Crisis Intervention-Ch 10. Suicide Flashcards
(89 cards)
1
Q
who quoted “ Anguish of mind has driven thousands to suicide; anguish of body, none. This proves that the health of the mind is of far more consequence to our happiness, than the health of the body, although both are deserving of much more attention than either of them receive.
A
C.C. Colton
2
Q
who explained that suicide is not an illness, rather suicide is “A human, psychological orientation toward life, not a biological, medical disease.
A
1989, Suicidologist Edwin Shneidman
3
Q
Epidemiology of Suicide:(study of how disease spread)
A
1998, the year for which the most recent statistics are available, suicide was the 8th leading cause of mortality in US. 30,000 deaths (83 deaths per day)
- homicide accounted for less than 21,000 deaths.
- 1999, suicide remained the 8th leading cause of death for all Americans.
4
Q
High Risk populations:
1999, US Public Health Service identified 5 US population to be at high risk for suicide.
A
- youth
- elderly
- medically ill
- specific population groups
- persons with mental and substance abuse disor.
5
Q
High Risk populations:
leading cause of death for 5 to 14 yrs olds.
A
Suicide, 6th leading cause of death
6
Q
suicide is currently the third leading cause of death for
A
15-24 yr old
7
Q
suicide is 4th leading cause of death for
A
25 to 44 yr olds
8
Q
between ____ and ___, the reported rates of suicide among adolescents and young adults nearly tripled.
A
1952 and 1998
9
Q
Currently, suicide is the second leading cause of death for
A
white adolescents and young adults 15 to 24 exceeded only by unintentional injury.
10
Q
Risk factors for attempted suicide in youth are
A
- depression
- alcohol or drug use disorder
- aggressive or disruptive behaviors
11
Q
Age:
1997, men accounted for 83% of suicides among persons aged ____ years and older.
A
65
12
Q
highest suicide rates reported were for white men over 85 years of age, however, this was not the leading cause of death for this age group.
A
empty
13
Q
1980-1997, largest relative increases in suicide rates occurred among people
A
80 to 84 years of age
14
Q
Age:
A
Americans 65 yrs or older account for 13% of US population, they accounted for 20% of all suicide deaths. (suicide among elderly are highest for those divorced or widowed.)
15
Q
older adult suicide victims, when compared to younger suicide victims, are more likely to be more depressed and more socially isolated. thus they frequently use highly lethal methods
A
empty
16
Q
Race:
Native America and Alaskan Natives have long had higher suicide rates than general population.
A
empty
17
Q
during period from 1979-1992
A
*suicide for Native Americans were 1.5 times the rates for general population.
*males 15 to 24 accounted for 64% of all suicides by Native American.s
*Suicide rates are higher than the national average for some groups of Asian Americans. ex: suicide rate among Asian Americans and Pacific Islanders in California is similiar to that of total population.
*Hawaii, the rate is higher.
*African American males aged 15 to 19 had increased over 105%
*
18
Q
in 1997, white males accounted for 72% of all suicides. Together, white males and white females accounted for more than 90% of all suicides in US
A
empty
19
Q
Gender:
A
*females attempt suicide more than males
*Males are at least 4 times more likely to die from suicide.
*Males under age 25 are much more likely to commit suicide than their female counterparts.
*1996 gender ratio:
age 15 to 19 was 5:1
age 20 to 24 was 7:1
*gay and lesbian youths are two to three tiems more likely to commit suicide than other youth.
20
Q
______ are the most common means of suicide among men and women, accounting for 59% of all suicide deaths.
A
firearms
21
Q
other states on firearms
A
1996- 79% of all firearm suicides were commited by white men.
between 1980 to 1996, suicide among African Americans males aged 15 to 19 yrs more than doubled with firearms.
*Firearms were most common method of suicide by both males and females, age 65 and older, 78%
22
Q
Region:
The Center for Disease Control examined suicide from 1990 to 1994 to determine whether regional variations in suicide rates are affected by differences in age, race, gender and to examine whether specific rates varied by region.
A
*154,444 suicides in US
*37% in south
25% in West
22% in Midwest
15% in Northwest.
