Suicide Prevention & Awareness For First Responders

Suicide Prevention & Awarenessfor First RespondersTom Walker, MSW, RSWHuman Factors SpecialistOrngeJuly 26, 2016, 1:00 p.m. - 2:00 p.m. ET#FirstResponders#MentalHealth

Important! Send questions/comments to‘All Panelists’@mhcc #FirstResponders #MentalHealth

PresenterTom Walker, MSW, RSWHuman Factors SpecialistOrnge@mhcc #FirstResponders #MentalHealth

(Frankl, 1963, p. 129)Suicide: Prevention, Intervention &Postvention StrategiesTom Walker MSW, RSW –Human Factors Specialist Clinical Traumatologist &Compassion Fatigue Specialisttwalker@ornge.ca

Good Afternoon!

As First Responders You: support people on a continuum from smallsituations to the worst day of their lives; see the horrific things people do to people; hear people’s pain, grief and trauma listen to their fears; listen to their rage; run toward chaos (the “norms”) run away; Accompany family in a time of change andmourning; are expected to be rational, calm, hopefuland compassionate.

Suicide – Prevention

Suicide – Prevention

My Take on Trauma As someone who lives with trauma Iargue that we all need to take care ofourselves and our colleagues We need to expect our organization tosupport us – but we also have to openup the dialogue This means being proactive – notstigmatizing “the bravery of asking forhelp” and Asking for help if you need it8/8/2016page 10

"We cannot become what we want to beby remaining what we are."Max DePree, Leadership is an ArtI Invite You to Think Going ForwardDo YOU need to think about Trauma& Suicide differently?Do not replicate without consent

Today We Will Discuss prevalence of suicide amongfirst responders Discuss factors leading up to suicide Discuss PTSD and its connection tosuicide Discuss prevention, intervention andpostvention Learn a bit about surfing .8/8/2016page 12

Looking at the Numbers How many people die by suicide inCanada each year? In 2012, 3926 Canadians died bysuicide. 2972 were males and 954 were females. (Not sure of the stats in the LGBTQ community) The suicide rate overall was 11.3 per100,000. 17.3 per 100,000 for males and 5.4 per100,000 for females.8/8/2016page 13

Looking at the Numbers In Canada, the ratio of male to femalesuicide is approximately 3:1. & 4:1 in US Male suicide 3 X’s higher than femalessince the 1950s The overall suicide rate for the generalpopulation aged 10 to 90 is 11.3 per100,000 citizens. During the working years (20 to 64) thegeneral population suicide rateincreases slightly to 14.3 per 100,000.8/8/2016page 14

This in Context toParamedics In April 2014 to 2015 there were anestimated 35 paramedic suicides inCanada We have an estimated 30,000paramedics in Canada The rate would be (35*100000/30000) 116.7 per 100000 Compared to our 14.3 percent of thepopulation in this age group. 8/8/2016https://en.wikipedia.org/wiki/Paramedics in Canadapage 15

First Responders 2016: 23 first responders and 5 militarymembers have died by suicide 2015: 40 first responders and 12military members have died by suicide. Between April 29 and December 31,2014: 27 first responders died bysuicide while in 2014 - 19 militarypersonnel died by suicide.8/8/2016page 16

PTSD & First Responders (1) PTSD raises a sufferer's suicide risk,but even less-severe injuries cancontribute as stressors. Such as:– Personal anxiety and poor health,family problems,– Abuse of alcohol and drugs,– Withdrawal,– Compassion fatigue and burnoutwhich often looks like depression.8/8/2016page 17

Arousal Levels Whenexposedtotorepetitiverepetitive crisis; Whenexposedcrisis; Ourarousalbeginsbegins toto rise;rise; Ourarousal Hyper or Hypo arousal becomes Hyper or Hypo arousal becomes thethe constant State;constant State; This influences positively and Thisinfluencesandnegativelyhowpositivelywe deal withnegativelyconflict? how we deal withconflict?8/8/2016page 18

Dissociation,Compulsive coping behaviours:i.e: self-injury, suicidal ideation.

PTSD & First Responders (2) A 2012 study noted that Canadianparamedics have a higher PTSD rate thanother emergency workers. Estimations are that 16%-24% of Canadianmedics will be diagnosed with PTSD. This is compared to 9.3% of the generalpopulation in that age range.8/8/2016page 20

Definitions PreventionPreventing situations by looking at both riskand resiliency factorsIntentional – PTSD is a possibility – not aninevitabilityInterventionDifferent from counselling:Suicide intervention’s main goal is keepingthe person safe.Requires the helper to be more active,directive and specific

Definitons (2) Postvention Refers to the services offered to support and assistthose affected by or bereaved by suicide - includingthe person who attempted. Suicide Postvention is also suicide prevention. The goals of suicide Postvention are: Assisting those affected by the suicide Supporting those who need specialized support. Providing appropriate and accurate information aboutsuicide. Mitigating the effects of suicide contagion. Facilitating the return to work.

