The Counseling Team Presents:

The Counseling Team International
and The Law Enforcement Wellness
Association Presents
Dealing with Depression
& Suicide Situations
Tactics for Prevention and Intervention
“Making Strides to Save Lives”
Suicide
A permanent solution to a
temporary situation…..
“Officers of the law are twice as likely to put
a gun to their heads as be killed by
someone else, and yet they are trained as if
exactly the opposite were true”
[Turvey]
Scope of the Problem
and Myths of Suicide
Why Are We Here?
“Although suicide is always complex
and multifactorial, most experts
feel the majority of suicides
remain preventable”
– Dr. Paul Quinnett, The QPR Institute
Why Are We Here?
“Now that we know suicide is
preventable, the race is between
education and tragedy”
– Dr. Paul Quinnett, The QPR Institute
Why Are We Here?
“Approximately 80% of suicides have
communicated their intent…”
– Ralph Slovenko – from the forward of
Dr. John Violanti’s book: Police Suicide; Epidemic in Blue
Statistics
Americans commit suicide at a rate of
about 11 per 100,000 residents
making suicide the 11th leading cause
of death in the United States
- American Association of Suicidology (AAS)
Statistics – 2003
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31,484 U.S. citizens committed suicide in 2003
Averages out to 86.3 per day
1 person every 16.7 minutes
Females make non-fatal attempts 3 times more
often than males
• However, males succeed 4 times more often
than females
• Catholics are far less likely to attempt suicide
Law Enforcement Statistics
The exact number of law enforcement suicides
are not known because…
• there is no national reporting forum such as,
for example, the FBI in the line of duty
death numbers
• most reputable studies are done within
geographical areas, not nationwide
• many experts feel the actual numbers are
under reported
Law Enforcement Statistics
• The Law Enforcement Suicide Rate
ranges between 17 and 22 per 100,000
- John M. Violanti, Ph.D.
• Well above the national average of 11
per 100,000
• 119 to 154 Law Enforcement Officers
are taking their own lives each year
Statistics
• Male officers are far more likely than
female officers to commit suicide
• Single never married are 2 times
more likely
• Married with small children –
lowest rate
Statistics
The “typical” officer who commits suicide is:
~ a white, 36.9 year-old, married male with 12.2
years of law enforcement experience
~ Off duty (86.3%)
~ With a gun (90.7%)
~ At home (54.8%)
–Michael G. Aamodt, Ph.D. and Nicole A. Werlick, M.A.
The “Real Truth”
Not a very pretty picture but the facts are:
• Police officers are 8 times more likely to die
from suicide than homicide
• 3 times more likely to die from suicide than
from accidental causes
• What is the true survival skill we seem to be
missing?
What we know…
and don’t know
• United States Law Enforcement
Personnel as of October 2000…
• 708,000 Full Time Sworn Officers
(State, County, and City)
U.S. Department of Justice
Bureau of Justice Statistics – Oct. 2002
Ranked Factors in Law
Enforcement Suicide
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Responses by NYPD Survey
Depression
Relationship conflicts or personal losses
Easy access to firearms
Drug and alcohol abuse
Financial difficulty
Internal investigations
Myths and Facts
Myth: People who talk about killing
themselves rarely commit suicide
Fact: Most people give definite warning
signs they will attempt suicide
Myths and Facts
Myth: Suicidal intentions are inherited and
passed from generation to generation
Fact: Suicide is not transmitted genetically
although chances are much greater if a
significant other has committed suicide
Myths and Facts
Myth: After depression begins to subside
the suicide danger is passed
Fact: In actuality, most suicides take
place within the first three months after
depression lifts
Myths and Facts
Myth: Only Experts can prevent suicide
Fact: Suicide prevention is everybody’s
business and anyone, with training,
can prevent the tragedy of suicide
Myths and Facts
Myth: Suicidal people keep their plans
to themselves
Fact: Most suicidal people communicate
their intent to someone within one
week of completing suicide
Myths and Facts
Myth: Once a person decides to
complete suicide, there is nothing
anyone can do to stop them
Fact: Suicide is viewed as the most
preventable form of death and almost
any positive action may save a life
Why Police Officers
Commit Suicide?
