Suicide Prevention Prepared by Jacqui Candlish, RN, BScN, Public Health Nurse

1. Suicide PreventionPrepared by Jacqui Candlish, RN, BScN, Public Health Nurse

2. Agenda • Introduction and overview • Power Point presentations • Review of handouts • Wrap up and questions

3. Objectives • Know the facts • Know the warning signs • Know how to help • Know where to get help

4. Definition Suicide is the act of deliberately killing oneself (World Health Organization, 2005)

5. Another Definition Suicide is the triumph of pain, loss and fear over hope. (Canadian Association for Suicide Prevention, 2004)

6. Suicide • Suicide- is not an illness or a condition but an intentional action that ends in death • Suicidal ideation - thoughts about killing oneself; making plans, when, where and how to carry out the suicide; thoughts about the impact of one’s suicide on others. • Suicide threats -utterances made to others that indicate intent to die by suicide. • Suicide attempts - behaviours that do not result in death and are largely determined by opportunity and access to methods.

7. Suicidal Behaviour • Not a mental illness, but is often associated with mental illness. • Suicidal behaviour can be the result of a mental illness and addiction. • Attempted suicide is a sign of serious distress. • Health Canada, 2002

8. World Suicide: • is a huge but largely preventable public health problem • causes almost half of all violent deaths • results in almost one million fatalities worldwide every year • costs billions of dollars every year • fatalities could rise to 1.5 million per year by 2020 WHO 2002

9. Canada • Stats Canada 2004 identified suicides as the leading cause of all injury related deaths • Accounts for one quarter of all injury deaths • More people die by suicide than in motor vehicle collisions.

10. Canada • Just under 4000 Canadians die by suicide every year • More than 20,000 attempt • Suicide accounts for 24% of deaths among 15-24 year olds and and 16% among 25-44 year olds. • The mortality rate due to suicide among males is 4 times the rate than females. • Females are hospitalised for attempted suicide at 1.5 times the rate of males. • Health Canada, 2002

11. Ontario • 4,794 suicide deaths between the years 2000-2004 • highest rate among the adult population Vital Statistics, Ontario Ministry of Health and Long Term Care, IntelliHEALTH ONTARIO Data, extracted July 2009 Under-represented stats: • suicides are not classified as such under the age of 10 • many suicides identified as undetermined due to insufficient evidence (Beckon test) . Office of the Chief Coroner, Province of Ontario (June 2009) Report of the Paediatric Death Review Committee and Deaths Under Five Committee.

12. Ontario • Every 10 hours one Ontarian dies by suicide -more than three quarters of these deaths are male. • Every day 26 Ontarians are hospitalized with self inflicted injuries -almost two thirds are female

13. Hamilton • 332 persons died by suicide between 1999 and 2005. • In 2005 there were 51 deaths by suicide compared to 20 motor vehicle collision deaths and 9 homicides • 34% increase in the number of suicides from 1999 to 2005 Hamilton Police Sudden Death Breakdown

14. Hamilton • On average, two suicides per year involve teens. • In 2002, there were 6 teen suicides. 4 happened in September alone. Hamilton Police Report, 2002

15. Impact of Suicide • On average, a single suicide intimately affects at least six other people. If a suicide occurs in a school or workplace it has an impact on hundreds of people.WHO 2002

16. Attitudes “For years suicide has been steeped in silence, secrecy, taboo”. CASP 2004

17. Attitudes • Often people with mental illness are treated differently than people with physical illness. • This is a result of stigma.

18. Stigma • is a set negative beliefs and attitudes • leads to discrimination • results in stereotypes and labels • causes fear and avoidance • prevents people from getting help for themselves and helping others

19. Stigma and Suicide Stigma: • prevents people from talking about suicidal thoughts or plans with service providers, family members or friends. • often prevents people at risk from seeking help.

20. Stigma and Mental Illness Stigma: • prevents recognition that mental illness is a legitimate illness. • prevents people from acknowledging they have a problem. • is a barrier to accessing diagnosis and treatment of mental illness. • contributes to social isolation

21. Talking about mental illness and suicide reduces stigma.

22. Talking About Mental Illness • TAMI program increases awareness about mental illness and the stigma that surrounds it. • provides accurate information and dialogue between students and people who have “lived experienced” with mental illness. • helps correct misconceptions and provides insight into living with a mental illness. Centre for Addiction &Mental Health

23. Suicide is a complex problem for which there is no single cause and no single reason.

24. Causes • is not a disease • is a multidimensional disorder • results from an interaction of biological, genetic, psychological, social, cultural, and environmental factors.

25. Causes • large number of complex underlying causes/factors • Risk factors may be thought of as factors leading to or being associated with suicide; that is, people ‘possessing’ the risk factor are at greater potential for suicidal behaviour.

26. Risk Factors Biopsychosocial Risk Factors • Mental disorders, particularly mood disorders, schizophrenia, anxiety disorders and certain personality disorders • Alcohol and other substance use disorders • Hopelessness • Impulsive and/or aggressive tendencies • History of trauma or abuse • Some major physical illnesses • Previous suicide attempt • Family history of suicide

27. Risk Factors cont. Environmental Risk Factors • Job or financial loss • Relational or social loss • Easy access to lethal means • Local clusters of suicide that have a contagious influence

28. Risk Factors cont. Social-cultural Risk Factors • Lack of social support and sense of isolation • Stigma associated with help-seeking behavior • Barriers to accessing health care, especially mental health and substance abuse treatment • Certain cultural and religious beliefs (for instance, the belief that suicide is a noble resolution of a personal dilemma) • Exposure to, including through the media, and influence of others who have died by suicide.

