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Willamette University

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									Suicide in the United States
     The basics                         From Reducing Suicide: A National Imperative


            Risk Factors                            Treatments that work

 Genetic component (30-50%):             Lithium treatment of bipolar
  Serotonergic function reduction,         disorder significantly reduces
  abnormal function of                     suicide rates.
  hypothalamic-pituitary-adrenal
  (HPA) axis                              Psychotherapy is also a
 Political and cultural                   necessary therapeutic relationship
  environment: Political disorder.         that reduces the risk, cognitive-
  Stigmas and cultural norms               behavioral approaches that
 Childhood trauma: sexual abuse           include problem-solving training
  accounts for 9-20% of suicide            seem to reduce suicidal ideation
  attempts (strong risk of developing      and attempts more effectively than
  mental disorders).                       other types of therapy.
 Lack of social support
 Mental illness: 90% of all
  suicides in America are among the
  mentally ill.
Populations with highest rates
           From Reducing Suicide: A National Imperative


Native                                    Lack of resources

 Americans: 1.7
 times the national
 average.
White males over                          Shame: Stigma of mental illness
 75 is exceptionally
 high.
Youth: third                              Compulsive behavior
 leading cause of
 death among
 90% of suicides    Suicide & Mental Disorders
  in the United
  States are
  completed by                     100

  individuals with                     90

                                       80
  mental or                            70
  substance abuse
                      Percentage
                                       60
  disorders                            50

                                       40

                                       30
 Between 30 and                       20
  90 percent of                        10

  these                                 0

  individuals have
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                                                           al
                                                                    Disorder
Suicide rates increase in rural America
      From Reducing Suicide: A National Imperative (1996-1998)

                                                                 Per 100,000 people


                                                                 1) Wyoming
                                                                    (21.1)
                                                                 2) Alaska
                                                                    (20.3)
                                                                 3) Montana
                                                                    (20.2)
                                                                 4) Nevada
                                                                    (19.5)
                                                                 5) New
                                                                    Mexico
                                                                    (18.8)

                                                                   Mountain
                                                                    region
                                                                    (16.9)
 Firearm suicide decreases with
urbanization From Reducing Suicide: A National Imperative
                                              „ Prevalence of
                                              guns cannot be the
                                              only factor, or
                                              necessarily the
                                              most important
                                              factor in suicide.
                                              „ Guns are a means
                                              but not the reason a
                                              person decides to
                                              kill themselves in
                                              the first place.
                                              „ Question? What
                                              about rural versus
                                              urban life is so
                                              decidedly
                                              hopeless?
 Scarce health resources in rural areas
 limited access to mental                  “There is too much discrimination. We
                                            are not getting the treatment to people,
  health services and                       especially children, especially
  emergency care                            minorities, especially poor, especially
 higher overall mortality                  rural areas, especially seniors. At
                                            minimum, we ought to end that
  rates from accidents and
                                            discrimination, and make sure there is
  injuries of all intents                   the coverage for the treatment. To end
  because of isolation from                 the discrimination, for those who
  care facilities                           cannot afford any coverage at all, we
                                            have got to make sure there is some
 mental health services are                coverage”
  poor in many rural areas
                                            ~Assistant Surgeon General of the
 travel distance to mental                 United States
  health treatment impedes                  (Hearing Before A Subcommittee of the Committee
                                            on Appropriations United States Senate. 106th Congress)
  use by rural residents
(Reducing Suicide: A National Imperative)       In 2003, there were 43.3 million
                                                people without health insurance
    Higher rates of suicide occur in rural
       versus urban areas worldwide.
 In rural China the     Country        Total    Year      Country        Total    Year
  rate is two to five     Armenia          1.8     1999     Mexico           3.1    1995

  times greater in
                          Austria         19.2     1999
                                                            Norway          12.1    1997
                         Azerbaijan        0.7     1999
  urban areas.            Belarus          34      1999   Philippines        2.1    1993


