Sandra is the Founder, Lead Legal Nurse Consultant, and Coordinator of Krug Consulting, a Legal Nurse Consulting firm. She is a Certified Registered Nurse Anesthetist (CRNA), Advanced Practice Registered Nurse (APRN), and Registered Respiratory Therapist (RRT). She has over 12 years of college ...
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Follow up on someone with suicidal thoughts
By Sandra Krug
Follow Up
How
After your initial contact with a person experiencing thoughts of suicide, and after you’ve connected them with the immediate support systems they need, make sure to follow-up with them to see how they’re doing. Leave a message, send a text, or give them a call.
The follow-up step is a great time to check in with them to see if there is more you are capable of helping with or if there are things you’ve said you would do and haven’t yet had the chance to get done for the person.
Why
This type of contact can continue to increase their feelings of connectedness and share your ongoing support. There is evidence that even a simple form of reaching out, like sending a caring postcard, can potentially reduce their risk for suicide.
Studies have shown a reduction in the number of deaths by suicide when following up was involved with high risk populations after they were discharge from acute care services. Studies have also shown that brief, low cost intervention and supportive, ongoing contact may be an important part of suicide prevention. Please visit our Follow-Up Matters page for more.
Research:
NIMH is committed to supporting research to improve the ability to identify who is at risk for suicide and develop effective treatments for at-risk individuals. As the government lead in the National Action Alliance for Suicide Prevention’s Prioritized Research Agenda for Suicide Prevention, NIMH has helped shape priorities in suicide prevention research.
For example, NIMH-supported researchers continue to study:
Long-term risk factors, such as childhood events like trauma
Immediate risk factors, such as mental health and recent life events
How genes can either increase risk of suicide or make someone more resilient to loss and hardships
Treatments for patients with treatment-resistant depression and active suicidal ideation (e.g., ketamine infusions)
Instruments to detect suicidal ideation and behavior
Visit the NIMH website to learn more about NIMH’s research priorities and recent research on suicide prevention.
For additional information about suicide prevention efforts, visit Zero Suicide: http://zerosuicide.sprc.org.
Suicide – Help Them Connect
By Sandra Krug
Suicide – Help Them Connect
How
Helping someone with thoughts of suicide connect with ongoing supports (like the Lifeline, 800-273-8255) can help them establish a safety net for those moments they find themselves in a crisis. Additional components of a safety net might be connecting them with supports and resources in their communities.
Explore some of these possible supports with them – are they currently seeing a mental health professional? Have they in the past? Is this an option for them currently? Are there other mental health resources in the community that can effectively help?
One way to start helping them find ways to connect is to work with them to develop a safety plan. This can include ways for them identify if they start to experience significant, severe thoughts of suicide along with what to do in those crisis moments. A safety plan can also include a list of individuals to contact when a crisis occurs.
The My3 app is a safety planning and crisis intervention app that can help develop these supports and is stored conveniently on your smartphone for quick access.
Why
Impact of Applied Suicide Intervention Skills Training on the National Suicide Prevention Lifeline found that individuals that called the National Suicide Prevention Lifeline were significantly more likely to feel less depressed, less suicidal, less overwhelmed, and more hopeful by the end of calls handled by Applied Suicide Intervention Skills Training-trained counselors. These improvements were linked to ASIST-related counselor interventions, including listening without judgment, exploring reasons for living and creating a network of support.
If you or someone you know has warning signs or symptoms of suicide, particularly if there is a change in the behavior or a new behavior, get help as soon as possible.
Often, family and friends are the first to recognize the warning signs of suicide and can take the first step toward helping an at-risk individual find treatment with someone who specializes in diagnosing and treating mental health conditions. If someone is telling you that they are going to kill themselves, do not leave them alone. Do not promise anyone that you will keep their suicidal thoughts a secret. Make sure to tell a trusted friend or family member, or if you are a student, an adult with whom you feel comfortable. You can also contact the resources noted below.
Helpful Resources
Help Line
National Suicide Prevention Lifeline
1-800-273-TALK(8255)
This hotline is available 24 hours a day. Phone calls are transferred to trained counselors.
When veterans, their families, or friends call this number and press 1, they can talk to a trained, caring professional in a specialized veterans call center. Calls are free and confidential, 24 hours a day, 7 days a week.
Websites
American Association of Suicidology
www.suicidology.org
Founded in 1968, the American Association of Suicidology (AAS) promotes research, public awareness programs, public education, and training for professionals and volunteers. In addition, AAS serves as a national clearinghouse for information on suicide.
