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Preventing Suicide Among Our Kids

Webinar Series September Topic: Youth Suicide Prevention

On September 12th, Megan Kelley, licensed counselor & art therapist of East Mountain Youth Lodge (a Division of Carrier Clinic), hosted a webinar on youth suicide prevention called “Preventing Suicide Among Our Kids” in support of National Suicide Prevention Month.

This post provides a breakdown of the information discussed during the webinar and is intended for mental health professionals, educators, and anyone concerned about a family member/loved one who may be at risk. Through this information, we seek to promote suicide awareness and help young people get the proper mental health care needed before it’s too late.

Sign Up for Our November Webinar

Our next webinar is on Our Military Veterans: Stress Busters and Self Care on November 1st. To learn more/sign up now visit carrierclinic.org/webinars/.

Preventing Suicide Among Our Kids

Goals for Youth Suicide Prevention

In critical moments of hopelessness, being aware and informed of the facts on depression and suicide can make all the difference. Our goal is to support the community to move into the world with a grounded understanding of how to help prevent teen suicide.

  • Increase community awareness that suicide is a preventable public health problem
  • Increase awareness that depression is the primary cause of suicide
  • Change public perception about the stigma of mental illness, especially about depression and suicide
  • Increase the ability of the public to recognize and intervene when someone they know is suicidal

Suicide Definitions

Suicide attempt: “is a non-fatal, self-directed, potentially injurious behavior with intent to die as a result of the behavior. A suicide attempt might not result in injury.”

Suicidal ideation: “refers to thinking about, considering, or planning suicide.”

This where Carrier’s inpatient treatment and teen residential treatment services come into the story – after critical incidents where there has been a suicide attempt or suicidal ideation.

Suicide: “is defined as death caused by self-directed injurious behavior with intent to die as a result of the behavior”

(National Institute of Mental Health (NIMH), 2018)

Suicide Fact Sheet

Suicide is the second leading cause of death among adolescents.

  • Ages 10-14: 436
  • Ages 15-24: 5,723

Facts reported from the National Institute for Mental Health show a total of 6,159 death by suicide across the age ranges of 10-24. Suicide is the second leading cause of death among adolescents after accidents.

(NIMH, 2018)

Suicide deaths vs. Suicide attempts

  • Males: completion rate of suicide is 3x greater
  • Females: attempt suicide twice as often

“The ratio of attempted suicides to completed suicides among adolescents is estimated to be 50:1 to 100:1.” (American Academy of Pediatrics (AAP), 2016)

The leading means of completed suicide are:

  • Suffocation (43%)
  • Firearms (42%)
  • Poisoning (6%)
  • Falling (3%) (AAP, 2016)

National Prevention Efforts

Risk Factors for Suicide

“Risk factors are characteristics that make it more likely that someone will consider, attempt, or die by suicide. They can’t cause or predict a suicide attempt, but they’re important to be aware of.” (National Suicide Prevention Lifeline (NSPL), 2018)

Psychological Factors

  • Mental disorders are the leading risk factor.
  • 90% of adolescent suicide deaths occur when the youth is presenting with criteria for a psychiatric disorder such as depression, anxiety, or a substance abuse disorder.

Environmental/Social Factors

“Bullying, impaired parent-child relationship, living outside of the home (homeless or living in a corrections facility or group home), difficulties in school, social isolation, and presence of stressful life events, such as legal or romantic difficulties or an argument with a parent. An unsupported social environment of [LGBTQ youth], increases suicide attempts.” (AAP, 2016)

Bullying – Studies show a clear relationship between suicidal behaviors/ideation and youth who are perpetrators AND victims of bullying; the worst outcomes are for youth who are BOTH bullies and victims

Case – We’ll call this case Sam Doe – might be an LQBTQ youth who witnessed community and/or domestic violence and presents with highly irritable interactions with mom, substance use with peers and in isolation, and struggles with thoughts of wanting to end it all. This youth may find themselves re-enacting power and control dynamics with peers through bullying. And is utilizing all possible means to cope, despite their detriments to healthy development.

Fixed Risk Factors

  • Family history of suicide/suicide attempts,
  • History of adoptions
  • Male gender
  • Parental mental health problems
  • LGBTQ orientation
  • History of physical/sexual abuse
  • Previous suicide attempt (AAP, 2016)

Protective Factors

Internal Protective Factors
  • Religious beliefs
  • Resiliency/ability to cope with stress, self-esteem, direction, mission, determination, perseverance, optimism, and empathy
  • Coping and problem-solving skills, insight, and intellectual ability
External Protective Factors
  • Family cohesion
  • Social support and close relationships, availability of caring adult, and participation and bond with school (Guild, Freeman, & Shanahan, 2004; SAMHSA, 2009; AAP, 2016).

