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LightUniversity1
TeenSuicide:Prevention,
Assessment,Intervention
andRecovery
P.O.Box739•Forest,VA24551•1-800-526-8673•www.AACC.net
TeenSuicidePAIRCertificationCourse
LightUniversity
WelcometoLightUniversityandthe“TeenSuicide:Prevention,Assessment, InterventionandAftercare”programofstudy.Our prayer is that you will be blessed by your studies and increase your effectiveness inreaching out to others. We believe you will find this program to be academically sound,clinicallyexcellentandbiblically-based.Our faculty represents some of the best in their field – including professors, counselors andministers who provide students with current, practical instruction relevant to the needs oftoday’sgenerations.We have alsoworked hard to provide youwith a program that is convenient and flexible –givingyoutheadvantageof“classroominstruction”onDVDandallowingyoutocompleteyourtrainingonyourowntimeandscheduleinthecomfortofyourhomeoroffice.Thetestmaterialcanbefoundatwww.lightuniversity.comandmaybetakenopenbook.Onceyouhavesuccessfullycompletedthetest,whichcoverstheunitswithinthiscourse,youwillbeawardedacertificateofcompletionsignifyingyouhavecompletedthisprogramofstudy.Thank you for your interest in this program of study. Our prayer is that you will grow inknowledge,discernment,andpeople-skillsthroughoutthiscourseofstudy.Sincerely,
RonHawkinsDean,LightUniversity
TeenSuicidePAIRCertificationCourse
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TheAmericanAssociationofChristianCounselors
• Represents the largestorganizedmembership (nearly50,000)ofChristian counselorsandcaregiversintheworld,havingjustcelebratedits25thanniversaryin2011.
• Known for its top-tier publications (Christian Counseling Today, the Christian CounselingConnectionandChristianCoachingToday),professionalcredentialingopportunitiesofferedthroughtheInternationalBoardofChristianCare(IBCC),excellenceinChristiancounselingeducation, an arrayof broad-based conferences and live training events, radioprograms,regulatoryandadvocacyeffortsonbehalfofChristianprofessionals,apeer-reviewedEthicsCode, and collaborative partnerships such as Compassion International, the NationalHispanic Christian Leadership Conference and Care Net (to name a few), the AACC hasbecomethefaceofChristiancounselingtoday.
• With the needed vision and practical support necessary, the AACC helped launch the
International Christian Coaching Association (ICCA) in 2011, which now represents thelargest Christian life coaching organization in the world with over 2,000 members andgrowing.
OurMission
The AACC is committed to assisting Christian counselors, the entire “community of care,”licensedprofessionals,pastors,and laychurchmemberswith littleorno formal training. It isourintentiontoequipclinical,pastoral,andlaycaregiverswithbiblicaltruthandpsychosocialinsights that minister to hurting persons and helps them move to personal wholeness,interpersonalcompetence,mentalstability,andspiritualmaturity.
TeenSuicidePAIRCertificationCourse
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TheAACC’svisionhastwocriticaldimensions:First,wedesiretoservetheworldwideChristianChurch by helping foster maturity in Christ. Secondly, we aim to serve, educate, and equip1,000,000 professional clinicians, pastoral counselors, and lay helpers throughout the nextdecade.WearecommittedtohelpingtheChurchequipGod’speopletoloveandcareforoneanother.We recognize Christian counseling as a unique form of Christian discipleship, assisting thechurch in its call to bring believers to maturity in the lifelong process of sanctification—ofgrowingtomaturityinChristandexperiencingabundantlife.Werecognizesomearegiftedtodosointhecontextofaclinical,professionaland/orpastoralmanner.Wealsobelieveselected laypeoplearecalledtocareforothersandthattheyneedtheappropriatetrainingandmentoringtodoso.WebelievetheroleofthehelpingministryintheChurchmustbesupportedbythreestrongcords:thepastor,thelayhelper,andtheclinicalprofessional.ItistothesethreerolesthattheAACCisdedicatedtoserve(Ephesians4:11-13).
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InthenameofChrist,theAmericanAssociationofChristianCounselorsabidesbythefollowingvalues:
VALUE1:OURSOURCEWearecommittedtohonorJesusChristandglorifyGod,remainingflexibleandresponsivetotheHolySpiritinallthatHehascalledustobeanddo.VALUE2:OURSTRENGTHWearecommittedtobiblicaltruths,andtoclinicalexcellenceandunityinthedeliveryofallourresources,services,trainingandbenefits.VALUE3:OURSERVICEWeare committed toeffectivelyandcompetently serve the communityof careworldwide—bothourmembership and the churchat large—withexcellenceand timeliness, andbyover-deliveryonourpromises.VALUE4:OURSTAFFWearecommittedtovalueandinvestinourpeopleaspartnersinourmissiontohelpotherseffectivelyprovideChrist-centeredcounselingandsoulcareforhurtingpeople.VALUE5:OURSTEWARDSHIPWe are committed to profitably steward the resourcesGod gives to us in order to continueservingtheneedsofhurtingpeople.
TeenSuicidePAIRCertificationCourse
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LightUniversity• Establishedin1999undertheleadershipofDr.TimClinton—hasnowseennearly200,000
students from around the world (including lay caregivers, pastors and chaplains, crisisresponders,lifecoaches,andlicensedmentalhealthpractitioners)enrollincoursesthataredelivered via multiple formats (live conference and webinar presentations, video-basedcertificationtraining,andastate-of-theartonlinedistanceteachingplatform).
• Thesepresentations,courses,andcertificateanddiplomaprograms,offeroneofthemostcomprehensive orientations to Christian counseling anywhere. The strength of LightUniversity is partially determined by its world-class faculty—over 150 of the leadingChristianeducators,authors,mentalhealthcliniciansandlifecoachingexpertsintheUnitedStates. This core groupof facultymembers represents a literal “Who’sWho” inChristiancounseling. No other university in the world has pulled together such a diverse andcomprehensivegroupofprofessionals.
• Educational and training materials cover over 40 relevant core areas in Christian—
counseling, lifecoaching,mediation,andcrisis response—equippingcompetentcaregiversand ministry leaders who are making a difference in their churches, communities, andorganizations.
OurMissionStatement
TotrainonemillionBiblicalCounselors,ChristianLifeCoaches,andChristianCrisisRespondersbyeducating,equipping,andservingtoday’sChristianleaders.
AcademicallySound•ClinicallyExcellent•DistinctivelyChristian
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Video-basedCurriculum
• UtilizesDVDpresentations that incorporateover 150 of the leading Christian educators,authors,mentalhealthclinicians,andlifecoachingexpertsintheUnitedStates.
• Eachpresentationisapproximately50-60minutesinlengthandmostareaccompaniedbyacorrespondingtext(inoutlineformat)anda10-questionexaminationtomeasurelearningoutcomes.Therearenearly1,000uniquepresentationsthatareavailableandorganizedinvariouscourseofferings.
• Learning is self-directed and pacing is determined according to the individual time
parameters/scheduleofeachparticipant.• With the successful completion of each program course, participants receive an official
Certificate of Completion. In addition to the normal Certificate of Completion that eachparticipant receives, Regular and Advanced Diplomas in Biblical Counseling are alsoavailable.
Ø TheRegularDiploma isawardedbytakingCaringForPeopleGod’sWay,BreakingFreeandoneadditionalElectiveamongtheavailableCoreCourses.
Ø TheAdvancedDiplomaisawardedbytakingCaringForPeopleGod’sWay,BreakingFree,andanythreeElectivesamongtheavailableCoreCourses.
Credentialing
• LightUniversitycourses,programs,certificatesanddiplomasarerecognizedandendorsedbytheInternationalBoardofChristianCare(IBCC)anditsthreeaffiliateBoards:theBoardofChristianProfessional&PastoralCounselors(BCPPC);theBoardofChristianLifeCoaching(BCLC);andtheBoardofChristianCrisis&TraumaResponse(BCCTR).
• Credentialing is a separateprocess from certificate or diploma completion.However, theIBCC accepts Light University and Light University Online programs as meeting theacademic requirements for credentialing purposes. Graduates are eligible to apply forcredentialinginmostcases.
Ø Credentialinginvolvesanapplication,attestation,andpersonalreferences.
Ø CredentialrenewalsincludeContinuingEducationrequirements,re-attestation,andoccureitherannuallyorbienniallydependingonthespecificBoard.
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OnlineTesting
TheURLfortakingallquizzesforthiscourseis:http://www.lightuniversity.com/my-account/.
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ContinuingEducationThe AACC is approved by the American Psychological Association (APA) to offer continuingeducationforpsychologists.TheAACCisaco-sponsorofthistrainingcurriculumandaNationalBoard of Certified Counselors (NBCC)ApprovedContinuing Education Provider (ACEPTM). TheAACC may award NBCC approved clock hours for events or programs that meet NBCCrequirements.TheAACCmaintainsresponsibilityforthecontentofthistrainingcurriculum.TheAACCalsoofferscontinuingeducationcreditforplaytherapiststhroughtheAssociationforPlayTherapy (APT Approved Provider #14-373), so long as the training element is specificallyapplicabletothepracticeofplaytherapy.It remains the responsibility of each individual to be aware of his/her state licensure andContinuing Education requirements. A letter certifying participation will be mailed to thoseindividuals who submit a Continuing Education request and have successfully completed allcourserequirements.
TeenSuicidePAIRCertificationCourse
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Presentersfor
TeenSuicide:Prevention,Assessment,Intervention
andRecovery
TeenSuicidePAIRCertificationCourse
LightUniversity
PresenterBiographies
Jennifer Cisney Ellers, M.A. is a Professional Counselor, life coach, crisis response trainer,authorandspeaker.Sheconductstraining,counselingandcoaching inthefieldofgrief,crisisandtraumathroughtheInstituteforCompassionateCare.Jenniferisanapprovedinstructorforthe International Critical Incident Stress Foundation, teaching several CISM courses. Also,Jenniferprovidesdivorcecoaching,trainingandspeakingthroughEmergeVictorious,aministryfor women rebuilding their lives after divorce. She is the co-author of The First 48 Hours:SpiritualCaregiversasFirstResponders,withherhusband,Dr.KevinEllers.Inaddition,Jenniferco-authored, Emerge Victorious: AWoman’s Transformational Guide after Her Divorce, withSandraDopfLee.KevinEllers,D.Min., istheTerritorialDisasterServicesCoordinatorforTheSalvationArmyintheU.S.A.CentralTerritory.HeisalsopresidentoftheInstituteforCompassionateCare,whichisdedicatedtoeducation,traininganddirectcare.Dr.Ellers isanassociatechaplainwiththeIllinoisFraternalOrderofPolice,servesas faculty for the InternationalCritical IncidentStressFoundation,adjunctprofessoratOlivetNazareneUniversity,andisamemberoftheAmericanAssociation of Christian Counselors Crisis Response Training Team. He has extensive trainingandexperienceinthefieldsofcrisisresponse,grief,trauma,disastermanagement,chaplaincy,pastoralministries,marriageandfamilytherapy,andsocialservices.Asanauthorandspeaker,heteachesbroadlyintheserelatedtopics.AmyFeigel,M.A.,isaVirginiaLicensedProfessionalCounselorandCaliforniaLicensedMarriageandFamilyTherapist.AmyreceivedherpreandpostgraduateeducationfromLibertyUniversityandhasover15yearsofexperienceworkingwithchildren,adolescents,andfamilies.ShehasservedasaSocialWorkerforChildProtectiveServices,aGroupFacilitatorworkingwithsexualabuse survivors through Parents United International, a Mental Health Clinician providingoutpatient counseling for at-risk youth, the Director of Member Care for the AmericanAssociation of Christian Counselors (AACC), the Director of the Extraordinary Womenorganization, and as a private practice therapist. Amy is currently employed full-time as atherapist at Light Professional Christian Counseling Clinic, part-time as an Adjunct FacultyProfessorwithLibertyUniversityOnlineand isalsoaSpecialAssistanttothePresidentoftheAACC.AmyisBoardCertifiedProfessionalChristianCounselorthroughtheInternationalBoardof Professional and Pastoral Counselors and recently received the Servant Leadership AwardfromtheIBCC.
TeenSuicidePAIRCertificationCourse
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Molly-CatherineK.Goodson,M.A.,Esq.,isaNorthCarolinaAssistantDistrictAttorney,AdjunctProfessor at Regent University, advocate, and speaker who is passionate about bringingprofessionals together to use a multi-faceted approach to address the issues of domesticviolence, sexual assault, and child abuse.Molly-Catherine graduated from Liberty UniversitySchoolof Lawwitha JurisDoctorandaMasterofArts inHumanServicesCounselingwithaChildren,Families,andtheLawspecialization.TheAmericanAssociationofChristianCounselorsandtheLibertyLegalJournalhavefeaturedherresearchonchildabuse,domesticviolence,andthe consequences of teen sexting. Her passion to “bridge the gap” between psychology andlaw, drives her to equip others on how to address the issues of domestic violence, sexualassault, and child abusewithanunderstandingof theheart andmindof a victim,ultimatelyleadingtoeffectiveadvocacyforthevictim.Frank S. Page, Ph.D. understands missional leadership. Having served as the president of alargeevangelicalentity,hehasalsoservedasseniorpastorfora4,500-plusmemberchurchandiscurrentlythepresidentoftheExecutiveCommitteeoftheSouthernBaptistConvention.Pageholds amaster of divinity andPh.D. fromSouthwesternBaptist Theological Seminary in FortWorth,Texas.HisPh.D. is inthefieldofChristianethicsfocusingonmoral,social,andethicalissues.Anexperiencedspeaker,Dr.Pagehasspokenatmanyrevivals,conferences,universities,seminaries, etc., allowing him to travel around the world to places such as Israel, Africa,Australia,Brazil,Canada,andmanyothers.Heisauthorofseveralbooks,includingTroublewiththe Tulip, Jonah (for The New American Commentary), The Incredible Shrinking Church,CommentaryonMark, andTheWitnessingandGivingLife, andhaswrittenmanyarticles forseveralmagazines and theological journals. He is currently the leadwriter for the AdvancedContinuingWitnessTrainingmaterials.Miriam Parent, Ph.D., holds a Ph.D. from Rosemead Graduate School. She has served as acounseloreducatorformorethantwentyyears.PriortocomingtoTrinityin1993,shetaughtatLibertyUniversity in the School of Religion. Dr. Parent is a licensed clinical psychologist. Shepracticed full-time for several years prior to teaching; since then she has maintained acounselingpracticeprovidingindividualandmaritalcounseling,aswellasdiagnosticevaluationand assessment. Over the years her speaking and writing have focused on areas such asspiritualformation,stressmanagement,burnout,andministryandprofessionalethics.Shealsoenjoys speaking inwomen’s groups and church retreats on a variety of Bible and counselingtopics. Her areas of interest include professional ethics, diagnosis and treatment planning,stressmanagement,women’sissues,andspiritualformation.LindaMintle,Ph.D.,isaLicensedMarriageandFamilyTherapist(LMFT),LicensedClinicalSocialWorker (LCSW), professor, author, and national speaker. She serves as Chair of BehavioralHealthattheCollegeofOsteopathicMedicineatLibertyUniversityinLynchburg,VA.With30yearsofclinicalexperienceworkingwithcouples,families,andindividuals,sheisanexpertonrelationshipsandthepsychologyoffood,weight,andbodyimage.Dr.Mintlealsoservesasanationalnewsconsultant,BeliefNetblogger,andradioshowhost.She isabest-sellingauthorwith 19 book titles, including I Married You, Not Your Family, and Divorce Proofing YourMarriage.