 Higher rural rates       Brazil          4.1     1995      Poland

                                                          Republic of
                                                                            14.3    1996


  are reported in         Canada
                           China
                                          12.3
                                          14.1
                                                   1997
                                                   1998
                                                            Korea            13     1997

  young males in          (rural
                                                           Russian
                                                          Federation       35.5     1998
  Australia and           areas)         23.3     1998     Singapore        11.7    1998
  Ukraine.              (urban areas)      6.8     1998    Sri Lanka         31     1991

 Greece where the       Finland         23.8     1998      Sweden          14.2    1996

  overall suicide         Georgia
                           Greece
                                           4.3
                                           3.8
                                                   1992
                                                   1998
                                                           Tajikistan        3.5    1995


  rate is relatively    Hungary          33.1     1999
                                                            Thailand          4     1994

                                                           Ukraine        29.1     1999
  low, urban areas          India         10.7     1998   Great Britain
  report                    Italy          8.2     1997
                                                          and Northern
                                                             Ireland         7.4    1998
  significantly lower      Japan          18.8     1997
                                                           United
  rates than rural         Kuwait          2.2     1999
                                                           States         10.7     1999
  areas.”               Lithuania        41.9     1999
Suicide and Cultural Stigma
                    From Reducing Suicide: A National Imperative

                                 40 percent of suicide victims had contact
UNITED STATES:
                                  with their health professional within a
“There is a shameful
stigma that exists in our         month of their death
society that treats mental       Even when depression is accurately
illnesses like personal           diagnosed, only a minority of patients
weaknesses or character           receive adequate treatment
flaws rather than real,
                                 Different stigmas propel suicide in different
disabling illnesses just
like heart disease or             countries. Widowed Hindu women are
diabetes, for which there         expected to kill themselves and in China
are extremely effective           suicide is a means of coping with
treatments.” ~US                  humiliation.
Assistant Surgeon                The most encouraging aspect of this stigma
General                           is that while societal attitude is such a
                                  powerful force, it is also realistically
                                  malleable†there is potential for
                                  modification
US Air Force Suicide Prevention Program
 In 1995, the suicide in
  the Air Force was
  nearing record heights
  at 15.8 per 100,000
  persons annually.
 In reaction, with
  collaboration from the
  US Surgeon General, the
  Air Force implemented a
  comprehensive
  community suicide
  prevention plan and by
  1999, the annual rate fell   Best Practice Initiative from the Assistant. (2002). Secretary for

  below 3.5/100,000            Health, US of Health and Human Services


  persons, a 80 percent
Blueprints of the US Air Force Plan

 1. Identify risk factors and hurdles that discourage help-
  seeking behavior (stigma towards mental illness, cultural
  norms, and beliefs).

 2. Change cultural norms and educate.

 3. Database established to capture demographic, risk factor,
  and protective factor information pertaining to individuals
  who attempted or completed suicide

 4. Deployable teams available to provide additional resources
  to installations hard hit by potentially traumatizing events as
  an integrated delivery system for human services.
Adapting Air Force Prevention Plan to
         a Civilian Context
Politicians are the quasi-military commanders
 of the civilian communities, granted with much
 less influence and less effective methods to
 elicit change.
The military provides universal availability of
 housing and healthcare. A huge component of
 the civilian suicide problem is inadequate or no
 mental health insurance.
              How the plan would look
   De-stigmization and changing cultural norms:
      Suicide is the 3rd leading cause of death among youths. Comprehensive suicide education and prevention
       program in schools that breeds a new generation of de-stigmatized adults and clearly identifies viable
       resources. Research studies demonstrate while impulsivity is linked to suicide among youth, coping skills
       and resiliency can be taught.
      Politicians and community leaders must change cultural norms by collaborating with public health services
       to consistently speak de-stigmatized language of mental health and the realities of suicide and suicide
       prevention. Suicide prevention must become a community priority and responsibility.

