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Tuesday, August 26, 2014

Monthly Update of Suicide Prevention Activities

From Anya Shaffer, Suicide Prevention Program Coordinator, Virginia Department of Health

Get Ready for World Suicide Prevention Day
September 10, 2014 is World Suicide Prevention Day. You can find materials to help you plan and implement activities for this important occasion on the International Association for Suicide Prevention website.

Comment on SAMHSA's Strategic Plan for 2015–2018
Feedback Deadline: Monday, August 18, 2014
SAMHSA is the agency within HHS that leads public health efforts to advance the behavioral health of the Nation. This strategic plan outlines work to increase the awareness and improve understanding about mental and substance use disorders; promote emotional health and wellness, and the prevention of substance abuse and mental illness; increase access to effective treatment; and support recovery. An important component of the plan is to prioritize six Strategic Initiatives and the linkages between these initiatives and SAMHSA's policy, programmatic, and financial planning. At its core, this plan offers a framework for common categories of initiatives that enables cross-collaboration and organization of SAMHSA's work.

New Report Gives Voice to Suicide Attempt Survivors
The National Action Alliance for Suicide Prevention’s Suicide Attempt Survivors Task Force has released The Way Forward, a report which gives voice to suicide attempt survivors and bridges the gap between suicide attempt survivors, clinicians, hospital policy makers, and suicide prevention leaders. The Way Forward summarizes eight core values and offers a lens through which suicide prevention can be envisioned to embrace safety and bring hope and meaning to those in suicidal despair. Read The Way Forward and the press release about this pivotal path for change and a roadmap to save lives.

Model School Policy from the Trevor Project
Reducing the risk of youth suicide requires making positive changes. To help make it easier for schools to prevent, assess, intervene in, and respond to suicidal behavior, The Trevor Project has collaborated to create a Model School District Policy for Suicide Prevention. This modular, adaptable document will help educators and school administrators implement comprehensive suicide prevention policies in communities nationwide. Download our fact sheet and full policy today – by adopting or advocating for this model policy in your school district, you can help protect the health and safety of all students.

Office of Juvenile Justice and Delinquency Prevention  Releases Bulletin That Examines Suicidal Thoughts and Behaviors Among Detained Youth
OJJDP has released “Suicidal Thoughts and Behaviors Among Detained Youth.” The bulletin is part of OJJDP's Beyond Detention series, which examines the findings of the Northwestern Juvenile Project—a large-scale longitudinal study of youth detained at the Cook County Juvenile Temporary Detention Center in Chicago, IL. This bulletin summarizes the study’s methods, findings, and implications of suicidal thoughts and behaviors among detained youth ages 10–18. The authors examined rates of suicidal ideation and behaviors, the relationship between suicide attempts and psychiatric disorders, and differences by gender and race/ethnicity.

Sharing Our Wisdom: A New Resource for AI/AN Communities
Sharing Our Wisdom is a new web-based resource that presents stories of projects that promote resilience and prevent suicide in American Indian/Alaskan Native communities. The first story in this series is from a rural area of Alaska.

Suicide Prevention Resources for Adult Corrections
SPRC’s The Role of Adult Corrections Officers in Preventing Suicide and Suicide Prevention Resources for Adult Corrections provide information and resources to help staff in adult corrections facilities prevent suicides.

Suicide Reporting and Mass Media
Suicide is a significant psychiatric and public health problem. It is not surprising that there is some influence of the media on people’s thoughts and behaviors. Although it is unrealistic to censor all potentially negative depictions of suicide in the media, it is important to consider our responsibility to patients and the health of the general population using our understanding of the role of the media and potential interventions. The purpose of the present article is to review the evidence regarding the relationship between suicide and its depiction in mass media.

New Study: LGBT Youth More Likely than Heterosexual Youth to Attempt Suicide
Based on Youth Risk Behavior Surveillance Surveys (YRBSs) a new study examined rates of serious suicide attempts requiring medical attention; results indicated that suicide attempt rates were much higher in sexual minority than heterosexual youth.