TeenSuicidePAIRCertificationCourse
LightUniversity
Eric Scalise, Ph.D., is the former Vice President for Professional Development with theAmericanAssociationofChristianCounselors,aswellasacurrentconsultantandtheirSeniorEditor.HeisalsothePresidentofLIVEnterprises&Consulting,LLC,andaLicensedProfessionalCounselor and LicensedMarriage&Family Therapistwithmore than37yearsof clinical andprofessionalexperienceinthementalhealthfield.HealsoservedforsixyearsontheVirginiaBoard of Counseling aftermultiple appointments from theGovernor’s office. Specialty areasinclude professional/pastoral stress and burnout, combat trauma and PTSD, marriage andfamilyissues,leadershipdevelopment,addictions,andlaycounselortraining.Heisanauthor,anational and international conference speaker, and frequently consults with organizations,clinicians,ministryleaders,andchurchesonavarietyofissues.GarySibcy,Ph.D.,isProfessorofCounselingandDirectorofthePh.D.programinProfessionalCounselingandPastoralCounselingattheCenterforCounselingandFamilyStudiesatLibertyUniversity, where he teaches courses in advanced psychopathology and its treatment. He isboth a Licensed Clinical Psychologist (LCP) and a Licensed Professional Counselor (LPC), hasbeen in private clinical practice for more than 20 years, and currently works at PiedmontPsychiatricCenter.Dr.Sibcyspecializesinanxietydisorders,includingOCDandpanicdisorder,andchronicdepressioninadults,aswellasthediagnosisandtreatmentofchildrenwithseveremooddysregulation.Heiscurrentlydevelopinganempiricallysupportedtreatmentwithintheframework of interpersonal neurobiology and attachment theory. Dr. Sibcy has co-authoredseveralbookswithDr.TimClinton,includingAttachmentsandWhyYouDotheThingsYouDo.Joshua Straub, Ph.D., is a speaker, author, family and relationship coach, and professor. Hespendsmuchofhistimespeaking,coachingfamilies,anddevelopingcurriculumandresources,primarilyintheareasofcounselingchildren,adolescentsandyoungadultsaswellasenrichingmarriagesandfamilies.JoshalsoservesontheteachingteamatWoodlandHillsFamilyChurchin Branson, MO and as assistant professor for Liberty University Online in the Center forCounseling and Family Studies. He is a Board CertifiedMaster Christian Life Coachwith theInternational Christian Coaching Association. In various roles, Dr. Straub has served as aprofessor, counselor, relationships coach, author, speaker, pastor, and administrator for thepast15years.
TeenSuicidePAIRCertificationCourse
LightUniversity
TeenSuicide:Prevention,Assessment,InterventionandRecovery
TableofContents:TNSU101:TheDynamicsofSuicide:What,Why,WhoandHow............................................1JenniferCisneyEllers,M.A.TNSU102:ChoosingtoDie:AModelofUnderstanding........................................................12JenniferCisneyEllers,M.A.
TNSU103:ATheologyofSuicide:BiblicalPrinciplesandaChristianResponse.......................22FrankPage,Ph.D.
TNSU104:MentalIllnessandtheEpidemiologyofSuicide....................................................31LindaMintle,Ph.D.TNSU105:TheChangingTideofTeenSuicide:InsightsintoaScreen-SaturatedGeneration..45JoshuaStraub,Ph.D.
TNSU106:TeenSuicideandSelf-injury:Assessment,Diagnosis,andTreatmentStrategies...50AmyFeigel,M.A.andMollyCatherineGoodson,M.A.,J.D.TNSU107:HelpingTeensinCrisis..........................................................................................64JoshuaStraub,Ph.D.TNSU108:TheEthicsofSuicideIntervention.........................................................................73MiriamParent,Ph.D.
TNSU109:SuicidePreventionandInterventionwithAdolescents.........................................82JoshuaStraub,Ph.D.
TNSU110:ConductingaSuicideAssessment:UsingtheSafe-TModel(withroleplays).........91GarySibcy,Ph.D.
TNSU111:FamiliesinCrisis:TheFirst48HoursFollowingSuicide.........................................98JenniferCisneyEllers,M.A.andKevinEllers,D.Min.TNSU112:GrievingaSuicide:Long-termSupportforSurvivorsandLovedOnes..................105JenniferCisneyEllers,M.A.andEricScalise,Ph.D.
TeenSuicidePAIRCertificationCourse
LightUniversity1
TNSU101:
TheDynamicsofSuicide:
What,Why,Who,andHow
JenniferCisneyEllers,M.A.
TeenSuicidePAIRCertificationCourse
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AbstractAspiritualbattletakesplaceeverydaybetweenlightanddark,andsuicideriskisabattleground.
Studies show suicide is on the increase with attempts outnumbering completions. There are
certainfactorsthatincreasesomeone’sriskforcommittingsuicide,suchasage,gender,marital
status, race and ethnicity, and geographical region by state. Methods include firearms,
suffocation, jumping from bridges and other high places, andwalking or driving in front of a
train. Mental illness, substance abuse, personality disorders, chronic or terminal medical
conditions,afamilyorpersonalhistory,environmentalfactors,thecontagioneffect,andaccess
to lethalmethods are all risk factors for suicide.Help is available throughmental healthcare,
positive connections, and thedevelopment of problem solving skills. Spiritual factors, such as
the power of prayer, God, and the Holy Spirit, are available in equipping mental health
professionalswiththetoolstohelpthoseatriskforsuicide.
LearningObjectives
1. Participantswill identifythosemostatriskforsuicidebylookingatfactorssuchasage,
gender,maritalstatus,raceandethnicity,andgeographicalregion.
2. Participants will define various methods used in the attempt and/or completion of
suicide.
3. Participantswillexploredifferentriskfactors involvedinsuicide,suchasmental illness,
substanceabuse,personalitydisorders,chronicorterminalmedicalconditions,familyor
personal history, environmental factors, the contagion effect, and access to lethal
methods.
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I. Introduction
A. ASpiritualBattle
1. Suicideisthebattlegroundinthebattlebetweendarkandlight.
2. Satanhasahandinconvincingpeopletheywanttotaketheirownlives.
3. Muchofthehealinginvolvedinsuicideisofaspiritualnature.
B. PersonalImpact
1. Caregivers are powerfully impacted when someone in their care attempts or
completessuicide.
2. Caregivers are also powerfully impacted when working with the loved ones or
familiesintheaftermathofasuicide.
3. Often caregivers have been impacted personally by suicide when loved ones and
familymembersstruggle.
II. TheNumbersSurroundingSuicide
A. AnIncrease(LookingatSuicideintheU.S.)
1. Suicideismoreprevalentinthenews,andresearchsupportsthatthisisanaccurate
portrayalofincreasedideation,attempts,andcompletedsuicides.
2. StatisticsfromtheCenterforDiseaseControl(CDC)2013
• In2013,therewere41,149suicides.
• Suicidewasthe10thleadingcauseofdeathintheUnitedStates.
• In2013,someonediedbysuicideevery12.8minutes.
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B. ThePercentages
1. From1986-2000,therewasadecreaseinsuicideratesfrom12.5%to10.4%.
2. In2001,thenumbersstartedtoincrease.
3. Therehasbeenaslow,butsteady,increaseto12.6%currently(2013).
C. Attemptsvs.Completion
1. Aninfinitelylargernumberofpeopleattemptsuicidethancompletesuicide.
2. Itisestimatedthatthereare864,950suicideattemptseachyear.
3. Manyattemptsarenotreported.
III. WhoisMostatRisk?
A. Age
1. Currently, the middle aged group (ages 45-64) has the highest rate of suicide at
19.1%.
2. Suicidehasincreasedby28%amongthemiddleagedinthelast10years.
3. The economic crisis is one of the factors that has led to the increase in this age
group’srateofsuicide.
4. Stresslevelsareveryhighforthemiddleaged.
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B. Gender
1. Womenattemptsuicidemorethanmen.
• Threetoonemorethanmen.
• Uselesslethalmeans–poisoningoroverdose.
2. Mencompletesuicidemorethanwomen.
• Mencompletesuicideonetofourtimesmoreoftenthanwomen.
• Thisisduetomen’suseofmorelethalmeans–firearms.
C. MaritalStatus
1. Bythenumbers,mostofthepeoplewhocompletesuicidearemarried.
2. When lookingat suicideby rate,peoplewhoaredivorcedhave thehighest rateof
suicidefollowedbythosewhoarewidowedandthenbythosewhoaresingle.
3. Marriedpeopleactuallyhavethelowestrateofsuicideoverall.
4. Livingaloneandbeingalonesignificantlyincreasestheriskforsuicide.
D. RaceandEthnicity
1. Caucasianshavethehighestsuiciderate.
2. AmericanIndianshavethesecondhighestrateofsuicide.
3. Black,Hispanic,andAsianpopulationshavethelowestsuiciderate.
• Duetofactorsofresilience
• Duetoreligiousfaithandparticipationinafaithcommunity
• Duetostrongfamilyconnectionsandsocialsupport
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E. Patterns
1. Middleagedandolderwhitemalesarethehighestriskgroupfordeathbysuicide.
2. In2013,whitemalesaccountedfor70%ofallcompletedsuicides.
F. GeographicalRegion
1. ThestateswiththehighestsuicideratesareintheWest:Montana,Alaska,Utah,New
Mexico,Idaho,Nevada,Colorado,andSouthDakota.
2. States with the lowest rates are Washington, D.C., New Jersey, New York,
Massachusetts,andConnecticut.
3. One conjecture as towhy suicide rates are higher in theWest is that firearms are
morereadilyavailable.
IV. SuicideDeathsbyMethod(2013)
A. Firearms
1. IntheU.S.,firearmsarethemostlethalandfrequentlyusedmethodofsuicide.
2. In2013,51.5%ofsuicideswerewiththeuseoffirearms.
B. Suffocation
1. 24.5%usedsomemethodofsuffocation.
2. Thisincludeshanging.
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C. OtherMethods
1. Theseothermethodsmakeup8%ofsuicides.
2. Theseothermethodsincludejumpingfrombridgesorotherhighplaces(theGolden
GateBridge)andwalkingordrivinginfrontofatrain.
D. Overview
1. WorldHealthOrganization–suicideinothercountries.
2. Firearmsarenottheleadingmethodofsuicideinothercountriesbecausepeopledo
nothavetheaccessibilitytofirearmsthatwehaveintheU.S.
3. Overdose
• Thereispotentiallyalargetimeframewheresomeonecanintervene/provide
medicalattention.
• Ourbodieshaveatremendousabilitytoovercomeevenlargelevelsoftoxicity.
• Thereisawindowofopportunityforpeopletoreconsidersuicide.
4. Firearms
• Littleopportunitytoreconsider.
• Thisaquickdecisionwithnoturningback.
• Thelethalityofthemeansisverysignificantwhenassessingrisk.
V. RiskFactorsforSuicideA. MentalIllness
1. Itisestimatedthat90%ofthosewhocommitsuicidehaveatreatablementalillness
atthetimeoftheirdeaths.
2. Mentalillnessisthemostreliableandconsistentriskfactorforsuicide.
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3. Mentalillnesseswithanincreasedriskforsuicide.
• Majordepression–Thisistreatablewithmedicationandcounseling.
• BipolarDisorder–Thisisalsotreatablebutcannotbecured.
B. SubstanceAbuse
C. PersonalityDisorders
1. Borderlinepersonalitydisorder
2. Antisocialpersonalitydisorder
3. Conductdisorderinyouth
4. Psychoticdisorders
5. Anxietydisorders
6. Post-traumaticstressdisorder
7. Thesedisordersareatanespeciallyhighriskforsuicidewhentheygoundiagnosed
anduntreated.
D. ChronicorTerminalMedicalConditions
1. Depressioncanfollowcertainmedicalillnesses.
• Cancer
• Pneumonia
2. Peoplewith terminalmedical conditionsmay believe that taking their own lives is
betterthanburdeningfamilymembersorsufferingthroughanextendedillness.
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3. Fearofpainanddeathcanmakepeoplesuicidal.
