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 • • • • 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 • • • • • • • 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… • • • • 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) • • • • • 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 • • • • • 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 • • • • • “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 • • • • • “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… • • • • • • 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!
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