Integrated Suicide Prevenon Iniave

Transcription

Integrated Suicide Preven on Ini a ve University of Alaska Southeast Suicide PrevenƟon
Gatekeeper
Train the Trainer Manual 2015 January 30, 2015
Welcome to the UAA Integrated Suicide Prevention Initiative Student Gatekeeper Train-theTrainer at UAS! By attending this training you are supporting the university’s efforts to make
a difference by increasing awareness of suicide risks and decreasing stigma surrounding
getting help for suicide related issues. As a trainer, you will have the opportunity to share
your knowledge of suicide prevention with members of the UAS community.
Suicide prevention gatekeeper trainings are common across the U.S. and have been found to
be particularly helpful with college-aged populations. These trainings have been provided by
the UAA Integrated Suicide Prevention Initiative (UAA-ISPI) since 2012. During 2011 to 2014,
the UAA-ISPI was supported by a federal grant from SAMHSA to provide gatekeeper
trainings to students, staff and faculty at UAA. We are pleased to be sharing this information
to other campuses in the UA system.
The Alaska Gatekeeper Training curriculum was originally developed in 2006 by Dr.
Christiane Brems, Dr. Suzanne Strisik, and Ms. Elizabeth King and other staff at UAA’s Center
for Behavioral Health Research and Services. Since then, revisions and trainings have been
implemented by the State of Alaska, Alaska Children’s Services, and numerous community
organizations across the state. UAA-ISPI has modified the curriculum for training to be
specific for faculty, staff, and students across Alaska college campuses.
The goal of this training is to provide lay individuals with basic knowledge of suicide risk,
predictors, and protective factors. With their knowledge, gatekeepers are able to apply skills
learned in the training to generally assess suicide risk factors, communicate with persons at
risk, provide support and encouragement, and, when appropriate, refer to appropriate
professionals on campus or in the community.
In this manual you will find all of the materials necessary to coordinate, advertise, support,
and train students to become suicide prevention gatekeepers as well as modifications for
staff and faculty. All of these materials can also be found in the USB drive included with this
manual.
1.1 | G a t e k e e p e r T r a i n - t h e - T r a i n e r M a n u a l 2 0 1 3
Gatekeeper Training Manual Table of Contents
Section 1 : Getting Started
a. Introduction ………………………………………………………………. p. 1.1
b. Table of Contents ………………………………………………………. p. 1.2
c. Planning a Campus Gatekeeper Training ………………………. p. 1.3
d. Activity: Preparing for Being a Gatekeeper ………………… p. 1.4
Section 2 : Gatekeeper Presentation Slides
a. Presentations with training notes
Section 3 : Things to Know about Suicide Prevention
a. Suicide Myths and Truth ……………………………………………. p. 3.1
b. Risk Factors for Suicide ………………………………………………. p. 3.3
i. Immediate Suicide Predictors ………………………….. p. 3.6
c. Protective Factors Decreasing Risk for Suicide ……………. p. 3.8
d. Non-Verbal Communication ……………………………………… p. 3.9
e. Active Listening …………………………………………………………. p. 3.12
a. Empathic Responding ………………………………………. p. 3.13
f. General Action Plan Principles …………………………………… p. 3.14
Section 4 : Tips for Trainers
a. How to Handle Problems in Training Sessions …………… p. 4.1
b. Framework for Culturally Responsive Teaching …………. p. 4.3
c. Group Characteristics ………………………………………………… p. 4.4
Section 5 : Student Gatekeeper Manual ..……………………………………… Pages 1 - 29
Section 6 : Training Materials
a. Resource Cards (Careline, Student Interaction, Faculty Resources)
b. Suicide Prevention Syllabus Statements
c. Alaskan Resources
d. Certificate of Completion Template
The development of these materials was funded by the Substance Abuse and Mental Health Services Administration
(SAMHSA) in the U.S. Department of Health and Human Services. Contents are solely the responsibility of the authors
and do not necessarily represent the views of the funding agency.
Section 1:
Getting Started
Planning Your Gatekeeper Training
Use the checklist below to help plan, coordinate, and deliver your training event.
Preparation Checklist
In advance of training:
•
Determine training date, time, and length
•
Reserve a room
•
Visit location; check facility layout. Make note of available equipment.
•
Send out announcements/invitations
•
Review materials. Do you have enough CareLine cards? Student (or
Staff/Faculty) interaction cards? Resource cards? Student manuals?
•
Consider your audience. Will you be using student posters and manuals for
the presentation? Or will you be using the advanced PowerPoint
presentation?
•
Practice presentation to fit your timeline
•
If applicable, obtain snacks, coffee, training props, etc.
Day of Training:
•
Arrive at least 20 minutes early to arrange room, prepare refreshments, set
up materials, etc.
•
Set up and test equipment
•
Ensure that all participants sign in
After Training:
•
Review and make notes of what went well and possible improvements for
next time
•
Email Certificates of Training to participants

Preparing to Be a Suicide Prevention Gatekeeper
An important step on becoming a suicide prevention gatekeeper is to evaluate our own opinions
and worldview related to death. One process for this is to finish the sentences below with the first
thought that comes to your mind. Don’t think about these sentences a long time. Write down your
first impulse.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Death is ______________________________________________________
_____________________________________________________________
A suicidal person must __________________________________________
_____________________________________________________________
When I think about dying ________________________________________
_____________________________________________________________
The worst thing about dying ______________________________________
_____________________________________________________________
The best thing about dying _______________________________________
_____________________________________________________________
When I am with someone who is dying _____________________________
_____________________________________________________________
If someone talks to me about suicide, I _____________________________
_____________________________________________________________
My fears about death ___________________________________________
_____________________________________________________________
Reasons for suicide _____________________________________________
_____________________________________________________________
I have witnessed a person’s death and I ____________________________
_____________________________________________________________
If I were around a person who is dying I ____________________________
_____________________________________________________________
People who want to kill themselves ________________________________
_____________________________________________________________
Suicide should _________________________________________________
_____________________________________________________________
The best words to use for death or dying are ________________________
_____________________________________________________________
A right to commit suicide ________________________________________
_____________________________________________________________
Section 2:
Gatekeeper Presentation Slides
Integrated Suicide Prevention Initiative
Center for Behavioral Health Research & Services




Statistics
College student risk & protective factors
Vague problems, suicide predictors, imminent risk
Interacting effectively with an at-risk student
◦ active listening
◦ speaking directly about suicide
◦ providing referrals


Balancing roles
Evaluation
United States
Alaska
10th
6th
3rd
1st
12.43
23.09
Rate per 100,000
7.53
36.44
Rate per 100,000
13.62
55.13
Cause of Death
(All Ages)
Cause of Death
(Ages 15-24)
Rate per 100,000
(All Ages)
(Ages 15-19)
(Ages 20-24)
Centers for Disease Control and Prevention, 2010



40.5% experienced hopelessness since attending
UAA
38% felt so depressed it was difficult to function
while attending UAA
Within the past 12 months:
◦
◦
◦
◦
Half report feeling very lonely
45% report overwhelming anxiety
36% overwhelmed with anger
6% seriously considered suicide



24% can confidently recognize warning signs
43% are confident asking someone who might be
at risk
96% want to learn how to recognize warning signs
and how to talk with students if they are
concerned


Someone who can generally intervene with a
person that is struggling
Faculty gatekeepers
◦ promote UAA student health and well-being
◦ recognize and provide referrals
◦ normalize seeking help

A gatekeeper is NOT expected to treat the suicidal
person



No single set of standards can be applied
universally to prevent suicide
This training prepares one to provide general help
to a student who is struggling
Even with this information, there is no guarantee
that suicide can be prevented
Demographic
Characteristics
Coping Style
Family &
Social
Influences
Immediate
Suicide
Predictors
Environmental
Influences
Psychological
& Behavioral
Aspects

Demographic characteristics
◦ Males, older students (25 years +), graduate students
◦ Non-traditional students
◦ Certain groups
 ethnic, military families, LGBTQ, first-year, international

◦
◦
◦
Environmental influences
Negative school experience
Trouble adjusting to higher education
Pending legal trouble

Psychological & behavioral aspects
◦ Overly withdrawn, feeling depressed or worthless
◦ Problems with alcohol or substance use
◦ History of suicide attempt

Family & social influences
◦ Career decision
◦ Oppression or stigmatization
◦ Interpersonal relationships

Coping styles
◦ Certain personality types
◦ Being easily overwhelmed, stressed, upset
◦ Inability or unwillingness to reach out for help
Individual
Characteristics
Sense of
Connection
Community
Belonging
Family & Social
Fulfillment

Verbal
◦ direct verbal communication
◦ indirect, such as via written material (e.g., assignments,
email messages, papers)

Behavioral
◦ giving away possessions, writing a suicide note,
acquiring means to complete suicide, organizing
personal matters, suddenly resigning from organizations
or clubs

Situational
◦ stressful or traumatic experience

Many people are uncomfortable and/or unsure
◦ Reacting to someone who may be suicidal
◦ Interacting with someone considering suicide
◦ Talking about suicide


Asking a person about suicide won’t make matters
worse
It is important to reflect on personal reactions to
suicide, including personal experiences and
readiness to respond
1. Appear calm
◦ You may feel inconvenienced, frustrated or frantic
◦ Avoid saying:
 “Don’t be ridiculous!” or “Why would you want to do that?”
2. Use reflective listening
◦ Begin with:
 “It sounds like…(reflect what you’ve heard).”
or
 “So what you’re saying is…(reflect what is heard).”
◦ Pay attention to potential nonverbal communication
3. Assess general risk
◦ Think about risk factors and potential stressors (e.g.,
substance use, relationships, academics, prior attempts)
4. Speak directly about suicide
◦ Avoid euphemisms or any indirect wording
◦ Use the actual words “death” and/or “suicide”
◦ Asking directly eliminates any guesswork
5. Emphasize that help is available and is effective
◦ Collaborate with the individual in considering options
6. Provide resources
◦ Normalize accessing support
 “I care about what happens to you. I hope you consider
following up with the [name specific resource].”
◦ Provide a hard copy of resources
◦ Even if the individual resists, continue to suggest and
provide resources when following-up
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Unexplained changes:
◦ Performance and/or attendance
◦ Interaction/participation pattern
◦ Mood, motor activity, or speech
◦ Physical appearance
Serious grade problems
Repeated request for special consideration
New or regularly disruptive behavior
Unusual or exaggerated emotional response

Highly disruptive behavior
◦ hostility, aggression

Inability to communicate clearly
◦ garbled, slurred speech, disjointed thoughts

Loss of contact with reality
◦ seeing/hearing things that are not there, beliefs or actions
at odds with reality

Overt suicidal thoughts and gestures
◦ suicide is a current option

Homicidal threats



A student is a direct threat to themselves
Campus police can ensure safety and provide
direct transport to services
Being as collaborative as possible with the student
can help
◦ “I’m really concerned for your immediate safety and feel
like someone needs to be here right now to help you
through this.”

Inform the Dean of Students as soon as possible


Faculty can care and maintain
responsibilities/roles as course instructors
Warning signs for suicide are cues
◦ If you’re seeing a student with an academic problem,
what else do you see?

