Entrenamiento Para la Prevención del Suicidio en Nebraska

Presentación del tema: "Entrenamiento Para la Prevención del Suicidio en Nebraska"— Transcripción de la presentación:

1 Entrenamiento Para la Prevención del Suicidio en Nebraska
Currículo desarrollado por medio de una beca del Nebraska Health Care Cash Fund dado al Southeast Nebraska Suicide Prevention Project Blue Valley Mental Health Center Community Mental Health Center de Lancaster County Bryan/LGH Medical Center Introduction: This program was designed by Blue Valley Mental Health Center, the Community Mental Health Center of Lancaster County, and BryanLGH Medical Center with funding from the Nebraska Health Care Cash Fund. The State of Nebraska’s Suicide Prevention Committee endorses this project and has been involved in its development. Nebraska chose to design it’s own awareness program with a goal of creating a common understanding among all Nebraskans about suicide and how to respond to someone who might be suicidal.

2 Objetivos Al final de esta presentación esperamos que usted
Entienda que el suicidio es un problema que afecta la salud publica Pueda identificar como uno se puede proteger a si mismo y a otros del suicidio Pueda identificar factores que aumentan el riesgo de suicidio Conozca las señales de advertencia del riesgo de suicidio Se sienta cómodo ofreciendo ayuda a alguien que este al riesgo de suicidio Objectives: [Review Objectives on the slide] This program is designed to give you information that you can use to recognize someone who might be at risk for suicide. It is also designed to give you the confidence to take actions that might prevent a suicide.

3 Mito o Realidad??? Personas que hablan de suicidarse no lo hacen– el suicidio ocurre sin advertencia Hablar del suicidio con un individuo puede darle la idea de intertarlo Las incidencias del suicidio son mas altas para personas de un bajo estado social/economico Mas hombres que mujeres se suiciden Una vez que una persona se suicida, el / ella es suicida para siempre Key point: Many myths exist about suicide. Present the items one by one while encouraging the participants to identify whether the statement is a myth or fact. These are actually starting points for discussion that can help raise participant’s awareness of misconceptions held about suicide. Below are the discussion points for each statement. This “quiz” is reprinted courtesy of San Francisco Suicide Prevention ©2001. People who talk about suicide don’t do it – suicide happens without warning It’s a Myth: Although suicide can be an impulsive act, it is often thought out and communicated to others, but people often ignore the clues. Talking about suicide may give someone the idea It’s a Myth: Raising the question of suicide without shock or disapproval shows that you are taking the person seriously and responding to their pain Suicide rates are higher for people of low income It’s a Myth: Suicide shows little prejudice to economic status. It is representative proportionally among all levels of society More men commit suicide than women It’s a Fact: Although women attempt suicide twice as often as men, men commit suicide twice as often as women Once a person is suicidal he/she is suicidal forever It’s a Myth: People who want to kill themselves will not always feel suicidal or constantly be at a high risk for suicide. They feel that way until the crisis period passes.

4 Mito o Realidad??? - Continued
Si una persona realmente quiere suicidarse, nadie tiene el derecho de prevenirlo La mayoría de los suicidios son causados por un solo evento dramático y / o traumático. No hay ninguna predisposición genética en el suicidio Mejoramiento después de una crisis personal o una depresión seria quiere decir que ya no hay riesgo de suicidio Personas que se suicidan no han buscado ayuda medica antes de atentarlo Reprinted from the San Francisco Suicide Prevention Web Page If a person really wants to kill him/herself, no one has the right to stop him / her It’s a Myth: No suicide has only one victim; family members, friends etc. all suffer from the loss of a life. You would try to save someone if you saw them drowning, why is suicide any different? Most suicides are caused by a single dramatic and traumatic event It’s a Myth: Precipitating factors may trigger a suicidal decision; but more typically the deeply troubled person has suffered long periods of unhappiness, depression, lack of self respect, has lost the ability to cope with their life and has no hope for the future. There is no genetic predisposition to suicide. It’s a Fact: There is no genetic predisposition to suicide – it does not “run in the family.” Improvement following a serious personal crisis or serious depression means that the risk of suicide is over It’s a Myth: The risk of suicide may be the greatest as the depression lifts. The suicidal person may have new energy to carry out their suicide plan People who commit suicide have not sought medical help prior to their attempt It’s a Myth: Suicidal individuals often exhibit physical symptoms as part of their depression and might seek medical treatment for their physical ailments. Often suicidal individuals seek counseling but are frustrated when they do not see immediate results.

