[Descriptive Transcript: Video opens with a title cover slide with text and images. Text: “2022 Collaborative Experience Conference November 3,4, & 5. For parents and professionals serving students who are deaf, deafblind, and hard of hearing. The MN gov logo is on bottom left An image with a magnifying glass resting on the chalkboard tray next to a pile of colored pencils. Text on bottom right: “Supporting the whole child reboot”.]
[Video transitions to a zoom style set up with three windows in a row. From left to right, Katy Kelley-Rademacher, Operations Director, MN Commission; Lori Vigesaa, Mental Health Professional, Therapeutic Service agency, DDBHH, LPCC, NCC; and the sign language interpreter. Titles and names briefly appear on the bottom of each individuals’ video and disappear after a few seconds. Both Katy and Lori sign while the interpreter voices.]
>> Katy: Okay. Hello, everyone. I'm Katy. I am the moderator for this workshop, so I'll be keeping an eye out for Lori. I'm very excited about this workshop and to introduce our next presenter. So, Lori is going to be presenting about suicide and suicide intervention, suicide prevention and intervention. So, we'll have this conversation, there will be some Q & A available to you, if you want it and, so, you can put questions in the chat, if you have a specific question that you want, and then I can convey that on to Lori. So, let's get rolling. Lori, go ahead.
>> Lori: This is Lori. Wonderful. Hello, everyone. I'm very happy to have you here today.
[Katy’s window closes and a slideshow appears on the left side: “Know the Signs” A white box with the title in center, with the O in “Know” replaced by two overlapping dialogue bubbles. Subtitle on top and below: “Pain isn’t Always Obvious. Sucicde is Preventable”. White text in the black area outside and below: “Suicide Prevention: Lori Vigesaa, LCC, NCC, Terhapeutic Service Agency, D/DB/HH Program.”]
>> Lori: This particular topic, I know, I'm sort of testing, hang on a minute. There we go.
[New slide: “Trigger warning”. Text below: STATISTICS, GRAPHS, AND OTHER CONTENT MAY BE ALARMING AND/OR TRIGGERING FOR SOME PARTICIPANTS. PLEASE TAKE CARE OF YOURSELF FIRST AND FOREMOST. IF YOU NEED TO LOOK AWAY, MUTE THE INTERPRETER, OR TAKE A BREAK PLEASE DO SO AND RETURN WHEN YOU ARE ABLE. THANK YOU!”.]
>> Lori: Um, I do have to give you a little bit of a trigger warning, because it is a sensitive topic for people, especially people who are survivors or have experience with other people who have died by suicide or family members. So, while I'm presenting, please take care of yourself. If you need to stand up, if you need to walk away, if you need to not look, if you need to turn off the sound, so you don't hear the interpreter for a moment, please do. Please take care of yourself, and that is first and foremost. You will always have access to the power point later, so, if you need to catch up on the information, you can get it that way.
[New slide: “Definitions”. Bulleted list below:
SUICIDE PREVENTION – EFFORTS THAT WORK TOWARDS REDUCING DEATHS BY SUICIDE
SUICIDE INTERVENTION – INTERVENING WHEN A PERSON IS HAVING THOUGHTS OF SUICIDE OR SUICIDAL BEHAVIORS.
SUICIDE POSTVENTION: ONGOING SUPPORT PROVIDED TO ANOTHER PERSON AFTER THEY HAVE A SUICIDE EXPERIENCE/ATTEMPT.
SAFETY PLAN – A PLAN/AGREEMENT OF WHAT SOMEONE WILL DUE WHEN THEY ARE IN ACTIVE SUICIDAL IDEATION.”.]
>> Lori: As we get started, I want to start with some definitions first. Suicide prevention, that means efforts that are working towards reducing deaths by suicide, whereas suicide intervention is intervening, that's actually the action you take when a person is having thoughts of suicide or indicating suicidal behaviors, so, you're trying to reduce those thoughts or reduce that behavior. That's the action of an intervention. We have something called suicide post-vention, which, basically, means ongoing support that we provide to a person after they have a suicide attempt, and it is not a completed attempt, so, we provide support systems, including therapy, um, safety plans, well, there's a variety of structures we can put in place that are post-vention actions, and a safety plan itself is a, well, it's well-named, it's a safety plan or an agreement of what someone will do and they agree to take these particular steps, that if those suicide ideations appear again, if they're starting to have those intrusive thoughts about suicide, then this is the plan that they will put into action. Typically, it's a set of steps to help keep people safe, establishing an emergency contact, working on their coping skills, whatever that they use to do as management. So, whatever for that particular person is and whatever the team that's working with that person decides, that's what goes into the safety plan.
[Lori’s video freezes momentarily.]
>> Lori: I have been disconnected. There we go. I seem to be reconnected.
[New slide: “Definitions Continued” Bulleted list below:
SUICIDAL IDEATION: PASSIVE THOUGHTS ABOUT WANTING TO BE DEAD OR ACTIVE THOUGHTS ABOUT KILLING ONESELF, NOT ACCOMPANIED BY SUICIDAL BEHAVIOR.
