Suicide - DOC

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					                                              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.
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                                        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.
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                                         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
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                                        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@
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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.
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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
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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
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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.
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                            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
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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
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                            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
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     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.
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      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
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                    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.
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                                 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
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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.
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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
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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.
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                             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.
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               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.
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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.
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 11.   I can break confidentiality if I
       believe a person is suicidal.



*Please do not consider euthanasia when responding to the above.

				
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