Multiple signs may indicate the need to ask the
student directly about suicide and refer to services
Alaska Careline Crisis Intervention Hotline
Campus
Student Health & Counseling Center
Psychological Services Center
Dean of Students Counselors
Residential Counselor
Disability Support Services
Campus Police
Community
877.266.4357
Chat: www.carelinealaska.com
Text 907.2LISTEN (907.254.7836)
907.786.4040
907.786.1795
907.786.6158
907.786.6158
907.786.4536
907.786.1120
Anchorage Community Mental Health Services
Vet Center Anchorage
Veterans Crisis Line
RH 116
SSB 255
SU 204
West Hall
RH 105
ESH114
907.563.3200
907.563.6366
1.800.273.8255, Press 1
Chat: veteranscrisisline.net
Text: 838255
Introduction
Welcome the students to gatekeeper training – a training geared toward the
prevention of suicide at UAA. Introduce yourself (and any co-trainers) and have
students introduce themselves (major/year/etc.)
Send around sign in form.
**Presenter Note: “Euphemisms” Ask participants to consider all the ways we talk
about death and dying without actually using those words. On whiteboard or flip
chart, make a list of all the phrases and sayings. For example:
Pushing up daisies; no longer with us; expired; six-feet under; with the angels;
asleep; bite the dust; called home; deader than a doornail; departed; expired; into
the fertilizer business; in a better place; kicked the bucket; living-impaired; offed; no
more; passed away; RIP (rest in peace); stiff as a board; stone dead; terminated;
worm food; met his maker.
Exploring Your Perceptions
We want to be sensitive to the fact that someone who participates in this training
may have been personally affected by suicide. Because of this, we want you to know
that you are not required to participate in activities if you feel uncomfortable doing
so and if at any time the topic becomes to be too much for you, you are welcome to
take a break and rejoin us when you see fit. Additionally we will be available after
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the training is over should you have questions about things that we are not able to
cover during our brief time today.
We realize that we all are here today with varying levels of experience and comfort
with the topic of suicide. Some people may feel uncomfortable with the topic and
even the word “suicide.” Regardless of your comfort level we’re glad you are here
because it shows that you seek to learn more about the topic and by doing that we
hope your comfort level will increase. It is important to contemplate and explore our
own assumptions and reactions about suicide. Doing so can help us to monitor our
own response as much as possible in order to be effective when intervening with
someone who may be at risk of suicide.
**Presenter Note: Consider activity “my beliefs about suicide” in student manual
What is the UAA-ISPI
I want to begin by briefly introducing this initiative to you.
In 2004, the Garrett Lee Smith Memorial Act was authorized by congress in response
to high rates of suicide among children and young adults. The GLS Act is aimed at
increasing prevention and early intervention to prevent suicide across the US
through federal grants.
In August of 2011, the Center for Behavioral Health Research and Services (a research
institute housed within the College of Arts & Sciences) received a GLS grant aimed at
preventing suicide on campus at UAA. The project is funded through July of 2014.
We define the UAA-ISPI as a compressive, coordinated, culturally-sensitive effort
aimed at promoting campus-wide suicide prevention education and awareness.
The aims of the project are
1) to provide suicide prevention training for UAA students, staff and faculty;
2) to develop a campus campaign and promote campus and local resources; and
3) to reduce stigma associated with seeking support for suicide risk.
To meet the first goal, the UAA-ISPI is offering gatekeeper trainings to UAA faculty,
staff, and students.
What is a Gatekeeper
A gatekeeper is someone who is comfortable speaking with someone who may be
suicidal and can help the person find resources (if necessary). Gatekeeper training is
a widely used training model to help people feel more confident in their ability to
intervene with someone who is suicidal.
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Gatekeepers learn how to consider warning signs of someone who may be suicidal,
recognize if someone is in need of help and provide suggestions on where to go for
help.
What’s important to remember is that a gatekeeper is NOT a mental health provider
and a gatekeeper is NOT expected to provide clinical services to a person who is
suicidal.
We know that student gatekeepers are important to our campus, because data
collected by CBHRS (SPEAKS, 2011) showed that students who are experiencing
suicidal ideation are more likely to seek help from their partner or friends than they
are parents, guardians, or mental health professionals.
Course Overview & Training Objectives
Today we are going to learn about:
• Prevalence rates of suicide,
• Factors contributing to suicide risk, protecting against suicide, and immediate
suicide predictors,
• How to communicate effectively, and
• What an action plan looks like.
By the end of our training today our hope is that you will feel more confident helping
someone who is suicidal. We hope to give you the tools to be able to listen
effectively and provide empathetic responses which will guide you to make a
determination about the level of risk that a person may be at. After your training
today you will part of a community that is growing on the UAA campus that has the
tools to help someone who is at risk for suicide.
Remember
It’s important to point out that there is no single set of standards that can be applied
universally to prevent suicide, because each individual and their situation is unique.
The purpose of this training is to help you feel more prepared to help someone that
is suicidal, however even with this information there is no guarantee that suicide can
be prevented.
Ultimately it is always the person’s choice, but as long as a person is living there is an
opportunity to intervene in an effort to prevent suicide.
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Suicide Prevalence
We all know suicide is a concerning problem across the United States and
particularly in Alaska. As indicated by this slide, suicide is the 10 th leading cause of
death in the U.S. but yet the 6th leading cause in the state of Alaska. The same
pattern is evident when we look at ages 15-24 in the U.S. as compared those in
Alaska. Historically, Alaska consistently reports one of the highest rates of suicide.
As shown here, college age Alaskans are at particular risk, with alarmingly high rates
of suicide that are 3-4 times the national rate for all ages.
In 2009 & 2011 CBHRS surveyed UAA students and faculty (NCHA II in 2009 and
SPEAKS in 2011) regarding awareness, knowledge and attitudes about suicide.
Of the students surveyed at UAA,
6% of students have seriously considered suicide in the last 12 months
What this tells us is that our students are at risk and, like all campus community
members, students are in a position to help.
CDC Stat changes for 2010
Still 10th leading cause of death nationally (3rd among 15-24 and 6th for all Alaskans
Rate per 100,000 total deaths by suicide up from 11.84 in 2008 to 12.43 in 2010
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Alaska
Suicide in 2010 was the number one cause of death for ages 15-24, this increased
from 2nd in 2008
Rate per 100,000 was 24.56 in 2008, dropped to 23.09 in 2010
Ages 15-19 AK is almost 5 times the national average
Ages 20-24 AK is over 4 times the national average
Retrieved from: http://webappa.cdc.gov/sasweb/ncipc/dataRestriction_lcd.html
2010 Population stats retrieved from:
http://quickfacts.census.gov/qfd/states/02000.html
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“It’s common to want to know what exactly causes suicide, however there is no one
specific risk factor that tells us that a person will attempt suicide.”
This graph illustrates the issues of suicide from a global perspective. This is not a
formula, but rather a collection of possible predictors. Suicide is a very complex issue
that rarely can be narrowed down to one single cause. If someone has one or some
of these risk factors, it is important to be aware of them AND does not necessarily
mean they will attempt suicide. So let’s talk about each of these risk factors
individually.
Since all of us are students that are part of a campus community, today will be
focusing on risk factors as they apply to college students because these are our
friends and peers that we interact with every day.
**Presenter Note: This chart is in your handbook and you’re welcome to jot down
notes.
Demographic characteristics
**Presenter Note: Ask students to identify some groups that they are aware are at a
greater risk of suicide
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Generally young adulthood can be marked with high risk behaviors (e.g., substance
abuse & promiscuity). A transition from living at home, to coming to college and
being on your own creates new stressors as we learn how to manage new roles,
responsibilities, and gain an understanding about the world. Some students learn
how to adequately cope with these stresses, but others find that stress becomes
unmanageable and interferes with learning.
The data that we are going to talk about comes from completed suicides, so
something to keep in mind is that this data does not adequately represent all
individuals who may attempt suicide. This is illustrated by the data that shows us
that while more males complete suicide, more women attempt.
Some groups of college students have been identified as having an increased risk for
suicide: males, older students (25 years +) and graduate students (Silverman et al.,
1997).
For example non-traditional students may have unique stressors such as balancing
work, family and school or they may have difficulty with academics after a prolonged
absence (Silverman, 2004; SPRC, 2004).
We also know that higher rates of suicide exist among individuals who identify with
certain culture groups of college students (e.g., LGBTQ, military students,
international students, first-year students).
Among Alaskan Natives, there is an increased rate of completed suicide across all
ages, nearly 2.2 times that of Caucasian Alaska residents (Alaska DHSS, 2010). Of
particular risk are young Alaska Natives ages 15-24, with suicide rates nearly five
times that of similarly-aged White young adults (Alaska Bureau of Vital Statistics,
2009). As such, it is unfortunately not uncommon for Alaskan Native students at UAA
to have lost someone to suicide or to have been impacted by suicide in some way.
It is important to remember that just because a student identifies with a certain
culture group that does not mean that risk for suicide is higher.
Environmental Influences
**Presenter Note: Ask for ideas of how a person’s environment may put them at risk
Research suggests that having a negative school experience, trouble adjusting to
higher education, and/or pending legal trouble can all be factors in a person’s
environment that can cause increased stress and may put someone at risk of suicide.
Additionally isolation tends to be a central theme when we look at a the
environment of someone who has completed suicide.
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Psychological & Behavioral Aspects
**Presenter Note: ask participants if they can think of any behaviors that may put
someone at risk
Some other risk factors that we know are being overly withdrawn, feeling depressed
or worthless. Or having problems with alcohol or substance use.
Data collected by CBHRS in 2009 and 2011 revealed that nearly half (40.5%) of
students have experienced hopelessness since attending UAA and that over one third
(38%) of students have felt so depressed it was difficult to function while attending
UAA.
Family & Social Influences
Because the rates of suicide are high in this geographic region, many people have lost
someone to suicide and may be at elevated risk themselves on any anniversaries or
important dates related to this significant loss.
Feelings of homesickness can be difficult for a college student to manage.
History of trouble in the community has also been found to be a risk factor.
Coping Style
**Presenter Note: ask students to identify how the way in which a person copes may
put them at risk for suicide
The coping skills that a person knows and uses can create an additional risk factors
(e.g. drinking)
Personality types more at risk for suicide might be overly rigid, aggressive, or
impulsive.
Inability or unwillingness to reach out for help
Immediate Suicide Predictors
So now that we discussed some factors that may put someone at risk, we are going
to discuss immediate suicide predictors. Remember these are cues that a gatekeeper
needs to take action.
A few types of immediate predictors are verbal, behavioral and situational.
Verbal predictors can be either direct or indirect. For example, direct verbal
communication might sound like: “I’m thinking about taking a razor and slitting my
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wrists.” Indirect verbal communication is more vague, like: “I just want it to be over.”
Additionally vague verbal predictors may come in the form of a post on Facebook or
a text message that makes you feel worried about the person.
Behavioral predictors include actions such as giving away personal belongings or
obtaining the means to complete suicide. As students we may see things like a
friend or roommate who stops going to class completely or who stops participating
in a club that used to be important to the person.
Situational predictors refer to incidences where a very stressful or traumatic
experience may put someone at a higher risk of suicide.
Again it is important to look for a cluster of signs. Just because someone goes
through a stressful situation it does not mean that they will attempt suicide, but you
want to be aware of other factors or immediate predictors that may indicate risk. A
suicidal person who gives warning signs will most often present more than one clue.
It’s important to point out though that there are sometimes where an individual may
indicate no signs of suicide risk, but it’s when signs are visible that we have a chance
to intervene.
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So now that we’ve talked about what factors may indicate that a person is at risk of
suicide, let’s talk about what factors may protect a person from suicide.
This include individual characteristics, a sense of connection, family & social
fulfillment, and community belonging.
**Presenter Note: ask group for suggestions of protective factors that may fit into
each group
Individual Characteristics refer to traits that a person may poses that may protect
them from considering suicide. These could be things like being very resilient and
having a strong ability to cope with trauma or stressors, or having a strong ability to
adapt to change.
Choosing stress reduction techniques, exercise instead of activities which may put
them at higher risk
Sense of Connection has to do with the relationships that a person has with their
family, community, church, etc.
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Family & Social Fulfillment is how strong they perceive those connections to be as
well as how supportive the connections are. This can also include factors such as a
positive school experience and positive peer modeling.
Community Belonging refers to the things like the opportunity to become involved
and how supported a person feels in their environment. Does the person volunteer
in the community or take part in community activities? Are they involved in a club on
campus or feel welcome to participate in things like open art receptions, music
events, etc.
UAA’s SPEAKS study found that 61% of UAA students feel a sense of togetherness
with their peers and 64% of students feel they have a supportive groups of friends on
campus. This is a real strength of our students and is something to keep in mind
when you are interacting with someone who is suicidal. What does the person you
are working with have going for them? What is the person’s support network like?
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When you are interacting with someone that you believe to be at risk of suicide, it’s
important to weigh the risk factors and protective factors that we have just talked
about. Weighing these factors will help you to have a better idea of the level of risk
a person is at for suicide.
It is important to emphasize that when immediate suicide predictors are present,
ACTION is necessary!
**Presenter Note: Read one vignette out loud. Now, we are familiar with risk factors,
immediate suicide predictors, and protective factors. Ask participants:
(Example – Vignette #1, “Sydney”)
• What are Sydney’s risk factors?
• What are Sydney’s protective factors?
• Are there any immediate suicide predictors?
(Risk factors – recent move from rural to urban setting, distance from friends and
family, time stressors from working full time and school full time, financial
responsibilities, challenges to intimate relationship, increased drinking, change in
attitude)
(Protective factors – close to friends and family at home, has made friends in
Anchorage)
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(Immediate suicide predictors – vague statement “I can’t take it anymore”, stressful
home & work/school situations)
Since we can identify risk factors, protective factors, and immediate suicide
predictors, it is time to discuss how to interact effectively with that person to make
sure they have the supports and resources they need to do well.
