Not One More!
Stopping the Suicide Epidemic
Suicide is…..
The Enemy Within
Play video clip “The Enemy Within”
Available from the California Highway Patrol
Definition of Suicide
“Suicide is a conscious act of self-induced
annihilation, best understood …as a
needful individual who defines an issue
for which the suicide is perceived as the
best solution.”
Dr. Ed Shneidman, Suicide as Psychache, 1993
Suicide Survivors
Family members and others who survive
•Spouse
•Grandparents
following the death of their
loved one by
•Significant Others
•Lovers
suicide:
6:1
•Parents
•Children
•Extended family
•Friends
•Co-Workers
•Classmates
Nationwide Statistics
2004 data
One suicide every 16 minutes
11th ranking cause of death in the US
811,000 suicide attempts every year
5 million living Americans have attempted suicide
Firearms used in 52% of suicides
Suicide in Specific Populations
20
18.5
18
15
13
10.7
10
5
0
Suicides per 100,000
General Population
White Males 21-55
Military
Law Enforcement
Law Enforcement Suicide Compared
20
18.5
15
9.1
10
4.5
5
0
Suicides per 100,000
LE Suicide Rate
LE LODD Rate
LE Homicide Rate
Law Enforcement and Retirement
3000
2616
2500
2000
1500
1000
335
500
33.5
0
Suicides per 100,000
Retired Comparison Group
Retired LE
Retired LE - Medical Disability
Write a Name Exercise
“It takes only the smallest of
changes to shatter an
epidemic’s equilibrium.”
Malcolm Gladwell in the “Tipping Point”
The Tipping Point:
Agents of Change
The Law of the Few
The Stickiness Factor
The Power of Context
The Law of the Few
Connectors
Mavens
Persuaders
The Stickiness Factor
Courage is taking the first step
Let us help each other live
Just do something!
Advice that is practical and personal
also becomes memorable…
The Power of Context
Epidemics strongly influenced by their
situation
Circumstances and conditions
Particulars of environments
Kitty Genovese
Graffiti
Courage
Communication
Awareness
One Voice
Attempt
“Suicide
is
completed
in
Gesture
inches not in leaps”
Ideation
Completion
Exercise
Write down the 3
most important
things in your life.
Myths?
•Happens without warning
•Low risk after mood improvement
•Once suicidal, always suicidal
•Only experts can prevent it
•Runs in the family
•No note = no suicide
More Myths..
• Suicide is not preventable
• Only certain “types” of people
become suicidal
• Don’t talk about suicide or they will
“do it.”
• Antidepressants cause people to
be suicidal
Phil’s Letter to Mom
Life’s Most Valuable
________
My mind
________
My family
________
My work
Loss or change in an important relationship
To avoid or end perceived pain
Escape intolerable situation
Gain attention
Manipulate
Punish others/Punish self
Become a martyr
Loss change
important
perceived
intolerable
Social Support System
Warning signs
Separation from family or friends
- Geographic, legal, temporary
Loss of significant others
A loner or newcomer
Rejected by peers
Feels like people don’t care
Why Police Officers Commit Suicide
Loss due to death or
divorce
Marital problems or a
bad relationship
Terminal illness
Guilt over partner’s
death
Legal Problems
Feeling alone
Sexual Accusations
Disability/Retirement
Internal Affairs
Investigation
Financial Problems
Arrest
Loss of Employment
PTSD
Loss of Rational Thinking
Lack of sleep
Stress or anxiety
Substance Abuse
Immaturity
Psychosis:
Command hallucinations
Alien control
Religious preoccupation
Symptoms of Depression
Change in sleep
Change in appetite
Loss of energy,
motivation
Loss of interest in
pleasurable activity
Apathy
Deterioration of
personal appearance
Deterioration of job
performance
Frequent physical
complaints
Preoccupation with
death
Intense
arousal
after
a
traumatic
event
It is from PTSD that the unseen
Overwhelms
coping
mechanisms
wounds of an
officer
begin to
manifest.
Since wefeeling
do nothelpless
see and
Leaves
the responder
these
out ofbattle
controlscars, we sometimes
PTSD
try
to
pretend
they
do
not
exist.
Posttraumatic stress is not prejudiced
Trying to pretend doesn’t make
PTSD invades the mind with almost
the pain go away.
constant thoughts about the event
It’s Everybody’s Business
The student will be able to list the
signs
Do& signals
Something!
of a person who
is at risk of suicide.
