuals(RealorPerceivedSocialSupport)

1. Decreasesthethreatlevelappraisalofexperiencedstress

2. Increasesphysiologicalfunctioning–cardiovascular,immune,endocrine

3. Buildsimmunitytodiseaseandresistancetostress

4. Discouragesmaladaptivecopingbehaviors

C. ConnectednessinFamily

1. Connectednessbetweenteensandtheirparentshasbeenassociatedwithdecreased

suicidalbehaviorsincross-sectionalstudiesacrossallcultures.

2. Disruptedsocialnetworks,suchasfamilydiscordorproblemswithfriends,havethe

oppositeeffect,significantlyincreasingtheriskofsuicidalideation.

3. EmotionalSafety

• Saferelationship=love–fear

• “Thereisnofearinlove;butperfectlovecastsoutfear,becausefearinvolves

punishment,andtheonewhofearsisnotperfectedinlove.Welove,because

Hefirstlovedus.”—1John4:18-19


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• “In attachment, we need to be open to our child, feeling that safety in

ourselvesandcreatingthesenseof‘lovewithoutfear’inourchild.”

• “…thequestionisn’tsomuch‘Areyouparentingtherightway?’asitis:‘Are

youtheadult thatyouwantyourchild togrowuptobe?”—BreneBrown,

Ph.D.,DaringGreatly

4. ConnectednessofFamiliestoCommunityOrganizations

• Schools/universities

• Placesofemployment

• Communitycenters

• Churchesandotherreligiousinstitutions

5. ConnectednessofCommunityOrganizationsandSocialInstitutions


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TNSU110:

ConductingaSuicideAssessment:

UsingtheSafe-TModel(withroleplays)

GarySibcy,Ph.D.


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AbstractInthissession,Dr.GarySibcyreviewsandunpackstheSafe-T5StepEvaluation&TriageSystem

for Suicide Assessment developed by the Substance Abuse and Mental Health Services

Administration(SAMHSA)oftheAmericanPsychologicalAssociation(APA).Throughthreerole

plays,Dr.Sibcydemonstrateshowtousethismethodwithclientsofvaryingsuiciderisk level.

Clinicians are encouragednot only to get a suicide assessment right, but to demonstrate and

document how they have thought through the factors competently and documented the

process.

LearningObjectives

1. ParticipantswillnameanddescribethefivestepsofusingtheSafe-Tmethodwithclients

whoneedsuicideintervention.

2. Participantswill be exposed to threedifferent role plays showing appropriate clinician

responsetodifferinglevelsofsuicidalideation.

3. Participants will understand how the client’s risk and protective factors informed

decision-makingineachofthethreescenarios.


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I. Introduction

A. ThreeRolePlays

B. Safe-TMethod

1. Safe-T5StepEvaluationandTriageSystemforSuicideAssessment

2. Developed by the Substance Abuse and Mental Health Services Administration

(SAMHSA)oftheAmericanPsychologicalAssociation(APA)

II. TheFiveSteps

A. Step1:RecognizeSuicideRiskFactors1. Thekindofthingsthatputpeopleatrisk.

2. Triggerscombinedwithmentalhealthriskfactors.

B. Step2:CompareRiskFactorswithExistingProtectiveFactors

1. Religiousbeliefs

2. Senseofobligation

3. Otherreasonsforliving

C. Step 3: Inquiry and Assess the Client’s State of Mind with Respect to Attachment,

History,andIdeation1. Dotheyhaveaplan?


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2. Dotheyhaveintention?

3. Howmuchdotheywanttodiecomparedwithhowmuchtheywanttolive?

D. Step4:DetermineaHigh,MediumorLowLevelofRisk

E. Step5:DocumentandImplementaTreatmentPlan

F. FollowingtheSafe-TMethod

1. Itisnotonlyimportanttogetasuicideassessmentright,butitisalsoimportantthat

you have thought through the factors competently and documented the process.

2. Whenapersonisreferredbysomeoneelseasopposedtocomingbecausetheyfeel

liketheyneedhelp,thisitselfispartofariskprofile.

III. RolePlay1:Jessica

A. Background

1. 22-yearoldcollegesenior

2. Referredbyparents

3. Beingreferredasopposedtocomingwillinglyispartoftheriskprofile.

B. RolePlay


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C. Summary

1. Thiswasamorecomplicatedandseriouscase.

2. Jessicahasanumberofriskfactors.

3. Jessica’smostnotable risk factor isherpreviousattemptaswellasher reaction to

theattempt.

4. Jessicadidnotregretherchoiceafterhersuicideattemptwasthwarted.

5. Triggersincludedthebreakup,adesireforrevenge,andhopelessnesscombinedwith

veryfewprotectivefactors.

