Innovative Approaches with People Who Are Suicidal
Innovative Approaches with People Who Are Suicidal
Despite national and local suicide prevention efforts, the suicide rate in the United States has steadily climbed over the past two decades. The same rise in suicide has been reported among veterans. As a society, we need to rethink our efforts to helping people who are suicidal.
This 11-seminar course will promote that “rethinking” effort. The 11 presentations will focus on the following:
- What are the social factors, such as unemployment and gun ownership, that are known to affect suicide rates?
- Why haven’t suicide awareness programs lowered suicide rates? Do antidepressants reduce—or increase—the risk of suicide?
- A public health effort in Oregon that has successfully reduced suicide rates.
- Innovative therapeutic programs, including several developed by people with lived experience, that are proving to be effective in lowering the risk of suicide.
- How to protect mental health providers from liability when working with people who are suicidal.
Note: All webinars will be recorded and available for viewing after the live event.
Suicide in the Age of Prozac: A Review of the “Evidence”
Thursday, March 5, 1:30-3 PM Eastern, 10:30-Noon Pacific
Robert Whitaker, Author and Founder, Mad in America
This presentation will provide a review of suicide rates for the last sixty years, and investigate the factors that may be driving the steady increase in suicide rates since 2000. It will explore the societal factors—such as unemployment and gun ownership—that are known to influence such rates. Next it will examine the rise of suicide prevention programs since Prozac arrived on the market in 1988, and the commercial and guild interests behind those efforts, which have emphasized the prescribing of antidepressants—and access to psychiatric care—as helpful to reducing the risk of suicide. Does this medical-model approach work? The presentation will review the research on the effectiveness of such efforts, and the research on the suicide risk associated with use of antidepressants.
1) Identify the risk factors that influence suicide rates
2) Describe changes in known risk factors that could account for the decline in suicide between 1987 and 2000
3) Explain the approach taken by the American Foundation for Suicide Prevention in developing suicide prevention efforts, ie what was touted as the best way to reduce suicide
4) Recite data from the Danish study showing the increasing risk of suicide with each increasing level of psychiatric care
5) Analyze the results of research on the relationship between antidepressant medication and risk of suicide
6) Assess the role of the Black Box Warning for youth taking antidepressants in actual suicide rates for this population
Issues in Dealing with Suicidal People...and What Experience with Military Veterans Teaches about Nonpathologizing Approaches for All
Thursday, April 2, 1:30-3 PM Eastern, 10:30-Noon Pacific
Paula Joan Caplan PhD, Du Bois Institute, Hutchins Center for African and African American Research, Harvard University
experience calls into serious question the traditional mental health system's
approach to suicide, while other approaches have been helpful. The speaker will
challenge the automatic labeling as "mentally ill" of people because
they report having suicidal thoughts or attempted or committed suicide. She
will discuss an alarming way the DSM-IV and DSM-5 encourage the pathologizing
of suicidal thoughts. Then she will describe primary reasons people have
thoughts of suicide and what can be understood once one takes a more humane,
nonpathologizing approach, using examples from a stage play, an Oscar-winning
documentary about a "suicide hotline," research and clinical work
about the effects of various kinds of trauma, and a project primarily involving
simple, wholehearted, nonjudgmental listening. Using examples from her work
with military Veterans and with nonveterans, she will discuss the wide range of
other approaches that are helpful to people who feel suicidal. What suicidal
nonveterans tend to have in common with Veterans is to have experienced trauma,
to be terribly isolated, and/or to be given psychiatric drugs. Also, the work
with Veterans applies to suicidal young people, since so many were teenagers or
very young adults when joining the military.
1) Explain how the traditional mental health system's approach to suicide may actually increase the likelihood of suicide.
2) Critique the automatic labeling as "mentally ill" of people who report having suicidal thoughts or have attempted or even committed suicide.
3) List primary reasons why people have thoughts of suicide.
4) Describe what can be understood about suicidal thoughts and actions once one takes a more humane, nonpathologizing approach.
5) Identify a wide range of alternative approaches to traditional practices in working with military Veterans and nonveterans.