23
Q
CDC files from 1990-1994, three leading methods of suicide.
A
firearms
strangulation
overdose
24
Q
Region suicides. After adjusting for age, race, sex, rates remained highest in the
A
West, followed by the south, Midwest and Northeast. Firearms were the leading method in all regions.
25
Misclassified Deaths and Attempted Suicide:
| Surgeon General's Call to Action to Prevent Suicide
reported that annually, approx half a million people required emergency room treatment as a result of attempted suicide. 1999
26
National Institute of Mental Health reported
there are an estimated 8 to 25 att suicides to one completion while the US Public Health Service reported there are an estimated 16 att suicides for each completed suicide, with gender ratio of 2:1. Attempted suicide higher with women, youth and lower with men and elder.
27
strongest risk factors for attempted suicide in youth are
depression
alcohol or drug use disorder
aggressive or disruptive behavior
those risk factors associated with att suicide in adults are depression, alcohol abuse, cocaine use and separation or divorce
28
Incidence of suicide pacts:
this professor believes that suicide pacts are most common in elderly couples, who often have been married to each other for many years, and cant imagine life w/o each other.
Dr David Shaffer, professor of Child psychiatry at Columbia Univ
29
Shaffer said suicide pacts are very unusual in young people. When they do occur, there is almost always some _______relationship between the partners.
romantic;
typically, one partner is dominating over the other.
all members of the pact had signs of mental illness before their deaths.
30
Conner identified several factors that seem to be prevalent in suicide pacts.
1. one or more people in the pact have mental illness or medical problem, in the midst of serverly painful emotional problems, depression, helplessness and hopelessness
2. person in misery can appreciate another persons misery and may feel better in company of others who feel same
3. these people are able to discuss their thoughts and feelings openly with each other, violent an suicidal thoughts
4. efforts to help each other fail and efforts to get help from others fall on deaf ears. At one time, they att to encourage each other to live, but eventually they lose hope
31
According to Conner, the essential dynamic of a suicide pact is that the _____ and ____ of living becomes worse than the fear of dying.
pain and fear
32
A suicide plan involving public display develops out of a motivation to give death a sense of _____ and _____
purpose and meaning
33
A public suicide is usually intended to send a message, inflict _____ harm and to ____ others.
emotional harm and to punish others.
34
A suicide following violent behavior is intended to escape ______ and _______
responsibility and accountability.
35
Suicide by Cop:
| Sincielli defines suicide by cop as a
collogquial term used to describe a suicidal incident whereby the suicidal subject consciously engages in a life-threatening behavior to the degree that it compels a police officer to respond with deadly force.
36
Parent states that suicide by cop and victim-precipitated homicide are terms that are sometimes used interchangeably; however there is a distinct difference.
while these terms are similiar in that the decedent's behavior did cause the use of deadly force by law enforcement in a defensive action, a psychological post mortem must be conducted to determine if decedents actions resulted from a clear intent to commit suicide.
37
Hutson examined 437 officer involved shootings by the Los Angeles County Sheriffs Dept occuring between 1987 and 1997. Four factors:
1. evidence of suicidal intent
2. evidence they specifically wanted officer to shoot them
3. evidence they possessed a lethal weapon or what appeared to be a lethal weapon
4. evidence they intentionally escalated the encounter and provoked officers to shoot them
38
Hutson found that suicide by cop accouted for
```
46 of the total 11%
10% involved suicide attempts
98% were males
17% used replica firearms
60% of suspects used their weapons
```
39
Characteristics of those who commit suicide by cope:
1. lower socioeconomic class
2. history of intimate partner violence
3. history of past suicide attempts
4. high alcohol and drug dependency
5. mental illness/depression
40
Motives for orchestrating a suicide by cop:
1. violent criminals go to death living their fantasy of dying in a shootout with police.
2. making police accountable for a persons death
3. avoiding sociological stigma or trying to reconcile the desire to kill themselves with belief that suicide is a sin
4. distancing themselves from the act by being shot by another
5. seems the only available method to them
41
Another type of person who commits suicide by cop is the ______ criminal who takes ever increasing chances, daring law enforcement to take him out.