SUICIDAL BEHAVIOR: PREPARATORY ACTS, SUICIDE ATTEMPTS INCLUDING COMPLETION OF SUICIDE
SUICIDAL ATTEMPTS: NON-FATAL SELF-DIRECTED POTENTIALLY INJURIOUS BEHAVIOR WITH INTENT TO DIE AS A RESULT OF THE BEHAVIOR
SUICIDE – DEATH CAUSED BY SELF-DIRECTED INJURIOUS BEHAVIOR WITH ANY INTENT TO DIE AS A RESULT OF THE BEHAVIOR.”]
>> Lori: All right, I want to talk about suicide ideation, and the way I sign it, which is SI, I just abbreviate it. Suicidal ideation are the thoughts, intrusive, persistent, of wanting to not be here, wanting to die. It's some sort of active and thinking about killing one's self. Thinking things like I'd be happier, or everybody would be happier, if I wasn't here, and suicidal behavior that's in preparation for a potential suicide. Suicide behavior is the preventatory act, and then a suicidal attempt is, again, well-named, it means that the person has done something to end their life. That was their intent and, in our case, if it's not completed, it is not, they do not die, they survive. Suicide itself is the, what we call the actual death of a person. So, if they die by self-injuries behavior, their intent was to die, their result is a suicide.
[New slide: Question 1, True or False?” Small text below: “PEOPLE THAT TALK ABOUT SUICIDE DO NOT DIE BY SUICIDE.”]
>> Lori: So, let me ask you, we've got a couple of things that we wonder about out there. So, in the chat, answer your question, what do you think about this? If a person is talking or signing about suicide, people that talk or sign about it are not the ones who die by suicide, is that true or false?
[A pause as folks enter comments in chat. The interpreter relays the information they see off-screen. “False, false, false,I’ve heard it’s false but it depends on the situation, false, false, both, it depends, false.” Lori nods at each response.]
>> Lori: That's great. I think that most of you are saying false. There's a couple of it depends.
[New slide: “True!” Smaller text below: “AT LEAST 80% OF INDIVIDUALS HAVE GIVEN DEFINITE INDICATIONS OF THEIR INTENT PRIOR TO AN ATTEMPT.”]
>> Lori: There's a little bit of true and, honestly, yes, it does depend. This is the actual answer. At least 80 percent of individuals who die by suicide have given clear indications of their intent prior to their attempt. People who talk about it, 80 percent die by suicide. So, 80 percent will say something about it or discuss it with persons or with people before the attempt. So, if that's true, that means there's a potential for intervention, there's a potential to stop that attempt before it takes place.
[New slide: “Question 2: True or False?” Small text below: “SUICIDE IS AN IMPULSIVE ACT.”]
>> Lori: Again, a true/false question. Suicide is an impulsive act.
[Pause as folks type responses into chat while Lori and interpreter watch screens off-screen. Lori occasionally nods at a response.]
>> Lori: Most of you are saying false, here's the response, and you are correct.
[New slide: “False”. Small text below: “MOST SUICIDES ARE THOUGHT ABOUT AND PLANNED FOR WEEKS IN ADVANCE OF THE ACTUAL ATTEMPT.”]
>> Lori: Most suicides have been thought about, they have been planned for weeks in advance. They may be very specific about when this is going to happen, when nobody's around, when they're going to be isolated, how this is going to take place, what exactly the steps are that they're going to take place. They acquire whatever methods or means that they're going to be using in the attempt, so, lots of planning. Does it mean that it's never impulsive? No. There are occasional suicides that happen on impulse, but it is not the most common experience.
[New slide: “Question 3: True or False?” Small text below: “MOST SUICIDES IN YOUTH/YOUNG ADULTS OCCUR IN WINTER MONTHS.”]
>> Lori: This is my last question. True or false, most suicides, in young people in particular, in young adults, occur, in young adults, I'm talking about college age, probably, most of those suicides happen during the winter months.
[Pause as folks respond via Chat. Lori and the interpreter watch the responses off-screen.]
>> Lori: So, most of you are answering that that's true, and here's the answer.
[New slide: “False”. Small text below: “ADOLESCENT SUICIDAL BEHAVIOR IS MOST COMMON IN SPRING AND EARLY SUMMER.”]
>> Lori: It's false. For adults, yes. Typically, we will see suicides, but for adolescents, suicidal behavior is most common in the spring or early summer. That's for teenagers, because, just think, that's a transition time. For adults, yes, the winter months, but not when you're looking at teenagers or youth, young adults.
[New slide: “Some Facts and Statistics”. Bulleted list below:
SUICIDE IS THE THIRD LEADING CAUSE OF DEATH IN YOUNG PEOPLE AGES 15 – 24.
SECOND LEADING CAUSE FOR YOUTH AGES 10 – 14.
AS OF FEBRUARY 2022 THE CDC REPORTED 6,643 DEATHS FOR YOUTH/YOUNG ADULTS
D/DB/HH CHILDREN/ADOLESCENTS DO NOT COMPLETE SUICIDE ANY MORE THAN THE GENERAL HEARING POPULATION BUT ARE AT MUCH HIGHER RISK AND HAVE MORE UNIQUE RISK FACTORS.
GIRLS/YOUNG WOMEN MORE VISITS TO ER FOR SELF HARM
GIRLS ARE MORE LIKELY TO ATTEMPT SUICIDE THAN BOYS.
BOYS ARE 4 TIMES MORE LIKELY TO DIE FROM SUICIDE THAN GIRLS. WHY?”]