5 Términos comunes usados en esta presentación
Suicidio – Quitarse Terminando la vida de uno mismo A proposito Actos del suicidio – acciones para herirse deliberadamente o atentar de herirse uno mismo sin resultar en la muerte. Conducta suicida – Pensamientos, planes, o acciones que, si son implementadas, puedan resultar en la muerte Sobreviviente del suicidio – Cualquiera que este afectado por perder a alquien cercano por el suicidio Key Point: There are a number of terms that will be used in this presentation that include the word suicide. Present these terms and definitions to the participants with the goal of having a common understanding of each one of them as you proceed. Suicide – Note that the word intentional or deliberate is used in most Dictionaries and Encyclopedias. Suicide act – This is often referred to with the terms suicide attempt or suicide gesture. There are some distinctions between the two terms, but for the purposes of this presentation all behaviors or actions that are self injurious and intentional that could end in death are lumped into one large category. When discussing suicide attempts or gestures, try to use the term suicide act. Suicide behavior – These are the precursors of the suicide act – including all stages of planning. Suicide Survivor – There have some estimates made that for each suicide that is complete, there are at least 6 survivors. You may wish to ask the participants for a show of hands of anyone who has been touched by the suicide of another person to illustrate the pervasive and relevant effects a suicide has, even locally.

6 Suicidio en Nebraska (Por cada 100,000 personas)
Key Point: Suicide is a problem in Nebraska Suicide is currently (2001) the 11th leading cause of death in the US – the second leading cause of death for people ages 25 – 34 years old. About 29,000 of the 650,000 suicide attempts each year in the US are successful. Some have estimated that there is a suicide every 17 minutes – There are then 6 survivors created every 17 minutes. By the end of the presentation it could mean that 3-4 people have completed suicide, leaving another 18 – 24 survivors. Nebraska’s rate of suicide for Native Americans between 1993 – 1997 was 16.7 per 100,000 people as compared to the overall rate of 10.5 per 100,000 people. Hispanic rate was 5.8 and black rate was 8.2 Self inflicted injuries was the third leading cause of injury in Nebraska during this same time period at a rate of 46.1 per 100,000 (the top source of injury was falls, followed by motor vehicle accidents) May 23, 2002 – Reuters Medical News: US health experts reported that up to 70% of all nonfatal, self inflicted injuries treated in hospital Emergency Rooms were the result of failed suicide attempts. A study by US CDC revealed that 158,466 of the 264,108 people who visited ER’s for self inflicted poisoning, cuts, gunshot wounds, and other injuries in 2000 had likely tried to commit suicide. Another 27,294 ER cases stemmed from possible suicide attempts. Adolescents between the ages of 15 – 19 years, and young adults 20 – 34 years of age accounted for 59% of the nonfatal, self inflicted injuries reported by hospitals. Women made up about 57% of the injuries. The rate of suicide (2001) for Lancaster County (Lincoln) was 11.3 per 100,000 (over the state rate) The rate of suicide for Gage County (Beatrice) that same time period was 17.3 per 100, The rate for Hall County (Grand Island) was 9.4 per 100,000. North Platte, Lincoln County, had a rate of 13.2 per 100,000 and in the panhandle, (Morrill County) the rate was 14.8 per 100,000 For more information about Nebraska suicide rates see