Prevention So when bad things happen, what areyou doing to mitigate PTSD? When is the last time you intentionallyput on your teflon (armour) when goinginto a bad call? i.e. First off: Stay out of people’s Shoes8/8/2016page 23

Unconscious EmpathyDon’t Walk In Their ShoesKnow About Your patient/victim’s shoes Treating them well However, if you are really uncomfortable Somewhere – Sometime you may haveslipped into their shoes – get out!!!

Types of TraumaDEVELOPMENTAL, SHOCKAND RELATIONALWhat do/did you struggle with?

Types of Trauma Developmental Trauma– Living in adverse conditions that affect thenervous system of the child (ambient) Shock Trauma– An unexpected event that is sudden andcan be extreme (May include medicalprocedures) Relational Trauma– Can be on the continuum of war, bullying,domestic violence to sexual assault orabuse by someone we know (ambient)

INTENTIONALITYExtinguish & Go SurfingWe’ll Always Have toRide the Waves

3-2-1 Grounding3 things youSee – Hear - FeelTalk to Yourself –Don’t listen Don’t take thingshome (developrituals) Positive self talk

Emotional FreedomTherapy (EFT)8/8/2016https://www.youtube.com/watch?v IWu3rSEddZIPa ge 29

Know Your ResourcesWhat happens when we stopcaring or become to defendedwith our Heart?Remember- Is it Possible to Care too Much?I am not letting you gethurt againDo not replicate withoutconsent

Compassion Fatigue Vicarious Traumatization Pearlman et. Al. Transformation in helper’s innerexperience; Cumulative effect of working withtraumatized people; General changes: withdrawal,despair, disconnection, cynicism,etc.

Effects of CF, VTPhysicalEmotional Sleep problems Irritable/ GI tract problemshypersensitivity Neck/backaches Emotionalnumbness Anxiety Hopeless/powerless Overwhelmed Sadness/depression

Effects of CF, VTMental Poor concentration Confusion/memory problems Difficulty making decisions Decreased self-esteemSpiritual/Relational Loss of meaning Sense of disconnection Interpersonal problems and conflict Worry about the future

High Risk Factors

8/8/2016page 35

What is your reaction? “I can understand that suicidal thoughts andplans can be how someone is coping ” “I can empathize with a person consideringsuicide that for them this is a possiblesolution” “I am afraid of how I might feel or what mighthappen if someone I know dies by suicide ”

Myths About Suicide Myth #1: People who talk about suiciderarely do it. Myth #2: The suicidal person wants to dieand there’s nothing anyone can do about it. Myth #3: A person who has attemptedsuicide will always have thoughts of suicide. Myth #4: If you ask a person directly aboutsuicide, it will lead them to a suicide attempt. Myth #5: A good job and stable relationshipsprevent people from contemplating suicide.

Suicide Intervention Steps 1. Look for an invitation and warning signs 2. Build rapport and approach 3. Ask the Question! 4. Listen and Understand – don’t try to fix it 5. Let them -- Ask about reasons for living 6. Assess severity of risk 7. Develop a safety plan 8. Follow-up

LEVEL OFRISKSuicidalIdeationFrequency(how often?)LOWMODERATE HIGHOccasionalIntermittent ContinuousIntensity (howstrong?)MildStrongOverwhelmingLethality ofmethodNot HighPossiblylethalOverwhelmingAvailability ofmeansDoesn't have Can getaccessaccessHasimmediateaccessSpecificity ofplan(how, what,8/8/2016where, when)NotconsideredDetailsworked outConsidereddetailspage 39

"We cannot become what we want to beby remaining what we are."Max DePree, Leadership is an ArtSo are you going to do anythingdifferently?Do not replicate without consent

REALLY DO YOU NEED TO DO SOMETHING?page 418/8/2016The only ones who really know what’s going on

Remember Good self-care It's okay to ask for help! When looking for a counsellor ask thesequestions: I need someone who’s very experience withtrauma (i.e. first responders) I need someone who I don’t have to take careof when I talk about the trauma I’ve seen andbeen through I need someone who’s going to work with merather than telling me: “you need to get a newjob.”8/8/2016page 42

Putting Theory into ActionYou’ll know you learned if:You Feel DifferentlyThink DifferentlyAct DifferentlyName three areas where you will use the skills;BRAINSTORM.

Questions@mhcc #FirstResponders #MentalHealth

Next Mental Health for FirstResponders WebinarOctober 4, 2016 at 1:00 p.m. ETTo watch our past webinars, visit our website mhcc #FirstResponders #MentalHealth

Thank youMental Health Commission of CanadaContact us: info@mentalhealthcommission.caVisit us: www.mentalhealthcommission.caFollow us:ORNGEVisit us: http://www.ornge.ca/Pages/Default.aspxTom Walker, Human Factors SpecialistEmail: twalker@ornge.ca

First Responders 2016: 23 first responders and 5 military members have died by suicide 2015: 40 first responders and 12 military members have died by suicide. Between April 29 and December 31, 2014: 27 first responders died by suicide while in 2014 - 19 military personnel died by suicide. 8/8/2016 page 16