At the East Mountain Youth Lodge, an NJ teen residential treatment facility, we look to really harness and develop these protective factors across assessment, treatment, and into the referral/discharge planning stages.

“Suicide is a relatively rare event and it is difficult to predict which persons with these risk factors will ultimately commit suicide. However, there are some possible warning signs.” (APA, 2018)

Warning Signs of Suicide

  • Talking about dying
  • Recent loss
  • Change in personality
  • Change in behavior
  • Change in sleep patterns
  • Change in eating habits
  • Fear of losing control
  • Low self-esteem
  • No hope for the future
  • Previous suicide attempts

(APA, 2018; ACA, 2018; NIMH, 2017)

Immediate Risk Factors

  • Agitation: When depression is energized by anger – agitation becomes an immediate risk factor for suicide.
  • Intoxication: Youth under the influence are also more likely to act on suicidal thoughts due to lowered inhibitions and decline in long-term thinking skills.
  • A recent stressful life event
    • External circumstance that overwhelm the at-risk youth
      • disciplinary problems
      • interpersonal issues
      • family violence
      • sexual orientation confusion
      • physical/sexual abuse and being the victim of bullying
        (AAP, 2016; APA, 2018)

“Many people have some of these risk factors but do not attempt suicide. It is important to note that suicide is not a normal response to stress. Suicidal thoughts or actions are a sign of extreme distress, not a harmless bid for attention, and should not be ignored.” (NIMH, 2017)

Case: Picking up on the case of –Sam Doe– perhaps a dating relationship break-up occurs, Sam is yelling at mom more often, isolating to the bedroom where the level of mess is escalating. One night, Sam comes home under the influence of alcohol, Sam gathers all the pills in the home in a suicide attempt. Here we see how a youth experiencing multiple risk factors can be in a very emotionally painful place. In Sam’s case, maybe mom was there to check-up and make the call to the ER where an assessment recommendation leads to supportive planning.

The 5 Steps Can Help

“The five action steps for communicating with someone who may be suicidal are supported by evidence in the field of suicide prevention.” (NSPL, 2018b)

In the case of Sam – so far, we see a critical need. Here we’ll look at were prevention comes in…what could have been done differently?

Step 1: Ask

Being direct and unbiased opens the door to communicating about emotional pain.

  • Ask: “Are you thinking about suicide?”, “How do you hurt?”, and “How can I help?”
  • Listen.

Do not ever promise to keep their thoughts of suicide a secret.

Show that you are open to communicating about suicide in a nonjudgmental way.

Take their answers seriously, do not ignore them, especially if they do indicate that they are experiencing thoughts about suicide.

Listen for reasons for being in such emotional pain and for their reasons to live. Both are incredibly important to what they are telling you. Focus on their reasons for living, do not impose your reasons for them to stay alive.

Step 2: Keep Them Safe

  • Have they already done anything to try and kill themselves before talking with you?
  • Do they have a specific, detailed plan?
  • What’s the timing of the plan?
  • What sort of access to they have to their planned method?

“This step is about putting time and distance between the person and their chosen method, especially methods that have shown high lethality (like firearms or medications).” (NSPL, 2018b)

“This is an important part of suicide prevention.” Studies show that when lethal means are made less available or less deadly, suicide rates decline.

“If someone really wants to kill themselves, they’ll find a way to do it.” Is a myth!

Research shows that when safety measures are put into place, choosing an alternate method when the original method was restricted frequently does not happen.

Step 3: Be There

“Being there for someone with thoughts of suicide is life-saving.”

In the “Ideation-to-Action Framework”… connectedness is the key not just against suicide, but also in terms of thoughts of suicide escalating into action. Their research has shown connectedness acts as a buffer against hopelessness and psychological plan.” (NSPL, 2018b)

How – This could mean being physically present, phone calls, or any other way that shows support to the person. An important aspect of this step is to make sure you follow through with the ways in which you say you’ll be able to support the person – do not commit to anything you are not willing or able to accomplish. If you are unable to be physically present with someone with thoughts of suicide, talk with them to develop some ideas for others who might be able to help as well (again, only others who are willing, able, and appropriate to be there). Listening is again very important during this step – find out what and who they believe will be the most effective source of help.

