Law Enforcement Suicide Prevention

Introduction

Organizations like the Tema Conter Memorial Trust in Canada and Reviving Responders in the US have highlighted the skyrocketing rate of suicide among first responders, including police officers, paramedics and firefighters. In 2015, there were over 100 suicides by law enforcement officers in the US. (Kulbarsh, 2016) They note the high incidence of PTSD among law enforcement officers and the stigma that prevents them from seeking support.

One way to reduce law enforcement suicide is through police academy training that provides all officers with suicide awareness training. This helps reduce the stigma of receiving mental health support and gives police the opportunity to act as peer supporters for their colleagues.

Overview of Curriculum

The material below comes from the Basic Course for Police Officers authored by the New Jersey Police Training Commission (2016). This 262-page manual provides a complete review of the curriculum that police officers in that state learn during their 24 weeks at the Academy.

One of the instructional units is named “Suicide Awareness and Prevention for the Law Enforcement Officer”. The description is as follows:

The trainee will understand the causes, symptoms, warning signs and risks associated
with officer suicide, and will identify appropriate intervention and prevention strategies
to effectively deal with this issue.

The outcomes of this module are as follows. Once completed, the police recruit will be able to:

  • Define suicide
  • Identify demographics associated with law enforcement suicide
  • Know stressors that contribute to suicide
  • Explain risk factors associated with suicide
  • Identify warning signs associated with suicide
  • Understand suicide myths
  • Explain and apply the AID LIFE acronym for intervening with suicide
  • Identify obstacles to effective suicide intervention
  • Note professional resources helpful to an officer
  • Identify strategies to prevention law enforcement suicide

The content from these modules is summarized below, but I’ve added references where appropriate to back up the un-cited information. The goal is to provide added-value and confirm the veracity of the material.

Defining Suicide

Suicide is defined as the intentional taking of one’s own life (Stedman, 2016).

Demographics of Law Enforcement Suicide

  • There are more deaths to police suicide than in the line-of-duty (Kulbarsh, 2016)
  • The police officer life expectancy is less than the general population (Violanti, 2013)
  • The suicide rate is approximately 14 deaths per 100,000 (Badge of Life, n.d.) compared to 13 per 100,000 in the general population (AFSP, 2014)
  • Although the curriculum maintains that the divorce rate is higher among police officers, the opposite is actually true. The divorce rate is slightly lower, at 14.47% versus 16.96% for all professions over the lifetime (Roufa, 2015)
  • The rate of substance abuse is higher among police officers (Cross & Ashley, 2004)

Stressors Contributing to Law Enforcement Suicide

In addition to the normal stressors such as depression, anxiety, substance abuse and relationship issues, the curriculum identifies some specific job-related stressors. These include:

  • Discipline issues (internal affairs and/or
    criminal investigations); and
  • Management issues (assignment – lack of promotion – supervision);
  • Retirement (loss of identity and sense of belonging).
  • Shift work;
  • Sleep deprivation;
  • Unfulfilled job expectations;

Risk Factors Associated with Law Enforcement Suicide

This section identifies historical, demographic risk factors that may increase suicide. These are listed below, and correspond to those in the SAD PERSONS Scale and the CPR Risk Assessment:

  • Knowledge of and access to lethal means;
  • Age;
  • Gender;
  • Ethnicity;
  • Previous history (self or family member);
  • Cumulative stressors;
  • Feeling of hopelessness and helplessness; and
  • Lack of intervention resources.

Warning Signs of Law Enforcement Suicide

Warning signs, as defined by the AAS (n.d.) are items that represent an imminent, increased risk (active factors) rather than the stable historical factors that don’t necessarily represent increased risk. For instance, being a male does not itself mean someone is suicidal, but being a man does increase the chances someone will die.

The warning signs listed in the curriculum (reproduced verbatim below) represent a mix of risk factors and AAS-type warning signs.