Wednesday, August 13, 2014

"Talking about Suicide and Robin Williams"

This blog post is reprinted with permission from Hollis Easter.  Please read more of Hollis' articles about mental health and suicide at

Robin Williams died today, at 63. The Marin County Sheriff’s department released a press statement saying they suspect it of being suicide by asphyxiation, and there’s other news on their site.
There will be a media frenzy about this for the next little while, and a lot of people are going to be talking about it. I want to help people talk about it in a way that’s as respectful and safe as possible for vulnerable people, so here are a few thoughts and requests.

Be respectful about thoughts of suicide

Wherever you are, there are people near you who are struggling with their own thoughts of suicide. Some of them are going to feel strongly affected by Williams’s death, and the research shows that a small subset of that group will find that this news pushes their own thoughts of suicide into the forefront.
Please be careful how you talk about what happened with Robin Williams, because these folks will hear your words and may apply them to their own situations. Do you feel that he was a sick or weak person because he had these thoughts? How would that thought sound to these other folks? Did he “lose his battle” by acting on his thoughts of suicide? Be aware that, in the ears of a vulnerable person, you may be calling them weak too.
In particular, please don’t call suicide a “permanent solution to a temporary problem”. Whether or not the problems really are temporary, it doesn’t help the person at risk to have their troubles minimized—it just paints us as being out of touch. You don’t actually need to do that much talking about suicide itself; instead, get the person talking about what they’re feeling and why they’re considering suicide. It’s fine to help them see that these feelings may not last forever—but the “permanent solution” language is really toxic for a lot of people. Leave the labels behind and get the person talking.
Research suggests that about 5% of people (1 in 20) report thinking about suicide in any given year. That makes having thoughts of suicide seem pretty normal, but only a small group of people will act on those thoughts. If you look around, you will see people who are fighting—and winning—their own battle with suicide every day. Be respectful about how you talk about the issue.
People who’ve never struggled with suicide often seem to think that considering suicide is a choice. That, if only they knew how stupid it was to consider suicide, people would just stop thinking about it. I’ve worked on a suicide hotline for the last 15 years. Believe me when I say that most of the suicidal people I’ve talked to would have given anything to be able to make those thoughts go away. Be kind.
If you’re a person who has thoughts of suicide and the news about Williams is pushing your buttons, please reach out for help. If you live anywhere in the USA, you can dial 1-800-273-TALK and get the National Suicide Prevention Lifeline, which is free and confidential and open 24/7.

Talk directly about suicide

It’s okay to use the words. Suicide. Killing yourself. Wanting to die.
We don’t need to be afraid of the words, and using clear language helps us communicate better. There’s no evidence to suggest that talking directly about suicide hurts vulnerable people, and there’s a lot of it showing that direct talk helps to reduce stigma and help vulnerable folks feel like they can talk openly about how they’re struggling.
“Committed suicide” isn’t great because it feels pretty judgmental (we commit sins). “Lost his battle” feels like it’s labeling him as weak.
So use the other words. It looks like Robin Williams died by suicide, may have killed himself, may have taken his own life. It’s okay to use the words. If you want to know more about the terms we use in the suicide intervention world, check out my guide and my other guide.

Remember the whole person

Williams’s wife has asked that we remember Robin Williams primarily by honoring the man he was, not merely by examining the way he died.
He lived a life that meant a lot to us. He was a brilliant comedian whose imitations inspired me as a child, whose ability to improvise staggers me with its breadth and clarity. He knew timing. He did good work and helped us to look at some important, difficult things in life, and he helped us do it with a twinkle in our eyes. Turns out that he was also struggling with depression, possibly bipolar disorder, and thoughts of suicide.
It’s important to talk openly and honestly about suicide, and to grieve for the loss we feel. We feel hurt by his death, and feel that he was taken from us too soon. That’s real, and that’s fine to talk about. But let’s refrain from making Williams a caricature of his own life. Suicide was a part of it, sure, but let’s not reinvent his whole life in this context.

