The Pillars of Postvention for Suicide Events Is your organization ready if a someone kills themselves? Presented by: Melissa Witmeier, Project Coordinator FLORIDA YOUTH SUICIDE PREVENTION PROJECT TEAM Funding for this presentation was made possible (in part) by grant number U79 SM060427-01 from SAMHSA. The views expressed in presentation materials do not necessarily reflect the views, opinions, or policies of CMHS, SAMHSA, or HHS; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government. Yesterday, 17 year old Sarah Smith, a client of a XYZ Behavioral Health Center for 6 months, watched a video about bullying in her health education class. During school, Sarah texted a friend that she often thought about harming herself. That afternoon, the friend told the guidance counselor about the text, and the school resource officer (SRO) made a visit to her home. Sarah said she was just venting to a friend. At 4 pm, after the SRO left, Sarah contacted the counseling center and left a message for her counselor that she needed to see someone immediately. No one returned her call. This morning, before school, Sarah killed herself. What happens next… What is the agency’s role? Provide mental health/psychological first aid to survivors Engage community, school and family in crisis intervention Strive to balance support for the grieving; including those that worked with deceased Help family members with practical matters Review clinical files Contact the legal department What is the school’s role? Identify youth and staff that may want to address mental health concerns or suicidal feelings Strive to balance support for the grieving Attempt to maintain educational routines Prevent suicide contagion; which is critical to the prevention of future suicidal behavior Training Outline Define Suicide Postvention Overview of the Pillars of Postvention Utilizing community resources Development or implementation of Immediate Response Plan Considerations for implementing of the Pillars Keys to Suicide Prevention efforts Goals for training Definition of Suicide Postvention Providing crisis intervention, support, and assistance for survivors of a suicide event *Requires effective planning Survivor/Bereaved Person who has lost someone Bereavement Process of adjusting to a loss (such as death by suicide) Grief Physical, emotional, cognitive and spiritual response to actual or threatened loss of a person Common Reactions Responses to suicide and attempts to cope vary among family, friends, staff, faculty, administration and community Confusion and shock Sadness Helpless Nervous and frightened Aversion and avoidance Adversarial Irritation, disgusted or angry Sense of responsibility and guilt Emotional exhaustion The Pillars of Postvention 1. Crisis Response Team 2. Community Connections 3. Immediate Response Plan 4. Media Communications 5. Bereavement Support 6. Self-Care 7. Memorials 8. Long-Term Monitoring and Suicide Prevention Training Crisis Response Team WHO ARE YOUR CRISIS RESPONSE TEAM MEMBERS? Crisis Response Team Recommended Team Members Director of the Team Assistant Director Clinical Staff Safety/Security Quality Assurance Finance Administrative Support Facilities or Grounds Crisis Response Team Once identified, convenes to develop protocol and plan for decisions and responsibilities Responsible for determining details of protocol and implementing tasks of response plan Established ahead of time Identify individuals based on role, diverse skills, and emotional competency Create linkages between staff and community partners CRT Planning Process What types of responses will be made to staff, family, parents, community, and the media? How will we address language and cultural considerations? How do staff identify those in need of aftermath intervention? Where will they be referred for any psychological trauma? Who will review the adequacy of each response and make appropriate revisions in crises response plans? What trainings are needed for staff? How will everyone be informed about emergency and crisis procedures? Community Connections Work with your community to help better meet the needs of students and staff Involve the community in the planning process Coordinate crisis plans Steps to Working with Your Community Identify resources and referrals Build connections and develop partnerships Empower leadership with partners Disseminate information Refer out to agencies within the community and at large (internet) Utilize Community Resources Community Mental Health Centers Local Crisis Center Police Department Mayor’s Office Coroner/Medical Examiner’s Office Clergy Funeral Directors Other Schools Who can help and what can they do? Immediate Response Plan Step-by-step protocol to guide CRT Develop in advance Immediate Response Plan Phase 1: Notify CRT Alert CRT Director of possible situation Verify the death Notify agency or workplace leadership Activate CRT Phase 2: Assessment and Decision Making Assess situation and choose level of response Reach out to family of deceased Determine what and how to share about death Immediate Response Plan Phase 3: Notify Other Key Personnel Front office staff Workplaces or schools attended by family of the deceased (siblings) Coordinate with external professionals Contact your Employee Assistance Plan Phase 4: Notify Agency or School Community Conduct staff meeting to notify staff: provide facts, guidance, and plans Coordinate announcements Notification of community (SPRC Guidelines) Immediate Response Plan Phase 5: Support Staff and Community Conduct daily CRT meetings Present updates to staff Provide guidance for talking to survivors Identify, monitor, support and/or refer Help with emotional regulation Provide support to staff, family and community Conduct meetings to share facts and guidance about helping survivors cope Participate and/or advise on appropriate memorialization Immediate Response Plan Phase 6: Minimize Risk of Contagion with Media Work with media representatives Monitor reporting of the death and postvention efforts to ensure objectivity and free of stigma Monitor social media Phase 7: Evaluate Response Review and evaluate the crisis intervention activities (what worked, barriers, etc.) Make plans for follow-up actions Revise protocol based on lessons learned Media Communications Develop partnerships Designate media spokesperson Plan ahead for all interviews: What are the key points to share with a reporter? Prepare for Common Questions: What prevention programming does your agency/school currently have