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Slide1
RichShannon
NCC,LMFT,LCADC
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Slide2
Thistrainingwillconsider:basicstrategiesinaddressingsuicidalthoughtsandbehaviors,techniquesforassessingsuicidalideationandconsiderationsforbestpracticesinrespondingtotheseuniquesituations.Inadditionwewillevaluatehowsuicidemayormaynothaveimpacteduspersonallyandtherolethatplaysinourpractice.
CourseDescription
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Slide3
https://www.samhsa.gov/sites/default/files/programs_campaigns/ccbhc-criteria.pdf
InCaseYouDon’tHaveIt
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Slide4
Atorientationandannuallythereafter,doestheclinicprovide(ataminimum)trainingon(1)riskassessment,suicideprevention,andsuicideresponse;(2)therolesoffamiliesandpeers;and(3)othertrainingsrequiredbythestateoraccreditingagency?
DoestheclinicprovideinstructionsonhowtoaccesscrisisservicesandPsychiatricAdvancedDirectivesusingappropriatemethods,language(s),andliteracylevelsinaccordancewiththepopulations identifiedduringtheneedsassessment?
Doclinicprotocolsandproceduresprovidefortransferofmedicalrecordsofservicesreceived(e.g.,prescriptions),activefollow-upafterdischarge,and,asappropriate,aplanforsuicidepreventionandsafety,andprovisionforpeerservices?
Doestheclinichavepoliciesorproceduresthataredesignedtoreducesuicideriskinplaceforindividualswhoareadmittedtothesefacilitiesasapotentialsuiciderisk?Ifagreementscannotbeestablished,whatistheclinicjustificationforlackofagreement?Ifagreementscannotbeestablished,doestheclinichaveasufficientcontingencyplanforprovisionofservicesorarefurthereffortsrequired?
InRelationtoSuicide
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Slide5
Doestheclinichaveanestablishedprotocolthatspecifiestheroleoflawenforcementduringtheprovisionofcrisisservices?
Anassessmentofwhethertheconsumerisarisktoselfortoothers,includingsuicideriskfactors
adiagnosticassessment,includingcurrentmentalstatus,mentalhealth(includingdepressionscreening)andsubstanceusedisorders(includingtobacco,alcohol,andotherdrugs);
assessmentofimminentrisk(includingsuiciderisk,dangertoselforothers,urgentorcriticalmedicalconditions,otherimmediaterisksincludingthreatsfromanotherperson);
Targetedcasemanagementshouldincludesupportsforpersonsdeemedathighriskofsuicide,particularlyduringtimesoftransitionssuchasfromanEDorpsychiatrichospitalization
DoestheCQIprocessaddresstrackingofsuicideattemptsandcommittedsuicides?
InRelationtoSuicide
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Slide6
ProcessingofAttitudes,ExperiencesandPerceptionsFactsandFiguresConsiderationsIncludingAlcohol,DrugsandBeyondAssessmentResponseApplication
Wherearewegoing?
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Slide7
Rememberthefirstsubstanceabuseclientyouinterviewed?Doyourememberyourinternalreactiontothatinterview?Now,you’realotmorecomfortabletalkingwithclientsabouttheirdrughistory,theircurrentsymptoms,andtheirplansforrecovery.Nothingreducesanxietymorethanpractice.Thesameholdstrueabouttalkingwithyourclientsaboutsuicidalthoughtsandbehaviors.Ifyouneedtoreduceyourinitialdiscomfortonthetopic,practicewithanothercounselororyourclinicalsupervisor.Getfeedbackabouthowyouarecomingacross.Startaskingeveryoneofyourclientsaboutsuicidality.Themoreexperienceyouhave,themorecomfortableyouwillbecome.(TIP50)
Practice,Practice,Practice
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Slide8
Whythismatters…
Processing
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Slide9
…yourattitudesaboutsuicidearestronglyinfluencedbyyourlifeexperienceswithsuicideandsimilarevents.Needlesstosay,yourresponsestosuicideandtopeoplewhoaresuicidalarehighlysusceptibletoattitudinalinfluence,andtheseattitudesplayacriticalroleinworkwithpeoplewhoaresuicidal.Anempathicattitudecanassistyouinengagingandunderstandingpeopleinasuicidalcrisis.Anegativeattitudecancauseyoutomissopportunitiestoofferhopeandhelportooverreacttopeopleinasuicidalcrisis.(TIP50)
AttitudeConsiderations:
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Slide10
Objectives:Minimizeanxietyaboutdiscussingsuicide.Exploreattitudetowardsuicideandpotentialforpersonalandprofessionalimpact.Whatismypersonalandfamilyhistorywithsuicidalthoughtsandbehaviors?WhatpersonalexperiencesdoIhavewithsuicideorsuicideattempts,andhowdotheyaffectmyworkwithsuicidalclients?Whatismyemotionalreactiontoclientswhoaresuicidal?HowdoIfeelwhentalkingtoclientsabouttheirsuicidalthoughtsandbehaviors?WhatdidIlearnaboutsuicideinmyformativeyears?HowdoeswhatIlearnedthenaffecthowIrelatetodaytopeoplewhoaresuicidal,andhowdoIfeelaboutclientswhoaresuicidal?WhatbeliefsandattitudesdoIholdtodaythatmightlimitmeinworkingwithpeoplewhoaresuicidal?
ProcessingofAttitudes,ExperiencesandPerceptions
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Slide11
PositiveAttitudeandBehavior1:Peopleinsubstanceabusetreatmentsettingsoftenneedadditionalservicestoensuretheirsafety.PositiveAttitudeandBehavior2:Allclientsshouldbescreenedforsuicidalthoughtsandbehaviorsasamatterofroutine.PositiveAttitudeandBehavior3:Allexpressionsofsuicidalityindicatesignificantdistressandheightenedvulnerabilitythatrequirefurtherquestioningandaction.
TIP50’s6PositiveAttitudesandBehaviorstoConsider
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Slide12
PositiveAttitudeandBehavior4:Warningsignsforsuicidecanbeindirect;youneedtodevelopaheightenedsensitivitytothesecues.PositiveAttitudeandBehavior5:Talkingaboutaclient’spastsuicidalbehaviorcanprovideinformationabouttriggersforsuicidalbehavior.PositiveAttitudeandBehavior6:Youshouldgiveclientswhoareatriskofsuicidethetelephonenumberofasuicidehotline;itdoesnoharmandcouldactuallysavealife.
TIP50’s6PositiveAttitudesandBehaviorstoConsider
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Slide13
Nowthatwehaveprocessedattitudes,experiencesandperceptionswhatisaprofessionalconsiderationforyoumovingforward?
