Mental Health EMERGENCIES. Mental Health: Emergencies This presentation deals with teen suicide,...

Mental HealthMental Health

EMERGENCIESEMERGENCIES

Mental Health: Mental Health: EmergenciesEmergencies• This presentation deals with teen suicide, which is This presentation deals with teen suicide, which is

a most difficult topic to consider.a most difficult topic to consider.• It is presented upon recommendations from It is presented upon recommendations from

national public and private organizations because national public and private organizations because teen suicide is a significant health issue for both teen suicide is a significant health issue for both teens and families.teens and families.

• It is based on current information from reliable It is based on current information from reliable sources, including:sources, including:– Mental Health AgenciesMental Health Agencies– Centers for Disease Control and PreventionCenters for Disease Control and Prevention– American Association of SuicidologyAmerican Association of Suicidology– Kids PeaceKids Peace– American Psychological AssociationAmerican Psychological Association

How Common Is Youth How Common Is Youth Suicide?Suicide?

In aIn a typical high school typical high school classroom in any one school classroom in any one school year…year…

• 55 students will have students will have considered suicide.considered suicide.

• 2.52.5 students will make a students will make a non-fatal attempt.non-fatal attempt.

• 11 student will make an student will make an attempt serious enough to attempt serious enough to require medical attention.require medical attention. Source: DE MHA, 10 / 2005


Suicide is the third leading cause of death Suicide is the third leading cause of death among young people ages 15 to 24. among young people ages 15 to 24.

Source: Source: http://www.cdc.gov/ncipc/factsheets/suifacts.htmhttp://www.cdc.gov/ncipc/factsheets/suifacts.htm


Boys are about four times more likely to Boys are about four times more likely to commit suicide as are girls, while girls commit suicide as are girls, while girls are twice as likely to attempt suicideare twice as likely to attempt suicide..

http://www.cdc.gov/ncipc/factsheets/suifacts.htmhttp://www.cdc.gov/ncipc/factsheets/suifacts.htm

Risk Factors in Youth Risk Factors in Youth SuicideSuicide

90 percent of children and adolescents 90 percent of children and adolescents who commit suicide have at least one who commit suicide have at least one mental disorder diagnosed before mental disorder diagnosed before their death.their death.


Risk factors are similar for boys and Risk factors are similar for boys and girls, but with marked differences in girls, but with marked differences in their relative importance:their relative importance:

• Among girls:Among girls:– The most significant risk factor is the The most significant risk factor is the

presence of presence of major depressionmajor depression, which , which increases the risk of suicide 12-fold. increases the risk of suicide 12-fold.

– The next most important risk factor is The next most important risk factor is a a previous suicide attemptprevious suicide attempt, which , which increases the risk approximately increases the risk approximately threefold.threefold.


Risk factors are similar for boys and Risk factors are similar for boys and girls, but with marked differences in girls, but with marked differences in their relative importance:their relative importance:

• Among boys:Among boys:– A A previous suicide attemptprevious suicide attempt is the most potent is the most potent

predictor, increasing the rate over 30-fold. predictor, increasing the rate over 30-fold. – The next most important risk factor is The next most important risk factor is

depressiondepression which increases the rate by about which increases the rate by about 12-fold.12-fold.

– Disruptive behaviorDisruptive behavior increases the by twofold. increases the by twofold.– Substance abuseSubstance abuse increases the risk by just increases the risk by just

under twofold.under twofold.


Social-cultural risk factors:Social-cultural risk factors:– Lack of social support and sense of isolation,Lack of social support and sense of isolation,– Stigma associated with help-seeking behavior,Stigma associated with help-seeking behavior,– Barriers to accessing health care, especially mental Barriers to accessing health care, especially mental

health and substance abuse treatment,health and substance abuse treatment,– Certain cultural and religious beliefs (for instance, Certain cultural and religious beliefs (for instance,

the belief that suicide is a noble resolution for a the belief that suicide is a noble resolution for a personal dilemma,personal dilemma,

– Exposure to others who have died by suicide,Exposure to others who have died by suicide,– Access to means of committing suicide (guns, Access to means of committing suicide (guns,

pills…).pills…).