Primary Reasons
• Legal troubles
• Depression
• Relationship problems
• Fear of a secret getting out
Primary Reasons
• Gain attention
• Punish self or others
• To solve a problem
• Time to escape pain
• Continued pain worse than death
(depression)
Primary Reasons
• The ultimate revenge
• Shame
• Death of a child or spouse
• Loss of a child or spouse through divorce
• Terminal illness
Primary Reasons
• Responsibility for partners death
• Killed someone out of anger
• Feeling alone
• Sexual accusations
Primary Reasons
• Perfectionism:
*Self-oriented – “It makes me uneasy
to see an error in my work”
*Other-oriented – “If I ask someone to do
something, I expect it to be done flawlessly”
*Socially prescribed – “My family expects me to
be perfect”
-Hewwitt & Flett
Understanding
Depression
A Word About Depression…
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The #1 cause of completed suicide
The common cold of modern life….
Has biological foundations - Serotonin
Very highly treatable if detected and
acknowledged
• Wishing to be dead is a frequent
symptom of untreated depression
A Word About Alcohol…
• Alcohol dissolves the “wall of resistance”
that often keeps suicidal individuals alive.
• Alcohol is found in the blood of most
completed suicides – whether or not they
were problem drinkers.
• ALCOHOL MAKES DEPRESSION
WORSE!
Signs
• Poor appetite
• Weight loss
• Sleep disturbances
• Loss of interest
Signs
• Loss of energy
• Feelings of worthlessness
• Difficulty concentrating
• Repeated thoughts of suicide
Signs
• Appearance-neglected
• Behavior-fatigue
• Mood/affect-down
• Perceptions/illusions
• Thinking slowed
Behavior Changes
• Diminished interests
• Quiet/detached
• Considering career change
Behavior Changes
• Crying
• Withdrawal
• Retardation
• Agitation
• Hallucinations
Cognitive Changes
• Negative self-concept
• Negative view of the world
• Negative expectations for the future
Cognitive Changes
• Self-blame
• Self-criticism
• Indecisiveness
Cognitive Changes
• Helplessness
• Worthlessness
• Hopelessness
• Delusions
Physical Changes
• Sleep disorder
• Eating disorder
Physical Changes
• Menstrual/irregularity
• Impotence/frigidity
• Weight loss
High Risk Factors
Symptoms of depression:
15% of people untreated will commit suicide
Complaints of physical illness
50% will have visited their primary
physician within 1 week of the suicide
High Risk Factors
Substance abuser
Anxiety disorders
High levels of stress in life
History of family pathology
Suicide of role model
• Watch for same sex parent
High Risk Factors
Becomes withdrawn – shy, solitary
Sleep deprivation is the general complaint
Sleep is a metaphor for “death”
~ Put to rest
~ Slumber room
High Risk Factors
Has communicated suicidal thoughts
Unable to concentrate
Unable to deal with frustration – easily
angered
Seems to lose love of the profession
Giving away possessions
High Risk Factors
Major Losses in Life
Death
Divorce
Second divorce high
Separation
Recently separated high
High Risk Factors
Major Losses in Life
Unemployment
Status
Physical capabilities
Body image
Types of Losses
(Loss of some part of self)
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Physical
Emotional
Psychological
Family member
Mental functioning
- Disease
Losses can…
• be by choice
• be beyond their control
• come suddenly or gradually
Career Losses
• Terminated
• Promoted
• Changing careers
Age Related
(necessary)
• Mature
• Mid-life
• Retirement
Limbo State
• Time of waiting
• Outcome unknown
• Not knowing
Assessing Lethality
Thinking about suicide?
Suicide plan?
Thoughts?
Where?
When?
How?
Means available?
Previous attempts?
Co-Worker/
Supervisor Helping
Skills
Co-Worker/Supervisor
Helping Skills
• Active listening
• Ask – “Are you going to commit
suicide?”
• Use “I” messages
• If the idea is not there you will not
plant it
• Identify problem
Co-Worker/Supervisor
Helping Skills
• Allow ventilation
• Point out finality of death
• “Do you really want to die?”
