Kirk Kinnell May 2005 Suicide Intervention

World Health Organisation 2000

1 Million suicides worldwide. 16 per 100,000 of population. 1 Suicide every 40 seconds. Attempts exceed completed acts by 20:1. Male suicide rate in U.K. can be a high as 33 per 100,000 of population. In Scotland suicides account for 17.8% of all male deaths in 15 24 age group.

Academic Studies
40% of those who commit suicide have previously

attempted.

( Kerkhof 2000 )

15-20% relate to the previous year. ( Kreitman & Casey

1988 )
History of Deliberate Self Harm increases future risk of Suicide by 10 30 times. ( Gunnell & Frankel 1994) 50% of those who commit suicide have a history of self harm. ( Roy 1986)

U.K. - Samaritans 2004 - Suicides

England

12 per 100,000 of population

N. Ireland
Wales Scotland

12 per 100,000 of population

14 per 100,000 of population 21 per 100,000 of population

The Male Factor

Tend towards more lethal and certain methods

commensurate with hospital admissions for attempted

suicide and DSH.

More likely disposed to substance abuse.

More inclined to impulsive violence.

Less liable to seek or accept help or advice when faced

with life problems. (Brent & Moritz 1996)

Suicide - Objectives
List the main reasons why people threaten suicide. Describe risk factors indicating potential suicide. Identify verbal clues which suggest suicidal intentions. Identify situational clues which suggest suicidal intentions. Outline behavioural clues which suggest suicidal intentions.

Suicide - Definitions
When a person takes their own life, whether with the assistance of others

or otherwise.
Or A deliberate act of Self harm which has caused the harmers death.

Suicide - Myths

They are all attention seekers. If they talk about it they wont do it.

Assisted Suicide Assistedsuicideholidays.co.uk.

I hope you have peace however you find it Maddy Good luck and I will see you on the other side. SIDHE

Assisted Suicide Assistedsuicideholidays.co.uk.

Gateway to Peace ?

Suicide - Myths

They are all attention seekers If they talk about it they wont do it Suicidal people are all Mentally / Physically ill Intelligent/educated people dont do it.

When the depression lifts, the risk goes.

If you ask about it you increase the risk.

Reasons For Suicide Threats

Suicide is the anchor point on a continuum of suicidal thoughts and behaviours. The continuum is one that ranges from risk taking behaviours at one end, extends through different degrees and types of suicidal thinking and ends up with suicide attempts and suicide. ( Redfield Jamieson 2000 )

Reasons For Suicide Threats

Suicide COMPLETERS continuum

Subjects With Other Motives (SWOM )

Reasons For Suicide Threats

Police Negotiator Control / Influence over: COMPLETERS

Managing Disappointment
Critical Incident Debriefing S.W.O.M. Success / Ego

Reasons For Suicide Threats

primary reason - wants to die COMPLETERS

- wants to end suffering

Reasons For Suicide Threats

Secondary Reasons ( S.W.O.M. ) Cry for help Attention seeker Test reactions Gain something Manipulate events Prevent entry Intend to die Suicidal desire impulse levels increasing

Suicide Indicators

Verbal Situational Behavioural

Suicide Indicators Verbal Threats

Refuses to talk Isolated - hopeless - helpless Specific death plan Deadline - last request No ifs or buts Commitment to die

Verbal / Situational

Suicide Indicators Situational

Police Negotiator should : Attempt to assess the subjects determination to complete the act and

Identify the level of sophistication of the plan.

( which side of the barrier )

Suicide Indicators Situational

Antecedent history Location Secluded / public Danger Convenient / Difficult Personally symbolic Special meaning. Socially symbolic Erskine Bridge Low self-esteem Emotional crisis Major life - marital - relationship events (last 24hours) Negotiator detects sense of hopelessness

Suicide Indicators Behavioural

Hostile threatening. Demands to be killed . Demands should be viewed as unsatisfied need. Past attempts. Final ritual - last will & testament. Inappropriate calmness - happy and content. Stripping of possessions relationships. Mental health. Method - slashing, cutting, firearms.