• Chronicmigraines
• Fibromyalgia
• Chronicjointpain
• Chronicbackandneckpain
E. Family History of Suicide Attempts or Completed Suicide and Personal History of
Attempts
1. Otherthanmentalillness,thisisthehighestriskfactorforsuicide.
2. Itisimportantformentalhealthprofessionalstoaskaboutfamilyhistoryofsuicide.
3. Researchhasshownsuicideriskcanbeinherited.
F. EnvironmentalFactors
1. Stressfullifeeventssuchasthedeathofacloselovedone
2. Financialloss
3. Legaltrouble
4. Chronicstressfulsituationssuchaslong-termunemployment
5. Seriousrelationshipconflictsuchasabreakupordivorce
6. Harassmentorbullying
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G. ContagionEffect
1. Exposuretoanotherperson’ssuicidecanmakeonemorevulnerabletobeingatrisk
forsuicide.
2. Only1%ofsuicidesareattributedtothecontagioneffect,butitissignificantenough
thatweneedtobeaware.
3. Thisexposurecanbedirectorindirect.
4. This is true with spouses, close friends, siblings, family members, and even
celebrities.
5. Donotromanticizeorsensationalizetheactofsuicide.
6. Teensaresignificantlymorevulnerabletothecontagioneffect.
H. AccesstoLethalMethodsatTimesofIncreasedRisk
1. Accesstohandgunsshouldbestrictlycontrolledamonghighrisksuicidepopulations,
such as those with serious mental illnesses that have been correlated with high
suiciderate.
2. 70-75%offamilieswhoareaskedtoremovefirearmsfromthehomechoosenotto
removethem.
3. Takeextrastepstoprotectindividualsvulnerabletosuicidefromaccesstofirearms.
VI. ProtectiveFactorsforSuicideA. ReceivingMentalHealthcare
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B. Positive Connections with Family, Friends, and Peers Through Social Institutions of
HealthyMarriagesandOurFaithCommunities
C. HelpingPeopleDevelopSkillsandAbilitiestoSolveProblems
VII. NeurobiologyofSuicide
A. PostmortemStudies
B. BrainSystemsinChargeofMood,ThinkingandStressResponse
VIII. SpiritualFactors
A. PowerofGod
B. FightingAgainstthePowersofDarkness
C. ConnectionThroughPrayer
D. PoweroftheHolySpirit
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TNSU102:
ChoosingtoDie:AModelofUnderstanding
JenniferCisneyEllers,M.A.
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AbstractJenniferCisneyEllersreviewsDr.ThomasJoiner’smodelofunderstandinghowandwhysuicide
occurs.Thedesiretodiebecauseofaperceivedburdensomenessandalowlevelofbelongingor
socialconnectednessandtheabilitytotakeone’sownlifeleadapersontobelievesuicideisthe
bestsolution.Suicidalpeopletendtobelievetheyareaburdentotheirlovedones.Theirsense
of value and self-worth has been undermined. Satan is the author of this ultimate lie, but
caregiverscanintervenebyreassuringpeopleoftheirvalue,helpingthemfeelproductive,and
relaying the message that care and concern are not a burden. Suicidal people also have a
thwartedconnectedness—asensetheydonotbelong.Thisfeelingofisolationcanbehelpedby
treating depression, fostering and building social connection, enhancing family relationships,
buildingsocialandrelationalskills,anddialoguingaboutstruggles.Peoplehaveastrongdesire
for self-preservation,but thereare factors thatcontribute tosomeoneacquiring theability to
enact self-injury. It is important forcaregivers toprovidepreventative support,educationand
traininginthesesituations.
LearningObjectives
1. Participants will identify the factors that lead a person to believe suicide is the best
solution.
2. Participants will list steps in intervening when a person experiences perceived
burdensomenessandathwartedconnectedness.
3. Participants will explore situations that lead someone to acquire the ability to enact
lethalself-injury.
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I. Introduction
A. TheAmericanFoundationforSuicidePrevention(Webpage)
1. Quote: “Our effectiveness in preventing suicide ultimately depends on more fully
understandinghowandwhysuicideoccurs.”
2. Whatisgoingonintheheartsandmindsofthosethinkingaboutsuicide?
3. PreventionandInterventiondependsonmorefullyunderstandingpeople.
B. Dr.ThomasJoiner
1. Book:WhyPeopleDieBySuicide
2. Personallyimpactedbysuicidewhenhisfathercommittedsuicide.
3. TheInterpersonalPsychologicalTheoryofSuicidalBehavior
C. Dr.EdSchneidman
1. Definition of suicide: “Suicide is a conscious act of self-induced annihilation best
understood as a multidimensional malaise in a needful individual who defines an
issueforwhichsuicideisperceivedasthebestsolution.”
2. Wehavetomakeaconcentratedefforttounderstandwhatisgoingoninthemindof
asuicidalperson.
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II. WhatLeadsaPersontoBelieveSuicideistheBestSolution?
A. TheDesiretoDie
1. PerceivedBurdensomeness–“Iamaburdentosocietyandmylovedones.”
2. Lowlevelofbelongingorsocialconnectedness.
• Thwartedconnectedness
• Feelsociallyalienated
B. TheAbilitytoTakeTheirOwnLives
III. PerceivedBurdensomeness
A. Definition
1. Thesensethatoneisaburden
2. Thekeywordisperceived.
3. Loved ones see the suicidal person’s pain as the burden, not the person as the
burden.
B. WhyPerceivedBurdensomeness?
1. MentalIllness
• Depression
• Bipolardisorder
2. Chronicphysicalillness
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3. Chronicpainconditionsordisabilities
4. Terminalillness
5. Situationalissues
• Relationshipproblems
• Financialloss
• Jobloss
• Legalproblems
C. MotivationtoLive
1. Perceived burdensomeness undermines our sense of value and self-worth.
2. We want to sense we are bringing something important to the world.
3. Man’sSearchforMeaningbyVictorFrankl
4. Ifamanhasawhy,hecanwithstandanyhow.
D. Suicide–ASelfishAct?
1. Suicidalpeoplebelievetheyarecommittingaselflessact.
2. Theyfeeltheyaretakingawayaburdenforthosetheylove.
3. IammakingachoicethatwillultimatelybebestforeveryoneIlovebecauseIama
burden.
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E. SpiritualElements
1. Suicidalpeoplestrugglewithfalsebeliefsandliesaboutthemselves.
2. Satanbeginstoconvincesomeonethattheyareworthless.
3. Satan’sultimatelie–Theworldwouldbebetteroffwithoutyou.
F. Dr.Joiner'sStudy
1. Dr. Thomas Joiner and his team confirmed perceived burdensomeness is one of
thefactorsmostcloselyassociatedwithsuicidalbehavior.
2. The link between perceived burdensomeness and suicidality is just as strong as
thelinkbetweenhopelessnessandsuicidality.
G. HowDoWeIntervene?
1. Reassurepeopleoftheirvalue.
2. Peopleneedtofeelproductive.
3. Peopleneedtounderstandcareandconcernarenotaburden.
4. StoryofJenniferCisneyEllerscaringforhermother.
IV. ThwartedConnectednessA. Definition
1. Thesensethatonedoesnotbelong.
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2. Frombirth todeath,deepandmeaningful connections toothersare critical toour
mental,physical,andspiritualwell-being.
B. Connectedness
1. Aprimaryfactorinconnectednessisface-to-faceinteractionswithotherpeople.
2. Additionally,afeelingofbeingcaredaboutiscrucialtoconnectedness.
C. FailuretoThrive
1. Canhappenwithinfantsandseniors.
2. This phenomenon leads us to an observation of how important connection is in
relationships.
D. DepressionandIsolation
1. Depressedpeoplemakelesseyecontact.
2. Depressedpeopleengageinlesshead-noddingduringconversation.
E. TimesofNationalCrisis
1. Peopleoftenpulltogetherandtheirsenseofbelongingincreases.
2. AssassinationofJFK
3. Terroristattacksof9/11
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F. MMPI–PredictorsforDeathbySuicide
1. Self-blameScale
2. SocialIntroversionScale
G. HowDoWeIntervene?
1. Treatdepression.
2. Fosterandbuildsocialconnectionasprevention.
3. Enhancefamilyrelationships.
4. Helpsociallyisolatedindividualsbuildsocialandrelationalskills.
5. Bemoreopentodialogueaboutstrugglesandlifechallenges.
V. AbilitytoEnactLethalSelf-injuryA. Self-preservation
1. AllmammalsaredesignedbyGodtoprotectandsavetheirlives.
• Strongimmunesystems
• Ourbodieshaveanincredibleabilitytoheal.
2. Psychologicalmechanism
• Peopleareprogrammedforsurvival.
• Fightorflightresponse
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B. HowDoesOneAcquiretheAbilitytoEnactLethalSelf-injury?
1. Previousattemptsorprevioussuicidalbehaviors
2. Fantasyactingout–thinkingaboutandplanningsuicide
3. Engaginginnonlethalactsofself-injury
• Cutting
• Burning
• Canbeagatewaytolethalself-injury
4. Childhood physical and sexual abuse or other painful, repeated experiences in
childhood
5. Involvementinviolence
6. Anythingthathabituatessomeonetopainandinjury
7. Peoplewhoareexposedtothepainandinjuryofotherpeopleintheirprofessions
C. HowDoWeIntervene?
1. Considerallofthefactorsinsuicideassessments.
2. Preventative support for people who have the experiences thatmight lower their
resistance
3. Educationandtrainingwithgoodself-care
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D. VideoofDr.KevinEllers
1. Thereisahugemisunderstandingofmentalillness.
2. Satanicforcesareatworkduringsuicide.
3. Sometimes suicide is a choice, but sometimes the one committing suicide truly
believeshe/sheisdoingthebestthingfortheoneswhoareliving.
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TNSU103:
ATheologyofSuicide:BiblicalPrinciples
andaChristianResponse
FrankPage,Ph.D.
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AbstractSuicideisadevastatingissueinourworldtoday,yethasbeenanage-oldtragedyformankind.
One can look back at history to see examples of suicide. Scripture records seven suicides:
Abimelech, Samson, King Saul, Saul’s armor bearer, Ahithophel, Zimri, and Judas. Although
Scripturedoesnotgiveusanyspecificwordaboutsuicide,itdoesindicatethatGodisthegiver
of lifeandonlyHehastherighttotake itaway.Weneedtofollowthebiblicalprinciplesthat
Godhasagreatplanforourlives;thesolutiontodespairandhopelessnessisfaithinHim;and
thoughtroublecontinuesinlife,theLordwillneverleaveus.OurChristianresponsetosuicide
needs to be one of confronting bad theology and thinking; encouraging people against using
tritestatementsand,instead,urginggoodtheologyandpractices;andpracticingtheministryof
presence.Ultimately,wecantrusttheLordandknowHisloveispowerful.
LearningObjectives
1. ParticipantswillbeabletoexploresevensuicidesmentionedinScripture.
2. Participantswillidentifybiblicalprinciplessurroundingtheissueofsuicide.
3. ParticipantswilldefineaChristian’sresponsetosuicide.
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I. Introduction
A. ExamplefromMarkTwain’sTheAdventuresofTomSawyer
1. Tomandhisfriendsaregonefromhomeforalongtimepretendingtobepirateson
theriverbank.
2. ThetownspeoplebelieveTomandhisfriendsaredead.
3. Tomandhisfriendssneakintotownandattendtheirownfuneral.
4. Thestoryendshappilywiththeboysrevealingtheirwhereaboutsandeveryonebeing
thrilledtoseetheyarealive.
B. SuicideStatistics
1. In our country, suicide is one of the leading causes of death, particularly among
teenagers.
2. Moresoldiersarebeinglosttosuicidethancombat.
3. Suicidehasrisenamongyoungwomen.
C. HistoricalExamplesofSuicide
1. MasadainIsrael
2. MasssuicidesfromthewallsofGamlainGalilee
3. SuicidesoftheJapaneseduringWorldWarIItoevadecapturebytheAmericans
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4. MasssuicidesduringtheJonestowntragedies(JimJones)
5. Orientalculturesglorifyingsuicidesratherthansurrendering
6. SuicidebombersintheMiddleEast
II. SuicidesMentionedinScripture
A. Abimelech
1. Judges9:52-54
2. Abimelechcommittedsuicideinatimeofpersonalcrisis.
B. Samson
1. Judges16:25-30
2. Samsondiedforacausehebelievedin,butalsoforrevengeuponthePhilistines.
C. KingSaul
1. 1Samuel31:4
2. Whatcouldhavebeenagreatlifeofvictoryturnedintoaterribletimeofdefeatand
sadness.
D. Saul’sArmorBearer
1. 1Samuel31:5
2. Followedtheexampleofhisking
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3. Impulsivedecision
4. Apermanentsolutiontowhatcouldhavebeenatemporaryproblem
E. Ahithophel
1. 2Samuel17:23
2. Bitternessanddepressionwerefactorsinhisdecision.
F. Zimri
1. 1Kings16:15-20
2. Bitternessbecameastrongholdinhislife.
G. Judas
1. Matthew27:3-5
2. Depression,greed,personalfailure,andregretledtoJudas’suicide.
III. ATheologyofLifeA. WhatdoestheBibleSay?
1. TheBibledoesnotgiveanyspecificwordaboutsuicide.
2. Scripturedoes indicateGod is the giver of life andonlyHehas the right to take it
away.
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B. Job1:21
“Hesaid,‘NakedIcamefrommymother’swomb,andnakedIshallreturnthere.The
LordgaveandtheLordhastakenaway.BlessedbethenameoftheLord.’”
C. 1Corinthians6:19-20
“OrdoyounotknowthatyourbodyisatempleoftheHolySpiritwhoisinyou,whom
youhavefromGod,andthatyouarenotyourown?Foryouhavebeenboughtwitha
price:thereforeglorifyGodinyourbody.”