Derek Blumke. (2020). An open letter to VA Secretary Robert Willkie: A plan for deprescribing veteran suicides. March 1. Vets’ suicides often due to the drugs. https://www.madinamerica.com/2020/03/open-letter-va-secretary-wilkie-deprescribing-veteran-suicides-plan/?mc_cid=fd6574e638&mc_eid=adf82dfbd5
Paula J. Caplan. (2016). When Johnny and Jane Come Marching Home: How All of Us Can Help Veterans. (Open Road Publishers). https://www.amazon.com/When-Johnny-Jane-Come-Marching/dp/150403676X/ref=as_li_ss_il?crid=1QTVHBGHEWJI&keywords=when+johnny+and+jane+come+marching+home&qid=1554480516&s=gateway&sprefix=When+johnny+and,aps,220&sr=8-1-fkmrnull&linkCode=li1&tag=whejohandja0d-20&linkId=1dbd7dedc192a717801d8a2ccc9ed082&language=en_US
Paula J. Caplan. (2018). Moral Anguish Is Not a Mental Illness!” Volunteers for America. July. https://www.voa.org/moral-anguish-is-not-a-mental-illness
Hom, M. A., Bauer, B. W., Stanley, I. H., Boffa, J. W., Stage, D. L., Capron, D. W., Schmidt, N. B., & Joiner, T. E. (2020). Suicide attempt survivors’ recommendations for improving mental health treatment for attempt survivors. Psychological Services.Advance online publication. https://doi.org/10.1037/ser0000415
Susan Stefan. (2016). Rational Suicide, Irrational Laws: Examining Current Approaches to Suicide in Policy and Law. (American Psychology-Law Society Series.) https://www.amazon.com/Rational-Suicide-Irrational-Laws-Psychology-Law/dp/0199981191/ref=sr_1_1?crid=3J3LXVFQIDZDU&dchild=1&keywords=susan+stefan+suicide&qid=1584969796&sprefix=Susan+Stefan%2Caps%2C126&sr=8-1
Steven Woolf & Heidi Schoomaker, quoted in American Psychiatric Association Press release called “U.S. Life Expectancy Falls as Rates of Death From Drug Overdose, Suicide Rise”
Firearms and Suicide: Is Intent All That Matters?
Thursday, April 16, 1:30-3 PM Eastern, 10:30-Noon Pacific
Matthew Miller, MD, MPH, ScD Professor of Health Sciences and Epidemiology, Northeastern University
Dr. Miller will present an overview of the epidemiologic evidence linking the availability of household firearms to suicide mortality, discuss the rationale for why reducing access to firearms can save more lives than perhaps any other suicide prevention strategy, and delve into some of his suicide-related work on suicide among military veterans, adolescents seen in emergency departments with acute mental health crises, and the current state of (mis)understandings among the general public and among practicing clinicians about the promise of means restriction (i.e., reducing access to firearms) as a way to save lives.
1) Identify the proportion of completed suicides in the US that involve firearms
2) Estimate the relative number of firearm suicides vs firearm homicides in the US
3) Discuss the rationale for means restriction to firearms
4) Identify Case Fatality Rates (CFRs) for firearms vs other common methods used in completed suicide
5) Compare the degree to which people who live in homes with guns have experienced mental health problems with the degree to which people who live in homes without guns have experienced mental health problems
6) Assess the likelihood that someone who survives a suicide attempt will go on to attempt and die by suicide thereafter
7) Compare the percentage of veteran vs. non-veteran suicides that involve guns, by sex and overall
How to Tell if a Drug is Causing Suicide and What to Do Next
Wednesday, May 6, 1:30-3 PM Eastern, 10:30-Noon Pacific
David Healy MD, Professor of Family Medicine, Health Sciences, McMaster University
Clinical practice is judicial in nature.This means that establishing what is going on depends on engaging with a person and working out how best to explain the problem they have.The "scientific" literature is not much help in this respect.The challenge is to get to an objective position shared by the affected person, a mental health professional and ideally others.This workshop will take participants through this process and outline strategies for working through objections that may arise with the persons and clinicians involved.
1) Assess the proportion of total healthcare budgets represented by medications
2) Describe the difference between RCT and anecdotal evidence
3) Discuss the way in which 30 RCTs of antidepressants in depressed children were distorted to make negative findings to appear positive
4) Explain how ghostwriting is more corrupting of practice than conflicts of interest and free meals and pens
5) Analyze the increased risk of suicide and sexual dysfunction resulting from antidepressants
6) Demonstrate the way in which patients are better at evaluating a drug than an RCT
If You Want to Save Lives, Start with the Dead: An Innovative Approach to Reducing Suicide
Thursday, June 4, 1:30-3 PM Eastern, 10:30-Noon Pacific
Kimberly Repp PhD, MPH, Washington County OR Public Health Department
For the third year in a row, U.S. life expectancy has lowered due to loss of life from suicides. Often, suicide prevention activities are implemented without the data necessary to tailor and target interventions, leading to an ineffective use of very limited resources. To change the direction of this trend, Washington County, Oregon created a nationally awarded suicide surveillance system. This suicide surveillance system facilitates the collection of risk factors and circumstances surrounding every suicide in the county within 48 hours of the death. The risk factors collected parallel those in the National Violent Death Reporting System, such as previous attempts, depressed mood, crisis, legal problems, etc., but without the multi-year data delay and with data reported by the actual forensic death investigator who completed the investigation. In conjunction with our suicide fatality review team, this surveillance system has produced demonstrably effective interventions with imminently suicidal people at hotels, animal shelters, those being evicted, amongst others. The true value of a surveillance system is measured by whether it leads to prevention or control of adverse events, and Washington County’s population suicide rate has dropped an unprecedented 40%. This course will demonstrate how fast, meaningful and accurate data are shifting the paradigm on how suicide prevention is done.
