Law Enforcement Suicide Prevention Intervention and Postvention Elizabeth

Law Enforcement Suicide: Prevention, Intervention and Postvention Elizabeth K. White, Ph. D.

Law Enforcement Suicide: Prevention, Intervention and Postvention Introduction to Suicide Prevention Intervention Postvention In Conclusion

Law Enforcement Suicide: Prevention, Intervention and Postvention Introduction to Suicide

Law Enforcement Suicide: Prevention, Intervention and Postvention Introduction to Suicide in General Law Enforcement Suicide and Sexual Orientation

Introduction to Suicide in General One suicide every 16. 7 minutes 11 th ranking cause of death in USA ~787, 000 annual attempts 31, 484 completed suicides in 2003 Each suicide significantly impacts six other people!

Introduction to Suicide Law Enforcement Suicide Is Law Enforcement Suicide an “Epidemic” or a Terrible Tragedy?

Introduction to Suicide Law Enforcement Suicide Confounding Variables • Sworn peace Who is a officers member of • Custody officers law enforcement? • Reserve officers? • Parole officers? • Retired officers? • Security officers?

Introduction to Suicide Law Enforcement Suicide Concerns of Police Survivors (COPS) sent out a survey 4 to 14, 000 agencies regarding RESPONDED! surviving family members of peace officers who had committed suicide

Introduction to Suicide Law Enforcement Suicide Confounding Variables Violanti, 1996

Introduction to Suicide Law Enforcement Suicide Estimated Law Enforcement Rates Aamodt & Stalknaker (2001) – 18. 1 / 100, 000 Loo (2003) – 22. 99 / 100, 000 Compion (2001) – 18. 1 / 100, 000

Introduction to Suicide Law Enforcement Suicide Rate Comparison? CDC WISQARS Data 2003

Introduction to Suicide Law Enforcement Suicide Rate Comparison

Introduction to Suicide Law Enforcement Suicide Military Suicide Rates 1990 -2004

Introduction to Suicide Law Enforcement Suicide 2006 Male Female White Black Hisp Asian LASD 84% 16% 52% 10% 32% 4. 2% LAPD 81% 19% 42% 13% 37% 6%

Introduction to Suicide Law Enforcement Suicide “A peace officer is twice as likely to die by his or her own hand than by the hand of a suspect!”

Introduction to Suicide Law Enforcement Suicide/Homicide Ratio 3. 6: 1 1. 8: 1 CDC WISQARS Data 2003

Introduction to Suicide Law Enforcement Suicide Confounding Variables Having a firearm in the home increases your risk for suicide five fold! Roggenbaum & Lazear, 2003

Introduction to Suicide Law Enforcement Suicide Confounding Variables Firearm suicide attempts result in death in approximately 85% of cases.

Introduction to Suicide Law Enforcement Suicide Confounding Variables

Introduction to Suicide Law Enforcement Suicide Confounding Variables The risk of suicide in alcoholics is 50 -70% higher than the general population.

Introduction to Suicide Law Enforcement Suicide Confounding Variables

Introduction to Suicide Law Enforcement Suicide Confounding Variables CDC WISQARS Data 2003

Introduction to Suicide Law Enforcement Suicide Confounding Variables Gaska, 1980

Introduction to Suicide & Sexual Orientation ü Research Difficulties ü Youth Studies ü Adult Studies

Introduction to Suicide and Sexual Orientation Research Difficulties Are you GLBTI? After the Fact Attempts vs. Completions Compared to What? Is it Because I am GLBTI?

Introduction to Suicide and Sexual Orientation Youth Suicide Attempts: Completion ratio estimated at 100: 1 Male: Female Attempt ratio estimated at 1: 3

Introduction to Suicide and Sexual Orientation Suicide Completions

Introduction to Suicide and Sexual Orientation GLB Youth Suicide §Serious Attempt Robin et al 2003

Introduction to Suicide and Sexual Orientation GLB Youth Suicide Attempts Youth 9 -14%

Introduction to Suicide and Sexual Orientation GLB Youth Suicide Remafedi, et al 1991

Introduction to Suicide and Sexual Orientation Adult Suicide Attempts: Completion ratio estimated at 25: 1

Introduction to Suicide and Sexual Orientation Special Populations

Law Enforcement Suicide: Prevention, Intervention and Postvention Prevention

Law Enforcement Suicide: Prevention, Intervention and Postvention Prevention Designing a Prevention Program Obtaining “Buy In”

Prevention Designing a Prevention Program ü Screening ü Education ü Tracking “at risk” personnel ü Critical incident intervention ü Resources/Referral

Prevention Designing a Prevention Program Screening Pre-employment Psychological Screening High Risk Assignment Screening – Special Weapons – Undercover – Arson/Explosives