Application
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Slide14
Objectives:Considerintentionalitywhenworkingwithallclientsanduniqueriskfactorsforspecificpopulations.
Createawarenessofthenumberofsuicidesandtheimpactonsocietyandothers.
FactsandFigures
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Slide15
Suicideisaleadingcauseofdeathamongpeoplewhoabusealcoholanddrugs(Wilcox,Conner,&Caine,2004).Comparedtothegeneralpopulation,individualstreatedforalcoholabuseordependenceareatabout10timesgreaterrisktoeventuallydiebysuicidecomparedwiththegeneralpopulation,andpeoplewhoinjectdrugsareatabout14timesgreaterriskforeventualsuicide(Wilcoxetal.,2004).Individualswithsubstanceusedisordersarealsoatelevatedriskforsuicidalideationandsuicideattempts(Kessler,Borges,&Walters,1999).
FactsandFigures
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Slide16 Peoplewithsubstanceusedisorderswhoareintreatmentareatespeciallyhighriskofsuicidalbehavior
formanyreasons,including:
Theyentertreatmentatapointwhentheirsubstanceabuseisoutofcontrol,increasingavarietyofriskfactorsforsuicide(Ross,Teesson,Darke,Lynskey,Ali,Ritter,etal.,2005).
Theyentertreatmentwhenanumberofco-occurringlifecrisesmaybeoccurring(e.g.,marital,legal,job)(Rossetal.,2005).
Theyentertreatmentatpeaksindepressivesymptoms(Rossetal.,2005).
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Slide17
Mentalhealthproblems(e.g.,depression,posttraumaticstressdisorder[PTSD],anxietydisorders,somepersonalitydisorders)associatedwithsuicidalityoftenco-occuramongpeoplewhohavebeentreatedforsubstanceusedisorders.Crisesthatareknowntoincreasesuiciderisksometimesoccurduringtreatment(e.g.,relapseandtreatmenttransitions).
Whatelsemightincreasesuicideriskamongpeoplewithsubstanceusedisorders?
Peoplewithsubstanceusedisorderswhoareintreatmentareatespeciallyhighriskofsuicidalbehavior
formanyreasons,including:
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Slide18
Suicideisthe10thleadingcauseofdeath,claimingmorethantwiceasmanyliveseachyearasdoeshomicide.1Onaverage,between2001and2009,morethan33,000Americansdiedeachyearasaresultofsuicide,whichismorethan1personevery15minutes.1Morethan8millionadultsreporthavingseriousthoughtsofsuicideinthepastyear,2.5millionreportmakingasuicideplaninthepastyear,and1.1millionreportasuicideattemptinthepastyear.3Almost16percentofstudentsingrades9to12reporthavingseriouslyconsideredsuicide,and7.8percentreporthavingattemptedsuicideoneormoretimesinthepast12months.4
AdditionalFactsandFiguresAboutSuicide
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Slide19
Despitetheseverypersonalexperiences,mostAmericansaresurprisedtolearnthatbetween2001and2009,anaverageof33,000suicidedeathsoccurredeachyearintheUnitedStates.Suicideisamongthetopfivecausesofdeathforadultsunderage45intheUnitedStates,andin2009,moreAmericansdiedfromsuicidethanfrommotorvehicletraffic-relatedinjuries.(U.S.DeptofHHS)
Afteradecadeofadvancementsinsuicideprevention,weNationalCouncilforSuicidePrevention(NCSP)remainconcernedthatthenationisstillinaperiodofrisingsuiciderates.Therefore,webelievethatthetimingforarevisedNationalStrategyisrightandthatitoffersanimprovedframeworkforachievingourultimategoalofsavinglives.(U.S.DeptofHHS)
AdditionalFactsandFiguresAboutSuicide
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Slide20
Theeffectofsuicideoncommunitiesacrossournationgoesbeyondthepersonal.Suicideaffectssomeofthemostimportantconcernsofourtime.SuicideamongthosewhoserveinourArmedForcesandamongourveteranshasbeenamatterofnationalconcern.Thelargestnumberofsuicidaldeathseachyearoccursamongmiddle-agedmenandwomen,sappingtheworkforceweneedtogrowoureconomy.Thefactthatsuicidalbehavioroccursamongsomeofourmostmarginalizedcitizensisacalltoactionwemustembrace.(U.S.DeptHHS)
AdditionalFactsandFiguresAboutSuicide
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Slide21
Istheresomethingyoudidn’tknow?
Istheresomethingthatsurprisedyou?
Istheresomethingthatincreasedyourawarenessthatcouldbeusedinprofessionalapplication?
Application
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Slide22
Objectives:Considerspecificpopulationsidentifiedasbeingathigherriskforsuicide.
Considerspecificlifeeventsthatmaycreateahigherriskforsuicide.
Considerationsincludingalcohol,drugsandbeyond.
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Slide23
Exceptasnoted,thefollowinginformationonsuiciderisksinspecificpopulationsisfromthe:
2012NationalStrategyforSuicidePrevention:GOALSANDOBJECTIVESFORACTIONAreportoftheU.S.SurgeonGeneralandoftheNationalActionAllianceforSuicidePrevention
Emphasishasbeenadded.
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Slide24
In2009,thesuiciderateamongAmericanIndians/AlaskaNatives(AI/AN)was11.91per100,000,whichissimilartotheoverallU.S.rateof11.77.However,suicideratesaremuchhigheramongAI/ANyouththanamongyouthoverall. In2009,therateofsuicideamongAI/ANyouthaged10to18yearswas10.37per100,000,comparedwithanoverallrateof3.95per100,000. SuicideisthesecondleadingcauseofdeathamongAI/ANyouthaged10to34years,withyoungNativemenaged20to24havingthehighestrateofsuicideintheAI/ANpopulation:40.79deathsper100,000.Althoughsuicideratesvarywidelyamongindividualtribes,itisestimatedthat14to27percentofAI/ANadolescentshaveattemptedsuicide.
AmericanIndians/AlaskaNatives
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Slide25
Researchindicatesthatculturalcontinuity, highlevelsofculturalspiritualorientation, andconnectednesstofamilyandfriends areprotectivefactorsforsuicidalbehaviorsamongAI/ANpopulations.Specificriskfactorsparticulartothisgroupincludealcoholandothersubstanceuse, discrimination, limitedmentalhealthservicesaccessanduse, andhistoricaltrauma. FindingsfromtheAdverseChildhoodExperiences(ACE)studysuggestthatthereisastrongandpositivecorrelationbetweenthenumberofadverseeventsinachild’slifeandtheprobabilityfornegativeoutcomesduringadulthood. Inreservationsettings,AI/ANyouthhaveconsiderableexposuretosuicideandmaybeatparticularriskforcontagion.MuchoftheresearchavailableonAI/ANracialandethnicdisparitiesdoesnotincludeurban(non-reservation)areas,whereamajority(78percent)ofNativepeopleintheUnitedStateslive. Comparedwithotherracialandethnicgroups,fewresourcesaredevotedtothehealthneedsoftheurbanAI/ANpopulation, andmanyhaveexperiencedlossesofcommunity,language,andethnicidentity.
