Military Suicide: Prevention, Assessment, …...Military Suicide PAIR Certification Course Light...
Transcript of Military Suicide: Prevention, Assessment, …...Military Suicide PAIR Certification Course Light...
MilitarySuicide:Prevention,
Assessment,Intervention
andRecovery
P.O.Box739•Forest,VA24551•1-800-526-8673•www.AACC.net
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Welcome to Light University and the “Military Suicide: Prevention, Assessment, InterventionandAftercare”programofstudy.Our prayer is that you will be blessed by your studies and increase your effectiveness inreaching out to others. We believe you will find this program to be academically sound,clinicallyexcellentandbiblically-based.Our faculty represents some of the best in their field – including professors, counselors andministers who provide students with current, practical instruction relevant to the needs oftoday’sgenerations.We have alsoworked hard to provide youwith a program that is convenient and flexible –givingyoutheadvantageof“classroominstruction”onlineandallowingyoutocompleteyourtrainingonyourowntimeandscheduleinthecomfortofyourhomeoroffice.Thetestmaterialcanbefoundatwww.lightuniversity.comandmaybetakenopenbook.Onceyouhavesuccessfullycompletedthetest,whichcoverstheunitswithinthiscourse,youwillbeawardedacertificateofcompletionsignifyingyouhavecompletedthisprogramofstudy.Thank you for your interest in this program of study. Our prayer is that you will grow inknowledge,discernment,andpeople-skillsthroughoutthiscourseofstudy.Sincerely,
RonHawkinsDean,LightUniversity
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TheleadershipofHopeQuestMinistryhasapassiontosharetheloveofGodto
others throughexhibiting care, compassion, and support to thosewhoarehurt
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relationshipsareformedandpeoplearepropelledtobecomeleaders.Individuals
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TheAmericanAssociationofChristianCounselors
• Represents the largestorganizedmembership (nearly50,000)ofChristian counselorsandcaregiversintheworld,havingjustcelebratedits25thanniversaryin2011.
• Known for its top-tier publications (Christian Counseling Today, the Christian CounselingConnectionandChristianCoachingToday),professionalcredentialingopportunitiesofferedthroughtheInternationalBoardofChristianCare(IBCC),excellenceinChristiancounselingeducation, an arrayof broad-based conferences and live training events, radioprograms,regulatoryandadvocacyeffortsonbehalfofChristianprofessionals,apeer-reviewedEthicsCode, and collaborative partnerships such as Compassion International, the NationalHispanic Christian Leadership Conference and Care Net (to name a few), the AACC hasbecomethefaceofChristiancounselingtoday.
• With the needed vision and practical support necessary, the AACC helped launch the
International Christian Coaching Association (ICCA) in 2011, which now represents thelargest Christian life coaching organization in the world with over 2,000 members andgrowing.
OurMission
The AACC is committed to assisting Christian counselors, the entire “community of care,”licensedprofessionals,pastors,and laychurchmemberswith littleorno formal training. It isourintentiontoequipclinical,pastoral,andlaycaregiverswithbiblicaltruthandpsychosocialinsights that minister to hurting persons and helps them move to personal wholeness,interpersonalcompetence,mentalstability,andspiritualmaturity.
OurVision
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TheAACC’svisionhastwocriticaldimensions:First,wedesiretoservetheworldwideChristianChurch by helping foster maturity in Christ. Secondly, we aim to serve, educate, and equip1,000,000 professional clinicians, pastoral counselors, and lay helpers throughout the nextdecade.WearecommittedtohelpingtheChurchequipGod’speopletoloveandcareforoneanother.We recognize Christian counseling as a unique form of Christian discipleship, assisting thechurch in its call to bring believers to maturity in the lifelong process of sanctification—ofgrowingtomaturityinChristandexperiencingabundantlife.Werecognizesomearegiftedtodosointhecontextofaclinical,professionaland/orpastoralmanner.Wealsobelieveselected laypeoplearecalledtocareforothersandthattheyneedtheappropriatetrainingandmentoringtodoso.WebelievetheroleofthehelpingministryintheChurchmustbesupportedbythreestrongcords:thepastor,thelayhelper,andtheclinicalprofessional.ItistothesethreerolesthattheAACCisdedicatedtoserve(Ephesians4:11-13).
OurCoreValues
InthenameofChrist,theAmericanAssociationofChristianCounselorsabidesbythefollowingvalues:
VALUE1:OURSOURCEWearecommittedtohonorJesusChristandglorifyGod,remainingflexibleandresponsivetotheHolySpiritinallthatHehascalledustobeanddo.VALUE2:OURSTRENGTHWearecommittedtobiblicaltruths,andtoclinicalexcellenceandunityinthedeliveryofallourresources,services,trainingandbenefits.VALUE3:OURSERVICEWeare committed toeffectivelyandcompetently serve the communityof careworldwide—bothourmembership and the churchat large—withexcellenceand timeliness, andbyover-deliveryonourpromises.VALUE4:OURSTAFFWearecommittedtovalueandinvestinourpeopleaspartnersinourmissiontohelpotherseffectivelyprovideChrist-centeredcounselingandsoulcareforhurtingpeople.VALUE5:OURSTEWARDSHIPWe are committed to profitably steward the resourcesGod gives to us in order to continueservingtheneedsofhurtingpeople.
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LightUniversity• Establishedin1999undertheleadershipofDr.TimClinton—hasnowseennearly200,000
students from around the world (including lay caregivers, pastors and chaplains, crisisresponders,lifecoaches,andlicensedmentalhealthpractitioners)enrollincoursesthataredelivered via multiple formats (live conference and webinar presentations, video-basedcertificationtraining,andastate-of-theartonlinedistanceteachingplatform).
• Thesepresentations,courses,andcertificateanddiplomaprograms,offeroneofthemostcomprehensive orientations to Christian counseling anywhere. The strength of LightUniversity is partially determined by its world-class faculty—over 150 of the leadingChristianeducators,authors,mentalhealthcliniciansandlifecoachingexpertsintheUnitedStates. This core groupof facultymembers represents a literal “Who’sWho” inChristiancounseling. No other university in the world has pulled together such a diverse andcomprehensivegroupofprofessionals.
• Educational and training materials cover over 40 relevant core areas in Christian—
counseling, lifecoaching,mediation,andcrisis response—equippingcompetentcaregiversand ministry leaders who are making a difference in their churches, communities, andorganizations.
OurMissionStatement
TotrainonemillionBiblicalCounselors,ChristianLifeCoaches,andChristianCrisisRespondersbyeducating,equipping,andservingtoday’sChristianleaders.
AcademicallySound•ClinicallyExcellent•DistinctivelyChristian
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Video-basedCurriculum
• UtilizesDVDpresentations that incorporateover 150 of the leading Christian educators,authors,mentalhealthclinicians,andlifecoachingexpertsintheUnitedStates.
• Eachpresentationisapproximately50-60minutesinlengthandmostareaccompaniedbyacorrespondingtext(inoutlineformat)anda10-questionexaminationtomeasurelearningoutcomes.Therearenearly1,000uniquepresentationsthatareavailableandorganizedinvariouscourseofferings.
• Learning is self-directed and pacing is determined according to the individual time
parameters/scheduleofeachparticipant.• With the successful completion of each program course, participants receive an official
Certificate of Completion. In addition to the normal Certificate of Completion that eachparticipant receives, Regular and Advanced Diplomas in Biblical Counseling are alsoavailable.
Ø TheRegularDiploma isawardedbytakingCaringForPeopleGod’sWay,BreakingFreeandoneadditionalElectiveamongtheavailableCoreCourses.
Ø TheAdvancedDiplomaisawardedbytakingCaringForPeopleGod’sWay,BreakingFree,andanythreeElectivesamongtheavailableCoreCourses.
Credentialing
• LightUniversitycourses,programs,certificatesanddiplomasarerecognizedandendorsedbytheInternationalBoardofChristianCare(IBCC)anditsthreeaffiliateBoards:theBoardofChristianProfessional&PastoralCounselors(BCPPC);theBoardofChristianLifeCoaching(BCLC);andtheBoardofChristianCrisis&TraumaResponse(BCCTR).
• Credentialing is a separateprocess from certificate or diploma completion.However, theIBCC accepts Light University and Light University Online programs as meeting theacademic requirements for credentialing purposes. Graduates are eligible to apply forcredentialinginmostcases.
Ø Credentialinginvolvesanapplication,attestation,andpersonalreferences.
Ø CredentialrenewalsincludeContinuingEducationrequirements,re-attestation,andoccureitherannuallyorbienniallydependingonthespecificBoard.
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OnlineTestingTheURLfortakingallquizzesforthiscourseis:http://www.lightuniversity.com/my-account/.
• TOLOGINTOYOURACCOUNT
Ø You should have received an email upon checkout that included your username,password,andalinktologintoyouraccountonline.
• MYDASHBOARDPAGE
Ø Once registered, youwill see theMyDVD Course Dashboard link by placing yourmousepointerovertheMyAccountmenuinthetopbarofthewebsite.Thispagewill include studentPROFILE informationand theREGISTEREDCOURSES forwhichyouareregistered.TheLOG-OUTandMYDASHBOARDtabswillbeinthetoprightofeachscreen.Clickingonthe>nexttothecoursewilltakeyoutothecoursepagecontainingthequizzes.
• QUIZZES
Ø Simplyclickonthefirstquiztobegin.• PRINTCERTIFICATE
Afterallquizzesaresuccessfullycompleted,a“PrintYourCertificate”buttonwillappearnearthetopofthecoursepage.YouwillnowbeabletoprintoutaCertificateofCompletion.Yournameandthecourseinformationarepre-populated.ContinuingEducationThe AACC is approved by the American Psychological Association (APA) to offer continuingeducationforpsychologists.TheAACCisaco-sponsorofthistrainingcurriculumandaNationalBoard of Certified Counselors (NBCC)ApprovedContinuing Education Provider (ACEPTM). TheAACC may award NBCC approved clock hours for events or programs that meet NBCCrequirements. The AACCmaintains responsibility for the content of this training curriculum,whichalsomeetsthequalificationsforcontinuingeducationcreditforMFTsand/orLCSWsasrequired by the California Board of Behavioral Science (#3552). The AACC offers continuingeducation credit for play therapists through theAssociation for Play Therapy (APTApprovedProvider#14-373), so longas the trainingelement is specificallyapplicable to thepracticeofplaytherapy.It remains the responsibility of each individual to be aware of his/her state licensure andContinuing Education requirements. A letter certifying participation will be mailed to thoseindividuals who submit a Continuing Education request and have successfully completed allcourserequirements.
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Presentersfor
MilitarySuicide:Prevention,Assessment,Intervention
andRecovery
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PresenterBiographiesGlenBloomstrom,M.Div., is currently theMilitaryDirector and FaithCommunity Liaison forLivingWorksEducation,aninternationalsuicideinterventiontrainingcompany.PriortojoiningLivingWorks,GlenservedasaU.S.ArmychaplainatalllevelsfrombattaliontotheArmystaff,retiringasaColonelafter30yearsofactiveduty.WhileservingatthePentagonfortheArmyChiefofChaplains,Glenhelpeddevelopandfieldinnovativesoldierandfamilyministry,suicideprevention,andchaplainprofessionaldevelopmentprograms.Hiscombatdeploymentsincludethe initial invasionofPanamaand tours in IraqandAfghanistan.Inaddition tohisworkwithLivingWorks,Glen servesas a consultantwith theU.S. SpecialOperationsCommandand theU.S. Navy, where he oversaw their 2015 Professional Development Training Conference:“Pastoral Care in Suicide Prevention Intervention and Postvention.” Glen also serves as anadjunctprofessoratBethlehemSeminaryinMinneapolis,MN,helpingtrainthenextgenerationofpastorsandchaplains.TimClinton,Ed.D.,Ed.D., isPresidentof thenearly50,000-memberAmericanAssociationofChristian Counselors (AACC), the largest andmost diverse Christian counseling association intheworld.HeisProfessorofCounselingandPastoralCare,andExecutiveDirectoroftheCenterforCounselingandFamilyStudiesat LibertyUniversity.He is recognizedasaworld leader infaithandmentalhealthissuesandhasauthoredover20booksincludingBreakthrough:WhentoGiveIn,WhentoPushBack.Jennifer Cisney Ellers, M.A. is a Professional Counselor, life coach, crisis response trainer,authorandspeaker.Sheconductstraining,counselingandcoaching inthefieldofgrief,crisisandtraumathroughtheInstituteforCompassionateCare.Jenniferisanapprovedinstructorforthe International Critical Incident Stress Foundation, teaching several CISM courses. Also,Jenniferprovidesdivorcecoaching,trainingandspeakingthroughEmergeVictorious,aministryfor women rebuilding their lives after divorce. She is the co-author of The First 48 Hours:SpiritualCaregiversasFirstResponders,withherhusband,Dr.KevinEllers.Inaddition,Jenniferco-authored, Emerge Victorious: AWoman’s Transformational Guide after Her Divorce, withSandraDopfLee.KevinEllers,D.Min., istheTerritorialDisasterServicesCoordinatorforTheSalvationArmyintheU.S.A.CentralTerritory.HeisalsopresidentoftheInstituteforCompassionateCare,whichisdedicatedtoeducation,traininganddirectcare.Dr.Ellers isanassociatechaplainwiththeIllinoisFraternalOrderofPolice,servesas faculty for the InternationalCritical IncidentStressFoundation,adjunctprofessoratOlivetNazareneUniversity,andisamemberoftheAmericanAssociation of Christian Counselors Crisis Response Training Team. He has extensive trainingandexperienceinthefieldsofcrisisresponse,grief,trauma,disastermanagement,chaplaincy,pastoralministries,marriageandfamilytherapy,andsocialservices.Asanauthorandspeaker,heteachesbroadlyintheserelatedtopics.
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DavidP.Mikkelson,Ph.D.,grewupinaMarineCorpsfamilyandlaterservedasaMarineCorpsartilleryofficerfor10yearsandanArmychaplainfor17years,including15monthsincombatin Iraq. He established and directed a pastoral counseling training center at Ft. Bragg, NC,wherehecounseledmanysoldiersandfamiliesaffectedbycombat.Davidretiredin2013andiscurrently in private practice in North Carolina as a LicensedMarriage and Family Therapist,clinicalsupervisor,andconsultantonthetopicsofmilitarycounseling,Christiancounseling,andPTSD.Heandhiswife,Dr.SuzanneMikkelson,liveinHighPoint,NC.SuzanneE.Mikkelson,Ph.D., isaLicensedMarriageandFamilyTherapistwithmorethan20years of experience counseling military and civilian couples and families, primarily in faith-based settings.Her clinical specialties are trauma recovery, adultery recovery,marital issues,andparenting.She isanEMDRIAApprovedConsultant forEMDRtrauma therapy.Suzanne isalsoanAAMFTApprovedSupervisor,providingclinicalsupervisionfortherapistsintraining.Sheandherhusband,Dr.DavidMikkelson,are inprivatepracticetogetherand live inHighPoint,NC.Theyhavebeenmarried31yearsandhavethreeadultsons.LindaMintle,Ph.D.,isaLicensedMarriageandFamilyTherapist(LMFT),LicensedClinicalSocialWorker (LCSW), professor, author, and national speaker. She serves as Chair of BehavioralHealthattheCollegeofOsteopathicMedicineatLibertyUniversityinLynchburg,Virginia.With30yearsofclinicalexperienceworkingwithcouples,familiesandindividuals,sheisanexpertonrelationshipsandthepsychologyoffood,weight,andbodyimage.Dr.Mintlealsoservesasanationalnewsconsultant,BeliefNetblogger,andradioshowhost.Sheisabest-sellingauthorwith 19 book titles, including I Married You, Not Your Family and Divorce Proofing YourMarriage.Eric Scalise, Ph.D., is the former Vice President for Professional Development with theAmericanAssociationofChristianCounselors,aswellasacurrentconsultantandtheirSeniorEditor.HeisalsothePresidentofLIVEnterprises&Consulting,LLC,andaLicensedProfessionalCounselor and LicensedMarriage&Family Therapistwithmore than35yearsof clinical andprofessionalexperienceinthementalhealthfield.Specialtyareasincludeprofessional/pastoralstress and burnout, combat trauma and PTSD, marriage and family issues, leadershipdevelopment, addictions, and lay counselor training. He is an author, a national andinternational conference speaker, and frequently consults with organizations, clinicians,ministryleaders,andchurchesonavarietyofissues.