7 Suicidio en los Estados Unidos
Muertes Anuales: 28,332 (2000) Tarifa de Muerte: 10 muertes por. 100,000 habitantes (2000) Causa de Muerte (Posición): 11o (2000) Causa de Muerte (Posición) para 5-14 Años: 5o (2000) Causa de Muerte (Posición) para Años: 3o (2000) Causa de Muerte (Posición) para Años: 4o (2000) National Vital Statistics Report Volume 49 N umber 12 Casi 3 de cada 5 suicidios en 1998 fueron cometidos con una arma. Tarifas del suicidio crecen con edad y son las mas altas entre Americanos mayores de 65 años. En 1999, 83% de’ los suicidios fueron personas mayores de 65 años Mas personas mueren del suicidio que el homicidio. Taken from the CDC Website – Key Point: Suicide is a Public Health Problem as declared by the Surgeon General of the United States Let the participants look at the data for a moment. Then point out that these are the facts that led David Taken (former Surgeon General of the US) to proclaim that suicide is a public health problem that is preventable. Invite participants to go to the Centers for Disease Control (CDC) website for more statistical information at their leisure. The real issue about suicide data is whether we can learn something from the data that allows us to intervene. Having an awareness of the uses and meaning of suicide data helps set the context for later intervention.These statistics also helps illustrate the size and scope of the problem of suicide. OPTIONAL ACTIVITIES: You can use optional activities if you have more than one hour to present the information. Using this activity requires no additional slide or equipment. Explore the attitudes and beliefs of participants about suicide given the data and information presented so far. Possible discussion points include the impact of religious, philosophical and legal views of suicide. Allow individuals to share their personal views of suicide – encouraging them to acknowledge these views and how they may impact their intervention style. This can be done in the large group or small groups. Note there are no right or wrong answers to the questions. The key point to this exercise is to recognize that your own beliefs about suicide can influence how you respond to someone who is suicidal. Discussion questions might include: Do people have the right to suicide? Do you expect to always be able to stop someone from committing suicide?

8 Estadísticas del Suicidio – Cont.
La demográfica de la persona que estadísticamente tiene la mayor probabilidad de suicidarse Hombre blanco americano Mayor de 45 años Divorciado o enviudado Abusa el alcohol or alcoholico Depresivo or sufre de depresion Aislado socialmente Ha visitado un doctor dentro de unas semanas antes del suicidio Tiene una condición que causa limitaciones físicas No se fíe de la demográfica para pronosticarlo! Demográficas nos ayudan a notar características comunes No hay un suicidio típico – Cada caso es una cominacion unica de factores Key Point: Statistics only assist us in identifying who may be at risk, it cannot predict who will suicide. The profile on the slide was garnered from the demographics and characteristics of people who completed suicide and is based on statistical reasoning. Use this slide to introduce the concept of protective factors, risk factors, and warning signs. Just as statistics help us see who may be at risk for certain diseases like lung cancer or diabetes, they can also provide assistance with determining risk for suicide. Behaviors like smoking or being obese can heighten your risk of lung cancer or diabetes. Other behaviors or lifestyle choices can serve as protective factors – for example, not smoking or discontinuing smoking can protect you against lung cancer, and exercising regularly along with good nutritional habits can serve as protection from some forms of diabetes. For these diseases there are also warning signs that signal great concern like a “smokers cough” or coughing up blood can signal a problem in the lungs; and unusual thirst or frequent urination can mean the development of diabetes. We will look at Suicide from the same perspective. We will look at things that can protect us from suicide, risk factors, and warning signs. Then we will talk about what you can do to assist someone that you believe is at risk for suicide.

9 Protección Contra el Suicidio Luz Verde...Listo para Proceder!
Factores Protectivos – Factores que reducen la probalilidad que algiuen se suicide Obtener ayuda para condiciones mentales, físicas, y abuso de substancias – Especialmente la depresion Acceso restrictivo a métodos letales del suicidio – Especialmente armas * Respaldo y apoyo de la familia y la comunidad Una relación establecida con un (a) doctor (a), pastor, profesor (a), consejero (a) u otro profesional que puede ayudar Buena Relacion con comunidad, la familia, o los (las) amigos ( as) Key Point: Protective Factors are those that inhibit suicide – With limited time, emphasize that these things make it less likely that someone becomes suicidal. Review the protective factors listed. The group may have examples that are not on the list which may apply to them– Allow the group to brainstorm additional ideas if there is time. There are no wrong answers in this exercise. If someone identifies a protective factor that is actually a risk factor, ask them to explain their idea further and respond by saying their perspective is interesting and valid. Then proceed to the next slide on risk factors, saying that the risk factors identified are derived from looking at common characteristics of people who have completed suicide.

