The Many Paths to Suicide Cause of Proximal Risk Factors Fundamental Risk Death “Triggers or Final Straws” Factors Biological Crisis in Poison Relation Genetic Load Sex Loss of Gun Freedom Race WALL OF RESISTANCE Age Personal/Psychological Increasing Fired/ Hanging Expelled Hopelessness Drugs Values Culture Contemplation Child Loss of or Religion Shock/ Alcohol of Suicide Abuse Parent Beliefs Shift as Solution Illness Autocide Model Environmental for Urban Suicide vs. Major Geo- Jumping Rural Loss graphy Season of year ? ? • All “Causes” are real. • Hopelessness is the common pathway. • Break the chain anywhere = prevention.
Wall of Resistance to Suicide Duty to others Others? Counselor or therapist Fear Good health Medication Compliance Responsibility Job Security or Support of significant for children Job Skills other(s) Difficult Access A sense of Positive to means Self-esteem HOPE Religious Calm AA or NA Pet(s) Prohibition Environment Sponsor Best Safety Treatment Friend(s) Agreement Availability -- Sobriety -- Protective Factors
Suicidal Crisis Episode Risk is Imminent 7 6 5 Risk 4 Level Initial Hazard is Encountered 3 2 Crisis Crisis Crisis 1 Stable Stable Begins Peaks Diminishes Years Days Hours Days Years Approximately 3 weeks
Contagion Effect Duration and Intensity of Risk Factors Increases Secondary Hazard Occurs Risk Continues (2nd and 3rd suicides occur) (e.g. anniversary date) to Increase First Suicide Occurs Very Initial Hazard High Encountered Crisis Risk Higher Continues Crisis Risk Crisis High Builds Remains Risk Crisis Risk Continues Stable Begins Years Days Hours Days Weeks Mos/Yrs Weeks Months Months Due to mounting losses, increasing frequency of anniversary dates, role-modeling effects, and building stress, the risk for additional suicides can remain present for months and even years. VW/1998
The Lethal Triad Upset Person Firearm Alcohol/drugs When these three are present — risk of violence is high.
Disease Management Model for Suicidal Patients Psychiatric Comorbid Transient Illness Psychological States Schizophrenia Agitation Depressive Disorder Perturbation Bipolar Disorder Psychic Pain Panic Disorder Hopelessness Substance Abuse Disorder Dopamine Deficit Personality Disorder Serotonin Deficit Alcohol Myopia Comorbid Physical Illness
Six QPR Goals Access Active Intervention Accompanied Referral Alleviation of Immediate Risk Factors Accurate Diagnosis Aggressive Treatment We can make a difference!
Gatekeeper training research results Increased knowledge Increased recognition of sources of stress Increased confidence and competence in helping someone in crisis Increased likelihood to intervene Increased likelihood to call a resource Satisfaction with the training For every 13 gatekeepers trained, there was one referral made Knowledge and skills are retained over time QPR Works!
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