>> Lori: Just a few statistics, let's take a look at those, and this is related to children and teens, young adults. Suicide is the third leading cause of death for young people who are in the age range of 15 to 24, and the concern more, for me, is this statistic with 10 to 15 year olds, where it is the second leading cause of death, and what is it about that particular age range that's bumping that statistic up? That's the question, but it really has become the second leading cause of death for those young kids. My suspicion is is, in that 10 to 14 range, they are doing, they might be engaged, they're engaged in things like parties, driving, things where it might be possible to cause an early death, but in a different way. That's the suspicion. February of 2022, the CDC set out the reports and the statistics about suicide. That report is 6643 deaths were youth and young adult, and that's from suicide directly, and that's in America. Those are American statistics, but that does not include the numbers of how many attempts might have happened. It is simply those suicides that are obvious suicides and completed. If we're looking at the deaf, deafblind, and hard of hearing population and those young people, comparatively, the statistics and the rates seem similar in terms of completed suicide, but for the deaf, deafblind, and hard of hearing students, risk is much higher, and their risks are unique to them. They have very specific factors influencing their risk. For young women in general, they have more visits to the emergency room associated with self-harm. Interestingly, girls are more likely to have an attempt than a boy, but a boy is four times more likely to actually die from suicide, by suicide than a girl, and that is because of this.
[New slide: “Tables Showing Means of Suicide”. Two tables side by side. Table on the left shows “Means of Suicde Among Males, United States 2020”. Table on right shows “Means of Suicde among Females, United States 2020”. ]
>> Lori: These charts here, the graphics, they're talking about the means, and if you compare males and females, what is their method, what is their means that they choose to complete their suicide and to end their life, boys, more typically, use lethal or more violent means, so, we're looking at firearms, we're looking at, um, means that, in the attempt, there is much less opportunity to have a completion, I mean, much more opportunity to have a completion. Now, it doesn't mean that girls don't use firearms or guns, certainly, females do too, but they do that less often than boys. They tend to use different means, and the means that they choose, it's possible to be found, for an intervention to happen even after the attempt has begun. So, if they're taking pills or they're doing something, it may be possible for them to survive, more likely for them to survive than you would, say, with a f firearm. So, girls attempt more, boys succeed more.
[New slide: “Risk Factors”.]
>> Lori: So, let me focus a little bit on those risk factors.
[New slide: “Risk Factors: Individual”. Bulleted list below:
ONE OR MORE MENTAL HEALTH OR SUBSTANCE ABUSE PROBLEMS (DEPRESSION)
IMPULSIVE OR AGGRESSIVE BEHAVIORS
FAMILY VIOLENCE INCLUDING PHYSICAL, SEXUAL, VERBAL, OR EMOTIONAL ABUSE
PAST SUICIDE ATTEMPT
SERIOUS PHYSICAL ILLNESS AND/OR CHRONIC PAIN
CRIMINAL OR LEGAL PROBLEMS
FINANCIAL PROBLEMS
CURRENT OR PRIOR HISTORY OF ADVERSE CHILDHOOD EXPERIENCES (ACES)
SENSE OF HOPELESSNESS
VIOLENCE, VICTIMIZATION, AND/OR PERPETRATION”.]
>> Lori: For each individual person, there's a set of risk factors, and this is the list of all those risk factors associated with an individual, whether or not, and, basically, they're cumulative. These risks get exponential. So, if a person has one or more of these risk factors, like mental health issues and a drug and alcohol addiction and, in this case, depression is the way I label that, the risk goes up, they're more likely to have suicidal ideation. If they tend to be an impulsive person or have aggressive behaviors, if they tend to react more quickly, less thoughtfully, if there's a history of family violence in their family, that includes physical, sexual, verbal, or emotional abuse, and they can have even more than one, not just one, and if there's been a past suicide attempt, it is more likely that they are at risk for attempting again. If they are a person with chronic pain, physical issues, we have a group of students who are deaf, what we call deaf plus, which means those students typically have physical limitations, maybe, are in chronic pain along with having the hearing loss, so, it puts them at risk at a higher rate, at a higher risk level. If they have a criminal or legal background, if things have happened and they've been involved in the criminal justice system, if there's financial problems in their life, and people always think, well, how can a young child have financial problems, but they are exposed to, perhaps, the family having financial problems, and they're hearing that their family doesn't have enough money, and if they're already dealing with negative thoughts, depression, maybe, they consider themselves to be the reason that finances are a problem, and if they weren't there, it would be more comfortable for their family, so, that's one of the things that a suicidal ideation can work into. If they have a history of what we call those adverse childhood experiences, hopelessness is an outcome of those kinds of experiences, and that is one of the things that I see really often, is that I see people come in for evaluation and assessment for services, and that is the thing I see a lot. Children and teens who are expressing hopelessness, feeling like the world is not safe, it's falling apart, it's dangerous, the family has issues, and that's not a safe place, there's arguments and violence in the home, so, they carry that sense of hopelessness, and I've heard really young children express that feeling. If they've experienced violence, if they're a victim of abuse, or if they are a perpetrator of violence, if they have harmed other people, again, that's an increased risk factor for a person, a general person.
[New slide: “Risk Factors: LGBTQ+” Bulleted list below:
DATA IS LIMITED AT THIS TIME
HIGHER RATES OF ATTEMPTS COMPARED TO HETEROSEXUAL INDIVIDUALS
APPROX. ¼ OF HIGH SCHOOL STUDENTS IDENTIFYING AS LGBTQ+ REPORT ATTEMPTING SUICIDE IN THE PAST YEAR.