Prevention Designing a Prevention Program Preventative Education Academy Supervisors Field Training Officers AOT

Prevention Designing a Prevention Program Tracking “At Risk” Personnel Divorced/Separated Bereaved Injured/Ill Under Investigation Substance Use Problem Approaching Retirement

Prevention Designing a Prevention Program Critical Incident Intervention Officer Involved Shootings Serious Threat to Life Secondary Traumatization Incidents

Prevention Designing a Prevention Program Available Resources Law Enforcement Mental Health Professionals (MHP) Peer Support Program Chaplains’ Program Self-Help Programs Peace Officer’s Fellowship

Prevention Designing a Prevention Program Referral Systems Supervisor Referrals Settlement Agreements

Prevention Obtaining “Buy In” ü “Top Down” backing ü Saturation outreach ü Making it stick

Prevention Obtaining “Buy In” “Top Down” Backing of upper managers - Initial materials cost - Training time coverage - Non-punitive/help orientation “Personal touch” roll out to middle managers

Prevention Obtaining “Buy In” “Saturation” Outreach Preview presentation/training to peer support personnel & chaplains Availability of materials through computer as well as briefing/training Incorporation of video into all existing trainings - where appropriate

Prevention Obtaining “Buy In” Making it Stick Easy to understand Easy to remember Remove impediments

Prevention Obtaining “Buy In” “Rolling Backup”

Law Enforcement Suicide: Prevention, Intervention and Postvention Intervention

Law Enforcement Suicide: Prevention, Intervention and Postvention Intervention Dynamics of Suicide Law Enforcement Complications So What Do I Do?

Intervention Dynamics of Suicide ü Myths & Reality ü Risk Factors ü Precipitants

Intervention Dynamics of Suicide - Myth Suicidal people want to die!

Intervention Dynamics of Suicide- Reality Suicidal people want a way out of intolerable pain. Some part of them wants to live if you can help them find a way to do it!

Intervention Dynamics of Suicide - Reality Mc. Cafferty et. al. (1992)

Intervention Dynamics of Suicide - Myth If someone really wants to die, you can’t talk them out of it.

Intervention Dynamics of Suicide- Reality Suicidal feelings are often impulsive and temporary!

Intervention Dynamics of Suicide - Myth Asking somebody if they are suicidal will push them over the edge – or they will lie anyway.

Intervention Dynamics of Suicide- Reality You CANNOT give somebody the idea of committing suicide. Many people want help and will be relieved to tell you the truth!

Intervention Dynamics of Suicide - Myth Any person who is suicidal will never fully recover!

Intervention Dynamics of Suicide- Reality Peace officers are resilient. Once they get help, they often recover and go on with their lives!

Intervention Dynamics of Suicide - Myth Any cop who feels suicidal can kiss his or her career goodbye!

Intervention Dynamics of Suicide- Reality NECESSARY AND SUFFICIENT INTERVENTION

Intervention Dynamics of Suicide - Reality

Intervention Law Enforcement Complications ü “Real cops” don’t feel ü “Real cops” solve their own problems ü I am not a “ding” ü Only Crazy People Go to Psychologists ü Only Really Crazy People Take “Meds” ü What about my career? ü Don’t get somebody in trouble

Intervention So What Do I Do? ü What Should I Know? ü Signs & Symptoms ü Asking the Questions ü SAFER Model ü Pushing on the Scale ü Some Do’s & Don’t

Intervention So What Should I Know? Understand the dynamics of suicide Know the myths vs. realities Know the signs & symptoms Know what to do if you suspect somebody may be suicidal Know about available resources Make a commitment to “Roll Backup”

Intervention Signs & Symptoms Risk Factors • • • Sex (male) Age (15 -34) (also 65+) Depression • • Previous exposure to suicide Ethanol/alcohol/drug abuse Rational thinking loss Social support system lacking Organized plan No spouse or significant other Sickness/Injury Patterson, W. , et al, 1983

Intervention Signs & Symptoms Precipitating Events • • • Witness to violence Victim of crime Sexuality concerns Failed promotion/specialty assignment Work problems/discipline Financial problems Substance abuse Physical abuse Sexual abuse/assault Legal problems/arrest Courtesy of Daniel Clark, Ph. D. • • Suicide of loved one Death of loved one Serious family illness Loss of health Divorce/separation Loss of employment Loss of cherished possessions • Retirement L O S S

Intervention Signs & Symptoms- Direct Verbal Clues I’m going to kill myself I wish I were dead You’d be better off without me I might as well be dead If …doesn’t happen, I’m going to end it I’m going to commit suicide Courtesy of Daniel Clark, Ph. D.

