PREVENTION: EDUCATION, RECOGNITION & INTERVENTION
Q: What causes a person
to want to kill themselves? A:
There are many factors, depression being the most common. It's important to understand that suicidal people don't
necessarily want to die, they just want the emotional pain to stop. Even though the pain is very real to the
person--and they are truly sincere about their feelings, they are ambivalent about dying. Every person is different
and the best way to find out why somone wants to kill themselves is to simply ask them.
Q: So why do people comitt suicide? A:
They are usually overwhelmed with mental anguishThey are unable to see a solution
to their problemsThey see death as the only solution.They see death as
the only source of relief 80% of suicides displayed some
sign prior to successful suicide. 50% of
these signs are readily observable. The remaining
50% require face-to-face interview to notice observable signs. 20%
of suicides display NO observable signs prior to successful suicide. Excessive
reliance on typical suicide profiles may distract you from a sincere and thorough assessment. Often,
if rapport is established, a suicidal person with no prior observable signs, may suddenly reveal signs as a cry for help because
they may be ambivalent about their choice. This situation will only unveil itself if you take the time
to talk, listen and be with the person. Suicide is a private
act. The most lethal suicidal persons have a very strong intent to die and want to be sure that no one
will intervene to stop them. This
intent can make them act and appear “normal” to avoid alerting anyone to their plan. People
with ambivalent intent also want privacy, but are more likely to display identifiable warning signs.
- ISOLATION INCREASES THE RISK OF SUICIDE -Shneidman's term "psychache," is the pain of loneliness, shame, guilt and
desperation. He believes if we listen more carefully to the needs of the mentally ill, we can save more of them from suicide.
You have to address the pain. You have to ask, "Where do you hurt?"-
Suicide really is an outcome of a combination of feelings and stressors that make a person feel like committing suicide, and
the individual's particular propensity for acting on those feelings -myths
& misconceptions“Suicides are more frequent during the holidays.”
FALSE: it appears that suicide rates are the highest in April, June & July
talk about suicide won't really do it."
80% of those who commit or attempt suicide have given some clue or warning. Do not ignore suicide threats.
Statements like "you'll be sorry when I'm dead," "I can't see any way out,"
no matter how casually or jokingly said, may indicate serious suicidal feelings.
"Anyone who tries to kill him/herself
must be crazy."FALSE: Most suicidal people are not psychotic or insane. They may be upset,
grief-stricken, depressed or despairing, but extreme distress and emotional pain are always signs of a mental illness and
not specifically signs of psychosis. Their emotional pain is REAL—NOT IMAGINED...Their perception
may be altered, but the pain is real.
"If a person is determined to kill him/herself, nothing is going to stop him/her."FALSE: Even
the most severely depressed person has mixed feelings about death, and most waver until the very last moment between wanting
to live and wanting to die. MOST SUICIDAL PEOPLE DO NOT WANT TO DIE—THEY WANT THE PAIN TO STOP AND SEE SUICIDE AS THE
ONLY SOLUTION TO THEIR PAIN. What needs to be remembered is that the impulse to end it all, however overpowering,
does not last forever."People who commit suicide are people who were
unwilling to seek help."FALSE: Studies of suicide victims have shown that more then half had sought medical help
within six month before their deaths and a majority had seen a medical professional within 1 month of their death."Talking
about suicide may give someone the idea."FALSE: You don't give a suicidal person morbid ideas by talking about suicide. The opposite
is true -- bringing up the subject of suicide and discussing it openly is one of the most helpful things you can do. SUICIDE PREVENTION active
is it important to listen? 1. Human beings want to express themselves and be heard. 2.
Listening can de-escalate most situations.
3. Listening shows you care. 4.
Failure to listen often breeds disastrous results. - HUMAN BEINGS
CAN LISTEN 4 TIMES FASTER THAN OTHERS CAN SPEAK UNDERSTANDING THIS GIVES A SKILLED LISTENER TIME TO SORT MATTERS AND DISCOVER
CONNECTIONS, SIMILARITIES & SOLUTIONS - ACTIVE LISTENING is
a communication skill that involves both the speaker and the listener. There are two goals
of active listening: 1.
