lot of patients in my office asked why american foundation for suicide prevention why are we benefiting through this health festival her organization and to share with you a little bit more than a decade ago my mother we lost her to suicide my wife when she was a teenager she lost her father and so we felt like in terms of just timing  mental health issues are very much on the rise in our country is in a little bit of disarray i would say right now so we felt like this was an appropriate time to bring to light a very very serious issue an issue that takes many many people's lives on a on a daily basis and if we can bring to light these these issues that that have devastated like i said close to i don't think there's anybody that has not been affected in some way through through some loss on that level so it's not something that is commonly talked about but that in today's presentation you kind of in the theme of hollowing which is very you know to be very scary and frightening i'm trying to hopefully take this the scare in the fright out of the topic of suicide prevention away  i'm going to be talking at the end of this presentation i'll spend a few minutes telling you my personal story both of experiencing a suicide loss as well as my own struggles with suicidal thinking and how i've overcome those what i'm hoping to get across today is a very hopeful story and that suicide can be prevented we just have to be smarter as a society about what to look for how to identify risk how to identify warning signs and how to intervene when somebody is that having a difficult time so we are the theme of this is talk saves lives because we do feel that talking about this will actually help us more by keeping it in the dark it hasn't done us any favors as a society i want to emphasize that suicide and what is behind suicide is a health issue this isn't a personality defect that somebody has or something they can really kind of think their way out of this is a real true medical issue and i want to really emphasize that through today's presentation it is also preventable there's been a lot of research and a lot of studies that have shown that the correct interventions the correct educational program education programs can reduce suicide rate in this country so just like any other medical issue or health issue such as heart disease or thyroid illness or diabetes there are risk factors to look for there are warning signs and symptoms and there are things that can be done to help and it does need to be treated and cared for just like any other type of a health condition today's agenda for this presentation i'm going to go over some basic statistics to sis show you what a huge impact this is for our country right now on our talk about some of the latest research highlights that we know about suicide and what is the underlying issue there and what we're learning through scientific research i'm going to talk about different preventive measures that have been proven to help and specifically what can you do if encounter somebody that you're concerned about what did some good things to do and maybe not some good things to do and if you yourself ever find a time where you're struggling what can you do is well let's talk about some basic statistics this is a worldwide issue this is not just a u s issue the world health organization accumulates data from different countries around the world some countries do a better job than others about the reporting suicide statistic data so this number of over eight hundred thousand people who die every year by suicide is probably severely under reported the number is probably much bigger than that but what's roughly what this equates to is that somebody dies in the world every forty seconds by suicide in the united of people who die from homicide natural disaster and war that number is more than double the combination of those this is a true crisis in pennsylvania our rate is slightly higher than the national average and we lose roughly somebody every five hours in pennsylvania for every suicide that occurs twenty five people survive a suicide attempt each suicide that occur fact quite a lot of people i certainly know that from my own experience and my sister's funeral but an average of one hundred fifteen people were affected when they know somebody who dies by suicide and on average forty of those people are very close to that person so they're leaving a lot of trauma and a lot of pain in the wake of that death and it has an economic impact as well the c d c estimates that forty four billion dollars a year is lost in lost wages and lost productivity due to the deaths that we experience by suicide so what can we learn from all of this what are we learning about suicide the one thing that we can say is that suicide has only been fairly recently been the subject of scientific research only in the past twenty or thirty years have there been real serious scientific studies going into it to better understand it so here's some of the things that we have learned one of the big question we often ask ourselves when somebody dies in this manner is why did they do it and we have a tendency to come up with very simplistic explanations right wrong or even downright nasty you hear explanations such as oh they died you know they committed suicide because they got a divorce or they were being selfish we try to simplify it but it's really not that simple there is no single cause for almost all suicides there is a complex intersection of things that happen that lead that poor person to that point so it's very even though we try to make it very simple it really isn't what we do know from doing a lot of research from family who's been left behind from somebody who dies by suicide is that roughly ninety percent of people who die in this manner have had some form of mental illness that has either been diagnosed or maybe it wasn't officially diagnosed because they never sought treatment for it but we do know that mental illness plays a significant contributing role to suicide however however mental illness is not it doesn't mean that just because you have a mental illness you're going to go on to have thoughts of suicide ever there's a lot and this is an area of research that we still need to discover a lot more is ok so one of the things that we