NEARLY FOUR TIMES HIGHER THAN THE RATE REPORTED AMONG HETEROSEXUAL STUDENTS.”]
>> Lori: Some people ask about the LGBTQ plus community and their risk factors and, at this point, we do not have a lot of data on that. It's very limited, unfortunately. We know there is a higher number of attempts. Approximately a quarter of the high school students identified as LGBTQ plus report attempting suicide in the past year, and that particular statistic is four times higher than the rate of heterosexual students and their peers.
[New slide: “Students with Disabilities” Bulleted list below:
YOUTH DIAGNOSED WITH MOOD, ANXIETY, AND DISRUPTIVE BEHAVIOR DISORDERS
ADOLESCENTS WITH EMOTIONAL DISORDERS WERE MORE THAN 6 TIMES AS LIKELY TO REPORT SUICIDE ATTEMPTS
ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)
DEAF, DEAFBLIND HARD OF HEARING
LEARNING DISORDERS
3 TIMES MORE LIKELY TO ATTEMPT SUICIDE
AUTISM SPECTRUM DISORDER (ASD)
WHY?
FEWER AND LESS DEVELOPED COPING SKILLS COMPARED TO THEIR PEERS
MORE ISOLATED.”]
>> Lori: Another set of risk factors is looking at students with disabilities. So, deaf, deafblind, and hard of hearing, but, also, students who have other disabilities or additional disabilities, some of them have specific diagnoses of mood disorders, disruptive behavior, ADHD, um, learning disability, autism, being on the spectrum, somehow. I mean, basically, or all of the above, and these are cumulative. Again, they're exponential, one with the other, and the reason that that's worse is because they have left, they have less developed coping mechanisms in place to manage the stresses that come with those disorders. There's, often, a sense of isolation and an experience of isolation. That's a huge challenge for those students. They don't connect to school or peers, their relationships at home might be affected, and relationships are huge.
[New slide: “Risk Factors: Relationship”. Bulleted list below:
BULLYING
SOCIAL ISOLATION
A FAMILY HISTORY OF SUICIDE
A PARENT WHO HAS DEPRESSION OR SUBSTANCE ABUSE DISORDER
A DISRUPTIVE OR ABUSIVE FAMILY LIFE
RECENT LOSSES, SUCH AS THE DEATH OF A PARENT OR LOSS OF A RELATIONSHIP.”]
>> Lori: So, if you look at the risk factors associated with relationships, this is with classmates, peers, they may experience bullying, a lot of social isolation. Interestingly, if there's a family history of suicide, that's a risk factor, so, that means they've already had somebody in their life that they know of who has died by suicide. If they have a parent who, themselves, has depression or alcohol substance use disorder, or if their family life is disruptive, if they're experiencing abuse, maybe, not just at me, but you see abuse within the family system, a young person who's had a loss of somebody who's very dear to them, a parent or a close relationship, somebody they cared about a great deal, a grandparent, a really good friend, perhaps, that increases the risk.
[Slide moves toa new one quickly before replacing with “Key Points About Suicide”. Bulleted list below:
NORMAL DEVELOPMENTAL CHANGES COMBINED WITH STRESSFUL LIFE EVENTS MAY CAUSE A TEEN TO THINK ABOUT SUICIDE.
MANY OF THE WARNING SIGNS OF SUICIDE ARE ALSO SYMPTOMS OF DEPRESSION.
ANY TEEN WHO EXPRESSES SUICIDAL THOUGHTS SHOULD BE EVALUATED RIGHT AWAY.
INTERSECTIONALITY OF RISK FACTORS NEEDS TO BE CONSIDERED AS A HIGHER RISK GROUP.”]
>> Lori: Just some important things to remember. There are normal developmental changes that come along with stressful life events that are going on, but a stressful life event on top of that could cause a teen, in particular, to think about suicide, and if they already have depression or if they're already diagnosed with some other issue and are overwhelmed, the symptoms and the warning signs of suicide look the same. So, it means that those stressors are becoming more and more difficult for them to manage. Those warning signs, they look like depression, so, sometimes, I'll be told that this is a student who is excessively d depressed, and they're labeled and diagnosed as somebody experiencing depression, but when we're having our conversation when they first come in, I will often ask, is this the appropriate diagnosis? Because it might be that this particular person is overwhelmed with a lot of these risk factors in their life and, at this point, they're having suicidal ideation, which is mimicking depression. So, we have to reduce the ideation before we can address anything else. So, if there's a teen in your life that expresses suicidal thoughts, they need to be evaluated right away. We know that students tend to be a little bit, I don't know how to say it other than dramatic, sometimes, in their expressiveness and, at the same time, related to suicide and suicidal ideation, if they actually use a phrase like I don't want to be here, maybe, everybody would be better off, if I weren't here, it is pretty safe to assume that you're going to need a referral and get an evaluation done, that that's one thing you really want to do anyway. I have a couple of slides here, too, that you'll be able to see that are just talking about some of the phrases or different things. That intersectionality might be going on of risk factors, so it's this, plus this, plus this, plus this altogether is leading to the risk being so high and the ideation.