Step 4: Help Them Connect

A safety plan includes ways to identify suicidal crisis moments and a list of contacts for when a crisis occurs.

  • Phone numbers for a trusted relative, friend, spiritual advisor, or mental health professional
  • The non-emergency number for the local police department
  • The Crisis Text Line: 741741
  • The National Suicide Prevention Lifeline: 1-800-273-TALK (8255)

Help them connect with ongoing supports establishes a safety net for moments of crisis (NSPL, 2018b).

How – Explore possible supports with them – are they currently seeing a mental health professional? Have they in the past? Is this an option for them currently? Are there other mental health resources in the community that can effectively help?

If concerns present on social media: Knowing how to get help for a social media friend can save a life. Contact the social media site directly, if you are concerned about a friend’s updates or dial 911 in an emergency. (NIMH, 2017)

Step 5: Follow Up

“Research shows that the number of suicide deaths goes down when someone follows up with the at-risk person.” (NSPL, 2018b)

Staying connected can make a difference. Make sure to follow-up with them to see how they are doing, check-in about anything you haven’t had the chance to help with that you said you would, or see if there is more you are able to help with. Research shows that the number of suicide deaths goes down when someone follows up with the at-risk person. Contact as simple as sending a postcard, texting, or calling can make a difference.

10 Things Parents Can Do to Prevent Suicide

  1. Don’t let your teen’s depression or anxiety snowball.
  2. Listen – even when your teen is not talking.
  3. Never shrug off threats of suicide as typical teenage melodrama.
  4. Seek professional help right away.
  5. Share your feelings.
  6. Encourage your teen not isolate from family and friends.
  7. Recommend exercise.
  8. Urge your teen not to demand too much of him or herself.
  9. Remind your teen who is undergoing treatment not to expect immediate results.
  10. If you keep guns at home, store them safely or move all firearms elsewhere until the crisis has passed (AAP, 2016b).

Treatments and Therapies to Prevent Suicide

“Multiple types of interventions have been found to be beneficial for individuals who have attempted suicide. These types of interventions may prevent someone from making another attempt.”

Psychotherapy

Psychotherapy, or “talk therapy,” can effectively reduce suicide risk.

  • “One type of psychotherapy is called cognitive behavioral therapy (CBT). CBT can help people learn new ways of dealing with stressful experiences…CBT helps individuals recognize their own thoughts and patterns and consider alternative actions when thoughts of suicide arise.
  • Another type of psychotherapy, [is] called dialectical behavior therapy (DBT)…A therapist trained in DBT helps a person recognize when his or her feelings or actions are disruptive or unhealthy, and teaches the skills needed to deal better with upsetting situations.”

Medication

Some individuals at-risk for suicide might benefit from medication.

  • “Doctors and patients can work together to find the best medication or medication combination, as well as the right dose.” (NIMH, 2017)

Professional Help

  • Identify Risk Factors: Note those that can be reduced
  • Identify Protective Factors: Note those that can be enhanced (SAMHSA, 2009)
  • Conduct a clinical suicide inquiry (suicidal thoughts, plans, behavior, intent)
  • Determine risk/level of interventions – determine risk. Choose appropriate intervention to address and reduce risk
  • Document – assessment of risk, rationale, intervention, and follow-up

Questions and Answers

Q: Will asking someone if they are suicidal make them want to commit suicide?

A: Studies show that asking at-risk individuals if they are suicidal does not increase suicides or suicidal thoughts. In fact, studies suggest the opposite: findings suggest acknowledging and talking about suicide may, in fact, reduce rather than increase suicidal ideation.

Q: Should I wait until my loved one asks for help?

A: Reach out. Isolation and depression go hand in hand.

Q: Does cutting mean that someone is suicidal?

A: Cutting is a coping mechanism – not a healthy one, but not everyone’s cutting is an attempt to kill themselves. “By definition non-suicidal self-injury [such as cutting] does not include intent to die, and risk of death is deliberately low. Nonetheless, non-suicidal self-injury is a risk factor for suicide attempts and suicide ideation.” (AAP, 2016)

Youth Suicide Prevention & Awareness Resources

For even more resources, support groups, and crisis lines, see our helpful resources page for mental health and addiction.

If you need to contact us about admissions you can call us 24/7 at 800-933-3579.