6. Acontractwouldnothavebeenappropriateas Jessicawasnot likely tohonor the

contract.

IV. RolePlay2:AngiePartOne

A. Background

1. Self-Referred

2. Angiehasrunintoanumberofstressors.

3. Angieisfeelinghopelesswithsuicidethoughts.

4. PayattentiontoAngie’slevelofthinking,amountofplanning,andhowthecontract

ismade.

B. RolePlay


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C. Summary

1. Angieisself-referred.

2. Sheisfeelingquitebadly,butwantshelp.

3. Non-suicidalself-injury(tensionreductionbehavior)isrevealed.

4. Angiedoesnothaveasignificanthistoryofsuicidalbehavior.

5. Angie’slevelofhopelessnessisinamoderaterange.

6. Angieisopentocontractingforsafetyandfollowingthesafetyplan.

7. Angiehasalowtomediumrisk.

8. Angiedoeshavehope.

9. Itisimportanttodocumentreasoningaswellasclient’sopennesstocontracting.

V. RolePlay2:AngiePartTwo

A. Background

1. ThisisacontinuationofthefirstroleplaywithAngie.

2. Angiehasbeenintherapybutherlevelofriskhaschanged.

3. YouwillseeanewplanbasedonAngie’slevelofrisk.

B. RolePlay


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C. Summary

1. CircumstanceshadgottenworseforAngie.

2. Angiefollowedtheplanshehadmadewithherclinician.

3. Theriskfactorshaveincreasedduetothestressorsandherlevelofhopelessness.

4. Protectivefactorsarestillinplace.

5. Angie’ssenseofnotbeingsafeisimportant.

6. Ifyoukeepaclient in theoutpatientsetting,makesureyouaredocumentingyour

decisionmakingprocessandthestepsyouaretaking.


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TNSU111:

FamiliesinCrisis:

TheFirst48HoursFollowingSuicide


withKevinEllers,D.Min.


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AbstractSuicide typically comes as a deep shock to surviving loved ones. Discovering the body of

someonewhohascommittedsuicideorreceivingadeathnotificationcanbetraumatictothe

pointthatthechemistryofthebrainchangesintheimmediateaftermath.Thisbrainchemistry

change can cause decision making to become overwhelmingly difficult. Throughout this

tumultuoustime,caregiverscanprovideemotionalandpracticalsupportthatminimizesfurther

secondarywoundstosurvivors.

LearningObjectives

1. Participantswillidentifywhatcanbedoneinthefirst48hourstotwoweeksfollowinga

suicidetohelpminimizefurthersecondarywoundstothesuicidesurvivors.

2. Participantswillunderstandhowtoprovidebothemotionalandpracticalsupportinthe

immediateaftermathofasuicide.

3. Participantswillexplorecommonissuesandwhatnottodoorsaytosuicidesurvivors.


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I. Introduction

A. GearedTowardCrisisIntervention

1. Firsttwoweeksoruntilthefuneral

2. Thefirstcrisisstageforfriendsandfamilymembers

3. Everything thathappens in thiswindow—positiveandnegative—impacts long-term

recovery.

B. FirstRespondersandOthers

1. Crisis responders, chaplains, law enforcement, medical professionals, clergy, and

others.

2. Allwhointeractwithsurvivorsinthefirst48hoursto2weeksfollowingthedeath.

II. DiscoveringtheBodyorReceivingaDeathNotificationA. TraumaticandUnexpected.

1. Even if the loved one had chronic mental illness or previous attempts.

2. “FightorFlight”response

3. Thechemistryofthebrainchanges.

• Activityinthefrontallobedecreases.

• Theamygdalaor“fearcenter”firesup.

• Thinkingiscompromisedandemotionsexplode.


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4. Maybechaotictimeandverydifficultforlovedones/family.

5. ThosewhodiscoverthebodymayexperiencesPostTraumaticStresssymptoms.

B. TheDeathScene

1. Thelocationofdeathlikelytobeacrimescene.

2. Thiscancomplicatesituationandbeverychaotic.

3. Themoregruesomethedeathscene,themoretraumacanoccur.

4. Logistics

• Lovedonesoftencan’tvieworbewithbody.

• Theremaybequestioningbypolice.

• Cleanupofscenewillneedtotakeplace.

5. NotifyingothersoftheDeath

• Difficultdecisionsregardingwhattosay/whatnottosay.

• Tellingchildrenpresentsadifficultchallenge.

• Notifyingimportantgroupsmusttakeplace–employers/co-workers,church,

friendsandpastrelationships.