10 Factores de Riesgo del Suicidio Luz Amarilla Procede con Caución
Acto o gestos de suicidio previo Condiciones mentales-especialmente condiciones afectivas, ej. depresion Condiciones mentales y abuso de alcohol y de substancias que ocurren simultáneamente Historia familiar de suicidio Sentirse sin esperanza Tendencias impulsivas o agresivas Barreras en obtener tratamiento de salud mental Perdidas relaciónales, sociales, vocacionales, o financieras Enfermedad física Acceso fácil a métodos letales, especialmente pistolas Edad, Cultura, o Relaciones Sociales Falta de Conectividad Abuso de alcohol, drogas Key Point – Some factors put us at higher risk - Yellow light commonly means proceed with caution. Emphasize that the presence of a single risk factor does not necessarily mean that a person has a high risk of suicide. A combination of risk factors, or a number of risk factors together can increase risk. Emphasize the presence of depression / bipolar disorder; hopelessness; substance abuse in combination with other risk factors increase risk significantly. Risk factors impact a person most when they lead to isolation and feelings of distress. An additional analogy that can be used is that of a Nebraska Weather Watch. Most of us in Nebraska know that the meteorologist will issue a weather watch if conditions are right for the development of a storm. When conditions are right, we begin watching the sky, tuning in to the weather, and taking precautions while we go on with our daily routines. The presence of risk factors, especially in clusters, is like a weather watch because we know conditions are right for the development of a problem. We begin tuning in to the signs and symptoms we see and start emphasizing any protective factors that are relevant. For example, as a person begins to notice signs of depression, it is important to seek help and to involve family and friends in their recovery if possible. Some participants may notice that a family history of suicide is listed as a risk factor, and tie that back to the myth that stated “There is no genetic predisposition to suicide.” There has not been proof of any genetic predisposition to suicide, but there has been research that indicates that some people may be more prone to depression or bipolar (manic/depressive illness) because of genetics. The predisposition to these mental illnesses and the trauma associated with surviving the suicide of a loved one may increase a person’s risk. Weather Watch . . .

11 This is a picture of Doppler Radar in southeast Nebraska
This is a picture of Doppler Radar in southeast Nebraska. It is an illustration of what we do when there is a weather watch – we tune into the television and radio to see hints of the storm before it hits. We become more watchful when risk factors for suicide are detected. The presence of these risk factors does not always mean a suicide act will occur, it means conditions are right for the development of a problem. Just like we watch radar for signs of bad weather coming our way, we watch for further signs that a problem with suicide is on its way. During a weather watch we are instructed to be watchful and to make preparations for bad weather. When risk factors are detected we assist the person and “prepare for any rough weather” by encouraging them to enhance their protective factors (get help, stay connected, talk to someone they trust). Sometimes the storm passes or never develops, and sometimes we can see it coming and have time to prepare.

12 Depresión Luz Amarilla – Advertencia del Tiempo
No todas las personas con depresión se suicidan, pero la depresión es el diagnostico mas comun del suicidio completado. Síntomas pueden incluir: Sentirse triste la mayor parte del día Perder interes en actividades usuales Perdiendo peso (no haciendo dieta) o aumentando de peso Durmiendo demasiado o muy poco o despertándose muy temprano, antes de lo usual Sentirse cansado y débil todo el tiempo Key Point: Depression is a risk factor that merits special attention as a high percentage of people who suicide, also have signs of clinical depression. Depression is a down mood in conjunction with other symptoms. Review the following definition of suicide from the National Institute of Mental Health (NIMH) below: When a "down" mood, along with other symptoms [listed on the slide], lasts for more than a couple of weeks, the condition may be clinical depression. Clinical depression is a serious health problem that affects the total person. In addition to feelings, it can change behavior, physical health and appearance, academic performance, social activity and the ability to handle everyday decisions and pressures. Review the symptoms of depression listed on this and the next slide.

13 Depresión (con.) Sentirse devaluado, culpable o sin esperanza
Sentirse irritable y nervioso todo el tiempo Tener dificultad concentrándose, tomando decisiones o acordándose de las cosas Teniendo pensamientos repetitivos de la muerte y el suicidio Adapted from World Health Organization 2000 End this slide by saying that not every symptom is present in everyone. You may have clinical depression if you experience a “down” or “sad” mood that you can’t seem to lose, along with several of the symptoms listed. Reemphasize that not everyone who is depressed is suicidal, but that depression is a serious illness that causes great psychological pain. It is a serious risk factor that can be treated.

