Denton ISD
August 16, 2011
Dr. Casey A. Barrio Minton, PhD, NCC
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Understanding youth suicide
Recognizing warning signs
Facilitating open conversations
Connecting with resources
Continuing education resources
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Suicide/completed suicide
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Suicide attempt
 “potentially self-injurious behavior with a nonfatal
outcome, for which there is evidence (either explicit
or implicit) that the person intended at some
(nonzero) level to kill himself/herself” (Brown, 2003,
p. 5).
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Suicidal ideation (self)
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Suicide threat (other)
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Suicidal Act
 Suicide or suicide attempt (with or without injuries)
 Nonzero intent to die
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Self-injurious behavior
 Deliberate infliction of direct physical harm
 Zero intent to die
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Instrumental Suicide-Related Behavior
 Desired appearance of intending to kill self (with or
without injuries)
 Zero intent to die
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Self-inflicted
Intent to kill self
 Nonzero
 Zero
Actual harm to self
Desired appearance and
response
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Child is brought to
Adolescent is found
emergency services from
making cuts on
her arms
Adolescent
a bottle
group
home aftertakes
digging
and legs in the
school
of
medications,
but
into his arms with safety
bathroom.
Later,
parents
medications
do
no
pin and saying that he’s
find harm
diary with poetry
physical
“tired of life like this…”
expressing student’s
loneliness and loss of
hope for the future.
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Leading cause of death
 Ages 5-14 (5th)
 Ages 15-24 (3rd)
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Estimated 100-200 attempts per completion
1 in 19 has thoughts in any 2 week period
2009 Dallas HS Students
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Overall
Felt sad or hopeless almost every
day for 2+ weeks*
33.0%
Seriously considered suicide
15.6%
Made a plan*
14.4%
Attempted suicide*
12.0%
Considerable variations among groups
“Psychache”
Intolerable
Interminable
Inescapable
Perturbation
(motivation)
Suicide
Lethality
(thought of
Stopping)
Stimulus
Stressor
Purpose
Goal
Emotions
Cognitions
Relational
Serial
Unendurable psychological pain
Frustrated psychological needs
Solution
Cessation of consciousness
Hopelessness, helplessness
Ambivalence, restricted perception
Tells of intention, egression
Consistent with lifelong pattern
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Someone who talks about it is not serious
Talking about it will increase risk
Attention-seeking
Suicide happens without warning
Suicidal people want to die / can’t stop
Suicidal people are crazy, mentally ill, insane
Danger reduced after crisis
 Access to treatment
 Support for help-seeking
 Effective clinical care for
mental, physical, and
substance abuse d/o
 Support from ongoing
medical and mental
health care relationships
 Family and community
support
(connectedness)
 Cultural and religious
beliefs
 Skills in
 problem solving
 conflict resolution
 nonviolent ways of
handling disputes
 Family hx of suicide
 Family hx of child
maltreatment, conflict
 Previous attempt(s)
 Mental disorders
 Alcohol/drug abuse
 Hopelessness
 Impulsive or aggressive
tendencies
 Loss
 Isolation
 Physical illness
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Cultural/religious beliefs
Local suicide epidemics
Barriers to accessing tx
Easy access to methods
Recent severe stressor
Unwilling to seek help
because of stigma
 Biological
 Impulsivity
 Age
 Psychological
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Inferiority / expendable
Depression
Anxiety
Aggression
Impulsivity
Internalizing
Poor coping skills
 Cognitive
 Immature view of death
 Concrete thinking
 Attraction/repulsion to life
and death
 Substance use
 Environmental
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Early loss
Parental conflict
Chaotic/inflexible family
Abuse / neglect
Parent mental health
Isolated or alienated from
peers
Poor social support
Poor social skills
Learning disabilities
Academic failure
 Precipitating events
 Psychosocial stressors, perceptions, and ability to
cope vary developmentally
 Recent exposure to suicide / contagion
 Previous coping via suicidal ideation or behavior
Ideation
Substance use
Withdrawal
Anger
Purposelessness Recklessness
Anxiety
Mood change
Trapped
Hopelessness
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Fixated on death
Worsening of school performance
Unhealthy peer relationships
Difficulty adjusting to gender identity
Bullying
Depression
Announcing a plan
Talking, writing, or posting about suicide or
death
 Hints
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 I wish I were dead. I'm going to end it all. You will be
better off without me. What's the point of living?
Soon you won't have to worry about me. Who cares if
I'm dead, anyway?