reduce conflict & anxiety2. gather information
& establish rapport The listener tries to understand what feelings, thoughts & beliefs (message) are trying
to be communicated AND accepts this with sincerity. The listener feeds back only what they believe the speaker is trying to say NOTHING MORE,
NOTHING LESS. This feedback involves verification that the listener correctly understood the speakers
message. The listener’s feedback will show the speaker that the listener understands therefore providing
the speaker an opportunity to share more. The listener avoids getting stuck in the speaker’s feelings of helplessness. the steps ENCOURAGE – INQUIRE
- REFLECT - RESTATE - SUMMARIZE - VALIDATE Remember that your Active Listening
techniques are not just so you will hear better, but so the subject will hear themselves. When
listening show understanding and acceptance by using non-verbal cues (75% of communication is non-verbal) such as; facial
expressions, vocal tone, posture, eye contact, gestures. Put yourself
in the subject’s place in order to understand what the subject is saying and yow they feel—try to hear what the
subject is saying WITHOUT making assumptions and judgments about what they say or how they feel. Avoid
interrupting, advice, suggestions, or similar feelings from your own past experience unless you believe it will have a positive
effect. Understanding pain is good, assuming you understand what they are feeling can be construed as callous.
Be careful. Sincerity always wins out. Remain neutral and do not take sides.Q:
What are obstacles to effective listening? 1. Insincerity or simply not caring (DELIBERATE INDIFFERENCE). 2. Noise, background conversation, or physical discomfort. 3. Pretending to listen (tuning the speaker out and dwelling on internal
Letting information from the speaker
(with which we may disagree) cause a negative emotional response from the listener. 5. Boredom, lack of focus & moving too fast or far ahead in the
listener’s thinking. 6. Thinking of a rebuttal and listening mainly for an opening in the conversation for
the opportunity to make a statement (also known as COMPETITIVE or COMBAT LISTENING). 7. Allowing the speaker’s poor characteristics or inability
to communicate prevent understanding.
- WE HAVE 2 EARS AND ONE MOUTH-GOD KNEW WHAT HE WAS DOING...THIS ILLUSTRATES
THAT LISTENING IS EITHER TWICE AS DIFFICULT OR TWICE AS IMPORTANT AS TALKING - if
the person is talking—they're NOT taking their own life.
communicating with suicidal persons Be calming and reassuring.
Use Active Listening techniques. Build trust. Express
empathy (“I can see that you’re hurting right now”). Redirect
attention on how the person is feeling, rather than on the act of suicide (“What would make you feel better?”).
Don’t uses phrases like; “Don’t worry”, instead use
“Try to relax” or “Stay calm” because the person will only hear, “Worry”, “Relax”,
or “Calm”. (for example, if someone says, “DON’T THINK
OF A RED-FACED MONKEY.” What do you think of?) Ask
the person if they actually have a plan to complete the act of suicide. Guide them to help.
Proceed slowly as you build realistic hope. effective
questions would anyone miss
you? (no)how certain are you of this? 50%?at
what time would someone miss you? when?what has changed since
A PERSON WHO IS SUICIDAL NEEDS SOMEONE WHO WILL LISTEN WITH ACCEPTANCE – do’s & dont’s DO: Listen. DON’T say, “Don’t
talk like that.” DO: Show you care by accepting
their feelings.DON’T judge or say, “Don’t feel that way.” DO:
Take the person seriously.DON’T minimize what is being said. DO:
Accept their emotional state.DON’T try to cheer them up. DO:
Ask for their reason for not wanting to live.DON’T make assumptions. DO:
Ask why they’ve chosen to live until now.DON’T let the reason become
the reason to give up. DO: Accept their particular
life perspective.DON’T be shocked or preachy. DO:
Be understanding.DON’T scold. DO: Try
to help them build realistic hope.DON’T make promises you can’t
keep. DO: Explain their feelings won’t last forever.DON’T
push them to move on or get over it.
Tone/Atmosphere/Communication/Time When trying to relate or communicate with an individual who has a mental illness or is exhibiting in crisis behavior
these tactics and attitudes seem to work best:
non-confrontational, respectful, patient, attentive, reassuring, truthful. Avoid taking anything said or
distractions, keep scene calm, maintain personal space, move slowly, observe verbal and non-verbal cues, if possible-allow
person to pace.
slowly, calmly, repeat yourself clearly. Listen and respond to feelings, NOT CONTENT. Give
firm and simple directions. Coax the subject to focus on your voice. Make your actions
clear. Make your expectations of them clear.
down. Assess the problem-develop a plan. Give the person processing time to “hear”
you. Slow down. Give the person time to vent. Use this time to obtain
appropriate resources. notes
on communication 55%
of communication is NON-VERBAL...38% is VOCAL TONE...7%
is CONTENT An aggressive approach versus an assertive approach...The aggressive approach
comes from insecurity. The assertive approach comes from knowledge & understanding. “The
Word Gap” -- We process 400 words per minute but can only talk 125 words per minute. This 275 word
gap causes us to listen less, assume more, and lose focus. suicidal
or distraught people don’t need advice...they need affirmation. The
execution of proper techniques will enable you to create a rapport and a “Psychological Umbilical Cord”.