14 DEPRESION EN PERSONAS FAMOSAS
Abraham Lincoln Edgar Allen Poe Robert Schumann Theodore Roosevelt Mike Wallace Mark Twain DEPRESION EN PERSONAS FAMOSAS Vincent van Gogh Ludwig von Beethoven Depression is a common illness that affects people regardless of their circumstances or position in life. This slide has names of well known people who had depression. The names were taken from the National Alliance for the Mentally Ill website. Drew Carey Virginia Woolf Dick Cavett

15 Depresión Luz Amarilla – Advertencia del Tiempo
Como ayudar a alguien que tiene depresión: 1. Ayudarlo (a) obtener tratamiento apropiado 2. Ofrecer apoyo emocional. (Entendimiento, Paciencia, Afección, Exhortación) The most important thing anyone can do for the depressed person is to help him or her get an appropriate diagnosis and treatment. This may involve encouraging the individual to stay with treatment until symptoms begin to lessen or go away (several weeks), or to seek different treatment if no improvement occurs. On occasion, it may require making an appointment and accompanying the depressed person to the doctor. It may also mean monitoring whether the depressed person is taking medication. The depressed person should be encouraged to obey the doctor's orders about the use of alcoholic products while on medication. The second most important thing is to offer emotional support. This involves understanding, patience, affection, and encouragement. Engage the depressed person in conversation and listen carefully. Do not disparage feelings expressed, but point out realities and offer hope. Do not ignore remarks about suicide. Report them to the depressed person's therapist or doctor. Invite the depressed person for walks, outings, to the movies, and other activities. Be gently insistent if your invitation is refused. Encourage participation in some activities that once gave pleasure, such as hobbies, sports, religious or cultural activities, but do not push the depressed person to undertake too much diversion and company, because too many demands can increase feelings of failure. (Recommendations taken from the National Institute of Mental Health) Point out that you are enhancing protective factors by encouraging the person to get help and to stay connected with people and activities that once gave them pleasure.

16 Señales de Advertencia del Suicidio Luz Roja – Pare – Obtenga Ayuda
Hablando, leyendo, o escribiendo sobre el suicidio o la muerte. Hablando de sentirse devaluado o sin la posibilidad de ayuda . Diciendo cosas como, “Voy a suicidarme,” “Deseo estar muerto,” or “No he debido haber nacido.” Visitando o llamando a personas para despedirse de ellas. Regalando cosas o devolviendo cosas prestadas. Conducta destructiva o riesgosa a si mismo. Cambio significante en conducta Sentirse sin esperanza sobre su propia situación Key Points Warning signs go beyond risk Warning signs are evident in what people say and do Compare risk factors to the yellow caution light, and warning signs to a red light. The Warning signs of suicide are like a weather warning in Nebraska. Not only are conditions right for a storm, but one has been sighted and is on its way. The storm is on the radar and storm spotters have seen it traveling in our direction. We’ve made preparations during the watch, but now it is now time to take more direct action to protect. Review the warning signs listed on the slide. Weather Warning

17 Señales de Advertencia del Suicidio Luz Roja – Pare – Obtenga Ayuda
Sintiéndose sin esperanza – frases typicas: “No tiene sentido seguir viviendo” “No puedo soportar mas” “No tengo nada porque que vivir” “No puedo parar el dolor, sufrimiento” “No siento que puedo tomar decisiones” “No puedo vivir sin _______” “Mi vida cada vez se pone peor” “Mejor me suicidio” Hopelessness is a component of depression and a risk factor for suicide. Peop0le experience hopelessness when they believe that there is no chance of improvement in the future. They may have reasons why their problems cannot get better in the future or that life will continue to be unbearably painful or even worsen. People who are suicidal often talk about feelings – for example they may say things like those listed on the slide. Usually there is a theme of intense psychological pain and a lack of hope about the future in these statements.

18 Esta es una fotografía de un tornado en el vecindario de Seward, Nebraska. La tormenta esta en camino. Ahora es el tiempo de tomar acción inmediata para asegurarse. Señales de advertencia del suicidio señalan lo mismo – una vez detectado es el tiempo de tomar accion inmediata.

