Today I had the opportunity to attend the Suicide to Hope Workshop offered by LivingWorks. This course is a complete overhaul of the suicideCare Workshop that was previously offered by LivingWorks. The seminar takes 8 hours, and includes a participant workshop (like ASIST) and also some handouts that can be used with clients. The purpose of Suicide to Hope is to provide long-term suicide prevention work after the suicide crisis is over and immediate safety is secured.
Pathway to Hope
The key to the Suicide to Hope model is the Pathway to Hope or PaTH. There are three phases (Understanding, Planning and Implementing) and six tasks. These six tasks are:
Explore Stuckness
Describe Issues
Formulate Goals
Develop Plan
Monitor Work
Review Process
The purpose of the workshop involves understanding how to do this, moving through each phase. In contrast to the old suicideCare workshop, Suicide To Hope is much more concrete. The goal is to identify the “stuckness” – the elements that an individual was having trouble moving through in order to reduce their suicidality going forward.
Workshop Structure
Prior to attending the workshop some pre-reading on the theoretical and empirical underpinnings of the worksheet. Once the workshop starts, registration is completed and participants are directed to a Helper Qualities worksheet. This sheet contains 20 values like “Belief in suicide recovery”, “Courage to face the pain” and “Tolerance for risk.” These qualities are looked at throughout the workshop.
Next is a review of the workshop and the five principles of hope creation. These five principles are ways in which a client can experience growth and recovery. They include:
Suicide
Safety First
Respect
Self-Growth
Take Care
Essentially these principles mean that the experience of surviving suicidal thoughts or suicide attempts may represent an opportunity for growth. Ensuring a client’s safety will ensure they’re in the right frame to begin recovery and growth work. Respect for the client is key to building a strong helping relationship with them. Self-growth refers to “walking the talk”, and being able to be true to yourself. The final principle involves being careful to apply the model and not oversimplifying or forgetting client’s uniqueness.
The Three Phases are reviewed, and video illustrations are included throughout. These include some short clips demonstrating individuals who are safe but still suicidal, followed by clips of their recovery and a 25 minute single-take demo to really cement the learning.
A short roleplay experience in a triad helps individuals become more comfortable with the variety of tools that are provided (such as the questions to ask and the worksheets that are available.)
The ABCs of Safety
One of the really useful elements is a sheet titled “The ABCs of Safety”, which is an excerpt from the Suicide to Hope Planning Tool provided to workshop participants. This includes some checkboxes under the headings “I am ready to start R&G work”, “I know how to keep myself safe while doing R&G work” and “I know how we will work together.” These elements ensure that clients entering into recovery work have a safety plan and understand informed consent elements related to the treatment or service provision they will be receiving.
Conclusion
I found the Suicide to Hope workshop a vast improvement over the old version. The materials would be extremely useful for case managers, counsellors, psychologists, social workers, therapists and other professionals that are providing support to individuals struggling with suicide.
To learn more about Suicide to Hope you can read about it on LivingWorks’ website or find available training opportunities here.
For those of you who don’t use it, the website Quora is an absolute goldmine for information on a wide variety of topics. It allows you to ask and answer questions by individuals who all use their real names, and who have to identify their area of expertise (their reason for knowing the answer.)
One of the questions asked was “What are some striking facts or figures about suicide?” My answer is the basis for this post. I identify a number of suicide facts and figures with citations. These may make useful additions to presentations that you do in the future.
Suicide Attempts
We know that in the United States, about 50% of suicide deaths are by firearm (CDC, 2016). This accounts for the startling statistic that 60% of people who attempt suicide will die on their first attempt (Bostwick, et. al., 2016)
Of those that survive, 70% of those who live will never go on to have a second attempt, hopefully because they get the help that they need. About 23% will go on to attempt again (sometimes repeatedly) and live, while 7% will die on a future attempt. (Owens, Horrocks & House, 2002)
Gun owners in particular at much higher risk of suicide. We know that gun owners are 57 times more likely to die by suicide within 7 days of their purchase (likely because they purchased it specifically intent on suicide), and 7 times more likely within the first year as non-gun-owners. (Wintermule, et. al., 1999)
Depending on the type of gun and other variables, 85-98% of firearm suicide attempts will end in death, while only about 2% of overdoses will end in death. (Elnour & Harrison, 2008).
