Introduction Suicide is defined as intentional, self-inflicted death. People usually attempt suicide to block unbearable emotional plain, which is caused by a wide variety of problems. It is often a cry for help. A person attempting suicide is often so distressed that they are unable to see that they have other options. We can help prevent a tragedy by endeavouring to understand how they feel and help them to envision alternatives. In many cases, the events in question will pass, their impact can be mitigated, or their overwhelming nature will gradually fade if the person is able to make constructive choices as they are dealing with the crisis when it is at its worst. In many cases a suicidal person would choose differently if they were not in great distress and were able to evaluate their options objectively. Most suicidal people give warning signs in the hope that they will be noticed, because they are intent on stopping their emotional pain, not on dying. As result of this workshop, it is hoped that you will have an increased awareness of the issue of suicide, know what the warning signs are, know what questions to ask, and be clear about how and when to refer. 2 FACTS ABOUT SUICIDE An average of over 3,636 recorded suicide deaths in Canada, per year. In 1997, 3,681 Canadians died as a result of suicide. (2,228 were males between the ages of 20 - 24; 313 were females.) In 1995, 122 Nova Scotia=s died as a result of suicide. In 1996, 116 men and women residing in Nova Scotia died as a result of suicide. In 1996 Canada=s rate of suicide among young men was 24.8 per 100,000 people and 3.7 per 100,000 for women. In 1996 Nova Scotia=s rate of suicide was 11.5 per 100,000 people. 75% of all suicidal behaviors remain undiscovered and/or are unreported. In Canada and most other countries, females attempt suicide approximately four times more often than males. Males generally use more lethal means in their attempts at suicide and are more likely to die from their attempts. Thus, men kill themselves approximately four times more often than women. Men are most likely to use firearms in urban areas, hanging in rural areas, or asphyxiation. Women are most likely to use drug overdoses and asphyxiation. Suicide is more common in the spring and fall, during transitional times. Suicide rates drop slightly prior to major holidays, including Christmas but often increase afterwards. Suicide is more likely to occur at night. Suicide is the 6th leading cause of death among males and is the 2nd cause of death for both males and females in the 15-24 age group. It is estimated that 80% of people who commit suicide were drinking at the time. Eight to twelve percent of alcoholics commit suicide. Improvements in ones emotional state may not necessarily mean the person is out of danger. The person may be feeling relieved that their decision to die has been made. Upon feeling this relief the person may have the required energy to put their feelings into action. 80% of people contemplating suicide will demonstrate warning signs or provide clues. 10 - 13% of people who attempt suicide ultimately kill themselves. 12% of all Canadians seriously consider suicide at sometime during their life. 3 RISK FACTORS People can usually deal with isolated stressful or traumatic events reasonably well, and the stress or trauma generated by a given event will vary from person to person depending on their background and how they deal with that particular stressor. However, when there is an accumulation of such events over an extended period, our normal coping strategies can be pushed to the limit. Therefore, the presence of multiple risk factors does not necessarily imply that a person will become suicidal, but the level of risk is increased. Depending on a person=s individual response, risk factors that may contribute to a person feeling suicidal include: Significant Changes In: Relationships Well-being of self or family member Body image Financial situation Job, university Significant Losses: Death of a loved one Loss of a valued relationship Loss of self esteem or personal expectations Loss of employment Perceived Abuse: Physical Emotional/Psychological Sexual Social Neglect 4 WARNING SIGNS When an individual is contemplating hurting themselves or committing suicide, they may display warning signs that others may notice. These signs can serve as cues which warrant action on your part. Physical Neglect Sudden changes in manner of dress, especially when the new style is completely out of character. Chronic or unexplained illnesses, aches, and pains. Sudden weight gain/loss. Sudden change in appetite. Change/loss of interest in sex. Disturbed sleep. Cognitive/Verbal AI wish I were dead@ AThe only way out is for me to die@ ANo one can do anything to help me now@ AAll of my problems will end soon@ AI won=t be