• Empathy vs. Sympathy
• Reflection of feelings
• Problem ownership
Validation
Reassurance that their feelings are okay…
• “I can understand that…”
• “I imagine I would feel…”
Silence…
 Provides constructive time for person
to think rather than react
 Provides time to absorb what was
just said or what just occurred
 Provides quiet time to reflect on
feelings
Minimal Encouragers
• “Uhhm, unhuh, o.k., yes”
• Keep conversation going
and a rapport will establish
• Be direct
• Reduce lethality
• Get means as far away as possible
Minimal Encouragers
 Find out if they have done anything to
start to reach that goal
 Offer help immediately
 “What has happened in the last
24 hours to make you want to
commit suicide?”
 Identify what is worth living for
Alternatives
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Explore alternatives
Feelings about these alternatives
Consequences of alternatives
The one link between life and death
Explore possibility of help from
family or friends
Alternatives
• Professional
• Clergy
• Family
• Friends
• Be familiar with community resources
• Brainstorm new ideas with Peer
• Make a referral
Some Favorable Effects
• Suicidal people are most frequently
ambivalent about suicide
• Most people lack knowledge of how to
cause death
• In most instances you will have
the ability to move the peer in a
positive direction
• You will have positive, caring authority
Co-Workers/Supervisors
tend to:
• Overreact
• Underreact
Reactions to a Co-worker
Suicide
• Feelings of loss
• Feelings of anger
• Being made to feel responsible
• Being rejected
• Be aware of the arousal of one’s own
impulses toward suicide
• Calmness and optimism may precede
the suicidal act
Indirect Self-Destructive
Behavior
“I S D B”
-Farberow (1980)
The Crisis Telephone Call
• Fear of dying
• A form of manipulation
• Wants someone to know
• Looking for verification and permission
The Crisis State
• There has been a precipitating event in the
last 24 hours
• People turn inward away from support systems
• Surpasses normal coping skills
• Your task is to help them return to a normal
level of functioning
“For most people, the hot phase of a suicide crisis
begins and ends within approximately 3 weeks”
–Paul Quinnett, Ph.D.
Purpose of Intervention
 Diffuse intense emotions
 Buy time
 Establish a relationship/rapport
 Provide a safe environment of:
 Concern
 Empathy
 Acceptance
Purpose of Intervention
“I would like to know you better”
“Could you tell me about it?”
“I would like to hear your side”
“Could you share it with me?”
Do’s of Intervention
• Remain calm
• Help define the problem
• Rephrase thoughts
• Focus on central issue
• Stay close
• Emphasize temporary nature of
problem
Listen…Listen…Listen!!!
Don’ts of Intervention
• Do not overlook signs
• Do not sound shocked
• Do not offer empty promises
• Do not debate morality
• Do not leave person alone
• Do not remain the only person helping
Important Questions
• Have you been thinking of killing
yourself?
• How would you do it? Do you have the
means available?
• Has anyone in your family committed
suicide?
• What are the odds you will kill yourself?
• What has been keeping you alive so far?
• What does the future hold for you?
A Cry for Help is
Communication
A window of opportunity to
act boldly!
Law Enforcement Suicide
Prevention and Intervention
with the QPR Model
• Question the meaning of suicidal
communication
• Persuade the person to get help
• Refer to competent counseling
QPR Introduction
(CD)
QPR
Ask a question…..Save a life!
QPR
• QPR is not intended to be a form of
counseling or treatment
• QPR is intended to offer hope through
positive action
Suicide Warning Signs
• The more clues and signs observed, the
greater the risk
• Take all signs seriously
Direct Verbal Clues
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“I’ve decided to kill myself”
“I wish I were dead”
“I’m going to commit suicide”
“I’m going to end it all”
“If (such and such) doesn’t happen I’m
going to kill myself
Indirect or “Coded” Clues
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“I’m so tired of life I just can’t go on”
“Who cares if I’m dead anyway”
“I just want out”
“I won’t be around much longer”
“Pretty soon you won’t have to worry
about me”
QPR…Behavioral Clues
• Any previous suicide attempt
• Stockpiling pills
• Co-occuring depression, moodiness,
hopelessness
• Putting personal affairs in order
• Giving away prized possessions
• Sudden interest or disinterest in religion
• Drug or alcohol abuse or relapse after
period of recovery
Situational Clues
• Being terminated or an IA investigation
• Loss of any major relationship (red flag)
• Death of a close loved one or cherished
friend especially if by suicide
• Diagnosis of a serious or terminal illness
Situational Clues
• Sudden unexpected loss of freedom / fear of
punishment
• Anticipated loss of financial security
• Loss of a cherished therapist or counselor
• A fear of becoming a burden to others
Q = Question
Tips for asking the suicide question…
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If in doubt, don’t wait, ask the question
If the person is reluctant, be persistent
Find a private setting for your talk
Allow the person to talk freely
Give yourself plenty of time
Know what resources you have. QPR
Card, phone numbers, counselor’s
names and numbers, etc.