[New slide: “What to watch for”]
[New slide: “Subtle Signs in Children and Adolescents”. Bulleted list below:
BECOMES SUDDENLY CHEERFUL AFTER A PERIOD OF DEPRESSION
WITHDRAWING FROM FRIENDS AND FAMILY.
BEING ANGRY OR HOSTILE.
DOING RISKY THINGS, LIKE DRIVING TOO FAST.
USING ALCOHOL OR DRUGS.
HAVING CHANGES IN EATING OR SLEEPING PATTERNS, SUCH AS EATING LESS OR SLEEPING MORE THAN USUAL.
FEELING HOPELESS, DEPRESSED, OR ANXIOUS
NO LONGER CARE ABOUT HOW THEY LOOK/PERSONAL HYGIENE SUFFERS
LOSS OF INTEREST IN SCHOOL AND/OR THINGS THAT THEY USED TO LOVE TO DO
LACK OF RESPONSE TO PRAISE.”]
>> Lori: There's a question, what about adults? I don't know what you're asking about adults. What do you want to know about adults? (Laughing.)
[Lori looks at a screen off-screen to read the question.]
>> Lori: If you go ahead and type what your clarification is about that adults question, I'll monitor for it.
[Lori looks over to the screen and nods.]
>> Lori: Oh, here you go. Oh, oh, yes, back to what we were talking about before, the rate of suicide within the winter months. Um, yes, for adults, the research shows that, compared to warmer weather, typically, it's the winter months where an adult will attempt suicide. So, that is a factor. I don't have the specific percent with me right now, because I always focus on youth and young people, so, I don't know their stats exactly. Anybody can be in touch with me, I will find the information and send it off to you, though, if there's anything else you want to know about that kind of thing. I have it somewhere in my files, I know I do. So, let's look at some of the signs that you might be looking for with children and teens and adolescents. If they have a sudden mood change, like, if they're, typically, kind of, in a funk, depressed, sad and, then, all of a sudden, seem exceedingly cheerful, happy, it seems like whatever they were suffering with it has completely disappeared, and the reason that that's something to attend to, because it, maybe, means that they have already found their answer, they have prepared, that they've decided and, now, they feel that burden of all the pain and all that stuff being lifted, because they know what it is that they're going to do to reduce that pain and to resolve all that issue. If they start to really withdraw from their friends, from their family, if they're somebody who is involved in activities and they suddenly stop doing that, they stop doing things in general, they don't socialize with their friends, if they're easily angry or extremely hostile, it's, like, if they have a quick temper, if they lose their temper really, really quick, those are signs of drug and alcohol use, too, and one of the things with that is they're, maybe, just starting it or they're increasing the use of drugs and alcohol too, they change, maybe, a pattern that they have, how they eat, how they sleep, maybe, they're eating a lot less, maybe, they're sleeping a lot more, if they're expressing feelings of that hopelessness, depression, and if you notice more behaviors related to anxiety, if, suddenly, they don't care how they look, they, maybe, stop showering, they wear the same clothes day after day, and they lose interest in school or activities or things that they used to like to do and, suddenly, they're not interested in any of that, we call that a an heed ru, right? Perhaps, they were really involved in a club or something at school, they used to love to fish, they used to love to swim and, now, suddenly, they just can't be bothered, they don't want to go anywhere, do any of the things they used to really love to do. When people provide praise, positive reinforcement, they have no response to it, or they just dismiss it as not relevant, because it doesn't have any impact on them or, sometimes, they'll actually be really resistant to praise, they won't accept it, they'll resist, and I think we're going to change interpreters here, so, hang on one second.
[Interpreter raises hand to pause, Lori nods. Interpreter switch.]
[New slide: “More overt signs of Suicidal Ideation” Bulleted list below:
TALKING ABOUT SUICIDE OR WANTING TO DIE OR DISAPPEAR
SAYS, “I WANT TO KILL MYSELF,” OR “I’M GOING TO COMMIT SUICIDE.”
DEVELOPS AN OBSESSION ABOUT DEATH AND DYING
WRITING OR DRAWING ABOUT DEATH
GIVES VERBAL HINTS SUCH AS “I WON’T BE A PROBLEM MUCH LONGER,” OR “IF ANYTHING HAPPENS TO ME, I WANT YOU TO KNOW…”
GIVES AWAY FAVORITE POSSESSIONS OR THROWS AWAY IMPORTANT BELONGINGS
WRITES ONE OR MORE SUICIDE NOTES.”]
>> LorI; These are some more overt signs of suicidal ideation. So, if there's an actual mentioning or talking about suicide or wanting to die or the person begins to disappear, they may even say I want to kill myself, or I am going to commit suicide. They may develop an obsession about death or dying. Maybe, they're writing about or drawing about a situation that leads to death. Maybe, they give verbal hints and say things like I don't want to be here any longer, you know, if anything happens to me this weekend, you should do blah, blah, blah, I just want you to know blah, blah, blah. If they start to give away their favorite items or throw away their important belongings, and you know that they cared for those things and, suddenly, they're disappearing to friends or family members, or they write one or more suicidal notes, suicide notes, those are more overt signs. So, when a person begins to think about or consider suicide as an option, we have a risk curve, as you can see on this slide.
[New slide: “Suicide Risk Curve” Graphic on the left side, title on the right side. Graphic shows a chart showing the correlation between risk on the vertical side and time on the horizontal side, with time in minutes and hours. A blue curved arrow on the time side, with text inside a box, text dark and unreadable.]