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GarySibcy,Ph.D.,isProfessorofCounselingandDirectorofthePh.D.programinProfessionalCounselingandPastoralCounselingattheCenterforCounselingandFamilyStudiesatLibertyUniversity, where he teaches courses in advanced psychopathology and its treatment. He isboth a Licensed Clinical Psychologist (LCP) and a Licensed Professional Counselor (LPC), hasbeen in private clinical practice for more than 20 years, and currently works at PiedmontPsychiatricCenter.Dr.Sibcyspecializesinanxietydisorders,includingOCDandpanicdisorder,andchronicdepressioninadults,aswellasthediagnosisandtreatmentofchildrenwithseveremooddysregulation.Heiscurrentlydevelopinganempiricallysupportedtreatmentwithintheframework of interpersonal neurobiology and attachment theory. Dr. Sibcy has co-authoredseveralbookswithDr.TimClinton,includingAttachmentsandWhyYouDotheThingsYouDo.Frank Page, Ph.D., is president and CEO of the SBC Executive Committee. His mission is toencourageBaptistseverywheretoparticipateinoursharedtaskofreachingmen,women,andchildren with the life-changing message of salvation through Jesus Christ. He has served inministryfor35years.HeistheauthorofMelissaaswellasseveralotherpublications.Dr.PageholdsaPh.D.inSociologyfromtheUniversityofUtah.Miriam Parent, Ph.D., holds a Ph.D. from Rosemead Graduate School. She has served as acounseloreducatorformorethantwentyyears.PriortocomingtoTrinityin1993,shetaughtatLibertyUniversity in the School of Religion. Dr. Parent is a licensed clinical psychologist. Shepracticed full-time for several years prior to teaching; since then she has maintained acounselingpracticeprovidingindividualandmaritalcounseling,aswellasdiagnosticevaluationand assessment. Over the years her speaking and writing have focused on areas such asspiritualformation,stressmanagement,burnout,andministryandprofessionalethics.Shealsoenjoys speaking inwomen’s groups and church retreats on a variety of Bible and counselingtopics. Her areas of interest include professional ethics, diagnosis and treatment planning,stressmanagement,women’sissues,andspiritualformation.
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MilitarySuicide:Prevention,Assessment,InterventionandRecoveryTableofContents:
MSIP101:TheDynamicsofSuicide:What,Why,WhoandHow...........................................15JenniferCisneyEllers,M.A.MSIP102:ChoosingtoDie:AModelofUnderstanding.........................................................26JenniferCisneyEllers,M.A.
MSIP103:ATheologyofSuicide:BiblicalPrinciplesandaChristianResponse.......................36FrankPage,Ph.D.
MSIP104:CombatStress,PTSD,ReintegrationandSuicide...................................................45GlenBlomstrom,M.Div.MSIP105:MentalIllnessandtheEpidemiologyofSuicide....................................................59LindaMintle,Ph.D.
MSIP106:TheEthicsofSuicideIntervention.........................................................................73MiriamParent,Ph.D.MSIP107:MilitarySuicide,PreventionandIntervention:WhatYouNeedtoKnow...............82GlenBloomstrom,M.Div.MSIP108:ConductingaSuicideAssessment:UsingtheSafe-TModel(withroleplays)..........95GarySibcy,Ph.D.
MSIP109:FamiliesinCrisis:TheFirst48HoursFollowingSuicide........................................102JenniferCisneyEllers,M.A.andKevinEllers,D.Min.
MSIP110:TheImpactofSuicideonMilitaryMarriagesandFamilies...................................109DavidMikkelson,Ph.D.,andSuzanneMikkelson,Ph.D.MSIP111:GrievingaSuicide:Long-termSupportforSurvivorsandLovedOnes..................120JenniferCisneyEllers,M.A.andEricScalise,Ph.D.
MSIP112:CaregiversinCrisis:WhenClientsTakeTheirLives..............................................128EricScalise,Ph.D.andJenniferCisneyEllers,M.A.
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BonusMaterial:MSIPBonusSession1:TheEthicsofSuicideInterventionforEducatorsandChurchandCommunityLeaders.............................................................................................................135MiriamParent,Ph.D.MSIPBonusSession2:ConductingaSuicideIntervention:TheRoleofMinistryLeadersandCaregivers(withdemonstrations)........................................................................................145GarySibcy,Ph.D.Appendix1.........................................................................................................................150GarySibcy,Ph.D.
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MSIP101:
TheDynamicsofSuicide:
What,Why,WhoandHow
JenniferCisneyEllers,M.A.
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AbstractA spiritual battle takes place every day between light and dark, and suicide risk is a
battleground. Studies show suicide is on the increase with attempts outnumbering
completions.Therearecertainfactorsthatincreasesomeone’sriskforcommittingsuicide,such
asage,gender,marital status, raceandethnicity,andgeographical regionby state.Methods
include firearms, suffocation, jumping from bridges and other high places, and walking or
driving in front of a train.Mental illness, substance abuse, personality disorders, chronic or
terminalmedicalconditions,afamilyorpersonalhistory,environmentalfactors,thecontagion
effect, and access to lethalmethods are all risk factors for suicide.Help is available through
mental healthcare, positive connections, and the development of problem solving skills.
Spiritual factors, such as the power of prayer, God, and the Holy Spirit, are available in
equippingmentalhealthprofessionalswiththetoolstohelpthoseatriskforsuicide.
LearningObjectives
1. Participantswillidentifythosemostatriskforsuicidebylookingatfactorssuchasage,
gender,maritalstatus,raceandethnicity,andgeographicalregion.
2. Participants will define various methods used in the attempt and/or completion of
suicide.
3. Participantswillexploredifferentriskfactorsinvolvedinsuicide,suchasmentalillness,
substanceabuse,personalitydisorders,chronicorterminalmedicalconditions,familyor
personal history, environmental factors, the contagion effect, and access to lethal
methods.
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I. Introduction
A. ASpiritualBattle
1. Suicideisthebattlegroundinthebattlebetweendarkandlight.
2. Satanhasahandinconvincingpeopletheywanttotaketheirownlives.
3. Muchofthehealinginvolvedinsuicideisofaspiritualnature.
B. PersonalImpact
1. Caregivers are powerfully impacted when someone in their care attempts or
completessuicide.
2. Caregivers are also powerfully impacted when working with the loved ones or
familiesintheaftermathofasuicide.
3. Often caregivers have been impacted personally by suicide when loved ones and
familymembersstruggle.
II. TheNumbersSurroundingSuicide
A. AnIncrease(LookingatSuicideintheU.S.)
1. Suicideismoreprevalentinthenews,andresearchsupportsthatthisisanaccurate
portrayalofincreasedideation,attempts,andcompletedsuicides.
2. StatisticsfromtheCenterforDiseaseControl(CDC)2013
• In2013,therewere41,149suicides.
• Suicideisthe10thleadingcauseofdeathintheUnitedStates.
• In2013,someonediedbysuicideevery12.8minutes.
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B. ThePercentages
1. From1986-2000,therewasadecreaseinsuicideratesfrom12.5%to10.4%.
2. In2001,thenumbersstartedtoincrease.
3. Therehasbeenaslow,butsteady,increaseto12.6%currently(2013).
C. Attemptsvs.Completion
1. Aninfinitelylargernumberofpeopleattemptsuicidethancompletesuicide.
2. Itisestimatedthatthereare864,950suicideattemptseachyear.
3. Manyattemptsarenotreported.
III. WhoisMostatRisk?
A. Age
1. Currently, the middle aged group (ages 45-64) has the highest rate of suicide at
19.1%.
2. Suicidehasincreasedby28%amongthemiddleagedinthelast10years.
3. The economic crisis is one of the factors that has led to the increase in this age
group’srateofsuicide.
4. Stresslevelsareveryhighforthemiddleaged.
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B. Gender
1. Womenattemptsuicidemorethanmen.
• Threetoonemorethanmen.
• Uselesslethalmeans–poisoningoroverdose.
2. Mencompletesuicidemorethanwomen.
• Mencompletesuicideonetofourtimesmoreoftenthanwomen.
• Thisisduetomen’suseofmorelethalmeans–firearms.
C. MaritalStatus
1. Bythenumbers,mostofthepeoplewhocompletesuicidearemarried.
2. Whenlookingatsuicidebyrate,peoplewhoaredivorcedhavethehighestrateof
suicidefollowedbythosewhoarewidowedandthenbythosewhoaresingle.
3. Marriedpeopleactuallyhavethelowestrateofsuicideoverall.
4. Livingaloneandbeingalonesignificantlyincreasestheriskforsuicide.
D. RaceandEthnicity
1. Caucasianshavethehighestsuiciderate.
2. AmericanIndianshavethesecondhighestrateofsuicide.
3. Black,Hispanic,andAsianpopulationshavethelowestsuiciderate.
• Duetofactorsofresilience
• Duetoreligiousfaithandparticipationinafaithcommunity
• Duetostrongfamilyconnectionsandsocialsupport
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E. Patterns
1. Middleagedandolderwhitemalesarethehighestriskgroupfordeathbysuicide.
2. In2013,whitemalesaccountedfor70%ofallcompletedsuicides.
F. GeographicalRegion
1. The stateswith the highest suicide rates are in theWest:Montana, Alaska,Utah,
NewMexico,Idaho,Nevada,Colorado,andSouthDakota.
2. Stateswith the lowest rates are D.C., New Jersey, New York,Massachusetts, and
Connecticut.
3. Oneconjectureas towhysuicide ratesarehigher in theWest is that firearmsare
morereadilyavailable.
IV. SuicideDeathsbyMethod(2013)
A. Firearms
1. IntheU.S.,firearmsarethemostlethalandfrequentlyusedmethodofsuicide.
2. In2013,51.5%ofsuicideswerewiththeuseoffirearms.
B. Suffocation
1. 24.5%usedsomemethodofsuffocation.
2. Thisincludeshanging.
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C. OtherMethods
1. Theseothermethodsmakeup8%ofsuicides.
2. Theseothermethodsincludejumpingfrombridgesorotherhighplaces(theGolden
GateBridge)andwalkingordrivinginfrontofatrain.
D. Overview
1. WorldHealthOrganization–suicideinothercountries.
2. Firearmsarenottheleadingmethodofsuicideinothercountriesbecausepeopledo
nothavetheaccessibilitytofirearmsthatwehaveintheU.S.
3. Overdose
• Thereispotentiallyalargetimeframewheresomeonecanintervene/provide
medicalattention.
• Our bodies have a tremendous ability to overcome even large levels of
toxicity.
• Thereisawindowofopportunityforpeopletoreconsidersuicide.
4. Firearms
• Littleopportunitytoreconsider.
• Thisaquickdecisionwithnoturningback.
• Thelethalityofthemeansisverysignificantwhenassessingrisk.
V. RiskFactorsforSuicideA. MentalIllness
1. Itisestimatedthat90%ofthosewhocommitsuicidehaveatreatablementalillness
atthetimeoftheirdeaths.
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2. Mentalillnessisthemostreliableandconsistentriskfactorforsuicide.
3. Mentalillnesseswithanincreasedriskforsuicide.
• Majordepression–Thisistreatablewithmedicationandcounseling.
• BipolarDisorder–Thisisalsotreatablebutcannotbecured.
B. SubstanceAbuse
C. PersonalityDisorders
1. Borderlinepersonalitydisorder
2. Antisocialpersonalitydisorder
3. Conductdisorderinyouth
4. Psychoticdisorders
5. Anxietydisorders
6. Post-traumaticstressdisorder
7. Thesedisordersareatanespeciallyhighriskforsuicidewhentheygoundiagnosed
anduntreated.
D. ChronicorTerminalMedicalConditions
1. Depressioncanfollowcertainmedicalillnesses.
• Cancer
• Pneumonia
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2. Peoplewith terminalmedical conditionsmaybelieve that taking theirown lives is
betterthanburdeningfamilymembersorsufferingthroughanextendedillness.
3. Fearofpainanddeathcanmakepeoplesuicidal.
• Chronicmigraines
• Fibromyalgia
• Chronicjointpain
• Chronicbackandneckpain
E. Family History of Suicide Attempts or Completed Suicide and Personal History of
Attempts
1. Otherthanmentalillness,thisisthehighestriskfactorforsuicide.
2. Itisimportantformentalhealthprofessionalstoaskaboutfamilyhistoryofsuicide.
3. Researchhasshownsuicideriskcanbeinherited.
F. EnvironmentalFactors
1. Stressfullifeeventssuchasthedeathofacloselovedone
2. Financialloss
3. Legaltrouble
4. Chronicstressfulsituationssuchaslong-termunemployment
5. Seriousrelationshipconflictsuchasabreakupordivorce
6. Harassmentorbullying
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G. ContagionEffect
1. Exposuretoanotherperson’ssuicidecanmakeonemorevulnerabletobeingatrisk
forsuicide.
2. Only1%ofsuicidesareattributedtothecontagioneffect,butitissignificantenough
thatweneedtobeaware.
3. Thisexposurecanbedirectorindirect.
4. This is true with spouses, close friends, siblings, family members, and even
celebrities.
5. Donotromanticizeorsensationalizetheactofsuicide.
6. Teensaresignificantlymorevulnerabletothecontagioneffect.
H. AccesstoLethalMethodsatTimesofIncreasedRisk
1. Access to handguns should be strictly controlled among high risk suicide
populations,suchas thosewithseriousmental illnessesthathavebeencorrelated
withhighsuiciderate.
2. 70-75%offamilieswhoareaskedtoremovefirearmsfromthehomechoosenotto
removethem.
3. Takeextrastepstoprotectindividualsvulnerabletosuicidefromaccesstofirearms.
VI. ProtectiveFactorsforSuicideA. ReceivingMentalHealthcare
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B. Positive Connections with Family, Friends, and Peers Through Social Institutions of
HealthyMarriagesandOurFaithCommunities
C. HelpingPeopleDevelopSkillsandAbilitiestoSolveProblems
VII. NeurobiologyofSuicide
A. PostmortemStudies
B. BrainSystemsinChargeofMood,ThinkingandStressResponse
VIII. SpiritualFactors
A. PowerofGod
B. FightingAgainstthePowersofDarkness
C. ConnectionThroughPrayer
D. PoweroftheHolySpirit
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MSIP102:
ChoosingtoDie:AModelofUnderstanding
JenniferCisneyEllers,M.A.
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AbstractJenniferCisneyEllersreviewsDr.ThomasJoiner’smodelofunderstandinghowandwhysuicide
occurs.Thedesiretodiebecauseofaperceivedburdensomenessandalowlevelofbelonging
orsocialconnectednessandtheabilitytotakeone’sownlifeleadapersontobelievesuicideis
thebestsolution.Suicidalpeopletendtobelievetheyareaburdentotheir lovedones.Their
senseofvalueandself-worthhasbeenundermined.Satanistheauthorofthisultimatelie,but
caregiverscanintervenebyreassuringpeopleoftheirvalue,helpingthemfeelproductive,and
relaying the message that care and concern are not a burden. Suicidal people also have a
thwartedconnectedness—asensetheydonotbelong.Thisfeelingofisolationcanbehelpedby
treating depression, fostering and building social connection, enhancing family relationships,
buildingsocialandrelationalskills,anddialoguingaboutstruggles.Peoplehaveastrongdesire
forself-preservation,buttherearefactorsthatcontributetosomeoneacquiringtheabilityto
enactself-injury.It is importantforcaregiverstoprovidepreventativesupport,educationand
traininginthesesituations.
LearningObjectives
1. Participants will identify the factors that lead a person to believe suicide is the best
solution.
2. Participants will list steps in intervening when a person experiences perceived
burdensomenessandathwartedconnectedness.
3. Participants will explore situations that lead someone to acquire the ability to enact
lethalself-injury.
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I. Introduction
A. TheAmericanFoundationforSuicidePrevention(Webpage)
1. Quote: “Our effectiveness in preventing suicide ultimately depends onmore fully
understandinghowandwhysuicideoccurs.”
2. Whatisgoingonintheheartsandmindsofthosethinkingaboutsuicide?
3. PreventionandInterventiondependsonmorefullyunderstandingpeople.
B. Dr.ThomasJoiner
1. Book:WhyPeopleDiebySuicide
2. Personallyimpactedbysuicidewhenhisfathercommittedsuicide.
3. TheInterpersonalPsychologicalTheoryofSuicidalBehavior
C. Dr.EdSchneidman
1. Definition of suicide: “Suicide is a conscious act of self-induced annihilation best
understood as amultidimensionalmalaise in a needful individual who defines an
issueforwhichsuicideisperceivedasthebestsolution.”
2. Wehavetomakeaconcentratedefforttounderstandwhatisgoingoninthemind
ofasuicidalperson.
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II. WhatLeadsaPersontoBelieveSuicideistheBestSolution?
A. TheDesiretoDie
1. PerceivedBurdensomeness–“Iamaburdentosocietyandmylovedones.”
2. Lowlevelofbelongingorsocialconnectedness.
• Thwartedconnectedness
• Feelsociallyalienated
B. TheAbilitytoTakeTheirOwnLives
III. PerceivedBurdensomeness
A. Definition
1. Thesensethatoneisaburden
2. Thekeywordisperceived.
3. Loved ones see the suicidal person’s pain as the burden, not the person as the
burden.
B. WhyPerceivedBurdensomeness?
1. MentalIllness
• Depression
• Bipolardisorder
2. Chronicphysicalillness
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3. Chronicpainconditionsordisabilities
4. Terminalillness
5. Situationalissues
• Relationshipproblems
• Financialloss
• Jobloss
• Legalproblems
C. MotivationtoLive
1. Perceived burdensomeness undermines our sense of value and self-worth.
2. We want to sense we are bringing something important to the world.
3. Man’sSearchforMeaningbyVictorFrankl
4. Ifamanhasawhy,hecanwithstandanyhow.
D. Suicide–ASelfishAct?
1. Suicidalpeoplebelievetheyarecommittingaselflessact.
2. Theyfeeltheyaretakingawayaburdenforthosetheylove.
3. IammakingachoicethatwillultimatelybebestforeveryoneIlovebecauseIama
burden.