  • Depression:
    • Attitude of hopelessness and helplessness;
    • Unexplained changes in appetite, weight, appearance, and/or sleep habits;
    • Difficulty making decisions;
    • Difficulty concentrating;
    • Overly anxious;
  • Previous suicide attempt;
  • Increase in the use of alcoholic beverages;
  • Overly aggressive or violent behavior;
  • Any changes in mood or behavior that are out of the ordinary, including a neutral mood;
  • Changes in work habits;
  • Behavioral clues of suicidal thoughts:
    • Giving away possessions;
    • Making a will;
    • Talking about a long trip;
    • Sudden interest or disinterest in religion;
    • Substance abuse relapse; and
    • Taking inappropriate duty-related and personal risks.
  • Anger / irritability; and
  • Concern expressed by family / friends / colleagues about a specific individual;

Identifying Common Suicide Myths

The myths that are discussed here include:

  • People who talk about suicide won’t attempt
  • Talking about suicide with someone does not reduce their risk
  • Warning signs are not present before a person dies by suicide
  • Suicidal individuals must have a mental illness
  • Suicidal individuals are beyond help
  • Suicidal individuals are committed to dying

See my article on suicide myths for a more complete discussion of these

AID LIFE for Suicide Intervention

AID LIFE is an acronym that is given in the training for a simple intervention procedure. The steps in AID LIFE are as follows:

  • A – Ask if the individual is thinking about suicide
  • I – Intervene immediately. Listen and let the person know they are not alone.
  • D – Don’t keep their suicidal thoughts a secret. Seek assistance
  • L – Locate help. This can include a supervisor, chaplain, physician, or other members of their support network. (Including crisis workers or the Emergency Room.)
  • I – Inform the Chain of Command. This can help get important resources like counselling in place.
  • F – Find someone to stay with the individual. (Dustin’s note: I’m actually not a big fan of this one, it shows up in the Marine Corps suicide awareness program as well; this is more important for high-risk, imminent suicide than it is for someone who may be low or moderate risk.)
  • E – Expedite. Get help now, rather than delaying it.

Obstacles to Effective Suicide Intervention

These obstacles are reproduced directly from the manual and include a variety of police-specific and more general obstacles to effective intervention with police officers who are struggling with suicidal thoughts.

  • Fear of stigma, isolation, humiliation, suspension, job loss;
  • Fear of change in duty status;
  • The police culture; (seeking mental health support may be perceived as a character weakness)
  • Denial that there is a problem; (by the officer, peer officers, supervisors, the command staff)
  • Reluctance of the officer to seek help for fear of the officer losing control of the situation;
  • The officer’s fear that confidentiality will not be maintained;
  • The officer’s distrust of management;
  • Supervisors and peers who protect or shield a troubled officer; and
  • Lack of knowledge by a troubled individual about the availability of counseling resources, and concern about being able to afford such services.

Professional Resources for Law Enforcement Suicide

Although this is a New Jersey Police manual, the resources presented are general enough to be a good reference. The resources that are recommended include:

  • Crisis Line
  • Employer Assistance Program (EAP)
  • Faith-based support (e.g. Chaplain or Church official)
  • Hospital emergency room
  • Mental Health Counselling (in person or otherwise)
  • Peer Support (from another officer or supervisor)

Strategies to Prevent Law Enforcement Suicide

The following 4 strategies are generally recommended for preventing suicide by both law enforcement officers and the general public. They include:

  1. Understanding the risk factors and warning signs of law enforcement suicide
  2. Using available resources and building a support network
  3. Challenging the stigma in seeking support
  4. Using the AID LIFE mnemonic

Other Police Suicide Prevention Programs

Together for Life was developed by Psychologists as a comprehensive suicide prevention program in Montreal. This program includes a half-day training session for all officers, a confidential telephone helpline, a full-day training session in more in-depth techniques for supervisors and awareness materials. Mishara & Martin’s 2012 evaluation showed:

  • 99% of those who attended the sessions said they would recommend the sessions to a colleague
  • 84% of supervisors were aware of the program
  • Positive increases in knowledge of risk factors and warning signs, and how to intervene
  • A nearly 80% decrease in the rate of Montreal police suicides (versus no change in the rate of police suicides in other police services in Quebec)

Badge of Life: Psychological Survival for Police Officers (Levenson, O’Hara & Clark, 2010) makes “emotional self-care (ESC)” the focus of a series of training modules delivered to police officers, along with mental health screenings and the delivery of peer support by other officers and the use of Critical Incident Stress Debriefing (CISD).