American Foundation for Suicide Prevention
www.afsp.org
The American Foundation for Suicide Prevention (AFSP) provides information about suicide, support for survivors, prevention, research, and more. [The Suicide Prevention Action Network merged with AFSP in 2009.]
Suicide Prevention Resource Center
www.sprc.org
The Suicide Prevention Resource Center has fact sheets on suicide by state and by populatioon characteristics, as well as on many other subjects.
Book
Ellis, T.E. (1996) Choosing to live: how to defeat suicide through cognitive therapy. New Harbinger Publications, Oakland, CA.
This CBT-based self-help book focuses on learning thinking strategies for overcoming suicidal thoughts.
Suicide – Be there for someone at risk
By Sandra Krug
September is National Suicide Prevention Month
What Is Suicide?
Suicide is when people direct violence at themselves with the intent to end their lives, and they die because of their actions. It’s best to avoid the use of terms like “committing” or a “successful” when referring to a death by suicide as these terms often carry negative connotations.
An attempt is when people harm themselves with the intent to end their lives, but they do not die because of their actions.
Week 3 – Be there for someone at risk
How
This could mean being physically present for someone, speaking with them on the phone when you can, or any other way that shows support for the person at risk.
An important aspect of this step is to make sure you follow through with the ways in which you say you’ll be able to support the person – do not commit to anything you are not willing or able to accomplish.
If you are unable to be physically present, talk with them to develop some ideas for others who might be able to help as well (again, only others who are willing, able, and appropriate to be there). Listening is again very important during this step – find out what and who they believe will be the most effective sources of help.
Why
Being there for someone is life-saving. Increasing someone’s connectedness to others and limiting their isolation (both in the short and long-term) has shown to be a protective factor.
Theories
Thomas Joiner’s Interpersonal-Psychological Theory highlights connectedness as one of its main components – specifically, a low sense of belonging.
In the Three-Step Theory (or more commonly known as the Ideation-to-Action Framework), David Klonsky and Alexis May also theorize that “connectedness” is a key protective factor, not only against suicide as a whole, but in terms of the escalation of thoughts to action. Their research has also shown connectedness acts as a buffer against hopelessness and psychological pain.
By “being there,” we have a chance to alleviate or eliminate some of these significant factors.
Please visit some of my other pages, such as:
Death by Suicide
Helpful Resources:
Help Lines
National Suicide Prevention Lifeline
1-800-273-TALK(8255)
This hotline is available 24 hours a day. Phone calls are transferred to trained counselors.
When veterans, their families, or friends call this number and press 1, they can talk to a trained, caring professional in a specialized veterans call center. Calls are free and confidential, 24 hours a day, 7 days a week.
Websites
American Association of Suicidology
Founded in 1968, the American Association of Suicidology (AAS) promotes research, public awareness programs, public education, and training for professionals and volunteers. In addition, AAS serves as a national clearinghouse for information on suicide.
Helpful Resources:
American Foundation for Suicide Prevention
The American Foundation for Suicide Prevention (AFSP) provides information about suicide, support for survivors, prevention, research, and more. [The Suicide Prevention Action Network merged with AFSP in 2009.]
Suicide Prevention Resource Center
The Suicide Prevention Resource Center has fact sheets on suicide by state and by populatioon characteristics, as well as on many other subjects.
Book
Ellis, T.E. (1996) Choosing to live: how to defeat suicide through cognitive therapy. New Harbinger Publications, Oakland, CA.
This CBT-based self-help book focuses on learning thinking strategies for overcoming suicidal thoughts.
Death by Suicide
By Sandra Krug
Death by suicide is a large and growing public health problem. Suicide is the 10th leading cause of death in the United States. It was responsible for more than 47,000 deaths in 2017, resulting in about one death every 11 minutes.
Every year, many more people think about or attempt suicide than die by suicide. In 2017, 10.6 million American adults seriously thought about suicide, 3.2 million made a plan, and 1.4 million attempted suicide.
Suicide affects all ages. Suicide is a problem throughout the life span. It is the second leading cause of death for people 10 to 34 years of age, the fourth leading cause among people 35 to 54 years of age, and the eighth leading cause among people 55 to 64 years of age.
September in Suicide Prevention Month, and today, Tuesday September 10th is World Suicide Prevention Day.