Bio-psychosocial risk factors:Bio-psychosocial risk factors:• Mental disorders, particularly mood disorders, Mental disorders, particularly mood disorders,

schizophrenia, anxiety disorders and certain schizophrenia, anxiety disorders and certain personality disorders,personality disorders,

• Alcohol and other substance use disorders,Alcohol and other substance use disorders,• Hopelessness,Hopelessness,• Isolation,Isolation,• Impulsive and/ or aggressive tendencies,Impulsive and/ or aggressive tendencies,• History of trauma or abuse,History of trauma or abuse,• Previous suicide attempt,Previous suicide attempt,• Family history of suicide.Family history of suicide.


• Substance abuse as suicide riskSubstance abuse as suicide risk– Alcohol and cocaine abuse are present Alcohol and cocaine abuse are present

in 2/3 of suicides among 18-19 year old in 2/3 of suicides among 18-19 year old males.males.

– They are not commonly associated with They are not commonly associated with female or younger male teen suicide.female or younger male teen suicide.

– Alcohol is a depressant and worsens Alcohol is a depressant and worsens depression.depression.

Warning SignsWarning Signs

The following signs could be an The following signs could be an indication that someone is at risk for indication that someone is at risk for suicide.suicide.

• A sudden worsening in school performance, A sudden worsening in school performance,

• Self-mutilation, Self-mutilation,

• A fixation with death or violence,A fixation with death or violence,

• Unhealthy peer relationships, Unhealthy peer relationships,

• Volatile mood swings or a sudden change in Volatile mood swings or a sudden change in personality. personality.

Warning SignsWarning Signs

• Indications that the student is in an Indications that the student is in an unhealthy, destructive, or abusive unhealthy, destructive, or abusive relationship, relationship,

• Risk-taking behaviors,Risk-taking behaviors,• Signs of an eating disorder, Signs of an eating disorder, • Difficulty in adjusting to gender identity, Difficulty in adjusting to gender identity, • Bullying, Bullying, • Depression.Depression.

Precipitating FactorsPrecipitating Factors

Most suicide attempts are precipitated by Most suicide attempts are precipitated by interpersonal conflicts and poor coping interpersonal conflicts and poor coping skills, including poor stress skills, including poor stress management.management.

Source: American Association of Suicidology www.suicidology.orgSource: American Association of Suicidology www.suicidology.org


Interpersonal conflicts often precede a Interpersonal conflicts often precede a suicide and/or suicide attempt. suicide and/or suicide attempt. – Getting into trouble at school or with a law Getting into trouble at school or with a law

enforcement agency, enforcement agency, – A ruptured relationship with a boyfriend or a A ruptured relationship with a boyfriend or a

girlfriend, girlfriend, – A fight among friends, A fight among friends, – Family instability or conflict.Family instability or conflict.


Stressful eventsStressful events often precede a often precede a

suicide or suicide attempt.suicide or suicide attempt. – Unplanned pregnancy,Unplanned pregnancy,– An event related to sexual An event related to sexual

orientation.orientation.

Source: Kids Peace The National Center for Kids Overcoming Crisis. www.kidspeace.orgSource: Kids Peace The National Center for Kids Overcoming Crisis. www.kidspeace.org


Suicide is often associated with poor Suicide is often associated with poor coping skills to deal with a seemingly coping skills to deal with a seemingly unbearable situation, such as:unbearable situation, such as:

•Grief or loss,Grief or loss,•Acute or prolonged pain (emotional and Acute or prolonged pain (emotional and

physical),physical),•Desire to join a deceased loved one,Desire to join a deceased loved one,•Means of self-punishment,Means of self-punishment,•Anger at others,Anger at others,•Act of defiance, punishment of survivors, or Act of defiance, punishment of survivors, or

revenge,revenge,•Aim to avoid punishment for a crime.Aim to avoid punishment for a crime.

