Gatekeepers to Prevent Suicide Lyna Polikar 7 October

Gatekeepers to Prevent Suicide Lyna Polikar 7 October 2014

Epidemiology in the Netherlands � 1, 600 people commit suicide annually (1, 753 in 2012, CBS) � 100, 000 attempt suicide (Trimbos 2006, 2011) � 14, 000 of them contact the emergency department (Kerkhof et al, 2007; RIVM, 2008) � 462, 500 suffer from suicidal ideation (Trimbos 2006, 2011) �The corresponding disease burden equals 231, 000 disability adjusted life years (DALY’s) (RIVM 2011)

The problem A lot of people who are suicidal do not seek treatment This inclination not to seek help is one of the core symptoms of the suicidal syndrome ◦ They don’t expect that treatment could help them ◦ They have feelings of shame and fear of stigma

Gatekeepers Problems involving suicidality generally need to be addressed by specialised care from qualified mental health professionals. Who is a gatekeeper? Gatekeeper is someone in a position to recognize a crisis and the warning signs that someone may be contemplating suicide.

Gatekeepers are people who regularly come into contact with individuals in distress, who could be suicidal. Gatekeepers are often the first to identify suicidality and address the subject. These gatekeepers could be ◦ police officers, care workers, district nurses, teachers, school counselors, pastors, geriatric care workers, volunteers of telephone helplines and many others who are strategically positioned to recognize and refer someone at risk of suicide.

Law enforcement officers trained as gatekeepers in Amsterdam 4 groups, among them 20 police officers working in different neighbourhoods 30 officers from peer support or mental health services, dealing with mental health problems of colleagues

The goal of gatekeeper training is straightforward ◦ To enhance the probability that a potentially suicidal person is identified and referred for assessment and care before an adverse event occurs.

Gatekeepers training based on the QPR-model QPR stands for the three basic tasks of the gatekeepers 1. Question: emphatically asking about suicidal ideation. Ask specific and concrete questions. 2. Persuade: motivate to look for help. 3. Refer: Gatekeepers should know when and where to refer to specialised mental health care services.

Course content �Introduction: participants introduce themselves ◦ Aim: to activate existing knowledge, attitudes and skills �Information about suicidal behavior ◦ Aim: to increase knowledge concerning suicidal behavior �Active role playing for each participant In three rounds every participant will be trained in skills to engage with and motivate suicidal people to talk about their problems. This will be achieved through intensive and repeated role playing including personalized support and feedback. ◦ Aim: To enhance skills in motivating people for referral �Group discussion (about how to refer) and conclusion ◦ Aim: To consolidate obtained knowledge, attitude and skills

Registration of the training as evidence -based practice in the USA Based on a growing research and documentation base, and investigators employing random trial designs, the program has now been registered in the National Registry of Evidence-based Practices and Policies (NREPP) at: http: //nrepp. samhsa. gov/View. Intervention. aspx? id=299

Effect of the training Increased knowledge Increased self-efficacy Increased gatekeeper skills (ability to engage in active listening, ask clarifying questions, make an appropriate referral) Keller, et al. (2009). Tenessee lives count: statewide gatekeeper training for youth suicide prevention. Professional Psychology- Research & Practice, 40 (2), 126 -133. Wyman, P. A. et al. (2008). Randomized trial of a gatekeeper program for suicide prevention: 1 year impact on secondary school staff. Journal of Consulting & Clinical Psychology, 76(1), 104 -115.

More on suicide prevention Information about the QPR-training: http: //www. qprinstitute. com/ Information about community or workplaces-based suicide prevention: www. workingminds. org Breaking the Silence: Suicide Prevention in Law Enforcement: http: //youtu. be/u-m. Dv. JIU 9 RI The video was produced by the Carson J Spencer Foundation, a Denver-based nonprofit leading innovation in suicide prevention, making a clear call to action to Police Chiefs around the world to make suicide prevention a health and safety priority. The video features real police officers, who describe their struggles in coping with challenges of law enforcement and their own experiences with suicide.