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Residence Life Staff Information |
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Suicide Awareness Summary*
Fact: Residence Life Staff play a crucial role in recognizing and responding to changes and distress residence students. Students may feel more comfortable speaking with a peer about difficult feelings, and may, by simple proximity and convenience, be more likely to come to Res. Life Staff when they face a crisis.
Challenge: This can feel like a huge responsibility, especially when a student is in distress, or may be suicidal. This training, and summary sheet, is intended to provide you with some guidance regarding identifying students at risk of suicide, and in referring the student to other supports so that you do not bear the entire responsibility for the student’s safety. If there is one message we would like you to receive today, it is: Don’t be afraid to explore feelings of suicide—there are many supports on campus available to support the student and you!!
Warning Signs: Research suggests that most people who attempt suicide give verbal or behavioural warning signs of their suicidal intent in the week preceding their attempt. Our ability to recognize and act on these warning signs depends on our emotional ability to acknowledge the warning signs, and basic knowledge of typical cues and how to clarify what is being communicated.
Emotional Ability: When someone talks about, or insinuates they may be suicidal, it is natural to feel frightened, anxious, shocked or to simply struggle to believe that the person is actually saying what we think they are saying. Our discomfort with this topic may lead us, without even being aware, to downplay their concerns or avoid exploring further. While this may feel “socially” appropriate (in terms of not talking about upsetting feelings), it may in fact alienate the person by giving the impression that their feelings are not acceptable or appropriate.
Recognizing our own emotional reactions, and putting them aside (temporarily), will help us to more clearly understand what the person in distress is expressing, and to help him or her receive the help he or she requires.
Once that person is safe, it is also essential that the “helper” have an opportunity to process feelings associated with the experience. More on this later.
SUICIDE KNOWLEDGE:
Suicidal feelings are complex, and have a variety of meanings for different people. The following are some examples of meanings suicidal feelings may represent:
· Feeling overwhelmed and simply wanting to “get away” from stress
· Feeling that one always has the option to “check out” if things get too hard
· A way of expressing anger/making others “pay”/ finally being recognized by others (this may be an expression of feeling insignificant/uncared about by others)
· Overwhelming hopelessness associated with clinical depression, the depressed phase of bipolar disorder, or subsequent to receiving devastating news (ie. physical diagnosis, expulsion from school/residence, loss of a relationship)
· Unbearable shame (specifically in cultures in which failure, or perceived failure, is not acceptable, or when family pressures feel all-encompassing).
Although it may not be your role to determine the meaning of a suicide hint or statement, the above themes may act as cues to explore the person’s feelings further.
SPCIFIC CUES/WARNING SIGNS:
Typically cues come in three forms, (or a combination of the three). As with any cue, it is important to recognize that this is just one piece of information that needs to be further explored, not a definitive sign that someone is suicidal.
Direct Verbal Cues:
These are the easiest to recognize. Statements such as: I’m going to kill myself; I’m going to off myself if …(such and such); I wish I were dead; I’m checking out (other examples?) Warning: people will sometimes make such statements in a joking or half hearted way, to see how others respond. It is important to ALWAYS explore such statements to see if the person needs follow up with a health care professional, or if they were truly “just joking”
Indirect/”Coded” Verbal Cues:
These are cues that are less clear. Statements like: I’m tired of life; What’s the point of going on?; You/my family etc. would be better off without me; Who/no one cares if I’m dead anyway; I’m not the person I used to be; Soon you won’t have to worry about me; You’re going to regret…(how you treated me); Take this (belonging); I won’t be needing it anymore; etc.
Behavioural Cues:
Behaviours you may observe without any specific statements but that warrant further investigation: Stockpiling pills, talking about death; giving away prized possessions; alienating friends and family; sudden interest or disinterest in religion;and/or relapse into substance use after a period of recovery.
Situational Cues:
Situations that may trigger feelings of hopelessness and suicidality may include: rejection by a loved one; recent move/significant change, especially if unwanted; death of an important person; diagnosis of terminal illness in self or significant other; sudden loss of freedom (ie. impending arrest, imprisonment); loss or anticipated loss of financial security; failing a course or program.