>> Lori: So, sometimes, this can be representative of a minute, sometimes, it can happen over an hour, where the thoughts begin, a plan develops, and it starts to increase, that curve goes up, and at the top of that curve, they might say, I want to do it, but during that buildup, that climb, that's where interventions can happen. That's the most critical time. If they do make a call or say something like I want to die, I don't want to be here, that's the time to take action, in the beginning part of that curve. Once a person is at the top, an intervention has arrived, then they can work through the rest of it, so their rate of success decreases, if intervention happens at the top of that curve.
[New slide: “Protective Factors”]
>> Lori: This slide shows some protective factors.
[New slide: “Protective Factors: Individual”. Bulleted list below:
EFFECTIVE COPING AND PROBLEM-SOLVING SKILLS
REASONS FOR LIVING (FAMILY, FRIENDS, PETS, HOBBIES, EXTRACURRICULAR ACTIVITIES)
STRONG SENSE OF CULTURAL IDENTITY
ACCESS TO NEEDED SERVICES AND SUPPORTS.”]
>> Lori: So, a part of my job is to provide these coping skills, to teach them to do some problem-solving skill development with the people that I work with. I also help, um, my clients to list out reasons for living. Let's talk about family, friends, pets, hobbies, anything that they find joy in, I, kind of, help them navigate or identify those things, find happiness in their lives, and we talk about that. Um, also, developing a strong sense of cultural identity is helpful, and that could be as a deaf, hard of hearing, or deafblind person. It could be, um, their ethnic identity, their ethnic culture. It could be various things. Could be their LGBTQ plus identity. Just, again, helping the individual internalize some of these cultural gems for themselves. Last, you see access to needed services and supports, and this is, again, very individualized.
[New slide: “Protective Factors: Relationship” . Bulleted text below:
SUPPORT FROM PARTNERS, FRIENDS, AND FAMILY
FEELING CONNECTED TO OTHERS
COMMUNICATION.”]
>> Lori: Protective factors in relationships, like, just needing support from partners, from friends, from family members, feeling supported, feeling, um, that there's at least one person in my realm, in my people that will listen to me, hear me, try to understand me. There's at least one and, you know, even if that other person doesn't fully understand, they're at least there. They're there for me. Feeling connected to others is huge. With children, it's so important that they feel connected to not only their school, but their teacher, their peers, and when we work with deaf, hard of hearing, deaf-blind kids, we can see that this is one of the main areas that they find lacking for themselves. They don't always feel connected to their peers and teachers in school. During elementary, especially those ages, they might feel connected to their teacher or their peers, but, then, as they age into middle school, high school, that's no longer the case. That can go down for some people. Life gets more complicated. You know, your social life, certainly, gets more complicated during those ages. So, its important that youth have that support, have that connection. Last listed on this slide, you see communication as something that's vital. An individual needs to have someone they feel they can communicate with. If they feel that they don't have the ability to communicate or they don't have the ability to express themselves to someone else, that is very difficult.
[New slide: “Protective Factors: Community”. Bulleted list below:
FEELING CONNECTED TO SCHOOL, COMMUNITY, AND OTHER SOCIAL INSTITUTIONS
AVAILABILITY OF CONSISTENT AND HIGH-QUALITY HEALTHCARE AND MENTAL HEALTH SERVICES.”]
>> Lori: So, this slide talks about protective factors in the community. That can be school, community at large, other social institutions. Like, some folks are heavily involved in their YMCA. Whatever is happening on a local level, sometimes, it's the ice hockey team, um, or 4H is really important to some folks. Whatever it is, it's just the feeling of being connected, I'm welcome here. Secondly, access to mental health services, huge, which seems odd, but it is extremely important to get the support at the level you need it, when you need it.
[New slide: “Protective Factors: Societal”. Bulleted text below:
REDUCED ACCESS TO LETHAL MEANS OF SUICIDE AMONG PEOPLE AT RISK
INVOLVEMENT IN AND WITH CULTURAL, RELIGIOUS, AND/OR MORAL GROUPS.”]
>> Lori: So, let's talk about societal protective factors. I know this can be a little contentious, but any reduced access for children or teens, um, to use lethal means is something we need to look at. Oftentimes, I work with families who, maybe, like, hunting is valuable to them, and I will say or ask, are your guns locked up, like, with a key and put somewhere safe and out of the hands of your youngsters, so they don't have access? If kids are actively having suicidal ideation, it's really important that families take into consideration what is in their environment that they could use to harm themselves, from knives to medication to guns. All of that, anything they could possibly use to harm themselves needs to be removed from their access. Remove access to the items. Secondly, here, is involvement in or with cultural, religious, and/or moral groups. So, there is some research that says kids who are involved in these types of organizations and in these settings, they have a stronger safety network, and they have a better sense, um, of identity, self-identity, if they are in these groups and organizations and, that, in and of itself, can reduce risk.
[New slide: “What Can I Do?”]
>> Lori: So, what can we do?
[New slide: “Recognize the Signs of Depression/Suicide”. Bulleted text below:
FEELINGS OF SADNESS, HOPELESSNESS, OR LONELINESS
DECLINING SCHOOL PERFORMANCE
LOSS OF INTEREST IN SOCIAL AND SPORTS ACTIVITIES
SLEEPING TOO LITTLE OR TOO MUCH
CHANGES IN WEIGHT OR APPETITE
NERVOUSNESS, AGITATION, OR IRRITABILITY.”]
