Suicide Prevention

To the person experiencing thoughts of suicide, hold on–even for one more minute!

If you’re wondering if you should ask for help . . . the answer is YES!

    • National Suicide Prevention Lifeline 1-800-273-8255 (TALK)
    • Suicide Prevention Lifeline – computer chat
    • Alaska’s Careline at 1-877-266-4357 or www.CARELINEALASKA.com
    • Text ’4help’ to 839863 (Tue.-Sat. from 3 to 11 pm)
    • Edgar Nollner Health Center, Galena – 907-656-1617 or 800-478-1618
    • Upper Tanana Health Center, Tok – 907-883-5185

Suicide is a not a disease, a disorder or the result of a character flaw. Rather it is a tragic combination of factors which lead a person to die intentionally. A person who has thoughts of suicide may experience feelings of hopelessness, helplessness, and intolerable isolation.

Most often people who choose suicide are suffering from intense psychological pain, and they see no other way to escape. There are many things that contribute to these feelings, including biological, psychological, and social factors.

Most importantly, we know that each of us has a role to play in preventing suicide. Starting with the strengths unique to our culture, we can protect ourselves and our youth from suicide. With each thing that contributes to a person having thoughts of suicide, there are many possible options and resources to prevent suicide:

    • We can mobilize as Native People, as communities, and as a region, to learn prevention skills and implement prevention methods that are proven successful and relevant to our culture.
    • We can learn to recognize people who are at risk of suicide, and help them in getting the personal support and professional care they need and so richly deserve.
    • We can work together to nurture strong, healthy communities, so that 20 years from now, we will look back on this period of time and acknowledge the strength and wisdom of the people who took their power back from the devastating impact of suicide by sitting down, starting a discussion, finding hope, learning how, and working together.
Factors

Predisposing Factors

There are things we are born with, like temperament or genetic make-up, or things we are born into, like family, community or culture, that can make us more vulnerable or less vulnerable to thoughts of suicide. Some people, for example, are just easy going.  They experience life’s problems like most of us, and yet they seem to bounce back and just keep right on going. They are less vulnerable to suicide.

Some people have a biological tendency to develop depression or other brain chemistry disorders, which, when untreated, make them more vulnerable to suicide.

We know that communities have experienced repeated trauma and loss of culture.  While there is no doubt that these losses have historically contributed to suicide, we also know that our culture is our path to prevention.  It is a strength that underlies so many things we cannot always put into words–but we know it is there, and we know it is what will.

We know that if we enhance protective factors, for example by teaching a person good problem solving skills, we also are likely to raise that person’s self esteem, increase his or her ability to make good choices, and most likely, reduce their use of alcohol or substances.  Ultimately, this combination of protective factors reduces the person’s suicide risk.

Each of us plays a role in increasing protective factors; indeed, each of us has a role in preventing suicide.

Risk Factors

Biological, psychological, and social Risk Factors

      • Mental disorders, particularly mood disorders, schizophrenia, anxiety disorders and certain personality disorders (especially if untreated, or if the person at risk doesn’t feel that treatment is helping).
      • Alcohol and other substance use disorders
      • Hopelessness
      • Impulsive and/or aggressive tendencies
      • History of trauma or abuse
      • Some major physical illnesses
      • Previous suicide attempt (especially within the last 2 months)
      • Family history of suicide

Environmental Risk Factors

      • Job or financial loss
      • Relational or social loss
      • Easy access to lethal means (firearms, poisons, etc.)
      • Local clusters of suicide that have a contagious influence

Socialcultural Risk Factors

      • Lack of social support and sense of isolation
      • Stigma associated with help-seeking behavior
      • Barriers to accessing health care, especially mental health and substance abuse treatment
      • Certain cultural and religious beliefs (for instance, the belief that suicide is a noble resolution of a personal dilemma)
      • Influence of others who have died by suicide

Protective Factors

There can be certain factors which help protect against and prevent suicide.  Here is a list of some of those key protective factors:

      • Restricted access to highly lethal means of suicide
      • Perceived strong connections to family and community support
      • Alaska Native Values
      • Effective clinical care for mental, physical and substance use disorders
      • Skills  in problem solving, conflict resolution and nonviolent handling of disputes
      • Cultural and religious beliefs that discourage suicide and support self-preservation

The  2005 Alaska Suicide Prevention Plan (610KB) also has great information on factors that protect against suicide

Warning Signs

Verbal Warning Signs

    • I’m thinking of ending it all.
    • I might as well shoot myself.
    • I can’t go on.
    • Life is not worth living.
    • Nothing matters anymore.
    • I wish I were dead.
    • I’m a loser.
    • I can’t do anything right.
    • No one can help me.
    • I just can’t keep my thoughts straight anymore.
    • If I killed myself then people would be sorry.
    • If I wasn’t around no one would miss me.
    • All of my problems will end soon.
    • I won’t be needing these things anymore.
    • I’m going to be with (names someone who has died).
    • Do you go to hell for suicide?
    • Everyone would be better off without me.
    • It’s not worth it anymore.