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“People are not driven to suicide by a caring person who inquires as to whether or
not they are suicidal. People may, however, be driven to suicide by an avoidance of
the topic on the part of the listener from whom they need a concerned response.”
We will be discussing these steps through the remainder of the workshop:
Step One: Listen with respect and accuracy through active listening.
Step Two: Speak directly about suicide.
Step Three: Develop an action plan.
When someone has indicated to you that they may be at risk for suicide (either
through direct or indirect communication), use active listening skills. Active listening
is an effective listening skill that allows a listener to reflect back what is heard. It
can:
Help the person feel understood
Encourage more disclosure
Elicit more information
It also involves observing non-verbal cues.
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Steps: (Pg. 8)
1. Identify to yourself what you are hearing the person express
2. Pick something you hear the person saying (for starters, focus on one statement)
3. Reflect back to the person what you have heard. Begin with:
“It sounds like…[reflect back something you have heard].”
or
“So what you’re saying is…[reflect back something you have heard].”
Note: The process can seem mechanical at first but gets easier through practice.
Step Two:
SPEAK DIRECTLY ABOUT SUICIDE
Asking a person directly about their risk for suicide eliminates guesswork for the
gatekeeper. Avoid indirect or vague working as this can deny the reality of suicide.
Being direct also allows the suicidal person to recognize the reality of the situation.
Use the actual words “death” and/or “suicide”.
Examples:
“Are you so stressed out that you’re thinking about suicide?”
“So you’re saying life is too much for you right now. Are you thinking about suicide?”
**Presenter Note: Remember when we discussed all the different ways you can talk
about death and dying without saying either word, like ____ (give an example they
provided)? Because we do not often talk directly about death, dying, or suicide we
have to practice in order to be comfortable! It may seem silly at first, but your
comfort with these words will be apparent to the suicidal person and help you to
speak openly. It is very important to use open wording – saying something like “You
would never think about suicide, would you?” tells the person it is not okay to talk
with you about their feelings.
Please pair up and have each person practice an open question using the word
“suicide” and an open question using the word “death/dying”.
6
Step Three:
DEVELOP AN ACTION PLAN
In general, this phase will involve three steps:
1. Generate ideas that match the person’s degree of risk
Remind the person of his/her strengths and coping skills. Use prior examples, if you
know this information, of when he/she has gotten through a difficult time.
Talk to the person about their plans for the day and evening. Help to structure time.
Also inquire about the next couple of days, if that length of time seems manageable
for the person to consider.
Help the person to recognize supports and resources (i.e., people, places, activities).
2. Take concrete action
Ask about being in safe environments. For example:
“Who is going to be with you tonight?”
“It’s probably best to stay sober tonight. Do you want to come over to my place?”
3. Follow up
Tell them when you will call or text them next.
Ask how they are doing the following day and the next several days.
7
The above steps are in the case where a person needs a considerably low level of
support. More extensive information describing different levels of action plans are
provided on the following pages.
**Presenter Note: Vignette #3 (practice as a group)
Roy is a 22-year-old male who attends UAA at night. He is friendly and enjoys his day job in
maintenance at an elementary school. You are in the same biology course this semester. You recently
formed a study group with Roy and a few other students.
Roy is usually cheerful and enjoyable when you see him in the study group; however, he missed the
last couple of study groups. Today he appears distracted and unkempt. He tells you recently that he
did not do well on the mid-term exams, including the chemistry course he is taking this semester.
When you start talking more about this he mentions that he’s “ready to give up”.
What would you do?
**Presenter Note: Vignettes 1, 2, & 4 (practice in small groups or in pairs)
Assign groups/pairs one of the vignettes. Ask them to complete the worksheet (identifying risk
factors, protective factors, and immediate suicide predictors), then work together to make an action
plan.
**ADDITIONAL NOTES ABOUT ACTION PLANNING ARE AVAILABLE IN SECTION 4 OF
YOUR TRAINING MANUAL
Some writers suggest that no person is 100% suicidal and, therefore, actions to
prevent suicide always have a chance (Shneidman, 1985). “Assessment of warning
signs . . . can be translated into life-saving actions by crisis workers or anyone else in
the physical or emotional proximity of suicidal persons . . . However, if the risk
factors, clues, or cries for help go unnoticed or unrecognized, the chances for
effective intervention are greatly reduced” (Gilliland and James, 1993, p. 135).
Generate an Action Plan to Match the Degree of Risk
The action plan needs to match the individual’s needs be realistic to the setting that
you are in (i.e., on or close to campus if transportation is an issue). Action plans for
similar types of suicidal ideation, for example, may be quite different depending on
whether the gatekeeper and suicidal individual live in a rural or urban area. The
following principles, however, always apply:
The higher the risk, the more restrictive the action plan
The higher the risk, higher likelihood other people/ resources need to be involved
The higher the risk, the less confidentiality for the person
7
The gatekeeper helps the suicidal individual “(1) separate thought from action, (2)
reinforce expression of feelings, (3) anticipate consequences of action, and (4) focus
on precipitating events and constructive alternatives” (Gilliland and James, 1993, p.
150). Attempting to manage the situation in the least restrictive and most
confidential manner, gatekeepers first focus on helping the suicidal individual:
• to recognize options and choices beyond suicide,
• to reduce tunnel vision,
• to improve cognitive processing and reality testing,
• to alleviate acute symptoms of agitation or anxiety,
• to focus on delaying impulse and action,
• to recognize the irreversibility of suicide,
• to recognize the ability to tolerate the pain, and
• to recognize personal strength and coping ability
As gatekeepers consider the lethality continuum, assessing and reassessing risk and
possible interventions in collaboration and cooperation with the suicidal individual,
they also make decisions regarding disposition once the person leaves the
gatekeeper’s presence. This decision refers to the continuum of care that ranges
from:
action plans not involving formal treatment to outpatient treatment
interventions to voluntary psychiatric hospitalization to involuntary
psychiatric hospitalization or commitment
General Action Plan Principles
A gatekeeper should develop an action plan in collaboration with the suicidal
person. It is ideal to minimize restrictiveness, maximizing confidentiality, and keep
the individual’s safety as the ultimate goal. All action plans, regardless of level of
crisis and level of restrictiveness of the intervention, have a few common
components and principles that will be of help to the gatekeeper. The following are
principles that always apply, though to different degrees depending on the action
plan option (to be presented below) that is chosen.
All of these principles apply to any action plan. However, they are most relevant to
the low level, less restrictive options that can be handled by a gatekeeper alone.
The more severe the crisis, and the less amenable the person is to resolving the crisis
at a low level, the more likely that these strategies will not suffice to keep the person
safe. The gatekeeper will then need to move to a more restrictive action plan that
likely involves other treatment providers who will support the gatekeeper’s efforts or
who may take over the care for the individual (e.g., hospitalization).
7
•
•
•
•
•
Acknowledge the Suicidal Person’s Feelings
Draw Out the Suicidal Person’s Strengths and Coping Skills
Problem-Solve Ways to Reduce the Suicidal Person’s Life Stressors
Help the Person Recognize Resources and Supports
Create a Safe Environment for the Suicidal Person
7
The Dean of Students office is located in the Student Union Building in room 204. They are available to UAA students by
appointment and provide short-term personal counseling for concerns affecting academic success such as stress, situational
crises, and life changes. Other services include student advocacy, workshop presentations, and referrals. If students are
worried about a fellow student, they may reach out to the Dean of Students for help.
The Department of Residential life has Resident Directors and Advisors that are available to resident students.
The National Veterans Crisis line connects Veterans in crisis and their families and friends with qualified, caring Department of
Veterans Affairs responders through a confidential toll-free hotline, online chat, or text. Veterans and their loved ones can
call 1-800-273-8255 and Press 1, chat online, or send a text message to 838255 to receive confidential support 24 hours a day, 7
days a week, 365 days a year.
The Psychological Services Center (PSC) is located in the SSB in room 255 and open 8am-8pm M-Th and Fridays 8-5 by
appointment only. They use sliding scale fees and are open to the public.
The Student Health and Counseling Center is located in Rasmussen Hall room 116 and is free to UAA students. Counselors are
available by appointment Monday through Thursday 8-7 and Fridays 8-5. Appointments can be made over the phone or inperson. It is okay to walk a student to the SH&C to make an appointment with them.
The University Police Department is located in Eugene Shorts Hall room 114 and is available 24 hours a day for students on
campus in the face of emergency.
The Alaska Careline is a free 24-7 service based out of Fairbanks. Online chat, text, and phone available. Support for those
actively struggling with suicide, feeling overwhelmed as well as for those who need help helping.
8
Section 3:
Things to Know about Suicide Prevention
Suicide Myths & Truths
The Myth
Myth #1:
“Suicide is only committed by people with
severe mental illness.”
Myth #2:
“Suicide usually occurs without warning.”
Myth #3:
“People who are suicidal will always be prone
to suicide.”
Myth #4:
“Discussing suicide may cause the person to
want to carry out the act.”
Myth #5:
“When a person has attempted suicide and
pulls out of it, the danger is over.”
Myth #6:
“The tendency toward suicide is inherited.”
Myth #7:
“People who talk about suicide don’t do it.”
The Truth
Although mental illness increases risk, it is not
always a contributing factor, especially among
young people.
Most suicide attempts are preceded by a
verbal threat; at least two-thirds of people
who attempt to kill themselves have told
someone about their intent.
Suicide can be induced by a temporary crisis;
once resolved, the person may not present
suicidal ideation again.
Talking about suicide may actuallydecrease a
person’s risk for carrying out the act, with the
threat having represented a cry for help;
talking about it validates for the person that
they are understood and heard.
The greatest period of danger may actually
occur after a person has made an unsuccessful
attempt or after depressive or anxiety
symptoms may appear to have been resolved.
Familial suicide increases suicide risk, but not
due to a genetic link to suicide; more likely,
factors leading to suicide (like depression) are
inherited or suicidal behavior is modeled.
People who attempt or complete suicide have
usually talked about their intentions
beforehand.
The Myth
Myth #8:
“Nothing could have stopped her once she
decided to take her life.”
Myth #9:
“A suicidal person who begins to show
generosity and share personal possessions is
showing signs of renewal and recovery.”
Myth #10:
“Suicide is always an impulsive act.”
Myth #11:
“A religious or spiritual practice is a protective
factor.”
Myth #12:
“A suicide attempt is just an attention-getting
device.”
The Truth
Often suicide threats and gestures are cries for
help that if heard can lead to improvement in
mood and can prevent the action.
If a suicidal person begins to give away their
possessions, this is usually a signal that they
have made a final decision to follow through
with killing themselves.
Suicide is not always impulsive; instead, it is
often carefully considered and planned.
A person must feel a sense of belonging and
attachment to a church or community for it to
be a protective factor against suicide.
An attempt is a serious warning sign of
lethality, and shows that self-destructive
forces are at work in the person.
Risk Factors for Suicide
Being aware of relevant risk factors for suicide will help gatekeepers reach out to
someone who may be suicidal. In the following pages, you will find more detailed
discussions of risk factors, immediate suicide predictors, and protective factors.
Learning more about these can better prepare you to answer questions during a
Gatekeeper Training.
Basic Demographic Characteristics Associated with Suicide Risk, Particularly in Alaska
Men present a greater risk than women
o women make more suicide attempts than men
o four times as many men as women complete suicide
o men employ more lethal methods than women do
 74% of men who commit suicide use firearms or explosives, as compared
to 42% of women
 26.7% of women who commit suicide use poisons, as compared to 6.2%
of men
Risk changes depending on the interaction of ethnicity and age
o Native American and Alaska Native teenage boys are at extreme risk
o as are white males over age 65
Risk is tied to ethnicity
o Adolescent boys who are Alaska Native are at extremely high risk
Social Support and Social Pressure Factors
Limited social support resources increases risk
o no or few family members, confidants, close friends, neighbors, co-workers
o limited access to professionals with crisis management or therapeutic skills (e.g.,
community availability of a crisis-line or emergency treatment center)
o lack of a social support network coupled with lack of a professional support
increases risk
Risk increases as the number of reported significant others decreases
o having no or few significant social support individual increases risk
o risk increases as the person decreases their involvement with others
For adolescents, risk comes more from social attachment to others or
pressure from a peer group than from social isolation
o if one young person commits suicide, other teen suicides can follow in the
community
o however, such cluster suicides are relatively rare; even for adolescents, whose
rates are highest, cluster suicides account for only 1 in 135 of all suicides
Regardless of availability of social supports, risk increases if the individual is
unwilling to reach out to their social support network
o having cut off or refusing all communication increases risk
o being too depressed, helpless, hopeless, or listless to ask for help increases risk
even if social support resources exist
Feeling a lack of social acceptance increases risk
o suicide rates are increasing among the LGBTQ community and veterans
o suicide rates are increasing among those living with HIV/AIDS
Pending legal action, such as sentencing, arrest or jail term increases risk
Family Variables
Individuals from socially isolated families are at higher risk for suicide
individuals from families with a history of rejection or instability are at
higher risk for suicide
Family history of suicide has implications for likelihood of suicide
completion
o risk increases from:
 no family history of suicide
 to family history suicide gestures/attempts
 to completed suicide by family members
Risk is particularly high if a family suicide occurred recently
Risk increases as the anniversary of a family member’s completed suicide
approaches
Mental Health History
Risk of suicide is high for people with a diagnostic history of the following:
o risk is high for people with a history of diagnosed depression
o risk is high for people with a history of bipolar disorder, especially with high
cyclical mood swings
o risk is high for people with a diagnosis of schizophrenia, especially if voices are
present that challenge or command the individual to kill him or herself (this
usually calls for hospitalization)
o risk is high for people with panic disorder or panic attacks and other anxiety
disorders
Disorientation and disorganization are related to suicide risk, with risk
Increasing with the level of severity of these symptoms
Risk for suicide increases during the three months immediately after
discharge from a psychiatric hospital
Drug and alcohol use are highly associated with suicide risk, with risk being
highest with chronic abuse
o drug use precipitates emotional or physical states (such as depression and
anxiety; or intoxication and withdrawal) that may lead to suicide
o drug use provides the means to complete suicide
o drug use in conjunction with mental health concerns increases risk even further
Physical illness may be related to risk for suicide
o risk is highest for chronic incurable and painful conditions such as cancer, peptic
ulcers, spinal cord injuries, multiple sclerosis, head injury, and Huntington’s Chorea
o the relation between physical illness and suicide appears to be stronger among men