Fringe criminal- ex: committing outrageously risky, poorly planned, day light armed robberies
42
One of the worst suicides by cop is when cops, usually on suspension or recently retired, for reasons having to do with deep resentment, loss, rage and what can be best described as a kind of temorary insanity, decide to set up colleagues on the job to kill them.
empty
43
frequent reactions of officers following a suicide by cop:
1. anger
2. resentment
3. disbelief
44
Suicide in Correctional Facilities:
| Leading cause of death within jails
suicide
45
Suicide is the _____ leading cause of death in prisons
third
46
Hayes and Rowan found that suicide rate in county jails is approx ____ times greater than that of general population white suicide rate in prisons is approx ___ and ____ times greater than in the comunity
9 times
| one and half times
47
profile of typical victim of jail suicide.
* Most likely White male, between 22-30.
* detained on nonviolent charge, most of those were alcohol/drug related charges
* 2 out of every 3 inmates were being held in isolation.
* more than half were dead within 24 hrs
* 27% occurred within first 3 hours
* 88% under influence of alcohol or drugs
* 94% by hanging
* 48% used their bedding
* 89% victims not screened
48
study funded by Office of Juvenile Justice and Delingquency Prevention, Parent reported
1. more than 11,000 juv engage in more than 17,000 incidents of suicidal behavior in juv facilities each year
2. suicides in secure custody found that youth suicide in juv detention and correctional facil were more than 4 times greater than youth suicide in general population
49
Characteristics of jail environment make them ideal suicide-prone settings:
1. authoritarian of jail environment
2. no apparent control over future
3. fear and uncertainty over legal process
4. isolation from family, friends, community
5. shame of incarceration
6. dehumanizing aspects of incarceration
7. fears
8. officer and staff insensitivity to arrest and incarceration
50
examining potential suicidal behavior, following predisposing factors:
1. excessive drinking or drug
2. recent loss of stabilizing resources
3. severe guilt or shame
4. same sex rape or threat
5. mental illness
6. poor health or terminal illness
7. approaching emotional breaking point
51
Certain high-risk periods for the inmate which correlate with phases of his incarceration or steps in criminal justice process:
1. first 24 hrs of confinement
2. intoxication/withdrawal
3. waiting for trial
4. sentencing
5. impending release
6. holidays
7. darkness
8. decreased staff supervision
9. bad news
52
Hayes believes the KEY to any suicide prevention program is ______
staff training
53
Nomenclature of Suicide:
(system of naming of suicide)
Three elements of suicidal behavior are included:
1. identifiable outcome
* injury
* no injury
* death
2. evidence of self infliction
3. evidence of intent to die by suicide
54
Nomenclature of suicide
1. Suicide- death from injury
2. Suicide attempt w/injuries
3. Suicide attempt w/o injuries
4. Instrumental suicide-related behavior- Potentially self-injurious behavior, did not intend to kill himself, wanted to attain some other end; help, punish others, receive attention
5. Suicide-related behavior- Potentially self-injurious behavior; intended at some level to kill himself; comprises suicidal acts an instrumental suicide-related behavior
6. suicide threat- interpersonal action, verbal or nonverbal, stopping short of directly self-harming act. communicating or suggesting suicidal act
7. suicidal ideation- self-reported thoughts of engaging in suicide related behavior
55
Theoretical Models to Explain Suicide:
| Epidemiological approaches have focused on
demographic characteristics
56
Theoretical Models to Explain Suicide:
| Philosophical theorists have focused on issues such as the
nature and purpose of life
57
Theoretical Models to Explain Suicide:
| sociocultural and sociological theories have emphasized the role of
society and culture
58
Theoretical Models to Explain Suicide:
| philosophers theorists have stressed
mental illness
59
Theoretical Models to Explain Suicide:
| Psychodynamic models have centered on
unconscious conflicts
60
Theoretical Models to Explain Suicide:
| Psychological theories have focused on
psychological pain and unmet psychological needs
61
Theoretical Models to Explain Suicide:
| Biologists theorists have stressed
biochemical imbalances
62
Theoretical Models to Explain Suicide:
| Rudd and Joiner support Shneidman's more inclusive model, which says suicide is caused by
psychache- psychological pain in the psyche (the mind)
Suicide and suicidal behavior are viewed as intrinsically psychological phenomena, a function of individual pain and tolerance, both of which are determined, influenced and modified by a multitude of factors:
63
Theoretical Models to Explain Suicide:
Rudd and Joiner believe this model "psychache" will help those involved in crisis intervention because they attend to two variables:
1. experienced pain
2. demonstrated pain tolerance.
