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7/31/2019 Suicidal 2005 Philippines V2
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Kirk Kinnell
May 2005
Suicide Intervention
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World Health Organisation 2000
• 1 Million suicides worldwide.
• 16 per 100,000 of population.
• 1 Suicide every 40 seconds.• Attempts exceed completed acts by 20:1.
• Male suicide rate in U.K. can be a high as
33 per 100,000 of population.• In Scotland suicides account for 17.8% of all
male deaths in 15 – 24 age group.
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Academic Studies
• 40% of those who commit suicide have previously
‘attempted’. ( Kerkhof 2000 )
• 15-20% relate to the previous year. ( Kreitman & Casey1988 )
• History of Deliberate Self Harm increases future risk of
Suicide by 10 – 30 times. ( Gunnell & Frankel 1994)
• 50% of those who commit suicide have a history of self
harm. ( Roy 1986)
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U.K. - Samaritans 2004 - Suicides
England 12 per 100,000 of population
N. Ireland 12 per 100,000 of population
Wales 14 per 100,000 of population
Scotland 21 per 100,000 of population
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The ‘Male’ Factor
• Tend towards more lethal and certain methods
commensurate with hospital admissions for attempted
suicide and DSH.
• More likely disposed to substance abuse.
• More inclined to impulsive violence.
• Less liable to seek or accept help or advice when faced
with life problems. (Brent & Moritz 1996)
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Suicide - Objectives
• List the main reasons why people threaten suicide.
• Describe risk factors indicating potential suicide.
• Identify verbal clues which suggest suicidal intentions.
• Identify situational clues which suggest suicidal
intentions.
• Outline behavioural clues which suggest suicidal
intentions.
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Suicide - Definitions
When a person takes their own
life, whether with the assistance of others
or otherwise.
Or
A deliberate act of Self harm which has caused
the ‘harmers’ death.
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Suicide - Myths
• They are all attention seekers.
• If they talk about it they won‟t do it.
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“I hope you have peace however you find it Maddy
Good luck and I will see you on the other side.”
SIDHE
Assisted Suicide
Assistedsuicideholidays.co.uk.
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Gateway to Peace ?
Assisted Suicide
Assistedsuicideholidays.co.uk.
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Suicide - Myths
• They are all attention seekers
• If they talk about it they won‟t do it
• Suicidal people are all Mentally / Physically ill
• Intelligent/educated people don‟t do it. • When the depression lifts, the risk goes.
• If you ask about it you increase the risk.
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Reasons For Suicide Threats
Suicide is the anchor point on a continuum
of suicidal thoughts and behaviours. The
continuum is one that ranges from risk
taking behaviours at one end, extends
through different degrees and types of
suicidal thinking and ends up with suicideattempts and suicide.
( Redfield Jamieson 2000 )
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Reasons For Suicide Threats
Suicide „COMPLETERS‟
continuum
Subjects With Other Motives (SWOM )
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Reasons For Suicide Threats
Police Negotiator Control / Influence over:
„COMPLETERS‟
• Managing Disappointment
• Critical Incident Debriefing
S.W.O.M.
• Success / Ego
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Reasons For Suicide Threats
• primary reason - wants to die
• „COMPLETERS‟
- wants to end
suffering
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Secondary Reasons ( S.W.O.M. )
• Cry for help
• Attention seeker
• Test reactions
• Gain something• Manipulate events
• Prevent entry
• Intend to die
• Suicidal desire impulse levels increasing
Reasons For Suicide Threats
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Suicide Indicators
• Verbal
• Situational
• Behavioural
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Suicide Indicators
Verbal Threats
• Refuses to talk
• Isolated - hopeless - helpless
• Specific death plan
• „Deadline‟ - „last request‟
• No „ifs‟ or „buts‟
• Commitment to die
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Verbal / Situational
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Suicide Indicators
Situational
Police Negotiator should :
• Attempt to assess the subjects determination to
complete the act
and• Identify the level of sophistication of the plan.
( which side of the barrier )
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Suicide Indicators
Situational
• Antecedent history• Location
– Secluded / public – Danger – Convenient / Difficult – Personally symbolic – Special meaning.
– Socially symbolic – Erskine Bridge• Low self-esteem• Emotional crisis• Major life - marital - relationship events (last 24hours)
• Negotiator detects sense of hopelessness
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Suicide Indicators
Behavioural
• Hostile – threatening.
• Demands to be killed .• Demands – should be viewed as „unsatisfied need‟.
• Past attempts.
• „Final ritual‟ - last will & testament.
• Inappropriate calmness - happy and content.
• Stripping of possessions – relationships.
• Mental health.
• Method - slashing, cutting, firearms.
