Introduction

On October 31st I had the opportunity to deliver a presentation on youth suicide to the Sigourney Kiwanis. Kiwanis is a service organization that works with youth. This was a wonderful, active group that I enjoyed having the opportunity to speak with.

I’ve expanded on the point-form presentation that I left participants with, if you’re interested in reading more.

Suicide in Iowa

According to the Iowa Department of Public Health (Fleig, 2018) there were 478 suicide deaths in Iowa in 2018 including 39 teenagers. This is a large increase over the 2016 data kept by the CDC. 478 deaths means someone dies every 18 hours.

Suicide in General

For every suicide death, we know there are as many as 50 suicide attempts. (Schwartz-Lifshitz, et. al., 2012) This is partly because of the method that is used. The survival rate for firearm suicide is about 2%, for hanging it is about 30% and for overdose it is 98%. (Elnour & Harrison, 2008; Spicer & Miller, 2000)

Suicide Risk Factors

Anything that overwhelms someone’s coping and makes them feel hopeless may lead to suicidal behavior. Examples include:

• Struggling in school
• Anxiety or depression
• Bullying
• Substance abuse
• Being a victim or survivor of abuse (physical, emotional, sexual)
• Being a child of a parent who is struggling with substance abuse

Suicide Warning Signs

Warning signs are signs that a suicide attempt may be imminent. They include:

• Giving away prized possessions
• Talking about death
• An unexpected peace or calm after a significant struggle (because the person has made the decision to attempt suicide)

Protective Factors Against Suicide

Protective factors are those things that help keep us safe from suicide or buffer us from suicide.

• Academic Achievement
• Parental and Non-Parental Connectedness (trusted adults)
• Supportive Friendships
• Involvement in Sports
• Strong mental health / wellness

How You Can Help

Recognize Statements of Lethality

Also called statements of finality or invitations – invitations to ask about suicide – statements of lethality let us know that someone might be struggling with suicide. Statements of lethality include:

• I can’t go on
• I can’t do it anymore
• I wish I was dead
• I’m at the end of my rope

Ask Clearly About Suicide

You will not put the idea in the person’s head if you ask them about suicide. What you will do is help reduce the isolation and loneliness that person is feeling and reduce the intensity of those suicidal thoughts.

Limit Access to Lethal Means

Limiting access to lethal means, by securing firearms or locking up pills is an important part of safety planning with a vulnerable youth.

Take Intent Seriously

Additionally, take suicidal intent seriously. If a teenager overdoses on a harmless product like melatonin that they believe will hurt them, treat that like a serious suicide attempt.

Recognize Self-Injury is Different from Suicide

Recognize that non-suicidal self-injury (cutting) is separate from suicidal behavior and is usually a coping strategy rather than a means to an end.

Suicide Risk Assessment (CPR Model)

If someone has indicated that they are struggling with suicide, I want to know their current plan, their previous exposure to suicide and their resources/lack of resources.

Current Plan of Suicide

The more detailed their plan, the higher the risk level. Do they have access to the plan? Do they know when or where they want to carry out the plan? We know that taking away those means (e.g. securing the pills), in most cases does not cause an individual to try a different method. Instead, they step back and reconsider their suicide plan.

Previous Exposure to Suicide

Have they attempted before? If so, what’s different now? What’s changed? And have they ever lost someone close to them to suicide? If they have this increases their own risk for suicide.

Lack of Resources or Supports

A lack of resources like friends, family or counselling is one of the most significant risk factors for suicide.

Really Simple Suicide Intervention

If the youth can keep themselves safe today, tonight, tomorrow – then I’m okay with that. I can make an appointment for a counsellor or put other supports in place. If that youth can’t, then I’m going to call 911 or get them to the hospital for some emergency supports.

How Communities Can Help

Communities can form a Youth Suicide Prevention Action Group (YSP), this is a group that brings together members from different sectors like education, mental health, faith and law enforcement to work on resources to help reduce youth suicide.

Implementing an evidence-based program like Yellow Ribbon can help.

Hope for the Future

Senate File 2113 signed in March, requires teachers to get suicide awareness trained
(1 hour of Gatekeeper Training)

70% of those who attempt suicide and live will never make a second attempt because they get the help that they need. (Owens, Horrocks & House, 2002)

References

Elnour, A.A. & Harrison, J. (2008) Lethality of suicide methods. Journal of Injury Prevention. 14(1). 39-45. doi: 10.1136/ip.2007.016246.

Fleig, S. (2018, Oct 29) Following historically high suicide rates, Iowa schools become mental health ‘gatekeepers’. The Des Moines Register.

Owens, D., Horrocks, J. & House, A. (2002) Fatal and non-fatal repetition of self-harm: systematic review. British Journal of Psychiatry. 181. 193-199.

Schwartz-Lifshitz, M., Zalsman, G., Giner, L., & Oquendo, M. A. (2012). Can we really prevent suicide?. Current psychiatry reports, 14(6), 624-33.

Spicer, R. S., & Miller, T. R. (2000). Suicide acts in 8 states: incidence and case fatality rates by demographics and method. American journal of public health, 90(12), 1885-91.

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