REMEMBER…………..
HOW YOU ASK THE QUESTION IS
LESS IMPORTANT THAN THAT
YOU ASK
How to Ask the Suicide Question
-Less Direct Approach• “Have you been unhappy lately?” “Have
you been very unhappy lately?” “Have
you been so unhappy lately that you have
been thinking of ending your life?”
• “Do you ever wish you could go to sleep
and never wake up?”
The Suicide Question
-Direct Approach• “You know, when people are as upset as you
seem to be, they sometimes wish they were
dead.” I’m wondering if you feel that way
too?”
• You look pretty miserable. Have you been
thinking of killing yourself?”
• “Are you thinking about killing yourself?”
(If you can’t ask the question, find someone who can)
P = Persuade
How to persuade someone to stay alive
• Listen to the problem with your full
attention
• Remember, suicide is not the problem,
only the solution to a perceived
insoluble problem
• Do not rush judgment
• Offer hope in any form
P = Persuade
Then Ask:
• “Will you go with me to get help?”
• “Will you let me help you get help?”
• “Will you promise me you won’t kill yourself
until we’ve found some help?”
YOUR WILLINGNESS TO LISTEN AND
HELP CAN REKINDLE HOPE AND MAKE
ALL THE DIFFERENCE!!
R = Refer
• Suicidal people sometimes feel they
can’t be helped so you may have to do
more
• The best referral involves taking the
person to immediate help
R = Refer
• The next best is getting a commitment from
them to accept help then making arrangements
for that help
• Third best is to give referral information and
attempt to get a good faith commitment not to
complete or attempt suicide. Any willingness
to accept help, even future help, is a good
outcome
Remember
• The closer someone is to attempting
suicide the more resistive they may be in
accepting help
• You must be patient and persistent
• Don’t give up!!
• During an intervention, you may have
really thrown in the “monkey wrench”
Remember
Since almost all efforts to persuade
someone to live instead of attempt
suicide will be met with agreement and
relief, don’t hesitate to get involved or
take the lead
Very Important!!
• In a suicide intervention, you will use
your communication skills
• Patience, compassion, understanding, and
listening skills will all come into play
• INSURE you have a plan in place and a
competent, qualified mental health
professional identified
For Effective QPR
• Say, “I want you to live, or “I’m on
your side….we’ll get through this”
• Get others involved. Ask the person
who else might help. Family? Friends?
Brothers or Sisters? Clergy?
Physician?
For Effective QPR
• Offer to work with the MHP or
whoever will be assisting the person
toward recovery
• Follow up with a simple visit, phone
call, or card. Let them know you care
about them. Caring may save a life
Please Remember
WHEN YOU APPLY THE
CONCEPTS OF QPR, YOU
PLANT THE SEEDS OF HOPE HOPE HELPS PREVENT
SUICIDE
Attitude
“The longer I live, the more I realize the impact of attitude on life.
Attitude, to me, is more important than facts. It is more important
than the past, than education , than money, than circumstances, than
failures, than successes, than what people think or say or do. It is
more important than appearance, giftedness or skill. It will make or
break a company…a church…a home. The remarkable thing is we
have a choice every day regarding the attitude we will embrace for
that day. We cannot change our past…we cannot change the fact
that people will act in a certain way. We cannot change the
inevitable. The only thing we can do is play on the one sure string
we have, and that is our attitude. I am convinced that life is 10%
what happens to me and 90% how I react to it. And so it is with
you…we are in charge of our own attitudes.”
Charles Swindoll
Good Bye &
Be Safe!