Suicide and Alcohol
Risk is 2-3x higher among alcoholics
15-25% of suicides are completed by
alcoholics
50% of those who completed suicide
were intoxicated
Among suicides of alcoholics, 89% were
actively drinking at time of death
Indirect Verbal Clues
•I can’t go on any longer
•Nobody needs me anymore
•I’m tired of life
•You won’t be seeing me any more
•I can’t take it any more
•You’d be better off without me
•I can’t take the pain
Buying a weapon
Indirect Suicide Indicators
Giving away possessions
Clues.... Clues.... Clues....
Changes in social behavior
•The
“practice
run”
Reckless officer safety/behavior
•Sudden religious
Changes in personality
interest/ disinterest
•Substance abuse
relapse
•More confrontational
with subject
Direct Verbal Clues
• I wish I were dead
• You’d be better off without me
• I might as well be dead
• If ___doesn’t happen, I’m going to
end it
• I’m going to commit suicide
• I’m going to kill myself
How Bad Is It?
How:
Is the plan specific?
Do they have the means?
Are the means lethal?
Lethality lets you know how
History:
much help you need and
Prior attempts?
how
fast
you
need
it
Any family history?
Help:
Are they alone?
Are they drinking?
Intervention is Action
Do Something!
Respond!
A Silent
Code 3 Request for Help
Barricades to Seeking Help
Denial
Avoidance
Anger
Fear:
Will impact job
Command will be contacted
Hospitalization
Being labeled
Do’s of Intervention
Remain calm
Accept their feelings
Focus on central issue
Stay close
Emphasize temporary
nature of problem
Explore resources
**
Listen what
** Listen
** Listen
Hear
is being
said
**
Don’ts of Intervention
Don’t sound shocked
Don’t offer empty promises
Don’t try to joke them out of it
Don’t debate morality
Don’t assume things will improve
Don’t leave person alone
Don’t keep it a secret
A Good Listener:
Copes with strong emotion
Is prepared to listen – time
Provides for comfort
Tolerates repetition
Listens carefully
Respect others perspective
Avoids interrupting
WAIT
THINK
RESPOND
The Question
Have you been thinking of
killing yourself?
Important Questions
How would you kill yourself?
When did you last think about suicide?
What is the closest you’ve come?
Have you ever attempted suicide?
Has anyone in your family attempted/completed
suicide?
What are the odds that you will kill yourself?
What has been keeping you alive so far?
What do you think the future holds in store for
you?
Referrals
•Employee Assistance Program
(EAP)
•Health Care Plan
Suicidal Thoughts
Relationship Difficulties
In!
DoBoxed
Something!
Depression/Trauma
Adverse Job Action
Alcohol Abuse
Do Something!
Continue C.P.R.:
Caring
Life
DoPreserving
Something!
Referrals and Resources
Suicide Postvention
Survivor Reactions
High risk groups
Children/Siblings
“Stigma spillover”
Friends/Coworkers
Parents
Those who find the body
Spouses/Significant Others
Those who witness the suicide
Survivor Reactions
“Survivor Syndrome”
Shock
Numbness
Denial of death as a Suicide
Religious concerns
Prolonged search for “Why??”
Fear of personal susceptibility
Survivor Reactions
Emotional
Shame
Anger
Responsibility
Blaming
Scapegoating
Abandonment
Survivor Reactions
Loneliness
Social Isolation*
Social stigma
Diminished social supports
Difficulty trusting others
Negative family relations
Over protectiveness
Play video clip “Suicide Interviews Take 2”
stored on Disk #2
Suicide Is…
The Cost of Suicide
Cut off from support
Achievements minimized
Private shame and guilt
No honors or recognition
Support network collapses
Decreased benefits
“Hindering” Survivors
Denying the death as a suicide
Ignoring or not taking the problem
seriously
Pressuring them to “get over it”
Self-medicating/Taking them drinking
Offering negative religious judgments
Being judgmental
Helping Survivors
Let them talk
I’m sorry for your loss…
How can I help?
Is there anyone I can call for you?
Since the suicide, what are the biggest
challenges for you?
Use the loved one’s name.
Additional Help:
Help the group care about the person,
and accept the choice he or she made
Refer individuals who are struggling
excessively with anger, loss, or guilt
Don’t remain the only one helping
“Attitudes outweigh facts.
Attitudes must change so that
statistics can change.”
KARL MENNINGER
Do Something!
Let us all have
Not the
One
More…
courage
to take a stand
Not One More…