AmericanIndians/AlaskaNatives
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Slide26Theimpactofsuicidecanbeprofoundandsometimesdevastatingforthosewhoareleftbehind.Eachyear,morethan13millionpeopleintheUnitedStatesreportthattheyhaveknownsomeonewhodiedbysuicidethatyear. Conservativeestimatessuggestthattherearetypicallyatleastfiveorsixfamilymemberswhoareaffectedwhenafamilymembertakeshisorherlife,andperhapsasmanyas30to60peopleinthelargersocialnetworkwhoalsomaybeaffected.Moreover,exposuretosuicidecarriesrisksforelevatedratesofguilt,depression,andotherpsychiatricsymptoms,complicatedgrief,andsocial isolation.Alarmingly,thereisalsocompellingevidencethatindividualsbereavedbysuicide(alsoreferredtoas“survivorsofsuicideloss”)mayhaveanincreasedriskforsuicidecompletionthemselves.Therefore,toparaphraseEdwinShneidman,helpingthosewhohavebeenbereavedbysuicideisadirectformofsuicidepreventionwithapopulationknowntobeatrisk.
IndividualsBereavedbySuicide
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Slide27
Suicideisoftenthesinglemostcommoncauseofdeathinsecurejusticesettings.Morethan400suicidesoccurannuallyinlocaljailsataratethreetimesgreaterthanamongthegeneralpopulation,andsuicideisthethirdleadingcauseofdeathinprisons. Youthinvolvedinthejuvenilejusticeandchildwelfaresystemshaveahighprevalenceofmanyriskfactorsforsuicide.Althoughstatisticsonprevalenceareunavailable,juvenilesinconfinementhavelifehistoriesthatputthemathighersuiciderisk,includingexperiencessuchasmentaldisordersandsubstanceabuse;physical,sexual,andemotionalabuse;andcurrentandpriorself-injuriousbehavior. Youthinfostercaresharemanyofthesetraumaticexperiences.Inonestudy,childreninfostercarewerealmostthreetimesmorelikelytohaveconsideredsuicideandalmostfourtimesmorelikelytohaveattemptedsuicidethanthosewhohadneverbeeninfostercare. Suicideamongyouthincontactwiththejuvenilejusticesystemoccursatarateaboutfourtimesgreaterthantherateamongyouthinthegeneralpopulation. Researchsuggeststhatyouthengageinmorethan17,000incidentseachyearinjuvenilefacilities,thatmorethanhalfofalldetainedyouthreportedcurrentsuicidalideation,andthatone-thirdalsohadahistoryofsuicidalbehaviors.
IndividualsinJusticeandChildWelfareSettings
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Slide28
ResearchofNSSIandDSHpopulationsshowsarelativelystrongrelationshipbetweenself-injuryandsuicidalbehaviors.AnAustralianstudyfoundthatapproximately30percentofpatientspresentingwithself-poisoningtoanemergencydepartment(ED)reportedpreviousepisodesofself-harm.OfpatientswhopresentedtotheEDonmorethanoneoccasion,3percentdiedbysuicidewithin5yearsand4percentwithin10years.Inafollow-upstudyofdeliberateself-harmconductedintheUnitedKingdom,deathbysuicidewas17timesmorefrequentthanexpectedinthosewhohadpreviouslypresentedtoageneralhospitalwithdeliberateself-harm. InanotherU.K.follow-upstudyofdeliberateself-harm,therewasanapproximately30-foldincreaseinriskofsuicidecomparedwiththegeneralpopulation.Suiciderateswerehighestwithinthefirst6monthsafterthefirstself-harmepisode.Asystematicreviewoftheinternationalliteratureonfatalandnonfatalrepetitionofself-harmfoundthatafter1year,nonfatalrepetitionofself-harmbehaviorswasapproximately15percent. Thereviewfoundthatsuicideriskwashundredsoftimeshigheramongself-harmpatientsthaninthegeneralpopulation.
IndividualsWhoEngageinNonsuicidalSelf-Injury
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Slide29
Aprevioussuicideattemptisaknownpredictorofsuicidedeath.Astudyofindividualswhohadsurvivedaserioussuicideattempt,conductedinNewZealand,foundthatalmosthalfmadeanotherattemptorsubsequentlydiedbysuicidewithin5years.Manyindividualsdonotreceiveongoingtreatmentormentalhealthcareafteranattempt,althoughtheymaycontinuetoexperiencesuicidalthoughts. Inaddition,astudyconductedintheUnitedKingdomfoundthatmanypeoplewhodiebysuicidedosowithin30daysofhavingbeendischargedfromahospitalforapreviousattempt,oftenbeforeanappointmentforservices.
IndividualsWhoHaveAttemptedSuicide
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Slide30
Morethan60percentofsuicidaldeathsoccuramongindividualswithmooddisorders.Suicideriskisparticularlyhighamongindividualswithbipolardisorders,whichisstronglyassociatedwithsuicidethoughtsandbehaviors.Overtheirlifetime,thevastmajority(80percent)ofpatientswithbipolardisordershaveeithersuicidalideationorideationplussuicideattempts.Inclinicalsamples,14to59percentofthepatientshavesuicideideation,and25to56percentattemptsuicideatleastonceintheirlifetime.Approximately15to19percentofpatientswithbipolardisordersdiefromsuicide.Thesuiciderateamongpatientswithbipolardisordersisestimatedtobemorethan25timeshigherthantherateinthegeneralpopulation.Severalfactorscanincreasetheriskforsuicideamongpatientswhohavemooddisorders.Thesefactorsincludearecentsuicideattemptandaseveremajordepressiveepisode,oftenaccompaniedbyfeelingsofhopelessnessandguilt,abeliefthatthatarefewreasonsforliving,thoughtsofsuicide,agitation,insomnia,appetiteandweightloss,andpsychoticfeatures. Suicidalbehaviorsamongmooddisorderpatientsoccuralmostexclusivelyduringanacute,severe,majordepressiveepisode.
