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Stop the Suicide

David Opalewski

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excerpt from Answering the Cry for Help

Recognizing the Signs of Distress: Assessing Suicidal Risk

Recognizing an Individual in Suicidal Crisis
It is not always easy to recognize a person in suicidal crisis, especially the student who is on the honor roll, is well liked, and seems to have a bright future. These are the students that are always there for their friends and classmates. What we tend to forget is these students have their down days as well. These students are also vulnerable to brain chemistry imbalance that may lead to depressive episodes. My experience has taught me it's very difficult for these students to ask for help. The smarter they are the better they are at wearing the "depression mask." These are the students who are difficult to recognize. Most of the new Health Education Curricula contain up-to-date lessons on depression, emphasizing that depression is a medical condition and not a character flaw. Most curricula contain a depression-screening component that can be taken by students to evaluate if they may be susceptible to depression. In my experience as an at-risk counselor, these students come forward as a result of being exposed to or when one of their friends are exposed to these effective and relevant curricula.

For additional information, you can consult the following Web sites:

  • www.lexapro.com to learn more about depression symptoms and methods of treatment.
  • www.revolutionhealth.com to learn about depression as a disease, screening tools, and other helpful information. There are several links you can visit from this Web site as well.

    Signs of Crisis Situations:
    A majority of adolescents in crisis exhibit signs they are in crisis. Below are nine signs to look for:
    1. A poor self-image.
    2. Antisocial behavior and isolation. They become introverted and withdrawn.
    3. A drastic change in behavior and loss of interest in things the individual once cared deeply about.
    4. Open threats or clues about ending their life. Clues may be in writing assignments or art projects.
    5. Excessive use of alcohol or other drugs.
    6. A change in habits of appearance. A usually well-groomed adolescent begins to let his appearance go; appearance is an important issue for most teens.
    7. Giving away prized possessions, especially for unknown reasons. Those in support groups have shared with me they gave away possessions so they "wouldn't be forgotten."
    8. Poor communication with family and friends.
    9. A history of prior attempts of suicide. As mentioned before, every attempt seems to be easier and more dangerous.

    Telltale Signs:
    If you suspect a person may be in crisis after assessing him/her from the list above, begin looking for more specific signs such as the following:
    1. Scratching or superficial cutting, especially if the cuts go vertically up the arm. If the cuts go up and down vertically, the person needs immediate professional help. This pattern is very painful and is done to create physical pain to take the focus off his/her emotional pain. It is also more dangerous as it can cause dangerous blood loss in a short period of time.
    2. A recent significant loss. It may be a death in the family, a divorce, a friend moving away, etc. The individual in crisis may not possess the resiliency skills to cope with the situation.
    3. Themes of death or depression in writing, artwork, or conversation.
    4. Statements like "I'd be better off dead," "Nothing matters," or "I won't be a bother to you much longer."
    5. Discord in the home, which stirs up fear of abuse.
    6. A sudden decline of academic performance.
    7. Acute personality changes.
    8. Feelings of helplessness and rejection.
    9. Previous suicide attempt(s).

    The SLAP Assessment
    Although the SLAP Assessment does not take the place of a clinical assessment, it can serve as a guide for all who work with adolescents. SLAP is an acronym for the following four points:

  • S- How Specific is the plan? Ask what the plan is. The more specific the plan, the more serious the person is about following through with the suicide.
  • L- What is the Lethality of the proposed method? This is a question the adult usually can answer without asking the person in crisis.
  • A- Has the person in crisis Acquired the means? How Available are the means?
  • P- What is the Proximity of helping resources where the plan will be acted out? Helping resources can be defined as hospitals, police stations, EMS offices, or any location where help could respond quickly in the event of an attempted suicide. The seriousness of the attempt can be judged by the proximity or time it would take for someone to discover and intervene thus stopping the attempt. (For example, if the person plans to attempt suicide in a remote area where no one might discover him, then the risk is very high they are serious about completing suicide.)

    Although the SLAP technique may not be a foolproof method in assessing suicidal risk, it can give you a very good indication about how serious the teen may be about suicide. Once again, it does not take the place of a clinical assessment.

    I strongly suggest however that if a teen approaches you stating he/she is thinking about suicide that you take the person seriously, even if they don't score significantly on the SLAP assessment. It will be very helpful to consult with at least one other knowledgeable adult. A second opinion may save a person's life and relieve your anxiety as well.

    Robertson Risk Factor Assessment
    The Robertson Risk Factor Analysis for Violence and Suicide (pages 82-84) is a simple tool to help a person assess an individual's predisposition to commit violence toward himself and others. This tool combines various familial, psychological, personality, and sociocultural factors to help identify these risk factors. The general assessment will lay the foundation to determine violence directed towards self and others. The specific assessments are helpful to determine suicidal or violent tendencies.

    Prevention Tips:
    In making suicide prevention a major emphasis of this work, I need to stress the following points:
    1. Remove all guns from the home. Impulsivity tends to be a dominant personality factor in adolescents. Removing guns will make it less likely for teens to act on impulse. Many avid hunters are very likely to resist this tip, so my plea to them is to keep hunting firearms under lock and key; keep ammunition out of the home, and/or keep firing pins in a separate place under lock and key. Most teen suicides involve firearms. Removing them has many times prevented a suicide.

    2. Early detection of substance abuse is critical. Many times, substance abuse is the result of unmet needs in a teen's life. The reason why the teen is using drugs is an issue that must be addressed. What needs are they trying to fill by using drugs? How can adults identify and help the teen satisfy these unmet needs? The earlier these issues are addressed, the more effective we will be in helping the teen get his life in order. Substance abuse is one of the leading causes of suicide at all age levels.

    3. Family therapy for families experiencing multiple stressors is essential. Many times the parent(s) forget or don't realize they also need therapy or professional counseling in dealing with their suicidal teen. They send the teen to counseling, thinking the counselor or therapist can fix the problem. The teen in crisis will have a better chance to recover if parents and counselor work together to improve the living environment of the teen and gain greater insight into the life of their troubled teen.

    It is also important to note that most of the time, a healthy teen will not attempt suicide just beca

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