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E. SpiritualElements
1. Suicidalpeoplestrugglewithfalsebeliefsandliesaboutthemselves.
2. Satanbeginstoconvincesomeonethattheyareworthless.
3. Satan’sultimatelie–Theworldwouldbebetteroffwithoutyou.
F. Dr.Joiner'sStudy
1. Dr. Thomas Joiner and his team confirmed perceived burdensomeness is one of
thefactorsmostcloselyassociatedwithsuicidalbehavior.
2. The link between perceived burdensomeness and suicidality is just as strong as
thelinkbetweenhopelessnessandsuicidality.
G. HowDoWeIntervene?
1. Reassurepeopleoftheirvalue.
2. Peopleneedtofeelproductive.
3. Peopleneedtounderstandcareandconcernarenotaburden.
4. StoryofJenniferCisneyEllerscaringforhermother.
IV. ThwartedConnectednessA. Definition
1. Thesensethatonedoesnotbelong.
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2. Frombirth to death, deep andmeaningful connections to others is critical to our
mental,physical,andspiritualwell-being.
B. Connectedness
1. Aprimaryfactorinconnectednessisface-to-faceinteractionswithotherpeople.
2. Additionally,afeelingofbeingcaredaboutiscrucialtoconnectedness.
C. FailuretoThrive
1. Canhappenwithinfantsandseniors.
2. This phenomenon leads us to an observation of how important connection is in
relationships.
D. DepressionandIsolation
1. Depressedpeoplemakelesseyecontact.
2. Depressedpeopleengageinlesshead-noddingduringconversation.
E. TimesofNationalCrisis
1. Peopleoftenpulltogetherandtheirsenseofbelongingincreases.
2. AssassinationofJFK
3. Terroristattacksof9/11
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F. MMPI–PredictorsforDeathbySuicide
1. Self-blameScale
2. SocialIntroversionScale
G. HowDoWeIntervene?
1. Treatdepression.
2. Fosterandbuildsocialconnectionasprevention.
3. Enhancefamilyrelationships.
4. Helpsociallyisolatedindividualsbuildsocialandrelationalskills.
5. Bemoreopentodialogueaboutstrugglesandlifechallenges.
V. AbilitytoEnactLethalSelf-injuryA. Self-preservation
1. AllmammalsaredesignedbyGodtoprotectandsavetheirlives.
• Strongimmunesystems
• Ourbodieshaveanincredibleabilitytoheal.
2. Psychologicalmechanism
• Peopleareprogrammedforsurvival.
• Fightorflightresponse
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B. HowDoesOneAcquiretheAbilitytoEnactLethalSelf-injury?
1. Previousattemptsorprevioussuicidalbehaviors
2. Fantasyactingout–thinkingaboutandplanningsuicide
3. Engaginginnonlethalactsofself-injury
• Cutting
• Burning
• Canbeagatewaytolethalself-injury
4. Childhood physical and sexual abuse or other painful, repeated experiences in
childhood
5. Involvementinviolence
6. Anythingthathabituatessomeonetopainandinjury
7. Peoplewhoareexposedtothepainandinjuryofotherpeopleintheirprofessions
C. HowDoWeIntervene?
1. Considerallofthefactorsinsuicideassessments.
2. Preventative support for peoplewhohave the experiences thatmight lower their
resistance
3. Educationandtrainingwithgoodself-care
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D. VideoofDr.KevinEllers
1. Thereisahugemisunderstandingofmentalillness.
2. Satanicforcesareatworkduringsuicide.
3. Sometimes suicide is a choice, but sometimes the one committing suicide truly
believeshe/sheisdoingthebestthingfortheoneswhoareliving.
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MSIP103:
ATheologyofSuicide:BiblicalPrinciples
andaChristianResponse
FrankPage,Ph.D.
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AbstractSuicideisadevastatingissueinourworldtoday,yethasbeenanage-oldtragedyformankind.
One can look back at history to see examples of suicide. Scripture records seven suicides:
Abimelech, Samson, King Saul, Saul’s armor bearer, Ahithophel, Zimri, and Judas. Although
Scripturedoesnotgiveusanyspecificwordaboutsuicide,itdoesindicatethatGodisthegiver
oflifeandonlyHehastherighttotakeitaway.Weneedtofollowthebiblicalprinciplesthat
Godhasagreatplanforourlives;thesolutiontodespairandhopelessnessisfaithinHim;and
thoughtroublecontinuesinlife,theLordwillneverleaveus.OurChristianresponsetosuicide
needs tobeoneof confrontingbad theologyand thinking; encouragingpeopleagainstusing
tritestatementsand,instead,urginggoodtheologyandpractices;andpracticingtheministryof
presence.Ultimately,wecantrusttheLordandknowHisloveispowerful.
LearningObjectives
1. ParticipantswillbeabletoexploresevensuicidesmentionedinScripture.
2. Participantswillidentifybiblicalprinciplessurroundingtheissueofsuicide.
3. ParticipantswilldefineaChristian’sresponsetosuicide.
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I. Introduction
A. ExamplefromMarkTwain’sTheAdventuresofTomSawyer
1. Tomandhisfriendsaregonefromhomeforalongtimepretendingtobepirateson
theriverbank.
2. ThetownspeoplebelieveTomandhisfriendsaredead.
3. Tomandhisfriendssneakintotownandattendtheirownfuneral.
4. The story ends happily with the boys revealing their whereabouts and everyone
beingthrilledtoseetheyarealive.
B. SuicideStatistics
1. In our country, suicide is one of the leading causes of death, particularly among
teenagers.
2. Moresoldiersarebeinglosttosuicidethancombat.
3. Suicidehasrisenamongyoungwomen.
C. HistoricalExamplesofSuicide
1. MasadainIsrael
2. MasssuicidesfromthewallsofGamlainGalilee
3. SuicidesoftheJapaneseduringWorldWarIItoevadecapturebytheAmericans
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4. MasssuicidesduringtheJonestowntragedies(JimJones)
5. Orientalculturesglorifyingsuicidesratherthansurrendering
6. SuicidebombersintheMiddleEast
II. SuicidesMentionedinScripture
A. Abimelech
1. Judges9:52-54
2. Abimelechcommittedsuicideinatimeofpersonalcrisis.
B. Samson
1. Judges16:25-30
2. Samsondiedforacausehebelievedin,butalsoforrevengeuponthePhilistines.
C. KingSaul
1. 1Samuel31:4
2. Whatcouldhavebeenagreatlifeofvictoryturnedintoaterribletimeofdefeatand
sadness.
D. Saul’sArmorBearer
1. 1Samuel31:5
2. Followedtheexampleofhisking
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3. Impulsivedecision
4. Apermanentsolutiontowhatcouldhavebeenatemporaryproblem
E. Ahithophel
1. 2Samuel17:23
2. Bitternessanddepressionwerefactorsinhisdecision.
F. Zimri
1. 1Kings16:15-20
2. Bitternessbecameastrongholdinhislife.
G. Judas
1. Matthew27:3-5
2. Depression,greed,personalfailure,andregretledtoJudas’suicide.
III. ATheologyofLifeA. WhatdoestheBibleSay?
1. TheBibledoesnotgiveanyspecificwordaboutsuicide.
2. Scripturedoes indicateGod is thegiverof lifeandonlyHehas the right to take it
away.
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B. Job1:21
“Hesaid,‘NakedIcamefrommymother’swomb,andnakedIshallreturnthere.The
LordgaveandtheLordhastakenaway.BlessedbethenameoftheLord.’”
C. 1Corinthians6:19-20
“Or do you not know that your body is a temple of the Holy Spiritwho is in you,
whom you have from God, and that you are not your own? For you have been
boughtwithaprice:thereforeglorifyGodinyourbody.”
IV. BiblicalPrinciplesA. GodHasaGreatPlanforyourLife
1. God’spurposeshouldtakeprecedentoverouragendas.
2. Jeremiah29:11–“ForIknowtheplansthatIhaveforyou,declarestheLord,plans
forwelfareandnotforcalamitytogiveyouafutureandahope.”
B. God’sPlanisforLife,notDeath
1. Romans6:23–“Forthewagesofsinisdeath,butthefreegiftofGodiseternallifein
ChristJesusourLord.”
2. John10:10–“The thief comesonly to stealandkill anddestroy; I came that they
mayhavelife,andhaveitabundantly.”
C. TheSolutiontoDespairandHopelessnessisNotSuicide,butFaithinGod
1. Psalm33:20-22–“OursoulwaitsfortheLord;Heisourhelpandourshield.Forour
heartrejoicesinHim,becausewetrustinHisholyname.Letyourlovingkindness,O
Lord,beuponus,AccordingaswehavehopedinYou.”
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2. ScripturepointstoourultimatefaithinGodasoursalvation.
D. ThoughTroubleContinuesinthisLife,OurLordWillNeverLeaveUs
1. John16:22–“Thereforeyoutoohavegriefnow;but Iwillseeyouagain,andyour
heartwillrejoice,andnoonewilltakeyourjoyawayfromyou.”
2. Matthew11:28–“CometoMe,allwhoarewearyandheavy-laden,andIwillgive
yourest.”
V. ChristianResponseA. ConfrontBadTheology
1. Thereisagreatdealofmisunderstandingwhenitcomestotheissueofsuicide.
2. Severalfaithgroupsteachthatonewhocommitssuicidecannotgetintoheaven.
3. Mostpeoplewhocommitsuicidehavereachedapointintheirlifewheretheyhave
losttouchwithreality.
4. TheBibledoesnotteachthatthosewhocommitsuicidegotohell(Romans5:8).
5. Scripturedoesteachaccountability.
• Ezekiel18
• Leviticus4:22
6. Peoplewhocommitsuicidegotoheaven if theyhaveapersonal relationshipwith
Christ.
7. Scripturedoesteachtherealityofdemonicoppressionandpossession.
8. Satancanusestrongholdsinamentallyillperson’slifetomakeasituationworse.
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B. ConfrontBadThinking
1. Whilecharacterflawsandbadparentingcancausedifficultyineverylife,struggles
are also found among people of tremendous character and in homes where
parentinghasbeendevoted,loving,andcaring.
2. Mentalillness,emotionalstruggles,anddepressionarenotmerelycharacterissues.
C. EncouragePeopleAgainstUsingTritePlatitudes
1. Donotsay,“Theyareinabetterplacenow.”
2. Donotsay,“Snapoutofit.”
D. EncourageGoodTheologyandGoodPractices
1. WeneedtoputourhopeinGod,andwecandothisthroughprayer.
2. Psalm46:1-3
3. Hebrews13:6
4. Isaiah26:3
E. PracticetheMinistryofPresence
1. StoryofFrankPage’sdaughter’ssuicide
2. ThepresenceofHisWord
3. ThepresenceoftheLord
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4. ThepresenceofGod’speople
5. There is a need for immediate action when there has been a suicide or suicide
attempt,butthatministryneedstobeongoing.
6. Do not let an awkward situation dissuade you from active Christian ministry to
hurtingpeople.
7. Behonestandbethereforthehurtingpeople.
8. Letthehurtingpersonexpresshis/herangerandconfusion.
9. Beabuilderofencouragement,notatransmitterofhurt.
VI. ConclusionA. WeCanTrusttheLord
B. God’sLoveisPowerful
C. 2Corinthians1:3-5
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MSIP104:
CombatStress,PTSD,
ReintegrationandSuicide
GlenBloomstrom,M.Div.
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Abstract
When learning about the area ofmilitary related suicide, it is vital that a thorough study of
trauma is completed. There are numerous ways trauma can occur in the life of a
servicememberandmanyreasonsmilitarypersonnelmaystruggleafterexperiencingtrauma.
Inthislesson,GlenBloomstromdiscussestheareaoftraumainthemilitaryfromhisownstudy
andknowledge,aswellashisownexperienceasamilitarychaplain.Beginningwithathorough
introduction to military culture and trauma, the presentation continues by discussing how
treatments have or have not aided in healthier minds post-trauma. Finally, Bloomstrom
presentsHogue’smodelofhelping traumavictims ingreatdetail, aswell asdiscussingother
successfulhelpingresourcesforthosestrugglingwithtrauma.
LearningObjectives
1. Participantswillexploreingreatdetailtheareaoftraumawithinthemilitaryculture.
2. Participantswillidentifydifferenttypesoftrauma,howtheyoccur,symptoms,andwhat
treatmentsmightbebest.
3. Participantswilldiscussstrategiesforhelpingindividualsstrugglingaftertrauma.
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I. Introduction
A. LearningObjectives
1. Describethecontextofmilitarytrauma
2. Identifytypesofmilitarytraumaresponsesbydefinition,symptomsandinteractions
3. Illustratecomponentsforhelpingandotherhelpingstrategies
B. MilitaryContext
1. Statistics/Recruitment
• ActiveMilitary–1.37M
• Reserve&NationalGuard–874K
• FamilyMembers–1.9M
• Retirees–2M
• Veterans–23M
• AnnualRecruitment
o 180,000recruitedasenlistedpersonnel
o 20,000arecommissionedasofficers
2. TransitionsintoCulture
3. TheContemporaryContextofWar
• Since1989continuousdeployments
• 2001-present:OIF/OEFCharacteristics
o No front line, demanding climate, sleep deprivation 24/7 operations,
multiple roles, confusing enemy appearance, tactics (often using civilian
shields),IEDs,rocket,mortarattacks,changingRulesofEngagement,
o Casualties,collateralcasualties
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• Stoploss,In-theaterextensions
• MultipleDeployments
• Shortdwell/resettimebetweendeployments
4. LifestyleChallenges
• DeploymentAffectsEveryone
• Transitionsafterdeployment
o Change
o Guilt
o Loss
o Finances
o CombatStress
o Identityloss
• ReserveComponent(RC)Challenges
o Changingexpectations
o LifeInterrupted
o CommunityUnaware
o MilitaryCommunityInfrastructuremissingforRC
II. MilitaryTraumaResponse
A. TermsofHistoryofWarRelatedTrauma
B. Statistics
1. PTSDVietnam(NVVRS)
• NationalVietnamVeteransReadjustmentStudy(NVVRS)
o Indicated30.9%who served inVietnamexperienced combat relatedPTSD
duringtheirlifetime
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o 15.2%hadcurrentPTSD(1990)
o Other commonly reported disorders: depression, alcoholism, generalized
anxietydisorder
• Lifeadjustmentissues:maritalandwork
2. PTSDVietnam(NVVLS)
• In2013-14afollowupstudy:theNationalVietnamVeteransLongitudinalStudy
(NVVLS)examinedhealthandmentalhealthovertime
• 11% rate (male) and 7% female had warzone PTSD and another 3% for
“subthresholdPTSD”
• Equatingto283Kmale400femaleveterans
• 50xhigherratesofdepressionforthosewithPTSD
• ThosewithwarzonePTSDat firstassessmentwere twiceas likely tohavedied
beforesecondassessmentthanthosewithoutPTSD.
3. GWOTPTSDRatesandHealthConcerns
• Studiesshow5-20%ofveteransinOIFOEFmeetcriteriaforPTSD
o Higherforthosewhoparticipateindirectcombat
o ComparabletothoseofVietnamveterans
• Otherhealthconcernstakeatoll
o Depression,substanceuse,suicide
o Other symptoms related to PTS include sleep problems, concentration,
memoryproblemsheadaches,backpain,hypertension
C. Treatment
1. ReserveComponentsvs.ActiveComponents
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2. Reluctancetoseekhelp
• Limitedappointments
• Workorchildreninterfering
• Stigma
• Hesitanttodiscussmemories
• MentalHealthCaretermsandlabels
3. TypicalTreatmentsandRecoveryRates
• TalkTherapies
• Medication
• RecoveryRates
o 50%seektreatment
o 20-40%dropoutbeforecompleting
o 60-80%ofcompletersrecover
• Elementsofbest“A-leveltherapiesforPTSD”
o Narration
o CognitiveRestructuring
o GradualExposure
o Stressinoculationskills
o Psychoeducation
III. Trauma
A. TraumaticEvents-ThreeGroups:
1. ActsofGod
2. UnintentionalthroughHumanInvolvement
3. HumanCaused
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B. WarTrauma
1. Constantthreatofattack
2. Witnessingcombat/accidentalinjuryordeath
3. Handlingbodyparts
4. Impactofkillingtheenemyorinnocentpersons
5. SexualAssault
6. Cumulativeeffects
C. PTS(CombatOperationalStress)
1. A common, normal, adaptive response to experiencing a traumatic or stressful
event;“fight-or-flight”
2. Symptoms
• Racingheart, shaking, nervous, drained, leeryof similar situations,maydream
about,mayhaveintrusivethoughts
• Symptomssubsideoverashortertime
3. PostTraumaticStressDisorder
• ResponsetoaTrauma
• Referstoasetof3criteria
o Re-experiencingtrauma
o Withdrawal/Detachment/Avoidance/Numbing
o Hyper-arousal(Hypervigilance)
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• Symptomspresentatleastonemonth
• What distinguishes PTSD from PTS is the degree to which these reactions
interferewith
o Makingasuccessfultransitionhome
o Interfere on an an ongoing basis with life, relationships, work, studies,
hobbies
• Similarparallelstopolice,firstresponders,firefighters
• “Reactions” called “symptoms” are also “survival skills” for Law Enforcement
officers&warriors
o Hypervigilance=situationalawareness,awarenesstolifesavingclues
o Numbing = channeling anger, emotions in the face of danger, casualties in
ordertolead
o Re-experiencing=rehearsalofimmediateactiondrillsinresponsetodanger
o Functioningonlittlesleepisanadaptivebehavior
4. TraumaticBrainInjury(TBI)
• TBIistheresultofasudden,violentbloworjolttotheheadresultinginpossible
bruisingofthebrain,tearingofnervefibersandbleeding
• TBIcanrangefrommild(mTBI)/concussiontomoderateorsevereTBI
• Symptoms
o Difficultywithconcentrationwhendistractionspresent
o Slowtotakeinnew,fast,complicatedinformation
o Problemswithrecentmemory,newlearning
o Executivefunctionissues,startingtasks,settinggoals,planning,organizing
5. mTBIandPTSD
• Arewar-related reactions such as cognitive problems, rage, sleep disturbance,
fatigue,headachesandothersymptomspsychological(PTSD)orphysical(mTBI)?