"suicide occurs, then, when individuals believe that they have exceeded their pain tolerance.
64
Factors Related to Suicide:
| US Public Health Service identified two set of factors related to suicide prevention"
1. risk factors
| 2. protective factors
65
Factors Related to Suicide:
| Rudd and Joiner identified three types of factors which can be used to assess suicidal tendencies:
1. predisposing factors
2. risk factors
3. protective factors
66
Factors Related to Suicide:
| Rudd and Joiner predisposing (chronic and invariable factors)
as those outside the control of individual.ex: age, psychiatric diagnosis, history of suicidal behavior, history of abuse, family violence.
These factors are included as risk factors by US Public Health Service
67
Factors Related to Suicide:
| Risk factors
those which serve to increase the potential for suicidal behavior. Risk factors include:
1. loss of job, financial status, relationships, physical or cognitive ability.
2. health problems,
3. psychiatric diagnosis
4. substance abuse
68
Factors Related to Suicide:
| Protective Factors serve to
mitigate risk of suicidal behavior. Such factors include:
1. involvement in treatment
2. good physical health
3. good problem solving skills
4. available social support
5. intact marriage or children, hopefulness
69
Factors Related to Suicide:
| According to NIMH, strongest risk factors for att suicide in adults are
1. depression
2. alcohol abuse
3. cocaine use
4. separation or divorce
70
Factors Related to Suicide:
| According to NIMH, strongest risk factors for youth att suicide is
1. depression
2. alcohol or drug use disorder
3. aggressive or disruptive behaviors
71
Factors Related to Suicide:
| US Public health Service also identifies following as protective factors:
1. easy access to variety of clinical interventions and support
2. restricted access to highly lethal methods of suicide
3. support from ongoing medical and mental health care relationships
4. learned skills in conflict resolution and nonviolent handling of disputes
5. cultural and religious beliefs that discourage suicide and support self-preservation
72
Assessment of Suicidal tendencies:
| the ___ and ____ assessment of suicide is critically important for two reasons.
formal and informal
1. first- assessment help identify those persons who are most in need of intervention
2. second- assessment can provide an initial screening so that person who is at risk can be identified.
73
Assessment of Suicidal tendencies:
The Modified Scale for Suicide Ideation is designed with standardized prompt questions so it can be completed by paraprofessionals. Consists of 18 items, evaluating three factors:
1. Suicidal desire
2. preparation for attempt
3. perceived capability of making an attempt
74
Assessment of Suicidal tendencies:
| Self-rated Scale for Suicide Ideation is modeled after the SSI-M. Has 19 items, which measures three factors:
1. Active suicidal desire
2. preparation
3. wish for death
75
Assessment of Suicidal tendencies:
Reasons for Living Inventory has 48 items assessing potential reasons for not committing suicide should the thought occur. There are 6 subscales:
1. Survival and coping beliefs
2. responsibility to friends
3. child concerns
4. fear of suicide
5. fear of social disapproval
6. moral obligation
76
Assessment of Suicidal tendencies:
Suicide Behaviors Questionnaire is a self-report instrument. 4 item questionnaire designed to be administered as a structured interview
empty
77
Assessment of Suicidal tendencies:
Suicidal Behavior Questionnaire for Children is a simplified version of the SBQ, written at a third grade reading level.
empty
78
Assessment of Suicidal tendencies:
Fairy Tales Test, also called the ___ and ____ Attitude Scale or the ____ ____ test. Consists of two parallel set of stories, with 4 stories in each set. Each have a animal or fantasy hero and delineates one of four attitudes:
Life and Death
Suicidal Tendencies
1. Attraction to life
2. Attraction to Death
3. Repulsion by life
4. Repulsion by death
79
Assessment of Suicidal tendencies:
Informal Assessments are also appropriate for assessment and evaluation of potential suicide victims. Identified more specifically as warning signs rather than informal assessment,simple checklist have been provided for parents, educators, physicians and others who notice changes in behaviors of others around them
```
Ex: San Francisco Suicide Prevention Center offers an easy-to-remember acronym to evaluate suicide potential: P.L.A.I.D.P.A.L.S.