The likelihood of successful cooperation is greatly increased.
Many times, handling a person’s basic physical needs, will make them more receptive to listening.
It’s difficult to focus when you’re too cold, hungry, or tired. Next to physical survival,
the greatest need of a human being is psychological survival--is to be understood, to be affirmed, to be validated, to be
cognitive dissonance theory no one
can hold 2 conflicting beliefs simultaneously. why is this important? Because if you
are trying to communicate with a subject and you hold a belief about them, you may miss what is really there.
Once a strong belief is developed, we become selective perceivers. This selective perception creates
a blind spot and we are then more susceptible to missing the obvious—this can be dangerous for everyone. We tend
to choose beliefs that protect us and keep us from looking foolish. We will communicate better if we step
back and try to look at the information from a different perspective and remain open-mined. literally changing your physical positioning, angle, posture—It
all creates new perspective.
imminent pre-death behavior & response persons who are making a final decision to complete an act of suicide may exhibit distinguishable
physical, visible or audible traits: ·
Hyperventilating and repeated deep
breaths audible on phone or visible and looking similar to a weightlifter preparing for a lift or a person trying to bolster
the courage to do a dangerous act (sky-diving, bungee jumping).·
Hyper-vigilance depicted by dramatically
scanning the area and formalization of plan.·
Readying for the act.· As self-termination nears, the deep breaths may not be in succession.· Count up or down (used more frequently in persons who are going to jump). if these
behaviors are observed, it may be helpful to disrupt the individual’s intense pattern of focus by yelling and telling
them to stop (sounds too easy, but is effective). When you observe these behaviors you must be aware
that a violent act is pending. You should retreat from any close proximity efforts, seek safety and VERBALLY
engage them to stop their behavior.
safety considerations Crisis
situations are unstable and you must continuously evaluate the crisis, their safety, and the safety of others. · Violence can be directed inward (suicide) or outward (homicide) and it can change rapidly.· Persons intent on suicide often have multiple means of completing the act. For
example, a person intending to jump may also have a gun. Avoid being lulled into a false sense of security.· Whenever possible, you should not rush to rescue or capture the subject when no one else is at
risk. Waiting and the passage of time allow emotions and the energy of self destruction to diffuse.· A person who is suicidal may have an expanded view of his/her personal space. Encroaching
upon the person’s personal space may provoke them to action. Do not make sudden moves or rush the
person to make decisions. LISTENING...jail stories—who
has listened to you. sometimes, because i did not fit into the persons expectation,
and i acted very little (A FORM OF DYNAMIC INACTIVITY)—i simply did not judge or reject—i took time—this
was the difference and evidence by their comments later, when they were healthy that “what you said really made sense”
or “i really thought about your words—i could hear them in my head.” what i “said”
is beyond me—and i doubt they could tell me what it was either—but it was part of the that 75% non-verbal communication—it
was caring and stillness in action that made the difference. so very often, i don’t have the answer,
and they don’t want one—or they know it—or we both know it and it doesn’t matter because what they
need is not an answer, but a hand to hold. call it what you like, but treating someone with respect works
better than reminding them that they screwed up or that they’re a ‘dirtbag’ or a ‘chud’.
none of that works. caring does. i’ve seen it first hand. evidence
in calming. asking questions...listening. some people want to be angry because they
are hurt—they feed off it...i get more grief from people wondering why i care—their identity and role is in their
anger. it’s their fuel—and no one is going to take it away from them. i
know. that’s my guy. *BEWARE OF IMPROVED MOOD*It
may indicate they have found the answer and truly decided on suicide
you create is critical to welfare. Environments that are negative, harsh, cold,
or uncaring – PROMOTE HOPELESSNESS...Environments that are positive, respectful, supportive and humane – PROMOTE
negative and positive attitudes are contagious. -BE SINCERE, SPREAD OPTIMISM & LEARN TO LOVE YOUR WORK-proving an individuals worthEver had
an eyelash in your eye—it affects you...As does a pebble in your shoe...As does something as simple as a smile.(GOLDEN
GATE BRIDGE SMILE STORY)...if a smile would’ve saved this man’s life—how do you know there isn’t someone
out there that needs YOU.as it has been discussed, feeling suicidal is what it is...but acting on those feelings
is a choice...and conveying to the person that it is a premature choice is important. (USE MALL
SHOOTING ANALOGY—YOU DON’T KNOW THOSE PEOPLE SO YOU WOULDN’T KILL THEM—YOU DON’T KNOW YOURSELF
ENOUGH TO KILL YOURSELF EITHER—GET TO KNOW YOURSELF FIRST)