Police Organization Providing Peer Assistance (POPPA) (Dowling, et. al., 2006) is a New York Police Department (NYPD) based program for preventing suicide. It combines a confidential helpline, support groups, printed suicide awareness and intervention materials distributed to all police officers, and tools to assess resiliency and stress. Applied Suicide Intervention Skills Training (ASIST) is also provided yearly.

Additional Resources

The book Police Suicide: Tactics for Prevention provides a comprehensive review of police suicide causes and potential interventions to reduce suicidal behaviour in this group.

References

American Association of Suicidology. (n.d.) “Warning Signs | American Association of Suicidology” Retrieved on September 4, 2016 from http://www.suicidology.org/resources/warning-signs

American Foundation for Suicide Prevention (AFSP). (2014) “Suicide Statistics — AFSP” Retrieved on September 4, 2016 from https://afsp.org/about-suicide/suicide-statistics/

Badge of Life. (n.d.) Police Suicide Myths. Retrieved on September 4, 2016 from http://www.badgeoflife.com/myths/

Cross, C.L. & Ashley, L. (2004) Police Trauma and Addiction: Coping With the Dangers of the Job. FBI Law Enforcement Bulletin. 73(10) Retrieved on September 4, 2016 from https://www.ncjrs.gov/App/Publications/abstract.aspx?ID=207385

Dowling, F.G., Moynihan, G., Genet, B. & Lewis, J. (2006). A Peer-Based Assistance Program for Officers With the New York City Police Department: Report of the Effects of Sept. 11, 2001. American Journal Of Psychiatry: Official Journal Of The American Psychiatric Association, (1), 151. doi:10.1176/appi.ajp.163.1.151

Kulbarsh, P. (2016) “2015 Police Suicide Statistics” Officer.com. Retrieved on September 4, 2016 from http://www.officer.com/article/12156622/2015-police-suicide-statistics

Levenson Jr, R. L., O’Hara, A. F., & Clark Sr, R. (2010). The Badge of Life Psychological Survival for Police Officers Program. International Journal Of Emergency Mental Health & Human Resilience, 12(2), 95-101.

Mishara, B. L., & Martin, N. (2012). Effects of a comprehensive police suicide prevention program. Crisis: The Journal Of Crisis Intervention And Suicide Prevention, 33(3), 162-168. doi:10.1027/0227-5910/a000125

New Jersey Police Training Commission. (2016) Basic Course for Police Officers.

Roufa, T. (2015) “What is the Divorce Rate for Police Officers?” The Balance. Retrieved on September 4, 2016 from https://www.thebalance.com/what-is-the-divorce-rate-for-police-officers-974539

Stedman, T. (2016) Stedman’s Medical Dictionary (28th ed.). Philadelphia: Lippincott Williams & Wilkins.

Cite this article as: MacDonald, D.K., (2016), "Law Enforcement Suicide Prevention," retrieved on November 17, 2017 from http://dustinkmacdonald.com/law-enforcement-suicide-prevention/.
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Means Restriction in Suicide Prevention

What is Means Restrictions?

Means restriction is a technique for preventing suicide that involves restricting or preventing access to the tools used to attempt suicide. This can be things like pills (for overdosing), firearms (for shooting), or railways (for jumping.)

Some suicide methods have much higher lethality or chance of causing death than others. For instance, while 85% of firearm suicides results in death, only about 2% of overdoses do. Hangings are approximately 70% (Vyrostek, Annest, & Ryan, 2004).

There is a myth that if we limit one suicide method (like removing firearms from the home), that someone will simply use another suicide method. While it’s true that not all suicide methods exist in all countries and suicides still occur, suicide method restriction does not generally lead to method substitution during that time-limited suicidal crisis.

Support for Means Restrictions

The idea of means restriction (and its connection to means substitution) was first explored in the 1970s and 80s with the change from toxic coal gas to far less toxic natural gas in Great Britain. It was noted at that time that there was no displacement or substitution of suicide method. This was summarized by Clarke (1989).

Daigle (2005) reviewed a number of studies on means restriction and suggested two primary reasons for the reduction in suicide risk associated with restricting means:

  1. Individuals plan their suicide carefully, including becoming attached to specific methods. By restricting access to those methods people are less attached to the idea of dying by suicide at all
  2. Suicidal crises are often short lived periods of intense acute risk. By limiting the most lethal methods people are forced to either delay their suicide plan or switch to a less lethal method, which will either provide time for the suicidal crisis to pass or (in the event of a suicide attempt carried out) time to be rescued

The literature supporting means restriction and it’s relationship to means substitution is reviewed below based on common suicide methods, which are considered high-lethality methods and therefore most affected by means restriction.