needing these things anymore@ AI=m a loser@ AEveryone will be better off without me@ AI can=t do anything right@ ANo one will ever love me@ AI just can=t take it anymore@ ANothing will ever change@ 5 Behavioral Making a will; writing poetry or stories about suicide or death Quietly putting affairs in order. Threatening suicide. Previous suicide attempts. Hoarding pills, purchasing and/or hiding weapons, describing methods of committing suicide. Decreased school activity; isolation. Sudden drop in achievement and interest in school subjects. Loss of interest in hobbies, sports, work, etc. Increased use of alcohol or drugs. Withdrawal from family and friends, sometimes acting in a manner which forces others away. Changes in friendship. Accident proneness. Increase in risk-taking behavior such as sexual promiscuity. Giving away prized possessions. Sudden changes in personality. Preoccupation with thoughts of death. Changing level of activity. A sudden unexplainable recovery from severe depression. Emotional Sense of hopelessness, helplessness, or futility. Inability to enjoy or appreciate friendships. Wide mood changes and sudden outbursts. Anxiousness, extreme tension, or agitation. Lethargy or tiredness. Changes in personality: from outgoing to withdrawn, from polite to rude, from compliant to rebellious, from well-behaved to Aacting out.@ Loss of ability to concentrate. Depression, sadness. Loss of rational thought. Feelings of guilt and failure. Self-destructive thoughts. Exaggerated fears of cancer, AIDS, or physical impairment. Feelings of worthlessness or of being a burden. Loss of enjoyment in activities. 6 Motivational To escape from an unbearable situation or problem. To relieve the burden they feel they place on others. To punish themselves. To punish others, seek revenge, or express extreme anger. To gain attention. To seek help. To reunite with those who have died before them. To get relief from overwhelming stress and turmoil. To try to influence a particular person or situation. To gain a sense of control over their own lives. It is important to note that depression is a major contributing factor to suicidal thinking. Many of the aforementioned warning signs are also indicative of depression. While depression does not necessarily mean that a person is contemplating suicide, depression does increase the risk that suicide may be considered. Depression negatively influences a person=s thought processes, making it difficult for them to envision healthy options. DEPRESSION What Is A Depressive Disorder? A depressive disorder is a Awhole-body@ illness, involving your body, mood and thoughts. It affects the way you eat and sleep the way you feel about yourself, and the way you think about things. A depressive disorder is not the same as a passing Ablue mood.@ It is not a sign of personal weakness or a condition that can be willed or wished away. People with a depressive illness cannot merely Apull themselves together@ and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment however, can help most people who suffer from depression. Types of Depression: Depressive disorders come in different forms, just as do other illnesses such as heart disease. There are three types of depressive disorders. However, within thee types there are variations in the number of symptoms, their severity, and persistence. Major depression is manifested by a combination of symptoms (see symptom list below) that interfere with a persons ability to work, sleep, eat, and enjoy once pleasurable activities. These disabling episodes of depression can occur once, twice, or several times in a lifetime. A less severe type of depression dysthmia, involves long-term, chronic symptoms that do not disable, but keep a person from functioning at Afull steam@ or from feeling good. Sometimes people with dysthymia also experience major depressive episodes. Another type is bipolar disorder, formerly called manic-depressive illness. Not as prevalent as other 7 forms of depressive disorders, bipolar disorder involves cycles of depression and elation or mania. Sometimes the mood switches are dramatic and rapid, but most often they are gradual. When in the depressed cycle, you can have any or all of the symptoms of a depressive disorder. When in the manic cycle, any or all symptoms listed under mania may be experienced. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, unwise business or financial decisions may be made when an individual is in a manic phase. Bipolar disorder is often a chronic recurring condition. Symptoms of Depression and Mania Not everyone who is depressed or manic experiences every symptom. Some people experience a few symptoms, some many. Also, severity of symptoms varies with individuals. Depression Persistent sad, anxious, or Aempty@ mood Feelings of hopelessness, pessimism Feelings of guilt, worthlessness, helplessness Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex Insomnia, early-morning awakening, or oversleeping Appetite and/or weight loss or overeating and weight gain Decreased energy, fatigue, being Aslowed down@ Thoughts of death or suicide; suicide attempts Restlessness, irritability Difficulty concentrating, remembering, making decisions Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain Mania Inappropriate elation Inappropriate irritability Severe insomnia Grandiose notions Increased talking Disconnected and racing thoughts Increased sexual desire Markedly increased energy Poor judgment Inappropriate social behavior Causes of Depression Some types of depression run in families, indicating that a biological vulnerability can be inherited. This seems to be the case with bipolar. Studies of families, in which members of each generation develop bipolar disorder, found that those with the illness have a somewhat different genetic makeup than those who do not get ill. However, the reverse is not true: Not everybody with the genetic 8 makeup that causes vulnerability to bipolar disorder has the illness. Apparently additional factors, possibly a stressful environment, are involved in its onset. Major depression also seems to occur, generation after generation, in some families. However, it can also occur in people who have no family history of depression. Whether inherited or not, major depressive disorder is often associated with having too little or too much of certain neuro-chemicals. Psychological makeup also plays a role in vulnerability to depression. People who have low self- esteem, who consistently view themselves and the world with pessimism, or who are readily overwhelmed by stress are prone to depression, but may never become depressed. A serious loss, chronic illness, difficult relationship, financial problem, or any unwelcome change in life patterns can also trigger a depressive episode. Very often, a combination of genetic, psychological, and environmental factors are involved in the onset of a depression disorder. Helping the Depressed Person The most important thing anyone can do for the depressed person is to help him or her get appropriate diagnosis and treatment. This may involve encouraging the individual to stay with treatment until symptoms begin to abate (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 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. Always tell someone who can help (RA, RC). 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 too soon. The depressed person needs diversion and company, but too many demands can increase feelings of failure. Do not accuse the depressed person of faking illness or of laziness, or expect him or her Ato snap out of it@. Eventually, with treatment, most depressed people do get better. Keep that in mind, and keep reassuring the depressed person that, with time and help, he or she will feel better. Depression is an illness like diabetis or MS. 9 ASSESSMENT OF SUICIDAL RISK Circle Appropriate Categories Behavior or Symptom Intensity of Risk Low Moderate High Suicide Plan Method Unclear Some plans Well thought out Time In the future Within a few hours Immediately Location Unplanned May be at place At location Details Vague Some specifics Well thought out Availability of Means Not present Have close by Have in hand Final Arrangements Vague Made some plans Written note /Giving away possessions/ made will Previous Attempts None or of low One or more of Multiple attempts of lethality moderate lethality high lethality Alcohol or Drug Abuse None or Frequently to Excess Continual abuse or Infrequently patterns of binges Depression Mild Moderate Severe Isolation/Withdrawal Vague feelings Some feelings of Hopeless, helpless, of depression/ being helpless, withdrawn, no withdrawal withdrawn self-deprecating Anxiety Mild Moderate High/Panic state Significant Others Several who are Few available Only one or none available available 10 Current Resources Several Some Few or none (Friends/Job/Money) Daily Functioning Fairly good Moderately good Not good in any activity Recent Losses None or occurred Within the last two Just realized loss months ago weeks Disorientation None Some Marked Lifestyle Stable Moderately Stable Unstable Psychiatric Help In The Past Positive attitude Yes and moderately Negative view of or no experience satisfied help received 11 QUESTIONS TO ASSESS LETHALITY If you become suspicious through observation or conversation that a person may be suicidal, there are a number of questions that NEED to be asked which will enable you to assess the degree of risk. These questions are designed to elicit responses that help you determine how immediate the danger is, and thus help you decide what to do. What has happened to make life so difficult? @ The more an individual describes the circumstances that have contributed to feelings of despair and hopelessness, the better opportunity for effective crisis management. The very act of describing stress-producing interpersonal situations and circumstances may begin to lower the feelings of stress and reduce risk. It is not unusual for an individual in the midst of a suicidal crisis to describe a multifaceted set of problems with family, peers, school, drugs, etc. The more problems an individual describes as stress-producing and the more complicated the scenario, the higher the lethality of risk. AAre you thinking of suicide? @ Individuals who are preoccupied with thoughts of suicide may experience a sense of relief to know there is someone who is willing to directly address the issue of suicide. Using the word Asuicide@ will convey that you have been listening and are willing to be involved; using the word Asuicide@ will not put the idea of suicide in the mind of a non-suicidal person. Obviously, someone who answers Ayes@ to this question is more lethal than someone who answers Ano.@ How long have you been thinking about suicide? @ Individuals who have been thinking intensely about suicide for a period of several weeks are more lethal than those who have had only fleeting thoughts. A good way to explore components of this question is to remember the acronym AFID@. When asking about suicidal thoughts, ask about frequency or how often they occur, intensity or how dysfunctional the preoccupation is making the individual (ACan you go on with your daily routine as usual?@), and duration or how long the periods of preoccupation last. Obviously, a person who reports frequent periods of preoccupation so intense that it is difficult or impossible to go to school, to work, or to see friends, and for increasingly longer periods of time so that periods of preoccupation and dysfunction are merging, is more lethal than an individual who describes a different set of circumstances. ADo you have a suicide plan? @ When an individual is quite specific about the method, the time, the place, and who will or will not be nearby, the risk is higher. If the individual describes use of a gun, knife, medication, or other means, ask if he or she has that item in a pocket or purse and request that the item be left with you. Never, however, enter into a struggle with an individual to remove a firearm. Most people will cooperate with you by telling you about the plan and allowing you to separate them from the means. ADo you know someone who has committed suicide? @ If the answer is Ayes@, the individual 12 is of higher risk especially if this incident occurred within the family constellation or a close network of friends. The person may have come to believe, as a result, that suicide is a problem-solving option. AHow much do you want to live? @ A person who can provide very few reasons for wishing to continue with life is of higher risk than a person who can provide a number of reasons for continuing to live. AHow much do you want to die? @ The response to this question provides the opposite view of the one above. An individual who gives a variety of reasons for wishing to die is more lethal than an individual who cannot provide justification for ending life. AWhat has been keeping you alive so far? @ This question, like the others, is an excellent one for assessment purposes. Individuals who do not seem to realize that death is permanent, that there is no reversal possible, and that they cannot return are at higher risk for an actual attempt. Also, persons who have the idea that death will be Aromantic@, Anurturing@, or Athe solution to current problems@ are at high risk. AHave you attempted suicide in the past? @ If the answer to this question is Ayes@, then the individual is at higher risk. It is more likely that a subsequent attempt will be successful as the individual may then correct the deficits in the original plan. AHow long ago was the previous attempt? @ This question should be asked of any person who answers Ayes@ to the previous question. The more recent the attempt, the more lethal the individual. AHave you been feeling depressed? @ Since a high percentage of individuals who attempt suicide are depressed, this is an important question. It is important to ask about frequency, intensity, and duration of depressive thinking. Persons who report frequent, intense and lengthy periods of depression resulting in dysfunctional episodes which are becoming closer and closer together, or are continuously experienced, are at higher risk. An individual who is depressed is often unable to see any positives in their life, unable to envision happiness in the future, and unable to see any workable solutions to their current problems, thereby increasing the risk of suicide. AIs there anyone to stop you? @ This is an extremely important question. If the person has a difficult time identifying a friend, family member or significant adult who is worth living for, the probability of a suicide attempt is high. ADo you use alcohol or other drugs? @ If the answer to this question is Ayes@, the lethality is higher because use of a substance further distorts, cognitions and weakens impulse control. An affirmative response should also be followed by an exploration of the degree of drug involvement and identification of specific drugs. 