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Suicide Indicators
Behavioural
• Offensive v Defensive threats
• Offensive – “ If you don‟t get my wife ..…I
will jump ”
• Defensive – “ If you try and grab me I will
jump “
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Behavioural Change
Staircase
Active
Listening
Situation
Empathy
Rapport
Influence
Change
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Come Down Plan
• Safest Possible Way
• Early
• Non-threatening
• “ I know that you are not ready to come down just yet,
but when you do could you come to the centre of theroof / fire escape etc.
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Resolution
Domestics
• Allow to vent feelings
• Label emotions
• Take a rational line
• Try not to take sides
• Emphasise the positive
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Resolution
• Depressive: no contact with reality
• Empathy
• Be patient for replies
• Beware of sudden movements
• Discuss “real world” v “abstract”
• Postpone action instead of changing mood
• Beware suicide by cop
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Resolution
Inadequate: in contact with reality
• Try to resolve without meaning another failure
• Talk of successes
• Raise esteem
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Resolution
Anti-social: in contact with reality
• Egocentricity in mind
• Be firmer to gain respect
• Safe release to his advantage• Reality checks
• Avoid intermediaries
• Saving face – coming out plan
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Resolution
Crime gone wrong
• Provide a solution
• Legal and media observers
• Appeal to reason
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Resolution
Terrorists
• Excess will now diminish your message
• You‟ve made your point
• The World is watching
• Come out only choice left to them
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Suicide Negotiation
Tactics Broaching the subject
• IF CLUES SUGGEST SUICIDE - ASK!• “It looks to me as if you want out of this”
• Visible - audible relief
• Motive? - purpose?
• Language implies suicide
• “Why do you want to kill yourself”
• “How/when do you plan to do it?”
• “What have you done?”
S i id N ti ti T ti B ildi
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Suicide Negotiation Tactics Building
Rapport
• One negotiator?
• Active listening.
• Speech - slow, clear, simple .
• Personal concern - empathy – trust.
• Making requests - be firm.
• Do not intimidate or become argumentative.
• Empathic statements & questions.
S i id N ti ti T ti M ki
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Suicide Negotiation Tactics Making
Progress
• Discourage alcohol/drugs.
• Establish problems - break down issue(s).
• Focus on situation - talk directly about it.
• Rationalise.
• Bid for time.
• Identify hook .
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Suicide Negotiation Tactics Resolution
SUICIDE INTERVENTION
• Allow to ventilate
• Try to get person to describe events as objectively aspossible
• Place more objective, rational view of events
• Use empathy, point out the normality of reaction
• Raise esteem
• Ask how they have handled it in the past
• Ask to go over options they have ruled out
• AVOID lecturing/moralising/giving advice
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Suicide Negotiation Tactics Resolution
SUICIDE INTERVENTION
• Be non-judgmental/non analytical
• Ask “Are you going to commit suicide?”
• Ask person to reduce immediate danger
• Focus on CAUSE of suicidal feelings and specific
SITUATION
• Express personal concern and EMPATHY
• Try to keep them on the line/talking
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Suicide Negotiation Tactics Resolution
SUICIDE INTERVENTION
• If insist, get promise not to harm and agree time to call
back
• Talk openly about the finality of death
• DON‟T go along with final requests
• Explore what is meaningful to person and what keepsthem going
• Bid for time, explore developing a realistic plan of
action.
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Method
• pills - how many ?- kind/strength? - when? -
anything else?• toxic substance - antidote ?
• gun/knife - ammunition ?- seriousness of wound?
• gas/carbon monoxide - when did action begin?
• other - slash wrist? - jump? - hanging?
Risk Reduction
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Risk Reduction
Ask person to reduce danger
• pills - flush down toilet - walk - stay awake• toxic substance - persuade to take antidote
• gun/knife - put away - unload - stop the bleeding
• gas/carbon monoxide - turn gas /ignition off –
open doors/windows
• other - discard razor - move away from danger -
reach safety
Third Party Intermediaries Beware
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Third Party Intermediaries Beware
- Help or Hindrance
Help
• Lowering the overall emotional level.
• Convinced subject to surrender.
Third Party Intermediaries Beware Help
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Third Party Intermediaries Beware - Help
or Hindrance
Hindered
• Making the situation more volatile.
• Provided audience for suicide or verbal will.
Third Party Intermediaries Beware Help
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Third Party Intermediaries Beware - Help
or Hindrance
• Family members
• Clerics - caution
• Interpreters
• Suicide audience
• Hostages - no hostages
• Briefing - control
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Issues for The Negotiator
• What is your strategy?
• Beware victim perpetrated homicide - ‘suicide by cop’
• Importance of briefing
• Personal safety - gather intelligence
• No deception• Offer help - be realistic
• Managing feelings
• Impact on individuals - critical incident debrief
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Own personal crisis
Rationalising
De-personalisation
Detachment
Projection Blocking
Distance
Acceptance
Team Action
Reflective Practise
Sharing
Active Discussion
Attempts to reduce dissonance by
Personal Interpersonal
Dissonance
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