Firearms

Anestis & Anestis (2015) examined the impact of four firearm-related laws: waiting periods to receive one, universal background checks, gun locks, and open carrying regulations on their impact of the suicide rate. Their research found that firearm suicides were reduced when each was implemented and background checks, gun locks and open carrying regulations also reduced the overall suicide rate.

This pattern, stricter firearm laws leading to lower suicide rates was observed in both England (Gunnell, Middleton, & Frankel, 2000) and Austria. (Kapusta, Etzersdorfer, Krall, & Sonneck, 2007)

Additionally, Wintemute et. al. (1999) found that the rate of suicide among handgun owners is 57x higher than the general population in the first week of ownership (because of people who buy a gun for the specific purpose of suiciding) and 7x higher at the end of the first year. It is likely that a person’s risk of dying by suicide remains elevated as long as someone owns a firearm.

Railways

Lukaschek, Baumert, Erazo, & Ladwig (2014) examined railway suicides in Germany over 2 separate periods and found that railway suicides were most common on Mondays and Tuesdays. They note that blue lights in Japan and physical barriers have been helpful in reducing railway suicides, in addition to comprehensive changes introduced by the German Railway Suicide Prevention Project.

The changes implemented included “an awareness programme, media approaches, hotspot analysis….and the introduction of a rule regarding announcements to passengers waiting in station or trains, which requires avoidance of the term ‘suicide’, and an indication that the delay is due to a ‘medical rescue operation underway.'”

Jumping

Law, Sveticic, & DeLeo (2014) examined the impact on the suicide rate in Australia after the installation of a suicide barrier on the Gateway Bridge in Brisbane. The barrier reduced the suicide rate 53%, while there was no shifting of means onto the nearby Stony Bridge.

Meanwhile in Auckland, New Zealand, a bridge barrier was removed on the Grafton Bridge and then reinstated; a 500% spike in the suicide rate occurred while the bridge barrier was absent. (Beautrais, 2009)

Counseling on Access to Lethal Means (CALM)

The Counseling on Access to Lethal Means (CALM) course provides a thorough exploration of means restriction to enable a worker to understand the theoretical basis for restricting access, but also the practical tools surrounding how, when and why to have the conversation about restricting means. It is particularly focused on youth but can be helpful for all populations.

Bibliography

Anestis, M.D., Anestis, J.C. (2015) Suicide Rates and State Laws Regulating Access and Exposure to Handguns. American Journal of Public Health. 105(10):2049-58. doi: 10.2105/AJPH.2015.302753

Beautrais, A.L., Gibb, S.J., Ferguson, D.M., Horwood, L.J., Larkin, G.L. (2009) Removing bridge barriers stimulates suicides: an unfortunate natural experiment. The Royal Australian and New Zealand College of Psychiatrists.

Clarke, R.V. Crime as OPportunity: A Note on Domestic Gas Suicide in Britain and the Netherlands. British Journal of Criminology, Delinquency and Deviant Social Behaviour, 29:1. 35

Daigle, M.S. (2005) Suicide prevention through means restriction: assessing the risk of substitution. A critical review and synthesis. Journal of Accident Analysis and Prevention. 37(4)625-32.

Gunnell, D., Middleton, N. & Frankel, S. (2000) Method availability and the prevention of suicide—A re-analysis of secular trends in England and Wales 1950–1975. Social Psychiatry and Psychiatric Epidemiology. 35:437–443

Kapusta, N.D., Etzersdorfer, E., Krall, C. & Sonneck, G. (2007) Firearm legislation reform in the European Union: Impact on firearm availability, firearm suicide and homicide rates in Austria. British Journal of Psychiatry. 191:253–257

Law, C.K., Sveticic, J., DeLeo, D. (2014) Restricting access to a suicide hotspot does not shift the problem to another location. An experiment of two river bridges in Brisbane, Australia. Australian and New Zealand Journal of Public Health. 38(2):134-8. doi: 10.1111/1753-6405.12157

Lukaschek, K., Baumert, J., Erazo, N., Ladwig, K.H. (2014). Stable time patterns of railway suicides in Germany: comparative analysis of 7,187 cases across two observation periods (1995-1998; 2005-2008). BMC Public Health. 14(1)

Vyrostek, S.B., Annest, J.L & Ryan, G.W. (2004) Surveillance for fatal and nonfatal injuries–United States, 2001. Morbidity and Mortality Weekly Report (MMWR). 53(SS07);1-57. Accessed electronically from  http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5307a1.htm on Jan 23 2016.