13 AWhen you think about yourself and the future, what do you visualize? @ A high risk individual will probably have difficulty visualizing a future scenario and will describe feeling too hopeless and depressed to even imagine a future life. FOLLOWING RISK ASSESSMENT Following an assessment of the immediacy and lethality of the suicide risk, it is crucial to have a clear sense of what you should do. The following will give you several options to pursue should you find yourself in a situation that could potentially end in suicide. Always keep in mind that you DO NOT HAVE TO BE A HERO, nor are you alone, in dealing with crisis situations. RISK LEVEL WHAT TO DO . . . Focus on the problem (What has happened to make life so difficult?) Ask open questions (What bothers you the most?) (How do you feel?) LOW RISK Listen empathically Generate alternatives Offer ongoing support Focus on here and now feelings Contract with the student MODERATE RISK Encourage/facilitate resource use Inform those in authority positions Offer ongoing support Act! Be direct HIGH RISK Do not endanger yourself Contact emergency resources as soon as possible Inform those in authority positions 14 GENERAL GUIDELINES TO KEEP IN MIND . . . 1. Always treat self-destruction or suicidal talk/behavior seriously. Don=t believe that Ait=s just a way to get attention.@ 2. Encourage the person to expand on their feelings and the situation. Seek clarification of their difficulties using open-ended questions. Do not judge or deny the significance of what you hear. 3. Be an active listener. Do a lot of listening and little talking. Let the person know you are hearing what they are saying through empathic responding and paraphrasing. Try to guard against engaging in a moral debate or giving quick advice. 4. Try not to: panic, preach, challenge, ignore, name call, criticize, blame, get angry, be appalled or offended, dramatize. See Barriers to Communication. 5. Tell someone about your concerns (Counsellor, R.C., Physician, residence authorities). This is one situation where it is OK to break confidentiality. In fact, someone=s life may depend on it. 6. Directly ask the person if he or she is considering suicide; you will not put the idea in their head. 7. Obtain information related to the possible plan surrounding thoughts of suicide. 8. Encourage the person to talk to a Counsellor. Offer to make the appointment and/or accompany the person. Counselling Services sets aside emergency hours every day for students in crisis, so it is usually possible to see someone quickly. The Physicians and Nurse in Health Services are also available daily. 9. If a person is in imminent danger, do not leave them alone. If possible, remove the means (pills, car keys), but do not endanger yourself. 10. If possible, obtain a specific agreement or contract from the person that he or she will not hurt themselves until they have spoken with a Counsellor, Chaplain, Physician, or parent as appropriate. 11. Continue to be involved. Let the person know you care beyond the immediate crisis. Even though the immediate risk of suicide has passed, the person may continue to need assistance. Remember that you are not expected to be a student=s sole support or therapist. If you feel unable to deal with a particular situation, it is good to ask for assistance. 15 WHEN TO REFER Trying to help a student with a serious problem when you possess only minimal skill and experience in that area may be more detrimental than helpful. Offering a referral lets the student know what your limits are as a helper in a caring way. An alternative to making a direct referral is to schedule a consultation between yourself and a more qualified resource person (Residence Co-ordinator, Director of Residence, Counsellor). HOW TO REFER The following guidelines will help you to accomplish an appropriate referral: 13. Explain in a clear and open manner why you feel it is desirable or necessary to refer the student. 14. Explain fully the services which can be obtained from the resource agency or person you are recommending. 15. Reassure the student about the capability and qualification of the resource to help meet the particular need expressed. 