in place? Is the agency/school prepared to handle this particular case? What impact has the death had on the community so far? Media Guidelines: What NOT to do Don’t sensationalize or romanticize the death by suicide Report/show pictures of flags at half-mast Permanent public memorial such as planting a tree, establishing a scholarship fund, or presenting a plaque Pictures of the death scene should not be used Don’t dramatize the impact of suicide through descriptions and pictures of grieving friends or family Don’t over simplify the problem or present suicide as a means of coping with personal issues Don’t talk about method of death by suicide Media Guidelines: What to do • Do provide factual info • Do state concern for the victim and their family • Do acknowledge the deceased person’s problems and struggles, as well as the positive aspects of his or her life • Do provide information on state, local, and school resources available for suicide prevention and crisis intervention • Do encourage news reporters to provide info that increases public awareness of risk factors, warning signs and community resources • Do communicate to news professionals the dangers of suicide contagion and inappropriate reporting Social Media Be prepared to manage rumors Use social media to your advantage Main goals: Distribute information and resources Monitor comments Collaborate with community Bereavement Support Suicide is unique kind of loss and disrupts normal functioning Be aware of common survivor responses and how to address them Active Listening Be present Be patient Recognize the loss and encourage sharing Provide a safe environment Offer support Recognize finality (impulsivity) Emphasize resources Follow up Interaction with Grieving Survivors Be calm and direct Give accurate information Emphasize that no one else is to blame Talk about emotions Convey a sense of hope Build coping strategies Get students connected Get students involved Return Survivors Returnof of Bereaved Bereaved Students What do you do about issues of depression? Communicate with the family Provide special support and accommodations Offer a list of community resources Link survivors to support services Self-Care for Survivors of Suicide Take care of yourself! Encourage your staff to ask for help Have support systems in place for staff Develop ongoing support groups Take advantage of resources Taking a yoga class Self-Care Activities Walk barefoot on the hot sand at the beach A bath at the end of the day Going for bike rides Watching a movie Cooking a meal for myself and being really present Getting up and listening to music Journaling Walking with my dogs Head out for a hike in nature Take a road trip and visit a friend What do you do for self-care? Memorials Survivors often desire service to remember the deceased Can be an important part of grieving Inappropriate memorials can lead to negative consequences Memorialization “Don’t”s Don’t treat certain deaths differently Don’t focus on cause or manner of death Don’t hold large student assemblies Don’t dedicate special events to the deceased Don’t establish permanent memorials Memorialization “Do”s Do treat all deaths alike Do focus on attributes about the deceased Do offer alternatives to memorials Hold a day of community service Put together a team for the AFSP Out of the Darkness Walk Sponsoring a Mental Health Awareness Day Have a Memorial Book for survivors to write in a give to family Memorials: Other Considerations Funeral/memorial service planning should take everyone into consideration After hours Off-site Supervised alternatives Recognize significant dates and be prepared Focus on education, prevention and living GIVE THE MESSAGE OF HOPE! Online Memorials Work with survivors to create a page & engage in social media memorialization appropriately Monitor content of posts Monitor the length of time that a memorialization page is kept active Be aware of any other online memorials that may have been created Suicide Contagion Be aware of “copycat” behavior Wanting to mimic the tendencies or behaviors of one who died by suicide Changes in environment help to reduce likelihood of contagion: Avoid glorifying the suicide Avoid excessive details Avoid normalizing Risk Factors for Suicide Contagion Make everyone aware of risk factors Survivors may be at-risk if they… Identify with or feel responsible for death Had a relationship with the victim Have a history of suicidal behavior, significant stressors, or psychopathology Show symptoms of helplessness/hopelessness Lack internal and external resources Long Term Monitoring and Suicide Prevention Training Updates to Response Plan Routine re-evaluation of postvention protocol Changes in staff or structure should be reflected Improve procedures as indicated by lessons learned during implementation Modify policies or procedures as research is produced Provide copies of protocol action steps Explain Immediate Reponses Plan Train staff in protocol implementation Communication policies Policies about memorialization Clearly specify rationale behind policies and changes Long-Term Prevention Follow-up with at-risk individuals This should continue for as long as necessary After allowing time to grieve, implement a system-wide suicide prevention plan including: Identification of warning signs Identification of risk factors Means reduction and gun safety Identification and promotion of protective factors Encouragement of help-seeking and adaptive coping skills Long-Term Prevention Mental Health Community ERs, Physicians, First Responders, Schools Agencies, Providers, Not for Profits Suicide Prevention Families Students & Youth Gatekeeper Training Intervention Training Peer to Peer Training Family Empowerment Community Based Services Community Coordinating Committee Training Staff and Communities Educate about mental health issues underlying suicide and suicidal behaviors Train on how to talk with youth about grief and coping Inform and provide a list of available resources in the community Practice the steps of the protocol Model and role play discussions with staff that may be suicidal Staff may feel hesitant and unequipped to respond to concerns Training staff techniques for responding to questions and support can increase staff confidence and boost supportiveness of the workplace climate Questions and Comments Melissa Witmeier Project Training Coordinator Florida Youth Suicide Prevention Project Florida Council for Community Mental Health 904.657.8224 Thank you for attending today’s training!