than women
o the relation between physical illness and suicide appears to be stronger for
depressed versus non-depressed medical patients
Psychological Factors
Hopelessness is “the most powerful antecedent” of suicide (Stelmachers,
1995, p. 374); increases in hopelessness are directly related to increases in
suicide risk
o hopelessness is the best predictor of immediate suicide
o hopelessness is the best predictor of a long-term potential for suicide
Recent losses such as a financial loss or the loss of a job, a relationship, or a
dream can be related to suicidal ideation
o the highest risk exists during the days immediately following the loss
o risk is highest when individuals blame themselves for the event that caused the
loss
Trauma experiences increase risk
o recent trauma and other environmental stressors (e.g., promotion, illness,
academic failure) make the person vulnerable to suicidal ideation and
completion
o risk also increases during time periods that signify the anniversary of a trauma
experienced some time ago
Despair increases risk
The inability to articulate reasons for living is considered to be a strong
danger sign
Feelings of shame, worthlessness, and loneliness are associated with suicide The
most profound relationship of suicidal ideation was with symptoms of
hopelessness, guilt, depressed mood, panic attacks, loss of libido, and
insomnia in that order
Recent Physical Changes
Loss of interest or pleasure in activities that used to be enjoyed
Lack of physical energy
Sleep problems
Loss of sexual interest
Loss of appetite
Many minor illnesses
Immediate Suicide Predictors
Immediate predictors of suicide tend to be directly related to suicidal thinking, or
suicide-related action and are strong clues for the gatekeeper to intervene:
The Verbal Suicide Threat
Individuals who have openly admitted to thinking about suicide or about
killing themselves are at greater immediate risk for suicide than individuals
who have not made such threats.
66% to 80% (depending on source) of people who killed themselves first
informed someone of their intent.
Most suicidal individuals have some ambivalence about suicide, which is
expressed when the individuals makes the threat of suicide to someone.
Although making a threat may be perceived as a request for help, the
individual’s risk is increased, nonetheless.
History of Suicidal Behavior and Intent
Immediate risk increases with the number of previous attempts
o lower risk with no previous attempt,
o moderately higher risk with one attempt, and
o significantly higher risk with multiple attempts
Of those persons who completed suicide, 30% to 40% had made previous
attempts
20% to 25% of chronically suicidal individuals ultimately succeed in killing
themselves
Immediate risk increases if the individual has had impulsive behaviors in the
past that suggest a loss of control over behavior that may result in a suicidal
act
Closure Behaviors and Preparations
Withdraws from friends, family, and/or social activities
Prepares for death by making out a will
Discusses death and makes final arrangements with family and friends
Gives away possessions (vehicles, snow machines, winter supplies, hunting gear,
savings, and prized possessions)
Addresses unresolved problems/issues with friends and family (possibly estranged)
Develops plan for family members to care for dependents (children/pets)
Writes about hopelessness and death or makes other expressions of wanting to die
Conducts ‘goodbyes’ in a meaningful and well-planned manner and/or through writings, in
person, or CB radio
Cleans house and throws items away or burns them
Making statements like “I’m better off dead,” “nothing matters,” “I won’t be seeing you
again,” and “I want to be less of a burden” to family can be forewarnings for suicide.
Similarly, talking about dying and harming self can be predictors of suicide
Warns of “going away for a while” or sudden preparations for a long, unscheduled
“hunting” trip across country, particularly solo
Fails to prepare for winter, including yet not limited to, letting fire wood pile get low, not
stocking up on food or not participating in hunting activities
Writes out list of property and personal items to be distributed
Eats, drinks, or uses substances with abandon
Visits relatives out of the blue, more frequent visits to relatives, less visits than usual
Does not participate in village meetings, activities, and withdraws from friends & family
Is unusually talkative or quiet, behaves in a manner out of character for that individual
(e.g., nicer, grumpier, unusually peaceful, sudden cheer after depression)
Talks about missing / reuniting with deceased loved ones
Unusual neglect of appearance
Sometimes nothing can be observed prior to a suicide
Protective Factors Decreasing Risk for Suicide
Just as there are things that put a person at increased risk for suicide, there are
also factors in a person’s life that, if discussed, may keep them from engaging in
the suicidal action, or may at least decrease the risk for suicide.
Common Protective Factors
Has strongly felt and perceived positive, non-stressful family commitments
o married or in a significant, committed and positive relationship
o embedded in a positive family support system
o has the role of responsible caregiver for children under the age of 18
(if they are not perceived as a current source of stress)
Has a system or source of strong positive social support
o embedded in a positive social support system, such as friends or
church
o a sense of belonging
o a sense of connectedness
Perceives a general purpose for living and/or has aspects of life that are still a
source of enjoyment or meaning
o employed or engaged in another structured program (educational or
vocational)
o expresses concrete and detailed plans for the future
o makes constructive use of leisure time, such as engaging in enjoyable
activities or hobbies
Has demonstrated effective coping and problem-solving skills
o history of being able to cope with stressful events and losses
o resilience (the ability to bounce back after trauma)
o ability to adapt to change
Is involved in and committed to mental health treatment
Holds religious or cultural beliefs that serve to endow life with meaning
and/or discourage self-harm, especially if these beliefs portray suicide as an
unacceptable alternative
Connection with a meaningful life
Nonverbal Communication
It is important to pay attention to nonverbal communication. First impressions of
people tend to come from their appearance, not from what they are saying.
When a gatekeeper is aware of different forms of body language it helps to get a
more accurate picture of what is happening with the person who may be suicidal.
Areas to be aware of someone’s eyes, eye contact, body movements, body
posture, body position, mouth, facial expressions, skin, voice, appearance, and
cultural background. It is important not to make snap judgments about the
meaning of a person’s nonverbal behavior. Whether a person comes from a cultural
heritage that is different from or the same as that of the gatekeeper, care must be
taken to consider the possible meaning of any outward behavior. Putting labels on a
person’s nonverbal communications based on cultural background is
to risk stereotyping when the actual intention is to be sensitive to cultural issues.
In rural Alaskan culture or Alaska Native culture, certain nonverbal behaviors may
differ from those of White European or urban Alaska cultures. For example,
direct eye contact, which might show attention in urban Alaska, might be
considered disrespectful or invasive in rural Alaska or in Alaska Native cultures. In
urban Alaska, avoidance of eye contact may express a wish for psychological or
emotional privacy. Similarly, in rural Alaska, a loud voice might be considered
somewhat aggressive.
In rural Alaska or Alaska Native culture, being direct and getting to the point
quickly might be considered clumsy or insensitive. A more relaxed style may be
preferred—approaching the topic slowly with patience may be considered
courteous and respectful.
Given how important it is to avoid stereotyping anyone, when reading the table
below, consider the variety of meanings offered for each nonverbal behavior. A
suicidal person’s behavior may or may not fit common cultural assumptions about
its meaning and the gatekeeper does best to strive to understand the person
individually.
For example, the gatekeeper should note the following in the other person:
if eyes are open, closed, teary, twitching;
if eye contact is steady, shifting, avoidant;
if body movement is jerky or is fidgety—such as tapping or shaking;
if body posture is stooped, slouched, or erect;
if body position is tense, relaxed, or rigid;
if the mouth is open, tight-lipped, smiling, drooping;
if the skin is clammy, flushed, blushing, pale, or sweaty;
if the voice is loud, fast, clear, or unsteady;
if appearance is neat, sloppy, disheveled, or well groomed.
Possible meanings could be as follows, although cultural and personal differences
may be significant in this regard and always need to be considered (more about this
below):
Feature
Nonverbal Expression
Eyes
Direct eye contact
Lack of eye contact
Looking down or away
Fixed staring
Darting or blinking eyes
Squinting or furrowed brow
Teary eyes and/or tears
Dilated pupils
Mouth
Facial
Expressions
Eyes moving to and from eye
contact
Smiling
Tight lips
Quivering lips
Biting or chewing on lips
Open mouth
Flushed face
Eyes open wide and mouth opening
Furrowed brow with tight mouth
Eyes looking up and mouth pursed
Possible Meanings
Attentiveness, Readiness for communication,
Comfort with setting and gatekeeper
Withdrawal, Avoidance of communication,
Respect or deference
Preoccupation, Avoidance, Concentrated thought
Preoccupation, Uptightness, Rigidity, Psychosis
Anxiety, Paranoia, Excitement, Dry contact lenses
Thoughtfulness or “aha” experience, Concern,
Annoyance
Sadness, Happiness, Frustration or anger, Concern
or fear
Alarm, Interest, Recent visit to eye doctor, Under
the influence of drugs
Recalling a memory, Interest
Greeting, Positive mood, Avoidance or denial
Stress, Anger or hostility, Concentration
Sadness or crying, Anger, Anxiety
Anxiety, Bad habit
Surprise, Boredom or fatigue (yawning), Having a
cold if breathing through open mouth
Embarrassment, Anxiety
Surprise, Startle response, Sudden insight
Deep thought or concentration, Irritation or
annoyance, Rejection of a therapist response
Memory retrieval, Disagreement, Thoughtfulness
or pondering of a suggestion
Feature
Nonverbal Expression
Head
Nodding up and down
Shaking left to right
Hanging
Cocked to one side
Shrugging
Shoulders
and Neck
Arms and
Hands
Slouched
Raised
Neck rolls
Folded arms
Trembling hands
Clenched fist or tight grasp
Stiff and/or unmoving
Open gesturing
Legs and
Feet
Body
Crossing and uncrossing
Foot tapping
Stiff and/or controlled
movements
Leaning forward
Leaning away or back
Turned to the side
Rocking or repetitive motion
Habitual movement (e.g., tapping,
hair twirling, squirming)
Breath
Slow and deep breathing
Hyperventilation
(over-breathing)
Under-breathing
Short, flat, and choppy breathing
Possible Meanings
Agreement, Listening and/or paying attention
Disagreement, Disapproval
Sadness, Hopelessness; Shame; Embarrassment
Pondering, Listening and/or paying attention
Uncertainty or ambivalence, Indifference or lack
of caring about something
Sadness, Withdrawal or shyness, Bad posture
Self-protection, Stretching
Tension, Stretching
Closed to contact, Dislike or emotional distance,
Creating a barrier for self-protection
Anxiety, Anger, Disease process (e.g.,
hypoglycemia, Parkinson’s)
Anger or imminence of acting out, Resistance to
disclosure, Intimidation, Bad habit
Anger, Anxiety, Reluctance or shyness, Sore
muscles
Openness to disclosure, Willingness to make
contact
Anxiety or nervousness, Depression, Selfprotection
Anxiety, Impatience
Anxiety, Closed to contact, Repressed attitude,
Sore muscles
Attentiveness and interest, Openness,
Connectedness
Withdrawal, Rejection of a gatekeeper
verbalization, Relaxation or comfort
Avoidance, Fear or expectation of rejection,
Reduced openness
Anxiety, nervousness, or worry, Bad habit,
Developmental disorder
Concentration and/or focused attention,
Boredom, Impatience, Anxiety or nervousness,
Bad habit
Relaxation or attempt at calming down, Comfort,
Good breathing habits
Anxiety or panic, Loss of emotional control
Anxiety, Depersonalization
Anxiety, Depression with crying, Poor breathing
habits
Active Listening
Active listening is one way to communicate with someone effectively and with
compassion. It is a skill people learn with practice over time. Below you will find
additional information about Active Listening which may help you when
introducing the skill during training.
Roadblocks/Pitfalls
Definition
Potential Consequences
Inadequate Listening
Gatekeeper is inattentive or
preoccupied with personal
worries or need states
Evaluative Listening
Gatekeeper makes judgments
about what is heard and thus
loses objectivity
Filtered or Selective
Listening
Gatekeeper hears what they
expect or want to hear based
on preconceived notions due
to prejudice, bias, or
stereotypes
Fact-Centered Listening
Gatekeeper only listens to
overt content (verbal
information) and misses the
latent or covert content
(personal and emotional
message)
Gatekeeper is preoccupied
with how to respond to the
person, formulating responses
while the person is speaking
and thus not attending fully
Person will not feel heard;
gatekeeper misses important
aspects of the person’s
communication
Person feels judged and
misunderstood; gatekeeper
tends to feel superior and to
give advice
Person feels misunderstood
and misrepresented;
gatekeeper fails to hear the
person’s true message and
misrepresents her or his state
of being
Person perceives gatekeeper
as experience-distant, nonempathic, and intrusive;
gatekeeper tends to overuse
questions
Rehearsing-WhileListening
Sympathetic Listening
Gatekeeper gets caught up in
the person’s story (content or
emotion) and over-identifies
with the person
Person feels misunderstood
and disrespected and
perceives the gatekeeper as
anxious; gatekeeper misses
essential aspects of
conversation and makes
comments that are wellphrased but off-target
Person may feel heard but not
helped; gatekeeper loses
objectivity and distance leading
to ineffectiveness and burn-out
Empathic Responding
Skill
Definition
Response Example Based
on the Above Scenario*
Encourager
Repetition of a word or phrase;
nonverbal encouragement to
keep talking (head-nodding,
leaning-in); semi-verbal
response (e.g., uh-huh)
Open-ended question
encouraging the person to say
more and showing the
gatekeeper’s interest and
attention
Repetition of the content of a
message using the person’s
words or phrases
person’s message, using the
therapist’s own words
Rephrasing of a person’s
message to clarify its affective
component or (hidden) essence
“What you have done?”
Opening Question
Restatement
Paraphrase
Reflection
Summarization
Rephrasing and/or restating of
several messages to tie them
together in their meaning or
affective content
“What kinds of things go through
your mind as you are pacing?”
“You are pacing, trying to figure out
what’s going on with her and what
you have done.”
“You are up all night worrying about
how she is doing and what you
might have done differently to
maybe keep this from happening.”
“You are worried about your
daughter, but also have some sense
of responsibility about your role in
what is happening between the two
of you.”
“You said earlier that your daughter
has said that she hates you and that
your husband has blamed you for her
anger at the two of you. Now you are
suggesting that you are taking some
responsibility for what is happening,
questioning what you might have
done.”
General Action Plan Principles
How does the gatekeeper arrive at an action plan with a suicidal person? Simply
put, collaboratively and with an eye on minimizing restrictiveness, maximizing
confidentiality, and foremost with the individual’s safety as the ultimate goal.
Following is an overview of general principles.
All action plans, regardless of level of crisis and level of restrictiveness of the
intervention, have a few common components and principles that will be of help to
the gatekeeper. The following are principles that always apply, though to different
degrees depending on the action plan option (to be presented below) that is
chosen.
REMEMBER: You are not expected to be a mental health professional or
provide treatment. Rather, your role is to assess risk & protective factors
while thinking of what you can do for help. In some situations additional
help is necessary, but often talking with someone is all that is needed.
The more severe the crisis, and the less amenable the person is to resolving the
crisis at a low level, the more likely that these strategies will not suffice to keep
the person safe. The gatekeeper will then need to move to restrictive action
plans that involve other treatment providers who will support the gatekeeper’s
efforts or who may take over the care for the individual (e.g., hospitalization).
Show respect and understanding for feelings that are expressed; do not tell a
person not to feel a certain way – this will only make the individual defensive
or will add to their sense of being misunderstood
Help the person recognize feelings that may underlie the suicidal ideation
but that are not openly expressed; help them recognize the sense of
hopelessness about ever feeling better that often accompanies suicidal
thoughts – do not force your interpretations on the person, simply suggest
that there may be other emotions that the person has not fully explored
Acknowledge the pain that is always present in a suicidal individual; be kind
and empathic in pointing this out, not forceful and imposing – let the