*Depression and Substance Use: Although these are other situational factors, they are significant enough to deserve their own category. Many people who feel suicidal are struggling with symptoms of depression. This is not surprising given the overlap between suicidal feelings and depression (hopelessness, helplessness, alienation, thoughts of death, lack of energy etc). However, when suicide is seen to be a solution to unending distress (such as that in depression), a suicidal person may in fact appear less depressed in anticipation of an end to their pain. Alternately, when a person’s depression is lifting, they may experience an increase in energy enough to facilitate a suicidal act that they did not have the energy for before.
Therefore, if a person is struggling with depression and suicidal feelings, it is best that they work with a mental health professional to ensure that they are safe and coping effectively, even if their current suicide risk is not deemed to be high.
Additionally, we know that many people who attempt suicide have used substances prior to their attempt. There may be many explanations for this correlation. Many substances (alcohol, marijuana) are actually depressants, and can make depression/suicidality more severe. Substances also reduce inhibitions, so that people may attempt something (such as suicide) that they would not ordinarily do. It may also be possible that people who are considering suicide use substances in an attempt to enable them to act on thoughts they previously only considered.
Regardless of reason, for a person experiencing suicidal thoughts, there cannot be safety without sobriety.
WHAT TO DO:
As a Residence Life Staff person, your role is to identify if a person is contemplating suicide, to persuade the student to accept help, and to refer the student to the appropriate resources. These steps can be easily remembered by the letters Q P R.
1. Q=Question:
Once you recognize that someone is exhibiting the verbal, behavioural, or situational cues that may suggest they are experiencing suicidal thoughts, the first step is to ask specific questions to determine if the cues actually indicate that the person is suicidal.
Remember: Cues are only one indicator; additional exploration via asking questions is required to understand the meanings of such cues.
Be aware of your setting/conditions in planning to question a student about suicide: it is preferable to have a space that is quiet and private, and to be able to take as much time as is needed to explore the person’s thoughts and feelings.
There are several ways to ask someone if they are suicidal. This will depend on your comfort level and your relationship with the student. Surprisingly, it can be hardest to ask the question with someone we are closest to or who is most like us. Again, awareness of your own feelings regarding this subject matter is an important part of being effective.
Less Direct Approach:
· Have you been unhappy lately?
· Have you been very unhappy lately?
· Have you been so unhappy lately that you (sometimes) wished you were dead?
· Do you ever wish you could go to sleep and not wake up?
· Sometimes when people are as unhappy/upset etc as you seem to be, they sometimes wish they were dead. Do you ever feel that way?
More Direct Approach:
· Have you ever wanted to stop living?
· You look really unhappy. Are you thinking of killing yourself?
· Are you thinking about suicide?
· Do you every think about ending it all?
Almost any question along these lines will help open up conversation and explore the issue. There is, however, one WRONG way to ask the question:
“You’re not thinking about suicide, are you??”
As is probably obvious from this example, such a question would more likely prevent a person from coming forward with suicidal feelings than it would encourage them.
As uncomfortable as it can be for the “questioner” to ask the suicide question, it is often a relief to the suicidal person to have someone that they can be real with. In fact, research has indicated that suicidal people feel decreased distress and alienation at having someone they can be honest with, and this, in fact, decreases the chance of suicide. So just by asking the question, you have decreased the risk for that person, and increased the chance of them accepting help!
Of course, if the person is not suicidal, they may be surprised at the question, and simply deny any such feelings. It is ok to probe a little further, and to explain that, in your role as Don/RLAC, it is your job to ask such questions.
2. Persuade:
If you determine that someone is suicidal, your next job is to persuade them to accept a referral to a professional who can help them cope with their feelings.