IndividualswithMentalDisorders:MoodDisorders
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Slide31
Thepresenceofanyanxietydisorderissignificantlyassociatedwithsuicidalideationandsuicideattempts.Anxietydisorderscommonlyoccuralongwithothermentalorphysicalillnesses,includingalcoholorsubstanceabuse,whichmaymaskanxietysymptomsormakethemworse.Thepresenceofanyanxietydisorderincombinationwithamooddisorderisassociatedwithahigherlikelihoodofsuicideattemptsincomparisonwithamooddisorderalone.Amongadultsinthegeneralpopulation(i.e.,notintheArmedForcesorveterans),panicdisorderandPTSDhavebeenfoundtobemorestronglyassociatedwithsuicideattemptswhenthereisaco-occurringpersonalitydisorder.
IndividualswithMentalDisorders:AnxietyDisorder
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Slide32
Ithasbeenestimatedthatbetween3and10percentofpatientswithBPDdiebysuicide. Recurrentsuicideattempts,self-injury,andimpulsiveaggressiveactsareoftenassociatedwithBPDandoftenresultinemergencyandinpatienttreatment.SuicidesinBPDoftenoccurlateinthecourseoftheillnessandfollowlongcoursesofunsuccessfultreatment.
IndividualswithMentalDisorders:BorderlinePersonalityDisorder
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Slide33
Theriskforsuicideinindividualssufferingfromschizophreniaisparticularlyhighintheearlystagesoftheillness(first3–5yearsofonset).Ameta-analysisofmorethan60studiesfoundthatalmost5percentofschizophrenicpatientswilldiebysuicideduringtheirlifetimes,usuallyneartheonsetoftheillness. Survivingtheinitialperiodofheightenedriskresultsinalesser,althoughstillconsiderable,riskofdeathbysuicide.Thegreatestindicatorofsuicideriskamongpeoplewithschizophreniaisactivepsychoticillness(e.g.,delusions)combinedwithsymptomsofdepression.Greaterinsightintothepsychoticillnessitself,theneedfortreatment,andtheconsequencesofthedisorderarestronglyrelatedtosuiciderisk. Increasedriskforsuicideisalsoassociatedwithhigherlevelsofeducationandhighersocioeconomicstatus.Alcoholabusehasbeenreportedinstudiesexaminingsuicideattempts.
IndividualswithMentalDisorders:Schizophrenia
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Slide34
StudiesoverthelastfourdecadessuggestthatLGBTindividualsmayhaveanelevatedriskforsuicideideationandattempts.Attentiontothisdisparityhasbeenlimited,inpartbecauseneithertheU.S.deathcertificatenortheNVDRSidentifydecedents’sexualorientationorgenderidentity.Thus,itisnotknownwhetherLGBTpeoplediebysuicideathigherratesthancomparableheterosexualpeople.
Lesbian,Gay,Bisexual,andTransgenderPopulations
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Slide35
Acrossmanydifferentcountries,astrongandconsistentrelationshipbetweensexualorientationandnonfatalsuicidalbehaviorhasbeenobserved. Ameta-analysisof25internationalpopulation-basedstudiesfoundthelifetimeprevalenceofsuicideattemptsingayandbisexualmaleadolescentsandadultswasfourtimesthatofcomparableheterosexualmales. Lifetimesuicideattemptratesamonglesbianandbisexualfemaleswerealmosttwicethoseofheterosexualfemales.Lesbian,gay,andbisexual(LGB)adolescentsandadultswerealsofoundtobealmosttwiceaslikelyasheterosexualstoreportasuicideattemptinthepastyear.Alatermeta-analysisofadolescentstudies concludedthatLGByouthwerethreetimesmorelikelytoreportalifetimesuicideattemptthanheterosexualyouth,andfourtimesaslikelytomakeamedicallyseriousattempt.Acrossstudies,12to19percentofLGBadultsreportmakingasuicideattempt,comparedwithlessthan5percentofallU.S.adults;andatleast30percentofLGBadolescentsreportattempts,comparedwith8to10percentofalladolescents.Todate,population-basedstudieshavenotidentifiedtransgenderparticipants,butnumerousnonrandomsurveysshowhighratesofsuicidalbehaviorinthatpopulation,with41percentofadultrespondentstothe2009NationalTransgenderDiscriminationSurveyreportinglifetimesuicideattempts.
Lesbian,Gay,Bisexual,andTransgenderPopulations
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Slide36
Moststudieshavefoundsuicideattemptratestobehigheringay/bisexualmalesthaninlesbian/bisexualwomen,whichistheoppositeofthegenderpatternfoundinthegeneralpopulation.Asintheoverallpopulation,thereissomeevidencethatthefrequencyofsuicideattemptsmaydecreaseasLGBadolescentsmoveintoadulthood,althoughpatternsofsuicideattemptsacrossthelifespanofsexualminoritypeoplehavenotbeenconclusivelystudied.WithinLGBsamples,especiallyhighsuicideattemptrateshavebeenreportedamongAfricanAmerican,Latino,NativeAmerican,andAsianAmericansubgroups.
Lesbian,Gay,Bisexual,andTransgenderPopulations
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Slide37
ThesuiciderateforactivedutymilitarypersonnelhashistoricallybeensignificantlylowerthantherateforacomparablepopulationofAmericans.However,boththenumbersandratesofsuicidehavebeenincreasingoverthepastdecade.In2001,theU.S.DepartmentofDefense(DoD)recorded160totalsuicidesforarateof10.3per100,000.Suicideratesbegantoincreasein2006,drivenprimarilybyasteadyupwardtrendinthenumberofsuicidesintheArmyandMarineCorps.In2009,theDoDidentified309totalactivedutysuicides,forarateof18.3per100,000.ThenumberofsuicideshasbeenontheriseintheReserveComponent(RC)aswell.In2009,therewere104suicidesofservicememberswhowereintheRCandnotonactivedutyatthetimeoftheevent. In2010,thisnumberincreasedto180,withtheArmyNationalGuardhavingthelargestincreaseinthetotalnumberofsuicidesfrom48in2009to101in2010.
MembersoftheArmedForcesandVeterans
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Slide38
Forcalendaryear2010,servicememberswhowerewhiteandundertheageof25,juniorenlisted(E1–E4),orhighschooleducatedwereatincreasedriskforsuiciderelativetocomparisongroupsinthegeneralpopulation.Servicemembersmostfrequentlyusedfirearmsasthemeansforsuicide.Drugoverdosewasthemostfrequentmethodforsuicideattempts,andthemisuseofprescriptionmedicationwasmorefrequentthanillegaldrugs.Mostservicememberswerenotknowntohavecommunicatedtheirpotentialforself-harmwithotherspriortosuicideorattemptedsuicide.Themajorityofservicememberswhodiedbysuicidedidnothaveaknownhistoryofamentalorsubstanceusedisorder.Finally,theoverwhelmingmajorityofsuicidesoccurredinanondeployedsetting,andmorethanhalfofthosewhodiedbysuicidedidnothaveahistoryofdeployment.