individual recognize that someone understands the person’s pain without
judging the individual
Do not shy away from discussing painful or sad emotions with the individual;
help the person air these emotions in an environment of caring
and concern – be open and supportive to the person’s need to express
what they have perhaps been holding onto for a long time
Help the person recognize that no one is without resources and inner
strength; help the individual see a small personal strength you have noticed
in her or him during your conversation – let the person feel this strength and
explore how that strength has helped her or him cope in prior difficult
situations (repeat this with as many personal strengths as possible)
Help the person recognize that her or his life has something positive;
recognize a protective factor– help the person see this issue as supportive
and help her or him problem-solve how that positive feature in her or his life
can be engaged to help with this crisis (repeat this with as many protective
factors as possible)
Discuss with the person a prior crisis situation she or he has weathered
successfully; explore what coping strategies she or he turned to then – use
these same strategies in the current action plan and use them to help point
out to the person that she or he is not helpless
Help the person remember that she or he is strong and capable and has
proven this through having lived and coped this long; summarize the
individual’s strengths, protective factors, and past coping – help the
person see how their existing inner resources can be put to use to
overcome their current sense of helplessness and hopelessness
Talk about which stressors in the person’s life may have triggered the
crisis– then talk about how to diffuse these stressors
Once some stressors relevant to the current situation have been identified,
look at each one with the individual; identify the ones that can be tackled in
some way right now – for each one of these immediate stressors, make a
mini-action plan for its removal or reduction
o e.g., if a relationship with a friend is a stressor, make a plan on how to
avoid meeting with this friend for the next week while the suicidal
person regains her or his inner strength
o e.g., if the person is struggling with finding child care, make contact
with a community resource that can provide temporary relief
o e.g., if the person is having problems coping at work, explore the
possibility of a brief medical or vacation leave
When considering resources and supports, a gatekeeper should start with family
and friends first. If family and friends cannot be mobilized or are not sufficient in
and of themselves, then the gatekeeper will move to include informal community
resources. If these informal resources are unavailable or insufficient, then the
gatekeeper adds formal outpatient and then inpatient treatment resources.
Through the risk assessment, identify possible existing resources and
supports in the person’s life; work with the person to make a list of positive
contacts in her or his life – then go through the list and identify the resources
the person may be willing to draw upon in this situation
o consider family members
o consider close friends
o consider acquaintances that the person finds positive or admirable in
some way
o consider co-workers who can be trusted
o consider individuals in settings that are supportive to the individual,
such as churches or clubs
Through the gatekeeper’s knowledge of the UAA Campus Resources identify
informal, self-help type resources or supports that may be accessible to the
person although they are not known to the individual; describe the most
relevant ones to the person – then identify a couple the person may be
open to using
o consider 12-step groups
o consider church groups
o consider support groups for specialty topics that are relevant (e.g.,
support groups for bipolar illness, for gays and lesbians, for cancer,
for relatives of people with Alzheimer’s, for parents grieving the
death of children, etc.)
Through the gatekeeper’s knowledge of the professional community,
identify formal outpatient treatment resources or supports that may be
accessible to the person although they are not known to the individual;
describe the most relevant ones to the person – then identify a couple the
person may be open to using
o consider mental health counselors or licensed professional
counselors
o consider substance abuse counselors
o consider psychiatrists or psychiatric nurse practitioners
o consider general medical doctors or nurse practitioners
o consider marriage and family counselors
Action Plans Not Involving Formal Treatment
Most typically, gatekeepers will need to try to resolve suicidal crises at this level,
especially in rural areas where additional and formal treatment options may be
limited.
Most typically, an action plan not involving formal treatment is the only level of
intervention that is possible for a gatekeeper alone. All other, more restrictive,
options listed later in this section are designed for a gatekeeper working in
collaboration with another care provider.
In fact, the gatekeeper’s primary role is to determine the degree of crisis and
link the individual with care providers who become responsible for the safety
and health of the individual. The gatekeeper is just that – someone who
keeps watch and identifies, but does not treat in the long term!
Action Plans Involving Only the Gatekeeper and Suicidal Person
Often, giving the individual an opportunity to talk about suicidal thoughts and to
identify supports relieves suicidal impulses. In such cases the gatekeeper can
resolve the situation with the individual without having to draw in additional
resources.
Action Plans Also Involving Family or Close Friends
If an action plan involving only the suicidal individual does not appear to suffice,
the gatekeeper can consider an action plan that includes the involvement of family
or friends of the suicidal individual. Such involvement of family or friends can
range greatly but has to be carefully negotiated with the suicidal person. A
gatekeeper should never view a suicidal person’s family member or friend as an
acceptable resource without checking with the suicidal person. Sometimes,
people who seem close to the person may actually be sources of stress and should
not be involved.
If the gatekeeper considers mobilizing family and friendship resources or support
networks, the suicidal individual needs to give permission to do so and needs to be
involved, if possible, in making contact with these individuals.
When family or friends are involved to help deal with a suicidal crisis, they can
assist with several functions. The level of their involvement is dictated by the
level of risk presented by the suicidal individual. The higher the risk, the more
intense the involvement. For example, family and friends:
Can be engaged in removing the means that were identified in the suicide
plan;
Can be with the individual so that there is no unsupervised time;
Can provide a temporary home;
Can contribute support services, such as food, shopping assistance, child
care, or transportation;
Can provide additional support by calling at regular intervals;
And so forth – only the gatekeeper’s creativity will limit how others can be
tied into a support network for the suicidal individual
Contacting others for support and help may be presented to the suicidal
individual who is ambivalent about this as a trade off: that is, the individual can
either agree to involve support people or can agree to seek hospitalization.
To summarize: the gatekeeper must seek careful guidance from the suicidal
individual with regard to whom to involve. A gatekeeper should not jump to
conclusions about family and friends:
Although there may be a spouse, it is entirely possible that this is not the
right person to draw into this situation.
It is important to make sure that the person(s) involved are not people who
contribute to the client’s stress or who may be triggers for the client (e.g.,
nagging and judgmental parents, abusive spouses, helpless children,
depressed and suicidal friends).
This is not a time when people should be engaged who have a history of
conflict with the client.
Finally, when involving others, it is important to balance the person’s
confidentiality needs with safety needs. Thus, involving a boss or supervisor
might need to be a last resort so as not to jeopardize the individual’s employment
situation. (This would only serve to add stress to the person’s life).
Voluntary Psychiatric Hospitalization
Voluntary hospitalization needs to be considered and initiated with the individual’s
collaboration, if the suicidal person is deemed incapable of inhibiting the suicidal
impulses.
REMEMBER: Gatekeepers are unlikely to be involved at this point. However, it
can be interesting to learn more about what happens with different treatment
options.
Voluntary hospitalization is much preferable to involuntary commitment as it retains
the choice for treatment with the individual and is generally considered to be a
collaboration between the suicidal individual and gatekeeper or mental health
professional without taking away control.
Involuntary Psychiatric Hospitalization Or Commitment
If individuals’ situations are considered highly lethal and risky, but they refuse to
check themselves into an inpatient facility on a voluntary basis, involuntary
hospitalization may be an option.
It is not uncommon for suicidal individuals who have refused voluntary
hospitalization to consent after all, once confronted with the reality that otherwise
they will be committed to inpatient treatment involuntarily. Often the decision
between voluntary and involuntary hospitalization has implications for where the
individual is hospitalized and generally, voluntary placements are more desirable
from the individual’s perspective.
Commitments generally lead to the use of the local non-profit, state-administered
psychiatric hospital, an option that many people would rather avoid. For
example, in Alaska individuals who need involuntary psychiatric hospitalization
may need to be admitted to the Alaska Psychiatric Institute (API). More detail
about API is provided later in this section.
Voluntary hospitalization, on the other hand, is generally to private psychiatric
hospitals or to psychiatric units in general hospitals or teaching hospitals, a muchpreferred setting for most people. For example, in Alaska voluntary hospitalizations
are possible to the designated evaluation and treatment units at Providence Alaska
Medical Center, Fairbanks Memorial Hospital, or Juneau’s Bartlett Hospital (see
resource list).
When faced with these choices, individuals often change their perspective and
choose voluntary placement over commitment.
Follow-Up for the Suicidal Individual
If the circumstances allow, it may be helpful for the individual and the gatekeeper
to have a follow-up meeting. However, in some circumstances the gatekeeper may
have passed the individual along to another care provider or a hospital. In
the latter case, it may be kind and compassionate to check in with the individual
once the crisis is resolved. This helps the individual feel cared for even after the
crisis and helps the individual see the gatekeeper as an ongoing resource.
This is also good practice for gatekeeper who thus has opportunity to experience
the individual when not in a crisis state.
Follow-Up for the Gatekeeper
Once a suicidal crisis has been resolved, the gatekeeper needs to debrief the
stress of this situation with someone else. Gatekeepers need to develop resources
for their own support and mental health, and to prevent burnout. In debriefing,
gatekeepers need to protect the privacy and confidentiality of the suicidal
individual. Thus, even though they will need to confide in someone about their
personal experience in serving as a gatekeeper, they need to try not to divulge
identifying information about the suicidal individual.
Possible resources for debriefing:
Other gatekeepers in the community
Other gatekeeper in another community
A gatekeeper who was trained in the same training workshop
Other professionals in the community
A preferred clergy member
A therapist
A close friend who can be trusted and is a good listener
A family member who can be trusted and is a good listener
Section 4:
Tips for Trainers
How to Handle Problems in Training Sessions:
Monopolizing
 Summarize the participant’s viewpoint (active listening), then move on.
 Ask others for their input. Say to the monopolizer “Thanks for sharing your thoughts. I’d
like to hear from someone else as well.”
 Ask the participant to hold off until a break.
Tangents
 Ask the participant to hold off until later in the seminar when the point is more relevant.
 Summarize the participant’s viewpoint and move on.
 Address directly the fact that a tangent has been raised – “That seems to be a different
issue,” – and restate the purpose of the discussion. Ask others for input.
Private Conversations
 Use nonverbal methods to regain the participants’ attention (e.g. make eye contact,
move closer).
 Ask one of them a question (making sure to say the participant’s name first).
 Ask them to refrain from talking (privately, if possible).
Jokes
 Privately ask the participant to minimize jokes.
 Resume the session after the humorous interjections (be as serious as possible).
Disagreeing
 Summarize the participant’s viewpoint; ask others for their opinions.
 Reframe participant’s opinion with what is known about the topic; “That’s an interesting
point; the best practices information regarding suicide prevention, however, tells us
that…”
 Agree in part, then state how you differ and why.
Distractions
 Use nonverbal means to get the participant’s attention (e.g., eye contact).
 Ignore if the behavior is not detracting from the session.
 Privately ask the participant to stop.
Doing Own Work
 Use nonverbal methods to get participant’s attention.
 If a group activity is under way, ask all to participate.
 Ignore the behavior if it is not affecting others.
 Privately ask the participant to participate actively in the program.
Time Schedules
 Ignore the behavior.
 Adhere to time schedules; don’t let everyone suffer for one person’s lateness.
 Remind participants of time frames.
 Privately request promptness (as a courtesy to the rest of the group, not just to you.)
Non-participation
 Use nonverbal means to draw the person into the discussion.
 Ask direct but non-threatening questions.
 Connect with the participant during breaks.
 Ask the participant to be the leader in a small group activity.
 Leave such participants alone (just because they are not participating does not mean
they are not learning).
Framework for Culturally Responsive Teaching
Establishing Inclusion
 Create a learning atmosphere in which learners and teachers feel respected by and
connect to one another.
o Use ice breaker activities to get to know one another.
o Control discussion so everyone who wants to participate is able to contribute.
o Other ideas: ___________________________________________________
Developing Attitude
 Create a favorable disposition toward the learning experience through personal
relevance and choice.
o Emphasis the ability for trainees to make a difference in their current
relationships within the scope of their current roles (i.e. friends helping friends).
o Lead “A Warm Wind Blows” activity or other activity to have trainees identify the
relevance of suicide prevention in their lives.
o Other ideas: ___________________________________________________
Enhancing Meaning
 Create a challenging, thoughtful learning experience that includes learners’ perspectives
and values.
o Use activities to engage trainees and discussion to include their contributions.
o Ask trainees to share their reactions to specific content areas with a partner.
o Other ideas: ____________________________________________________
Engendering Competence
 Create an understanding that learners are effective in learning something they value.
o Give trainees a chance to practice skills and compliment their growth in a specific
area.
o Ask trainees to brainstorm ways they will apply their new skills.
o Other ideas: _____________________________________________________
Group Characteristics
Depending on the cultural background and make-up of the group, it may be important for the
trainer to engage in one or more of the following strategies to adapt the training to the group’s
particular learning needs.
 The trainer can increase the speed of the presentation by:
o reviewing selections of the material in less depth
o increasing rate of speech
o choosing to skip some material
o reducing the time allotted for group exercises
o reducing the amount of group discussion
 The trainer can decrease the speed of the presentation by:
o reviewing some material in greater depth
o increasing the time allotted for group exercises
o increasing the amount of group discussion
 The trainer can increase the amount of group discussion by:
o asking about personal experiences using open-ended questions
o encouraging the group to share thoughts and ideas
o adding additional group exercises
o considering relevant questions for a particular group of participants
o asking participants how their own experiences apply to the topic
 The trainer can reduce the amount of group discussion by:
o acknowledging what has been shared and moving to the next point or topic
o requesting explicitly that the group try to stay on task
Rowdy Groups
High-energy, talkative group members may be disruptive to the other participants in a group.
In such situations adding appropriate structure can be greatly beneficial to the integrity of the
learning environment. Strategies that may introduce structure when it is needed are outlined
below.