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• Research from New England Journal ofMedicine in 2008-9 showed that these
symptoms are “more likely to be associated with PTSD than with concussion
mTBI.”
6. MilitarySexualTrauma
• VAtermforsexualassaultorrepeated,threateningsexualharassment
• Againstone’swillwhileinthemilitary.
o Notadiagnosis
o MayresultinPTSDsymptomsforsome
o Pressured, without consent, unwanted touching, grabbing, remarks or
advances-Betrayal
o Victimoftenmadetofeeltobetheguiltyparty
o ViolationofWarriorEthos,BandofBrothersbond
7. MoralDistress
• Ethicsandmoralsrelatedtorightandwrongconduct
• Ethicsarerulesprovidedtoanindividualbyanexternalsource
• Moralsrefertoanindividual’sownprinciplesregardingrightandwrong
• MoralDistressoccurswhenoneknows theethicallyorprofessionalprescribed
actiontotakebutindoingsoviolatestheirmoralcode
8. MoralInjury
• “anactofserioustransgressionthat leadstoserious innerconflictbecausethe
experienceisatoddswithcoreethicalandmoralbeliefsiscalledmoralinjury”
• “perpetrating,failingtoprevent,bearingwitnessto,orlearningaboutactsthat
transgressdeeplyhelpmoralbeliefsandexpectations”(Litzetal.,2009)
• “SoulWound”–EdTickWarandtheSoul
• “Violation of the Geneva Convention of the Soul” – Larry Dewey War and
Redemption
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IV. HelpingA. Hogue’sLANDNAV
1. Elements
• Aboutwarriorsnavigatingfindingawayintransitions
• Commoneverydaywarriorlanguage
• Explanationsofwhattoexpectintheprocess
• Specificstepsforwarriorsandfamilymembers
2. LANDNAV–LifeSurvivalSkills–UnderstandingyourwarriorreflexesandImproving
Sleep
• Becomemoreawareofyourreactionsbykeepingajournal
• Learntoacceptreactionswithoutjudgmentoranger
• Improvephysicalconditioningandrelaxmuscletension
• Improvesleep
• Learnhowalcoholordrugsaffectyourreactions
3. LANDNAV – Attend – learn to pay attention to and modulate your reactions,
emotionsandwaysofthinking
• Payattentiontoyourphysiologicalreactionsandanxietylevel
• Learntopayattentiontoyourfeelingsandemotions
• Createspacebetweenyourreactionstostressfuleventsandbehaviors
• Learntomonitorandeliminate“should”andrelatedwordsorphrases
• Noticeyourbreathing
• Improveyourfocusandattentionthroughmeditationandmindfulness
4. LANDNAV–Narrate–learntonarrateyourstory
• “Imaginalexposuretherapy”
o Leadstothebodyandmindlearningthereisn’taneedtoreacttothestory
likeit’stheactualtraumaticevent
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o “Habituation”
5. LANDNAV–LearningtoDealwithstressfulsituations,stupidstuff,peopleandanger
• Resiliency“inoculationtraining
• Dealingwiththe“stupidstuff”peopledo
• Dealingwithmoreserioussituationsinvolvingpeople
• Dealingwithanger,rageandrelatedemotions
6. LANDNAV–Navigatingthemedicalandmentalhealthcaresystems
• Reasonstoseekmentalhealthtreatment
• Understandingandovercomingstigmaandotherbarrierstocare
• Whattoexpect-aroadmapforgettinghelp
• Typesoftreatment
• TreatmentandDisability
7. LANDNAV–Acceptance:LivingandCopingwithMajorLosses
• Understandingtheemotionsofloss
• Exploringtheconnectionsbetweencomplexandprimaryemotions
• Lettinggoofunanswerablequestions
• Copingwithgriefandsurvivor’sguilt
• Acceptingotherdifficultthingsthathappenedincombat
8. LANDNAV–Fivequalitiesofdiscoveringmeaningandpurposeinyourjourney
• Vision–beingpresentinthemoment
• Voice–howtheWarriorandfamilyexpressesthemselvesintheworld
• Village(Community)–connectingandfunctioninginalargereffort
• Joiedevivre(joyofliving)–joy&happinesscanbediscoveredthroughsuffering
bygrace
• Victory–applyinggracetocreateabetterworld
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B. BasicsofHelping
1. SMisaperson,notadiagnosis
2. Understandmilitaryculture
3. Learntolistenwellandpatiently
4. Berealandempathetic
5. Beinformedandaware
6. SharetheloveofamercifulandforgivingGodthroughyourfaithcommunity
C. HelperSelfCare
1. Thehelpermustbealertforvicarioustrauma
2. TrainingandEducationareessential
3. Monitoryourself
4. Selfcareisessentialforthehelper
V. ConclusionA. OtherHelpingStrategies
1. VetCrisisLineintegratedwithNSPL800-273-8255,press1forVeterans
• www.veteranscrisisline.net(havelivechat)
• Textto838255
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2. VAOEF/OIFTeamsatVAMedicalCenters
• OutreachandEducation877-927-8387
3. VAVeteranCenters
• http://www2.va.gov/directory/guide/vetcenter_flsh.asp
• Call 877-WAR-VETS (927-8387) to speak with counselor or get
info.
4. MilitaryOneSourcewww.militaryonesource.com
B. FaithBasedStrategies
1. MoralInjury(FaithBased)BriteDivinitySchoolSoulRepair
• http://brite.edu/academics/programs/soul-repair/resources/#ministers
2. WebsiteforPTSD/Suicide/MoralInjury(FaithBased):
• www.militaryoutreachusa.org
3. SaddlebackChurch“TheGatheringforMentalHealthandtheChurch”
• HowtostartaMentalHealthMinistry(Includingveterans)
C. OtherHelps
1. GetHelp–FollowupwithMentalHealthCare
2. GetConnected–WiththeFaithCommunity,orwithVeteranServiceOrganizations
(VSOs),VeteranPeerGroupscanhelpreduceisolation
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3. GetActive–someVSOsgatherforfitness,naturalmentalhealthbenefitscanresult
4. GiveBack–Serve–Intimebyservingotherswithpurposeishealing
5. SpiritualRituals – traditions, study, prayer groups, retreats (formenandwomen)
arerestorative
6. Remember – celebrate life on anniversaries of loss, civic holidays, go to unit
reunions,gatherings
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MSIP105:
MentalIllnessandtheEpidemiologyofSuicide
LindaMintle,Ph.D.
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AbstractSuicideisacomplexissuewithmultiplecontributinggeneticandenvironmentalfactors.Mental
illness isakey factor in identifyingsomeoneashavingapredisposition for suicide.Thereare
riskfactorssurroundingsuicide,suchasgender,age,race/ethnicity,maritalstatus,geography,
professions/occupations,economics, timeofyear, illness,andothers.Methodsarediscussed,
along with common triggers and general warning signs. Protective factors and prevention
strategiesareimportantindealingwithpeopleinsuicidalcrisis.
LearningObjectives
1. Participantswillexplorevariousmythssurroundingsuicide.
2. Participants will define risk factors for suicide, such as gender, age, race/ethnicity,
marital status, geography, professions/occupations, economics, time of year, and
medicalconditions/illness.
3. Participants will identify common methods and triggers of suicide, general warning
signs,protectivefactors,andpreventivestrategies.
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I. Introduction
A. StoryAboutProminentLawyer’sSuicide
1. SuicideisatragedyandJesussaysitisalossnotagain.
2. Proverbs23:18
“Surelythereisafuture,andyourhopewillnotbecutoff.”
B. Definitions
1. Epidemiology is the study and control of disease or injury patterns in human
populations.
2. Suicideisthepurposefulacttoendone’slife.
3. Suicideattempt isanactofself-harmincludingwhatwaspreviouslyreferredtoas
“para-suicidalbehavior”-theattempttohurtoneselfwithoutkilling.
• Thisisnowcallednonsuicidalself-injury.
C. CommonMythsAssociatedwithSuicide
1. Peoplewhotalkaboutsuicidewon’treallydoit.
2. Anyonewhotriestokillhimself/herselfmustbecrazy.
3. Ifapersonisdeterminedtokillhimself/herself,nothingisgoingtostophim/her.
4. Peoplewhocommitsuicidearepeoplewhoareunwillingtoseekhelp.
5. Talkingaboutsuicidemaygivesomeonetheideatocommitsuicide,andthenthey
couldactonit.
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D. KeyFacts
1. Globally,over800,000peopledieduetosuicideeveryyear.AccordingtotheWorld
HealthOrganization,suicideisthefifthleadingcauseofdeath(2012).
2. Suicideisthe10thhighestcauseofdeathforallages,sexes,andethnicities.
3. IntheU.S.alone,40,600suicideswerereported.Thisequatestoonesuicideevery
12.9minutes.
4. Foreverysuicide,therearemanymorepeoplewhoattemptsuicideeveryyear.
5. A prior suicide attempt is the singlemost important risk factor for suicide in the
generalpopulation.
II. TheRoleofGenetics,EpigeneticsandEnvironment
A. FamilyandTwinStudies
1. There is a higher rate of suicidal behavior in relatives of suicide victims and
attempterscomparedtorelativesofnon-suicidalcontrols.
2. Most suicide attempters/completers have underlying neuropsychiatric diagnoses,
butfamilytransmissionmaybeindependentofthosepsychiatricdisorders.
B. AdoptionStudies
1. Showthatsuicideinvolvestheinheritedtraitoftemperamentofimpulsivityandthe
regulationofimpulsivityisinvolved.
2. Suicidecanhappenimpulsivelyinmomentsofcrisis,unrelatedtopsychiatricillness.
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C. TheFieldofEpigenetics
1. Looksatthepossibilitythatpartofthestronggeneticcomponentisdeterminedby
DNAmodification.
2. Epigeneticsignaturesareheritable,butcanbemodifiedbytheenvironment.
3. Thisisagrowingfield.
4. A number of recent studies have shown epigenetic alterations associated with
suicidalbehavior.
D. EnvironmentInteractingwithGenes
1. Apersonalhistoryofchildhoodabusehasbeenrepeatedlyimplicatedasariskfactor
forsuicidalbehavior.
2. Someepidemiologicalstudieshaveestimatedthatsexualabusemayexplain20%of
theriskvarianceinsuicide.
III. TheRoleofMentalIllnessinSuicide
A. PsychiatricDiagnoses
1. Majordepressivedisorder
2. Conductdisorder
3. Anxietydisorder
4. Substanceuse
5. PTSD
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B. Statistics
1. Ninetypercentofpeoplewhocommitsuicidehaveoneormorediagnosablemental
illnesses.
2. Sixtypercentofallsuicidesarecommittedbypeoplewithmooddisorders.
3. Approximately 30% of suicides are committed by people who have psychiatric
disordersotherthanmooddisorders.
4. Thirty percent of all clinically depressed individuals attempt suicide. About half
aresuccessful.
5. Persons discharged from mental hospitals are 34 times more likely to commit
suicidethanthegeneralpopulation.
6. Menwithasubstanceusedisorderareapproximately2.3timesmorelikelytodieby
suicidethanthosewhoarenotsubstanceabusers.Amongwomen,asubstanceuse
disorderincreasestheriskofsuicideby6.5times.Morethanone-fourthofsuicides
arealcoholrelated.
7. Bipolarwith comorbid substanceusehasalmosta40% rateof lifetimeattempted
suicidecomparedtothosewithasubstanceuseonly.
8. The majority of suicidal behavior occurs in depressed patients, but the role of
antidepressantsiscontroversial.
IV. WhoisatRisk?
A. Gender
1. Menarefourtimesmorelikelytocommitsuicidethanwomen.
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2. Womenattemptsuicidethreetimesmoreoftenthanmen.
B. Age(WorldHealthOrganization–2012)
1. Generally,suicideratesincreasewithage.
2. Thehighestsuicideratewasamongpeople45-59yearsold.
3. Thesecondhighestrateoccurredinthose75andolder.
• Untreateddepression
• Physicalcauses
• Medication
• Healthcaresystem
4. Suicideisthesecondleadingcauseofdeathamong15-19yearolds.
C. Race/Ethnicity
1. Whitemalesaccountfor65%ofallsuicides.
2. ThesecondhighestrateisamongAmericanIndiansandAlaskanatives.
3. Much lower and similar rates were found among Asians and Pacific Islanders,
Hispanics,andblacks.
D. MaritalStatus
1. Marriage is associated with lower rates of suicide (heterosexual data only).
2. Divorcedpeoplearethreetimesmorelikelytocommitsuicidethanpeoplewhoare
married.Thisisthenumberonefactorinurbancenters.
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3. Divorcedandwidowedmenaremorelikelythandivorcedandwidowedwomento
commitsuicide.
4. Livingaloneandbeingsingleincreasetheriskofsuicide.
5. Beingaparentdecreasestheriskofsuicide,especiallyformothers.
E. Geography
1. Mountainstateshavethehighestsuicidecompletionrates.
2. Peoplelivinginruralareasareathigherriskforsuicidethanthosewholiveinurban
areas.
3. ThelowestrateswereinNewJersey,NewYork,RhodeIsland,andMassachusetts.
F. ProfessionsandOccupations
1. Physicians
2. Dentists
3. Financeworkers
4. Lawyers
5. Policeofficers
6. Militaryveterans
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G. Economics
1. Extremesinwealthorpovertyareassociatedwithhighersuiciderates.
2. Timesofeconomicdepressionshavebeencorrelatedtoincreasedsuiciderates.
3. Unemployment or being in debt increases an individual’s feeling of hopelessness
makinghim/hermoresusceptibletosuicide.
H. TimeofYear
1. Despitepopularbeliefs,suicideratesdonot increaseduringthewinterholidaysor
on an individual’s birthday. December is the lowest month related to completed
suicides.
2. Mostsuicidesoccurinthespring.
3. Statistically,therearemoresuicidesonMonday.
4. Norelationshipexistsbetweensuicidesandthephaseofthemoon.
I. MedicalandIllness
1. Terminallyill
2. Serious/chronicillnesses
3. Chronicpain
J. OtherFactors
1. Previousattempt(#1)
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2. Feelingsofhopelessness
3. ProtestantsmorethanCatholics
4. Culturalandreligiousbeliefsinwhichsuicideisglorified
5. Localepidemicsofsuicide
6. Isolation
7. Barrierstoaccessingmentalhealth
8. Loss
9. Easyaccesstolethalmethods
10. Unwillingnesstoseekhelpduetothestigmainvolved
11. Peoplewhohavelostafamilymemberorfriendtosuicide
12. Copycat
13. Sexualorientation(LGBT)
14. Peopleinvolvedinorarrestedforcommittingcrimes
15. Victimsofdomesticviolence
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V. MethodsofSuicide
A. Firearms
1. #1method
2. Accountsforover50%ofallsuicidedeaths
B. Suffocation
1. Includeshanging
2. Almost25%rate
C. Poisoning
1. Overdosing
2. 16.6%rate
VI. CommonTriggers
A. Loss
1. Romanticrelationship
2. JoborEducationalOpportunity
B. Grief
C. Changes
1. Healthofalovedone
2. Socialoreconomicstatus
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D. LegalProblems
VII. GeneralWarningSigns
A. TalkingAboutSuicide
B. SeekingLethalMeans
C. PreoccupationwithDeath
D. NoHopefortheFuture
E. GettingAffairsinOrder
F. SayingGoodbye
G. WithdrawingfromOtherPeople
H. Self-destructiveBehavior
I. SuddenSenseofCalm
J. Caseexample
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VIII. ProtectiveFactors
A. EffectiveClinicalCare
B. EasyAccesstoClinicalInterventions,SupportandHelp
C. FamilyandCommunityConnectedness
D. SupportfromOngoingMedicalandMentalHealthcareRelationships
E. Skills in Problem Solving, Conflict Resolution, and Nonviolent Ways of Handling
Disputes
F. CulturalandReligiousBeliefsthatDiscourageSuicideandSupportSelf-preservation
IX. Screening
A. Definitions
1. Suicide screening refers to a procedure in which a standardized instrument or
protocolisusedtoidentifyindividualswhomaybeatriskforsuicide.