19 Que se puede hacer PREGUNTA…… ATTIENDE
“Yo siento que estas pensando de suicidio pero estas teniendo dificultad de hablar sobre el tema.” “Esta pensando sobre el suicidio?” “Algunas veces personas en ciertas situaciones se sienten como quitarse la vida. Ha estado pensando en herirse de alguna forma?” ATTIENDE ATTIENDE Y BUSCA SENALES DE ADVERTENCIA / FACTORES RIESGOSOS Pregunta sobre lo que esta causando el malestar PREGUNTA SOBRE LAS RAZONES PARA VIVIR Y PLANES QUE HAN HECHO PARA MORIR Averigua lo que es importante para la persona y porque podrían escoger seguir viviendo “Tiene un plan para suicidarse?” Pregunta Como, Donde, Cuando, y si tienen lo que necesitan para hacerlo (Tienen una pistola/ píldoras/ soga o cualquier cosa que piensen usar?) Key Point: These are actions you can take to help someone who is in the midst of the storm – with whom warning signs are detected. Ask if the person is thinking about suicide. Introducing the topic of suicide will not put the idea into their head, instead, they will probably feel relief that they can finally share and talk about it. Talking about suicide can be tension reducing. We want the person to talk in detail about the pain, things they have tried, plans, etc. Saying things out loud may help the person actually hear it for the first time and bring a new perspective to the situation. Listen Look and listen for the presence of warning signs and accompanying risk factors. Sometimes asking about what is causing the distress and really listening can be helpful. If it is too much for you to handle, make sure there is someone who can listen and talk to the person – it may be another friend or family member, clergy, doctor, counselor, teacher. Ask the person about reasons for living as well as reasons for dying. Listen for any plans the person has to suicide. Is the plan well thought out? Do they have what they need to carry out the plan? American Association of Suicidology (AAS) recommends you Be Direct – talk openly and matter of factly about suicide. Don’t act shocked. Be non-judgmental – Offer hope without “glib assurances” Additional questions to ask – Do you have a plan? – what is the plan – when are you going to do it – where are you going to do it

20 Que hacer - Continuado TOME ACCION
Remueva objetos como armas y píldoras Ofrezca su apoyo en obtener ayuda de un profesional de salud mental No deje la persona sola una vez que haya determinado que el o ella corre riesgo de suicidarse Haga a la persona recordar que buscar ayuda para la depresión no es una seña de debilidad y que el chance de recuperación es excelente. Key Point: There are specific actions you can take to lessen suicide risk in addition to listening and gathering information. These are steps that can be taken when you think the person is in imminent danger. Review the action steps presented. Anything that can increase the connectedness felt by the suicidal person is recommended while encouraging them to seek help. Refer back to the protective factors and ask participants to brainstorm what they might do to increase these factors for someone. Solicit practical suggestions for each of the factors listed. Define these actions as positive steps you can take to help the suicidal person. Encourage participants to seek assistance from others in taking actions if needed. Note that even the best attempts at prevention and intervention sometimes don’t stop all suicides. Talk about the possibility that the person might choose suicide even when all steps are taken to preserve their life. Recognizing that the suicidal person is ultimately responsible for their decision is an important factor for survivors.

21 Que hacer - Continuado Que debo decir??? “Te (Lo) escucho”
“Quiero entenderte (lo)” “Te amo” “No esta (s) solo” “Voy a encontrarte (lo) ayuda” Key Point: Some people want to know what is helpful to say to a person who is suicidal. Generally statements of understanding and concern are encouraged. Review what to say and the next slide, what not to say.

