HOW TO HELP WITH ISSUES OF SUICIDE PREVENTION?

"You need to work at becoming strong and to keep clean so you will be ready for your spirit powers when they come to you," his grandmother told Xat. "And respect our traditions even when they seem to contradict what you would like to believe. Live up to your name Rootstump, and put down deep roots. Don't let your whims lead you astray."

Xat and the Feather Kite (Beck, 1991, p. 104)

GOALS: 9.1 To provide a basic understanding of the dynamics of suicide prevention;

9.2 To know how to establish a supportive relationship;

9.3 To be genuine and communicate respect in the helping process;

9.4 To effectively use helping skills in a supportive manner.

COMMENT: Ask the participants if they have any question from the previous module. Allow 5 minutes for questions. If more time is needed, tell the participants you will meet with them after the module.

ACTIVITY 9.1: Presentation

TIME: 20 Minutes

TITLE: What You Can Do To Help the Suicidal?

There is nothing as tragic as the loss of a life just beginning to "flower," but to lose a life through self inflicted means is indeed a tragedy. How can it be that one would become so miserable, so despairing and so desperate as to take one's life. Suicide is a door that once entered cannot be reopened. It is homicide turned inward. They kill themselves with guns, cars, ropes and assorted poisons, and always with hopelessness. Among First Nations people suicide has reached alarming proportions. We all know brothers and sisters who have entered this "door," never to return. In the book, First Nations: Race, Class, and Gender Relations, Wotherspoon and Satzewich (l993) state:

"Nationally, the suicidal rate among native peoples has been estimated as at least twice the rate for the total Canadian population. Data from l982, for instance, reveal that suicides accounted for 36.1% of violent deaths among status Indians compared with a rate of 14.3% among the general population; most of these suicides occurred among males in the 15-24 year age group." (p. 169)

Most suicidal people are not interested in killing themselves in a physical sense, but only in a conscious sense. In other words, the focus is not on dying, but to kill the conscious self - the feeling and thinking part of themselves. Suicidal people want to cleanse the mind of the self-doubt, of the pain, of the anger, and the memories. Suicide is the message of the desperate who feel they have no other option. That is why suicide prevention places emphasis on providing other options - other alternatives to death.

For peer support givers, the most important ingredients in suicide prevention is understanding the signs, alerting the professionals and offering the essence of human nourishment - support. This means that the peer support giver makes a commitment to be open to passing on to others a sense of HOPE. Hope not only ensures there is a "tomorrow," but it also provides the opportunity for growth, physically, mentally, emotionally and spiritually. The skills of empathy, dereflection, self-disclosure, and problem-solving are a few examples. Strategies of helping others to cope with suicidal behaviours gives the peer support giver goals to help other First Nations people to achieve a more satisfying quality of life.

Who is at Risk?

In a sense all of us are at risk at one time or another, because we all have contemplated suicide. Most of us reject suicide and find some other method of relieving the pain. Professionals divide suicidal into three categories - low, moderate, and high. Those in the low category demonstrate positive physical, mental, social and spiritual well-being. Those in the moderate category express suicidal thoughts, negative emotional states, or exhibit poor physical, mental, social and spiritual well-being. Those in the high risk category have made prior suicide attempts or threats, possess negative emotional states or poor physical, mental, social and spiritual well-being. Most importantly, those in the high risk category not only talk about suicide, but have a detail plan for carrying out the suicide. This means they have thought up a specific means, the lethality of the means, and the availability of the means. A detailed plan of the specifics presents a high danger, particularly if the means, such as a hunting rifle, is available. For example, a person who states: "I will shoot myself with my brother's rifle on the stair-well at three o'clock tomorrow" should be considered at high risk for suicide. If on the other hand, the person talks about death, without specifying any means, the potential for carrying out the threat is much less. However, any communication of any threat should always be taken seriously. In fact, almost two-thirds of those who commit suicide communicate their thoughts before actually carrying out the act. Thus, any signs are a cry for help.

The Identification of Potential Suicide Scale demonstrate those clinical qualities that professionals use to classify those at risk (France & Harvey, l984):

IDENTIFICATION OF POTENTIAL SUICIDE

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How do you handle a suicidal person?

In dealing with suicidal people, professional counsellors take three steps: they establish rapport with the person; they access the risk; and they take action or get help immediately.

The skills of active listening, dereflection, self disclosure and problem solving that you developed in the first part of the training are the best tools you can use to establish rapport. In addition to these skills, peer support givers can ask questions which help assess how the suicidal person feels and what plans have been made in regards to the act. Some good questions are:

1. How are you feeling?

2. How often do you feel like that?

3. Who do you turn to when you feel that way?

4. Have you thought how you might do it?

5. Are there any other options besides suicide?

6. Have you ever felt this way before?

7. Have you talked with anyone else about this?

8. If there could be a magic solution to this, what would it be?

The key in suicide prevention is paying careful attention to the feelings and thoughts of the person. You cannot be to pushy, because the feelings of the person are ambiguous. You need to constantly check the accuracy of your perceptions. The best way to do that, is to summarize from time to time what the person has told you. What you want to do is guide the person in the direction of seeking help, so you should not reprimand the person for what he or she is sharing. If you do, you risk loosing rapport. In other words, do not make any judgments. Share with the person that suicide is permanent solution to a temporary problem. At this point you can ask the person if he or she would like to see a counsellor. You can share that you know someone who is really trustworthy and helpful. If you have ever had similar feelings you might want to consider sharing your experiences. If need be, go with the person and make the appointment for him or her.

