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?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

• Hopelessness

• Worthlessness

• 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 abuserAnxiety disordersHigh levels of stress in lifeHistory of family pathologySuicide of role model

• Watch for same sex parent

High Risk Factors

Becomes withdrawn – shy, solitarySleep deprivation is the general complaintSleep is a metaphor for “death”

~ Put to rest

~ Slumber room

High Risk Factors

Has communicated suicidal thoughtsUnable to concentrateUnable to deal with frustration – easily

angeredSeems to lose love of the professionGiving away possessions

High Risk Factors

Major Losses in LifeDeathDivorceSecond divorce highSeparationRecently separated high

High Risk Factors

Major Losses in Life

UnemploymentStatus

Physical capabilitiesBody 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

problemListen…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 Have you been thinking of killing yourself?yourself?

• How would you do it? Do you have the How would you do it? Do you have the means available?means available?

• Has anyone in your family committed Has anyone in your family committed suicide?suicide?

• What are the odds you will kill yourself?What are the odds you will kill yourself?• What has been keeping you alive so far?What has been keeping you alive so far?• What does the future hold for you?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 = QuestionTips 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 QuestionThe Suicide Question--Direct Approach-Direct Approach-

• ““You know, when people are as upset as you You know, when people are as upset as you seem to be, they sometimes wish they were seem to be, they sometimes wish they were dead.” I’m wondering if you feel that way dead.” I’m wondering if you feel that way too?”too?”

• You look pretty miserable. Have you been You look pretty miserable. Have you been thinking of killing yourself?”thinking of killing yourself?”

• ““Are you thinking about killing yourself?”Are you thinking about killing yourself?”

(If you can’t ask the question, find someone who can)(If you can’t ask the question, find someone who can)

P = PersuadeP = PersuadeHow to persuade someone to stay aliveHow to persuade someone to stay alive

• Listen to the problem with your full Listen to the problem with your full attentionattention

• Remember, suicide is not the problem, Remember, suicide is not the problem, only the solution to a perceived only the solution to a perceived insoluble probleminsoluble problem

• Do not rush judgmentDo not rush judgment• Offer hope in any formOffer hope in any form

P = PersuadeThen 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 = ReferR = Refer

• The next best is getting a commitment from The next best is getting a commitment from them to accept help then making arrangements them to accept help then making arrangements for that helpfor that help

• Third best is to give referral information and Third best is to give referral information and attempt to get a good faith commitment not to attempt to get a good faith commitment not to complete or attempt suicide. Any willingness complete or attempt suicide. Any willingness to accept help, even future help, is a good to accept help, even future help, is a good outcomeoutcome

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!