1) Compare the age-adjusted suicide rate for Oregon vs United States by years 2000-2017
2) Describe the kind of data collected by NVDRS
3) Identify the missing element in the NVDRS process of investigating death
4) List the differences between the CRAP data set and the OVDRS data set
5) Discuss the unexpected key findings of the Washington County death investigator
6) Recite the three steps anyone can learn to prevent suicide
Repp KK. 2019; Applying an outbreak risk assessment profile to suicide: Getting actionable data to community organizations for effective policy change that saves lives. Council of State and Territorial Epidemiologist annual meeting, Raleigh, North Carolina.
Repp KK. 2018; Ultimate Death Match: National Violent Death Reporting System versus the real-time Suicide Risk Factor Surveillance System, Council of State and Territorial Epidemiologist annual meeting, West Palm Beach, Florida.
Large, Matthew Michael. The role of prediction in suicide prevention. Dialogues Clin Neurosci. 2018 September 20 (3)
Working with Indigenous People Who Are Dealing with Suicide
Thursday, July 2, 1:30-3 PM Eastern, 10:30-Noon Pacific
Tunchai Redvers, Director of “We Matter", Canada
“We Matter is an Indigenous youth-led and nationally registered non-profit organization committed to Indigenous youth support, hope and life promotion. Our founding project is the We Matter Campaign – a national multi-media campaign in which Indigenous role models and allies from across Canada submit short video, written and artistic messages sharing their own experiences of overcoming hardships, and communicating with Indigenous youth that no matter how hopeless life can feel, there is always a way forward.”
To Dream the Impossible Dream: How to Actually Help Suicidal Patients Without Having Nightmares about Liability
Thursday, August 6, 1:30-3 PM Eastern, 10:30-Noon Pacific
Susan Stefan JD, Author, Rational Suicide, Irrational Laws: Examining Current Approaches to Suicide in Policy and Law, Oxford University Press 2016
In this talk, I invite you to question some assumptions you may have about people who are suicidal, challenge entrenched mythology about which provider actions risk or create liability for the suicide of a patient; and provide specific and concrete suggestions about how mental health professionals can best support people struggling with suicide while also protecting against vulnerability to liability.These suggestions are win-win--they enable you to provide better care while reducing your liability exposure.
1) Identify misconceptions related to provider liability in litigation involving patient
2) Describe suicide care practices that are of particular importance in liability cases.
3) Explain system or organizational level improvements to suicide care that can
enhance an organization’s abilities to deliver quality care and minimize liability
4) Describe a new framework for helping suicidal patients.
Alternatives to Suicide Groups: Peer Support Strategies When Life is On the Line
Thursday, September 3 1:30-3 PM Eastern10:30-Noon Pacific
Sera Davidow, Director, Western Massachusetts Recovery Learning Community)
This webinar features Sera Davidow, Director of the Western Massachusetts Recovery Learning Community, where the Alternatives to Suicide approach was first developed. Although now a fully formed approach usable by providers, family members, and supporters of all kinds, Alternatives to Suicide originated as a peer-to-peer support group informed by the experiences of many who had 'been there' themselves. The groups have now been running for over a decade, and spread to several states in the US, as well as parts of Canada and Australia. This webinar will explore some of the myths about suicide that led up to the need for and development of Alternatives to Suicide, as well as providing an overview of some of the fundamental pieces of what the groups are actually about. Some of the paradoxes of suicide will also be explored including the hard reality that so often in order to have influence in someone's life, we need to first learn to let go of the idea that we can or should try to control them.
1) Identify at least two myths related to working with people who are suicidal
2) Identify at least two strategies for minimizing power imbalances in support relationships
3) Explain at least two paradoxes related to working with people who are suicidal.