Other FactorsOther Factors

– Impulsive act during a psychotic Impulsive act during a psychotic episode,episode,

– Copycat intent – when there is a Copycat intent – when there is a suicide in a large school, the chance suicide in a large school, the chance of a second one increases by 300%.of a second one increases by 300%.

When to Act to Prevent When to Act to Prevent SuicideSuicide

Some warning signs of suicide demand Some warning signs of suicide demand immediate action:immediate action:– Talking or writing about suicide or death,Talking or writing about suicide or death,– Giving direct verbal cues, such as "I wish I Giving direct verbal cues, such as "I wish I

were dead" and "I'm going to end it allwere dead" and "I'm going to end it all““,,– Giving less direct verbal cues, such as "You will Giving less direct verbal cues, such as "You will

be better off without me," "What's the point of be better off without me," "What's the point of living?", "Soon you won't have to worry about living?", "Soon you won't have to worry about me," and "Who cares if I'm dead, anyway?"me," and "Who cares if I'm dead, anyway?"

– Expressing the belief that life is meaningless. Expressing the belief that life is meaningless.

When to Act to Prevent When to Act to Prevent SuicideSuicideSome warning behaviors of suicide demand Some warning behaviors of suicide demand

immediate action:immediate action:– Isolating him- or herself from friends and family,Isolating him- or herself from friends and family,– Giving away prized possessions,Giving away prized possessions,– Exhibiting a sudden and unexplained Exhibiting a sudden and unexplained

improvement in mood after being depressed or improvement in mood after being depressed or withdrawn,withdrawn,

– Neglecting appearance and hygiene,Neglecting appearance and hygiene,– Dropping out of school or social, athletic, and/or Dropping out of school or social, athletic, and/or

community activities,community activities,– Obtaining a weapon (such as a firearm) or Obtaining a weapon (such as a firearm) or

another means of hurting him- or herself (such another means of hurting him- or herself (such as prescription medications)as prescription medications)””..

How to Respond to Threats How to Respond to Threats of Suicide of Suicide

ACTACT

• Acknowledge their distress.Acknowledge their distress.

• Care about them.Care about them.

• Tell someone who can help them.Tell someone who can help them.

Source: Source: find the source of the acronym ACT and credit its usefind the source of the acronym ACT and credit its use

How to Respond to Threats How to Respond to Threats of Suicide of Suicide

• TAKE THEM SERIOUSLY. TAKE THEM SERIOUSLY.

• Call 911 if the threat is immediate.Call 911 if the threat is immediate.

• Call ANYWAY – even if they make you Call ANYWAY – even if they make you promise not to call.promise not to call.

• Find out where they are.Find out where they are.

• Remove any items with which the person Remove any items with which the person may hurt themselves.may hurt themselves.

Getting HelpGetting Help

Only 20 percent to 40 percent of Only 20 percent to 40 percent of adolescents and children who attempt adolescents and children who attempt suicide receive follow-up care after suicide receive follow-up care after receiving medical treatment in hospital receiving medical treatment in hospital emergency rooms – for the most part emergency rooms – for the most part because parents and children fail to because parents and children fail to respond. respond.

http://www.apa.org/monitor/jun00/suicide.htmlhttp://www.apa.org/monitor/jun00/suicide.html

Barriers to Getting HelpBarriers to Getting Help

– Mental disorders are often denied Mental disorders are often denied by youth.by youth.

– Those in need often refuse to seek Those in need often refuse to seek help.help.

– Those in need often believe nothing Those in need often believe nothing could help.could help.

– Those in need often do not know Those in need often do not know where to go.where to go.

Source: DE MHA, 10 / 2005

Mental Health EMERGENCIES. Mental Health: Emergencies This presentation deals with teen suicide,...

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