Behavioral Warning Signs

    • Withdraws from friends and family.
    • Increases use of drugs or alcohol.
    • Acts recklessly.
    • Unexplained “accidents” (snow machine, car, boat…could indicate passive suicide attempts).
    • Puts affairs in order (finds someone to care for beloved pets, makes a Will, gives away valued possessions).
    • Gets into fights, gets into trouble in school or with the law.
    • Destructive impulsiveness.
    • Preoccupation with death or suicide.
    • Change in self-care (physical needs and appearance).
    • Changes in eating habits.
    • Sudden, unexplained happiness after depression (may indicate a suicide plan).
Resources

Veteran Resources

If you are returning from hostile fire areas:

      • Operation Enduring Freedom (OEF)
      • Operation Iraqi Freedom (OIF)
      • Alaska VA Healthcare System

The  OEF/OIF Program (167KB) is available to meet the needs of veterans returning from Iraq, Afghanistan or other “hostile fire” areas. Their mission is to assist OEF/OIF veterans in accessing all aspects of VA care/benefits.

Youth Resources

Bullying

Bullying includes many things, such as someone:

      • calling you a name or saying hurtful things to you
      • starting rumors or saying mean things about you on Facebook or social media sites
      • taking money or food off you
      • swearing at you
      • pushing you around
      • hurting your body in any way, such as pushing, pinching, punching or kicking you
      • leaving you out or ignoring you

Bullying is not your fault, and never something that you deserve so please, tell someone you can trust!

      • Reach Out gives great advice on what to do if you are being bullied
      • Reach Out describes what’s wrong with just being a bystander?
      • Stop Bullying tells you what should I do  if I don’t want to just be a bystander?
      • Reach Out encourages kids to stop cyberbullying

Online Safety

    • Brain Pop’s cool games and activities – and you can learn more about staying safe in cyberspace!

Relationships

Self Screening

Here are some self screenings you can use as a guide for when to talk to your doctor about behavioral health concerns.  Remember: always ask for help if something is bothering you or if you are struggling with a problem.

Tools for Survivors of Sexual Assault

Wellness

Prevention Strategies

Research has shown that prevention is more successful when we use multiple strategies.  For example, we know that education, combined with activities that build on cultural strengths is more effective than education alone.  TCC uses all 6 of the following recommended Federal strategies:

    1. Information Dissemination – Awareness and knowledge on topics related to mental wellness and substance use. It provides information about available prevention programs, services, and efforts at the local level.
    2. Education – Enhance critical life and social skills, including decision-making, refusal skills, critical analysis (e.g. of media messages) and judgment abilities.
    3. Alternative Activities – Healthy activities that will deter participants from the use of substances and promote coping and resiliency skills.
    4. Problem Identification and Referral – Screening, referral to appropriate level of care, and follow-up.
    5. Community-Based Process – The goal is to build community capacity to more effectively provide prevention services and make programs sustainable.
    6. Environmental – Establishing or changing written and unwritten community social norms to enhance wellness.

With guidance from the Tribal Advisory Council, TCC selected prevention efforts that build upon strengths unique to the culture within the TCC region and blend with other prevention efforts to enhance protective factors at the commuity level.

Communities are at different stages of readiness according to Colorado State University’s Tri-Ethnic Center.  Some have realized that there’s a problem and are thinking about how to bring people together; some communities are planning prevention strategies, and others are actively engaged and want to do more.  At whatever stage, there’s no right or wrong—TCC wants to support communities at their level of readiness.

To support communities in prevention efforts that are autonomous, village-based, and sustainable, TCC offers training in the Strategic Prevention Framework.  This training will help communities:

    • Assess their prevention needs based on data that identifies what’s going on in the community, i.e., youth substance abuse, youth binge drinking, adult binge drinking, drinking by pregnant women, etc.
    • Build prevention capacity by identifying community members and resources to bring together to solve the problem
    • Develop a strategic plan to addess the problem
    • Implement the plan, which can include proven, culturally relevant prevention programs, policies and practices, and
    • Evaluate outcomes to see what’s working, what isn’t, and what needs to be changed.
Training

TCC’s strategies are evidence-based, meaning they have been proven effective, and are adaptable to our culture and communities.

