Post on 10-Feb-2016
description
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Suicide & Crisis Prevention
Bruce Michael Cappo, Ph.D.Clinical Associates, P.A.
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PremiseNearly all suicidal people do not
want to die
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PremiseThey are in a suggestible state &
likely to respond to your demandsTell them what they must do
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PremiseWhen suicidal - people are acutely
suicidalImminent danger lasts only seconds,
minutesIntervene prior to this critical stage
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PremiseThey have mixed emotions(That is why they called you)They want to be talked out of hurting
themselves
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Three H’sHopelessnessHelplessnessHaplessness
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HopelessnessStrongest predictor of suicideStronger than depressionOnly people who have lost all hope
kill themselvesDo whatever you can to build hope -
however smallThe want to have hope in the future
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HelplessnessPerson views himself as unable to
make any changes to the situationPerson views himself as unable to
make any changes in lifeHigh risk situation
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HaplessnessThese folks have sad lives25% have history of successful
suicides in familyHistory of mental illness, divorce,
abuse, unemployment, etc.Multiple problems at the same timeOverwhelmed
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Hardcore SuicideSerious about killing themselvesNothing you can do to stop them<5% of suicidal populationThey do NOT leave notes, call help
lines or even talk about their ideationYou only have contact with them after
they have completed the act
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Guns DO kill people64% of men use guns41% of women use guns
Dramatic increase for women over drug use since 1970
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NOT a spontaneous activityGradual wearing down away timeUsually no single precipitating eventSeries of eventsSeeds perhaps sown in childhoodIf child under 5 kills himself then
sibling is 9x more likely to attempt
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A Form of CommunicationUnderstand attempts as a form of
communicationDo not treat in a punitive mannerAsk:
what are they tryin gto say what needs are unsatisfied how can this be expressed differently what can I do to generate hope
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AmbivalenceLive & die at the same timeConfusion seeks resolution & they callFeelings peak prior to taking actionWhen they pull the trigger they have
resolved the ambivalence and are satisfied with the decision
Use ambivalence to help themYou do not want them to reach the resolution
stage
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The Significant OtherUsually another person is involvedFind out who would be most effected
by their actionMay seek a short term solution to a
problem involving this persone.g. had a fight & walked out - you help
restore communication without manipulations the underlying motivator
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Motivations for AttemptersEscape intolerable situationsJoin a deceased loved oneManipulate othersGain attentionPunish survivorsRevengeControl when death occursBecome a martyrNot want to be a burden to othersTerminal disease
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Early Signals75% of attempters give notice
behavioral, written, verbalDo not ignore these signsDo not panic at first sign - Inquire, attend & look for a clustering
of symptoms
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Types of SignalsHigh risk situationDepressive symptomsVerbal warningsBehavioral warnings
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High Risk SituationsSudden, unexpected trauma that
strikes at heart of our existenceOne spouse dies in a situation where
they are highly dependent on one another
Great athlete becomes paralyzedDiagnosis of traumatic illness
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Depressive SymptomsLoss of appetite or eat constantlyAnhedoniaLethargyApathyWithdrawalNot care about appearanceSubstance use
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Verbal WarningsThey come right out and tell you that
this is an option for them and that they are considering it
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Behavioral WarningsStrongest behavioral warnign is an
unsuccessful attemptOver 40% of completers have at
least one prior attempt
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DIRTDangerousnessImpression of degree of riskRescueTiming
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DangerousnessHow dangerous was attempt3 pills or whole bottle
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Impression of Degree of RiskDid they think they would dieThey may have thought 3 pills would
kill them
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RescueChances that they would be found
and rescuedDid it happen right after everyone
left in morning or right before they were to return home
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TimingThe more recent the attempt the
more dangerous
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DON’TsNEVER say “why would you do that -
you have so much to live for”Focus on HOW they would do it to
asses lethality & imminence of situation
Do not be afraid to ask straight out - you will not give ideas
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Assessing Seriousness - SLAPSpecific
More specifc = greater riskLethality
Gun to head more lethal than cutting wristsAvailability
Can they get what they need easilyProximity
The farther from the greater the lethality
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Okay, Okay, all that is fine and good…
BUT …What do I do if someone actually calls when I am on the phones?
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Establish Relationship with the PersonReinforce for them having calledBe non-judgementalExude confidence & concernReassure them that you will be there
to helpGet info (phone #, location, etc.)
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Assess RiskSLAP
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Identify the ProblemKeep in mind that they may have
been dwelling on this for years & you will not have a magic answer for them
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Assess their ResourcesAsk about significant others, etc.
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Mobilize Their ResourcesHave them involve others
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DOsSound calm & understandingTake a positive approachTry to remove accessibility to the
means
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DON’TsBe shocked by what they sayStress the embarassment they would
put others throughEngage in debate or argue
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75% of those who attempt or complete will threaten
35% of completers have a prior attempt
10% of attempters successfully complete
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Teens80-90% of adolescent attempts are
via drugsMost completers involve firearms
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Completers - 14 and OlderMost often Male 3.7 : 1Most often by firearm in homeMales tend to act out prior to
completion with conduct disordersFemales tend to act out prior to
completion with prior suicidal attempts
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Attempters 14 and OlderMost often female 3 : 1
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Significant Events in 12 Months Prior to DeathDeath of grandparentHospitalization of parentSeparation of parentDivorce of parentRemarriage of parentSerious psychological trauma
watch spousal homicide, etc.
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Alerting Signs - History of ...Family Hx positive for suicide,
depressionExposure to peer, sibling suicidePrior attemptSignificant change (anticipated or real)Parental conflictParental pathology
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Alerting Signs - Current ...Antisocial acting out behaviorsDepressed or withdrawnHoplessnessSubstance abuseRigid perfectionismIdetifies with peer who
attempted/completedFeels trapped
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Assessing ImminenceCompulsion to actInability to stop self from doing itAvailable & readily accessible
methodNote already written
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Contraindications to Imminent ActionResources / Supports / Alliances
through therapist, crisis line, etcAbility to form short term ‘no harm’
contractAbility to engage in cognitive rehearsalAbility to engage in self assessmentCan see positives and gray areasSituation specificity of suicidal urge
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Children 5-14 y/oCompletions rareSome completions may be disguised
as accisdents running into traffic, etc.
12,000 inpatient admits for attempts each year
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Adolescents 15-24 y/o 1 of 2
5000 completions each year2nd leading cause of death for white
males75% of all completions are by white males80% of all attempts are by white femalesIncreased use of firearms by both genders
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Adolescents 15-24 y/o 2 of 2
Attempts estimated at 110 for every completion
Only one in eight may be treatedTopeka survey estimates that
2,000,000 high school students under age 19 have at some time in their lives made an attempt
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Older AdultsFastest growing groupHighest for divorced or widowedHigher prevalence of alcohol abuseHigher prevalence of depressionUse highly lethal methodsFewer attempts per suicideHave more illnessHave increased social isolation
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Time For Your Questions