>> Lori: I know, everything I've said so far, that's the hard stuff. I see some chat comments like, oh, this is heavy, this is tough, and it is. It is. Let's talk about what we can do. If we can all be paying attention to those potential warning signs that we've discussed so far, you know, depression leading to suicide, um, in schools, often, you'll see kids make comments to each other about their mood, perhaps, don't be afraid to say something, like, hey, I noticed, you know, the last couple of days, you seem a little down and out, is something going on? If something is going on, please tell me, you can come and talk to me at anymore, and if you don't want to talk to me, that's okay, too, I can find someone else you can talk to, you know, whether it's a family member or other people. Just reminding them that there are folks here that you can express yourself to. If you notice a change in grades, maybe, your formerly all shining A-student is now a D-student, that's something to keep an eye on. If there's a change or loss of interest in social or sport activities, if you notice someone sleeping too much, or they're always arriving to school late, because they're sleeping in, um, or, perhaps, a parent or a student will say, like, man, when I got home, I just zonked, I was done. They wake up to eat, and then they go back to bed, that's something to be mindful of. You know, also, noticing a change in weight, whether they're gaining or losing and, I should say, the caveat is without clear explanation. If you notice that it's, perhaps, intentional, like they're trying to gain or lose for whatever specific reason, that's different, but if there does not seem to be an explanation, keep your eye on that. If you notice your student's more nervous, more irritable, more agitated, and it may be that all of that energy is not directed at just one thing, but it is a pattern of behavior, sort of across the board, an increase, an accumulation of all of this, those are all red flags.
[New slide: “Reduce the Chancees of Children/Teen Attempting Suicide”. Bulleted list below:
KEEP MEDICINES AND GUNS AWAY FROM CHILDREN AND TEENS.
GET A CHILD OR TEEN HELP FOR ANY MENTAL HEALTH OR SUBSTANCE ABUSE PROBLEMS.
SUPPORT CHILDREN AND TEENS. BY LISTENING, DO NOT TO OFFER UNDUE CRITICISM, AND STAY CONNECTED.
BECOME INFORMED ABOUT TEEN SUICIDE.
GET THEM IN FOR AN EVALUATION – PREFERABLY WITH A CULTURALLY AFFIRMATIVE AND LINGUISTICALLY SPECIFIC THERAPIST
USE AN EVIDENCED-BASED SUICIDE PREVENTION PROGRAM AND PERIODIC SCREENING WITH FOLLOW THROUGH TREATMENT IN YOUR SCHOOL.”]
>> Lori: So, we want to reduce, um, the chances of children and teens attempting suicide. So, you know, a couple of items here, you know, just keeping medicines, guns away from children and teens, removing that access, like I said already, making sure that kids are getting help, including mental health services or drug and alcohol substance use services, if needed. Oftentimes, I hear people say, oh, it's just because, it's their age, or that's normal for a teenager, or it gets brushed off to the side. So, my question is always, but what if it's not? What if it is serious? We want to be supporting children and teens by listening to what they say and not offering criticism and, that part, by the way, especially for parents, sometimes, teachers, too, that's tough, because you may hear a student complaining about something, and you're like, oh, come on, it's fine, you can do it, you got this, um, this is no big deal, you know, you're just being lazy, or I've, sometimes, heard the term, too, suck it up, let's go. Like, back in my day, I did blah, blah, blah. We don't want to do any of that. Make sure you're listening, and make sure you say things like, oh, wow, well, that's not my experience and, gosh, if I were you, I'm not sure either and, you know, things like that, or how can I help you? Like, yes, of course, we want to still make sure that they're accountable for their grades and things like that. I want to highlight this sort of thing to keep in mind. When things appear out of the ordinary with your student, become informed about teen suicide, you know, pay attention to, um, you know, the new statistics that come out. There's research studies constantly available. Keep up-to-date on that, you know, and if you're feeling like, oh, boy, I am not sure what's going on, um, go ahead and have someone sit down and do an evaluation with the student and, preferably, with someone who is culturally competent and knows the language, especially as it relates to our deaf, hard of hearing, deaf-blind students, if possible, having someone who understands hearing loss and can communicate directly with the student, that is better, and a student is more likely to be honest and express themselves in that situation than if there's more people in the room. They're also more likely, like, if you do need to have an interpreter, it's not their school interpreter. Don't do that. Bring in someone else, some other neutral third-party, someone from a different building, if necessary or, perhaps, a free-lance interpreter from the outside to do an evaluation like this, and I say that because, sometimes, this sort of evaluation or intervention can be very embarrassing for your student, or they are concerned that if they are honest, my classroom interpreter's going to tell my mom, or it's going to get back to my home, and this, I'm speaking from my own experience, I've seen this happen, you want to draw that line and keep the interpreter separate. Also, use evidence-based suicide programs and interventions in your school. If your school doesn't have anything like that, I highly encourage you to start discussing that and setting something up formally. If they do have something, please make sure that your staff is aware of what it is and that it's actually being utilized and, periodically, you're going to want to screen and make sure that the information is still good and valid. Give kids an opportunity to know that this is something that's on your radar as school administration, there are people in the building who care about you, that want to talk with you, hear from you, and everything is confidential. I think a lot of students might hear this said, but they don't actually fully grasp what that looks like, how to access it. Like, are you for real? Is this really going to happen, if I get help? So, like, posting posters is great, you know, exposing students as often as possible, this is something that's on our mind, and we are here to help you, we are available, you make it as visible as possible, even though, nowadays, let me back up. Perhaps, the student doesn't have the issue today, but next week, next month, they might have a problem then. So, they have been seeing these posters all year long, who knows when they may need it?