4) Identify at least three elements of the format of Alternatives to Suicide peer support groups
Suicide Redefined: The Biology of Prevention
Thursday, October 1, 1:30-3 PM Eastern, 10:30-Noon Pacific
James Greenblatt, MD. Chief Medical Officer, Walden Behavioral Care, Waltham, MA
Suicide is a public health issue of critical importance, one which merits our best, most focused efforts towards treatment and prevention.This webinar will introduce a biologic framework for suicide prevention, one in which the concept of suicidality as the result of underlying nutritional, genetic, and psychosocial risk factors is explored.Scientific research supporting significant associations between malnutrition, essential fatty acid deficiencies, lithium deficiency, low cholesterol, and suicidality will be reviewed.Studies illustrating the benefits of targeted nutritional augmentation to mitigate risk factors will be presented; evidence-based interventions will be described; and a prevention model centered upon objective biologic measurement and a concept of biochemical individuality will be elucidated.
1) Identify the 7 major categories of factors that increase risk of suicide
2) List the antidepressants that increase risk of suicide
3) Explain the way nutritional deficiencies increase the risk of suicide
4) Design a clinical procedure for improved assessment of suicide risk based on research
Intentional Peer Support and Conversations about Suicide
Thursday, November 5, 1:30-3 PM Eastern, 10:30-Noon Pacific
Chris Hansen, Director, Intentional Peer Support
Intentional Peer Support focuses on validating and understanding the feelings and experiences behind thoughts of suicide. Traditional assessment-based practices focus on risk and liability (stopping suicide from happening). This presentation will be about having a conversation where both of us are present and able to benefit, acknowledging the context of what's happened- past and present, and providing opportunities to explore meaning and possibilities.
1) Define Intentional Peer Support
2) List the 3 key tasks in using Intentional Peer Support approaches
3) Explain the basics of connection in the IPS model and the kinds of actions that cause disconnection
4) Describe the reasons why attending to worldview is important in working with people
5) Compare the peer approach and the service approach
6) Identify the elements of the language of pain
Health At Every Size(R), Fat Liberation, and Fat Community as a Framework for Suicide Prevention in People with Eating Disorders
Thursday, December 3, 1:30-3 PM Eastern, 10:30-Noon Pacific
Rachel Millner, Psy.D., CEDS-S, CBTP(R)
This webinar has been approved for 1 CE. Click here for more information.
This webinar will explore the intersecting relationship between eating disorders, diet culture, weight stigma, and suicide. We will take a critical look at current approaches to addressing suicidality in people with eating disorders and identify how these interventions frequently lead to retraumatization and exposure to further weight stigma. We will talk about the role diet culture and fat phobia play in the development of eating disorders and body dissatisfaction and the importance of naming how they contribute to the false belief that bodies are to blame not just for their size and shape, but for being suicidal. We will discuss how fat phobia in the eating disorder field contributes to higher weight clients being traumatized in treatment and leads to increased risk of suicide. We will identify how weight stigma is responsible for the increasing number of people having bariatric surgery and the heightened risk of suicide following the surgery. This webinar will look to Health at Every Size(R), fat liberation, and fat community as a framework for suicide prevention in people with eating disorders.
1) Explain the impact of diet culture and weight stigma on people with eating disorders
2) Describe how diet culture and weight stigma may contribute to increased suicidality in people with eating disorders
3) Understand current approaches to addressing suicidality in people with eating disorders and how they may contribute to retraumatization and stigmatization
4) Discuss Health at Every Size, fat liberation, and fat community as a possible form of suicide prevention
Accommodations for the Differently Abled
Who should view this series
This series is designed for mental health professionals, advocates, psychiatric survivors, people with lived experience, family members, and the general public.
We anticipate receiving approval for a total of 10.0 CEs (1.0 CE credits for each webinar) for psychologists, social workers, nurses, licensed professional counselors, and marriage/family therapists.
The fee for individuals is $150 for the 11 webinar series. There is an "organizational" rate of $100 per individual for programs that wish to allow staff and members to register for the entire series. And there is a "group" rate of $50 per staff or member for those programs that wish to have a group viewing. For more information about the webinar or course fees, please contact MIA Continuing Education Director Bob Nikkel at [email protected]
The early bird rate expired on February 15.
Commonwealth Educational Seminars (CES) seeks to ensure equitable treatment of every person and to make every attempt to resolve grievances in a fair manner. Please submit a written grievance to: Bob Nikkel, [email protected], Phone: (503) 929-9346.Grievances would receive, to the best of our ability, corrective action in order to prevent further problems.