   Providing resources:
      Politicians also have the responsibility of addressing one of the key differences between the civilian and
       military suicide prevention programs†the availability of health services to all community members. Also,
       insurance coverage equal to that of general health services should be extended to mental health services.

   Detecting suicide risk:
      Civilian physicians must be thoroughly trained in general suicide risk identification and mental illness
       treatment, adopt a easy, routine screening process for every patient they see, and act as educators about
       the stigma of mental illness.

   Crisis Intervention Teams:
      In civilian terms, critical stress management teams look like “Crisis Hotlines”†sites with non-judgmental
       trained personnel who serve as compassionate listeners and knowledgeable intermediaries to mental
       health resources. These services require more government funding so they can more effectively assist their
       clients with treatment options.
Crisis and Information Hotline
 Accredited by American Association of
  Suicidology
 Certified by JAKO. Only 7% of social
  services nationally are certified by
  JAKO. The Salem Hospital is the only
  other certified entity in Salem.
 Primary focus is suicide intervention
 Hotline is also skilled at providing
  Critical Incident Stress Management
  services, teaching people how to deal
  with immediate trauma and stress.
 Hotline also provides limited financial
  assistance for issues covering housing,
  utility emergencies, medication
  assistance, and miscellaneous
  emergency needs, i.e., car repairs, etc.
 The Hotline provides 24/7 access,
  including an 800#, a TDD number,
  and interpreters for over 130 different
  dialects and languages.
                                                                       Number of calls
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                  Type of Call
                                           In usi
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                                                                                                                                                                  My first shift: Sat 4pm to 12am




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                                                                                                                       Saturday, March 12




                                      Pa          ed
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Jessica/Melissa
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                                                                                                                                                                                                    Depression: x




                                       an Sui
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                                                                                                                                            Info & Referral: xx




                                                      tio
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                                                                                                Reassurance: xxxxxxx
  How to talk with a suicidal caller:
 Are you thinking of
  killing yourself?

 Do you have a
  plan?

 What is your plan?

 Do you have the
  means (pills,
  weapons, etc) to
  carry out your
  plan?
 Educate the suicidal caller
 Nobody knows what
  happens when you die.

 A person probably is more
  negative about life than
  positive about death.

 Often callers don’t associate
  death with suicide.

 As a last ditch effort, the
  hotline utilizes SHOCK
  THERAPY:
             SHOCK THERAPY
 If you die at home, who’s going to discover the body?

 If you shoot yourself, who do you think is going to clean up that mess? The
  police and cornor won’t do it†your family and friends will be responsible.

 If you die and nobody finds you for several days, what do you think your dog
  is going to eat?

 When you overdose, it’s not peaceful; you could have seizures, or die
  choking on your own vomit.

 When you die, your bladder and bowels release; is that the final picture you
  want to leave the world? Your family and friends will have to clean that up
  also.
 To be a mental patient is to…
 live on $82 a month in food stamps     to act glad when you’re sad, and calm
  and watch your shrink come back         when you’re mad.
  to his office from lunch, driving a    participate in stupid groups that call
  Mercedes Benz.                          themselves therapy; music isn’t music,
 never be taken seriously.               it’s therapy; volleyball isn’t a sport, it’s
 to be a statistic.                      therapy; sewing is therapy; washing
 to watch TV and see shows about         dishes is therapy.
  how violent, dangerous, dumb,          is not to die†even if you want to†and
  incompetent, crazy you are              not to cry, and not to hurt, and not to
 be a resident of a ghetto,              be scared, and not to be angry, and not
  surrounded by other mental              to be vulnerable, and not to laugh too
  patients, who are scared and            loud ‟because, if you do, you only
  hungry, and bored, and broke as         prove that you are a mental patient
  you are.                                even if you are not.
 tell your psychiatrist he’s helping
  you, even if he’s not.

								
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