16. Attempt to personalize the experience by giving the student the name of a contact person to ask for in the particular service agency. Offer to stay with the student while they call for an appointment, or offer the accompany the student to the appointment. 17. Encourage the student to get back in touch with you after visiting the recommended resource. 18. Follow up to see how they are doing. 16 EMERGENCY CONTACTS The following resources are not listed in order of importance; which resource you use will depend upon the time of day as well as the severity of the situation. Depending on the degree of suicidal risk, contact with these resources could range from facilitating an appointment at Counselling Services (low risk/no plan) to calling the police (high risk/imminent death). CAMPUS SECURITY (24 hours) 420-5577 EMERGENCY NUMBER (24 hours) 420-5000 RESIDENCE SECURITY (24 hours) 420-5591 EMERGENCY (POLICE, FIRE) (24 hours) 911 QEII EMERGENCY (24 hours) 473-2043 HELPLINE (24 hours) 421-1188 HEALTH SERVICES (9 - 5) 420-5611 COUNSELLING SERVICES (9 - 5) 420-5615 RESIDENCE OFFICE (9 - 5) 420-5589 For RA=s, Residence Co-ordinators are available after the Residence office closes. For more information . . . Suicide Information and Education Centre (SIEC) #201-1615 - 10th Avenue, S.W. Calgary, Alberta T3C 0J7 (403) 245-3900 17 COMMUNICATION SKILLS TRAINING All skills outlined in this handout are to aid the participant in being helpful with students. These skills must be practiced to become habit. Once used as part of everyday communication, the skills are integrated into all conversations. We put our own style on these skills using some with more comfort and genuineness than others. Remember practice is the key. It is important to try not to get so wrapped up in communicating effectively as not to listen. The Helper might be so concerned with what Athe best@ response is that the student=s concerns are overlooked. There is no Aright or wrong@ thing to say, sometimes just wiser choices in words or body language. 1. ATTENDING SKILLS: Attending skills are the foundation upon which all other skills rest. To attend both physically and verbally means to show through both body gestures and language that you are interested in what the student is saying. Attending is a sign of respect for the other person. A. Physical attending: The acronym FELOR makes remembering these skills easier. F - face the student E - maintain eye contact L - lean slightly forward O - maintain an open posture R - keep fairly relaxed With physical attending, the Helper uses their body to show interest in what the student is saying and encourages them to talk. Practising FELOR is called positive attending. Negative attending is not practising the above skills. This is useful in terminating a conversation. B. Verbal attending: Verbal attending skills encourage the student to speak. There are three basic verbal attending skills, they are: 1) Minimal encouragers are short statements which lead the student onward e.g. AUh-huh@. AI understand@, Ago on@. A nod of the head, or similar gesture also conveys the same message. 2) Restatement of a key word, last word or meaningful phrase spoken by the student. This shows the Helper is truly listening. 3) Verbal following involves just being polite by not interrupting, changing subjects or giving personal opinions. Verbal following also allows the student to speak in their language at their own pace. The student sets the pace and tone, not the Helper. 18 2. LISTENING SKILLS: These skills entail giving feedback, focusing, asking for clarification, reflecting on student thoughts and summarizing. The following are brief descriptions of various listening skills. 1. Reflecting: mirroring the feeling behind a statement AFrom what you=ve been saying it seems that you are feeling sad@. 2. Clarifying: translating what the student has said into more familiar language so that it can be more clearly understood ABased on what I=ve heard you say about your relationship, you are overwhelmed@. 3. Summarizing: reviewing what has been discussed in content only. Pulling together and making explicit what has been dealt with AOkay, we have both agreed that if you worked less hours at the job you wouldn=t be as behind in your studies@. 4. Focusing: helping the student select and further explore the essential elements of the problem AI know you=re upset, but it seems from what you have said that your parents are bothering you, more than your friend.@ 5. Exploring: picking up a lead and going with it AJust a minute ago you said life is hopeless, what did you really mean by that?@ 3. QUESTIONING: Asking good questions can open up the lines of communication and allow for information to be obtained. Poor questions close down conversation by eliciting short and sometimes meaningless responses. There are two types of questions and both have advantages. Open questions are used to create rapport. a. Open questions: These questions encourage the student to open up and talk. They usually begin with Ahow@ or Awhat@. Compare the following two examples in terms of probable responses AHow are you handling your courses?