Suicide Prevalence
Women attempt suicide about 3 times as frequently as men do (Vijayakumar, 2015) but tend to die 3 times more frequently (Varnik, 2012) chiefly because of their use of more lethal methods like firearm and hanging, when compared to women who more commonly use overdose.
Suicide is most common in the middle ages, accounting for 54% of suicides in Canada (Statistics Canada, 2013) and 51% of suicides in the United States (CDC, 2011).
Suicide Antecedents
It’s been suggested that up to 90% of those who die by suicide have a diagnosable mental illness (Bertole & Fleischmann, 2002). Although this figure has been challenged because it is based on psychiatric autopsies (reviews with those left behind) that might be vulnerable to bias, it is common enough to be valuable.
Conclusion
Did I miss any suicide facts and figures that you’d like to see? Let me know and I’ll update the article. Thanks all!
Centers for Disease Control and Prevention (CDC). Web-based Injury Statistics Query and Reporting System (WISQARS) [Online]. (2013, 2011) National Center for Injury Prevention and Control, CDC (producer). Available from http://www.cdc.gov/injury/wisqars/index.html
Hi all, after a summer hiatus, I’m back! Mobile giving is all-the-rage these days, especially after natural disasters. We’ve all seen advertisements that say “Text HAITI to 90999” in order to donate $5 to the Red Cross. (That’s a real number.) You might be wondering how you can leverage this concept for your own crisis line or organization.
How Mobile Giving Works
Mobile giving, or donate-by-phone is an easier way to engage your donors. They simply text an SMS short-code from their cell phones, and a pre-determined amount of money is added to their bill. It’s a snap for you and individuals who, in order to donate previously, would have had to sign up with organizations like CanadaHelps, PayPal, or deal with the administrative burden of trying to give you cash or cheques directly.
Advantages
As already stated, mobile giving is easy. Most donors have SMS-capable cell phones and can take the 10 seconds to fire off a text message. In Canada, a mobile giving campaign can be set up that, after the payment of flat service fees, runs automatically. 100% of the money raised is given to your organization.
Mobile giving fundraising messaging is effortless. It can be distributed across social media like Facebook or Twitter, sent in a fundraising letter, or even included on a digital sign. This makes it ideal for almost any time of year, and any type of fundraising.
Disadvantages
There are some disadvantages to mobile giving: namely, if your intended audience does not use a cell phone or does not use SMS texting, they may be more apprehensive. This means that organizations that traditionally solicit funds from an older adult or elderly clientele may prefer fundraising letters or other tangible ways of donating.
Secondly, you have less information provided to you by your fundraising clients. For example, in the simplest mobile giving campaign, you have only the individual’s phone number. This means that giving tax receipts or following up on fundraising is more difficult.
Implementing Mobile Giving At Your Crisis Line
This guide is based on my experience implementing mobile giving at Distress Centre Durham. We elected to run a short, 3-month campaign starting on World Suicide Prevention Day (September 9, 2017). In Canada, all Mobile Giving is managed by the Mobile Giving Foundation (MGF) of Canada, a project of the Canadian Wireless Telecommunications Association (CWTA).
The Mobile Giving Foundation has agreements with each of the major telecoms in Canada so that 100% of the money donated is given to the charities.
After going to the Mobile Giving Foundation website (http://mobilegiving.ca), we navigated to the “For Registered Charities” section of the website. There, we see the MGF Standards of Participation. These requirements which include being a registered charity, being in good standing with the CRA, operating for more than one year, and having a donor privacy policy, are required to ensure that the MGF only runs campaigns with reputable charities.
There is a short questionnaire in order to receive approval by the MGF to submit a more comprehensive campaign application. After submitting the campaign application, we were emailed the application.
In addition to the organizational information, we also had a few choices to make:
Donation amount
Which short-code
Length of campaign
Use of widgets
Use of MGF built-in technology or an ASP
These will be explored below.