MembersoftheArmedForcesandVeterans
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Slide39
TheCentersforDiseaseControlandPrevention(CDC)estimatesthatveteransaccountforapproximately20percentofthedeathsfromsuicideinAmerica. ThereiscontroversyinthescientificliteratureaboutwhethersuicideratesarehigheramongveteransthanamongotherAmericansaftercontrollingforsex,age,andminoritystatus. However,ratesappeartobeincreasedamongtwoimportantgroups:veteranswhohaverecentlyreturnedfromserviceinAfghanistanandIraq, andthosewhoreceivehealthcareservicesfromtheVeteransHealthAdministration(VHA), thehealthcaresystemoperatedbytheU.S.DepartmentofVeteransAffairs(VA).Inthemostrecentyearsforwhichdataareavailable,suicideratesformaleVHApatientswereapproximately1.4timesgreaterthanforotherAmericanmen.ForfemaleVHApatients,rateswereapproximatelytwiceashighasamongAmericanwomen.Bothincreasesreflectthehigherratesofmedicalandmentalhealthconditions,disability,andotherriskfactorsforsuicidethatoccuramongVHApatients.InVHA,asinDoD,firearmsrepresentedthemostcommonmeansforsuicideandoverdosesrepresentedthemostcommonmeansforattempts. ApproximatelyhalfofallsuicidesinVHAoccurredamongpatientsknowntohavementalhealthconditions. Anincreaseinthesuiciderateamongreturningveteransfirstappearedin2006, andratescontinuetobemonitoredclosely.TheratesasobservedechotheincreasethatoccurredforthefirstfewyearsafterveteransreturnedfromserviceinVietnam.
MembersoftheArmedForcesandVeterans
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Slide40
Whilesuiciderateshavetendedtodecreaseorremainstableformostagegroupsinthepasttwodecades,suicidesinmiddleadulthoodhaveincreased.Menintheiradultyears,fromtheirearly20sthroughtheir50s,accountforthebulkofsuicidesandthemajorityofyearsoflifelostduetosuicide. Yettherehasbeenlittleresearchonthisdemographicgroup,whencomparedwiththenumberofstudiesconductedwithadolescentsandolderadults.
MeninMidlife
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Slide41
Althoughresearchexploringtherecentsurgeinsuicideinmidlifeislacking,existingstudiessuggestthatthefactorsthatmayincreasetheriskforsuicidalbehaviorsinthisgrouparesimilartothoseamongotheragegroupsandinbothsexes:mentalillnessthatcanbediscernedfromretrospectiveanalyses(particularlymooddisorders),substanceusedisorders(particularlyalcoholabuse),andaccesstolethalmeans. However,thesefactorsarelikelytobeexacerbatedbyotherrisk-relatedcharacteristicsthatoccurmorefrequentlyamongmales,suchastheunderreportingofmentalhealthproblems, areluctancetoseekhelp,engagementininterpersonalviolence, distressfromeconomichardship(e.g.,unemployment),anddissolutionofintimaterelationships.
MeninMidlife
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Slide42
Oldermen,inparticularthosewhoarewhite,havedisproportionatelyhighratesofdeathbysuicide.In2009,therateofdeathbysuicideamongolderwhitemenwas30.15per100,000—almostthreetimestherateamongthegeneralpopulation(11.77per100,000).Severalfactorscanincreasetheriskforsuicidalbehaviorsamongoldermen,includingthepresenceofamentaldisorder.Researchsuggeststhatolderadultswhodiebysuicidearemorelikelytomeetcriteriaforaffectivedisorders(especiallymajordepressivedisorder)thanyoungeradults.Otherimportantriskfactorsincludephysicalillnessandfunctionaldecline.Finally,anextensivebodyofliteratureindicatesthatsocialdisconnectionincreasesriskfordeathbysuicideinoldermen.
OlderMen
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Slide43
Suicideinlatelifeisqualitativelydifferentthaninyoungeradults.Olderadultsaremorelikelythanyoungeradultstodiebysuicideasaresultoftheirfirstsuicideattempt,inpartbecauseolderadultsaremorelikelythanyoungeradultstousehighlylethalmeanstoattemptsuicide. Anotherimportantdifferenceisthatolderadultsarelesslikelythanyoungeradultseithertohavereportedsuicidalideationortohavesoughtmentalhealthtreatmentpriortotheirdeaths. Interestingly,however,researchsuggeststhatmostolderadultswhodiebysuicideareseenbyprimarycarephysiciansinthelastthreemonthsoflife.Althoughmanysuicidepreventioneffortshavetargetedyouth,olderadultshavealsobecomeafocusofsuicideprevention.Since2001,manynationalandregionalconferenceshavefeaturedthetopic,andmanystateshavebroadenedorareintheprocessofbroadeningtheirsuicidepreventionstrategiestoincludeolderadults.Somestates(e.g.,OregonandMaine)haveseparateplansforthisagegroup.MentalhealthparityforMedicareisnowbeingphasedinsothatseniorsintheUnitedStateswillhavethesamecopay(20percent)formentalhealthcareasforphysicalhealthcare.
OlderMen
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Slide44
Severalphysicalillnessesareassociatedwithanincreasedriskforsuicidalbehaviors. Thefactorsthatmayhelpexplainthisincreasedriskvarybymedicalconditionbutcanincludechronicpain,cognitivechangesthatmakeitdifficulttomakedecisionsandsolveproblems,andthechallengesandemotionaltollthatcanbeassociatedwithlong-termconditionsandlimitations.
IndividualsWithMedicalConditions
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Slide45
Cancerisoneofthemostcommonphysicalillnessesassociatedwithelevatedsuiciderisk.TheNationalCancerInstitutehasidentifiedcancersofthemouth,throat,andlungasriskfactorsforsuicidalbehaviors.Whilesuiciderisktendstobehighestinthefirstfewmonthsafterdiagnosis,riskremainselevatedinthefirst5years. Fearassociatedwithhowthediseaseisperceivedandmanaged,ratherthanthefearofdeathitself,isafrequentprecipitatorofsuicidalbehaviors. Theconsequencesorsideeffectsoftreatmentcanalsoresultinpsychologicalproblems. Fatigueand/orexhaustion,someofthemostfrequentlyreportedsideeffectsofcancertreatments,canbeariskfactorforsuicidalbehaviors. Inaddition,depressionandanxietyarecommonincancerpatients.About63to85percentofindividualswithcancerwhodiebysuicidemeetcriteriaforseveredepression,anxiety,andthoughtdisorder. Itisnotalwaysclearwhetherthesetypesofmentaldisordersaretriggeredbythedisease,occurasaconsequenceofthedisease,orareanadverseeffectofthetreatmentitself.