@ vs. AAre you unhappy with your courses?@ b. Closed questions: Closed questions are useful to focus or terminate a conversation. These questions are usually answered with a short response or a yes/no. E.g.: AHave you been happy?@ vs. AHow have you been keeping your spirits up?@ 4. EMPATHY: In therapy or personal counselling this is the most important skill to learn and master. Empathy is sometimes confused with sympathy and yet the two are very different. Sympathy 19 means feeling badly for someone, whereas empathy means understanding how they are feeling. Empathy involves putting yourself in the student=s shoes and thinking of how you would feel in the same situation. For example think how you would feel going to see a counsellor for the first time - the emotions might be fear, confusion, panic, being overwhelmed etc. As helpers we need to get in touch with the feelings students are experiencing to understand how to help them. AI am trying to imagine how overwhelmed and hopeless you are feeling. Can you tell me more so that I understand better?@ AYou seem to be feeling uncertain about your future. Is that right?@ SOME GUIDELINES FOR EMPATHIC LISTENING 1. Give undivided attention. 12. Let the person set the pace - don=t push faster or further than the person wants to go. 13. Don=t feel you have to Asolve the problem@ - there are other people to help as well (RC=s, Counsellors). 14. Listen to what the person is saying and how it is being said. 15. Watch for non-verbal clues to the person=s feelings. Use your eyes as well as your ears for listening. 16. Be aware of the content and the feelings in what the person is saying. 17. Reply - use words to describe the content and feelings. Respond to all you hear and nothing more. 18. Be honest - let the person know if you lose them or don=t understand something they say. 19. Keep focussed on listening. Adapted with permission from Peavy, V. Empathic Listening Workbook. Victoria, B.C.: Adult Counselling Project. University of Victoria, 1977. 20 BARRIERS TO COMMUNICATION As it is important to be aware of what is helpful, an effective volunteer should also know what is not helpful to say. Bolton (1979) outlines twelve communication stoppers, these are: Criticizing Name-calling Diagnosing Judging Praising Ordering Threatening Moralizing Sending solutions Inappropriate Questioning Diverting Logical Argument Avoiding the student=s concerns Reassuring Some of the above are considered by the untrained to be helpful, they are not. 21 SUICIDE INTERVENTION QUESTIONNAIRE T F 1. Suicide is generally committed without warning. T F 2. Suicide rates are higher in poor people. T F 3. Asking a person to discuss suicidal thoughts/behaviors encourages them to attempt suicide. T F 4. Once a person is suicidal, that person is suicidal forever. T F 5. Many suicidal persons are depressed. T F 6. There is a strong correlation between suicide and alcohol abuse. T F 7. The tendency toward suicide is inherited. T F 8. People who attempt suicide are always fully intent on dying. T F 9. Females have the highest rate of suicidal behavior in North America. T F 10. Improvement in emotional state means decreased risk of suicide. T F 11. The motives or causes of suicide are readily established. T F 12. Winter is the season of the highest number of suicides. T F 13. Men kill themselves at least three times as often as do women. T F 14. All suicidal persons are suffering from a mental disorder. T F 15. Many suicides are preventable. T F 16. Suicides usually happen during the day (before sunset and after sunrise). T F 17. Most people who die by suicide have made previous attempts. T F 18. When adults talk about committing suicide, they are just trying to get attention. It=s best to ignore them. T F 19. Nothing can be done to stop a person from making the attempt once they have made the decision to commit suicide. 22 T F 20. Suicide is among the top ten causes of death in Canada. ATTITUDES SURVEY Strongly Strongly Agree Agree Disagree Disagree 1. Suicide is always wrong. 2. Suicide is immoral. 3. There is life after death for people who commit suicide. 4. Suicide is justifiable under some circumstances. 5. Suicide is a rational act. 6. Suicide is a selfish act. 7. People who commit suicide are not responsible for their actions. 8. I must stop a person from committing suicide using all possible means. 9. I have failed if a person I am helping commits suicide. 10. A person should have the right to take their own life. 23 11. I can break confidentiality if I believe a person is suicidal. *Please do not consider euthanasia when responding to the above.