Wintemute, G.J., Parham, C.A., Beaumont, J.J., Wright, M., & Drake, C. (1999) Mortality among recent purchasers of handguns. New England Journal of Medicine. 341(21):1583-9

Cite this article as: MacDonald, D.K., (2016), "Means Restriction in Suicide Prevention," retrieved on November 17, 2017 from http://dustinkmacdonald.com/means-restriction-suicide-prevention/.
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Common Suicide Myths

There are many prevailing myths about suicide, suicide risk assessment, and suicide intervention. Learning that someone is suicidal can be very frightening both for the person experiencing the thoughts and helpers. It’s important that as a well-informed helper you do your best to stop the spread of these myths by educating yourself in the basic theory of suicide risk.

These myths below are common in individuals with no training in suicide risk, but even if you have no formal training, dispelling these myths can help you to reduce the stigma. How many did you get right?

Myths

#1  – Asking someone about suicide will put it in their head

False! Humans have a strong self-preservation instinct, and asking someone if they’re feeling suicidal will in no way put it in their heads. (Dazzi, et. al., 2014) Instead, asking someone if they’re feeling suicidal will often result in relief if they are feeling suicidal, because it shows that you’re willing and able to talk about it openly.

#2 – Someone who talks about suicide is unlikely to attempt it

False! Many times people who are feeling suicidal will drop hints (lethality statements) like “Sometimes I wish I could just fall asleep and not wake up.” People not trained in suicide assessment may not pick up on these subtle hints, or they may fear asking whether they are feeling suicidal because they don’t know what to do if the person says yes.

As suicide statistics reveal, most women to die by suicide have attempted before, and most men use such lethal methods that they don’t get a second chance. Therefore you should always treat a suicidal threat or statement as real.

#3 – Revealing suicidal thoughts will lead to being hospitalized against one’s will

False! While people who are in immediate danger can (and are encouraged) to go to their local hospital emergency room for urgent help, most people who are experiencing suicidal thoughts can get help on an outpatient basis, connecting with their loved ones and getting referrals to counsellors, therapists, or other mental health care.

#4 – You have to be crazy or mentally ill to experience suicidal thoughts

False! Although upwards of 90% of people who die by suicide have a mental illness (Mann, 2002), having suicidal thoughts by no means you are mentally ill. In fact, most people report having suicidal thoughts at one point or another during their life. They are a normal experience and as long as steps are taken to help, most people with suicidal thoughts can overcome them.

#5 – Once a person has been to the hospital for a suicide attempt, their risk is eliminated

False! Certainly, going to the hospital and seeking emergency physical and mental health care is important. Someone who has overdoses needs physicians to make sure they’re healthy, and to get an assessment of their mental state. But this reduction in risk is only temporary.

Once a person has been discharged, if nothing else changes in their environment they are likely to find themselves in the same suicidal thoughts as before. In fact, sometimes suicide risk can even speak after a discharge. (Large, et. al., 2011)

This is why it’s so important to ask what happened during a person’s last suicide attempt, if they have one, as part of a risk assessment. You want to know what has changed.

#6 – Suicide only affects poor people

False! Suicide is blind. Young and old, poor and rich, in every country of the globe people die by suicide, an estimated 800,000 people a year. (World Health Organization, n.d.)

Sometimes people feel like they’re not entitled to feel suicidal because they’ve lived a life of privilege but this is not the case, and bottling those feelings up and not talking to people can make things worse.

#7 – Feeling suicidal is a sign of weakness

False! Suicide is a response to an overwhelming set of circumstances. Humans have evolved to problem-solve, and sometimes we run out of solutions. In that situation, suicide can look like an attractive solution. This is not a sign of weakness, it’s simply a sign that you don’t have enough resources to deal with what you’re going through.