Avoid assumptions about Williams’s treatment history

A lot of the initial stories have focused on Williams’s alleged history of struggling with bipolar disorder, and I’ve read a ton of Facebook statuses and tweets saying “if only he could have gotten treatment” or “I wish he’d known there was help available”.
This is well-intentioned but not really that helpful. We don’t know whether Williams was receiving treatment or not, but the sad truth is that treatment doesn’t always work. Medicine is imperfect. People react to different drugs and therapies differently, and there’s no magic solution out there. The field of psychiatry is getting better at treating bipolar disorder, and there’s a lot of reason to be hopeful, but it’s not anywhere close to 100% yet.
Remember, most people with thoughts of suicide want to stop having them. If treatment were easy and fully effective in all cases, don’t you think most people would have taken that option already?
If it helps you to understand why this sort of statement is unhelpful, imagine that Williams had died of cancer. Would it feel useful to say “oh, if only he’d known that treatment was available!” or “he should have fought harder”?
Would it help his family to hear that people made those assumptions about how easily Williams could have gotten better? Remember that the survivors of suicide loss are all around us, too.

Do encourage people to seek help

For a lot of people, talking about their thoughts of suicide helps them to go away. Some people need the help of a trained professional, and some people need drug treatment or hospitalization. But a lot of people just need a caring person to listen. If someone starts telling you about their own thoughts of suicide in the aftermath of this, stay present and listen.
Ask them why they’re feeling that way. Let them talk about the reasons for it. Start with the feelings. Don’t try to shove reasons for living down their throats—they won’t be able to breathe. They know there’s stuff worth living for; let them talk about the reasons they’re thinking about dying.
And encourage them to keep talking, to you and to others. As I said above, invite people to talk to the NSPL at 1-800-273-TALK or call a crisis line or reach out to other caregivers.

Avoid assuming it’s suicide

We know that Robin Williams has died, and the coroner has preliminarily ruled it a suicide. That said, we still don’t know for sure—they’ve also said that the investigation continues and there will be a press conference tomorrow. There can be benign (non-suicidal) reasons for a person dying by asphyxia at home. Let’s do our best to refrain from contributing to the frenzy about suicide until the professionals have reached their conclusions. Actually, let’s do our best to hold back the frenzy even afterwards.

Talk about suicide and mental health

This is a big one. This is what we need to be doing if we want to prevent deaths by suicide in the long term. There remains a huge amount of social stigma around thoughts of suicide and mental health concerns in general, and it’s still hard for people to get help.
Tons of our hotline callers tell us they feel they can’t talk to their doctors or families about the way they’re feeling because they fear people won’t understand, will judge them, will label them, will lock them up, or simply won’t listen. We can and should do better.
So let’s talk about it, and not just in the gossip-ridden aftermath of a celebrity’s death. Let’s talk about expanding access to health care for all citizens, and then let’s make sure that we train health care workers about mental health AND build systems that give them enough patient contact time to have these crucial conversations.
Let’s make it easier to get access to mental health care, and let’s fund agencies that do the work. Let’s have the hard conversations about how we care for people who struggle with suicide in our communities, and let’s actively seek the voices of the people who struggle so we don’t make too many assumptions about what would help.
There’s a whole group of professionals who’ve learned a lot about how suicide happens and what we can do to prevent it. I’m one of them. We’re doing our best to get the messages out, but we need help. Will you help us? Join a suicide awareness group or help out with the American Foundation for Suicide Prevention. Talk to your legislators about securing funding for mental health and crisis organizations, and ask them to help make that funding a lasting priority. Talk to your family and friends about suicide, and let’s start treating it like a public health topic rather than a sin.
Most of all, let’s keep talking—and do it with respect and kindness in our hearts.
(My background: I run a suicide hotline and served for years on the national governing board for crisis hotlines. I teach several different suicide prevention, intervention, and postvention curricula, and if you’d like more information, please ask. Remember that if you need to talk to someone about thoughts of suicide, there’s probably a crisis hotline near you. 1-800-273-TALK is a great starting point anywhere in the USA.)