have to understand through research is why is it that some people who have mental illnesses go on to have suicidal thoughts and suicidal behaviors but then the vast majority of them don't what makes those individuals different you have so many people who are diagnosed with depression or anxiety or bipolar disorder so what is it about this small percentage of people that put them at a higher risk category we're starting to learn a lot more about that frankly we're not all the way there and one of the things our organization does is we pump several million dollars of funding into scientific research specific to suicide because we're not getting adequate research at the federal level so raising like what we're all doing here today is a big contributor to this oh it's one in four people will suffer from some form of mental illness in their life for many people this might come and go it might be a transience illness they might have a period of high anxiety in their life that maybe they don't have ever again for some people it's a much more of a chronic situation but again most of those people do not go on to die or even have thoughts of suicide when we know that what some of the things we are learning from research that makes people different is that those who have completed an act of suicide or have made a serious attempt this for in an organ in their body called the brain we all have organs in our body that are affected by disease and are affected by do various things the brain is no different so there are structural differences that we're learning in brains as well as functional differences such as chemical imbalances or even different deficiencies in certain proteins and things in the brain so we need to dig in a lot more there from a scientific research standpoint because once we can better understand those differences then we can target specific treatments this is a slide that i really want to linger on for a moment we talked a little bit at the beginning about how people try to have a simple simple explanation for why somebody goes onto to make a suicidal act speaking from personal experience which you will hear from a little bit later most people who have suicidal thoughts or have an attempt they don't necessarily want to die in that way does that make sense to anybody do you guys understand what that means what's happening is because of their mental illness most likely and other things that are going on in their life they are so overloaded and in so much emotional pain that you almost develop blinders and because of that when those blinders are on you can't open it up and see that there are other treatment options available and that there are other solutions available so what happens is those blinders and tunnel vision close in on you and you're in so much pain you don't necessarily want to die you just want the pain to end you want to wait out and that's where the thinking can become highly distorted and highly irrational and that's a point where intervention is needed as soon as possible but we know from research from studying and doing research for people who have made suicide attempts who have lived and who've been subject to research and put themselves out there for research we've learned from a lot of interviews with those people that a crisis point in their life has been reached they are desperate to escape the pain in their thinking becomes very limited one of the things we've also learned from these people is that suicidal thoughts can come and go and they can come and go within a matter of minutes or  few hours or few days you might have the thoughts and then they pass and then they might come back and they pass again and that's all because of that sort of tension that's going on internally where again you don't necessarily want to die you just won another way out of the psychological and emotional pain so other goals that we're seeking for research is to better understand file markers their blood work or any kind of biological testing that we can do for an individual that says you might potentially be at higher risk for this one day are there different or vention there different psychotherapies that can be more effective for certain individuals medications that are more effective for certain individuals there's actually an interesting study that is going on at the university of pittsburgh right now in the area of biomarkers dr lisa pan who has been a recipient of some of our research grants in the past is working with a group within western psych where they have a number of younger individuals who are they have severe forms of depression who have not been it's called treatment resistant depression and what it really means is that traditional treatments don't work for a very very small percentage of people and researchers and doctors haven't been able to figure out why so dr lisa pan spin working on trying to figure out what's going on but they did actually a bunch of biomarker studies for these individuals and it's a very small sample group it's only about forty some people and they took cerebral spinal fluid out of them and found that they had a full  deficiency they started giving them full weight supplements and for more than half within weeks their depression symptoms started to lift so again that's a very small percentage of people with depression that are in that group but that's an example of how different biomarkers and research can help us to understand these things we're all snowflakes right we're all individual so what works for the masses may not work for a small percentage of people and we need to get smarter about this science is going to help us get there hopefully we can pick up the speed on that and that's going to take money to do it what else are we learning about research we're learning a lot more about who is at risk again what makes it different for certain people who have depression to who never have these thoughts and never will have these thoughts and some people who do one of the things that we know is that there is a convergence of risk factors that go into this health history the person's history as well as external influences that hit that person so let's talk about each of these three areas certainly mental health conditions as as i mentioned and can't mention enough or a significant risk