Suicide Indicators Behavioural

Offensive v Defensive threats Offensive If you dont get my wife ..I will jump Defensive If you try and grab me I will jump

Behavioural Change Staircase

Change
Influence Rapport Empathy Active Listening Situation

Come Down Plan

Safest Possible Way Early Non-threatening I know that you are not ready to come down just yet, but when you do could you come to the centre of the roof / fire escape etc.

Resolution

Domestics

Allow to vent feelings

Label emotions Take a rational line Try not to take sides Emphasise the positive

Resolution

Depressive: no contact with reality

Empathy Be patient for replies Beware of sudden movements Discuss real world v abstract Postpone action instead of changing mood Beware suicide by cop

Resolution

Inadequate: in contact with reality

Try to resolve without meaning another failure Talk of successes Raise esteem

Resolution

Anti-social: in contact with reality Egocentricity in mind Be firmer to gain respect Safe release to his advantage Reality checks Avoid intermediaries Saving face coming out plan

Resolution

Crime gone wrong

Provide a solution
Legal and media observers

Appeal to reason

Resolution

Terrorists

Excess will now diminish your message Youve made your point The World is watching Come out only choice left to them

Suicide Negotiation Tactics Broaching the subject

IF CLUES SUGGEST SUICIDE - ASK! It looks to me as if you want out of this Visible - audible relief Motive? - purpose? Language implies suicide Why do you want to kill yourself How/when do you plan to do it? What have you done?

Suicide Negotiation Tactics Building Rapport

One negotiator? Active listening. Speech - slow, clear, simple . Personal concern - empathy trust.

Making requests - be firm.

Do not intimidate or become argumentative. Empathic statements & questions.

Suicide Negotiation Tactics Making Progress

Discourage alcohol/drugs. Establish problems - break down issue(s). Focus on situation - talk directly about it.

Rationalise.
Bid for time. Identify hook .

Suicide Negotiation Tactics Resolution

SUICIDE INTERVENTION
Allow to ventilate Try to get person to describe events as objectively as possible Place more objective, rational view of events Use empathy, point out the normality of reaction Raise esteem Ask how they have handled it in the past Ask to go over options they have ruled out AVOID lecturing/moralising/giving advice

Suicide Negotiation Tactics Resolution

SUICIDE INTERVENTION Be non-judgmental/non analytical Ask Are you going to commit suicide? Ask person to reduce immediate danger Focus on CAUSE of suicidal feelings and specific SITUATION Express personal concern and EMPATHY Try to keep them on the line/talking

Suicide Negotiation Tactics Resolution

SUICIDE INTERVENTION

If insist, get promise not to harm and agree time to call

back Talk openly about the finality of death DONT go along with final requests Explore what is meaningful to person and what keeps

them going
Bid for time, explore developing a realistic plan of

action.

Method

pills - how many ?- kind/strength? - when? anything else?

toxic substance - antidote ?

gun/knife - ammunition ?- seriousness of wound? gas/carbon monoxide - when did action begin? other - slash wrist? - jump? - hanging?

Risk Reduction Ask person to reduce danger

pills - flush down toilet - walk - stay awake

toxic substance - persuade to take antidote

gun/knife - put away - unload - stop the bleeding gas/carbon monoxide - turn gas /ignition off open doors/windows other - discard razor - move away from danger reach safety

Third Party Intermediaries Beware - Help or Hindrance

Help

Lowering the overall emotional level. Convinced subject to surrender.

Third Party Intermediaries Beware - Help or Hindrance

Hindered Making the situation more volatile. Provided audience for suicide or verbal will.

Third Party Intermediaries Beware - Help or Hindrance

Family members Clerics - caution Interpreters

Suicide audience
Hostages - no hostages Briefing - control

Issues for The Negotiator

What is your strategy? Beware victim perpetrated homicide - suicide by cop

Importance of briefing
Personal safety - gather intelligence No deception

Offer help - be realistic

Managing feelings Impact on individuals - critical incident debrief

Dissonance

Personal

Interpersonal

Attempts to reduce dissonance by

Distance

Active Discussion

Projection

Blocking

Detachment

Sharing

De-personalisation
Rationalising Own personal crisis

Reflective Practise
Team Action Acceptance