IV. BiblicalPrinciplesA. GodHasaGreatPlanforyourLife
1. God’spurposeshouldtakeprecedentoverouragendas.
2. Jeremiah29:11–“ForIknowtheplansthatIhaveforyou,declarestheLord,plans
forwelfareandnotforcalamitytogiveyouafutureandahope.”
B. God’sPlanisforLife,notDeath
1. Romans6:23–“Forthewagesofsinisdeath,butthefreegiftofGodiseternallifein
ChristJesusourLord.”
2. John10:10–“Thethiefcomesonlytostealandkillanddestroy;Icamethattheymay
havelife,andhaveitabundantly.”
C. TheSolutiontoDespairandHopelessnessisNotSuicide,butFaithinGod
1. Psalm33:20-22–“OursoulwaitsfortheLord;Heisourhelpandourshield.Forour
heartrejoices inHim,becausewetrust inHisholyname.Letyour lovingkindness,O
Lord,beuponus,AccordingaswehavehopedinYou.”
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2. ScripturepointstoourultimatefaithinGodasoursalvation.
D. ThoughTroubleContinuesinthisLife,OurLordWillNeverLeaveUs
1. John16:22–“Thereforeyou toohavegriefnow;but Iwill seeyouagain,andyour
heartwillrejoice,andnoonewilltakeyourjoyawayfromyou.”
2. Matthew11:28–“CometoMe,allwhoarewearyandheavy-laden,and Iwillgive
yourest.”
V. ChristianResponseA. ConfrontBadTheology
1. Thereisagreatdealofmisunderstandingwhenitcomestotheissueofsuicide.
2. Severalfaithgroupsteachthatonewhocommitssuicidecannotgetintoheaven.
3. Mostpeoplewhocommitsuicidehavereachedapointintheirlifewheretheyhave
losttouchwithreality.
4. TheBibledoesnotteachthatthosewhocommitsuicidegotohell(Romans5:8).
5. Scripturedoesteachaccountability.
• Ezekiel18
• Leviticus4:22
6. Peoplewho commit suicide go toheaven if theyhave a personal relationshipwith
Christ.
7. Scripturedoesteachtherealityofdemonicoppressionandpossession.
8. Satancanusestrongholdsinamentallyillperson’slifetomakeasituationworse.
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B. ConfrontBadThinking
1. Whilecharacter flawsandbadparentingcancausedifficulty inevery life, struggles
are also found among people of tremendous character and in homes where
parentinghasbeendevoted,loving,andcaring.
2. Mentalillness,emotionalstruggles,anddepressionarenotmerelycharacterissues.
C. EncouragePeopleAgainstUsingTritePlatitudes
1. Donotsay,“Theyareinabetterplacenow.”
2. Donotsay,“Snapoutofit.”
D. EncourageGoodTheologyandGoodPractices
1. WeneedtoputourhopeinGod,andwecandothisthroughprayer.
2. Psalm46:1-3
3. Hebrews13:6
4. Isaiah26:3
E. PracticetheMinistryofPresence
1. StoryofFrankPage’sdaughter’ssuicide
2. ThepresenceofHisWord
3. ThepresenceoftheLord
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4. ThepresenceofGod’speople
5. There is a need for immediate action when there has been a suicide or suicide
attempt,butthatministryneedstobeongoing.
6. Do not let an awkward situation dissuade you from active Christian ministry to
hurtingpeople.
7. Behonestandbethereforthehurtingpeople.
8. Letthehurtingpersonexpresshis/herangerandconfusion.
9. Beabuilderofencouragement,notatransmitterofhurt.
VI. ConclusionA. WeCanTrusttheLord
B. God’sLoveisPowerful
C. 2Corinthians1:3-5
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TNSU104:
MentalIllnessandtheEpidemiologyofSuicide
LindaMintle,Ph.D.
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AbstractSuicideisacomplexissuewithmultiplecontributinggeneticandenvironmentalfactors.Mental
illnessisakeyfactorinidentifyingsomeoneashavingapredispositionforsuicide.Therearerisk
factors surrounding suicide, such as gender, age, race/ethnicity, marital status, geography,
professions/occupations, economics, timeof year, illness, andothers.Methods are discussed,
along with common triggers and general warning signs. Protective factors and prevention
strategiesareimportantindealingwithpeopleinsuicidalcrisis.
LearningObjectives
1. Participantswillexplorevariousmythssurroundingsuicide.
2. Participants will define risk factors for suicide, such as gender, age, race/ethnicity,
marital status, geography, professions/occupations, economics, time of year, and
medicalconditions/illness.
3. Participantswillidentifycommonmethodsandtriggersofsuicide,generalwarningsigns,
protectivefactors,andpreventivestrategies.
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I. Introduction
A. StoryAboutProminentLawyer’sSuicide
1. SuicideisatragedyandJesussaysitisalossnotagain.
2. Proverbs23:18
“Surelythereisafuture,andyourhopewillnotbecutoff.”
B. Definitions
1. Epidemiology is the study and control of disease or injury patterns in human
populations.
2. Suicideisthepurposefulacttoendone’slife.
3. Suicideattempt is anactof self-harm includingwhatwaspreviously referred toas
“para-suicidalbehavior”-theattempttohurtoneselfwithoutkilling.
• Thisisnowcallednon-suicidalself-injury.
C. CommonMythsAssociatedwithSuicide
1. Peoplewhotalkaboutsuicidewon’treallydoit.
2. Anyonewhotriestokillhimself/herselfmustbecrazy.
3. Ifapersonisdeterminedtokillhimself/herself,nothingisgoingtostophim/her.
4. Peoplewhocommitsuicidearepeoplewhoareunwillingtoseekhelp.
5. Talkingaboutsuicidemaygivesomeonethe idea tocommitsuicide,andthenthey
couldactonit.
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D. KeyFacts
1. Globally,over800,000peopledieduetosuicideeveryyear.AccordingtotheWorld
HealthOrganization,suicideisthefifthleadingcauseofdeath(2012).
2. Suicideisthe10thhighestcauseofdeathforallages,sexes,andethnicities.
3. In theU.S.alone,40,600suicideswere reported.Thisequates toonesuicideevery
12.9minutes.
4. Foreverysuicide,therearemanymorepeoplewhoattemptsuicideeveryyear.
5. A prior suicide attempt is the single most important risk factor for suicide in the
generalpopulation.
II. TheRoleofGenetics,Epigenetics,andEnvironment
A. FamilyandTwinStudies
1. There is a higher rate of suicidal behavior in relatives of suicide victims and
attempterscomparedtorelativesofnon-suicidalcontrols.
2. Mostsuicideattempters/completershaveunderlyingneuropsychiatricdiagnoses,but
familytransmissionmaybeindependentofthosepsychiatricdisorders.
B. AdoptionStudies
1. Showthatsuicideinvolvestheinheritedtraitoftemperamentofimpulsivityandthe
regulationofimpulsivityisinvolved.
2. Suicidecanhappenimpulsivelyinmomentsofcrisis,unrelatedtopsychiatricillness.
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C. TheFieldofEpigenetics
1. Looksatthepossibilitythatpartofthestronggeneticcomponent isdeterminedby
DNAmodification.
2. Epigeneticsignaturesareheritable,butcanbemodifiedbytheenvironment.
3. Thisisagrowingfield.
4. A number of recent studies have shown epigenetic alterations associated with
suicidalbehavior.
D. EnvironmentInteractingwithGenes
1. Apersonalhistoryofchildhoodabusehasbeenrepeatedlyimplicatedasariskfactor
forsuicidalbehavior.
2. Someepidemiologicalstudieshaveestimatedthatsexualabusemayexplain20%of
theriskvarianceinsuicide.
III. TheRoleofMentalIllnessinSuicide
A. PsychiatricDiagnoses
1. Majordepressivedisorder
2. Conductdisorder
3. Anxietydisorder
4. Substanceuse
5. PTSD
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B. Statistics
1. Ninetypercentofpeoplewhocommitsuicidehaveoneormorediagnosablemental
illnesses.
2. Sixtypercentofallsuicidesarecommittedbypeoplewithmooddisorders.
3. Approximately 30% of suicides are committed by people who have psychiatric
disordersotherthanmooddisorders.
4. Thirty percent of all clinically depressed individuals attempt suicide. About half
aresuccessful.
5. Persons discharged from mental hospitals are 34 times more likely to commit
suicidethanthegeneralpopulation.
6. Menwithasubstanceusedisorderareapproximately2.3timesmorelikelytodieby
suicidethanthosewhoarenotsubstanceabusers.Amongwomen,asubstanceuse
disorderincreasestheriskofsuicideby6.5times.Morethanone-fourthofsuicides
arealcoholrelated.
7. Bipolarwith comorbid substance use has almost a 40% rate of lifetime attempted
suicidecomparedtothosewithasubstanceuseonly.
8. The majority of suicidal behavior occurs in depressed patients, but the role of
antidepressantsiscontroversial.
IV. WhoisatRisk?
A. Gender
1. Menarefourtimesmorelikelytocommitsuicidethanwomen.
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2. Womenattemptsuicidethreetimesmoreoftenthanmen.
B. Age(WorldHealthOrganization–2012)
1. Generally,suicideratesincreasewithage.
2. Thehighestsuicideratewasamongpeople45-59yearsold.
3. Thesecondhighestrateoccurredinthose75andolder.
• Untreateddepression
• Physicalcauses
• Medication
• Healthcaresystem
4. Suicideisthesecondleadingcauseofdeathamong15-19yearolds.
C. Race/Ethnicity
1. Whitemalesaccountfor65%ofallsuicides.
2. ThesecondhighestrateisamongAmericanIndiansandAlaskanatives.
3. Much lower and similar rates were found among Asians and Pacific Islanders,
Hispanics,andblacks.
D. MaritalStatus
1. Marriage is associated with lower rates of suicide (heterosexual data only).
2. Divorcedpeoplearethreetimesmorelikelytocommitsuicidethanpeoplewhoare
married.Thisisthenumberonefactorinurbancenters.
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3. Divorcedandwidowedmenaremore likely thandivorcedandwidowedwomento
commitsuicide.
4. Livingaloneandbeingsingleincreasetheriskofsuicide.
5. Beingaparentdecreasestheriskofsuicide,especiallyformothers.
E. Geography
1. Mountainstateshavethehighestsuicidecompletionrates.
2. Peoplelivinginruralareasareathigherriskforsuicidethanthosewholiveinurban
areas.
3. ThelowestrateswereinNewJersey,NewYork,RhodeIsland,andMassachusetts.
F. ProfessionsandOccupations
1. Physicians
2. Dentists
3. Financeworkers
4. Lawyers
5. Policeofficers
6. Militaryveterans
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G. Economics
1. Extremesinwealthorpovertyareassociatedwithhighersuiciderates.
2. Timesofeconomicdepressionshavebeencorrelatedtoincreasedsuiciderates.
3. Unemployment or being in debt increases an individual’s feeling of hopelessness
makinghim/hermoresusceptibletosuicide.
H. TimeofYear
1. Despitepopularbeliefs,suicideratesdonotincreaseduringthewinterholidaysoron
an individual’s birthday. December is the lowest month related to completed
suicides.
2. Mostsuicidesoccurinthespring.
3. Statistically,therearemoresuicidesonMonday.
4. Norelationshipexistsbetweensuicidesandthephaseofthemoon.
I. MedicalandIllness
1. Terminallyill
2. Serious/chronicillnesses
3. Chronicpain
J. OtherFactors
1. Previousattempt(#1)
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2. Feelingsofhopelessness
3. ProtestantsmorethanCatholics
4. Culturalandreligiousbeliefsinwhichsuicideisglorified
5. Localepidemicsofsuicide
6. Isolation
7. Barrierstoaccessingmentalhealth
8. Loss
9. Easyaccesstolethalmethods
10. Unwillingnesstoseekhelpduetothestigmainvolved
11. Peoplewhohavelostafamilymemberorfriendtosuicide
12. Copycat
13. Sexualorientation(LGBT)
14. Peopleinvolvedinorarrestedforcommittingcrimes
15. Victimsofdomesticviolence
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V. MethodsofSuicide
A. Firearms
1. #1method
2. Accountsforover50%ofallsuicidedeaths
B. Suffocation
1. Includeshanging
2. Almost25%rate
C. Poisoning
1. Overdosing
2. 16.6%rate
VI. CommonTriggers
A. Loss
1. Romanticrelationship
2. JoborEducationalOpportunity
B. Grief
C. Changes
1. Healthofalovedone
2. Socialoreconomicstatus
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D. LegalProblems
VII. GeneralWarningSigns
A. TalkingAboutSuicide
B. SeekingLethalMeans
C. PreoccupationwithDeath
D. NoHopefortheFuture
E. GettingAffairsinOrder
F. SayingGoodbye
G. WithdrawingfromOtherPeople
H. Self-destructiveBehavior
I. SuddenSenseofCalm
J. Caseexample
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VIII. ProtectiveFactors
A. EffectiveClinicalCare
B. EasyAccesstoClinicalInterventions,SupportandHelp
C. FamilyandCommunityConnectedness
D. SupportfromOngoingMedicalandMentalHealthcareRelationships
E. Skills in Problem Solving, Conflict Resolution, and Nonviolent Ways of Handling
Disputes
F. CulturalandReligiousBeliefsthatDiscourageSuicideandSupportSelf-preservation
IX. Screening
A. Definitions
1. Suicide screening refers to a procedure in which a standardized instrument or
protocolisusedtoidentifyindividualswhomaybeatriskforsuicide.
2. Suicide assessment usually refers to a more comprehensive evaluation done by a
clinician to confirm suspected suicide risk, estimate the immediate danger to the
patient,anddecideonacourseofaction.