A good rule of thumb in dealing with a suicidal person is to be genuine. The old First Nations adage of walking in an other’s moccasins is a helpful reminder. How would you want to respond if you were the other person? You have to remember the person may feel ambivalent - they want the pain to cease and they don't want to die. You need to go at the pace of the other person. What we have found in dealing with suicidal people is that they generally do not do anything once they have made a commitment to something. In that sense, they become very concrete. For example, after talking with a suicidal eighteen year old woman for over an hour on the telephone, I became convinced that this was a serious situation. I told her that I'd like to come over and talk with her. She promised not to do anything until I got there. She was waiting as she promised. Eventually, I took her to the emergency room of a local hospital where she got treatment. Things worked out very well for her and the suicidal feelings past. The following are some helpful responses you can use:

1. "Promise me that you will go and see Mrs. Antoine, the counsellor, who will help."

2. "I would like to go with you to see the counsellor, if it's OK with you."

3. "Will you call me tomorrow at 9 am?"

4. "I'm going to call Mrs. Antoine, the counsellor, right now. Can you promise to see me again?"

5. "I care about you. Promise me that you'll do nothing to hurt yourself?"

6. "I will be here for you, because I care about you!"

7. "Can you promise me you will call one of these hot line telephone numbers?"

8. "Promise me you will call me or someone when you feel this way again!"

What Can You Do After A Suicide or Suicide Attempt?

Sometimes we are too late and a person, out of despair, despite everything people do, succeeds in killing themselves. This is a tragedy because, in a sense, it is a sign that all of us have failed. Alternately, a suicide attempt has been made, but the life has been saved. The damage in both cases to the survivors is great. Now our focus, as peer support givers, has to shift to those who have survived. Anyone, who has been in this situation, whether family or friends, feels the loss. A common reaction for people is to ask themselves if they could have done something to prevent the suicide or something which would have provided hope. Post-prevention procedures have often been describe as psychological "first aid."

The following guidelines should be used in the aftermath of a suicide or suicide attempt:

1. bring everyone involved together either at the long house or at a friends house to discuss their feelings and thoughts about what has happened;

2. to dispel rumors about how it happened or why, provide all of the known facts after checking out the details with the family;

3. provide everyone involved with the opportunity of sharing their feelings of loss, good or bad memories, about the victim;

4. use letters, poems, drawings or music to help people express their grief;

5. address the feelings of anger and guilt that people maybe feeling by providing the appropriate place and atmosphere;

6. encourage people to talk about depression, death and suicide;

7. monitor those people who were close to the victim by giving them telephone calls or contacting them so they know you care and are available to help them;

8. encourage friends of the victim to offer support to the family by telephoning, writing or visiting them.

Conclusion

We are sometimes our own greatest enemy when it comes to dealing with personal issues. The extent of suicides is a sign that our community needs healing and support. Working with those who are suicidal is a complex and difficult task. Do not feel afraid to get help when you think someone is at risk. In fact, in dealing with people who have the potential of killing themselves you should routinely get help. You can do this by either: getting advice in what to do; referring the person to someone who is a professional counsellor; or taking the person to a hospital or counsellor immediately. If the risk is really great, you should even consider calling the police. It is not uncommon for a suicidal person to talk about it so much that everyone, including family and friends, become angry with the person, thereby making the person feel even more rejected. This rejection can lead to a further assault on the person's self-esteem, making the risk for suicide even greater. Disclosures about suicide must always be taken seriously. Obviously any strategies you use may make the person angry or resistant, however, it is better to lose a friend than to lose a life.

ACTIVITY 9.2: What are the Facts?: A True or False Quiz

TIME: 30 Minutes

DIRECTIONS: The purpose of this activity is to get the participants to become more aware of some of the facts and fables that most people in society hold in regards to suicide. Ask the participants to answer true or false to each of the questions, followed by the correct answer. To generate a short discussion, ask the participants if there were any surprises.

1. People who talk about suicide don't commit suicide?

FALSE: Research shows that 8 out of ten people who kill themselves give concrete warnings that they are going to commit suicide.

2. Suicides runs in families and is consider an inherited trait?

FALSE: Research conclusively demonstrates that suicide does not run in family, but is an individual pattern.

3. People who commit suicide do not really want to die?

TRUE: Suicidal people are not really sure is they want to die, but can't think of any other options. They leave it up to others to save them.

4. Once a suicidal person, always a suicidal person?

FALSE: Most suicidal people are feel this way for a short period of time.

5. Most suicides occur in the Spring rather than in Autumn?

TRUE: Ironically, suicides generally increase in the spring, just when nature is coming alive

6. The suicide rate goes down in time of war.

TRUE: Suicides decrease dramatically in times of war.