VideowithDr.KevinEllers:HowCrisisRespondersCanAdvocateforFamiliesOn-Scene

6. Caregiverscanadvocateforsomeoneelsetocleanupthedeathscene.


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7. IfCauseofDeathisUndetermined

• Nosuicidenote

• Maynothavedeterminationforsometime

• Mayneverhavedefinitedetermination

• Each person must be allowed their own timetable for coming to

conclusions/answers.

• Some people may be very resistant to accepting the idea of a loved one

committingsuicide.

8. SuicideNotes

• Familymembersshouldhaveaccess tothisnote,particularly ifpositivesare

shared.

VideowithDr.KevinEllers:SuicideNotes

VideowithDennisMinns:SuicideAftermath

III. ImmediateIssues

A. NotificationofDeath

1. Thinkingclearlyandrememberingthegroupstotell.

2. Dowetellthetruth?

B. Emotions

1. Shock/denial

2. Guilt/Self-Blame


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3. Blameofothers

4. Inabilitytothinkclearly

5. Difficultymakingdecisions

C. ProblemswiththeTerm“CommittedSuicide”

VideowithDr.KevinEllers:SuicideTerms

IV. ContagionEffectA. SuicideRiskIncreasedforCommunity

B. At-RiskPopulationandCloseFamilyMembers

C. Windowof48Hours–TwoWeeks

V. PracticalAssistanceA. DecisionMaking

B. BasicNeeds

1. Shelter–ifhomeiscompromised

2. Food


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3. SocialSupport

4. SpiritualSupport

5. Helpinginmakingplans/decisions

6. Helpingettinginformation

C. Funeral/MemorialArrangements

1. Practicalfuneraldecisions

2. FinancialAssistance

D. EmotionalProtection

1. Protectionfromignoranceandthehurtfulorpainfulthingspeoplesayanddooutof

thatignorance.

2. Workasabuffer.

E. LookingintoLifeInsurance

VI. Conclusion:SelfCareforFirstResponders


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TNSU112:

GrievingaSuicide:

Long-termSupportforSurvivors

andLovedOnes


andEricScalise,Ph.D.


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AbstractInthissession,JenniferCisneyEllersandDr.EricScalisewilldescribethecomplicatedgriefthat

followsa suicideand theexperienceof survivors. Strategies to facilitatehealthygrievingand

healingareoutlined.Viewerswillalsolearnwhatisunhelpfulandhowtoavoidresponsesthat

causefurtheralienationandshameforsurvivors.Anemphasisisplacedonhelpingsurvivorsstay

connectedtosupportsystemsandsafespiritualenvironments.

LearningObjectives

1. Participants will identify the causes and impact of complicated grief as it relates to

survivingalovedone’ssuicide.

2. Participantswillunderstandthechallengesofworkingthroughthesuicideofalovedone,

includingthecommonlackofsocialsupport.

3. Participantswilllearnwhyconnectednessandcommunityareofutmostimportancefor

suicidesurvivorsworkingthroughthegriefprocessandtowardshealing.


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I. Introduction

A. SupportingSurvivorsIsPrevention

1. Supportingsurvivorsintheaftermathofasuicideisalsopreventingsuicideinfuture

generations.

2. Survivors of suicide get less support and have more complicated grief than other

typesofdeath.

B. ConnectednessofClinician

C. AwarenessisNeeded

II. TheUniqueGriefProducedbySuicide

A. WeGrieveBecauseWeLove

Godwhispersinourpleasures,speaksinourconsciousness,butshoutsinourpain.Itishis

megaphonetoadeafworld.–C.S.Lewis

B. ResearchShows:

1. Similartolossbysuddenorviolentdeath.

2. Shock/numbness

3. Denial


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C. Recovery

1. Expecta4-7yearrecoveryperiod.

2. Maynotbe“pathological”grief,butcomplicatedbythefactorssurroundingsuicide.

D. Unhelpful“Helpers”

1. Donotgivepatanswers

2. Donotofferclichés

3. Survivorstendtohearcommentsthatcomeoutof ignorance,andthiscanresult in

secondarywounding.

VideowithDr.KevinEllers:SecondaryWoundingvs.Grace

4. Suicide survivors receive less social support than survivors of other types of loved

ones’deaths

5. Theyexperiencegreatershameandguilt.

6. Maystrugglewithmore“Whatifs”and“Whys.”

7. Experiencemorecomplicatedandlong-termgriefissues.

8. ClinicianResponse:

• Helpthesurvivorchangethe“Why”questionstothe“What”questions.

• Heartheheartofthecry.