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3. DetectionTools
• BeckDepressionInventory
• The19-itemScaleforSuicidalIdeation
• TheColumbia-SuicideSeverityRatingScale(C-SSRS)
X. PreventionStrategiesA. RecognizeEarlyWarningSignsandIntervene
B. ReduceAccesstoLethalMethods
C. Follow-upSupport
D. BetterTrainingforPrimaryCareWorkers
E. Community-basedInterventions
F. SeniorPeer-counselingPrograms
G. ImprovementsinMentalHealthServicesThroughSuicidePreventionCenters
H. NationalHotline–(1-800-273-TALK)
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TNSU105:
TheChangingTideofTeenSuicide:Insights
intoaScreen-SaturatedGeneration
JoshuaStraub,Ph.D.
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AbstractAreyouastudentofyourteenager?Intoday’sculture,theinfluxofmediaandtechnologyhas
completely changed the teenage world. Suicide is rampant, and parents, counselors, and
caregivers need to be equippedwith knowledge and awareness in order to stem the tide of
suicide.Mainstreammediaisnormalizingsuicide,andteenagersneedhelpnowmorethanever.
Inthispresentation,Dr.JoshuaStraubwilldiscusstheimportanceoflisteningtoteenagersand
providepracticalstepsforparentsandcounselors.
LearningObjectives
1. Participantswillexploretheroleoftechnologyandmediainteenagesuicide.
2. Participants will uncover practical first steps to equipping parents, counselors, and
caregiversagainsttheriseofsuicide.
3. Participantswilldiscussthecoreneedsofteenagersandhowcaregiverscanhelpprovide
fortheseneeds.
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I. TeenSuicideinaChangingGeneration
A. BecomingStudentsofToday’sTeenagers
1. TVShows:13ReasonsWhy
• Suicideisnotsomebodyelse’sfault
• Adultsandmentalhealthprofessionalscanhelp
2. InternetGames
• BlueWhaleChallenge
3. SocialMediaBullying
• Kik
• Ask.fm
• Snapchat
• PornographyfromviraltextsorWhatsApp
B. ListenToTeenagers
1. Ameltingchocolatebar
2. Thescopeoftheproblem
C. EducateandSupportParents
1. Mainstreammediaisnormalizingsuicide,butinreality,suicideisamentalillness
2. Theillnessonlywinstemporarily
3. Emotionallysafehomesarecritical
4. Parentsarethefirstlineofdefense
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5. SettingLimits
• Snapchatlocationservices
• Passwordsharing
D. EducatingStudents
1. Threecoreneedsofstudents
• Identity
• Belonging
• Purpose
2. Empoweringstudents
E. PartnerwithStudentAdvocatesinYourLocalCommunity
1. iContactvs.eyecontact
2. Thereisnothingmorepowerfulthansomeonewhocaresenoughtositwithand
listentoastrugglingteenager.
3. Connectedness
II. StoppingtheTideofTeenSuicide
A. IndividualSolutions
1. Askslidingscalequestions
2. Adolescenttimeframesarenowandnotnow
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“Thereforewedonotloseheart.Thoughoutwardlywearewastingaway,yetinwardly
wearebeingreneweddaybyday.Forourlightandmomentarytroublesareachievingfor
usaneternalglorythatfaroutweighsthemall.Sowefixoureyesnotonwhatisseen,
butonwhatisunseen,sincewhatisseenistemporary,butwhatisunseeniseternal.”
– 2Corinthians4:16-18
3. Resourcefulness
B. FiveConversationsTeensLongforfromParents
1. Tellmeaboutsex
2. HowtofindGodformyself
3. Howtothinkthroughanxietyanddepression
4. Howtomakeresponsibledecisionsinabiblicalway
5. Howtoviewmyselfrightly
C. KeyComponents
1. Listening
2. Empathy
3. Psychoeducation
4. Community
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TNSU106:
TeenSuicideandSelf-injury:Assessment,
Diagnosis,andTreatmentStrategies
AmyFeigel,M.A.,and
MollyCatherineGoodson,M.A.,J.D.
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AbstractSuicidehasbecomethesecondleadingcauseofdeathamongtoday’steens-itisclearwemust
knowhowtoaddressandtreatthisepidemic. Studieshaveshownthat fouroutof fiveteens
will give some kind of warning sign prior to a suicide attempt. Do you know thesewarning
signs?Doyouknowhowyouwouldhelpayoungteenstrugglingwithsuicidalideationorself-
injuriousbehavior? Doyouhaveaplanfortreatment? Ifyouanswered"No"toanyofthese
questions, this video lesson is for you. Latest statistics, prevalence, etiology, assessment,
ethical/legalconcernsandsuccessfultreatmentstrategieswillbecovered.
LearningObjectives
1. Participantswillunderstand thecurrent trendsandcultureof suicideand self-injury in
today'syouth.
2. Participants will be able to utilize successful treatment strategies covered in this
workshoptoassistteensintheircommunity.
3. Participantswill know how to recognizewarning signs present in teens contemplating
suicide.
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I. TeenSuicideRisk
A. GuidingPrinciplesforCounselors
1. Identifythelocusoftheclient’sunbearablepain(EdwinShneidman,1972)
2. Inthecontextofacaringrelationshipweassisttheclientindiscoveringtheirhurtand
helpthemmanagelife’schallenges.(Shneidman,1968)
3. Allbehaviorsarepurposeful
4. Currentresearchinsuicideprovidessubjectivedata
5. Seekto“understand”yourteenclientversus“treat”yourteenclient
6. Becomeastudentofyourteenager
B. StagesofPsychosocialDevelopment
1. Ages13-19
2. Identityvs.roleconfusion
3. Riskfactorsduringthistime:
• Decreasedhopeaboutfuture
• Parentalexpectations
• Insecurity
• Lackofopportunitytofindpassion
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C. Statistics
1. ThePediatricAcademicSocietiesMeetinginMay2017,foundthatthenumberof
childrenandteensadmittedtochildren'shospitalsforthoughtsofsuicideorself-
harmhavemorethandoubledduringthelastdecade.
2. In2014,HamiltonCounty(Cincinnatiarea)sawfoursuicidesofpeople18andunder.
In2015,therewerefive.In2016,therewere13.
3. Theannualnumberofteenyouthsuicideseachyearfromages10-24isabout4,600.
4. Theaveragenumberofteensuicidesperdayis12.
5. Theaveragenumberofsuicideattemptsperyearis575,000.
6. 20%ofhighschoolstudentssurveyedsaytheyhaveseriouslyconsideredsuicide.
D. 10LeadingCausesofDeathbyAgeGroup10-24
1. Unintentionalinjury
2. Suicide
3. Homicide
4. MalignantNeoplasms
5. HeartDisease
6. CongenitalAnomalies
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7. Influenza&Pneumonia
8. DiabetesMellitus
9. ChronicLowRespiratoryDisease
10. Cerebrovascular
E. TheMostCommonMethodsofSuicide
1. Suffocation
2. Firearms
3. Poisoning
II. UnderstandingSuicide
A. 10MythsofSuicide
1. Suicideshappenwithoutwarning
2. Suicideissolelygenetic
3. Onlycertaintypesofpeoplediebysuicide
4. Suicideisanactofaggression,anger,orrevenge
5. Talkingtoteensaboutsuicidemakesthemlikelytokillthemselves
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6. Peoplewhotalkaboutsuicidearenotseriousaboutkillingthemselves
7. Suicidalthoughtsandbehaviorsarewaystogetattention
8. Suicidalteensoverreacttolifeevents
9. Teensareatlessriskforsuicideassoonastheystarttofeelbetter
10. Suicidecannotbeprevented
B. Definitions
1. Non-SuicidalMorbidIdeation:Thoughtsof,“ItwouldbebetterifIjustwenttosleep
andneverwokeup.”
2. SuicidalIdeation:Thoughtsinwhichself-inflicteddeathisthedesiredoutcome.“I
wanttokillmyselfbutIhaven’tformulatedaplan.”
3. SuicidalBehavior:
• Non-suicidalself-injury
• Suicideattempt,potentiallyinjuriousbehaviorwithanon-fataloutcomefor
whichthereisevidenceofintenttodie
• Interruptedsuicideattempt
• Abortedsuicideattempt
• Suicidedeath
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C. TheoriesofSuicide
1. Shneidman’sTheoryoftheSuicidalMind
• Unmetandthwartedneeds
• Intolerablepsychologicalpain
2. ThomasJoiner’sInterpersonalTheoryofSuicide
• Perceivedburdensomeness
• Failedbelongingness
• Acquiredcapability
3. JosephRichman’sFamilySystemsTheoryofSuicide
• Roleconflict
• Overlypermeableboundaries
• Dysfunctionalalliances
• Rigidity
• Inabilitytochange
• Poorcommunicationskills
D. MentalIllness
1. Depressivedisorders
2. Anxietydisorders
3. Traumaandstressdisorders
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III. RiskAssessment
A. AssessmentTips
1. Thetherapeuticallianceisthemostimportantfactorinasuccessfulassessmentof
suicidalideationandintent.
2. Understandandactivelylisten
3. Payattentiontobodylanguageandhesitancyofanswers
4. Assessmentdoesnotbeginwithdirectinquiryaboutsuicidalthoughtsorbehaviors
5. ISPATHWARM?
• Ideation
• Substanceabuse
• Purposelessness
• Anxiety
• Trapped
• Hopelessness
• Withdrawal
• Anger
• Recklessness
• MoodChanges
6. Thechallengeoftheadolescent—JackKlott,Suicidologist
• Emergingmentaldisordersandself-medicating
• Isolationandrejection
• Victimofbullying
• Acculturationissues
• Academicperformanceanxiety
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• Familydiscord
• Impulsivityandavailabilityoffirearms
• Survivorofsuicide
B. HowDoWeHelp?
1. DialecticalBehaviorTherapy
• Balancingproblem-solvingandvalidation;synthesizeopposingtensionsbetween
acceptanceandchange,goodandbad,positiveandnegative;
• Decreasebehaviorsthatarelife-threateningandincreasebehavioralskills,(2)
Decreaseposttraumaticstress,(3)Increaseself-respectandachievingindividual
goals,(4)Resolveasenseofincompletenessfindingfreedomandjoy.
2. CognitiveBehavioralTherapy
• Perceptionofyourenvironmentsignificantlyshapessubsequentaffect,andaffect
isinturnassociatedwiththeirbehavioralresponses.
• Keycomponents:emotionregulation,cognitiverestructuring,enhancing
problem-solvingskills,improvinginterpersonaleffectiveness
• Solicitingsocialsupportfromothers;commitmenttotreatmentstatements;
relaxation;crisiscards;journaling;art;moodgraphing;hopekits
3. Attachment-basedFamilyTherapy
• ABFTaimstorepairrupturesintheattachmentrelationshipandestablishor
resuscitatethesecurebasethatissoimportantforadolescentdevelopment
• Accesslongingforgreaterclosenessandrebuildingtrust.
• Buildanalliancewithadolescent.
• Buildanalliancewithparent.
• Reattaching–thefamilysession.
• Promotecompetency—pursuingprosocialactivitiesoutsideofthehome.
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C. TheUltimateGoalsforTreatment
1. Findthesourceofthepain
2. Findanewsolution
3. Instillaneternalsenseofhopeandbelonging
D. TheTwoQuestions
1. Wheredoyouhurt?
2. HowcanIhelpyou?
IV. SocialMedia,Sexting,andCyberbullying
A. Statistics
1. DigitalTechnologyOwnership
• 88%ofAmericanteenagers(ages13-17)haveorhaveaccesstoamobilephone
ofsomekind.73%ofthosehavesmartphones
• 87%ofAmericanteenagers(ages13-17)haveorhaveaccesstoadesktopor
laptopcomputer
• 58%ofteenshaveorhaveaccesstoatabletcomputer
• 81%ofteens(ages13-17)haveorhaveaccesstoagameconsole
2. TeenagersandtheInternet
• 24%ofteenagersgoonlinealmostconstantly
• 92%ofteenagersreportgoingonlinedaily
• 56%ofteenagersgoonlineseveraltimesaday
• 12%ofteenagersreportgoingonlineonceaday
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3. TeenagersandTexting
• 91%ofteencellphoneownersusetextmessagingdirectlythroughtheirphone,
anapp,orawebsite
• 33%ofteenswithcellphonesusemessagingapps
4. TeensandSocialMedia
• 89%ofteenagersreportthattheyuseatleast1socialmediasite
• 71%ofteenagersusetwoormoresocialmediasites
• 71%useFacebook,52%useInstagram,41%useSnapchat,33%useTwitter
B. Sexting
1. Sexting:Theactofsendingorreceivingsexuallyexplicitmessagesandphotosviacell
phoneorotherelectronicdevice.
2. Sextingforteenagersisillegalandisconsideredchildpornography.
3. Statistics
• 1in5girlsand1in10youngergirlshaveelectronicallysentorpostednudeor
semi-nudephotosofthemselves
• 37%ofteenagershavesentorpostedsexuallysuggestivetexts,emails,orinstant
messagestootherteenagers
• 51%ofgirlssaythatguyspressuredthemtosendsexymessagesorimages
• 18%ofboyssaythatgirlspressuredthemtosendsexymessagesorimages
• 69%ofteenshavesentsexualimagesormessagestoaboyfriendorgirlfriend
• 39%ofteenshavesentsexualimagesormessagestosomeonetheyhavedated
• 30%ofteenshavesentsexualimagesormessagestosomeonetheywanttodate
• 11%ofteenshavesentsexualimagesormessagestosomeonetheydidnoteven
know.