22 Que hacer - Continuado Escuche
“Suena (s) muy [triste, deprimido, ansioso, etc]” “Parece que esta (s) pasando un tiempo muy dificil” Pregunte “?Esta (s) pensando suicidarse (te)?” “?Le (te) provoca hacerse daño hoy dia? ?Ahora? ?Cuando? “?Alguna vez has tratado de hacerse (te) dano?” “?Que serio esta (s) sobre eso hoy dia?” “?Ha (s) pensado de formas que lo haria (s)?” “?Ha (s) estado tomando (bebiendo)?” “?Tiene alguna pistola (s) (cuchillos, pildoras, cortadores) en la casa?” “?Le ha (s) dicho ha otra persona como se (te) siente (s)? [doctor, amigo (a), consejero (a)]” The best thing you can do is to listen and ask questions. You are trying to determine if any of the risk factors, warning signs or protective factors are present. OPTIONAL ACTIVITY: If there is time, allow small groups to form and let participants role play. One person can be a suicidal person who should be instructed to make statements that mirror the warning signs and risk factors. Ask that this person choose two of the protective factors to reveal during the course of the conversation as well. The other person or persons in the small group can assume the role of a friend and ask questions, listen, and encourage the suicidal person to get help. The purpose of this exercise is to allow participants the opportunity to actually ask direct questions about suicide to another person while listening for risk factors, warning signs, and protective factors. An alternative to breaking into small groups is to ask for two or three people to come in front of the group to do a single role play that can be observed by other participants. Follow up these activities by processing the interaction with participants. Ask how if felt to ask the questions; what it was like to assume the role of the suicidal person; What the person in the suicidal role wanted the other participant to ask or say that they didn’t; What question or behavior was helpful.

23 Que NO hacer… No diga…. “Ya lo superara (s)” “Es solo una etapa en su (tu) vida” “Deje (a) de ser tan egoista” “Solo esta (s) tratando de llamar la atencion” “Debe (s) levantarse (te) y seguir adelante” No los deje convencerle que el o ella no necesita ayuda. Depression by John McManamy 5/25/99 Review these items with the idea that they are often said by well meaning people. Explain that they are not helpful to someone who is feeling intense pain and may be suffering from depression.

24 Sobrevivientes del suicidio
Nececidades de Sobrevivientes del Suicidio Información sobre el proceso legal Información sobre los factores envueltos en la muerte de la persona Apoyo de otros sobrevivientes / Victim-Witness Unit (Unidad de Victimas y Testigos) / Conexiones sociales Permiso de hablar sobre el suicidio sin culpabilidad Información sobre condiciones mentales y el suicidio Refer back to the statistics regarding suicide attempts (650,000 people in the US) – highlight their increased risk Begin discussion about suicide survivor risk with introduction of family history of suicide. Ask class how many of them have known someone who either attempted suicide or completed suicide if you have not already done so. If you asked the question early in the presentation, refer back to the number of people who raised their hand at that time. Note that it is estimated that there are 6 survivors for every suicide – and if a suicide occurs every 17 minutes, there are 6 new survivors created as well. Persons close to the person who suicides are at increased risk themselves. Survivors are often in shock when they learn of a loved one’s suicide. The death is often sudden, leaving survivors with many questions. The death is also treated differently than natural deaths by authorities. Survivors need help understanding why they must endure an investigation and / or autopsy. They need facts about the situation and the process. Support from other survivors or support networks helps. The survivor needs to know that it is ok to talk about suicide as the cause of death. Many people blame themselves for not seeing warning signs or being unable to stop a suicide. They feel shame and the stigma of suicide. The more information survivors have about mental disorder and the role it plays in suicide, the less shame and stigma they experience. Often, suicide is about stopping intense psychic pain for the person committing it, rather than about being dead. We know that survivors of suicide are at higher risk for suicide themselves – therefore, intervention now can make it less likely that they will consider suicide for themselves later.

25 Reservas Community Mental Health Center of Lancaster County
Línea telefónica de 24 horas / evaluación móvil Centro de Crisis 2200 S. St. Mary’s Avenue (Av. St. Mary’s Sur) BryanLGH Medical Center West Enfermera 24 horas u 2300 South 16th Street (Calle 16 Sur) Nationwide 1-800-SUICIDE (Contestado por Boys Town en Omaha) Southeast Nebraska Suicide Resources for emergency intervention. Calling law enforcement is a last resort option. Referring a person to a family doctor or spiritual leader is also an option.

26 Reservas Blue Valley Mental Health Center
Línea local para las áreas de York y Seward: Línea local para el área de Nebraska City: Línea local para el área de Beatrice:

27 Factores de Riesgo para Adolescentes
Los 3 factores de riesgo principales para adolescentes Estado depresivo Abuso de alcohol o drogas Conducta impulsiva o agresiva, frecuentes expresiones de rabia. These slides are optional and can be added if there is time or interest in specific risk factors for teens. You can add them on at the end of the presentation, or move them to the “Yellow Light” risk factor section. Add them after slide 18, the Seward Tornado Slide.