Plan
Lethal
Availability
Illness
Depression
Previous
Alone
Loss
Substance abuse
```
80
Models of Suicide Treatment:
| Two models of suicide treatment have been identified by Pulakos
1. Crisis Intervention model- paternalistic and controlling , assumes thoughts of suicide are acute and suicide is preventable. Primary focus is to keep the person alive until crisis is resolved at which time therapy can take place
2. continuing-therapy model-described by Berman as "laissez-faire", emphasizes chronic suicidal behavior and assumes that suicide is not preventable. Focus on suicidal behavior and att suicide. This model involves freedom and responsibility; patient has the right to kill himself, ultimately responsible for his action.
81
Models of Suicide Treatment:
| One of primary difference between the two models is the assumption of the duration of the suicidal state.
* Crisis intervention model assumes that the suicidal crisis is an acute state
* Continuing-therapy model acknowledges that there can be both acute and chronic suicidal states, which require different therapeutic responses.
* Second major difference deals with ability to prevent suicide. Crisis intervention model assumes that suicide is preventable while the Continuing-therapy model states that all suicides are not preventable.
82
Intervention for Suicide:
| Treatment center:
suicidal person has to contact the suicide prevention center.
83
Intervention for Suicide:
| Telephone Hotlines is one way to screen and train personnel for answering hotlines is thru the use of
Suicide Intervention Response Inventory.
| Assessment consists of 25 statements that suicidal person makes. Examiner is given two forced choice responses.
84
Intervention for Suicide:
Partnership Strategies is an arrangement wherein a mental health center established a partnership with school officials to cooperatively address suicide among adolescents.
Mental health center established a 24 hr teen-counseling center, a toll free hotline.
85
On-site Intervention Strategies:
1. Establish rapport- First STep in intervention
2. Seek information- exploration of the persons specific ideation.
3. make contacts- collateral phone calls to prior health care providers, family members, friends
4. Assess risk level- two step
*Assessing the risk factors known to be
associated with suicide.
*After ascertaining risk factors, intervener can
then determine risk level.
86
On-site Intervention Strategies:
| Rudd and Joiner recommended the following continuum of suicidality:
1. nonexistent-no identifiable suicidal ideation
2. mild- suicidal ideation of limited
3. moderate- frequent suicidal ideation
4. severe-frequent, intense,enduring ideation
5. extreme-frequent,intent, enduring ideation, specific planning, clear subjective intent.lack of self control, severe psychache, many risk factors, no protective factors
87
On-site Intervention Strategies:
Determine Appropriate Course of Action will be determine by severity of the ideation. First guideline that must be followed is
NEVER IGNORE A SUICIDE THREAT OR ATTEMPT.
| A suicidal person should not be left alone and needs immediate mental health treatment.
88
Challenges in Preventing Suicide:
| Lester suggests that in seeking to prevent suicide, three different levels of prevention should be considered:
1. Primary- involves the prevention of developing of suicidal tendencies in the individual which is extremely difficult because it presupposes there are known causes of suicide. Modern medications, psychotherapy, wellness programs
2. Secondary- early intervention with persons who are on the verge of suicide. 24 hr hotline, walk-in clinics, emergency outreach teams. Immediate crisis counseling
3. Tertiary- prevention of the recurrence of suicide in those who have already been suicidal.
89
Increased Awareness of Suicide:
1999, The Surgeon General's Call to Action to Prevent Suicide, introduced a plan for reducing suicide. Both evidence-based and highly prioritized by leading experts, 15 key recommendations serve as a framework for action. Steps are categorized as
1. Awareness
2. Intervention
3. Methodology
(AIM)