2. Suicide assessment usually refers to amore comprehensive evaluation done by a
clinician to confirm suspected suicide risk, estimate the immediate danger to the
patient,anddecideonacourseofaction.
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3. DetectionTools
• BeckDepressionInventory
• The19-itemScaleforSuicidalIdeation
• TheColumbia-SuicideSeverityRatingScale(C-SSRS)
X. PreventionStrategiesA. RecognizeEarlyWarningSignsandIntervene
B. ReduceAccesstoLethalMethods
C. Follow-upSupport
D. BetterTrainingforPrimaryCareWorkers
E. Community-basedInterventions
F. SeniorPeer-counselingPrograms
G. ImprovementsinMentalHealthServicesThroughSuicidePreventionCenters
H. NationalHotline–(1-800-273-TALK)
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MSIP106:
TheEthicsofSuicideIntervention
MiriamParent,Ph.D.
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AbstractWorkingwithpeopleinsuicidalcrisisisaverystressfulandethicallycomplicatedscenario.The
ethicalprinciplesofbeneficence,non-maleficence,autonomy,justice,fidelity,andveracityare
importantwhendealingwithclientsinregardtosuicide.Itisimportanttonotethatlawsdiffer
ineachstatewhenitcomestodutytowarn/dutytoprotectandendoflifelegislation.There
are several questions a mental health provider should ask when deciding to break
confidentiality in suicidal crisis. During ethical decision making, the mental health provider
should identify theproblemandpotential issues involved, knowand reviewall ethics codes,
laws, regulations and policies, obtain consultation, consider all possible courses of action,
choosewhatappearstobethebestcourseandfollowthrough,anddocumenttheprocessand
outcomes.
LearningObjectives
1. Participantswillidentifytheethicalprinciplesinvolvedindealingwithclientsinsuicidal
crisis.
2. Participants will understand important questions which need to be addressed when
decidingtobreakconfidentialityinsuicidalcrisis.
3. Participantswillexplorethestepsneededduringethicaldecisionmaking.
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I. Introduction
A. Ethics
1. Noteveryone’spassionbutitdoesneedtobeourconcern.
2. WemustprovidequalityeducationandinterventionsinawaythathonorsGod.
3. Wemustmeetthecivilandprofessionalresponsibilitiesthatwehaveagreedto.
B. WorkingwithPeopleinSuicidalCrisis
1. Consistentlyranksasoneofthemoststressfulandethicallycomplicatedscenarios.
2. Self-careindealingwithsuicidalcrisisisamajorethicalresponsibility.
3. Burnoutishighandcanleadtohurtingyourselfandothers.
4. Daniel6:5
Thenthesemensaid,“WewillnotfindanygroundofaccusationagainstDaniel
unlesswefinditagainsthimwithregardtothelawofhisGod.”
5. GodwillprovideuswiththewisdomanddiscernmentweneedifweseekHim.
II. EthicalPrinciplesA. Hippocrates
1. Beneficence–dogood
2. Non-maleficence–donotharm
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B. Justice
1. Equalaccess
2. Fairness
3. Equality
C. Veracity
1. Integrity
2. Truthfulness
D. Autonomy
1. Self-determination–myrighttochoose.
2. Bedrockofinformedconsent.
3. In suicidal crisis, we are often faced with the dilemma of overriding someone’s
autonomy.
E. Fidelity
1. Trustandconfidentiality.
2. Bedrockofamentalhealthpractice.
3. Allowspeoplethesafetytotalkabouttheirpain.
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III. CompetingEthicalIssues
A. Confidentiality
1. Tiedtotheissueoftrustandfidelity.
2. Essentialtoanycounselingrelationship.
3. Clientsneedtoknowandhaveinwritingtheconditionswhenconfidentialitymaybe
waivedorlimited.
4. Harmtoselforothersneedstobeoneofthoseclearlimits.
5. When dealing with suicidal crisis, we are constantly balancing confidentiality and
keepingourclient’strustwithpreservinglife.
B. PreservingLife
1. Interveninginsuicidalcrisis
2. Weshouldintervenetherapeuticallyinwaysthathonortheclinicalrelationship.
3. When clinical interventions are insufficient, we may have to override
confidentiality.
4. Example–AACCCodeofEthics
IV. CompetingLegalIssues
A. Privilege/Confidentiality
1. Privilege is therightoftheclienttodeterminehowandwithwhominformation is
shared.
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2. Protectedformentalhealthprofessionalsbystateandfederallaw.
3. Fewunderstandthedifferencesbetweenthelegalrequirementofprivilegeandthe
ethicsofconfidentiality.
B. VariableStateLegislation
1. Inregardtoharmtoselforothers,statelawsvary.
2. Tarasofflaws–dutytoprotect/dutytowarn.
3. Map– states vary. Some statesmandatewhileother statespermitmental health
professionalstoreport.
C. IntenttoHarmCriteria
1. Thethreatisserious.
2. Thethreatisimminent.
3. Thethreatisdoable.
4. Thethreatisagainstselforanidentifiableperson(s).
D. FutureTrends
1. Statelawsarechangingtoreflectthedebateoverfirearms.
• NYSAFEAct(2013)
• ILFOIDMentalHealthReporting(2014)
2. DeathwithDignitydebates
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V. BreakingConfidentialityinSuicidalCrisis
A. WhoHoldstheLegalPrivilege?
1. Inmostcases,aminordoesnothold legalprivilege. Theparentor legalguardian
does.
2. Ifanadultchoosesnottohavethementalhealthprofessionaldisclose,theirrightto
privilegeisbeingoverridden.
B. IsThereanAppropriateInformedConsentAgreement?
1. Isthereawritten,signeddocument?
2. Hasthisbeenreiteratedinverbaldiscussion?
C. WhatInformationisNeededtoPreserveLife?
1. Limitdisclosuretoessentials.
2. Therestofthementalhealthrecordcanremainconfidential.
D. WhoisintheBestPositiontoIntervene?
1. Sometimesitisfamily.
2. Sometimesitislegalormedicalauthorities.
3. Custodialissuesmayneedtobeconsidered.
4. Beverycarefulwithinstitutionalinvolvement.
E. IsthisaMandatedorPermissiveReportingSituation?
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VI. EthicalDecisionMaking
A. IdentifytheProblemorDilemma
1. Articulatethedilemma.
2. Isitanethical,legal,professional,clinical,orspiritualissue?
B. IdentifythePotentialIssuesInvolved
C. KnowandReviewallRelevantEthicsCodes,Laws,Regulations,andPolicies
D. ObtainConsultation
1. ConsultGodthroughprayer.
2. Consultotherprofessionalstogetasecondsetofeyesonthesituation.
E. ConsiderallPossibleCoursesofActionandtheirConsequences
F. ChoosewhatAppearstobetheBestCourseandFollowThrough
G. DocumenttheProcessandOutcomes
VII. Conclusion
A. Ethically
1. Be proactive.
2. Haveclear,written,informedconsentregardingconfidentialityforeveryclient.
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B. Spiritually
1. Seekwisdom.
2. Knowledgeplusdiscernmentequalswisdom.
3. Proverbs9:10
“ThefearoftheLordisthebeginningofwisdom,andtheknowledgeoftheHoly
Oneisunderstanding.”
C. Professionally
1. Haveestablishedpolicies.
2. Knowthegeneralpoliciesthatarerequiredorexpectedinyourarea.
D. Clinically
1. Carefortheclient.
2. Seektodogood.Donotdoharm.
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MSIP107:
MilitarySuicide,PreventionandIntervention:
WhatYouNeedtoKnow
GlenBloomstrom,M.Div.
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Abstract
Withatopicasburdensomeandimportanttodiscussassuicidewithinthemilitary,itishighly
beneficialtohaveawell-experiencedchaplaindiscussthebestwaystopreventsuicide inthe
lives of military service members and veterans. Glen Bloomstrom begins by presenting the
statistics and rates related to military suicide and what this means for prevention and
intervention.Mr.Bloomstromalsopresentsmanyhelpfulsuicidepreventionand intervention
programs,programorigination,whattheprogramshouldconsistof,andhowtheprogramsare
proven most beneficial. This presentation is highly educational and resourceful through a
discussion of the facts surrounding suicide prevention and intervention, alongwith practical
application.
LearningObjectives
1. Participantswillidentifythecontext,statisticsandratesrelatedtomilitaryandveteran
suicides.
2. Participantswilldiscussvariousmilitaryandveteransuicidepreventionprograms.
3. Participantswillanalyzecomponentsforeffectivesuicideintervention.
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I. Introduction
A. LearningObjectives
1. Reviewthecontext,statisticsandratesrelatedtomilitaryandveteransuicides
2. Overviewmilitaryandveteransuicidepreventionprograms
3. Overview types of military and veteran suicide intervention training and analyze
componentsforeffectiveintervention
B. MilitaryandVeteranContext,StatisticsandRates
1. MilitaryStatisticsandRecruitment
• ActiveMilitaryServiceMembers(SM)–1.37Million
• ReserveandNationalGuard–874,000
• FamilyMembers–1.9Million
• Retirees–2Million
• Veterans–23Million
• AnnualRecruitment
o 180,000recruitedasenlistedpersonnel
o 20,000arecommissionedasofficers
o Attritionrate(1stterm)=20%orhigher
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2. DoDSuicideNumbersandRates
3. DoDSuicideExtendedImpact
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4. VeteranRate
• 22veteransuicidesperday
• Averageveteranageis59.6
5. DeploymentConnectiontoSuicide
• Nostudyhasdefinitivelyconfirmedanindependentassociateswithdeployment
• Greaterexposureincreasescapacityforsuicide
6. PTSDVietnamStatistics
• National Vietnam Veterans Readjustment Study (NVVRS) indicated 30.9%who
servedexperiencedcombatrelatedPTSDduringtheirlifetime
• Australian Study: the Retrospective Cohort Study found a 21% increase in
veteransuicidesfrom1982-1994
• NewEnglandJournalofMedicine1986studynoteda65%greaterlikelihoodof
suicidethancivilians
7. OIFandOEFVeteranSuicideRates
• 1.28millionactivedutyveteransservingfrom2001-2007
• 1,868suicides(29.5per100,000rate)
• Ratesarehighestthefirstthreeyearsafterdischarge
• Rateswere16%higherforthosewhodidnotdeploytoOIF/OEF
• Femaleveteransare6timeshigherratethancivilianrate
8. Summary
• Veteransare22%ofallUSsuicides,butonly7%oftheUSpopulation
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II. MilitarySuicidePreventionConsiderations
A. Schneidman–10Commonalities(TheSuicidalMind)
1. Purposeofsuicideistoseekasolution
2. Stimulusofsuicideispsychologicalpain
3. Stressorinsuicideisfrustratedpsychologicalneeds
4. Cognitivestateofsuicideisambivalence
5. Perceptualstateinsuicideisconstriction
6. Interpersonalactinsuicideiscommunicationofintention
B. Joiner
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C. Stigma
1. Stigma=“abrandasonacriminal;amarkofdisgraceordisrepute
2. ServiceandVeteranIndividualStigmaPerceptions
• Seekinghelpwouldbeembarrassing
• Seekinghelpwouldhurtone’sreputation
• Seekinghelpwouldnotbekeptconfidential
• Seekinghelpwouldresultinbeingtreateddifferently
3. CulturalStigmaandConsequences
• SupervisorsmaybelievetheSMisexaggeratingornotreallysuffering
• Servicemembercanbelabeled
• Consequence:miss,dismissoravoidthetopicofsuicide
4. Stigma’sInfluence
• Perceived or stated Community or Cultural Shame is communicated to SM or
Veteran
• LeadstoasenseofnotbelongingandIsolation
• Resultsinlossofhope
D. ChoosingSuicide
1. WhySMandVetsKillThemselves
• Priorsuicideattemps
• Substanceabuse
• Mentalillnessdiagnosis
• Accesstolethalmeans
• Combatexposure
• PTSDincombinationwithdepression
• MultipleTraumaticBrainInjuries
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• Physical/sexualassaultasanadult
• ChildhoodTrauma
• Triggeringevents:financial,legal,orrelational
2. ProtectiveFactors
• EffectiveMHcare
• Connectedness
• Problem-SolvingSkills
• ContactswithCaregivers
• UnitCohesion
• Post-deploymentsocialsupport
• Post-deploymentsenseofpurposeandcontrol
• CommunitywithVSO,Communitycanhelptomakeasmoothtransition
• GuardandUSARLackBaseInfrastructureofADmustlocal/availableresources
3. WarningSignsofSuicide
• Talkingaboutwantingtodieorkillself
• Lookingforwaystokillself,onlinesearch,buyingaweapon
• Talkabouthopelessness,noreasontolive
• Talkaboutfeelingtrappedorinunbearablepain
• Talkaboutbeingaburdentoothers
• Increasinguseofalcoholordrugs
• Lackofconcernforhygiene
• Actinganxiousoragitated;behavingrecklessly
• Sleepingtoolittleortoomuch
• Withdrawingorisolatingthemselves
• Showingrageortalkingaboutseekingrevenge
• Displayingextrememoodswings
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4. SuicideTriggers
• Relationships
• FinancialIssues
• Legal
• SubstanceAbuse
• BehavioralHealth/MedicalIssues
• Emotional/SocialIssues
III. MilitaryandVeteranSuicidePreventionProgramsandStructure
A. DoD(DefenseSuicidePreventionOffice)
1. Allservicesoffersuicidepreventiontraining
• Militarychaplains
• Militarybehavioralhealth
• Operationalstresscontrol
• Mandatoryannualprevention
• Suicidepreventionprogrammanagers
• Sexualassaultresponseprogramsandcoordinators
1. Programs
• GeneralMilitaryPreventionandAwareness:
o ArmyACE
o NavyACT
o USMCRACE
o USAF
• HolisticApproaches
o ComprehensiveSoldierFitness
o USMC
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2. SafeTALK
• AlertnessTraining(3.5-4hours)
• NestswithASISTprogram
• UsedmostwidelyinUSNavyandAirForce
• Skillsorientedwithpractice
3. NationalGuard
• StateSPCoordinators–largest,Armylead
• ManytrainedChaplainsandChaplainAssistants(inASIST)
• DirectorsofPsychologicalHealthineachstate
4. VeteransAdministration1
• VetCrisisLineintegratedwithNSPL
o 800-273-8255,press1forVets
o www.veteranscrisisline.net
o textto838255
• VeteranCenters
o www2.va.gov/directory/guide/vetcenter_flash.asp
o call877-WAR-VETS(927-8387)
• MaketheConnectioncampaign
• RuralClergyInitiative
5. VeteransAdministration2
• VASuicidePreventionCoordinators(SPC)
o Link to SPC/Crisis Centers:
www.veteranscrisisline.net/gethelp/resourcelocator.aspx
o TakecallsandlinkatriskVetstoMHscreeningNLT72hoursaftercall
o ProvideOutreachTraining
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6. OtherResources
• MilitaryOneSource:www.militaryonesource.com
• Real Warriors Campaign:
www.realwarriors.net/family/support/preventsuicide/php
• StopSoldierSuicide:www.stopsoldiersuicide.org
• Webinar:SuicideinMilitaryandVeteranPopulations:ImplicationsforChaplains,
Health Care Providers and Leaders – www.
Dcoe.mil/Training/Monthly_Webinars/Archive.aspx
IV. SuicideInterventionA. Intervention
1. Thenextlevelofsuicidefirstaidthatcollaborativelyworkswithapersonatriskwith
agoalofkeepingthemsafe
2. NotlimitedtoBehavioralHealthProfessionals
3. “Gatekeeper”focus
B. VA/DoDInterventionTools
1. VAandUSNavy
• ColumbiaSuicideSeverityRatingScale
• VASafetyPlan
2. USArmyandNavy
• AskCareEscort
• AppliedSuicideInterventionSkillsTraining(ASIST)
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C. InterventionChallenges
1. Interventionisfrightening
2. Suicideiscomplexandunique
3. FirstAidCaregivermustknowtheirownattitudesandstigma
4. Respectandsafetymustinformprotocol
D. InterventionProgramEssentials
1. TrainingFocus–NotEducation
2. FoundedonSuicidologyresearchandlearningmethodology
3. Reflectshelperattitudes
4. Validatedevidenceofeffectiveness, feedback fromhelpersandpersonswith lived
experience
5. Conceptualmodelsandpracticeforskilldevelopment
6. Commoncomponents
• Establishacaringcollaborativerelationship
• TellyourSMorVetchangesyounotice
• Askclearlyanddirectlyaboutsuicide
• Listentotheirstory
• KeepsafeplanandConfirmActionsSafetysteps
• Partnerwithpersonatrisk’sresources
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7. LivingWorksASISTandsafeTALK
• 3,000DoDtrainers
• Trained32,000personnelin2014
• TwoDayGatekeeperskillbasedtraining
• Regularlyupdatedover30years
• Highresearchvalidity,highsatisfaction
• 7,000+USCanada,InternationalTrainers
• StandardforNationalSuicidePreventionLifeline
V. Conclusion
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MSIP108:
ConductingaSuicideAssessment:
UsingtheSafe-TModel
GarySibcy,Psy.D.