28 Adolescentes Latino-Americanos
1 de cada 3 latinas que son estudiantes secundarias (“high school”) contemplan el suicidio National Alliance for Hispanic Health Escuelas avecés no están preparadas para estudiantes que hablan español La mayoría de las investigaciones clínicas excluyen los que no hablan ingles La cultura latina y la importancia de la familia contrasta con la cultura adolescente americana Latino teens experience some unique stress. This is especially true for those who speak only Spanish or whose family speaks only Spanish. Latino culture places traditional expectations on their daughters. When a Latino family immigrates to the United States, some tees find themselves in a push and pull match between the culture they were born into and the new culture they want to embrace. (Marisa Trevino – Health& Environment Rising Number of Latina Teens Trying Suicide There is not much research specific to the Latino teen because most research excludes all non-English speaking persons. Teens want to do things their way – In the Hispanic culture the family is more interdependent and here the kids don’t want to be held so close to the family unit.

29 Factores de Riesgo Adicionales
Episodios frecuentes de escarpase de la casa o siendo encarcelado Perdida de familiares o instabilidad; problemas significantes con los padres Expresiones de pensamientos suicides, o hablando sobre la muerte o la vida después o durante momentos de tristura o aburrimiento

30 Factores de Riesgo Continuado
Separación emocional o física de amistades y familiares Dificultades lidiando con su orientación sexual Perdida de interés en o disfrutando actividades que antes eran gozadas Embarazo no planeado

31 Factores de Riesgo Continuados
Adolescentes considerando el suicidio generalmente se sienten solos, sin esperanza, y rechazados Son especialmente vulnerable a estos sentimientos si han pasado una perdida de alguien, humillación, o trauma de algún tipo – mala nota en un examen, terminacion con un enamorado o enamorada, padres con problemas con el alcohol o las drogas o que son abusivos, o una vida familiar affectada por discordio entre los padres, la separacion, or el divorcio* *Un adolescente puede estar depresivo o suicide sin ninguna de estas condiciones adversas

32 Señales de Advertencia de Adolescentes
“Limpiar su casa” – regalar cosas, limpiar su cuarto, botar cosas en la basura Después de un tiempo de depresión podría de repente volverse contento Atentos del suicidio anteriores = mayor riesgo para atentos en el futuro Claves verbales, “Prefereria estar muerto”, o “No voy a hacer un problema para ti (usted) por mucho mas tiempo.”

33 Señales de Advertencia de Adolescentes
Cualquier cambio dramático o que pasa de repente que afecta la producción, asistencia, o conducta debe tomarse seriamente como: Falta de interés en actividades usuales Disminucion en general de las notas académicas Disminución del esfuerzo Mala conducta en el salón de clase Ausencia o inexplicable o repetitiva Fumando tabaco o tomando alcohol excesivamente o abuso de drogas (incluyendo mariguana) Incidentes que envuelven la policía y violencia de estudiantes

34 Adultos Mayores Americanos mayores (mas de 65 años) tienen desproporcionadamente mas chance de suicidarse que la población general Ellos representan 13% de la población pero representan 20% de los suicidios Muchos adultos mayores que se suicidan han visitado su doctor 20% el mismo día que el suicidio 40% dentro de una semana 70% dentro de un mes National Institute of Mental Health – Depression & Suicide Facts for Older Adults This is an optional slide to address information specific to older adults. This slide illustrates the extent of the problem within this population. If using this slide, refer back to the section on profiling, after the presentation of statistics, and reinforce the statistical information that the person at highest risk for suicide is the whiet male age 85 and older.

35 Adultos Mayores Depresión no es una parte normal de la vejez.
Depresión puede ser tratada efectivamente con medicina y / o psicoterapia. Key Point: Depression in older adults is not a normal sign of aging. The National Institute of Mental Health has begun a marketing campaign that begins with the words Before you say, “I’m fine” Ask yourself if you feel: [list symptoms of depression] These may be symptoms of Depression, a treatable medical illness. But your doctor can only treat you if you say how you are really feeling. It is important to note that in this Public Service Announcement Depression is called a medical illness, not a mental illness. Many older adults fear being labeled as having a mental illness and don’t seek treatment for that reason. Reframing depression as a treatable medical illness makes it more likely that the older adult will reveal symptoms and accept treatment.