IndividualsWithMedicalConditions
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Slide46
Overallthereisstrongevidencethatpsychologicalandsocialfactors(e.g.comorbiddepression,hopelessness,lossofdignity,andtheimpactofspiritualbeliefs),ratherthanthephysicalones(e.g.functionalstatusandlevelofpaincontrol),arethechiefdeterminantsofthedesiretohastendeath.(MaytalandStern2006)
IndividualsWithMedicalConditions
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Slide47
DegenerativeDiseasesoftheCentralNervousSystemTheprevalenceofsuicideisbelievedtobetwotofourtimesgreaterinindividualswithHuntingtondiseasethanamongthegeneralpopulation.Thelifetimehistoryofsuicideattemptsrangesfrom4.8to17.7percent.MajordepressivedisordermaybepresentinuptohalfofpatientswithHuntington’sdiseaseandisthoughttobeaconsequenceofthediseaseitself,ratherthanapsychologicalreactiontohavingaseriousillness. Inaddition,anxietydisorders,obsessive-compulsivedisorders,psychosis,mania,aggression,irritability,impulsivity,andpersonalitychangeshaveallbeenreportedinpatientswiththedisease.
IndividualsWithMedicalConditions
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Slide48
MultipleSclerosis:Studiesconfirmanincreasedriskofsuicideamongpatientswithmultiplesclerosis. Lifetimeprevalenceratesofdepressionrangefrom37to54percent,andtheprevalencerateofdepressionisalmostthreetimesthelifetimeprevalencereportedinthegeneralpopulation.Generalizedanxietydisorder,panicdisorder,andbipolaraffectivedisorder(manicepisodes)arealsopresentmorefrequentlyinthesepatients.
IndividualsWithMedicalConditions
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Slide49
Parkinson’sdiseaseisoftenassociatedwithoneormorepsychiatricorcognitivedisorders,suchasdepression,psychosis,anddementia.Mostoftheobservationssupportthehypothesisthatdepressionisaprimaryconsequenceofbraindysfunction,althoughsituationalfactorsmaycontributetomoodchangestosomeextent. Suicideandsuicideattemptsareuncommondespitethefactthattheratesofsuicidalideationareelevated.Depressionseemstobethemostimportantpredictorofsuicideideation.
IndividualsWithMedicalConditions
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Slide50
TraumaticInjuriesoftheCentralNervousSystem:Suicideandsuicideattemptsoccurmorefrequentlyinthosewithspinalcordinjuries(SCI)thaninthegeneralpopulation.PeoplewithSCIarefivetimesaslikelytoexperiencedepressioncomparedwiththegeneralpopulation,andtheratesofdepressionfollowingatraumaticspinalcordinjurymaybeashighas45percent.Othershavefoundthat10to13percentofSCIpatientssufferfromanxiety andhighlevelsofpost-traumaticstressdisorder.TraumaticBrainInjury:Peoplewithmoderatetoseveretraumaticbraininjury(TBI)mayhavewidespreadcognitiveimpairmentthatcanaffectattention,memory,executivefunctioning,languageandcommunication,visual-spatialskills,andprocessingspeed. TBIsurvivorsmayalsohaveperceptualdeficitsandmotordeficits.Executivebraindysfunctionisacontributingfactorrelatedtosuicidalbehaviors. Areviewoftheliteraturefoundthatonthewhole,thereisanincreasedriskofdeathbysuicide(threetofourtimesgreaterforthosewithsevereTBI),ahigherfrequencyofattempts,andclinicallysignificantsuicidalideationin21to22percentoftheTBIpopulation.
IndividualsWithMedicalConditions
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Slide51
Ingeneral,patientswithmigrainearetwotofourtimesmorelikelytodevelopdepression,twotosixtimesmorelikelytodevelopgeneralanxietydisorder,fivetimesmorelikelytodevelopobsessive-compulsivedisorder,anduptoseventimesmorelikelytodeveloppanicdisorderthanthegeneralpopulation.Furthermore,depressedpatientsareaboutthreetimesmorelikelytodevelopmigraineintheirlifetime.Migrainewithanauraisbelievedtohaveastrongerassociationwithpsychiatricconditionsthanmigrainewithoutanaura.Therelationshipbetweenmigraineanddepressionandanxietyappearstobebidirectional,witheachincreasingtheriskoftheothercondition.Theriskofsuicideideationandattemptsishigheramongmigrainepatients,especiallyinthosewhohavemigrainewithaura.
IndividualsWithMedicalConditions
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Slide52
HIV/AIDSMoststudiesamongindividualslivingwithHIVreportlifetimeprevalenceofsuicideattemptsthatrange from22to50percent.IndividualswithAIDSwere44timesmorelikelytoattemptsuicidethanthose withoutAIDS.WhilemoststudiesreportthatpersonslivingwithHIV/AIDShavemuchhighersuicideratesthanthegeneralpopulationorthosewithotherlife-threateningillnesses,studieshavereportednosignificantdifferencesinsuicideratesbetweenHIV-infectedindividualsandothergroupsatriskforsuicide,suchasinjectiondrugusersandpsychiatricpatients.Hence,HIVstatusmaynotbethemostrelevantfactorrelatedtosuicide,butratherthatothersuicideriskfactorsthatarecommonamongHIV-infectedindividualsplayamoreimportantrole.StudieshaveshownthatsuicideattemptsandsuicideideationamongpeoplewithHIVoccurmostofteninthosewhohaveapreviouspsychiatrichistoryandothersocialandenvironmentalriskfactorsforsuicide.Mood,anxiety,substanceabuse,andpersonalitydisordersareprevalentamongthosewithHIV.
IndividualsWithMedicalConditions
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Slide53
ChronicKidneyDiseaseThefollowingpsychiatricdisordershavebeenfrequentlyobservedinpatientswithsevereend-stagekidneydiseasewhorequirehemodialysis:affectivedisorders,dementiaanddelirium,drug-relateddisorders(e.g.,alcoholdependence),schizophreniaandotherpsychoses,andpersonalitydisorders. Theprevalenceofdepressivedisordersinhemodialysispatientsisestimatedat20to30percent,witharateof10percentformajordepression.Hemodialysispatientswithmajordepressivedisordercommonlydemonstrateasenseofhopelessness,aswellaslackofpleasureandenergy,andotherdepressivesymptoms.Thissubsetofpatientshasbeennotedtobethemostlikelytorequestwithdrawalfromhemodialysis.