Donation Amount
We had the choice of $5, $10, or $25 per text. We decided to go with $10 as that is a small enough that most individuals would be willing to make that donation without much thought, but large enough that a short campaign would still be effective. You can run multiple campaigns with different dollar amounts.
For example, you could have donors text SPRITE 5 to donate $5 or SPRITE 10 to have them donate $10. This is achieved through the use of keywords and sub-keywords.
Choosing a Short-Code
We had the choice of 5 short-codes to choose from. We decided to go with 41010, each of the short-codes is a similar 5 digit number (e.g. 21212 or 101010). In a campaign like this, your short-code should be memorable and not easily confused with another organization, if there are others fundraising in the same geographical area.
Choosing a Campaign Length
The MGF allows you to choose a 3-month, 6-month, or 12-month campaign. The service fees (which includes a $350 application fee and then small additional monthly fees for each additional keyword/sub-keyword or widget you use) will be based on the length of your campaign. Many of the add-ons are free with a 12-month campaign which makes this very economical.
Using Widgets
Widgets are follow-ups that you may add to your campaign after the individual texts in to donate. For instance, you might text them back with a Thank You that directs them to a contact page, or to another page on your website. Another widget allows your donors to opt-in to receiving up to 3 follow-up messages.
For the Distress Centre Durham campaign we elected not to use any widgets, preferring to keep the campaign simple.
Using MGF Technology or an Application Service Provider (ASP)
An ASP or Application Service Provider is an organization that can help you manage your campaign. They provide additional tools that allow you to track or manage your campaign more easily, for a fee. Distress Centre Durham elected not to use any ASP when running our first campaign as we wanted to see what was possible with the MGF technology. It turns out their built-in features are more than enough for our needs.
Choosing Keywords and Sub Keywords
A Keyword is the word that an organization texts to donate to you. For example, someone could text SPRITE to 21212 to donate $5 to your fundraising campaign. You might decide that if they text PEPSI to 21212 that they will donate $10, and you could establish these as two separate keywords for your 12-month campaign.
A sub keyword is an additional word that is added onto your keyword in order for you to more granularly manage fundraising. For example, while Distress Centre Durham decided on “SUPPORT” as our keyword, we added the sub keyword DURHAM for fundraising we ran within the Region. Since we have other Online Text and Chat (ONTX) community partners participating, they each have their own sub keyword for their area.
Cost of Campaign
The cost of a mobile campaign is minimal. After your questionnaire is approved, the MGF sends you a price list. Most of the add-ons are free when running a 12-month campaign, with the largest fee simply being the $350 application fee. This makes mobile giving an ideal fundraising campaign for even a very small charity.
I would recommend for a 12 month campaign using one keyword, that you set aside $1,000 for the application fee, and other administrative costs (including getting information like audited financial statements or others available) and paying for advertising to promote your campaign.
Conclusion
Did I miss anything? Do you have any other questions? Please let me know. If you’d like to support Canada’s Online Text and Chat (ONTX) Program or Distress Centre Durham you may text SUPPORT DURHAM to 41010.
Nonprofits and registered charities, like other incorporated entities, are required to have a Board of Directors to perform governance and oversight. Boards review the financial situation of the organization, write policies and perform risk management, among other duties.
There are a number of theories on the most effective form of Board Governance. Boards are generally separated into 3 types, with some overlap:
Working Board: This is a Board that participates heavily in the day-to-day operations of the organization. This might be the case at a very small or very new organization where a “Steering Committee” who helped build the organization moves into the role of the Board
Hybrid Board: This is a Board that performs some operational work (such as writing grants) but ideally spends the majority of their time performing governance and policy tasks
Policy (or Governance) Board: A Policy Board or a Governance Board is one that spends no time performing operational duties and strictly works on Governance and Policy
There are pros and cons to each approach, but most large organizations have Policy Boards to ensure that the operational tasks are appropriately handled by the paid staff, while the Board acts as the stewards of the organization. One model of policy governance (arguably the model that popularized policy governance) is nicknamed the Carver Model, after its creator John Carver.
The Policy Governance Model is a registered trademark of John Carver, all rights reserved.