Intervention Signs & Symptoms- Indirect Verbal Clues I can’t go on any longer I’m taking the plunge We all have to say goodbye sometime Nobody needs me anymore I’m tired of life You won’t be seeing me any more Life has lost meaning for me I can’t take it any more You’d be better off without me I can’t take the pain Eat my gun You’re going to regret how you treated me Cash in my chips Courtesy of Daniel Clark, Ph. D. Fold my hand

Intervention Signs & Symptoms- Behavioral Clues ü Buying a weapon ü Giving away possessions ü Making a will ü Taking unusual risks ü Changes in personality ü The “practice run” ü Sudden religious interest/disinterest ü Substance abuse relapse Courtesy of Daniel Clark, Ph. D.

Intervention Signs & Symptoms- Behavioral Clues HIGH risk clues ü History of a suicide attempt (40%)* ü Family/friend suicide attempts/ completions ü Substance use ü Plan is specific and well defined ü Plan is viable ü Lethality of method Rubenowitz et al. 2001

Intervention Signs & Symptoms - Precipitating factors Aamodt 2001

Intervention Signs & Symptoms - Precipitating factors O’Neill 2001

Intervention Signs & Symptoms - Precipitating factors Janik & Kravitz 1994

Intervention Asking THE Question Have you been thinking of hurting or killing yourself?

Intervention Any other questions? Have you been thinking of hurting or killing yourself? è When did you last think about suicide? è How would you kill yourself? è Do you have the means available? è Have you ever attempted suicide? è Has anyone in your family attempted/completed suicide? è What are the odds that you will kill yourself? è What has been keeping you alive so far? Courtesy of Daniel Clark, Ph. D.

Intervention SAFER Revised Model 1. Stabilize the Situation - Mitigate affective escalation. - Remove from provocative stressors. - May use a diversion (i. e. walk, coffee, etc. ). 1. Acknowledge the Crisis - What happened? - Establish rapport and a sense of safety. - Provide for cathartic ventilation. 1. Facilitate Understanding - Explain the symptoms. - Normalize reactions. Courtesy of Daniel Clark, Ph. D.

Intervention SAFER Revised Model 1. Encourage Effective Coping Techniques - Teach basic stress survival skills. - Improve immediate and short term coping. - Develop a plan for immediate use. 1. Recovery or Referral - Assess current adaptive functioning. - Assess need for further assistance. - If needed, identify appropriate referral. Courtesy of Daniel Clark, Ph. D.

Intervention Pushing on the Scale – Factors Towards Suicide

Intervention Pushing on the Scale – Factors Against Suicide Time Sleep Social Supports/Obligations Spirituality* Sobriety Dervic et al, 2004

Intervention Pushing on the Scale – Final Equation • Time/Sleep • Social Support • Spirituality • Sobriety • Counseling

Intervention “Do List” üRemain calm üTake all suicidal comments/behaviors seriously üListen, listen üHelp define the problem üRephrase thoughts/feelings

Intervention “Do List” üFocus on central issue/ prioritize üIdentify preventative forces üCapitalize on old strengths üIdentify options üExplore resources

Intervention “Don’t List” ü ü ü Don’t sound shocked Don’t deny/minimize threat Don’t offer empty promises Don’t debate morality Don’t leave the person alone Don’t be the only person helping

Law Enforcement Suicide: Prevention, Intervention and Postvention

Law Enforcement Suicide: Prevention, Intervention and Postvention Survivors How Can I Help? Impact on Your Agency

Postvention Suicide Survivors Friends, family and colleagues who survive following the death of a loved one by suicide 31, 484 suicides per year 6 survivors per suicide 188, 904 suicide survivors per year

Postvention Suicide Survivors - How is suicide different? Often compromises usual mourning rituals Typically not pathological but often complicated: – – Leaves “unfinished business” Often leaves a violent death scene Scene is a “crime scene” Media involvement Expect a 4 -7 year recovery period Disrupts normal functioning for an extended period of time

Postvention Suicide Survivors - How is suicide different? Survivor Reactions Denial of the death as a suicide Preoccupation with “why” Guilt/Responsibility Religious concerns Extreme anger, abandonment feelings Complications from others: – – Blaming the survivor Condemning the loved one Awkwardness from social support Social isolation

Postvention How Can I Help? Understand that… Grief is a process not an event Each person grieves at a different rate and in a different way You do not “get over” grief, but you can be “in recovery” Repetition is part of recovery

Postvention How Can I Help? Help by… Listening, listening Non-judgmental Don’t answer questions you don’t know the answer to! Normalize feelings–even negative ones Share the memories

Postvention How Can I Help? As time goes by… Memorials Special dates Keeping in contact Self-help/support groups Grief counseling Be aware of follow up suicides