IndividualsWithMedicalConditions
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Slide54
ArthritisArthriticdisordersoftenco-occurwithotherphysicalconditions,especiallychronicpainconditionsincludingbackpain,migraine,andotherchronicheadaches. Theassociationbetweenarthritisandproblemssuchasanxiety,substanceuse,andpersonalitydisordershasbeendemonstratedinlarge,population-basedstudies. Therelationshipbetweenarthritisandsuicidalbehaviormaybelargelyexplainedbycomorbidmentalhealthdisordersaloneorincombinationwithotherfactorssuchaslevelofpainand/ordisabilitythatareassociatedwithalowerqualityoflife.
IndividualsWithMedicalConditions
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Slide55
AsthmaAdolescentswithasthmaaremorelikelytoreportdepressivesymptoms,panicattacks,suicideideationandbehavior,andsubstanceabusewhencomparedwiththosewithoutasthma. Itisnotclearwhethertheassociationbetweenasthmaanddepressiveandanxietydisorders,aswellaswithsuicidalideationandbehavior,resultsfromasharedunderlyingprocessorfromsharedriskfactors.
IndividualsWithMedicalConditions
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Slide56
About8.5percentofU.S.adultsareestimatedtohaveanalcoholusedisorder,whichincludesalcoholdependenceandalcoholabuse.Aboutone-fourthofallthesuicidesintheUnitedStatesareestimatedtooccuramongindividualswithalcoholusedisorders.Acute(e.g.,bingedrinkingepisodes)andchronicuseofalcoholareassociatedwithsuicidalbehaviors.Amongindividualswithalcoholusedisorders,suicidefrequentlytakesplacewithinthecontextofamajordepressionandinterpersonalstressors.Aggression,impulsivity,hopelessness,andpartner-relationshipdisruptionsarealsoriskfactors. Studieshaveshownthatdepressionispresentin45percent tomorethan70percent ofthosewithalcoholandsubstanceusedisorderswhodiebysuicide.Althoughlessisknownabouttherelationshipbetweensuicideriskandotherdruguse,thenumberofsubstancesusedseemstobemorepredictiveofsuicidethanthetypesofsubstancesused. Findingsfromafewinitialstudiessuggestthattreatmentofdrugabusemayhelpreducetheriskforfuturesuicidalbehaviors.
SubstanceUseDisorders
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Slide57
SUDsandchronicsubstanceusecanleadtoconsequencesandlossesthatcontributetosuicideriskfactors.Individualsintreatmentforsubstanceusedisordersand/ortransitioningbetweenlevelsofcaremaybeespeciallyvulnerable.Alargenumberofpeopleintreatmenthaveco-occurringmentaldisordersthatincreasesuiciderisk,particularlymooddisorders.Atthetimetheseindividualsentertreatment,theirsubstanceabusemaybeoutofcontrol,theymaybeexperiencinganumberoflifecrises,andtheymaybeatpeaksindepressivesymptoms.Inaddition,mentaldisordersassociatedwithsuicidalbehaviors,suchasmooddisorders,PTSD,anxietydisorders,andsomepersonalitydisorders,oftenco-occuramongpeoplewhohavebeentreatedforsubstanceusedisorders.Crisesthatareknowntoincreasesuiciderisk,suchasrelapseandtreatmenttransitions,mayoccurduringtreatment.Accordingtoonestudy,comparedwiththegeneralpopulation,individualstreatedforalcoholabuseordependencehavea10timesgreaterriskofeventuallydyingbysuicide. Amongthosewhoinjectdrugs,theriskisabout14timesgreaterthaninthegeneralpopulation.
SubstanceUseDisorders
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Slide58
Alcoholanddrugabusearesecondonlytodepressionandothermooddisordersasthemostfrequentriskfactorsforsuicide.AccordingtodatafromtheNationalViolentDeathReportingSystem(NVDRS),in2008alcoholwasafactorinapproximatelyone-thirdofsuicidesreportedin16states.Opiates,includingheroinandprescriptionpainkillers,werepresentin25.5percentofsuicidedeaths,antidepressantsin20.2percent,cocainein10.5percent,marijuanain11.3percent,andamphetaminesin3.4percent.Suicideisaleadingcauseofdeathamongpeoplewithsubstanceusedisorders(SUDs).Substanceusemayincreasetheriskforsuicidebyintensifyingdepressivethoughtsorfeelingsofhopelessnesswhileatthesametimereducinginhibitionstohurtingoneself. Alcoholandsomedrugscancausea“transientdepression,”heightenimpulsivity,andcloudjudgmentaboutlong-termconsequencesofone’sactions.
SubstanceUseDisorders
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Slide59
Researchconsistentlyshowsahighprevalenceofsuicidalthoughtsandsuicideattemptsamongpersonswithsubstanceabuseproblemswhoareintreatment(Ilgen,Harris,Moos,&Tiet,2007)andasignificantprevalenceofdeath-by-suicideamongthosewhohaveatonetimebeeninsubstanceabusetreatmentwhencomparedwiththosewhodonothaveadiagnosisofsubstanceusedisorder(Wilcoxetal.,2004).
SubstanceUseDisorders
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Slide60
Asaresult,substanceabusetreatmentprovidersmustbepreparedtogatherinformationroutinelyfrom,refer,andparticipateinthetreatmentofclientsatriskforsuicidalbehavior.Suicidalthoughtsandbehaviorsarealsoasignificantindicatorofotherco-occurringdisorders(suchasmajordepression,bipolardisorder,PTSD,schizophrenia,andsomepersonalitydisorders)thatwillneedtobeexplored,diagnosed,andaddressedtoimproveoutcomesofsubstanceabusetreatment.
SubstanceUseDisorders
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Slide61
Objectives:Review/introducecommonassessmenttools.
Assessment
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Slide62
Thereisnosubstitutefordirectquestioning.Cliniciansmustbewillingtoaddresssuicidedirectly,confidentlyandwithintentionalityinassessmentandresponse.Allwhileusingtherapeuticskillsincludingempathyandcare.
Intentionality
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Slide63
∗ Clientsinsubstanceabusetreatmentshouldbescreenedforsuicidalthoughtsandbehaviorsroutinelyatintakeandatspecificpointsinthecourseoftreatment.Screeningforclientswithhighriskfactorsshouldoccurregularlythroughouttreatment.