factor for this depression is by far the most common mental health disorder and most commonly associated with suicidal risk but bipolar disorder even though it's much is found in a much smaller percentage of the population it is also a very high risk for suicide we're learning that anxiety disorders sustained over a long period of time and not left well treated can also be a risk factor and then there are some others substance use certainly can add fuel to the fire so if you are currently suffering from a mental health condition and you start using too much alcohol or drugs that's only kind of just throwing gasoline on the whole situation other health factors can contribute as well and these can exist with or without a mental health disorder sometimes they can precede a mental health disorder serious or chronic pain or serious or chronic health conditions can actually start to generate other types of mental health concerns in an individual or they may not you might just have these singularly but these can also put somebody at greater risk head injuries including concussions or other traumatic brain injuries can can be a factor as well environmental factors or the external things so you might have different health things going on so that's one layer now you have external factors playing a role in this as well so if you're only having depression and it's fairly well managed and you've got nothing else going on you're probably ok but if you start to pile on additional things that's when we start to see things layer access to lethal means we'll talk about that in in a little bit but if you're starting to have suicidal thoughts and you have easy access to do something and you have that impulse that is a huge risk factor exposure and happens there is somebody dies by suicide somebody close to them in their community the family or a peer might also currently be at risk might be having those thoughts they see this as an example as a way out of that pain oh they did it then i feel a little more comfortable with what i'm thinking so now i'm going to go ahead and do it so that is a huge risk factor and something we try to work hard at educating  schools and communities on how to reduce contagion effects prolonged stress such as job stress relationships things like that or stressful life events such as the death of a close family member from fernand suicide suicide again a contagion effect within the family a family history of mental health disorders we do know that for many in many cases mental health disorders can run in families there might be history of childhood abuse physical sexual abuse things like that and that person might have had previous suicide attempts so just because somebody attempted five years ago and they never did anything it didn't you know they're still alive they're still with us we already know from that attempt that that person is at higher risk and then you start piling on more things in their life again things might be smooth sailing for a while but then you start piling things on and that starts to increase their risk once again so when we do hear about the suicide we often hear just about the external factors in that person's life so what others know here's an example of a man dies by suicide what everyone is saying is well his wife just left him for another man right so that's why ray that that's what people snow because that's what they can see that's what they're aware of what they might not know is that that person was already at a genetic risk because maybe one of his parents had had bipolar disorder or severe depression he himself was already suffering from depression maybe he was getting treatment maybe he wasn't you know we don't know he might have also been experiencing prolonged stress at work maybe his a boss was a total jerk and just ride him all the time and he was having difficulty there and then in order to cope with a lot of those things if he suspected his wife was having an affair he might have been drinking more than usual so all of these things pile on so with typically not for most people with healthy coping skills and healthy brains if your wife or you know something happens you're not going to go to that place of suicidal thinking but if you have all of these other risk factors layered on then you start to get in in a pretty high risk plants so let's talk about how we can prevent this hopefully you all can start to see some areas where we can intervene with individuals there are areas of protection that we know work one is getting care for your mental health condition family and community support can be very important and lacking those things that can can be a difficult situation teaching better problem solving skills and cultural and religious beliefs that can help provide support and purpose in  but of all those things mental health care certainly is probably the most important ingredient and cannot be emphasized enough if again if you have diabetes or heart disease or something if you don't treat that condition it's going to get worse over time so you really want to make sure you're taking good care of yourself the problem is even though we're talking about mental health a little bit more as a society only one in five people who recognize that they're having symptoms actually will go out and get treatment so there's still a lot of stigma associated with this that we're still working on as a society to make sure people understand that this isn't a personality defect this isn't something you can just sort of think your way out of jogger way out of you know you sometimes need like real treatment for this  the most the classic combination of treatment is to go to talk therapy you such as a psycho therapist or cognitive behavioral therapist combined with medication that has been proven time and time again that that is the most effective form of treatment if a speed does not advocate any specific treatment we don't take a position on any of that but we do want to encourage people is to talk to their doctor talk to their medical advisors and figure out what they need to do to start getting care for themselves there are other types of treatments available as well as part of medical kind of classic evidence based medical treatment the good news is insurance for those of us lucky enough to have  it most