[New slide: “How Can Teens Help Other Teens?” Bulleted text below:
TAKE THEIR FRIEND’S BEHAVIOR AND TALK OF SUICIDE SERIOUSLY.
ENCOURAGE THEIR FRIEND TO SEEK EXPERT HELP. GO WITH THE FRIEND, IF NEEDED.
TALK WITH AN ADULT THEY TRUST ABOUT THEIR FRIEND.”]
>> Lori: I went to a school, um, and they had a great suicide prevention program. They had resources in the bathroom, lots of great, positive messaging, things that were on the mirror, like, there were comments on the mirror that said, you're great, um, we have a counseling center here, um, they had, um, like, the crisis line, all of the phone numbers were there, the suicide hot-line was available, it was plastered all over the building, and it wasn't so obtrusive that you were annoyed, but you knew that the information was there and available, and some of it was very creative and well-done by that school, because the school had the kids make some decisions, like, hey, what should we post, where should we post it, you tell us, you're the ones who are going to be seeing it. So, the kids had some buy-in and some ownership over how the program was utilized in this school. So, this slide talks about how teens help each other. Oftentimes, you can hear it in friend groups. It's just discussed, you know? Of course, they listen to each other. Kids listen to their peers, other kids, and you encourage their friends to refer their friend to an expert, if needed. Like, I'm here, I'll go with you, if you want to, you don't have to go alone, come on, it sounds like you need some help, let's go, or if their friend's resistant, then they may have to say something like, I'm going to go tell, I've got to go and tell the counselor, like, I love you, you're my friend, um, you've said these things, and I'm really worried. Oftentimes, kids tend to be more afraid that they're going to lose their friend, if they spill the beans. That comes up a lot, but when I'm giving these talks to students, I emphasize that, you know, if you don't take that step, you might lose the friend either way, and permanently.
[A pause as Lori checks the comments off-screen.]
[New slide: “If You See Something, Say Something”. Bulleted list below:
REMEMBER 8 OUT OF 10 PEOPLE WHO ARE CONSIDERING SUICIDE GIVE SOME SIGN OF THEIR INTENTIONS
TALKING ABOUT SUICIDE IS NOT A TYPICAL RESPONSE TO STRESS
ALL TALK OF SUICIDE SHOULD BE TAKEN SERIOUSLY AND BE ADDRESSED IMMEDIATELY.”]
>> Lori: So, if you've heard this phrase, if you see something, say something, I counsel this all the time. It's absolutely true. Just remember that statistic, that eight out of ten people who have suicidal ideation, um, move forward with some intentions and give signs of their intentions. They usually say something, they give hints, and this idea, talking about suicide is not a typical response to stress, it's not, it is not typical for anyone to just bring it up. Suicide is very serious, so, if you hear someone mention it, refer to it, anything at all, we need, we have to give our attention to it: Any discussions at all should be considered as extremely serious and should be acted upon immediately.
[New slide: “References”. List below:
CENTER OF DISEASE CONTROL (CDC)
JOHNS HOPKINS MEDICINE
KAISER PERMANENTE
NATIONAL ALLIANCE ON MENTAL ILLNESS (NAMI)
NATIONAL ALLIANCE ON MENTAL ILLNESS MINNESOTA (NAMI)
SUICIDE PREVENTION RESOURCE CENTER.”]
>> Lori: So, we don't have a lot of time. I'm going to open it for questions.
[Slideshow ends and closes, and Katy’s window reappears.]
>> Katy: This is Kelly speaking. There was a comment that was made, um, just saying that this is such an important topic, um, just having the strength and the fortitude to ask a direct question of the person you may be concerned about, and I am monitoring to see if there are any other questions. Not seeing any so far.
>> Lori: And, yes, I just wanted to mention, it's not always a comfortable conversation, it absolutely is not a comfortable conversation. For me, and take into consideration that I'm a professional, I do this for a living, and it's not comfortable for me. This is heavy stuff. It's hard to see someone in that much pain and dealing with those kinds of emotions.
[Katy looks off-screen.]
>> Katy: I'm sure people are, probably, just processing. I don't see any other questions though. Very helpful information. Thank you so much for presenting today.
>> Lori: Yes, and thank you for letting me come to present and, again, um, contact me, if any questions come to mind later on. Feel free. I'm completely open to that.
>> SPEAKER: Thanks again. Thanks so much. Take care, everyone.
[All windows close and are replaced by the QR slide with text on left side and a QR code with “SCAN ME” on the right side. Text: “Suicide Prevention Evaluation Link” (link below). “Presenters: Lori VIgesaa”.]
[All windows are replaced by a slide with a photo of an apple next to a magnifying glass and colored pencils on top left corner, and another photo of a pile of stacked books on bottom next to the mn.gov logo. Text on top right corner: “2022 Collaborative Experience Conference November 3-5, Thank you for joining!.” Text on bottom right: “Supporting the whole child, reboot.”]
[Video ends.]