7. Suicide is the act of mentally ill person?

FALSE: Studies demonstrate that suicidal people are very unhappy, but they are not mentally ill or necessarily psychotic.

8. Suicide is highest among poor people?

FALSE: Suicide occurs among all class of people.

ACTIVITY 9. 3: Sharing Personal Experiences About Suicide

TIME: 45 Minutes

DIRECTIONS: The purpose of this activity is to desensitize any participant who has had any first hand experiences with anyone who attempted or committed suicide. Start by sharing with the participants the theory of A. Alvarez (l973), who wrote the book, The Savage God: A Study of Suicide, that "...suicide is a human characteristic, like sex, which not even the most perfect society will erase" (p. 91). Then ask the participants any of the following questions to provide a forum for sharing:

1. Does anyone know someone who attempted or committed suicide?

2. What were your reactions to the suicide?

3. How did you feel and what were your thoughts about it?

4. What were the reactions of other people in the community to the suicide?

5. What were the signs that there might be a suicide?

ACTIVITY 9. 4: Helping Circle

TIME: 60 Minutes

DIRECTIONS: Everyone should be sitting in a circle during this activity. Start by explaining that you will ask someone to role play someone with a problem relating to suicide. The purpose of this activity is to provide the group with ideas for ascertaining suicidal risk and steps they can take in getting the person immediate help. Stress that regardless of the risk factor, getting help is a priority. The helping process should follow the three phases outlined in the presentation: establishing rapport, accessing risk and getting help. Anyone at anytime in the group can jump in and ask questions or use any of the helping skills of active listening, dereflection, self-disclosure, support or problem solving. You may want to establish a speaking order by using a "speaking stick" or eagle feather. The role of the facilitator, is to keep the process on task and to ensure that people are provided with feedback at the end of the activity (allow about 20 minutes at the end for this purpose). The idea is not to solve the problem, in a short time, but to provide the participants with the opportunity to work together.

ACTIVITY 9.5: Modeling

TIME: 15 Minutes

DIRECTIONS: Ask one of the participants to role play a person who has expressed that he or she is so depressed about grades that suicide is a possible option. Then demonstrate how you will talk to the person, using empathy and any of the following responses (the modeling does not have to be longer than 3-5 minutes):

1. "Promise me that you will go and see Mrs. Antoine, the counsellor, who will help."

2. "I would like to go with you to see the counsellor, if it's OK with you."

3. "Will you call me tomorrow at 9 am?"

4. "I'm going to call Mrs. Antoine, the counsellor, right now. Can you promise to see me again?"

5. "I care about you. Promise me that you'll do nothing to hurt yourself?"

6. "I will be here for you, because I care about you!"

7. "Can you promise me you will call one of these hot line telephone numbers?"

8. "Promise me you will call me or someone when you feel this way again!"

At the conclusion of the modeling, ask the participants to give you feedback using the four feedback guidelines. Be sure to reinforce effective feedback and gently make suggestions to those who do not use it.

ACTIVITY: 9.6: Individual Practice

TIME: 30 Minutes

DIRECTIONS: Ask the participants to get into a triad, with each participant taking one of the following roles: peer support giver, person, and observer. The person being helped is to make a statement indicating suicidal thoughts. The peer support giver is to use empathy and any combination of the responses presented in the modeling activity and the observer is to give feedback using the feedback guidelines. The observer should also be the time keeper, allowing the role play to last 5 minutes and the feedback 5 minutes. After 9 minutes ask the participants to change roles, until everyone in the triad has had a turn in each role.

ACTIVITY: 9.7: Brainstorming a Case of a Suicidal Person

TIME: 30 Minutes

DIRECTIONS: The purpose of this activity is to discuss possible ideas of what can be done with a suicidal person. Write on the black board the following hypothetical ad: "I am a female First Nations student, aged 21, who plans to kill myself next week. I can't think of any reason to live, but if you can find any reasons, please write to me at Box 485."

After sharing the ad, ask the participants to respond with their own ad which answers the initial ad in an appropriate manner. Give the group about 10 minutes to think about their replies. Ask the participants to get into dyads and discuss how they might respond to the person. Afterwards, have the dyads share their ideas with the group as a whole.

ACTIVITY: 9.8: Presentation on Organizations that Help the

Suicidal

TIME: 20 Minutes

DIRECTIONS: This activity should be presented in an informal, but instructive manner. The purpose is to provide the participants with some background on the groups in their community who work with the suicidal and how to access those groups. Information can be provided by either verbally sharing or by giving printed information. A number of private and government agencies provide information about what do in situations where a person may be at risk. [Assemble a number of brochures and share them with the participants. For example, the Ministry of Health within every Province and State has brochures explaining where to get help at out-patient services, community help lines, or through the community mental health center’s. You might want to contact your local mental health Centre and invite one of their counsellors to speak to your group on the topic of referring someone. Another source of information is the telephone book. You can look under the following titles to find people and organizations that might be of assistance:

Counsellors Psychologists

Health Services B.C. Mental Health

Social Workers Health & Welfare

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|Page Updated: May 2, 2000 |