• Don’tunderestimatethepowerofapersonshowingup.


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III. ComplicatedGrief

A. Differsfrom“Typical”Grief

1. Forasuicide,workingthroughgrieftakestwiceasmuchtime,andsometimesfrom4-

7years.

2. Theaveragepersonhasneverpreparedthemselvesforalossofthisnature.

B. ExperienceofComplicatedGriefafterSuicide

1. Guiltcanbecomeimmobilizing.

• Thiscanbeanindicationthatapersonis“stuck”

• Self-blameanddebilitatingguilt

2. Shameforasurvivorcancomefrominternalandexternalmessages.

• Study by Calhoun, Selby, and Faulstich, 1980, showed that respondents

viewedparentsofachildwhocommittedsuicidetobe:

Ø Lesslikeable

Ø Moretoblame

Ø Moreashamed

Ø Moreabletopreventdeath

3. Themodeofdeathcancomplicatetheexperienceofthesurvivor.

4. Dependencyorunhealthyattachmentcancomplicatethegriefprocess.

5. Inadditiontopainandgrief,survivorsoftenfeelanger.

• Theymayfeelthesuicidewasaselfishact.

• Thepersonisnolongertheretoworkthroughtheemotionswith.


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6. Survivorsmayfeelasenseofrelief.

• Thiscanhappenatthesametimeasfeelingsadthepersonisgone.

• Survivorscanbeveryashamedofthisfeeling.

7. Religiousandspiritualissues

• Caregiversshouldworkthroughtheseissuesintheirownheartsandminds.

• Theyshouldnotdothistogiveanswers,asassurancesshouldbelefttoGod

alone.

VideowithDr.KevinEllers:HelpingGrievingPeoplePrepare

IV. WhatDoesandDoesNotHelp

A. Unhelpful

1. Ignoring/Avoidance

2. Denial

3. Pressuringthemto“getoverit”

4. NegativeReligiousjudgments

5. Anyjudgment

6. Keepingitsecret

7. Encouragingornotconfrontingself-medication


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B. Helpful

1. Bewillingtotalkabouteverything-eventheuncomfortableanddifficultparts.

2. Encouragetheemotionalprocessing.

3. Practicalandtangiblesupport.

4. Encouragegrievingrituals.

• Sayinggoodbyeinaletter

• Sendingwishes

• Emptychairdiscussion

5. Rememberrealistically.

6. Allowsurvivorstoworkthroughguiltissuesattheirownpace.

7. Help them get information from other sources (mental health professionals, law

enforcement,medicalprofessionals,co-workers,friends.)

8. Help families grieve together – different grieving styles, ways of coping and

timetables.

9. Helpthemfindsafespiritualenvironmentandcomfortinfaith.

10. Facilitateprocessingwiththedeceasedthroughexperientialtechniques.

11. Helpthemprocessthetraumaofdiscovery.

12. Referraltomentalhealthprofessionalifneeded.

13. Helpthemwithlong-termsupport.


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14. Prepareforanniversariesandothertriggerevents.

15. Supportgroupsforgriefandifpossiblesurvivorsofsuicide.

VideowithDr.KevinEllers:HelpingGrievingPeopleRememberLovedOnes

V. Conclusion:

A. HelpingSurvivorsFindClosure

B. HelpingSurvivorsFindSafeSpiritualHomes

1. Pastors

2. Churches

3. SurvivorSupportGroups

C. Revelation21:1-5

“ThenIsawanewheavenandanewearth;forthefirstheavenandthefirstearthpassed

away, and there is no longer any sea. And I saw the holy city, new Jerusalem, coming

downoutof heaven fromGod,made readyasabrideadorned forherhusband.And I

heardaloudvoicefromthethrone,saying,“Behold,thetabernacleofGodisamongmen,

andHewill dwell among them, and they shall be His people, andGodHimselfwill be

amongthem,andHewillwipeawayeverytearfromtheireyes;andtherewillnolonger

beanydeath; therewill no longerbeanymourning, or crying, or pain; the first things

havepassedaway.’AndHewhositsonthethronesaid,‘Behold,Iammakingallthings

new.’AndHesaid,‘Write,forthesewordsarefaithfulandtrue.’“Revelation21:1-5


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A. PsychologicalAutopsy/Debriefing

1. Nottodetermineblamebutexploretheissueandallowforprocessing

2. Prepareforthefuture

B. OnlineSupport

1. AmericanAssociationofSuicidology–Clinician-SurvivorTaskForce–

http://www.suicidology.org/suicide-survivors/clinician-survivors

2. AmericanFoundationforSuicidePreventionwww.afsp.org


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