If You Know Someone in Crisis: Call the toll-free National Suicide Prevention Lifeline (NSPL) at 1–800–273–TALK (8255), 24 hours a day, 7 days a week. The service is available to everyone. The deaf and hard of hearing can contact the Lifeline via TTY at 1–800–799–4889. All calls are confidential.
Contact social media outlets directly if you are concerned about a friend’s social media updates or dial 911 in an emergency. Learn more on the NSPL’s website. The Crisis Text Line is another resource available 24 hours a day, 7 days a week. Text “HOME” to 741741.
Death by suicide is a serious and preventable public health problem that can have lasting harmful effects on individuals, families, and communities.
While the causes of suicide vary, suicide prevention strategies share two goals: to reduce factors that increase risk and to increase factors that promote resilience or coping.
Suicide does not discriminate. People of all genders, ages, and ethnicities can be at risk.
The main risk factors for suicide are:
A prior suicide attempt
Depression and other mental health disorders
Substance abuse disorder
Family history of a mental health or substance abuse disorder
Family history of suicide
Family violence, including physical or sexual abuse
Having guns or other firearms in the home
Being in prison or jail
Being exposed to others’ suicidal behavior, such as a family member, peer, or media figure
Medical illness
Being between the ages of 15 and 24 years or over age 60
Even among people who have risk factors for suicide, most do not attempt suicide. It remains difficult to predict who will act on suicidal thoughts.
A combination of individual, relationship, community, and societal factors contribute to the risk of suicide. Risk factors are those characteristics associated with suicide—they might not be direct causes.
Prevention requires a comprehensive approach that occurs at all levels of society—from the individual, family, and community levels to the broader social environment.
Some groups have higher rates of death by suicide than others. Suicide rates vary by race/ethnicity, age, and other population characteristics, with the highest rates across the life span occurring among non-Hispanic American Indian/Alaska Native and non-Hispanic White populations.
Other Americans disproportionately impacted by suicide include Veterans and other military personnel and workers in certain occupational groups like construction and the arts, design, entertainment, sports, and media field.
To contact the National Suicide Prevention Lifeline
Call 1-800-273-TALK (1-800-273-8255)
Use the online Lifeline Crisis Chat
Both are free and confidential. You’ll be connected to a skilled, trained counselor in your area.
For more information, visit the National Suicide Prevention Lifeline
World Suicide Prevention Day 2019 #BeThe1To
By Sandra Krug
World Suicide Prevention Day 2019 is Tuesday September 10th
Asking the question “Are you thinking about suicide?” communicates that you’re open to speaking about suicide in a non-judgmental and supportive way. Studies show that asking at-risk individuals if they are suicidal does not increase suicides or suicidal thoughts. In fact, studies suggest the opposite: findings suggest acknowledging and talking about suicide may in fact reduce rather than increase suicidal ideation.
In honor of #SuicidePreventionMonth, @800273talk will be releasing a series of graphics that will list the 5 steps you can take to help someone in suicidal crisis. Learn more about #BeThe1To by visiting bethe1to.com
Week 1 (9/1-9/8): ASK
If you think someone might be considering suicide, take the first step and #BeThe1To ask. Ask directly, “Are you thinking about killing yourself?”
Helpful Resources:
Help Lines
National Suicide Prevention Lifeline
1-800-273-TALK(8255)
This hotline is available 24 hours a day. Phone calls are transferred to trained counselors.
When veterans, their families, or friends call this number and press 1, they can talk to a trained, caring professional in a specialized veterans call center. Calls are free and confidential, 24 hours a day, 7 days a week.
Websites
American Association of Suicidology
Founded in 1968, the American Association of Suicidology (AAS) promotes research, public awareness programs, public education, and training for professionals and volunteers. In addition, AAS serves as a national clearinghouse for information on suicide.
American Foundation for Suicide Prevention
The American Foundation for Suicide Prevention (AFSP) provides information about suicide, support for survivors, prevention, research, and more. [The Suicide Prevention Action Network merged with AFSP in 2009.]
Suicide Prevention Resource Center
The Suicide Prevention Resource Center has fact sheets on suicide by state and by populatioon characteristics, as well as on many other subjects.
Book
Ellis, T.E. (1996) Choosing to live: how to defeat suicide through cognitive therapy. New Harbinger Publications, Oakland, CA.
This CBT-based self-help book focuses on learning thinking strategies for overcoming suicidal thoughts.
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