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C. Cyberbullying
1. Statistics
• 34%ofstudentsexperiencecyberbullyingintheirlifetime,with17%sayingthatit
happenedinthelast30days
• 64%ofthestudentswhoexperiencecyberbullyingsaythatitreallyaffectstheir
abilitytolearnandfeelsafeatschool
• 12%ofstudentsadmittedcyberbullyingothersintheirlifetime
2. Commonlyreportedbehaviorsofcyberbullyinginclude:
• 60%-spreadingrumorsonline
• 58%-postingmeancommentsonline
• 54%-threateningtohurtsomeone
• 83%ofstudentswhohavebeencyberbulliedwithinthelast30dayshavealso
beenbulliedatschool
• 69%ofstudentswhoadmittedtobullyingothersinschoolalsobullyonline
3. Jessica’sstory
4. Audrey’sstory
D. WhatCanParentsDo?
1. Beopenandhonestwithteenagersaboutthedangersofteensexting
2. Understandthatyourteenagerisstillyounganddoesnotfullyunderstandthe
ramificationofdecisions
3. Setacurfewforyourteenager’scellphone
4. Knowwhatappsareonyourteenager’sphonesandhowtheywork
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5. Beawareofwhatyourteenagersaretextingabout
6. Knowhowsocialmediaappswork
7. Knowwhatyourteenagersarelookingatonline
8. Ifyourteenagerisinvolvedinpornography,getthemprofessionalhelp
9. Ifyourteenagerisbeingbulliedonline,provideasafespaceforthemandaccessto
appropriateresources
10. Loveyourteenager
“ItisGod’swillthatyoushouldbesanctified:thatyoushouldavoidsexualimmorality;thateach
ofyoushouldlearntocontrolyourownbodyinawaythatisholyandhonorable…ForGoddid
notcallustobeimpure,buttoliveaholylife.”
—1Thessalonians4:3-4,7
“Doyounotknowthatinaracealltherunnersrun,butonlyonegetstheprize?Runinsucha
wayastogettheprize.Everyonewhocompetesinthegamesgoesintostricttraining.Theydoit
togetacrownthatwillnotlast,butwedoittogetacrownthatwilllastforever.ThereforeIdo
notrunlikesomeonerunningaimlessly.”
—1Corinthians9:24-26a
“Therefore,sincewearesurroundedbysuchagreatcloudofwitnesses,letusthrowoff
everythingthathindersandthesinthatsoeasilyentangles.Andletusrunwithperseverancethe
racemarkedoutforus.”
—Hebrews12:1
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Resources
• AmericanFoundationforSuicidePrevention(AFSP)—www.afsp.org
• NationalSuicidePreventionLifeline—www.suicidepreventionlifeline.org
• SocietyforthePreventionofTeenSuicide—www.sptsusa.org
• AmericanAssociationofSuicidology(AAS)—www.suicidology.org
• HeartLightMinistries–parentingtodaysteens.org(MarkGregston)
References
Lenhart,A.(2015).“Teens,socialmedia&technologyoverview2015.”PewResearchCenter.Retrievedfrom
http://www.pewinternet.org/2015/04/09/teens-social-media-technology-2015/
FloridaAtlanticUniversity.(2017).“Nationwideteenbullyingandcyberbullyingstudyrevealssignificantissues
impactingyouth.”Retrievedfromhttp://www.prnewswire.com/news-releases/nationwide-teen-bullying-
and-cyberbullying-study-reveals-significant-issues-impacting-youth-300410161.html
Judge,A.M.,(2012).“Sexting”amongU.S.adolescents:Psychologicalandlegalperspectives,HarvardReviewof
Psychiatry,20(2),86-96.
Comartin,E.,Kernsmith,R.,&Kernsmith,P,(2013).Sextingandsexoffenderregistration:Doage,gender,and
sexualorientationmatter?,DeviantBehavior,34,38-52.
Mitchell,K.J.,Finklehor,D.,Jones,L.M.,&Wolak,J.(2012).Prevalenceandcharacteristicsofyouthsexting:A
nationalstudy,Pediatrics,129(1),13-20.
Rosin.,H.(2014).Whykidssextandwhattodoaboutit.TheAtlantic,November2014,66-77.
Jolicoeur,M.,&Zedlewski,E.,(2010).Muchadoaboutsexting.NationalInstituteofJustice(June2010),Retrieved
fromhttps://www.ncjrs.gov/pdffiles1/nij/230795.pdf.
Madden,M.,Lenhart,A.,Duggan,M.,Cortesi,S.,&Gasser,U.(March13,2013).TeensandTechnology2013.
Retrievedfromhttp://www.pewinternet.org/Reports/2013/Teens-and-Tech.aspx.
Hindjua,S.,&Patchin,J.W.,(September2014).Statesextinglaws:Abriefreviewofstatesextinglawsandpolicies,
CyberbullingResearchCenter.Retrievedfromhttp://www.cyberbullying.us/state-sexting-laws.
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TNSU107:
HelpingTeensinCrisis
JoshuaStraub,Ph.D.
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AbstractThe teen years are some of the most challenging in many ways. Teenagers must face new
pressures,changingbodies,andadevelopingsenseofidentity.Counselorsandcaregiversneed
to be aware of the crises that teenagers face during these formative years, and must be
equipped with knowledge and tools to help teenagers through their individual crises. In this
presentation,Dr.JoshuaStraubpresentsanoverviewoftheproblemthroughcurrentstatistics
andresearch,thenprovidesastep-by-stepmethodforeffectivelyhelpingteenagers.
LearningObjectives
1. Participants will identify the scope of the issues and problems that teens today
experience.
2. Participantswilldiscoverthesevenstepsofhelpingteenagersthroughcrises.
3. Participantswillexploreabiblicalperspectiveonteenagersandsuffering.
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I. UnderstandingtheStatistics
A. SelfEsteem
1. 85%ofteenswanttoimprovesomethingaboutthemselvesphysically.Thetoptwo
arelosingweightandtoningup.
2. 63%ofteengirlsfeelinsecurewearingtheirswimsuitonthebeach.
3. 27%believetheylook“hot”intheirswimsuit.
4. 75%ofgirlshavewishedtheycouldsurgicallychangesomethingabouttheirbodies.
5. 20yearsago,modelsweighed8%lessthantheaveragewoman.Today,models
weigh23%lessthantheaveragewoman.
6. 81%of10yearoldsthinkthey’retoofat.
7. 70%ofgirlsbelievetheydonotmeasureup.
8. 62%ofgirlsfeltinsecureorunsureofthemselves.
9. 57%ofgirlshadamomwhocriticizesherownlooks.
10. 75%ofgirlsreportedengaginginnegativeactivitiessuchasdisorderedeating,
cutting,bullying,and/ordrinking,andfeelingbadforthemselves.
11. 67%ofgirlsages13-17turntotheirmotherasaresourcewhentheyfeelbadlyabout
themselves,comparedto91%ages8-12.
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12. Girlswithlowself-esteemarelesslikelytoreceivepraisefromeitherparentand
morelikelytoreceivecriticism.
13. Thetopwishofallteenagegirlswasthattheirparentswouldcommunicatewith
them.
B. TheHookupCulture
1. 82%ofnon-Christianteensbelieveitisoktocohabitatebeforemarriage.
2. 64%ofteenshavehookedupwithsomeonetheyconsiderafriend.
3. Nearly50%havehadsexualintercourse.
4. 33%ofteenagershavehadsexualintercourseinthepast3months.
C. TeenSuicide
1. Teensuicideisamongthetopleadingcausesofdeathamongteenagers.
2. ThreemillionstudentsannuallywilldevelopanSTD.
3. Studentsspendabout5.5billiondollarsonalcoholalone.
4. TheU.S.ranksamongthehighestintheworldforstudentswhodonotfeelhappy
withtheirlives.
5. 1in4girlsintheU.S.and1in5boysdonotfeelhappy.1in5girlsadmittofeeling
lonely.
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D. AdditionalIssues
1. 90%of8-16yearoldshaveviewedpornonline.
2. 70%ofteenagemalesregularlyviewpornography.
3. 33%ofteenagewomenreportsexualabuse.
4. 1in4boysexperiencesexualabuse.
5. 40%ofAmerica’schildrenliveinafatherlesshome.
6. Fatherlesshomesaccountfor63%ofyouthsuicides,90%ofhomelessandrunaway
children,85%ofchildrenwithbehaviorproblems,71%ofhighschooldropouts,85%
ofyouthsinprison,andover50%ofteenmothers.
E. WhatTeensNeedtoKnow
1. Painandsufferingbuildscharacter.
2. Theamountofsufferingisnotequaltotheamountofsininourlives.
3. Ascounselors,wemustdevelopatheologyofsuffering.
II. TheSevenStepsofHelpingTeenagersintheMidstofCrisis
A. SeeThem
1. Wecannottreatwhatwedonotsee.
2. Theabilitytoseeourteenagersisproportionatetoourabilitytohelpthem.
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B. StabilizetheSituation
1. Lookatthedifferencebetweentheeventandthereactions.
2. Weacknowledgethereactiontotheevent,nottheeventitself.
3. Wemustremainstablewhenworkingwithteenagers.
4. Don’tgetcaughtinthepanic,butdon’tminimizeortrivializeaperson’ssuffering.
C. CreateSafety
1. Teenswhoneedyouwilltestyoutoseeifyouaresafeandcanbetrusted.
2. Yourauthoritycomesfromyourknowledge.
3. Weneedtoseetheteenager’sattachmentstyle.
D. NormalizeThoughtsandFeelings
1. Don’tassumethemeaningofateenager’spain.
2. Thisdoesnotmeanthatweagreewiththeirthoughts,butteenagersneedtoknow
thatwhattheyareexperiencingisnormal.
3. Sympathyisfeelingbadforsomeone,empathyisfeelingbadwithsomeone.
4. Don’tminimizeorjudgetheirfeelings.
5. Don’tuse“Christian-ese”.
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6. Respecttheteenagerforwhotheyareevenifyoudon’tagreewiththem.
7. Reframethemeaningoftheirstory.
8. Identifythekeyfactorsandrelationshipsintheteenager’sstory.
9. Weneedtoteachteenagerstoforgiveandacceptforgiveness.
10. Sevenstagesofhelpingteenagersnormalizethoughtsandfeelings:
• Listentotheminsteadofofferingopinions
• Offerrespectratherthanjudgment
• Seekinformationfromthem
• Don’tassumethemeaningoftheirpain
• Usereflectivelistening
• Askopen-endedquestions
E. DevelopStructure
1. Setgoalswiththeteenagerinsuchawaythatwillhelpthemgetthroughthecrisis.
2. Setrealistic,short-termgoalsthatwillbreedsuccessovertime.
F. EstablishSupport
1. Supportisthebiggestfactorinhelpingpeopleovercomecrises.
2. Themoreweloveandsupporttheteenagerandcreateasafeenvironment,the
bettertheywillbeabletogetthroughthecrisis.
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G. ReferWhenNecessary
1. Knowyourlimitations.
2. Don’tovercommityourself.
3. Knowyourroleasthecounselororcrisisinterventionist.
III. ABiblicalPerspective
A. TheHolySpirit
1. 25%ofAmericansreadtheBibleatleast10minutesdaily;80%ofthat25%percent
areover55.
2. Recommendedscripturereadings:
• Acts4:13
• Psalm44
• Psalm139
B. Conclusion
1. Sometimesyouaredealtabadhandinlife,butwhatdifferentiatesthepeoplewho
makeitandthepeoplewhodon’tistheabilitytoplaythatpoorhandwell.
AsHepassedby,Hesawamanblindfrombirth.AndHisdisciplesaskedHim,“Rabbi,
whosinned,thismanorhisparents,thathewouldbebornblind?”Jesusanswered,“It
wasneitherthatthismansinned,norhisparents;butitwassothattheworksofGod
mightbedisplayedinhim.WemustworktheworksofHimwhosentMeaslongasit
isday;nightiscomingwhennoonecanwork.–John9:1-4
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2. Nomatterwhatthecrisisis,knowingtheanswertothe“Why”questionstillwould
notsatisfy.
3. Comfortdoesnotcomefromexplanations.Comfortcomesfromthepromisesof
God.
4. Don’task“Why”–ask“Towhatpurpose”?
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TNSU108:
TheEthicsofSuicideIntervention
MiriamParent,Ph.D.
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AbstractWorkingwithpeopleinsuicidalcrisisisaverystressfulandethicallycomplicatedscenario.The
ethicalprinciplesofbeneficence,non-maleficence,autonomy, justice, fidelity,andveracityare
importantwhendealingwithclientsinregardtosuicide.Itisimportanttonotethatlawsdiffer
ineachstatewhenitcomestodutytowarn/dutytoprotectandendoflifelegislation.Thereare
severalquestionsamentalhealthprovidershouldaskwhendecidingtobreakconfidentialityin
suicidal crisis. During ethical decisionmaking, themental health provider should identify the
problemandpotential issuesinvolved,knowandreviewallethicscodes, laws,regulationsand
policies,obtainconsultation,considerallpossiblecoursesofaction,choosewhatappearstobe
thebestcourseandfollowthrough,anddocumenttheprocessandoutcomes.
LearningObjectives
1. Participantswill identifytheethicalprinciplesinvolvedindealingwithclientsinsuicidal
crisis.
2. Participants will understand important questions which need to be addressed when
decidingtobreakconfidentialityinsuicidalcrisis.
3. Participantswillexplorethestepsneededduringethicaldecisionmaking.
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I. Introduction
A. Ethics
1. Noteveryone’spassion,butitdoesneedtobeourconcern.
2. WemustprovidequalityeducationandinterventionsinawaythathonorsGod.
3. Wemustmeetthecivilandprofessionalresponsibilitiesthatwehaveagreedto.
B. WorkingwithPeopleinSuicidalCrisis
1. Consistentlyranksasoneofthemoststressfulandethicallycomplicatedscenarios.
2. Self-careindealingwithsuicidalcrisisisamajorethicalresponsibility.
3. Burnoutishighandcanleadtohurtingyourselfandothers.
4. Daniel6:5
Thenthesemensaid,“Wewillnot findanygroundofaccusationagainstDaniel
unlesswefinditagainsthimwithregardtothelawofhisGod.”
5. GodwillprovideuswiththewisdomanddiscernmentweneedifweseekHim.
II. EthicalPrinciplesA. Hippocrates
1. Beneficence–dogood
2. Non-maleficence–donotharm
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B. Justice
1. Equalaccess
2. Fairness
3. Equality
C. Veracity
1. Integrity
2. Truthfulness
D. Autonomy
1. Self-determination–myrighttochoose.
2. Bedrockofinformedconsent.
3. In suicidal crisis, we are often faced with the dilemma of overriding someone’s
autonomy.
