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 real to them and they are very serious, 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 anguish

They are unable to see a solution to their problems

They 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

"People who talk about suicide won't really do it."

FALSE: nearly 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 listening

Why 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 & anxiety

2. 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 distractions).

4. 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 then?

- 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.

T.A.C.T.

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:

Tone

Calm, non-confrontational, respectful, patient, attentive, reassuring, truthful. Avoid taking anything said or done personally.

Atmosphere

Reduce distractions, keep scene calm, maintain personal space, move slowly, observe verbal and non-verbal cues, if possible-allow person to pace.

Communication

Speak 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.

Time

Slow 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 appreciated.

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

The environment 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 HOPE.

Both negative and positive attitudes are contagious.

-BE SINCERE, SPREAD OPTIMISM & LEARN TO LOVE YOUR WORK-<