By widening your support network it’s like adding floor joists to your sub-floor. You’re still carrying the same amount of weight but it’s spread out over a larger area, reducing the amount of load on any one spot.

#8 – Suicides are more common during the cold winter months

False! Depending on country, suicides peak at different months (Fruehwald, et. al., 2004), and in Canada and the US tend to peak in April and May (Bridges, et. al., 2005), and are often quite high during the summer. There are a number of explanations for this, one of which is that during the cold winter months, everyone is inside (and so are you.) When the winter is over, people begin to go outside, and it gets warmer; the suicidal person sees that everyone is enjoying themselves but they are not, and the incongruence can elevate suicide risk.

Additionally, the winter months are often associated with the holidays. Thanksgiving (in the US) and Christmas are a time of celebration and being together with family, who in many cases are a strong protective factor. During the spring and summer there are not as many holidays and people don’t see their families as often (if at all.)

#9 – Teenagers and young adults are at greatest risk for suicide

False! Although teenagers experience an increase in suicide risk compared to earlier adolescents, people in their 20s actually have one of the lowest rates of suicide. After a person’s 20s and 30s, suicide risk tends to climb with age, and individuals 65 and over experience the highest rates of suicide, followed by middle-aged individuals, aged 45-54. (Statistics Canada, 2014)

Explanations for this include empty-nester syndrome in women, where they feel like their purpose has been served and they are only a burden on others, and a “mid-life crisis” in men where they begin to evaluate where they are and where they’ve been and decide that they haven’t lived up to their potential.

#10 – If someone has lost someone close to them to suicide, their grief will prevent them from doing the same

False! In fact, losing someone to suicide (becoming a suicide survivor) actually increases risk. (Jordan, 2008) This is because losing that person has provided a behaviour role model, which serves to give the suicidal person permission.

Additionally, they may experience a lack of support because the person they relied on is now gone. Factoring in grief from the loss and a desire to want to be reunited and it becomes easy to see why suicide bereavement is such a powerful predictor of suicide. (McEnamy, 2008)

More Myths

These are just a few of the myths that are frequently spoken or thought when the topic of suicide comes up. With your help, you can change people’s attitudes towards suicide and create a more open atmosphere for everyone. Can you think of any other suicide myths?

Bibliography

Dazzi, T., Gribble, R., Wessely, S., & Fear, N. T. (2014). Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence?. Psychological Medicine, 44(16), 3361-3363. doi:10.1017/S0033291714001299

Mann, J.J. (2002). A current perspective of suicide and attempted suicide. Annals of Internal Medicine. Vol 136

Large, M., Sharma, S., Cannon, E., Ryan, C., & Nielssen, O. (2011). Risk factors for suicide within a year of discharge from psychiatric hospital: a systematic meta-analysis. Australian & New Zealand Journal Of Psychiatry, 45(8), 619-628. doi:10.3109/00048674.2011.590465

World Health Organization. “WHO | suicide Data” (n.d.) Retrieved electronically from http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/ on January 29, 2015

Statistics Canada. (2014) “Suicides and suicide rate, by sex and by age group (Both sexes no.)” from CANSIM, table 102-0551. Retrieved electronically from http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/hlth66a-eng.htm on January 29, 2015.

Fruehwald, S., Frottier, P., Matschnig, T., Koenig, F., Lehr, S., & Eher, R. (2004). Do monthly or seasonal variations exist in suicides in a high-risk setting?. Psychiatry Research, 121(3), 263-269. doi:10.1016/S0165-1781(03)00253-1

Bridges, F. S., Yip, P. S. F., Yang, K. C. T. (2005). Seasonal changes in suicide in the United States, 1971 to 2000. Perceptual and Motor Skills, 100, 920–924

McMenamy, J. M., Jordan, J. R., & Mitchell, A. M. (2008). What do Suicide Survivors Tell Us They Need? Results of a Pilot Study. Suicide & Life-Threatening Behavior, 38(4), 375-389.

Jordan, J. (2008) Bereavement After Suicide. Psychiatric Annals. 38(10)



Cite this article as: MacDonald, D.K., (2015), "Common Suicide Myths," retrieved on November 17, 2017 from http://dustinkmacdonald.com/common-suicide-myths/.

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