Strategy One: The trainer starts the group with an active icebreaker exercise. An animated
icebreaker that demands physical exertion helps a lively group work out excess energy and
helps them settle down to the task.

Strategy Two: The trainer stands up to best address a rowdy group. Standing up is
especially useful in the initial hour of the presentation. Standing conveys a higher level of
authority and makes it easier to keep control of an active group.

Strategy Three: If an individual dominates, the trainer shifts attention to other group
members and politely (not rudely) ignores the dominant member. This simple procedure
gives more of the group members opportunity and permission to speak.

Strategy Four: The trainer uses a low tone of voice that requires participants to quiet down
to hear what is said.
Quiet Groups
Some groups are not open to sharing experiences, thoughts, and ideas on their own or in a
spontaneous manner. One way to create an atmosphere of openness that will help group
members express themselves is to help them feel comfortable in the training. Some strategies
to help participants become more involved in the group process follow.

Strategy One: The trainer shares at the same level at which she or he would like to see
group members participate; the trainer is the first to share and encourages others to
follow.

Strategy Two: The trainer creates a close-knit or trusting atmosphere by removing
obstacles to intimacy, including excess chairs and tables.

Strategy Three: The trainer encourages conversation at any level and then allows it to
deepen to the preferred level of disclosure.

Strategy Four: The trainer creates intimacy by sitting with participants rather than standing.

Strategy Five: The trainer introduces a group exercise that energizes all participants (such
as an ice breaker activity.)

Strategy Six: The trainer addresses specific questions to specific group members and then
goes around the room inviting each person individually to comment about and add
information to the answer to the question.
Emotional Groups
Many people have been personally touched by suicide, especially in Alaska, and it can be a very
emotional subject. It is important to recognize a group in which many individuals have recently
encountered suicide or have strong emotional responses to the topic of suicide. In such a
group, the trainer needs to be sensitive and needs to create an environment in which members
feel safe sharing their thoughts, feelings, and experiences. It is easier to create safety in a small
group, such as 10 or fewer individuals, than in a large group. Some strategies for creating safety
follow.

Strategy One: The trainer uses behaviors to help people feel comfortable:
o speak and act in a way that facilitates intimacy
o lower voice volume while still speaking clearly
o keep voice tones low and resonant
o slow down the rate of speech
o control anxiety by breathing deeply and limiting physical tension
o keep your body open and facing forward
o avoid sitting crossed legged
o avoid hand-wringing or clenching
o show only neutral or pleasant emotions and feelings
o avoid negative or unpleasant emotion