29. Suicide is Not about Death • It is about ending the pain • Adults know problems are temporary • Youth don’t have broader perspective on life • Believe the unhappiness is a permanent condition

30. Mental Health Service Use Among Adolescents • Among adolescents aged 15 to 18 years with depression, 40% had not used any mental health services. • This rate was higher for adolescents with suicidality at 50%. • In young adults aged 19 to 24 with depression, 42% had not used any mental health services. • Among young adults with suicidality, 48% had not accessed services. The Canadian Journal of Psychiatry, Vol 52, No 4, April 2007

31. Youth Net Hamilton • Youth Net Hamilton • is a mental health promotion and early intervention program of Hamilton Public Health Services • The value of Youth Net Hamilton stems from the basic philosophy of youth helping other youth. Through discussion groups and broader involvement in the community, the program works to increase understanding of youth issues and emphasize the value that youth bring to our community.

32. Hamilton Youth Results from a 2004-2006 survey of 2073 youth 13-18 years of age who participated in Youth Net Hamilton focus groups showed: • 14% of females and 6% of males self-reported having ever had serious thoughts of killing themselves • 7% of females and 4% of males self-reported having ever purposely tried to kill themselves • 46% of females and 32% of males self-reported having been concerned about their mental or emotional health a few times a month, a few times a week, or all the time over the last 3 months Source: Youth Net Hamilton Raw Data, April 2004 to March 2006

33. Previous suicide attempt Low self-esteem Helpless, hopeless In trouble; at school, with the law Abused or neglected Perfectionist Sexual identity issues Youth at Risk

34. Youth at Risk • Recent loss, break-up, traumatic event • Loner, socially isolated • Victim of violence- bullying/dating • Suicide of family member or friend • Physical illness, disabled • Unstable family • Risk-taking or self-destructive behaviour • Substance abuse

35. Warning Signs • Feeling hopeless, helpless, sad, depressed • No sense of purpose in life • Anxiety, agitation • Unable to sleep or sleeping all the time • Anger, rage, revenge • Feeling trapped, like there’s no way out • Withdrawing from friends, family, society • Acting reckless • Talking or writing about death or suicide • Dramatic mood changes • Increased alcohol or drug use

36. IS PATH WARM? • IS PATH WARM Easy-to-Remember Mnemonic: • I Ideation • S Substance Abuse   • P Purposelessness • A Anxiety • T Trapped • H Hopelessness   • W Withdrawal • A Anger • R Recklessness • M Mood Changes

37. Changes at School • Cutting classes • Poor performance in school work • Problems concentrating • Lack of interest and withdrawal from friends and activities • Overly concerned about death/suicide- writing and/or drawing pictures about death • Alcohol/drug use in school

38. How to Help • Listen • Avoid making judgments or giving solutions This delivers two critical messages: 1. I take your problems seriously 2. I care enough about you to want to help • Be alert for: “I’d rather die than … “I can’t take it any more” “Everyone would be better off without me”

39. Evaluating the Risk Best way to find out is ask! • Does not put ideas into their head • Does give them the freedom to talk about it Ask “Are you thinking of killing yourself?”

40. If the answer is YES Then ask: • “How are you going to kill yourself?” • “When do you think you will kill yourself?” • "Do you have what you need to kill yourself?”

41. Assessing Risk Degree of Risk = lethality + availability + time frame

42. Get Help • Do not ever agree to keep someone’s suicidal intentions a secret. Don’t assume the person isn’t the suicidal type. Anyone can be suicidal • Be sure the person is not left alone if there appears to be a risk • Call 911 if in immediate danger • Call COAST if unsure what to do

43. Important Contacts • COAST- Crisis Outreach and Response Team – 905.972.8338 • EPS St. Joseph’s Hospital • Suicide Crisis Line – 905.522.1477 • Contact Hamilton – 905.570.8888 • Family Physician/ Nurse Practitioner • Public Health Nurse • School Social Worker • Kids Help Phone – 1.800.668.6868

44. Learn More • LivingWorks • safeTALKteaches how to recognize persons with thoughts of suicide and to connect them to suicide intervention resources • ASISTis a two-day interactive suicide first aid course designed to teach the risk and warning signs and how to intervene to prevent the immediate risk of suicide

45. Suicide is almost always preventable through caring, compassion, commitment and community. Suicide prevention is everyone’s responsibility. CASP Blue Print 2004

46. Resources • Hamilton Suicide prevention Strategy • Appendix A: Suicide Prevention and Related Services in Hamilton • Appendix B: Suicide Prevention and Related Resources

47. References • CASP Blueprint for a Canadian National Suicide Prevention Strategy, 2004. • Hamilton Police Sudden Death Breakdown 1999-2005 • Health Canada (2002). Capter 7: Suicidal Behaviour. Found in A Report on Mental Illness in Canada. Ottawa, Canada. • Kaneva, N. & Zadvomy, T. (2002). Suicide Analysis 01st January 1999 - 31st October 2002. Unpublished Hamilton Police Report. • Langlois, S. & Morrison, P. (2002). Suicide Deaths and Attempts. Canadian Social trends, 66 (Autumn), 20-25. • Statistics Canada (1998). Suicides, and Suicide Rate by Sex, by Age Group. http://www.statcan.ca/english/Pgdb/health01.htm • World Health Organization. Suicide Prevention. http://www.who.int/mediacentre/news/releases/2004/pr61/en/index.html