John Carver
John Carver earned a Bachelor’s degree in Business and Economics, a Masters in Educational Psychology and a PhD in Clinical Psychology from Emory University in 1968. (Carver, 2006) He has published five books and 13 monographs and authored over 200 journal articles. (Policy Governance Model, 2016)
10 Principles of Policy Governance
The ten principles of policy governance are as follows (BoardWorks, 2005):
The Trust in Trusteeship. This means the Board should be a steward or trustee of the organization – not just financially or for those who have a legal stake in the organization but all stakeholders, including clients or others to whom the Board has a moral responsibility to.
The Board speaks with ‘one voice’ or not at all. A Board should never be fragmented. Reaching a collective decision ensures that the Board will be able to carry out their mission effectively and consistently. A single voice provides true leadership and avoids politics.
Board Decisions should predominantly be policy decisions. Rather than intervening in operational or day-to-day decisions, the Board should restrict itself to making decisions in the form of written policies. The Carver Model actually sets out four types of policies (Carver & Carver, 2001) that the Board should concern themselves with :
Governance Process. These policies set out the actions of the Board like its responsibility to perform visioning and accountability
Board-Staff Linkage. These policies govern the relationship between the Board and the Executive. Examples of these policies include how the staff are monitored by the Board and who is responsible for making what decisions (operational vs governance.)
Executive Limitations. These policies set out what the executive (e.g. the Executive Director or CEO) cannot do. For instance, in some organizations the disposal of real estate may only be with the consent of the Board – this could be codified in an Executive Limitations policy
Ends Policies. Ends Policies set out the goal of the organization – the reason for its existence. This may be codified in a mission or visions statement in addition to an Ends policy.
Boards should formulate policy by determining the broadest values before progressing to the more narrow ones. This means that policies should be developed from the broad (such as a policy statement that sets out the need for evaluation) down to the narrow (the policy surrounding the use of Key Performance Indicators.) The result is that policy flows logically from very large to very small.
A board should define and delegate rather than react and ratify. This principle means that the Board should create policies that delegate tasks to the CEO and then respect the delegation. If situations are covered in existing policies, when something new comes up those policies will kick into effect, rather than the Board writing new policies.
Ends determination is the pivotal duty of governance. The Board should always keep in mind the outcomes of the organization. Their goal should be to monitor outcomes and delegate the achievement of those outcomes to the CEO or Executive Director. The Board should remain strategic.
The board’s best control over staff means is to limit, not prescribe. This means that the Board should indicate (as in principle 3, Executive Limitations) what an Executive is not permitted to do. They should not be telling the Executive what they should do. This subtle difference gives the Executive Director the freedom to achieve the goals set out by the Board.
A board must explicitly design its own products and services. This means the Board should write their own policies rather than merely adopting policy templates that may not be relevant for their specific needs.
A board must forge a linkage with management that is both empowering and safe. The CEO must feel that the Board will honour its commitment to policy governance while the Board has trust in the CEO or Executive’s ability to manage. If this trust breaks down, leadership will falter.
Performance of the CEO must monitored rigorously, but only against policy criteria. Objective measurement criteria for the Executive is important – but this must be measured in relation to the Ends policies.
Strengths of the Carver Model include emphasizing the role of the Board as trustees of the organization and highlighting the importance of moral ownership, not just legal ownership. Additionally, the focus on policies and a rejection of operational decision-making avoids micromanagement of the Executive and prevents rubber-stamping of policies or decisions.
Finally, the focus on the “Ends” – the visioning and the measurement of the Executive against those outcomes rather than the methods to achieve them, produces a future-focused Board.
Disadvantages of the Carver Model include a lack of focus on operational priorities. Although the goal of the Board is to help set the strategic priorities, a Carver Board is not involved in the implementation of those policies which can lead to them becoming corrupted.
Additionally, some activities that are performed by working or hybrid boards like fundraising are not performed by a true Carver Board. This means that it may be unsuitable for some small organizations where the Board holds the responsibility for major fundraising in the organization.