insurance plans now are required to provide good access to mental health care one of the things that we're struggling with in as a society right now in the us is there is a significant shortage of mental health care professionals particularly psychiatrists and emergency beds emergency beds in hospitals for psychological issues were tim murphy is going to be speaking  next he is championing amazing bill that our organization has been completely behind since he started drafting it which is the families in mental health helping families in mental health crisis to help people get better access we need more reform at the federal level and we need more incentives to get people into the field of mental health care so that we can improve the veil ability of services we also know that there are a lot of self care things that you can do to make things better for yourself in addition to the medical treatment so we kind of you know want people to think about a holistic approach one thing that you might be prescribed anti depressants but the pill itself might restore some chemical balance to your brain but it doesn't teach you how to have new healthier lifestyle habits right it's not going to automatically put you on a better nutritional path or a better exercise path or or do other self care things that are part of an overall health strategy so exercise exercise we know can elevate mood can improve emotions and things like that eating a healthy diet having good sleep hygiene getting enough sleep not too much not too little managing your stress through things like maybe prayer for some for some people it might be meditation or religion or other types of coping skills and the really great aroma therapy radio in there that those are great for stress management let's talk about limiting access to means so one of the things that we really want to talk about too is is when somebody is at risk and they're in a crisis you really want to make it as hard as possible for them to act on an impulse of thought as i mention those thoughts can come and go so you really want to take access away from them some examples of this might be and this could be a regulatory issue in the future which is to his stall carbon monoxide sensors in cars that would automatically shut off a car if it detect too much c o two outside barriers on bridges has been proven to be very effective in certain locations bridges can become magnets for an entire geography that's around it and we have seen real difference when there have been barriers placed on certain target bridges blister packaging for  medication most of us are familiar with the dump a big you know pile of pills and chug and well if you're having those thoughts even a few seconds of saving time can interrupt that thought pattern so having to punch out every single thing could be anough time for that person to have a second thought about it change their mind and move on firearm safety we do not say you shouldn't how firearms but if there is somebody in your household or a close family member who may be lives a few doors down who is at a crisis point really go the extra mile to have safety extra safety precautions around access to firearms fifty percent of suicides are the result of a firearm so we really want to make sure people understand that it's a highly lethal mean unlike some of these others you can't change your mind after you've started the process it's you know it's a it's a tough situation but we really want to educate folks about that and survivors of lost can also be very traumatized by this  can themselves become at risk i can't tell you how many times i've met with other people who've experienced a loss who are now thinking about it themselves and they never did prior so we do have to have a lot of love and care for those folks as well so what can you do we're going to talk about the warning signs to watch out for how to reach out and how to seek help so there are three areas of warning signs one is verbal talk or written talk especially on today's world of social media behavior and examples of talk there are sort of very explicit obvious examples and then there are more subtle examples certainly if somebody is talking about ending their life you want to take that very seriously every time i give this presentation a couple weeks ago when somebody said why have a friend who says they're going to kill themselves like once a week and i just ignore it so if they're saying that they're saying it for a reason just because they haven't done anything yet doesn't mean that they're not seriously thinking about it and they might just still be trying to figure out what are they going to do and they're there in that tunnel vision area where they are not seeing other options and they might be having some tension around that so if somebody is talking about this is should be taken very very seriously and there should be immediate action to try to get them there can be other less obvious types of dialogues such as i really just don't have any reason to anymore or i can't take this anymore i can't go on like this anymore things like that i'm a burden to everybody i'm a burden to my family those are also less obvious but equally serious types of verbalisation feeling trapped and being in unbearable pain so these are some examples of talk and that could be on social media as well behavior if you see for that individual a very increased use of alcohol or drugs to try to cope with what they're dealing with that's a big warning sign as well as sleep disruptions and reckless behavior such as racing their car a very high speeds or withdrawing these two here with more of a with drawl they're almost taking themselves out of the game a little bit they're withdrawing from life they're detaching themselves from other people and it's all because they want to start you know they're thinking about leaving and those are very very serious signs looking for ways to kill themselves certainly especially internet research trying to accumulate pills from other people things like that and giving away possessions on the mood side these can be fairly easy to detect you can see of somebodies mood for that person if it really changes in a in a bad way alarming way my sister's mood changed very strangely and i'll talk about that in a moment and say these are