E. Fidelity
1. Trustandconfidentiality.
2. Bedrockofamentalhealthpractice.
3. Allowspeoplethesafetytotalkabouttheirpain.
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III. CompetingEthicalIssues
A. Confidentiality
1. Tiedtotheissueoftrustandfidelity.
2. Essentialtoanycounselingrelationship.
3. Clientsneedtoknowandhaveinwritingtheconditionswhenconfidentialitymaybe
waivedorlimited.
4. Harmtoselforothersneedstobeoneofthoseclearlimits.
5. When dealing with suicidal crisis, we are constantly balancing confidentiality and
keepingourclient’strustwithpreservinglife.
B. PreservingLife
1. Interveninginsuicidalcrisis
2. Weshouldintervenetherapeuticallyinwaysthathonortheclinicalrelationship.
3. Whenclinicalinterventionsareinsufficient,wemayhavetooverrideconfidentiality.
4. Example–AACCCodeofEthics
IV. CompetingLegalIssues
A. Privilege/Confidentiality
1. Privilege is the rightof the client todeterminehowandwithwhom information is
shared.
2. Protectedformentalhealthprofessionalsbystateandfederallaw.
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3. Fewunderstandthedifferencesbetweenthelegalrequirementofprivilegeandthe
ethicsofconfidentiality.
B. VariableStateLegislation
1. Inregardtoharmtoselforothers,statelawsvary.
2. Tarasofflaws–dutytoprotect/dutytowarn.
3. Map – states vary. Some statesmandate while other statespermitmental health
professionalstoreport.
C. IntenttoHarmCriteria
1. Thethreatisserious.
2. Thethreatisimminent.
3. Thethreatisdoable.
4. Thethreatisagainstselforanidentifiableperson(s).
D. FutureTrends
1. Statelawsarechangingtoreflectthedebateoverfirearms.
• NYSAFEAct(2013)
• ILFOIDMentalHealthReporting(2014)
2. DeathwithDignitydebates
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V. BreakingConfidentialityinSuicidalCrisis
A. WhoHoldstheLegalPrivilege?
1. Inmost cases, aminor does not hold legal privilege. Theparent or legal guardian
does.
2. Ifanadultchoosesnottohavethementalhealthprofessionaldisclose,theirrightto
privilegeisbeingoverridden.
B. IsThereanAppropriateInformedConsentAgreement?
1. Isthereawritten,signeddocument?
2. Hasthisbeenreiteratedinverbaldiscussion?
C. WhatInformationisNeededtoPreserveLife?
1. Limitdisclosuretoessentials.
2. Therestofthementalhealthrecordcanremainconfidential.
D. WhoisintheBestPositiontoIntervene?
1. Sometimesitisfamily.
2. Sometimesitislegalormedicalauthorities.
3. Custodialissuesmayneedtobeconsidered.
4. Beverycarefulwithinstitutionalinvolvement.
E. IsthisaMandatedorPermissiveReportingSituation?
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VI. EthicalDecisionMaking
A. IdentifytheProblemorDilemma
1. Articulatethedilemma.
2. Isitanethical,legal,professional,clinical,orspiritualissue?
B. IdentifythePotentialIssuesInvolved
C. KnowandReviewallRelevantEthicsCodes,Laws,Regulations,andPolicies
D. ObtainConsultation
1. ConsultGodthroughprayer.
2. Consultotherprofessionalstogetasecondsetofeyesonthesituation.
E. ConsiderallPossibleCoursesofActionandtheirConsequences
F. ChoosewhatAppearstobetheBestCourseandFollowThrough
G. DocumenttheProcessandOutcomes
VII. Conclusion
A. Ethically
1. Be proactive.
2. Haveclear,written,informedconsentregardingconfidentialityforeveryclient.
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B. Spiritually
1. Seekwisdom.
2. Knowledgeplusdiscernmentequalswisdom.
3. Proverbs9:10
“ThefearoftheLordisthebeginningofwisdom,andtheknowledgeoftheHoly
Oneisunderstanding.”
C. Professionally
1. Haveestablishedpolicies.
2. Knowthegeneralpoliciesthatarerequiredorexpectedinyourarea.
D. Clinically
1. Carefortheclient.
2. Seektodogood.Donotdoharm.
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TNSU109:
SuicidePreventionand
InterventionwithAdolescents
JoshuaStraub,Ph.D.
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AbstractSuicidalbehaviors,suicidalideation,andnon-suicidalself-mutilatingbehaviors(SMB)areissues
surrounding today’s adolescents. Today’s youthmayengage in SMB to stopbad feelings, feel
something(evenifitispain),punishthemselves,relievefeelingsofnumbnessoremptiness,feel
relaxed, or give themselves something to do when alone. There are risk factors involved in
suicidal behaviors and causes/triggers that caregivers need to understand. Caregivers and
parentsareinstrumentalinpreventingandinterveningduringasuicidalcrisis.Adolescentswant
tobeunderstood.Connectednessmustbebuiltbetweenindividuals,withinthefamily,between
families and community organizations, and between community organizations and social
institutions. Emotional safety is key for an adolescent because a safe relationship equals love
minusfear.
LearningObjectives
1. Participantswill identify risk factors, causes/triggers, andmultifaceted factors involved
withsuicidalbehaviors.
2. Participants will define steps parents can take involving technology that will be
instrumentalinkeepingtheiradolescentssafe.
3. Participantswill explore the importanceof connectedness for adolescents in regard to
suicidepreventionandintervention.
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I. Introduction
A. SuicidalBehaviors(FatalandNonfatalAttempts)
B. SuicidalIdeation
C. Non-suicidalSelf-MutilatingBehaviors(SMB)
D. Statistics
1. Foryouthbetweentheagesof10and24,suicide isnowthethird leadingcauseof
death.
2. The top three methods used in suicides of young people include firearms (45%),
suffocation(40%),andpoisoning(8%).
3. Moresurvivesuicideattemptsthanactuallydie.
• Anationwidesurveyofyouth ingrades9-12 inpublicandprivateschools in
theUnitedStates foundthat16%ofstudentsreportedseriouslyconsidering
suicide, 13% reported creating a plan, and 8% reported trying to take their
ownlives.
4. Boysaremorelikelythangirlstodiefromsuicide.
5. Girlsarethreetimesmorelikelytoattemptsuicidethanboys.
6. Hispanicyoutharemorelikelytoreportattemptingsuicidethantheirblackorwhite
peers.
7. TheNativeAmericanpopulationisveryhighamongyouthsuicides,aswell.
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E. Self-injuryStatistics
1. In2007,someformofnon-suicidalself-injury(NSSI)wasself-reportedbynearlyhalf
ofhighschoolstudents.
2. 40%ofindividualswhoharmthemselvesreportsuicidalideations.
3. 64%ofadolescentswhoengageinself-injuryarefemale.
II. Self-mutilatingBehaviors(SMB)
A. TopFiveMethods
1. Cuttingorcarvingone’sskin
2. Pickingatwounds
3. Hittingoneself
4. Scrapingone’sskintodrawblood
5. Bitingoneself
B. TopSixReasons
1. Tostopbadfeelings
2. Tofeelsomething,evenifitispain
3. Topunishoneself
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4. Torelievefeelingsofnumbnessoremptiness
5. Tofeelrelaxed
6. Togiveoneselfsomethingtodowhenalone
C. Self-MutilatingBehaviorProtocol
1. IdentifyingthefunctionoftheSMB
2. Findingfunctionallyequivalentbehaviors
3. Improvingemotionregulation
4. Learningbehavioralwaystorelax
5. Learningwaysofengagingtheworld
III. SuicidalBehaviors
A. RiskFactors
1. Historyofprevioussuicideattempts
2. Familyhistoryofsuicide
3. Historyofdepressionorothermentalillness
4. Alcoholordrugabuse
5. Stressfullifeeventorloss/bullying
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6. Easyaccesstolethalmethods
7. Exposuretothesuicidalbehaviorofothers
8. Incarceration
B. Causes/Triggers
1. Majordisappointment
2. Rejection
3. Failure
4. EducationalStruggles
5. Loss–suchasbreakingupwithagirlfriendorboyfriend
6. Witnessingfamilyturmoil
7. Mentalorsubstance-relateddisorder
C. MultifacetedFactors
1. Genetics
• Thereisnoscientificevidencethatsuicideispasseddowngenetically.
• Thereisanindirecteffectthroughfamilyturmoil.
• There is an indirect effect through other family members who have
committedsuicide.
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2. Physiological(brainchemistry)
• Non-pharmacologicaltreatment
• Pharmacologicaltreatment
3. Developmentalfactors
• Puberty
• Hormones
4. Environmentalfactors
5. Socialfactors
• What’shappeningatschool?
• What’shappeningonline?
• Bullying
• Cyberbullying(ask.fm)
6. Culturalfactors
• Economy
• Sexualidentityissues
D. StepsforParents(Technology)
1. Keepallcomputersinthelivingroom.
2. Tellyourchildrennottogiveoutpersonalinformationtoanyoneonline.
3. Gooveryourchildren’sbuddy/friendlistsandaskthemwhoeachpersonis.
4. Discuss and help them understand more about cyber bullying as a victim and a
perpetrator.
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IV. SuicidePreventionandIntervention
A. CentersforDiseaseControl(CDC)Recommendations
1. Connectedness–thedegreetowhichapersonorgroupissociallyclose,interrelated,
orsharesresourceswithoneanother.
2. Promote individual, family, and community connectedness to prevent suicidal
behavior.
B. ConnectednessBetweenIndividuals(RealorPerceivedSocialSupport)
1. Decreasesthethreatlevelappraisalofexperiencedstress
2. Increasesphysiologicalfunctioning–cardiovascular,immune,endocrine
3. Buildsimmunitytodiseaseandresistancetostress
4. Discouragesmaladaptivecopingbehaviors
C. ConnectednessinFamily
1. Connectednessbetweenteensandtheirparentshasbeenassociatedwithdecreased
suicidalbehaviorsincross-sectionalstudiesacrossallcultures.
2. Disruptedsocialnetworks,suchasfamilydiscordorproblemswithfriends,havethe
oppositeeffect,significantlyincreasingtheriskofsuicidalideation.
3. EmotionalSafety
• Saferelationship=love–fear
• “Thereisnofearinlove;butperfectlovecastsoutfear,becausefearinvolves
punishment,andtheonewhofearsisnotperfectedinlove.Welove,because
Hefirstlovedus.”—1John4:18-19
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• “In attachment, we need to be open to our child, feeling that safety in
ourselvesandcreatingthesenseof‘lovewithoutfear’inourchild.”
• “…thequestionisn’tsomuch‘Areyouparentingtherightway?’asitis:‘Are
youtheadult thatyouwantyourchild togrowuptobe?”—BreneBrown,
Ph.D.,DaringGreatly
4. ConnectednessofFamiliestoCommunityOrganizations
• Schools/universities
• Placesofemployment
• Communitycenters
• Churchesandotherreligiousinstitutions
5. ConnectednessofCommunityOrganizationsandSocialInstitutions
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TNSU110:
ConductingaSuicideAssessment:
UsingtheSafe-TModel(withroleplays)
GarySibcy,Ph.D.
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AbstractInthissession,Dr.GarySibcyreviewsandunpackstheSafe-T5StepEvaluation&TriageSystem
for Suicide Assessment developed by the Substance Abuse and Mental Health Services
Administration(SAMHSA)oftheAmericanPsychologicalAssociation(APA).Throughthreerole
plays,Dr.Sibcydemonstrateshowtousethismethodwithclientsofvaryingsuiciderisk level.
Clinicians are encouragednot only to get a suicide assessment right, but to demonstrate and
document how they have thought through the factors competently and documented the
process.
LearningObjectives
1. ParticipantswillnameanddescribethefivestepsofusingtheSafe-Tmethodwithclients
whoneedsuicideintervention.
2. Participantswill be exposed to threedifferent role plays showing appropriate clinician
responsetodifferinglevelsofsuicidalideation.
3. Participants will understand how the client’s risk and protective factors informed
decision-makingineachofthethreescenarios.
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I. Introduction
A. ThreeRolePlays
B. Safe-TMethod
1. Safe-T5StepEvaluationandTriageSystemforSuicideAssessment
2. Developed by the Substance Abuse and Mental Health Services Administration
(SAMHSA)oftheAmericanPsychologicalAssociation(APA)
II. TheFiveSteps
A. Step1:RecognizeSuicideRiskFactors1. Thekindofthingsthatputpeopleatrisk.
2. Triggerscombinedwithmentalhealthriskfactors.
B. Step2:CompareRiskFactorswithExistingProtectiveFactors
1. Religiousbeliefs
2. Senseofobligation
3. Otherreasonsforliving
C. Step 3: Inquiry and Assess the Client’s State of Mind with Respect to Attachment,
History,andIdeation1. Dotheyhaveaplan?
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2. Dotheyhaveintention?
3. Howmuchdotheywanttodiecomparedwithhowmuchtheywanttolive?
D. Step4:DetermineaHigh,MediumorLowLevelofRisk
E. Step5:DocumentandImplementaTreatmentPlan
F. FollowingtheSafe-TMethod
1. Itisnotonlyimportanttogetasuicideassessmentright,butitisalsoimportantthat
you have thought through the factors competently and documented the process.
2. Whenapersonisreferredbysomeoneelseasopposedtocomingbecausetheyfeel
liketheyneedhelp,thisitselfispartofariskprofile.
III. RolePlay1:Jessica
A. Background
1. 22-yearoldcollegesenior
2. Referredbyparents
3. Beingreferredasopposedtocomingwillinglyispartoftheriskprofile.
B. RolePlay
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C. Summary
1. Thiswasamorecomplicatedandseriouscase.
2. Jessicahasanumberofriskfactors.
3. Jessica’smostnotable risk factor isherpreviousattemptaswellasher reaction to
theattempt.