MilitarySuicidePAIRCertificationCourse
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AbstractInthissession,Dr.GarySibcyreviewsandunpackstheSafe-T5StepEvaluation&TriageSystem
for Suicide Assessment developed by the Substance Abuse and Mental Health Services
Administration(SAMHSA)oftheAmericanPsychologicalAssociation(APA).Throughthreerole
plays,Dr.Sibcydemonstrateshowtousethismethodwithclientsofvaryingsuiciderisklevel.
Cliniciansareencouragednotonly togetasuicideassessmentright,but todemonstrateand
document how they have thought through the factors competently and documented the
process.
LearningObjectives
1. Participants will name and describe the five steps of using the Safe-T method with
clientswhoneedsuicideintervention.
2. Participantswillbeexposedtothreedifferentroleplaysshowingappropriateclinician
responsetodifferinglevelsofsuicidalideation.
3. Participants will understand how the client’s risk and protective factors informed
decision-makingineachofthethreescenarios.
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I. Introduction
A. ThreeRolePlays
B. Safe-TMethod
1. Safe-T5StepEvaluation&TriageSystemforSuicideAssessment
2. Developed by the Substance Abuse and Mental Health Services Administration
(SAMHSA)oftheAmericanPsychologicalAssociation(APA)
II. TheFiveSteps
A. Step1:RecognizeSuicideRiskFactors1. Thekindofthingsthatputpeopleatrisk.
2. Triggerscombinedwithmentalhealthriskfactors.
B. Step2:CompareRiskFactorswithExistingProtectiveFactors
1. Religiousbeliefs
2. Senseofobligation
3. Otherreasonsforliving
C. Step 3: Inquiry and Assess the Client’s State of Mind with Respect to Attachment,
History,andIdeation1. Dotheyhaveaplan?
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2. Dotheyhaveintention?
3. Howmuchdotheywanttodiecomparedwithhowmuchtheywanttolive?
D. Step4:DetermineaHigh,MediumorLowLevelofRisk
E. Step5:DocumentandImplementaTreatmentPlan
F. FollowingtheSafe-TMethod
1. Itisnotonlyimportanttogetasuicideassessmentright,butitisalsoimportantthat
you have thought through the factors competently and documented the process.
2. Whenapersonisreferredbysomeoneelseasopposedtocomingbecausetheyfeel
liketheyneedhelp,thisitselfispartofariskprofile.
III. RolePlay1:Jessica
A. Background
1. 22yearoldcollegesenior
2. Referredbyparents
3. Beingreferredasopposedtocomingwillinglyispartoftheriskprofile.
B. RolePlay
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C. Summary
1. Thiswasamorecomplicatedandseriouscase.
2. Jessicahasanumberofriskfactors.
3. Jessica’smostnotableriskfactor isherpreviousattemptaswellasherreactionto
theattempt.
4. Jessicadidnotregretherchoiceafterhersuicideattemptwasthwarted.
5. Triggers included the breakup, a desire for revenge, and hopelessness combined
withveryfewprotectivefactors.
6. AcontractwouldnothavebeenappropriateasJessicawasnot likelytohonorthe
contract.
IV. RolePlay2:AngiePartOne
A. Background
1. Self-Referred
2. Angiehasrunintoanumberofstressors.
3. Angieisfeelinghopelesswithsuicidethoughts.
4. PayattentiontoAngie’slevelofthinking,amountofplanning,andhowthecontract
ismade.
B. RolePlay
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C. Summary
1. Angieisself-referred.
2. Sheisfeelingquitebadly,butwantshelp.
3. Non-suicidalself-injury(tensionreductionbehavior)isrevealed.
4. Angiedoesnothaveasignificanthistoryofsuicidalbehavior.
5. Angie’slevelofhopelessnessisinamoderaterange.
6. Angieisopentocontractingforsafetyandfollowingthesafetyplan.
7. Angiehasalowtomediumrisk.
8. Angiedoeshavehope.
9. Itisimportanttodocumentreasoningaswellasclient’sopennesstocontracting.
V. RolePlay2:AngiePartTwo
A. Background
1. ThisisacontinuationofthefirstroleplaywithAngie.
2. Angiehasbeenintherapybutherlevelofriskhaschanged.
3. YouwillseeanewplanbasedonAngie’slevelofrisk.
B. RolePlay
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C. Summary
1. CircumstanceshadgottenworseforAngie.
2. Angiefollowedtheplanshehadmadewithherclinician.
3. Theriskfactorshaveincreasedduetothestressorsandherlevelofhopelessness.
4. Protectivefactorsarestillinplace.
5. Angie’ssenseofnotbeingsafeisimportant.
6. Ifyoukeepaclientintheoutpatientsetting,makesureyouaredocumentingyour
decisionmakingprocessandthestepsyouaretaking.
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MSIP109:
FamiliesinCrisis:
TheFirst48HoursFollowingaSuicide
JenniferCisneyEllers,M.A.
withKevinEllers,D.Min.
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AbstractSuicide typically comes as a deep shock to surviving loved ones. Discovering the body of
someonewhohascommittedsuicideorreceivingadeathnotificationcanbetraumatictothe
pointthatthechemistryofthebrainchangesintheimmediateaftermath.Thisbrainchemistry
change can cause decision making to become overwhelmingly difficult. Throughout this
tumultuoustime,caregiverscanprovideemotionalandpracticalsupportthatminimizesfurther
secondarywoundstosurvivors.
LearningObjectives
1. Participantswillidentifywhatcanbedoneinthefirst48hourstotwoweeksfollowinga
suicidetohelpminimizefurthersecondarywoundstothesuicidesurvivors.
2. Participantswillunderstandhowtoprovidebothemotionalandpracticalsupportinthe
immediateaftermathofasuicide.
3. Participantswillexplorecommonissuesandwhatnottodoorsaytosuicidesurvivors.
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I. Introduction
A. GearedTowardCrisisIntervention
1. Firsttwoweeksoruntilthefuneral
2. Thefirstcrisisstageforfriendsandfamilymembers
3. Everything thathappens in thiswindow-positive andnegative- impacts long term
recovery.
B. FirstRespondersandOthers
1. Crisis responders, chaplains, law enforcement, medical professionals, clergy, and
others.
2. Allwhointeractwithsurvivorsinthefirst48hoursto2weeksfollowingthedeath.
II. DiscoveringthebodyorreceivingadeathnotificationA. Traumaticandunexpected.
1. Even if the loved one had chronic mental illness or previous attempts.
2. “FightorFlight”response
3. Thechemistryofthebrainchanges.
• Activityinthefrontallobedecreases.
• Theamygdalaor“fearcenter”firesup.
• Thinkingiscompromisedandemotionsexplode.
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4. Maybechaotictimeandverydifficultforlovedones/family.
5. ThosewhodiscoverthebodymayexperiencesPostTraumaticStresssymptoms.
B. TheDeathScene
1. Thelocationofdeathlikelytobeacrimescene.
2. Thiscancomplicatesituationandbeverychaotic.
3. Themoregruesomethedeathscene,themoretraumacanoccur.
4. Logistics
• Lovedonesoftencan’tvieworbewithbody.
• Theremaybequestioningbypolice.
• Cleanupofscenewillneedtotakeplace.
5. NotifyingothersoftheDeath
• Difficultdecisionsregardingwhattosay/whatnottosay.
• Tellingchildrenpresentsadifficultchallenge.
• Notifyingimportantgroupsmusttakeplace–employers/co-workers,church,
friendsandpastrelationships.
VideowithDr.KevinEllers-HowCrisisRespondersCanAdvocateforFamiliesOn-Scene
6. Caregiverscanadvocateforsomeoneelsetocleanupthedeathscene.
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7. IfCauseofDeathisUndetermined
• Nosuicidenote
• Maynothavedeterminationforsometime
• Mayneverhavedefinitedetermination
• Each person must be allowed their own timetable for coming to
conclusions/answers.
• Some people may be very resistant to accepting the idea of a loved one
committingsuicide.
8. SuicideNotes
• Familymembersshouldhaveaccesstothisnote,particularlyifpositivesare
shared.
VideowithDr.KevinEllers-SuicideNotes
VideowithDennisMinns:SuicideAftermath
III. ImmediateIssues
A. NotificationofDeath
1. Thinkingclearlyandrememberingthegroupstotell.
2. Dowetellthetruth?
B. Emotions
1. Shock/denial
2. Guilt/Self-Blame
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3. Blameofothers
4. Inabilitytothinkclearly
5. Difficultymakingdecisions
C. ProblemswiththeTerm“CommittedSuicide”
VideowithDr.KevinEllers:SuicideTerms
IV. ContagionEffectA. SuicideRiskIncreasedforCommunity
B. At-RiskPopulationandCloseFamilyMembers
C. Windowof48Hours-2Weeks
V. PracticalAssistanceA. DecisionMaking
B. BasicNeeds
1. Shelter–ifhomeiscompromised
2. Food
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3. SocialSupport
4. SpiritualSupport
5. Helpinginmakingplans/decisions
6. Helpingettinginformation
C. Funeral/MemorialArrangements
1. Practicalfuneraldecisions
2. FinancialAssistance
D. EmotionalProtection
1. Protectionfromignoranceandthehurtfulorpainfulthingspeoplesayanddooutof
thatignorance.
2. Workasabuffer.
E. LookingintoLifeInsurance
VI. Conclusion:SelfCareforFirstResponders
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MSIP110:
TheImpactofSuicideon
MilitaryMarriagesandFamilies
DavidMikkelson,Ph.D.
andSuzanneMikkelson,Ph.D.
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Abstract
Theissueofsuicidewithinmilitaryservicemembersandveteranshasbeenandcontinuestobe
a topic thatmust be further researched and discussed. As important as this is, it is equally
importantforresearchers,counselors,chaplains,andcivilianstobecomeawareoftheimpact
suicidehasonthefamilyoftheservicemember.Losingaservicemembertosuicidehasmany
notabledifferencesandimpactsonthefamilythanifacivilianlosesafamilymembertosuicide.
Dr.’s David and SuzanneMikkelson present the specific impact suicide has on the family of
militarypersonnelandhowthoseinthehelpingfieldcanbestinterveneintheirlivesafterthe
suicidehastakenplace.Themostimportantthingahelpercandoistofirstunderstandmilitary
cultureandhowmovingfromthisculturewillaffectthefamilymost.
LearningObjectives
1. Participantswillgainanunderstandingforhowsuicideandthemilitaryculture impact
militaryfamilies.
2. Participants will identify ways the military will directly affect a family following the
suicideoftheservicememberandwhattheseactionswillrequireofthefamily.
3. Participantswilldiscussthebestmethodsandinterventionswhenworkingwithafamily
afterthesuicideoftheservicemember.
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I. Introduction
A. LearningObjectives
1. Exploresuicidesuniqueimpactonfamilies
2. Understandmilitaryculture
3. Discussdynamicssurroundingmilitarysuicides
4. Learnhowtohelpmilitaryfamiliesafterasuicide
5. Discusswhathappenswhenaservicememberisactivelysuicidal
6. Learnhowtohelpmilitaryfamilieswithasuicidalfamilymember
C. Suicide’sImpactonFamily
1. FamilyNarrativeisdifferentbecausethefamilyidentityisaltered
2. Spouseissuddenlynolongerpartofacouple
3. Socialstigmaandoftenspiritualstigma
4. Discordance of grief reactions causes disruption in communication, empathy and
support
5. Witnessingthedeath,thebodyorthesceneaddstothetrauma
6. Childrenoftenfeelresponsible(magicalthinking)
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7. Childrenmaybeleftwithatraumatizedpossiblydysfunctionalcaregiver
8. Childrenmaybecomeveryanxiousaboutlosingtheremainingparent
9. Unspokenfamilyrulesaroundhowtotalkaboutthelostperson;oftenincludeswhat
totellchildrenandwhen
10. Dying by suicide can put family members at risk for contagion of maladaptive
behaviors
11. Survivorsloseconfidenceintheirownrelationalinstincts
D. MilitaryCulture
1. ConceptslikeDuty,Honor,Country,andSacrificearenotjustasloganbutawayof
life.
2. Themilitaryplacesahighfocusonhowonedieswhileinuniform.
• Thephrase,“he/shemadetheultimatesacrifice”isanimportantone.
3. The military honors their fallen warriors, and that respect and legacy is a great
sourceofcomfortforsurvivingfamilymembers.
4. Themilitaryplacesgreatvalueonloyaltyandteamwork.
• “You’reonlyasstrongasyourweakestlink”isacommonstatement,andnoone
wantstobethatweakestlink.
5. Disciplineandself-sacrificearealsoimportantvaluesinthemilitaryculture.
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6. Being in themilitary ismuchmore than justaplaceof steadyemployment; it isa
lifestyleforthewholefamily.
7. Partofthemilitarycultureistheimportanceofgenerationalmilitaryservice.
TolearnmoreaboutmilitaryculturecheckouttheCommunityProviderToolkitat
www.mentalhealth.va.gov
II. WhenSuicideHappens
A. MilitaryProtocol
1. Militaryfamilymembersareoften livingfarfromtheirtraditionalsupportnetwork
suchasextendedfamily,long-termfriends,andahomechurch.
2. An official “15-6” investigation is conducted to determine if the servicemember’s
deathwasinthelineofdutyorinvolvedcriminalactivity.
• This can take a long time and create an atmosphere of suspicion,
embarrassment,andshame.
3. Familymustoftenrelocatewithinafewmonthsoftheservicemember’sdeath.
4. Command involvement can highly influence the family’s experience of feeling
supportedorrejected.
5. Familymaynothavenormalsupportfromunitduetothenatureofthedeath
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6. Theservicemembermaynotbeincludedonamemorialwallsorplaquethathonors
thefallenfromthatunit.
• AsofNov6,2014,Armyregulationdirectsthateverysoldierwhodiesonactive
duty, including suicides, be honored with a ceremony, unless the soldier was
guiltyofseriouscriminalactivity.
• Prior toNov 2014, this decisionwas often left to local commanders and their
policymayhavebeendifferent.
7. Familiesmay fear that thedeathby suicidewillovershadowhowtheperson lived
andthememoryofwhotheywere,includingtheirhonorableservicetothecountry.
8. Following death of the servicemember, the family is separated from the military
community,causingthemtofeel“cut-off”fromthemilitaryfamily
9. Civiliansmay be less judgmental about the suicide andmore open to accept the
narrativethattheservicememberhaddeployedtocombatorhadPTSD.
• Thiscancauseleavingthemilitaryfamilytofeellikeapositivelifechange
B. HowtoHelptheFamilyAfterASuicide
1. Geteducatedaboutmilitaryculturefromthefamilyandfromothersources; learn
fromyourclientwhatmilitarylifewaslikeforthem
2. Connectthemwithresources:TAPS,SOS(Army),GriefShare,Chaplains
3. Helpwithtransitionsfrommilitarytocivilianlife
4. Legacymanagement
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5. Addressthespiritualimplicationsofdeathbysuicide
6. Instillhopeforfuture
7. Monitorcontagionofsuicidalideation
8. Recognizeandaddressmaladaptivegrief
9. Helpadultsremainappropriatelytruthfulwithchildren
10. Helpsurvivorscreateanewfamilynarrativethatincludesthesuicide
11. Helpthemhaveawaytospeakaboutthedeceasedwithrespectandhonor
12. Helpfamilyunderstandthesuicidalmind
13. Helpsurvivorslearntotrusttheirowninstinctsagain
14. Tailoryourhelpingtosuicidesurvivors likeusing“suicided”ratherthancommitted
suicide
15. Rememberthatthefamilymayseeitasanaccidentormurder
16. Firstyearisaboutthe“why”
17. Secondyearisoftenharderthanfirst
• Thisisnotregressionbutpartofthejourney
• Nowitisrealaftertheangerandthewhygiveswaytogrief
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C. Grief
1. Trackgriefresponsesintermsofadaptiveandmaladaptive
• Source:Kaplow, J.B., Layne,C.M., Saltzman,W.R.,Cozza, S .J., Pynoos,R. S.,
(2013).