Finally, because many decisions are made by the CEO rather than the Board this can lead to weakened information flow and a lack of transparency as decision are made by the CEO out of view of the Board. (Coyne, n.d.)
Conclusion
The Carver Model represents one way of governance that has become increasingly popular in Canada and the US. Implementing the Carver Model may allow you to make a more effective Board despite the potential drawbacks and criticisms that have been levied at the model.
Carver, J. & Carver, M. (2001) Le modèle Policy Governance et les organismes sans but lucratif [The Policy Governance Model and non-profit organizations]. Gouvernance. 2(1). 30-48. Retrieved on July 2, 2017 from http://www.policygovernance.com/pg-np.htm
Carver, J. (2006). Boards that make a difference: A new design for leadership in nonprofit and public organizations. San Francisco, CA: Jossey-Bass.
There are a variety of models of suicidal behaviour. These models attempt to map suicidal behaviour or put it into boxes so that a helping professional can better understand how suicidal behaviour forms and how it can be treated and resolved. This Biopsychosocial Model comes from Kumar, U. & Mandal, M.K. (2010).
The model is first presented in textual format, followed by an image, and then an explanation.
Biopsychosocial Model
Biological, Environmental and Event factors feed into a Psychological Process. This psychological process leads to the development or exacerbation of a mental health issue and to suicidal behaviour. On a cognitive level, this affects how the individual thinks and feels about the past, present and future.
Biological Influences in Suicide
There are a number of biological factors that can increase the risk of suicide which have been reviewed by Pandey (2013). These include genetic predisposition of suicidal behaviour (Turecki, 2001) which may be related to increased prevalence of impulsiveness and aggressiveness.
5HT receptors are receptors in the brain that are activated by the neurotransmitter serotonin. Serotonin plays an important role in mood (Yohn, Guerges & Samuels, 2017), appetite and eating (Sharma & Sharma, 2012), sleep, memory and sexual function. Improperly functioning 5HT receptors may play a role both in depression and in suicidal behavior.
It has been well-documented that teens and adolescents are more impulsive than adults as their brains continue to develop up to age 25 (Kasen, Cohen & Chen, 2011) and this can increase their risk of suicide and homicide. (Glick, 2015) Witt et. al. (2008) examines this through the lens of the Interpersonal Theory of Suicide – suggesting that impulsive individuals are more likely to have acquired capability (through being exposed to pain), which is one of the 3 key elements of that Theory of Suicide.
Environmental Influences in Suicide
Environmental influences on suicidal behaviour include literal environmental factors like sunlight exposure and situational factors like presence of abuse, history of suicide attempts and other items that are commonly known as suicide risk factors.
Souêtre et. al. (1990) found that decreased sunlight exposure and lowered temperature was linked to increased risk of suicide. This may explain the high rate of suicide in Nordic and Scandinavian countries that lack many of the other risk factors for suicide. Lam et. al. (1999) found that light therapy decreased suicidal ideation in a population of women who struggled with Seasonal Affective Disorder (SAD).
Evans, Owens & Marsh (2005) found that an external locus of control (believing that life “happens to one” rather than one having control over their life) was associated with an increased risk of suicide in adolescents. This likely holds true in adults as well.
Other risk factors for suicide include the American Association of Suicidology’s IS PATH WARM mnemonic:
Ideation (thoughts of suicide)
Substance Abuse
Purposelessness
Anxiety
Trapped (a feeling of being trapped)
Hopelessness
Withdrawal (from others)
Anger
Recklessness
Mood Changes
Event Influences in Suicide
Sometimes an event occurs in someone’s life that is so devastating that it may lead to suicide. For instance, relational changes and other interpersonal issues (such as a loss of a relationship or fights with a friend) commonly precede a suicide attempt (Yen et. al., 2005; Bagge, Glenn & Lee, 2013; Conner, et. al., 2012)
In addition to interpersonal events as described above, events that may lead to suicidal behaviour include being arrested, charged or sentenced with a crime (Cooper, Appleby & Amos, 2002). Zhang & Ma (2012) also found this in a Chinese sample of suicide attempters, with the most common stressful life events preceding suicide involving family/home, hospital/health and marriage/love.