4. Jessicadidnotregretherchoiceafterhersuicideattemptwasthwarted.
5. Triggersincludedthebreakup,adesireforrevenge,andhopelessnesscombinedwith
veryfewprotectivefactors.
6. Acontractwouldnothavebeenappropriateas Jessicawasnot likely tohonor the
contract.
IV. RolePlay2:AngiePartOne
A. Background
1. Self-Referred
2. Angiehasrunintoanumberofstressors.
3. Angieisfeelinghopelesswithsuicidethoughts.
4. PayattentiontoAngie’slevelofthinking,amountofplanning,andhowthecontract
ismade.
B. RolePlay
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C. Summary
1. Angieisself-referred.
2. Sheisfeelingquitebadly,butwantshelp.
3. Non-suicidalself-injury(tensionreductionbehavior)isrevealed.
4. Angiedoesnothaveasignificanthistoryofsuicidalbehavior.
5. Angie’slevelofhopelessnessisinamoderaterange.
6. Angieisopentocontractingforsafetyandfollowingthesafetyplan.
7. Angiehasalowtomediumrisk.
8. Angiedoeshavehope.
9. Itisimportanttodocumentreasoningaswellasclient’sopennesstocontracting.
V. RolePlay2:AngiePartTwo
A. Background
1. ThisisacontinuationofthefirstroleplaywithAngie.
2. Angiehasbeenintherapybutherlevelofriskhaschanged.
3. YouwillseeanewplanbasedonAngie’slevelofrisk.
B. RolePlay
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C. Summary
1. CircumstanceshadgottenworseforAngie.
2. Angiefollowedtheplanshehadmadewithherclinician.
3. Theriskfactorshaveincreasedduetothestressorsandherlevelofhopelessness.
4. Protectivefactorsarestillinplace.
5. Angie’ssenseofnotbeingsafeisimportant.
6. Ifyoukeepaclient in theoutpatientsetting,makesureyouaredocumentingyour
decisionmakingprocessandthestepsyouaretaking.
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TNSU111:
FamiliesinCrisis:
TheFirst48HoursFollowingSuicide
JenniferCisneyEllers,M.A.
withKevinEllers,D.Min.
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AbstractSuicide typically comes as a deep shock to surviving loved ones. Discovering the body of
someonewhohascommittedsuicideorreceivingadeathnotificationcanbetraumatictothe
pointthatthechemistryofthebrainchangesintheimmediateaftermath.Thisbrainchemistry
change can cause decision making to become overwhelmingly difficult. Throughout this
tumultuoustime,caregiverscanprovideemotionalandpracticalsupportthatminimizesfurther
secondarywoundstosurvivors.
LearningObjectives
1. Participantswillidentifywhatcanbedoneinthefirst48hourstotwoweeksfollowinga
suicidetohelpminimizefurthersecondarywoundstothesuicidesurvivors.
2. Participantswillunderstandhowtoprovidebothemotionalandpracticalsupportinthe
immediateaftermathofasuicide.
3. Participantswillexplorecommonissuesandwhatnottodoorsaytosuicidesurvivors.
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I. Introduction
A. GearedTowardCrisisIntervention
1. Firsttwoweeksoruntilthefuneral
2. Thefirstcrisisstageforfriendsandfamilymembers
3. Everything thathappens in thiswindow—positiveandnegative—impacts long-term
recovery.
B. FirstRespondersandOthers
1. Crisis responders, chaplains, law enforcement, medical professionals, clergy, and
others.
2. Allwhointeractwithsurvivorsinthefirst48hoursto2weeksfollowingthedeath.
II. DiscoveringtheBodyorReceivingaDeathNotificationA. TraumaticandUnexpected.
1. Even if the loved one had chronic mental illness or previous attempts.
2. “FightorFlight”response
3. Thechemistryofthebrainchanges.
• Activityinthefrontallobedecreases.
• Theamygdalaor“fearcenter”firesup.
• Thinkingiscompromisedandemotionsexplode.
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4. Maybechaotictimeandverydifficultforlovedones/family.
5. ThosewhodiscoverthebodymayexperiencesPostTraumaticStresssymptoms.
B. TheDeathScene
1. Thelocationofdeathlikelytobeacrimescene.
2. Thiscancomplicatesituationandbeverychaotic.
3. Themoregruesomethedeathscene,themoretraumacanoccur.
4. Logistics
• Lovedonesoftencan’tvieworbewithbody.
• Theremaybequestioningbypolice.
• Cleanupofscenewillneedtotakeplace.
5. NotifyingothersoftheDeath
• Difficultdecisionsregardingwhattosay/whatnottosay.
• Tellingchildrenpresentsadifficultchallenge.
• Notifyingimportantgroupsmusttakeplace–employers/co-workers,church,
friendsandpastrelationships.
VideowithDr.KevinEllers:HowCrisisRespondersCanAdvocateforFamiliesOn-Scene
6. Caregiverscanadvocateforsomeoneelsetocleanupthedeathscene.
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7. IfCauseofDeathisUndetermined
• Nosuicidenote
• Maynothavedeterminationforsometime
• Mayneverhavedefinitedetermination
• Each person must be allowed their own timetable for coming to
conclusions/answers.
• Some people may be very resistant to accepting the idea of a loved one
committingsuicide.
8. SuicideNotes
• Familymembersshouldhaveaccess tothisnote,particularly ifpositivesare
shared.
VideowithDr.KevinEllers:SuicideNotes
VideowithDennisMinns:SuicideAftermath
III. ImmediateIssues
A. NotificationofDeath
1. Thinkingclearlyandrememberingthegroupstotell.
2. Dowetellthetruth?
B. Emotions
1. Shock/denial
2. Guilt/Self-Blame
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3. Blameofothers
4. Inabilitytothinkclearly
5. Difficultymakingdecisions
C. ProblemswiththeTerm“CommittedSuicide”
VideowithDr.KevinEllers:SuicideTerms
IV. ContagionEffectA. SuicideRiskIncreasedforCommunity
B. At-RiskPopulationandCloseFamilyMembers
C. Windowof48Hours–TwoWeeks
V. PracticalAssistanceA. DecisionMaking
B. BasicNeeds
1. Shelter–ifhomeiscompromised
2. Food
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3. SocialSupport
4. SpiritualSupport
5. Helpinginmakingplans/decisions
6. Helpingettinginformation
C. Funeral/MemorialArrangements
1. Practicalfuneraldecisions
2. FinancialAssistance
D. EmotionalProtection
1. Protectionfromignoranceandthehurtfulorpainfulthingspeoplesayanddooutof
thatignorance.
2. Workasabuffer.
E. LookingintoLifeInsurance
VI. Conclusion:SelfCareforFirstResponders
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TNSU112:
GrievingaSuicide:
Long-termSupportforSurvivors
andLovedOnes
JenniferCisneyEllers,M.A.
andEricScalise,Ph.D.
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AbstractInthissession,JenniferCisneyEllersandDr.EricScalisewilldescribethecomplicatedgriefthat
followsa suicideand theexperienceof survivors. Strategies to facilitatehealthygrievingand
healingareoutlined.Viewerswillalsolearnwhatisunhelpfulandhowtoavoidresponsesthat
causefurtheralienationandshameforsurvivors.Anemphasisisplacedonhelpingsurvivorsstay
connectedtosupportsystemsandsafespiritualenvironments.
LearningObjectives
1. Participants will identify the causes and impact of complicated grief as it relates to
survivingalovedone’ssuicide.
2. Participantswillunderstandthechallengesofworkingthroughthesuicideofalovedone,
includingthecommonlackofsocialsupport.
3. Participantswilllearnwhyconnectednessandcommunityareofutmostimportancefor
suicidesurvivorsworkingthroughthegriefprocessandtowardshealing.
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I. Introduction
A. SupportingSurvivorsIsPrevention
1. Supportingsurvivorsintheaftermathofasuicideisalsopreventingsuicideinfuture
generations.
2. Survivors of suicide get less support and have more complicated grief than other
typesofdeath.
B. ConnectednessofClinician
C. AwarenessisNeeded
II. TheUniqueGriefProducedbySuicide
A. WeGrieveBecauseWeLove
Godwhispersinourpleasures,speaksinourconsciousness,butshoutsinourpain.Itishis
megaphonetoadeafworld.–C.S.Lewis
B. ResearchShows:
1. Similartolossbysuddenorviolentdeath.
2. Shock/numbness
3. Denial
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C. Recovery
1. Expecta4-7yearrecoveryperiod.
2. Maynotbe“pathological”grief,butcomplicatedbythefactorssurroundingsuicide.
D. Unhelpful“Helpers”
1. Donotgivepatanswers
2. Donotofferclichés
3. Survivorstendtohearcommentsthatcomeoutof ignorance,andthiscanresult in
secondarywounding.
VideowithDr.KevinEllers:SecondaryWoundingvs.Grace
4. Suicide survivors receive less social support than survivors of other types of loved
ones’deaths
5. Theyexperiencegreatershameandguilt.
6. Maystrugglewithmore“Whatifs”and“Whys.”
7. Experiencemorecomplicatedandlong-termgriefissues.
8. ClinicianResponse:
• Helpthesurvivorchangethe“Why”questionstothe“What”questions.
• Heartheheartofthecry.
• Don’tunderestimatethepowerofapersonshowingup.
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III. ComplicatedGrief
A. Differsfrom“Typical”Grief
1. Forasuicide,workingthroughgrieftakestwiceasmuchtime,andsometimesfrom4-
7years.
2. Theaveragepersonhasneverpreparedthemselvesforalossofthisnature.
B. ExperienceofComplicatedGriefafterSuicide
1. Guiltcanbecomeimmobilizing.
• Thiscanbeanindicationthatapersonis“stuck”
• Self-blameanddebilitatingguilt
2. Shameforasurvivorcancomefrominternalandexternalmessages.
• Study by Calhoun, Selby, and Faulstich, 1980, showed that respondents
viewedparentsofachildwhocommittedsuicidetobe:
Ø Lesslikeable
Ø Moretoblame
Ø Moreashamed
Ø Moreabletopreventdeath
3. Themodeofdeathcancomplicatetheexperienceofthesurvivor.
4. Dependencyorunhealthyattachmentcancomplicatethegriefprocess.
5. Inadditiontopainandgrief,survivorsoftenfeelanger.
• Theymayfeelthesuicidewasaselfishact.
• Thepersonisnolongertheretoworkthroughtheemotionswith.
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6. Survivorsmayfeelasenseofrelief.
• Thiscanhappenatthesametimeasfeelingsadthepersonisgone.
• Survivorscanbeveryashamedofthisfeeling.
7. Religiousandspiritualissues
• Caregiversshouldworkthroughtheseissuesintheirownheartsandminds.
• Theyshouldnotdothistogiveanswers,asassurancesshouldbelefttoGod
alone.
VideowithDr.KevinEllers:HelpingGrievingPeoplePrepare
IV. WhatDoesandDoesNotHelp
A. Unhelpful
1. Ignoring/Avoidance
2. Denial
3. Pressuringthemto“getoverit”
4. NegativeReligiousjudgments
5. Anyjudgment
6. Keepingitsecret
7. Encouragingornotconfrontingself-medication
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B. Helpful
1. Bewillingtotalkabouteverything-eventheuncomfortableanddifficultparts.
2. Encouragetheemotionalprocessing.
3. Practicalandtangiblesupport.
4. Encouragegrievingrituals.
• Sayinggoodbyeinaletter
• Sendingwishes
• Emptychairdiscussion
5. Rememberrealistically.
6. Allowsurvivorstoworkthroughguiltissuesattheirownpace.
7. Help them get information from other sources (mental health professionals, law
enforcement,medicalprofessionals,co-workers,friends.)
8. Help families grieve together – different grieving styles, ways of coping and
timetables.
9. Helpthemfindsafespiritualenvironmentandcomfortinfaith.
10. Facilitateprocessingwiththedeceasedthroughexperientialtechniques.
11. Helpthemprocessthetraumaofdiscovery.
12. Referraltomentalhealthprofessionalifneeded.
13. Helpthemwithlong-termsupport.
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14. Prepareforanniversariesandothertriggerevents.
15. Supportgroupsforgriefandifpossiblesurvivorsofsuicide.
VideowithDr.KevinEllers:HelpingGrievingPeopleRememberLovedOnes
V. Conclusion:
A. HelpingSurvivorsFindClosure
B. HelpingSurvivorsFindSafeSpiritualHomes
1. Pastors
2. Churches
3. SurvivorSupportGroups
C. Revelation21:1-5
“ThenIsawanewheavenandanewearth;forthefirstheavenandthefirstearthpassed
away, and there is no longer any sea. And I saw the holy city, new Jerusalem, coming
downoutof heaven fromGod,made readyasabrideadorned forherhusband.And I
heardaloudvoicefromthethrone,saying,“Behold,thetabernacleofGodisamongmen,
andHewill dwell among them, and they shall be His people, andGodHimselfwill be
amongthem,andHewillwipeawayeverytearfromtheireyes;andtherewillnolonger
beanydeath; therewill no longerbeanymourning, or crying, or pain; the first things
havepassedaway.’AndHewhositsonthethronesaid,‘Behold,Iammakingallthings
new.’AndHesaid,‘Write,forthesewordsarefaithfulandtrue.’“Revelation21:1-5
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A. PsychologicalAutopsy/Debriefing
1. Nottodetermineblamebutexploretheissueandallowforprocessing
2. Prepareforthefuture
B. OnlineSupport
1. AmericanAssociationofSuicidology–Clinician-SurvivorTaskForce–
http://www.suicidology.org/suicide-survivors/clinician-survivors
2. AmericanFoundationforSuicidePreventionwww.afsp.org
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