2. Encouragemovementtowardsadaptiveresponses
3. Adaptive
• Missingthedeceased
• Heartacheoverthelovedone’sfailuretoreturn
• Longingtobereunitedwithyourlovedone
• Searchingfornewidentity,meaning,purpose,orfulfillment
• Strugglingwithnewrolesorfunctions
• Sadness,anger,horror
4. Maladaptive
• Identifyingwithunhealthybehaviorsorvaluesofthedeceased
• Developmentalregressionorarrest
• Inabilitytoprovidecareforchildren
• Suicidalideationorbehaviors
• Severeorunresolvableidentitycrisis:“Ishould’vediedwithhim/her”
• Hopelessness,risk-taking,apathy,survivorguilt
• Persistentrage,shame,numbing,retaliatoryfantasies,vengefulbehavior
III. Resources
A. TAPS:TragedyAssistanceProgramforSurvivors1. Forallbranchesofservice
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2. Provideshope,connectedness,support,andmeaningfollowingthedeath
3. Provide professional therapy, trauma care, help with memorial services, legal and
financialhelp
B. VAWebsite–CommunityProviderToolkit
C. CourageAfterFirebyArmstrong,Best,andDomenici
D. WhyPeopleDieBySuicidebyThomasJoiner1. Theoryfocusedoninterpersonalconnectedness
• ThreeElements:o Perceived burdensomeness to others and the conviction that others will
benefitmorefrommydeaththanfrommylife.Thisisarobustpredictorof
suicidality
o Lowbelongingness,asensethatoneisnotanintegralpartofavaluedgroup
o Capacityforlethalitythatinvolvesbothacognitivedecisionacquiredthrough
repeated exposure to painful, fearsome, or lethal experiences that can
habituate the person to death, and the ability to access and use lethal
means.
IV. WhenAServicememberisActivelySuicidal
A. BarrierstoSeekingHelp
1. Limitedappointmentsandlongwaitingtimes
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2. Stigma-howtheywillbeviewedbyothers
3. Concernsaboutsecurityclearanceandimpactoncareer
4. Concernsaboutonlybeinggivenmedications
5. Denialthattheyhaveaseriousproblemorneedhelp
6. UnitresponsestosuicidalSMscanbeopenlyshaming
7. Catch 22: suicide risk increases without help, but the help they receive can be
intrusiveordismissive
B. EncouragingHelp-SeekingBehaviors
1. Helpservicememberconsider the risksofnot seekinghelp; “howbadwould things
needtoget…?”
2. Appeal to their sense of courage to seek help and to protect their family. See the
bookCourageAfterFire
3. Increase suicidal person’s senseof belongingbyhelping them reconnectwithGod,
theirfamily,thechurch,theircalling
4. Askthehardquestionsandbewillingtoactonsuicidalthreats
5. Providepersonalreferralstohelpingagenciesorpersons
6. Chaplainsprovideconfidentiality,evenincasesofsuicideideationsandintentions
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C. HowtoHelptheFamily
1. Beavailabletoseethefamilyorsuicidalfamilymemberregularly
2. Family members are at risk for burnout, compassion fatigue, numbing,
hypervigilence,orexhaustion
3. Incorporate asmany resources as available: church family, neighbors,medications,
extendedfamily,friends
4. Confrontperceivedburdensomeness
5. Offerhope:thisisatemporaryproblem,notapermanentsituation
6. Offertopraywiththefamilyandincorporatescripturalreassuranceduringsession
V. Conclusion
A. DisplayChristinYou
B. OfferHope
Notonlyso,butwealsogloryinoursufferings,becauseweknowthatsuffering
producesperseverance;perseverance,character;andcharacter,hope.Andhopedoes
notputustoshame,becauseGod’slovehasbeenpouredoutintoourheartsthrough
theHolySpirit,whohasbeengiventous.-Romans5:3-5
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MSIP111:
GrievingaSuicide:
Long-termSupportforSurvivors
andLovedOnes
JenniferCisneyEllers,M.A.
andEricScalise,Ph.D.
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AbstractInthissession,JenniferCisneyEllersandDr.EricScalisewilldescribethecomplicatedgriefthat
followsasuicideandtheexperienceofsurvivors. Strategiestofacilitatehealthygrievingand
healingareoutlined.Viewerswillalsolearnwhatisunhelpfulandhowtoavoidresponsesthat
cause furtheralienationand shame for survivors.Anemphasis isplacedonhelping survivors
stayconnectedtosupportsystemsandsafespiritualenvironments.
LearningObjectives
1. Participants will identify the causes and impact of complicated grief as it relates to
survivingalovedone’ssuicide.
2. Participantswill understand the challenges ofworking through the suicide of a loved
one,includingthecommonlackofsocialsupport.
3. Participantswilllearnwhyconnectednessandcommunityareofutmostimportancefor
suicidesurvivorsworkingthroughthegriefprocessandtowardshealing.
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I. Introduction
A. SupportingSurvivorsIsPrevention
1. Supportingsurvivorsintheaftermathofasuicideisalsopreventingsuicideinfuture
generations.
2. Survivors of suicide get less support and havemore complicated grief than other
typesofdeath.
B. ConnectednessofClinician
C. AwarenessisNeeded
II. TheUniqueGriefProducedbySuicide
A. WeGrieveBecauseWeLove
Godwhispersinourpleasures,speaksinourconsciousness,butshoutsinourpain.Itis
hismegaphonetoadeafworld.–C.S.Lewis
B. ResearchShows:
1. Similartolossbysuddenorviolentdeath.
2. Shock/numbness
3. Denial
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C. Recovery
1. Expecta4-7yearrecoveryperiod.
2. Maynotbe“pathological”griefbutcomplicatedbythefactorssurroundingsuicide.
D. Unhelpful“Helpers”
1. Donotgivepatanswers
2. Donotofferclichés
3. Survivorstendtohearcommentsthatcomeoutofignorance,andthiscanresultin
secondarywounding.
VideowithDr.KevinEllers:SecondaryWoundingvs.Grace
4. Suicide survivors receive less social support than survivorsofother typesof loved
ones’deaths
5. Theyexperiencegreatershameandguilt.
6. Maystrugglewithmore“whatifs”and“whys.”
7. Experiencemorecomplicatedandlong-termgriefissues.
8. ClinicianResponse:
• Helpthesurvivorchangethe“why”questionstothe“what”questions.
• Heartheheartofthecry.
• Don’tunderestimatethepowerofapersonshowingup.
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III. ComplicatedGrief
A. Differsfrom“Typical”Grief
1. Forasuicide,workingthroughgrieftakestwiceasmuchtime,andsometimesfrom
4-7years.
2. Theaveragepersonhasneverpreparedthemselvesforalossofthisnature.
B. ExperienceofComplicatedGriefafterSuicide
1. Guiltcanbecomeimmobilizing.
• Thiscanbeanindicationthatapersonis“stuck”
• Self-blameanddebilitatingguilt
2. Shameforasurvivorcancomefrominternalandexternalmessages.
• Study by Calhoun, Selby, and Faulstich, 1980, showed that respondents
viewedparentsofachildwhocommittedsuicidetobe:
Ø Lesslikeable
Ø Moretoblame
Ø Moreashamed
Ø Moreabletopreventdeath
3. Themodeofdeathcancomplicatetheexperienceofthesurvivor.
4. Dependencyorunhealthyattachmentcancomplicatethegriefprocess.
5. Inadditiontopainandgrief,survivorsoftenfeelanger.
• Theymayfeelthesuicidewasaselfishact.
• Thepersonisnolongertheretoworkthroughtheemotionswith.
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6. Survivorsmayfeelasenseofrelief.
• Thiscanhappenatthesametimeasfeelingsadthepersonisgone.
• Survivorscanbeveryashamedofthisfeeling.
7. Religiousandspiritualissues
• Caregiversshouldworkthroughtheseissuesintheirownheartsandminds.
• Theyshouldnotdothistogiveanswers,asassurancesshouldbelefttoGod
alone.
VideowithDr.KevinEllers:HelpingGrievingPeoplePrepare
IV. WhatDoesandDoesNotHelp
A. Unhelpful
1. Ignoring/Avoidance
2. Denial
3. Pressuringthemto“getoverit”
4. NegativeReligiousjudgments
5. Anyjudgment
6. Keepingitsecret
7. Encouragingornotconfrontingself-medication
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B. Helpful
1. Bewillingtotalkabouteverything-eventheuncomfortableanddifficultparts.
2. Encouragetheemotionalprocessing.
3. Practicalandtangiblesupport.
4. Encouragegrievingrituals.
• Sayinggoodbyeinaletter
• Sendingwishes
• Emptychairdiscussion
5. Rememberrealistically.
6. Allowsurvivorstoworkthroughguiltissuesattheirownpace.
7. Help them get information from other sources (mental health professionals, law
enforcement,medicalprofessionals,co-workers,friends.)
8. Help families grieve together – different grieving styles, ways of coping and
timetables.
9. Helpthemfindsafespiritualenvironmentandcomfortinfaith.
10. Facilitateprocessingwiththedeceasedthroughexperientialtechniques.
11. Helpthemprocessthetraumaofdiscovery.
12. Referraltomentalhealthprofessionalifneeded.
13. Helpthemwithlong-termsupport.
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14. Prepareforanniversariesandothertriggerevents.
15. Supportgroupsforgriefandifpossiblesurvivorsofsuicide.
VideowithDr.KevinEllers:HelpingGrievingPeopleRememberLovedOnes
V. Conclusion:
A. HelpingSurvivorsfindClosure
B. HelpingSurvivorsfindSafeSpiritualHomes
1. Pastors
2. Churches
3. SurvivorSupportGroups
C. Revelation21:1-5
“Then I saw a new heaven and a new earth; for the first heaven and the first earth
passedaway,and there is no longerany sea.And I saw theholy city, new Jerusalem,
comingdownoutofheavenfromGod,madereadyasabrideadornedforherhusband.
And I heard a loud voice from the throne, saying, “Behold, the tabernacle of God is
among men, and He will dwell among them, and they shall be His people, and God
Himselfwillbeamongthem,andHewillwipeawayeverytearfromtheireyes;andthere
willnolongerbeanydeath;therewillnolongerbeanymourning,orcrying,orpain;the
firstthingshavepassedaway.’AndHewhositsonthethronesaid,‘Behold,Iammaking
allthingsnew.’AndHesaid,‘Write,forthesewordsarefaithfulandtrue.’“Revelation
21:1-5
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MSIP112:
CaregiversinCrisis:
WhenClientsTakeTheirLives
EricScalise,Ph.D.
andJenniferCisneyEllers,M.A.
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AbstractCaregiverswhoexperiencethesuicidaldeathofaclientorparishionerexperienceamultitude
ofemotionsrangingfromguilt,shame,sadness,griefandlosstoangerandanxiety.Inaddition
totheprofoundpersonalimpact,theseprofessionalsfeeladeepprofessionallossastheyoften
strugglewithfearofblameandquestioningthemselves.Counselorswhohavelostaclientto
suicide oftendescribe the event as oneof themost profoundly difficult experiences of their
professionalcareers. In this session,youwill learnhowtoprepareorcare foryourself in the
event of a client’s suicide, and you will learn how to care for other clinicians who have
experiencedthisdevastatingevent.
LearningObjectives
1. Participantswillidentifyhowcounselorscanprepareforthepossibilityofthetragedyof
losingaclient to suicide throughkeeping themselvesaccountable,healthyandhaving
theirownsupportsysteminplace.
2. Participantswillnameanddescribethecommonemotionalandprofessionalresultsof
losingaclientorparishionertosuicide.
3. Participantswilldiscoverhowtohelpacaregiver intheaftermathof losingaclientto
suicide.
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I. Introduction
A. SurvivorsofSuicide
1. Any and all people who experience the pain of a suicidal death and who
acknowledgethatthe losshasaffectedtheminpainandprofoundways(Jobes,et
al.,2000)
2. MentalHealthProfessionals inalldisciplinesarenot recognizedas survivorswhen
thoseundertheircarefortreatmentcommitsuicide.
• Emotionsaresimilartothosereportedbyfamilymembersandlovedones.
• Professionals may also experience reactions related to their professional
position.
B. ARelationshipisTraumatized
1. Thereisadepthofrelationshipbetweenclinicians/clients
2. Manycounselorstrulylovetheirclients.
II. CommonExperiencesforClinicianSurvivors
A. Emotions
1. Guiltandshame
2. Sadness,grief,loss
3. Anger
4. Emotionalnumbness
5. Intensedistress
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6. Anxiety/fearofblame
7. Lossofself-esteem
8. Intrusivethoughtsofthesuicide
B. FeltExpectations
C. Dr.Scalise’Testimony
1. Sometimestheclientdoesnotgivehonestfeedbackordivulgeallinformation.
2. Therecanbeashockvalueinthistypeofsituation.
D. ProfessionalSymptoms
1. Lossofcontrol
2. Compassionfatigue
• Compat-tosufferwith
3. Stress
• Theneurobiologyofstress
• Adrenaline
• Cortisol
• Longtermseriouseffects
• Theamygdala-trafficcop
Ø Newpathways
Ø Cortexis“skipped”
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Ø Reactionsandemotionalexperience
Ø Thenewpathbecomeseasierandeasiertowalk
4. Doubtaboutone’sskillsandclinicalcompetence
5. Heightenedfocusonsuicidecues
6. Increaseduseofpeer/colleagueconsultation
7. Hospitalizationoflowriskoutpatients
8. Refusaltoacceptreferralsofanypatientsknowntohavesuicidaltendencies
III. Preparation
A. Support
B. Accountability
C. VariedAtmosphere&ChallengesbySetting
1. Hospital/ResidentialSetting
2. Students/Residents/Interns
3. Therapyorsupportgroups
4. PrivatePractice
5. Church/Pastors
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D. PreparingforGreyAreas
E. PreparingforConfidentialityIssues
VideowithDr.KevinEllers:CaregiverSurvivors
IV. HowtoHelpAClinician-Survivor
A. CounselorsShouldBeCounseled
B. AllowCliniciantoProcessandVentilateConcerns/Feelings
C. NormalizePTSandGrief
D. DiscussMeetingswithFamilyMembersandAttendanceatFuneral
E. DiscussLiability/LegalIssues
F. RecommendSessionswithaTherapist
V. ResourcestoHelpClinician-Survivors
A. Organizations/Supervisors/Colleagues
1. InstituteforCompassionCare-http://institute4compassionatecare.com
2. AmericanAssociationofChristianCounselors–www.aacc.net
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B. PsychologicalAutopsy/Debriefing
1. Nottodetermineblamebutexploretheissueandallowforprocessing
2. Prepareforthefuture
C. OnlineSupport
1. AmericanAssociationofSuicidology–Clinician-SurvivorTaskForce–
http://www.suicidology.org/suicide-survivors/clinician-survivors
2. AmericanFoundationforSuicidePreventionwww.afsp.org
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MSIPBonusSessionOne:
TheEthicsofSuicideIntervention
forEducatorsand
ChurchandCommunityLeaders
MiriamParent,Ph.D.
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AbstractWorkingwithpeopleinsuicidalcrisisisaverystressfulandethicallycomplicatedscenario.The
ethicalprinciplesofbeneficence,non-maleficence,autonomy,justice,fidelity,andveracityare
importantwhendealingwithindividuals inregardtosuicide. It is importanttonotethat laws
differ ineachstatewhenitcomestodutytowarn/dutytoprotectandendof life legislation.
Thereareseveralquestionsapeople-helpershouldaskwhendecidingtobreakconfidentiality
insuicidalcrisis.Duringethicaldecisionmaking,thepeople-helpershouldidentifytheproblem
andpotentialissuesinvolved,knowandreviewallethicscodes,laws,regulationsandpolicies,
obtainconsultation,considerallpossiblecoursesofaction,choosewhatappearstobethebest
courseandfollowthrough,anddocumenttheprocessandoutcomes.
LearningObjectives
1. Participants will identify the ethical principles involved in dealing with individuals in
suicidalcrisis.
2. Participants will understand important questions that need to be addressed when
decidingtobreakconfidentialityinsuicidalcrisis.
3. Participantswillexplorethestepsneededduringethicaldecision-making.
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I. Introduction
A. Ethics
1. Noteveryone’spassionbutitdoesneedtobeourconcern.
2. Wemustprovidequalitypeople-helpinginawaythathonorsGod.
3. Wemustmeet the civil and societal responsibilities that arepartof the setting in
whichGodhascalledustominister.
B. WorkingwithPeopleinSuicidalCrisis
1. Consistentlyranksasoneofthemoststressfulandethicallycomplicatedscenarios.
2. Self-careindealingwithsuicidalcrisisisamajorethicalresponsibility.
3. Burnoutandcompassionfatiguearefartoooftentheendresultforthehelper.
4. Daniel6:5
Thenthesemensaid,“WewillnotfindanygroundofaccusationagainstDaniel
unlesswefinditagainsthimwithregardtothelawofhisGod.”
5. GodwillprovideuswiththewisdomanddiscernmentweneedifweseekHim.
II. GeneralPrinciplesRegardingMoralandEthicalParameters
A. CompetingMoralIssues
1. Sometimeswe are caught between our call to serve others and issues of our own
competence.
2. Lovingothersasourselves.
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3. TheParableoftheGoodSamaritan(Luke10:25-37).