One of the most effective ways of persuading someone to get help is the simplest: LISTEN. However, this is not the same as giving advice or feedback. The best listening means:
· Give your full attention
· Try to not interrupt
· Watch for statements that may be interpreted as judgmental or condemning
· Try to tame your own anxiety or personal reactions so you can focus fully on what the student is saying
Hopefully, after the person feels “heard” and understood, they will be open to some feedback and referral persuasion from you. This may be as simple as saying something like: “I can see how difficult/upsetting this is for you and I am concerned/worried for you. I’d like to help you receive more support to get through this (difficult time). Let’s explore what options are available together…
A word about choices: It is important to not offer choices/promises that you can’t keep.
For instance, in the example above, you if you feel there is no/limited suicide risk, you may be able to say “let’s explore the options…” and give the student a choice of which, or whether, to follow up.
If you have any questions about a student’s safety, this may not be an option, and you may need to be more directive: “ I can see how difficult/upsetting this is for you and I am concerned/worried about you. I need to contact…..(my RLAC or other supports) to make sure that we are doing all we can to help you stay safe.”
In the same way, you may encounter students who offer to speak with you, but only if you agree to keep information confidential. It is important to be cautious in agreeing to this, or you may want to outline situations in which you are not able to keep information confidential, such as risk of harm to self or others, before speaking to the person. There is nothing harder than having critical information and feeling restricted from sharing it.
Another thing you can do to reduce the risk of suicide is to remove any means a person may use to kill him/herself, such as medication, sharps, ropes etc., or have a friend/support stay with the student when he or she is feeling at risk. This would be done in conjunction with the RLAC/Manager of Residence Life.
3. Refer:
We are extremely fortunate on the Laurier campus to have a wealth of referral options available, both on campus and in the community. A list of referral options is included at the end of this summary, but the following information may be helpful in the referral process.
The most effective referral involved personally taking the student to the referral appointment. This ensures that the student knows where to go, actually gets there, and gives him or her support in taking this important step. If you are referring to Counselling Services, you can remind the student that they may choose to attend a one-time consultation only, that their information is kept strictly confidential, and that the service is free. (If you are escorting a student for a crisis appointment, it is always best to call ahead (x2338) to ensure a crisis appointment is available at the time you need it, or to explore other options that might be helpful.)
If there are no immediate safety concerns, the next most effective referral is if the student agrees to see a professional, and calls to confirm an appointment while with you. It is also important to ensure the student knows exactly where on campus the service is located. If there are moderate safety concerns, you may ask for the student’s permission to contact the service ahead of time, and to ask for confirmation that the student attended the appointment.
The next best referral is obtaining a commitment that the person will accept help in the future. A deadline (ie. before Thanksgiving I will…) can help keep the person focussed on their goal.
SELF CARE:
No matter how often or rarely one does this type of work, speaking with someone about their wish to end their life provokes powerful feelings. As indicated earlier, it is important to be aware of one’s own reactions to this subject matter, but, to be effective in the moment, we may need to put our own feelings on hold temporarily to be of assistance to the student.
It is essential, however, once the crisis has passed, that the “helper” have a chance to process his/her own feelings about the experience. This can be done by speaking to a friend, a family member, a Residence Life Staff person, or another Laurier support. Counselling Services is always available to support students in distress, or those in the position of helping students in distress. Please feel free to contact Counselling at x 2338 to explore what support might be right for your situation.
The following is a list of other supports on campus that might be helpful:
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WLU Counselling Services http://www.mylaurier.ca/counselling Mon-Thurs. (8:30am-8:00pm), Fri (8:30am–4:30pm) 519-884-0710 x2338 WLU Health Services Mon–Thurs (8:30am–7:15pm), Fri (8:30am–4:15pm) 519-884-0710 x3146 WLU Special Constables 24 hrs. daily, 519-885-3333 WLU Peer Help Line 7:00pm–3:00am daily, 519-884-733 |
WLU Staff EAP (Catholic Family Counselling Centre) 24 hrs. daily, 1-800-743-4140 Distress Centre (Warm Line) 24 hrs. daily, 519-745-1166 Crisis Services (Mobile Team) 24 hrs. daily, 519-744-1813 24 hrs. daily, 519-742-3611 Withdrawal Management Centre (Drug & Alcohol Use & Misuse) 24 hrs. daily, 519-749-4318 |
*Source: QPR Suicide Awareness Training brochure