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Meaninglessness
Giving away prized possessions
Dropping out of school, activities
Obtaining a weapon
Youth’s biases and fears
Our biases and fears
Our desire to fix, change,
or convince otherwise
 Leakage myth
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Tune in to own responses
Be direct – kill, suicide, dead
Tune in to hesitancy
Investigate “not really”
Look for nonverbals
Get out from behind the desk
Take your time
Don’t try to fix or give advice
Prepare to be persistent and
creative
 Focus on relationship over details …
but get details if the time seems right
Ask questions regarding concrete behavioral
facts or thoughts
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 “When you ‘threw a fit,’ what exactly did you do?”
“Did you put the razor blade up to your wrist?”
“What happened next?”
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Ask question so not as threatening
 “Sometimes drinking can lead people to have
thoughts of killing themselves that they normally
wouldn’t have. Has that ever happened to you?”
Assume suspected behavior is occurring and
frame a ? based on assumption
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 “What other ways have you thought of killing
yourself?” “How often do you cut?”
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Normalize the experience
 “Some people tell me that, at times, living is so
painful that they have thoughts of wanting to kill
themselves. Have you had any thoughts like
that?”
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Communicate caring and comfort
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Specific reason for interview
Not in trouble
Safe to tell truth
No right or wrong answers
Caretaking w/in interview
Determine who is present for interview
Beware of limits to language, leading language,
and repeated questions  adapt language,
integrate drawing
 Attend to developmental understanding of
death
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Precipitating events, Supporting assessments
 Warning signs
stressors, triggers
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 inescapable
 intolerable
 interminable
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Suicidal
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Ideation
Plans
Means
Intent
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Prior history
Reasons for dying
Reasons for living
Supports
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Summarize situation and reflect feelings
Use owning statements
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Be very direct
 You sound
, are you thinking of suicide?
 Sometimes when people
, they are thinking of
suicide. Are you thinking of suicide?
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Honor choice to share
Let him or her tell you way
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After giving child room to share
 Summarize content and reflect feelings
 Restate thoughts of suicide
 Use owning statement regarding needing to know
more
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Elicit details regarding ideation
 (see guidelines handout)
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Plan
Means
Methods
Intent
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Consider
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How
Could he/she? Access
Lethality
Timeline, action taken
Level of specificity (more specific  ↑ risk)
Degree of access
Level of lethality
Action already taken
Degree of commitment
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“What has kept you from…” (details vip)
“Who/what is a source of support for you…”
“What are the pros and cons of your plan?”
 Look for
 Strength/nature of deterrents
 Any hope? Change in feeling?
 Family, spiritual beliefs can be
critical
 Ideation
 Substance use
 Purposelessness
 Anxiety
 Trapped
Hopelessness
Withdrawal
Anger
Recklessness
Mood change
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History
 Prior suicide attempts
 Prior violence
 Prior diagnoses / treatment
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Mental status
Behavior changes
Ideation
Plan
Lethality
Intent
None
No
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Mild
Some
No
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Moderate
Yes
Vague
Low
--
Severe
Yes
Specific
High
--
Extreme
Yes
Specific
High
Yes
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Counselor/client relationship
Perceived pain
Perceived resources
Previous attempts
Mental health history & disorders
Balance of reasons for living and dying
Is risk grid a
dangerous
myth?
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Follow organizational protocols for youth crisis
Do not leave the youth alone
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Notify caregivers and/or emergency providers
 Empower youth to share himself/herself
Arrange for mental health assessment and
services
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Follow-up with youth
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Comprehensive suicide assessment
Appropriate management plan
Family involvement
Consultation with professionals
Implementation of plan
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Emergency/crisis services (24/7)
Hotlines
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Inpatient hospitalization
Intensive outpatient/Partial hospitalization
Outpatient services
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Standardized Trainings
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ASIST (Applied Suicide Intervention Skills Training)
safeTALK (suicide alertness for everyone)
QPR
SOS (Signs of Suicide)
Trevor Project Lifeguard Workshop
Crisis response planning
 www.ed.gov/emergencyplan
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United Way’s 211 (or www.211.org)
Suicide Prevention Lifeline (800/273-TALK)
The Trevor Project
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National Suicide Prevention Lifeline
 800-273-TALK
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Suicide Prevention Resource Center
American Association of Suicidology
Suicide Prevention Action Network
The Trevor Project
American Foundation for Suicide Prevention
SAMHSA NREPP