TCC partners with communities in each sub-region to collect data in order to ensure that training and prevention strategies introduced at the community level are based on current local data so that communities can plan effectively and evaluate if what they are doing is working.

TCC is also coordinating technical support from state and federal partners to ensure that communities have the tools and information needed to ensure successful prevention efforts.

* Some people may be ready to participate in these trainings while others may not be—that’s okay!  Please attend only if it feels comfortable to you.

    • SafeTALK – SafeTALK is grounded in the belief that virtually everyone over the age of 15 can learn how to help a person who is having thoughts of suicide. The training generally takes 3-5 hours, and focuses on how to identify friends and others who may have thoughts of suicide and on how to connect them to suicide first aid resources.
    • ASIST – Applied Suicide Intervention Skills Training (ASIST) is suicide intervention training for community members to identify and respond to persons at risk of suicide.  ASIST workshops are two days in length.
    • Mental Health First Aid – Attend a traditional first aid class, and you will learn checklists for assessing and responding to cuts, burns and strokes.   Attend a Mental Health First Aid class and you will learn how to recognize and respond to a mental health crisis.MHFA is an interactive two-day class that provides an overview of mental illness and substance use disorders and introduces participants to risk factors and warning signs of mental health problems.  Class participants learn a 5-step action plan encompassing the skills, resources and knowledge to help an individual in crisis connect with appropriate professional, peer, social, and self-help care.Mental Health First Aid is appropriate for a variety of people, including: primary care professionals, employers and business leaders, faith communities, school personnel and educators, state police and corrections officers, nursing home staff, mental health authorities, state policymakers, volunteers, young people, families and the general public.
    • Provider treatment:  At the top of the pyramid, is help for people to discover solutions to the struggles they face and break free from old patterns of behavior.  Only a select few highly trained individuals will provide this treatment.
    • Connect Postvention – Connect training provides important steps for reducing risk of suicide clusters, including encouraging appropriate memorial services, safe messaging, survivor support, and social and mainstream media response. Knowing a person who has committed suicide is one of the highest risk factors for multiple suicides; knowing how to respond is a strong prevention tool.  Postvention teaches community members how to respond to a suicide event.  Training includes:
      • Best practices on how to coordinate a comprehensive and safe response to a suicide
      • Strategies for reducing the risk of contagion
      • Review of the complexity of suicide-related grief, especially for different age groups
      • Recommendations for funerals and memorial activities
      • Suggestions of how to talk to survivors of suicide loss to promote their healing
      • Best practices for safe messaging about suicide and responding to the media
      • Identification of community resources to promote healing
    • Crisis Response Teams – TCC is available to provide training to communities to create village-based Crisis Response Teams (CRTs).  Training will include:
      • Identifying CRT Members
      • Establishing a Crisis Preparedness Plan
      • Creating a Crisis Response Plan
      • Implementing the Crisis Response Plan
      • Debriefing
      • Creating a Postvention Plan (after a crisis)
      • Implementing a Postvention Plan

If you would like to receive training offered by TCC, please email us, or give us a call, toll free in Alaska, at 1-800-478-6822 ext. 3167 to discuss your community’s needs. We will need at least two months notice so that we may make arrangements and order materials.

All training is free of charge — however, in order to meet our grant requirements, we will ask your community to help us out with some paperwork and to sign a memorandum of agreement.

Coalitions

Your Tools

    1. Using local data take a look at the issues in your community and determine whether to form a coalition.
    2. Recruit the right people.
    3. Create a set of preliminary objectives and activities.
    4. Invite people to a coalition meeting–offer refreshments and a door prize.
    5. Anticipate the necessary resources.
    6. Identify what a successful coalition structure will look like.
    7. Maintain coalition vitality by setting clear roles and responsibilities, staying connected, and sharing successes (even the little ones)!
    8. Make improvements through evaluation.

Coalition Member Engagement

Questions to Consider

      • Who should you recruit?
      • Are there community structures for the community sector or population group, and if so, what are they?
      • What are effective techniques for engaging with the agency/organization, community structure, or population group?
      • What is the best method for communicating information on the agency/organization or project?
      • What are effective techniques for beginning the discussion with a potential new member?
      • What are the elements of culture that you may want to understand in order to be successful at engaging members?

Source: Adapted from Community Anti-Drug Coalitions of America (2001). Building Drug-Free Communities: A Planning Guide. Washington, DC: U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention.

Board packet

We recommend using a Board Packet to define the structure and some basic rules for your Coalition.  You can  download and modify (135KB) the sample below, based upon the needs of your community and coalition.

Checklist

If you have an activity or project coming up,  our checklist can help (95KB).