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Wednesday, December 11, 2013

Depression and Suicide Prevention in the Fire Services

Depression and Suicide Prevention in the Fire/EMS Services

Teresa Meunier, Assistant Risk Manager, Risk Management and Safety Office 
Prince George's County Fire/EMS Department

According to the National Institute of Mental Health, suicides are preventable.  Over 90% of people that have committed suicide were suffering from clinical depression or some other diagnosis of psychiatric illness and/or substance abuse, which are treatable conditions. 
In July 2011, the NFFF hosted a summit on depression and suicide in the fire services and they were extremely fortunate to have the nations' preeminent subject matter experts share their knowledge about suicide, and how this information might influence our industry's understanding of these sad but important topics.  In October 2013, they convened another meeting to develop a strategic plan for moving this issue forward.  Enhancements to Firefighter Life Safety Initiative 13, The Everyone Goes Home (R) Behavioral Health Initiative, firefighters and their families must have access to counseling and psychological support.
Suicide is a complex phenomenon that is not well understood, even by many professionals called to deal with its prevention and intervention. Though often described as being among the leading causes of death in the United States, suicide is not technically a cause, but rather a mode of death, a medico legal determination regarding intent.  Based on population rates, we are three times more likely to see suicides than Line of Duty Death (LODD).
This document is intended to provide quick reference material that may help you recognize the warning signs of suicide, and provide you with the knowledge that will allow you to overcome the fear and anxiety, and will help you to act quickly should a crisis arise.  Remember it takes an act to stop an act.  

There are many myths out there about suicide and it is very important that you know the difference.   Listed below are just a few examples of each.
People who talk about it, don’t do it.
Most suicides are done within a week of verbally communicating the intent.
No one can stop a suicide, it is inevitable.
If people in crisis get the help they need , they will probably never be suicidal again.
Confronting a person will only make them angry and plant the idea.
Asking someone directly about their intent, lowers their anxiety and opens up communication, thereby lowering the risk for an impulsive act. 
Professionals are the only ones that can stop a suicide.
Suicide is everybody’s business and anyone can help.

The interpersonal theory of suicide proposes that suicide results from three mental states:
·     Social Disconnectedness
·     Perceived Burdensomeness
·     Capability to engage in suicidal behavior
The American Association for Suicidology devised the mnemonic IS PATH WARM to help people remember the warning signs for suicide:
I -  IDEATION - refers to suicide or death ideation - thinking about killing oneself or wishing for death
S - SUBSTANCE ABUSE - is a significant risk factor for suicidal behavior
P - PURPOSELESSNESS - is the feeling of being without purpose or meaning
A - ANXIETY/AGITATION - or feeling like you are "crawling out of your skin," is also seen in people at
      acute risk for suicide.
T - TRAPPED - Feeling trapped is reported by people at risk for suicide.
H - HOPELESSNESS - Feeling hopeless is reported by people at risk for suicide
W - WITHDRAWAL - from family, friends, and co-workers is seen frequently prior to suicide attempts
A -  ANGER - significant anger and rage can be precursors to suicide attempts
R -  RECKLESSNESS - reckless behavior and significant mood changes are also signs of risk for suicide
Dr. Paul Quinnett, Clinical Psychologist, and author of Question, Persuade, Refer (QPR), developed an organized approach that anyone can use to react instinctively when dealing with a crisis.  There is a technique behind the acronym. QPR Gatekeeper Training is not just for psychiatrists, psychologists and social workers to save lives. Like CPR, QPR uses a "chain of survival" approach in which a gatekeeper learns to recognize early suicide warning signs.  Peers can utilize this skill set to potentially save a life.  When you apply QPR, you plant the seed of hope and hope can prevent suicide.
The steps listed below are an example of the approach suggested in the QPR Gatekeeper Training that can be done on-line.  For additional information regarding the training, you can contact the Risk Management and Safety Office. 
First you should recognize risk factors and clues.  Listed below are a few examples of each:
·     Risk Factor(s) - Drug or alcohol use or relapse after a period of recovery, unexplained anger, aggression.
·     Direct Verbal Clues - Direct verbal clues such as making statements like I have decided to kill myself.  I wish that I was dead.  I am going to end my life.  I’m tired of living; my family would be better off without me.
·     Behavioral Clues - Past attempts, Moodiness, Helplessness, Hopelessness, Burdensomeness, Worthlessness, Co-curring depression.
·     Situational Clues - Diagnosis of any major mental illness, sudden unexpected loss of financial security, untreated depression leads to fear of becoming burden to someone.

If the risk factors and clues are evident, you move forward with QPR. 
Question their meaning to determine:
·     Suicide intent or desire
·     Persuade the person to accept or seek help
·     Refer the person to appropriate resources.
Question - Don't wait to ask questions.  Be persistent.  Talk in private.  Speak directly and not in long sentences. Let them talk freely and listen actively.  Give yourself plenty of time. You can use a direct approach EX: When people are upset as you seem to be, they often think about suicide.  Never say, you’re not thinking about suicide, are YOU?   You can also use a less direct approach:  Have you been very unhappy lately?  Do you wish you could go to sleep and never wake up?

Persuade - The first step is to listen to the problem and give your FULL attention.  Suicide is not the problem, only solution to the perceived insoluble problem.

Ask them if they will go with you to get help? Ask them if they will let you go with them to get help?
Will you promise me not to kill yourself until we find someone to help? Make them commit to that.

Refer - The best way to refer someone to help is to take them directly.  Remember get a commitment from them.
Effective QPR would be to tell them you want them to live and you are on their side.  We will get through this together.  Get others involved (Family, Friends, Brothers, Sisters).
If they refuse help, seek consultation from a professional.  If you are in a crisis and need immediate assistance, you should contact a mental health professional, such as EAP/VAP  (301) 883-6270, APS Healthcare 1 (877) 334-0530, or calling 1-800-273-TALK (8255) for a referral. 
All Fire/EMS Stations and work sites should post the 1-800-273-TALK number for the National Suicide Prevention Hotline and firefighter/medics should know when to use or encourage others to use this number.