Postvention Helpful phrases How Can I Help? Phrases to avoid J I’m sorry for your loss… L How can you bear that ____ went to hell… J How can I help? J Is there anyone I can call L You are young enough to for you? J What is the most difficult part for you? J When you are ready, I would like to share my memories of _____ J You don’t have to deal with everything right away. Courtesy of Daniel Clark, Ph. D. find somebody new. L Get over it. L Didn’t you see this coming? L At least he is no longer suffering. L Don’t think bad of her. L I know how you feel. L Time heals all wounds

Postvention How Can I Help? Support is out there… Survivors of Suicide http: //www. survivorsofsuicide. com Concerns of Police Survivors http: //www. nationalcops. org Compassionate Friends (children) http: //www. compassionatefriends. org Survivors of Law Enforcement Suicide http: //www. tearsofacop. com Family & Friends of Suicide http: //www. friendsandfamiliesofsuicide. com

Postvention How Can I Help? “Effective postvention for suicidally bereaved families may be one of the most important forms of multigenerational prevention available to mental health professionals. ” Jordan, 2001 Courtesy of Daniel Clark, Ph. D.

Postvention ü Impact on Your Agency ü “Postvention Team” ü Target Group Interventions ü Funeral Considerations ü Agency Actions That Help

Postvention Helping Your Agency Recover- Impact Who is impacted …? • • Work friends Based on law Work colleagues enforcement Immediate supervisors suicide rates, an Unit commanders agency the size of • First theresponders LASD can • expect Homicideto investigators have 1 -2 • Personnel Department suicides a year

Postvention Helping Your Agency Recover- Impact Greater impact on law enforcement… Increased sense of responsibility Increased cohesion increases loss Increased sense of personal identification Increased media attention due to profession of law enforcement May have had to handle the scene

Postvention Helping Your Agency Recover- Impact Some of the ways this impact appears… Attendance problems Decreased work quality and quantity Increased alcohol consumption Increased number of injuries/accidents Negative impact on interactions between supervisor, coworkers, citizens and inmates Reminders will reactivate grief

Postvention How Can I Help? Suicide Policy? All suicides are not created equal! Jordan, 2001 Courtesy of Daniel Clark, Ph. D.

Postvention Helping Your Agency Recover A Postvention Team consists of… Unit commander/Chief Human resources representative Psychologist (preferably who rolled) Family representative Peer support/CISM leader Chaplain (preferably who rolled) Risk management/Legal representative Line staff representative

Postvention Helping Your Agency Recover Team responsibilities… Death notification Internal announcements Media statement Cleaning out the locker Cleaning the scene Funeral/memorial planning CISM Monitor for ongoing/delayed reactions

Postvention Helping Your Agency Recover Target Group Interventions - Family… On scene (or hospital) crisis intervention Death notification Chaplain assistance Funeral assistance Peer support Grief counseling Referrals

Postvention Helping Your Agency Recover Target Group Interventions – Line Staff… On scene (or hospital) crisis intervention Death notifications Chaplain assistance Individual/group CISM Peer support Grief counseling Referrals

Postvention Helping Your Agency Recover Target Group Interventions-Supervisors… On scene (or hospital) crisis intervention Chaplain assistance Individual/group CISM Peer support Grief counseling Referrals Follow up training

Postvention Helping Your Agency Recover The FORGOTTEN Ones… Medical assistance providers Transportation providers Dispatchers Crime scene personnel Homicide investigators Partners/Former partners Training officers Crisis negotiators

Postvention Helping Your Agency Recover Funeral Considerations… Flag ceremony 21 gun salute Bagpipes Honor guard “Brass” attendance Attendance (off duty, on duty, assisted) Uniform/Non-uniform Official/organized assistance to family Official/organized financial assistance

Postvention Helping Your Agency Recover Agency Actions That Aid in Postvention… Confidential counseling available to all ü Employees’ aware of resources ü Decrease stigma of seeking help Postvention Team üPolicy/procedure in place üEmergency activation system in place üPersonnel, and their roles, identified

Law Enforcement Suicide: Prevention, Intervention and Postvention In Conclusion

Law Enforcement Suicide: Prevention, Intervention and Postvention In Conclusion Summary Additional Resources Questions

In Conclusion Summary Make a personal commitment to “Roll Backup”

In Summary Additional Resources American Foundation of Suicide Prevention http: //www. afsp. org American Association of Suicidology http: //www. suicidology. org Daniel Clark, Ph. D. http: //www. criticalconcepts. org SAMHSA Suicide Prevention http: //www. mentalhealth. samhsa. gov Center for Disease Control http: //www. cdc. gov

In Conclusion Questions? ? ?

In Conclusion Elizabeth K. White, Ph. D. LASD-ESSB 4700 Ramona Blvd. Monterey Park, CA 91754 -2169 ekwhite@lasd. org (661) 272 -8880