∗ Counselorsshouldbepreparedtodevelopandimplementatreatmentplantoaddresssuicidalityandcoordinatetheplanwithotherproviders.
ExpertRecommendations
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Slide64
∗ Ifareferralismade,counselorsshouldcheckthatreferralappointmentsarekeptandcontinuetomonitorclientsaftercriseshavepassed,throughongoingcoordinationwithmentalhealthprovidersandotherpractitioners,familymembers,andcommunityresources,asappropriate.
∗ Counselorsshouldacquirebasicknowledgeabouttheroleofwarningsigns,riskfactors,andprotectivefactorsastheyrelatetosuiciderisk.
ExpertRecommendations
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Slide65
∗ Counselorsshouldbeempathicandnonjudgmentalwithpeoplewhoexperiencesuicidalthoughtsandbehaviors.
∗ Counselorsshouldunderstandtheimpactoftheirownattitudesandexperienceswithsuicidalityontheircounselingworkwithclients.
∗ Substanceabusecounselorsshouldunderstandtheethicalandlegalprinciplesandpotentialareasofconflictthatexistinworkingwithclientswhohavesuicidalthoughtsandbehaviors.
ExpertRecommendations
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Slide66
Practice,practice,practice.
Whatstrategywouldyouusetointroducethetopicofsuicide?
Whatassessmentstrategywouldyouusetoassessforsuicide?
Application
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Slide67
http://www.youtube.com/watch?v=nbTsOAy2M0Q
http://www.samhsa.gov
Resources
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Slide68
http://www.thencsp.org/
http://actionallianceforsuicideprevention.org/
http://actionallianceforsuicideprevention.org/sites/actionallianceforsuicideprevention.org/files/CDCResponse.pdf
Resources
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Slide69
Objectives:Determinebaselineforprofessionalresponsetoanassessedsuicidethreatand/orrisk.
Considerwhatpolicyandproceduresexistatcurrentplaceofpractice.
Developawarenessofnationalandlocalorganizations,hotlinesandresources.
Response
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Slide70
Point1:Almostallofyourclientswhoaresuicidalareambivalentaboutlivingornotliving.Point2:Suicidalcrisescanbeovercome.Point3:Althoughsuicidecannotbepredictedwithcertainty,suicideriskassessmentisavaluableclinicaltool.Point4:Suicidepreventionactionsshouldextendbeyondtheimmediatecrisis.
TIP50TenPointsToKeepYouonTrack
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Slide71
Point5:Suicidecontractsarenotrecommendedandareneversufficient.Point6:Someclientswillbeatriskofsuicide,evenaftergettingcleanandsober.Point7:Suicideattemptsalwaysmustbetakenseriously.Point8:Suicidalindividualsgenerallyshowwarningsigns.
TIP50TenPointsToKeepYouonTrack
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Slide72
Point9:Itisbesttoaskclientsaboutsuicide,andaskdirectly.Point10:Theoutcomedoesnottellthewholestory.
TIP50TenPointsToKeepYouonTrack
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Slide73
Researchsuggeststhatevensimpleeffortstochallengeisolationandprovidefollow-upsupporttopeoplelivinginthecommunityafteranattemptcanhaveapowerfulimpactandreducefutureattempts. Aprogramthatusedhand-writtenpostcardswithbriefpersonalmessagesshowedremarkableresultsinreducingreattempthospitaladmissions,revealingthatasmallamountofeffortintheareaofsocialsupportmaybeverypowerful.Inaddition,agrowingnumberofprogramsthatprovidesuicideattempt survivorswithself-helptoolsandsocialsupportshowgreatpromiseinreducingisolationandempoweringpeopletomanagetheirownsuicideriskandmentalhealth.
AfteranAttempt
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Slide74
Atwhatpointandhowwouldyouinterveneifyouassessedforsuiciderisk?
Areyouawareofthepolicyandproceduresatyourcurrentplaceofpracticeinregardtosuicideassessmentandresponse?Ifnothowcouldyoufindout?
Whatresourceswouldyouconsiderprovidingyourclient?
Application
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Slide75
Objectives:Review/introducecommonassessmenttools.
Brainstormotherconsiderations.
Assessment
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Slide76
Social:AvailabilityoflethalmeansofsuicideUnsafemediaportrayalsofsuicideCommunity:FewavailablesourcesofsupportiverelationshipsBarrierstohealthcareRelationship:HighconflictorviolentrelationshipsFamilyhistoryofsuicideIndividual:MentalillnessSubstanceabusePrevioussuicideattempts
RiskFactors
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Slide77
Social:Availabilityofphysicalandmentalhealthcare.RestrictionsonlethalmeansofsuicideCommunity:SafeandsupportiveschoolandcommunityenvironmentsSourcesofcontinuedcareafterpsychiatrichospitalizationRelationship:Connectednesstoindividuals,family,communityandsocialinstitutionsSupportiverelationshipswithhealthcareprovidersIndividual:CopingandproblemsolvingskillsReasonsforlivingMoralobjectionstosuicide
ProtectiveFactors
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Slide78
Thereisnosubstitutefordirectquestioning.Cliniciansmustbewillingtoaddresssuicidedirectly,confidentlyandwithintentionalityinassessmentandresponse.Allwhileusingtherapeuticskillsincludingempathyandcare.
Intentionality
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Slide79
PPriorAttemptsIIntentMMeansPPlan
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Slide80
DDisorderEEnvironmentalStressorsAAccesstoFirearmsDDisinhibitionPPriorAttemptsIIdeationMMalePPlan
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Slide81
IIdeation
SSubstanceAbuse
PPurposelessness
AAnxiety
TTrapped
HHopelessness
WWithdrawal
AAnger
RRecklessness
MMoodChange
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Slide82
“Thereisnogenerallyacceptedandstandardizedinstrumentthatcanaccuratelymeasuresuicidepotential.Suicidescreeningandassessmentscalescanbeusedasaids,butifaclientshowssignsofbeingatriskofsuicide,thesescalesarenotasubstituteforathoroughclinicalinterviewbyaqualifiedmentalhealthclinician,duringwhichclientandcounselorcantalkopenlyaboutsuicidality.Anyclientshowingwarningsignsorriskfactorsforsuicidality shouldbeassessedbyamentalhealthprofessionalspecificallytrainedinconductingsuicidalriskevaluations(APA,2000).”(TIP48)
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Slide83
Practice,practice,practice.
Whatstrategywouldyouusetointroducethetopicofsuicide?
Whatassessmentstrategywouldyouusetoassessforsuicide?
Application
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