Strategy Two: The trainer uses behaviors to help people feel heard:
o listen carefully to what is said
o validate and empathize with feelings and thoughts that are expressed
o avoid making dismissive statements, such as “Yes, but,” so the participant who
discloses and those that are observing know that their thoughts and feelings are
accepted
Section 5:
Student Gatekeeper Manual
SUICIDE PREVENTION
Gatekeeper Training for
UAA Students
“UAA-ISPI is a comprehensive, coordinated,
culturally-sensitive effort promoting campus-wide
suicide prevention education and awareness.”
WHAT IS A GATEKEEPER?
A gatekeeper is a person who can intervene with someone who is at risk
for suicide by listening effectively, providing a caring response, and
helping the person connect to supportive resources. Gatekeepers can
help to promote the reduction of stigma associated with suicide risk and
can promote the understanding that treatment for mental health problems
is effective. Gatekeepers are not professional mental health providers
and are not expected to solve the person’s problems, but they are a vital
part of suicide prevention efforts on our campus.
COURSE OVERVIEW
1.
2.
3.
4.
5.
Suicide prevalence
Risk and protective factors for suicide
Immediate predictors of suicide
General risk assessment
Helping someone at risk for suicide
TRAINING OBJECTIVES
By the end of this workshop, participants will gain:
 An understanding of the factors that increase and reduce suicide
risk.
 An increased ability to listen and provide effective responses to
individuals at risk for suicide.
 An increased confidence in assessing a person’s risk for suicide.
 Knowledge of campus and local resources that are available to
assist someone at risk for suicide.
UAA Student Gatekeeper Workshop
2
MY BELIEFS ABOUT SUICIDE
How true is each statement below?
“Suicide is only completed by
people with severe psychological
problems.”
“Suicide usually occurs without
warning.”
“People who are suicidal will
always be prone to suicide.”
“Discussing suicide may cause a
person to want to carry out the act.”
“When a person has attempted
suicide and pulls out of it, the
danger is over.”
“The tendency toward suicide is
inherited.”
“People who talk about suicide
don’t do it.”
“Nothing could have stopped her
once she decided to take her life.”
“A suicidal person who begins to
show generosity and share personal
possessions is showing signs of
renewal and recovery.”
“Suicide is always an impulsive
act.”
“A religious or spiritual practice is a
protective factor.”
“A suicide attempt is just an
attention-getting device.”
Not at
all true
Somewhat
true
Very
true
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
3
RISK FACTORS FOR SUICIDE
Demographic
Characteristics
Coping Style
Immediate
Suicide
Predictors
Family &
Social
Influences
Environmental
Influences
Psychological
& Behavioral
Aspects
4
PROTECTIVE FACTORS
Individual
Characteristics
Community
Belonging
Sense of
Connection
Family &
Social
Fufillment
5
VIGNETTE #1
Sydney is a 20-year-old student at UAA who lives off campus with her boyfriend.
She grew up in a rural town in Alaska and moved to Anchorage last year. Her
family and several close friends still live in her hometown.
Sydney is in her sophomore year and her classes have become more demanding
this semester. In addition to attending school full time, Sydney works 30-40 hours
a week at her off-campus job. She supports herself and her boyfriend as he is
unable to work due to a recent accident. She and her boyfriend often argue about
finances. He wants to marry Sydney but she is not always sure.
Over the past several months, Sydney has started to drink more on the weekends.
You have been a friend of Sydney’s for the past year and over the last month or so,
you have noticed a change in her usual upbeat attitude. Sydney sends you a text
today that includes “I can’t take it anymore.”
What are Sydney’s risk factors?
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
What are Sydney’s protective factors?
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Are there any immediate suicide predictors?
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
6
VIGNETTE #2
Nick is an 18-year-old student at UAA. His father is in the military and his family
has been in Alaska quite a bit longer than most military families. Although Nick is
smart and does well in his classes, he is shy and finds it hard to make friends. He
lives in student housing where many others seem to have connected with campus
activities and organizations.
Nick spends a lot of time by himself either writing or watching television. He
keeps oversleeping and is missing his morning classes. You are Nick’s neighbor in
the dorms and ask him how he’s doing. He appears upset and tells you that
everything is going wrong and that he failed an exam this morning. Hurriedly, he
asks that you not speak to anyone about this.
What are Nick’s risk factors?
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
What are Nick’s protective factors?
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
7
VIGNETTE #3
Randi is a 22-year-old student who attends UAA at night. She is friendly and
enjoys her day job as a teacher’s aid at an elementary school. You are in the same
biology course this semester. You recently formed a study group with Randi and a
few other students.
Randi is usually cheerful and enjoyable when you see her in the study group;
however, she missed the last couple of study groups. Today she appears distracted
and unkempt. She tells you recently that she did not do well on her mid-term
exams, including the chemistry course she is taking this semester. When you start
talking more about this she mentions that she’s “ready to give up.”
What are Randi’s risk factors?
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
What are Randi’s protective factors?
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
8
VIGNETTE #4
Colin is a 30-year-old student who is working on his Masters degree in Creative
Writing at UAA. In addition to attending graduate school, he works part time and
has been your co-worker for the past few months.
As you get to know Colin, he shares with you that he quit a pretty good job in sales
to pursue his goal of becoming a writer. He often feels conflicted about his choice
because he has not been enjoying his courses as much as he thought he would. He
has a hard time feeling like his work is acceptable and often feels like the majority
of his classmates are much more talented writers. He has also told you that his
family members frequently make negative comments about his choice to go back
to school in creative writing.
The two of you start doing things together outside of work and enjoy playing pool
at a local pub. Tonight at the pub, Colin seems more distant than usual. He does
not engage in conversation with you in his usual way. When he does finally
iniatiate a topic of discussion, he casually asks if you have ever taken someone
else’s prescription pain killers before. He says that he sees his roommate’s
prescription in the medicine cabinet several times a day so the idea keeps crosssing
his mind.
What are Colin’s risk factors?
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
What are Colin’s protective factors?
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________
9
WEIGH RISKS AGAINST PROTECTIVE FACTORS
10
HELPING A SUICIDAL PERSON
“People are not driven to suicide by a caring person who inquires as to whether
or not they are suicidal. People may, however, be driven to suicide by an
avoidance of the topic on the part of the listener from whom they need a
concerned response.”
Fujimura, Weis, & Cochran, 1985, p. 613
The remainder of the workshop, and this handbook, focuses on three steps for
helping a suicidal person:
Step One: Listen with respect and accuracy through active listening.
Step Two: Speak directly about suicide.
Step Three: Develop an action plan.
11
Step One:
Listen with respect and accuracy through
ACTIVE LISTENING
When someone has indicated to you that they may be at risk for suicide (either
through direct or indirect communication), use active listening skills. Active
listening is an effective listening skill that allows a listener to reflect back what is
heard. It can:
 Help the person feel understood
 Encourage more disclosure
 Elicit more information
It also involves observing non-verbal cues.
Steps:
1. Identify to yourself what you are hearing the person express.
2. Pick something you hear the person saying (for starters, focus on one
expression).
3. Reflect back to the person what you have heard. Begin with:
 “It sounds like… [reflect back something you have heard].”
or
 “So what you’re saying is… [reflect back something you have
heard].”
Note: The process can seem mechanical at first but gets easier through practice.
12
TYPES OF ACTIVE LISTENING
Skill
Definition
Response Example
Restate
Verbalizing the content of a
message using the person’s
words or phrases.
“You feel like giving up.”
Open-Ended
Question
A question that cannot be
“What goes through your
responded to by saying “yes” or mind when you think about
“no.” This type of question
giving up?”
encourages the person to say
more and shows the gatekeeper’s
interest and attention.
Encourage
Repetition of a word or phrase;
“I know you can get
nonverbal encouragement to
through this.”
keep talking (e.g., head nodding,
leaning in); semi-verbal response
(e.g., “uh-huh”).
Paraphrase
person’s message, using the
listener’s own words.
Reflect
Rephrasing of a person’s
“You are stressed out about
message to let them know you’re your grades and want to
listening.
give up.”
Summarize
Rephrasing and/or restating of
several messages to tie them
together.
“You’re not doing as well
as you hoped in your
classes and don’t want
anyone to know what
you’re going through.”
“You seem distracted lately
and stressed out. It must be
hard to keep everything
together right now.”
13
Step Two:
SPEAK DIRECTLY ABOUT SUICIDE
Asking a person directly about their risk for suicide eliminates guesswork for the
gatekeeper. Avoid indirect or vague wording as this can deny the reality of suicide.
Being direct also allows the suicidal person to recognize the seriousness of the
situation.
Use the actual words “death” and/or “suicide.”
Examples:
“Are you so stressed out that you’re thinking about suicide?”
“So you’re saying life is too much for you right now. Are you thinking
about suicide?”
14
Step Three:
DEVELOP AN ACTION PLAN
Some writers suggest that no person is 100% suicidal and, therefore, actions to
prevent suicide always have a chance (Shneidman, 1985).
“Assessment of warning signs . . . can be translated into life-saving actions by
crisis workers or anyone else in the physical or emotional proximity of suicidal
persons . . . However, if the risk factors, clues, or cries for help go unnoticed or
unrecognized, the chances for effective intervention are greatly reduced” (Gilliland
& James, 1993, p. 135).
In general, an action plan will involve three steps:
1. Generate ideas that match the person’s degree of risk
 Remind the person of his/her strengths and coping skills. Use prior
examples, if you know this information, of when he/she has gotten through
a difficult time.
 Talk to the person about their plans for the day and evening. Help to
structure time. Also inquire about the next couple of days, if that length of
time seems manageable for the person to consider.
 Help the person to recognize supports and resources (i.e., people, places,
activities).
2. Take concrete action
 Ask about being in safe environments where another person is present. For
example:
o “Who is going to be with you tonight?”
o “It’s probably best to stay sober tonight. Do you want to
come over to my place?”
3. Follow up
 Tell them when you will call or text them next.
 Ask how they are doing the following day and the next several days.
The above steps are in the case where a person needs a considerably low level of
support. More extensive information describing different levels of action plans are
provided on the following pages.
15
GENERATE AN ACTION PLAN TO MATCH THE
DEGREE OF RISK
The action plan needs to match the individual’s needs and be realistic to the setting
that you are in (i.e., on or off campus, remote location, etc.). Action plans for similar
types of suicidal ideation, for example, may be quite different depending on whether
the gatekeeper and suicidal individual live in a rural or urban area. The following
principles, however, always apply:
The higher the risk, the more restrictive the action plan.
The higher the risk, the more likely other people/resources need to be involved.
The higher the risk, the less confidentiality for the person.
When considering resources to help the person who is struggling, begin to think about
the least restrictive and most confidential possibilities. Gatekeepers first focus on
helping the suicidal person:
 to recognize options and choices beyond suicide;
 to reduce tunnel vision;
 to improve the ability to think more rationally and realistically;
 to alleviate immediate symptoms of agitation or anxiety;
 to focus on delaying impulse and action;
 to remember the irreversibility of suicide;
 to understand they can tolerate difficulties; and
 to recognize personal strength and coping ability.
After a gatekeeper has made a general assessment about the suicidal person’s level of
risk, it is not uncommon to reassess risk. As the gatekeeper talks about possible
resources and interventions in collaboration and cooperation with the suicidal
individual, they are also making decisions regarding the person’s suicide risk once the
person leaves the gatekeeper’s presence. All of this information helps to inform the
best action plan. Interventions and resources fall along a continuum of care:
Least restrictive
Action plans
not involving
formal
treatment
Most restrictive
Outpatient
treatment
interventions
Voluntary
psychiatric
hospitalization
Involuntary
psychiatric
hospitalization
16
General Principles Associated with Action Plans
Action plans should be developed, to the extent possible, in collaboration with the
suicidal person. It is ideal to minimize restrictiveness, maximize confidentiality, and
keep the individual’s safety as the ultimate goal. All action plans, regardless of the
level of crisis and level of restrictiveness of the intervention, have a few common
components and principles that are helpful to keep in mind. The following are
principles that always apply, though to different degrees depending on the action plan
option (to be presented below) that is chosen.
All of these principles apply to any action plan. However, they are most relevant to
the low level, less restrictive options that can be handled by a gatekeeper alone.
The more severe the crisis and the less amenable the person is to resolving the crisis at
a low level, the more likely that these strategies will not suffice to keep the person
safe. The gatekeeper will then need to move to a more restrictive action plan that
likely involves other treatment providers who will support the gatekeeper’s efforts or
who may take over the care for the individual (e.g., hospitalization).
 Show respect and understanding for feelings that are expressed; do not tell a
person not to feel a certain way – this will only make the individual defensive
or will add to her/his sense of being misunderstood.
 Help the person recognize that no one is without resources and inner strength;
help the individual see a small personal strength you know or have noticed in
him/her – remind the person how that strength has helped him/her cope in prior
difficult situations (repeat this with as many personal strengths as possible).
 Help the person recognize that her/his life has something positive; recognize a
protective factor identified in the risk assessment – help the person see this
factor as supportive and help her/him problem-solve how that positive feature
in her/ his life can be engaged to help with this crisis (repeat this with as many
protective factors as possible).
 Discuss with the person a prior crisis situation he/she has weathered
successfully; explore what coping strategies he/she mobilized then – use these
same strategies in the current action plan to help point out to the person that
he/she is not helpless.
 Help the person remember that she/he is strong and capable and has proven this
through having lived and coped this long; summarize the individual’s
strengths, protective factors, and coping skills – help the person see how
her/his existing inner resources can be put to use to overcome the current sense
of helplessness and hopelessness.
17
 Recognize through the risk assessment which stressors in the person’s life
appear to have triggered the crisis; voice this to the individual – then talk about
how to diffuse these stressors.
 Once some stressors relevant to the current situation have been identified, look
at each one with the individual; identify the ones that can be tackled in some
way right now – for each one of these immediate stressors, make a mini-action
plan for its removal or reduction. For example:
o If a relationship with a friend is a stressor, make a plan on how to avoid
meeting with this friend for the next week while the suicidal person
regains his/her inner strength.
o If the person is struggling with finding child care, make contact with a
community resource that can provide temporary relief.
o If the person is having problems coping with school, explore the
possibility of a brief medical or personal leave.
When considering resources, note that the gatekeeper should start with family and
friends first. If family and friends cannot be mobilized or are not sufficient in and of
themselves, then the gatekeeper should consider informal community resources. If
these informal resources are unavailable or insufficient, then the gatekeeper might
think about formal outpatient and then inpatient treatment resources. At any point, the
gatekeeper can confer with campus and community resources for ideas or assistance.
Remember, the Alaska Careline is always available (877.266.4357).
 Through the risk assessment, identify possible existing resources and supports
in the person’s life; work with the person to make a list of positive contacts in
her/his life – then go through the list and identify the resources the person may
be willing to draw upon in this situation. Consider:
o family members
o close friends
o a mentor that the person finds positive or admirable in some way
o people in settings that are supportive to the individual, such as churches
or clubs
 Through the gatekeeper’s knowledge of the campus community, identify
informal, self-help type resources or supports that may be accessible to the
person although they are not known to the individual. Describe the most
relevant ones to the person – then identify a couple the person may be open to
using. For example:
o church groups
o UAA Multicultural Center (AHAINA)
o something related to relevant specialty topics (e.g., support groups for
vets, for cancer, for relatives of people with Alzheimer’s, for grief, etc.)
18
 Through the gatekeeper’s knowledge of the professional community, identify
formal outpatient treatment resources or supports that may be accessible to the
person although they are not known to the individual. Describe the most
relevant ones to the person – then identify a couple the person may be open to
using. For example:
o Talking to a mental health counselor for a few sessions at the
Psychological Services Center (in SSB)
o A consultation to explore the options of therapy or medication at
Student Health & Counseling Center
o Visiting the Vet Center
o Calling the Alaska Careline for support
 The gatekeeper might also consider more structured, formal treatment resources
or supports that may be accessible to the person although they are not known to
the individual. Describe the most relevant ones to the person – then identify one
the person is open to using. For example:
o Evaluation and treatment at Providence Hospital or the Alaska Native
Medical Center for adult beneficiaries
o Hospital admission to Alaska Psychiatric Institute
o Transport and follow-up by Anchorage Community Mental Health
Create a Safe Environment for the Suicidal Person
 Using the information gained from the risk assessment, talk about the means
accessible to the person that may be used to attempt to die by suicide. Discuss
how the means may be involved in the current suicide plan, then make a plan
on how to eliminate the means from the environment. For example:
o If the person plans to use a gun, make arrangements for the person to
surrender the firearm.
o If the person plans to mix prescription medications and alcohol,
confiscate all alcohol and leave the person only enough prescription
medications to make it through a couple of days.
o If the person plans to run his/her car off a bridge, consider confiscating
the car keys and make arrangements for alternative transportation.
19
Action Plans Not Involving Formal Treatment
Most typically, gatekeepers will need to try to resolve suicidal crises at this level,
especially in circumstances where additional and formal treatment options and/or
resources may be limited.
Usually, an action plan that does not involve formal treatment is the only level of
intervention that is possible for a gatekeeper alone. All other, more restrictive, options
listed later in this section are designed for a gatekeeper working in collaboration with
another care provider.
The gatekeeper’s primary role is to determine the degree of crisis and link the
individual with care providers who become responsible for the safety and health of
the individual. The gatekeeper is just that – someone who keeps watch and
identifies, but does not treat in the long term!
Action Plans Involving Only the Gatekeeper and Suicidal Person
Often, giving the individual an opportunity to talk about suicidal thoughts and to
identify supports relieves suicidal impulses. In such cases the gatekeeper can resolve
the situation with the individual without having to draw in additional resources.
Talking together about decisions and conclusions in a conversation is an effective and
confidential way to help the individual.
Action Plans Also Involving Family or Close Friends
If an action plan involving only the suicidal individual does not appear to suffice, the
gatekeeper can consider an action plan that includes the involvement of family or
friends of the suicidal individual. Such involvement of family or friends can range
greatly but has to be carefully negotiated with the suicidal person. A gatekeeper
should never view a suicidal person’s family member or friend as an acceptable
resource without checking with the suicidal person. Sometimes, people who seem
close to the person may actually be sources of stress and should not be involved!
If the gatekeeper considers mobilizing family and friendship resources or support
networks, the suicidal individual needs to give permission to do so and needs to be
involved, if possible, in making contact with these individuals. When family or
friends are involved to help deal with a suicidal crisis, they can assist with several
functions. The level of their involvement is dictated by the level of risk presented by
the suicidal individual. The higher the risk, the more intense the involvement should
be. For example, family and friends:
 can be engaged in removing the means that were identified in the suicide plan;
 can be with the individual so that there is no unsupervised time;
 can provide a temporary home;
20
 can contribute support services, such as food, shopping assistance, child care,
or transportation;
 can provide additional support by calling at regular intervals;
 and so forth – only the gatekeeper’s creativity will limit how others can be tied
into a support network for the suicidal individual
Contacting others for support and help may be presented to the suicidal individual
who is ambivalent about this type of plan as a tradeoff. That is, the individual can
either agree to involve supportive people or can agree to seek hospitalization.
To summarize: the gatekeeper must seek careful guidance from the suicidal individual
with regard to whom to involve. A gatekeeper should not jump to conclusions in this
regard. Remember:
 Although there may be a partner or spouse, it is entirely possible that this is not
the right person to draw into this situation.
 It is important to make sure that the supportive individual(s) involved are truly
supportive and are not people who contribute to the person’s stress (e.g.,
nagging and judgmental parents, abusive spouses, helpless children, depressed
and suicidal friends).
 This is not a time to involve anyone who has a history of conflict with the
person.
Finally, when involving others, it is important to balance the person’s confidentiality
needs with safety needs. Thus, involving a boss or supervisor might need to be a last
resort so as not to jeopardize the individual’s employment situation (as this would
likely only serve to add stress to the person’s life).
IMPORTANT: If the suicidal individual refuses the involvement of others, but the
gatekeeper believes it to be necessary, a more restrictive option needs to be
exercised. In such cases, the gatekeeper has to take charge and overrule the
suicidal individual by moving minimally to the next level of intervention (see next
section, Outpatient Treatment Interventions).
21
Outpatient Treatment Interventions
Again, at this level of intervention, the gatekeeper begins to involve other
professionals in the care of the individual. This level of intervention implies that the
suicidal individual is unable to commit to staying safe (i.e., not to kill herself/himself)
and is in need of additional resources. For example:
 The individual may want to talk to a qualified counselor or therapist.
 The individual may want to consider psychiatric medication.
 The individual may need regular contacts with a friend to continue feeling
supported.
Several resources exist on campus and in Anchorage for additional mental healthcare
support. Campus resources are no cost to UAA students or based on a sliding-scale
fee. Several community resources are within walking distance from campus, should
this be a preferred by the individual. Gatekeepers need to be familiar with the
resources in their local communities. A list of resources is provided in this handbook.
Keep in mind this list is a starting point and is not meant to be all-inclusive.
The essential feature of the Outpatient Treatment Intervention is:
The gatekeeper is no longer working alone and most likely is no longer the primary
individual who keeps the suicidal person safe.
The following arrangements may be of use as needed:
 Being with the person when calling for an appointment
 Going with the person to an appointment with a health care provider
 Helping the person increase the number sessions per week with a mental health
care provider
 Being creative in working out arrangements that keep the individual safe and
engaged in the intervention
 Providing the person with a card that has local information about resources
including a 24-hour crisis numbers or 24-hour walk-in options for crisis
situations
If outpatient support is chosen as the best avenue for intervention, serious
consideration should be given to involving family members and/or close friends. The
suicidal person must make a strong commitment to utilize the emergency contacts
should the suicide crisis recur between scheduled sessions or contacts with providers.
22
Voluntary Psychiatric Hospitalization
Voluntary hospitalization needs to be considered and initiated in collaboration with
the individual:
…if the suicidal individual is deemed incapable of resisting suicidal impulses.
Voluntary hospitalization is much preferable to involuntary commitment as it retains
the choice for treatment with the individual and is generally a collaborative endeavor,
rather than an intrusive endeavor on the suicidal person.
If the individual agrees to go to the hospital, necessary steps need to be taken
immediately to facilitate the process:
 The gatekeeper must be familiar with local resources to know which facilities
are available. Have phone numbers to these services handy.
 The individual and gatekeeper then collaborate in calling these facilities to let
the facility know that the person is on the way.
 Once a resource has been identified and secured, the gatekeeper and the
individual must think about transportation to the facility. It is best that the
suicidal individual does not transport themselves, even if their personal
transportation is easily available.
If the gatekeeper is comfortable transporting the person to the hospital, then the
gatekeeper may consider providing transport.
 Find assistance of a trusted family member or friend to meet the individual at
the gatekeeper’s location and to transport the individual to the facility. If no
family members or friends are available, or if the individual refuses to involve
them, Anchorage Community Mental Health has a mobile team available to
provide transportation and UPD or APD can help as well. Several facilities are
within walking distance from campus so the gatekeeper could accompany the
individual even without automobile transportation.
23
Involuntary Psychiatric Hospitalization or Commitment
If individuals’ situations are considered highly lethal and risky, but they refuse to
check themselves into an inpatient facility on a voluntary basis, involuntary
hospitalization needs to be discussed. In Alaska, involuntary admission for psychiatric
hospitalization means placement at Alaska Psychiatric Institute (API). The contact
number for information on admission at API is 907.269.7100.
It is not uncommon for suicidal individuals who have refused voluntary
hospitalization to consent after all, once confronted with the reality that otherwise
they will be committed to inpatient treatment involuntarily. Often the decision
between voluntary and involuntary hospitalization has implications for where the
individual is hospitalized and voluntary placements are often more desirable from the
individual’s perspective.
Commitments generally lead to the use of the local non-profit, state-administered
psychiatric hospital (e.g., Alaska Psychiatric Institute), an option that many people
would rather avoid.
Voluntary hospitalization, on the other hand, is generally to private psychiatric
hospitals or to psychiatric units in general hospitals or teaching hospitals, a muchpreferred setting for most people. For example, in Alaska voluntary hospitalizations
are possible to the designated evaluation and treatment units at Providence Alaska
Medical Center.
When faced with these choices, individuals often change their perspective and choose
voluntary placement over commitment.
If commitment is necessary, and it does happen, especially if the individual has severe
psychiatric symptoms that significantly distort his/her perception of reality, the
gatekeeper must take care to have sufficient information to initiate commitment
proceedings.
 Most specifically, the gatekeeper must have collected evidence either
themselves or through a professional that the individual clearly presents a
danger to self.
 The gatekeeper must have organized the information that was collected from
the person so far.
 The gatekeeper should be prepared to respond to questions about the
assessment of the individual’s level of risk.
 The gatekeeper should work closely with the individual to try to maintain a
relationship despite the involuntary nature of the action plan.
24
The exact nature of the process of involuntary commitment varies greatly from state
to state and across professional credentials. In Alaska in general:
An involuntary commitment can be done by police officers or by practitioners
who have admission privileges (e.g., a psychiatrist, who is an MD). If you
believe an involuntary commitment may be inevitable, connect yourself and the
suicidal person with a law enforcement officer who can do the following:
 complete a Peace Officer’s Application,
 take the suicidal individual into custody, and
 transport the individual to the psychiatric facility.
A potential problem with this process is that peace officers called to the scene must
make their own assessment of the suicidal individual’s mental status and if the
suicidal person denies suicidal ideation, the officers may decide not to complete the
Peace Officer’s Application. In such circumstances, the gatekeeper should consider
communicating directly with the hospital (e.g., Alaska Psychiatric Institute) or a
specialized team (e.g., Anchorage Community Mental Health and their mobile
response team) to ensure the person’s safety. If necessary, these resources can assist
the gatekeeper with filing an ex parte order with probate court to mandate
confinement.
Involuntary commitment is greatly facilitated if the individual’s family cooperates and
agrees; however, at times commitment proceedings may have to be initiated not only
against the individual’s wishes but also against the family’s wishes. If gatekeepers
judge that an individual presents an unacceptable risk, they must initiate an
involuntary commitment, even under such hostile family circumstances.
In Alaska, involuntary admission for psychiatric hospitalization means placement at
Alaska Psychiatric Institute (API). The contact number for information on Admission
at API is 907.269.7100.
Procedures for Admission to Alaska Psychiatric Institute (API)
The procedures for admission to API are similar for voluntary admissions, Peace
Officer applications, and involuntary ex parte admissions. To be eligible for
admission, one of these criteria must be met:
1) Patient poses a threat to herself/himself (suicidal ideation)
2) Patient poses a threat to others (homicidal ideation)
3) Patient is gravely disabled
All patients must be medically cleared before admission. Medical clearance is usually
ascertained at Providence Psychiatric Emergency Department or by the medical care
facility in the patient’s hub community. Once a patient has medical clearance and has
been admitted to API by the psychiatrist on duty, he/she is transferred to the facility
and is met by an Admission Screening Officer at API who completes the intake by
conducting a comprehensive medical, psychiatric, and substance abuse history.
25
TAKE CONCRETE ACTION TO ACCOMMODATE
NEEDS AND RESOURCES
To review, the primary concrete actions a gatekeeper will engage in after a risk
assessment is complete and the gatekeeper has a sense of the level of urgency and
intervention necessary are:




Eliciting help from others
Linking the person with local resources
Providing support and companionship
Preparing the person for the next steps
 Handing over the case to a professional
The more urgent and dangerous the situation, the more other helpers the gatekeeper
will need to seek out. At low levels of intervention, the gatekeeper may resolve the
situation with the suicidal individual alone. The higher the risk, however, the more
the gatekeeper’s role shifts to one of linking the individual with other resources.
If the gatekeeper needs to draw on other resources, the interaction with the
individual will shift to one of support and preparation. The gatekeeper will be there
to help the individual make contacts with other helpers, will tell the individual
what to expect with each coming step, and will ultimately hand the individual over
to another individual who will become responsible for the care of the suicidal
person.
Throughout the process of connecting the suicidal individual with other
resources, the gatekeeper applies good active listening skills, is empathic in
her/his relationship with the individual, and assures that the individual feels
heard, understood, and respected.
26
FOLLOWING UP
Follow-Up for the Suicidal Individual
If the circumstances allow, it may be helpful for the individual and the gatekeeper
to have a follow-up meeting. In some circumstances the gatekeeper may have
passed the individual along to another care provider or a hospital. In such cases, it
may be kind and compassionate to check in with the individual once the crisis is
resolved. This helps the individual feel cared for even after the crisis and helps the
individual see the gatekeeper as an ongoing resource.
This is also good practice for the gatekeeper who then has opportunity to interact
with the individual when not in a crisis state.
Follow-Up for the Gatekeeper
Once a suicidal crisis has been resolved, the gatekeeper may need to debrief the
stress of this situation with someone else. Gatekeepers need to avail themselves of
their own resources, such as the Alaska Careline, for support and to prevent
burnout. In debriefing, gatekeepers need to protect the privacy and confidentiality
of the suicidal individual. Thus, even though they will need to confide in someone
about their personal experience in serving as a gatekeeper, they should not divulge
identifying information about the suicidal individual.
Possible resources for debriefing:





Other gatekeepers
The Alaska Careline (listed under “Resources”)
A clergy member
A close friend who can be trusted and is a good listener
A family member who can be trusted and is a good listener
27
PUTTING IT TOGETHER
What factors
indicate risk?
What factors protect?
Are there any immediate
suicide predictors?
What is the level of risk?
Create a Concrete Action Plan:
Generate ideas to keep this person safe TODAY.
Determine what resources might be useful for
further care, and make plans for follow up.
28
RESOURCES
Alaska Careline Crisis Intervention Hotline
877.266.4357
www.carelinealaska.com
Campus Resources
UAA Student Health & Counseling
907.786.4040
RH 116
UAA Psychological Services Center
907.786.1795
SSB 255
UAA Dean of Students Counselors
907.786.6158
SU 204
UAA Campus Police
907.786.1120
ESH114
Community Resources
Anchorage Community Mental Health Services
907.563.3200
Providence Psychiatric ER
907.562.2211
Southcentral Foundation, Denaa Yeets’ Program
907.729.5260
Alaska Psychiatric Institute
907.269.7100
Vet Center Anchorage
907.212.3200
1.800.273.8255, Press 1
Chat: veteranscrisisline.net
Text: 838255
www.uaa.alaska.edu/ISPI
29
Section 5:
Training Materials & Resources
Help is available and it works.
University of Alaska Anchorage
Alaska Careline
1-877-266-4357
Alaska Careline
1-877-266-4357
Available 24 hours/7 days
Crisis Intervention Hotline
Additional Resources
Student Health & Counseling
Campus Police
ACMHS Crisis Line
907.786.4040
907.786.1795
907.786.6158
907.786.1120
907.563.3200
1.800.273.8255
(Press 1)
UAA Integrated Suicide Prevention Initiative
Campus Police
ACMHS Crisis Line
This card can help you know
what to say to a friend and how to help.
907.786.4040
907.786.1795
907.786.6158
907.786.1120
907.563.3200
1.800.273.8255
(Press 1)
Alaska Careline
1-877-266-4357
Alaska Careline
1-877-266-4357
Campus Police
ACMHS Crisis Line
907.786.4040
907.786.1795
907.786.6158
907.786.1120
907.563.3200
1.800.273.8255
(Press 1)
Campus Police
ACMHS Crisis Line
907.786.4040
907.786.1795
907.786.6158
907.786.1120
907.563.3200
1.800.273.8255
(Press 1)
Risk factors & warning signs:
Things to say:
Things to say:
Risk factors:
Previous suicide attempt
Problems with alcohol or substance use
Trouble adjusting to major life changes
Becoming easily overwhelmed or upset
Relationship problems
I’ve noticed you’re feeling upset.
Risk factors:
What’s going on in your life?
What do you think might help?
Are you thinking about suicide?
I care about what happens to you.
Will you let me help you get help?
Warning signs:
Acquiring means to complete suicide
Feeling hopeless or purposeless
Becoming increasingly withdrawn
Talking about wanting to kill oneself
Increased substance use
Dramatic mood changes
Uncontrolled anger
Being overly isolated
Ideas to help:
Stay with the person
Emphasize that treatment is effective
Make plans to connect the next day and
over the next several days
Offer to take them to see a counselor
Call the Alaska Careline together
Warning signs:
Uncontrolled anger
Continue to ask how things are going
Ideas to help:
Things to say:
Things to say:
Risk factors:
Risk factors:
Warning signs:
Uncontrolled anger
Ideas to help:
Warning signs:
Uncontrolled anger
Ideas to help:
Alaskan Suicide Awareness and Prevention Resources
The following media resources were created by Alaskans and designed to address issues of suicide
awareness, prevention, and survival as well as mental health concerns. These resources have been
compiled in cooperation with the Alaska Youth Suicide Prevention Project and highlight local efforts to
address suicide prevention.
Video Resources:
•
Railway of Hope: This is a short film written by a teenager, Sophie Clark, living in Klawock,
Alaska. The film tells the story of Landon, a high-school senior who struggles with his failing
grades, relationships, and the memory of his father.
o
•
http://vimeo.com/71570573 (Password: roh)
ANTHC Digital Storytelling: The Alaska Native Tribal Health Consortium (ANTHC) has developed
a team to blend storytelling traditions with computer-based technology as a way for people to
be able to tell their own story. Storytelling serves to empower people to share a meaningful,
heart-felt message as they exercise their power to write and create their own personal
narrative.
o http://www.youtube.com/user/ANTHCDigitalStories
•
We Breathe Again: This feature length documentary film is filmed in Alaska with a specific focus
on the impacts of suicide within Alaska Native communities. The film "presents journeys of both
hardship and beauty; and it illuminates everyday paths toward reconnecting the severed ties
between the people, the land, and the waters." This project is a collaboration between Gwanshii
LLC, the Indiginous Leadership Institute, and Crawl Walk Run Productions. Premier viewings of
the film are expected to start in January of 2014.
o http://www.kickstarter.com/projects/1009036513/we-breathe-again-heartbreakand-hope-in-alaska
o http://www.alaskadispatch.com/article/we-breathe-again-documentary-takes-aimsuicide-among-native-alaskans-video
Other Resources:
•
The Winter Bear Project: This play, written and performed in Alaska, uses the Alaska Native
tradition of storytelling to create a safe space to share about the experience of suicide in Alaska.
In this story, an Alaska Native teenager rises above the traumas of his past to become a leader in
his community, with the help of mentor Sidney Huntington and a Winter Bear.
o http://www.winterbearproject.com/
•
Kake Culture Camp: While many communities in Alaska host "culture camps" where Alaskan
youth spend a week learning about traditional practices, the Tlingit village of Kake, Alaska also
takes this opportunity to address the emotionally-charged issue of suicide. The success of this
program has been covered in the media and local residents report that by openly addressing
suicide with Native traditions a new spirit of resiliency can be found within their teen
populations.
o http://www.alaskapublic.org/2013/07/26/ak-culture-camp/
o http://www.kcaw.org/2013/07/29/kake-25-years-of-suicide-prevention-withtraditional-foods/
o http://www.youtube.com/watch?v=AbwbVNvkOw8
Faculty Syllabus Statements
Brief Syllabus Statement: 53 words
The UAS community is committed to and cares about all students. If you or someone you know
at UAS feels overwhelmed, hopeless, depressed, and/or is thinking about dying by suicide,
supportive services are available and effective. For immediate help contact the Alaska
Careline: 877-266-4357. More information and local resources are located
at www.uaa.alaska.edu/ispi.
Basic Mental Health Syllabus Statement: 93 words
As a student, you may experience a range of challenges that can interfere with learning, such
as strained relationships, increased anxiety, substance use, feeling down, difficulty
concentrating and/or lack of motivation. These mental health concerns or stressful events may
diminish your academic performance and/or reduce your ability to participate in daily activities.
UAS services are available and treatment does work. You can learn more about confidential
mental health services available on campus at: www.uas.alaska.edu/juneau/counseling/. 24
hour emergency help is also available through the Alaska Careline at 877-266-4357 or
at www.carelinealaska.com.
Signs and Resources Syllabus Statement: 170 words
The UAS community is committed to and cares about all students. Recognizing the signs and
symptoms of mental health problems can help you or others to consider seeking care that can
help. These are some signs that may be reason for concern:
1. Feeling hopelessness, worthlessness, depressed, angry or guilty
2. Withdrawal from friends, family and activities that used to be fun
3. Changes in eating or sleeping patterns
4. Feeling tired or exhausted all of the time
5. Trouble concentrating, thinking, remembering or making decisions
6. Restlessness, irritability, agitation or anxious movements or behaviors
7. Neglect of personal care
8. Reckless or impulsive behaviors (e.g., drinking or using drugs excessively or being
unsafe in other ways)
9. Persistent physical symptoms (e.g., headaches, digestive problems or chronic pain) that
do not respond to routine treatment
10. Thoughts about death or suicide *
Treatment for mental health problems is effective. More information and resources are located
at www.uas.alaska.edu/juneau/counseling/. Immediate help (24/7) is available through the
Alaska Careline: 877-266-4357 or at www.carelinealaska.com.
Personal Investment Syllabus Statement: 184 words
Diminished mental health, including significant stress, mood changes, excessive worry,
or problems with eating and/or sleeping can interfere with optimal academic performance. The
source of symptoms might be strictly related to your course work; if so, please speak with me.
However, problems with relationships, family worries, loss, or a personal struggle or crisis can
also contribute to decreased academic performance.
UAS provides mental health services to support the academic success of students. The
UAS Counseling Center offers confidential services to help you manage personal challenges.
Any student who is enrolled in credit courses for the current semester is eligible.
In the event I suspect you need additional support, I will express my concerns and the
reasons for them, and remind you of campus resources (e.g., Counseling Services, Student
Services, etc.) that might be helpful to you. It is not my intention to know the details of what
might be bothering you, but simply to let you know I am concerned and that help, if needed, is
available.
Getting help is a smart and courageous thing to do -- for yourself and for those who care
about you.

Integrated Suicide Prevenon Iniave

Transcription

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