Conclusion
It’s clear that the biopsychosocial model of suicide has a fair amount of support for its component parts. It may be difficult to apply the Biopsychosocial Model directly in a clinical or therapeutic context. For that reason, other models may be preferred for intervention purposes.
References
Bagge, C. L., Glenn, C. R., & Lee, H. (2013). Quantifying the impact of recent negative life events on suicide attempts. Journal Of Abnormal Psychology, 122(2), 359-368. doi:10.1037/a0030371
Conner, K. R., Houston, R. J., Swogger, M. T., Conwell, Y., You, S., He, H., & … Duberstein, P. R. (2012). Stressful life events and suicidal behavior in adults with alcohol use disorders: Role of event severity, timing, and type. Drug & Alcohol Dependence, 120(1-3), 155-161. doi:10.1016/j.drugalcdep.2011.07.013
Cooper, J., Appleby, L., & Amos, T. (2002). Life events preceding suicide by young people. Social Psychiatry & Psychiatric Epidemiology, 37(6), 271.
Evans, W. P., Owens, P., & Marsh, S. C. (2005). Environmental Factors, Locus of Control, and Adolescent Suicide Risk. Child & Adolescent Social Work Journal, 22(3/4), 301-319. doi:10.1007/s10560-005-0013-x
Glick, A. R. (2015). The role of serotonin in impulsive aggression, suicide, and homicide in adolescents and adults: a literature review. International Journal Of Adolescent Medicine And Health, (2), 143. doi:10.1515/ijamh-2015-5005
Kasen, S., Cohen, P., & Chen, H. (2011). Developmental course of impulsivity and capability from age 10 to age 25 as related to trajectory of suicide attempt in a community cohort. Suicide And Life-Threatening Behavior, (2), 180.
Kumar, U & Mandal, M.K. (2010). Suicidal Behavior: Assessment of People-at-Risk. New Delhi, India: SAGE Publications.
Lam, R. W., Carter, D., Misri, S., Kuan, A. J., Yatham, L. N., & Zis, A. P. (1999). A controlled study of light therapy in women with late luteal phase dysphoric disorder. Psychiatry Research, 86185-192. doi:10.1016/S0165-1781(99)00043-8
Pandey, G. N. (2013). Biological basis of suicide and suicidal behavior. Bipolar Disorders, 15(5), 524-541. doi:10.1111/bdi.12089
Sharma, S., & Sharma, J. (2012). Regulation of Appetite: Role of Serotonin and Hypothalamus. Iranian Journal Of Pharmacology & Therapeutics, 11(2), 73-79.
Souêtre, E., Wehr, T.A., Douillet, P. & Darcourt, G. (1990) Influence of environmental factors on suicidal behavior. Psychiatry Research. 32(3):253-63.
Turecki, G. (2001). Suicidal behavior: is there a genetic predisposition?. Bipolar Disorders, 3(6), 335-349.
Witte, T. K., Merrill, K. A., Stellrecht, N. E., Bernert, R. A., Hollar, D. L., Schatschneider, C., & Joiner, J. E. (2008). Research report: “Impulsive” youth suicide attempters are not necessarily all that impulsive. Journal Of Affective Disorders, 107107-116. doi:10.1016/j.jad.2007.08.010
Yen, S., Pagano, M. E., Shea, M. T., Grilo, C. M., Gunderson, J. G., Skodol, A. E., & … Zanarini, M. C. (2005). Recent Life Events Preceding Suicide Attempts in a Personality Disorder Sample: Findings From the Collaborative Longitudinal Personality Disorders Study. Journal Of Consulting And Clinical Psychology, 73(1), 99-105. doi:10.1037/0022-006X.73.1.99
Yohn, C. N., Gergues, M. M., & Samuels, B. A. (2017). The role of 5-HT receptors in depression. Molecular Brain, 101-12. doi:10.1186/s13041-017-0306-y
Zhang, J., & Ma, Z. (2012). Research report: Patterns of life events preceding the suicide in rural young Chinese: A case control study. Journal Of Affective Disorders, 140161-167. doi:10.1016/j.jad.2012.01.010
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