B. Compassion
1. Compassion,althoughessential,maynotbeenough.
2. Compassioncausesustostop,tosee,andtodesiretoactonsomeone’sbehalf.
3. Compassioncallsusforward.
C. Care
1. Alongwithcompassion,wealsoneedtobeabletoprovidethecarethatisneeded.
2. Thisincludesthephysicalabilitiesrequiredandthefinancialresourcesnecessary.
D. Commitment
1. Thisispartofourserviceanddemonstratedlovetoothers.
2. Commitmentinvolvesfollow-up.
E. Competency
1. Ifwelackthenecessarycompetency,wemaydomoreharmthangood.
2. Competency,whichcomesfromthehead,maynecessitatesteppingback.
3. Mydesiretoservemaycompetewithmyownassessmentofcompetency.
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F. Gifts,AbilitiesandTalents
1. Romans12:4-6a
“For just aswe havemanymembers in one body and all themembers do not
have the same function, so we, who are many, are one body in Christ, and
individuallymembersoneofanother.Sincewehavegiftsthatdifferaccordingto
thegracegiventous,eachofusistoexercisethemaccordingly….”
2. EachmemberinthebodyofChristhasbeenequippeddifferentlyforHisservice.
3. Understandingmygifts,talents,andabilitiesisanethicalandmoralresponsibility.
4. TrainingandexperiencecanhoneourgiftsandabilitiesforGod’sservice.
G. PracticalConcerns
1. Family issues suchas young childrenathomemaykeepus fromservingothers in
crucialmoments.
2. SometimesourservicemaybebringingtheindividualbeforetheLordinprayerand
askingtheLordtoprovidetherightpersonwhohastheskillstohelpthatindividual
incrisis.
3. Perhapswecannotcommittotheindividuallong-term,butcanconnecthim/herto
someonewhocan.
III. EthicalandMoralConsiderations
A. NoExemptionfromEthicalandLegalResponsibilities
1. AACC2014CodeofEthics.
2. People-helpers are still expected to attend to certain ethical and legal
considerations.
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3. People-helpersneedtounderstandthe foundationalprinciplesonwhichcodesof
ethicsarebuilt.
B. SixPrinciplesthatGuideProfessionalCodesofEthics
1. Beneficence–dogood.
2. Non-maleficence–donotharm.
3. Justice–fairnessandequality.
4. Veracity–integrityandtruthfulness.
5. Autonomy–self-determination.
6. Fidelity–trustandconfidentiality.
C. SocietalViews
1. Societalviewsonsuicidearechanging.
2. Fivestatesnowallowforphysician-assistedsuicide.
IV. CompetingEthicalIssues
A. Confidentiality
1. Confidentialityisessential.
2. Confidentialityprovidessafety.
3. Breakingtrustdemandsexplicitconsentorveryclearjustification.
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4. Thelimitationsofconfidentialityneedtobeveryclearlyarticulated.
• Writtenandverbalized
• Harmtoselforothers
B. MoralValueforPreservingLife
1. Confidentiality is the expectation but codes of ethics provide an exception in the
caseofharmorseriousthreattolife.
2. Ministry workers should be aware of the greater expectation to access violent
behaviorandtotakesomeaction.
3. Lackofcivilliabilitydoesnotprecludeourresponsibilitytotakeappropriateaction.
4. Statelawsvary.
C. IntenttoHarmCriteria
1. Thethreatisserious.
2. Thethreatisimminent.
3. Thethreatisdoable.
4. Thethreatisagainstselforanidentifiableperson(s).
V. BreakingConfidentialityinSuicidalCrisisA. WhoisatRiskforWhat?
1. Ifthepersonatriskisaminor,theparentsmayneedtobeinvolved.
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2. Determineifthepersonatriskisconsideringonlyharminghimorherselforharming
othersaswell.
B. HaveExpectationsaboutConfidentialitybeenDiscussed?
1. Talkaboutthelimitsofconfidentiality.
2. Thereshouldbewritten,signeddocumentation.
C. WhatInformationisNeededtoPreserveLife?
1. Limitdisclosuretoessentials.
2. Therestofthementalhealthrecordcanremainconfidential.
D. WhoisintheBestPositiontoIntervene?
1. Sometimesitisfamily.
2. Sometimesitislegalormedicalauthorities.
3. Custodialissuesmayneedtobeconsidered.
4. Beverycarefulwithinstitutionalinvolvement.
E. IsthereanEstablishedPolicytoFollowinRegardstoReporting?
F. WhataretheLikelyRepercussions?
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VI. EthicalDecisionMakingModel
A. IdentifytheProblemorDilemma
1. Ifaminorisinvolved,talktotheparents.
2. Don’tgetcaughtupinemotionwhendeterminingifthereisadilemma.
B. IdentifythePotentialIssuesInvolved
1. Aretherelegalissues?
2. Aretherespiritualconsiderations?
3. Aretherefamilydynamics?
C. KnowandReviewallRelevantEthicsCodes,Laws,RegulationsandPolicies
1. Knowthepoliciesrelevantinyourministry’ssetting.
2. Knowthebodyofknowledgethatisavailableandhowitwillhelp.
D. ObtainConsultation
1. ConsultGodthroughprayer.
2. Limittheinformationwhenconsultingothers.
E. ConsiderallPossibleCoursesofActionandtheirConsequences
F. ChoosewhatAppearstobetheBestCourseandFollowThrough
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G. DocumenttheProcessandOutcomes
VII. Conclusion
A. Ethically
1. Beproactive.Don’twaitforthecrisis.
2. Setclearexpectationsaboutconfidentiality.
3. Knowthegeneralproceduresexpectedinmysituation.
B. Spiritually
1. Seekwisdom.
2. Proverbs9:10
“ThefearoftheLordisthebeginningofwisdom,andtheknowledgeoftheHoly
Oneisunderstanding.”-Proverbs9:10
C. CaringfortheIndividualGodhasPlacedBeforeMe
1. IwanttodogoodforthoseGodhascalledmetoserve.
2. Havetheintenttoserve.
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MSIPBonusSessionTwo:
ConductingaSuicideIntervention:TheRoleof
MinistryLeadersandCaregivers(with
demonstrations)
GarySibcy,Ph.D.
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AbstractInthissession,Dr.SibcyagainutilizestheSafe-Tmethod,butthistimewithanemphasisonthe
role of pastors andother lay caregivers in conducting a suicide intervention. It is of utmost
importancethatwhenasuiciderisk isclearlypresent,referralsystemsareinplacetogetthe
at-riskparishionertoatrainedclinicianwhocanhelp.
LearningObjectives
1. ParticipantswillnameanddescribeeachstepofthefivestepSafe-Tsuicideintervention
model.
2. Participantswillunderstandimportantconsiderationsforlaycaregiverswhoencountersuiciderisk.
3. Participantswillviewanexampleofreferringtoappropriateresources.
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I. Introduction
A. SuicideCrisis
1. Theriskisprevalent.
2. Ifyouworkwithpeopleinacaregivingrole,youwilllikelyencountersomeonewith
suicidalthoughtsandideationwhomaybeatriskforsuicidecompletion.
3. Thisistrueevenifyouarenotworkingasacounselor.
4. Preparing for the instance of suicide threat is absolutely crucial to intervention
outcome.
B. TheSafe-TMethod
1. Safe-TFive-StepEvaluation&TriageSystemforSuicideAssessment
2. Developed by the Substance Abuse and Mental Health Services Administration
(SAMHSA)oftheAmericanPsychologicalAssociation(APA).
3. Payattentiontosignificantstressorsinyourparishioners’lives.
II. TheSafe-TMethod
A. Step1:RecognizeanIndividual’sRiskFactors
B. Step2:CompareRiskFactorswithExistingProtectiveFactors
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C. Step3:Inquiry
1. Assess the client’s state of mind with respect to attachment, history, ideation.
2. Thethreefactorstobalancearerisk,protectivefactors,andsuicidestateofmind.
3. Asalayclinician,itisimportanttobereadytorecognizewhensomeoneneedshelp,
andbepreparedtoplugthemintohelp.
D. Step4:DetermineaHigh,Medium,OrLowLevelofRisk
E. Step5:DocumentanImplementaTreatmentPlan:WhatYouDid,WhyYouDidIt,and
HowYouDidIt.
1. Trytounderstandaperson’sstateofmindbeforetryingtointervene.
2. Ifsomeone’slevelofriskishighormoderate,gettingthemconnectedtosomeone
whocaninterveneataprofessionallevelistheimmediateconcern.
3. It is importanttohavearicharrayofpeoplewhoyoucanrefertoandunderstand
theirprocesses.
• Youwillwant toknowwhohasa longwaiting listandwho leavesspace in
theirscheduleforemergencyclients.
• Getcontactinformationandhaveitreadilyavailable.
• Understand how to access the local Emergency Room and what their
proceduresare.
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III. RolePlay1
A. Background
B. RolePlay
C. Review
IV. RolePlay2
A. Background
B. RolePlay
C. Review
V. RolePlay3
A. Background
B. RolePlay
C. Review
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Appendix1:
ASystematicProcessforAssessing
SuicideRisk:TheSAFE-TMethod
GarySibcy,Ph.D.
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ASystematicProcessforAssessingSuicideRisk:
TheSAFE-TMethod
GarySibcy,Ph.D.
Thelastcenturyhaswitnessedanexplosionofeffectivetreatmentsforavastarrayofillnesses
anddeathrateshavedroppeddramatically.Paradoxically,though,suiciderateshaveincreased
by60%overthelast45years.1Every20minutes,thereisacompletedsuicide.Suicide—aself-
inflictedactofviolence—representstheninthmostcommoncauseofdeathamongadults; in
youthages15to24,itisthethirdmostcommoncauseofdeath,andfor25to34-year-olds,itis
the second leadingcauseofdeath.2Therearemany,manymore suicideattempts—10 to40
timesmorethancompletedsuicide.WithintheU.S.alone,therearenearly650,000attempted
suicidesperyear,3whichtranslatesintoonesuicideattempteveryminute.Nearlyonequarter
ofallmentalhealthprofessionalshaveworkedwithaclientwhohascompletedasuicide.Given
theexpandingmagnitudeofthepotentialrisk,assessingsuicideisoftenadailytaskformental
healthcounselors.4
Currently, there are no singlemeasures that accurately and effectively assess suicide
risk. Proper assessment requires amultidimensional approach that balances awide array of
relevant factors. One of the most accepted examples is the Suicide Assessment Five-step
Evaluation and Triage (SAFE-T) system. The protocolwas developed by the SubstanceAbuse
and Mental Health Services Administration (SAMHSA), and based on data and
recommendationsprovidedbytheAmericanPsychiatricAssociationPracticeGuidelines.These
steps are used at all initial evaluationswith clients throughout the course of treatment and
wheneverthecliniciansuspectsthatsuicideriskmayincrease.
SAFE-T5 is a process measure that involves balancing three aspects: risk factors,
protective factors, and an assessment of the client’s current state of mind with respect to
suicide. The process begins with an assessment of risk for key factors through a clinical
interviewandfrompreviousrecords.Theseinclude:
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§ Theclient’ssuicidehistoryintermsofanypastattemptsorahistoryofself-injurious
behavior.Apastattemptisthenumberonepredictorofcompletingasuicideinthe
future. This is especially true for individuals who have utilized a highly lethal
method,butsomehowsurvivedagainsttheirwill.Themoreserioustheintent,the
greaterthefuturerisk.
§ Theclient’scurrentandpastpsychiatrichistory,aswellas their familyhistory that
requiredhospitalization.Highrisk individualsare likelytopresentwithahistoryof
mooddisorders suchasmajordepressionandbipolardisorder.Otherdisordersof
risk are psychotic disorders, alcohol and substance abuse problems, ADHD (when
combined with another disorder like depression), PTSD, traumatic brain injuries
(TBI),antisocialbehavior,impulsivity,andaggression.
§ Varioustypesofprecipitantsandstressorsthatmaytriggerasuicidalcrisis.Manyof
these are interpersonal in nature, especially those that produce a sense of
humiliation,shameordespair.Chronicpainandongoingmedicalillnessesthataffect
the central nervous system (such as Multiple Sclerosis, Parkinson’s, ALC, and
Huntington’s) are also considered risk factors. Other relevant triggers include
changesintreatmentandmedicationregimensorchangesintreatmentproviders.
§ Current psychological and emotional symptoms such as a significant loss in the
clientsabilitytoexperiencepleasure(anhedonia),feelingsofhopelessness, intense
anxiety and panic symptoms, pervasive insomnia, impulsivity, substance
intoxication,andcommandhallucinations.
The SAFE-T balances the above-mentioned risk factors with protective factors, which
canbeacombinationofbothinternalandexternalresources.
§ Internal resourcesmay include a capacity fordistress/frustration tolerance, coping
skills,andstronglyheldreligiousbeliefs.
§ External factors may include a sense of responsibility to children, a positive
therapeuticrelationship,andaccesstotrustedsocialsupportnetworks.
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Withbothriskandprotectivefactorsinmind,aclinicianshouldconductamoreformal
suicideinquiry.Thisentailsasetofsensitivelydeliveredquestionsassessingtheclient’scurrent
stateofmindwithrespecttosuicideandincludethefollowingareas:
§ Suicide ideation,which involves the frequency, duration, and intensity of suicide
thoughtsoverthelast48hours.
§ Anassessmentoftheclient’ssuicideplansandbehaviorsandwhethertheclienthas
determined the locationand time inwhichheor shewouldwant tocarryout the
act.Thepotentiallethalityoftheplan,realisticaccesstoitemsneededtocarryout
theplan,andpreparatoryacts(suchasrehearsingtheactmentallyorbehaviorally)
are also important. Thismay include non-suicidal, self-injurious behaviors such as
cuttingandburning.
§ Assessing client intent—the degree of motivation and extent to which the client
believestheplanwillbe life-endingversusself-injurious.Withminors,theclinician
shouldalsoaskparentsandguardiansaboutevidenceofsuicidethoughts,plansand
behaviors.
TheSAFE-Tprovidesguidelines fordeterminingrisk levelandcorrespondingclassesof
interventions.Theseinclude:
§ HighRiskStatus involvessignificantrisk factorsthatoutweighprotective factors in
combinationwithpersistentsuicideideation,aplanand/orintention.Interventions
would includehospitalization,preferablyvoluntaryadmission incollaborationwith
theclient,butinvoluntaryifnecessary.
§ Moderate Risk Status involves a number of risk factors with very few protective
factors. However, unlike the high risk category, such individualsmay have suicide
ideationandaplan,butno intentandnoovertbehaviororrehearsals.Thetrigger
may be relatively transient and modifiable and the client has some internal
resources for coping. Interventions may include hospital admission or a detailed
crisis plan with a commitment from the client to call should his or her condition
changefortheworse.
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§ LowRiskStatusinvolvesriskfactorsthatarelessintense,transientandmodifiableto
problem-solving and other types of interventions. The client also possesses a
numberofprotectivefactors,suchasstrongreligiousbeliefsagainstsuicideand/ora
sense of obligation or commitment to the care of others.Moreover,while clients
may report persistent thoughts of death, they do not report any suicide plans,
intentions, behaviors or rehearsals. In such cases, interventions are focused on
outpatient symptom reduction with phone numbers available in case of crisis or
emergencysituations.
ThefifthandfinalstepoftheSAFE-Tprocessisdocumentation.Thisisaveryimportant
stepbecause it creates a permanent and legal record about themeasures taken to properly
assessandevaluateaclient’ssuicidalrisk.Thekeyhereistodemonstraterationaleformaking
clinicaldecisionsandfollowingasystematic,best-practicesapproachregardingriskfactorsand
clinicalintervention.Thetreatmentplanshouldbedocumentedonhowitisdesignedtotarget
currentandfutureriskfactors.Forminors,documentationshouldreflecttherolesofparents
andguardians.
Itiscrucialthatcliniciansworkdiligentlyatmaintainingasolidtherapeuticrelationship
and be mindful of how suicide assessment can sometimes challenge the quality of the
therapeutic alliance. This is particularly challenging with clients who may present with a
moderatetohighdegreeofrisk,butwhoarenotopentomoreintenseinterventions,especially
hospital admission. Even for seasoned therapists who are treating difficult cases, effective
clinical decision-making often requires ongoing consultation and collaboration with other
professionalshavingexpertiseinsuicideriskassessment.
A helpful resource can be found atwww.SPRC.orgwhere a pocket card that outlines
thesefivestepsandhelpsmanagesuicideriskinyourclinicalpracticecanbedownloaded.
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Endnotes1WorldHealthOrganization(2005).WorldHealthOrganization:SuicidePrevention.RetrievedOctober26,2005,fromhttp://www.who.int/mental_health/prevention/suicide/suicideprevent/en/2 Centers for Disease Control and Prevention (CDC). Web-based Injury Statistics Query andReporting System (WISQARS) [Online]. (2007). National Center for Injury Prevention andControl,CDC(producer).Availablefromwww.cdc.gov/injury/wisqars/index.html3 Goldsmith, S.K., Pellmar, T.C., Kleinman, A.M. & Bunney,W.E. (2002). Reducing Suicide: ANationalImperative.Washington:InstituteofMedicine,NationalAcademiesPress.4Ibid.5SAFE-T Drew Upon the American Psychiatric Association Practice Guidelines for theAssessmentandTreatmentofPatientswithSuicidalBehaviors.http://www.psychiatryonline.com/pracGuide/pracGuideTopic_14.aspxDerived from: American Psychiatric Association (2003). American Psychiatric AssociationPracticeGuideline
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