all things to look out for the big thing is to trust your gut if you're concerned about some easy don't assume that somebody else is going to do something about it because that may not be the case you know i was talking to college students at pitt two weeks ago and i said you know if some of your friends if that you might be concerned about you might think well i'm not going to say anything because their parents will probably do something about it and i don't want to interfere well in that situation they're probably more able to see what's going on with that person than those persons parents because they're away at college so you just never know so try assume that you're the only one who's going to reach out and start to talk to them and begin a dialogue about this you want to talk to them in private never in a in a group really listen to their story play a supportive role express concern and caring it's ok to ask them if they're having thoughts of suicide because if they are then they might feel some sense of relief that they can actually talk about this now  and encourage them to seek treatment and seek support and hopefully they'll do that voluntarily we want to lead people down the path of of getting treatment and getting support you want to avoid minimizing their feelings such as oh you're just having a bad day you want to try to kill don't try to convince them that life is worth living because they're just not really thinking along those lines right now they're not thinking rationally and you will in the avoid advice on how to fix it well just stop drinking so much or why don't you just get more exercise right so somebody who is having a real health crisis and is not able to think clearly that advice is just not going to be helpful to them what they really need to do is to get encouraged to go and get treatment and get some help for this if you think that they are in imminent danger to themselves the game changes a little bit you really want to stay with them and not leave them alone people left alone under those circumstances the risk goes way up so if somebody can stay with them that's always best if you can't try to get somebody else there to come and stay with them if you can safely do so remove access to lethal means if they have access to that and if possible escort them to mental health services believe me western psych is yours no trip to the picnic or you know it's no it's no grand  neither is an emergency room visit but this could be what that person needs in a crisis there's also the suicide prevention lifeline this is a national toll free number that you can call it anytime and of course if  there's a true emergency nine one one so hopefully i've helped give you some more information about the nature of suicide warning signs risk factors things like are there any questions about this before i just spend just five minutes on my apart were two years apart and we had the exact same birthday so we grew up always together like we were just best friends she was my only sibling we had birthday parties together she shadow when i joined soccer she joined soccer and when i joined track she joined track when i went to pitt she decided to go to pitt you know and then we never even after we both graduated we never lived more than five blocks from each other we were just like best friends it was when she was in her early twenty's that she started developing signs of depression shortly after she graduated from college maybe even a little bit before and about a year in she realized there was something really wrong and she started to get some treatment for it at that time she was a cancer researcher at the university of pittsburgh she was brilliant i mean i was blown away by her she was just a brilliant person by her mid twenty's she already had her name on scientific research papers and things like that she was very smart and she was you know she was diagnosed with major depression and which is a step up from regular sort of classic depression and she had that she have what i would call very difficult to treat depression she might have even fit into that bucket of that research study that i was talking about earlier she was seeing fare is she was on different medications at different times she started really paying attention to her nutrition she got a lot of exercise and she was a r she was doing a lot of really great things and she was doing fairly well for many years for several years around the age of i would say the beginning of the summer of two thousand and one she wasn't quite twenty six yet she decided that she wasn't really crazy about the side effects from some of her medications and she said you know i just want to see i'm just going to go off of all of them and see how i do and i this was a terrible idea i said did you talk to your doctor about it she said no i said well don't you think you should just said no and she is went off everything cold turkey she stopped seeing her psychotherapist she stopped but she kept doing some of the other self care things she kept eating well and running and doing other things and about a month into this she started really seeing that there was a problem you know she her mood actually changed for the better she was very elated almost and very euphoric and she it was a very strange she became much more social and she could telling everybody that she was doing better and doing better it was very unlike her this wasn't my sister who was very shy and quiet and it was very odd change she abruptly broke up with her boyfriend of three years and she kept telling me she was doing ok and a month later she was dead when i got the call from her office her employer i was her merchants a contact number she hadn't reported to work for three days and when my husband at the time and i went to her house we found her star car parked outside and we knew this was not going to be good i won't get into all the details of that because it's not really  important but what we did learn from all of this is that there were a lot of things that we missed there were things i was concerned about that there were things that we we missed but then there were also things that were very obvious here's somebody with a mental health disorder that's diagnosed doing pretty good on treatment completely ends all her treatment very abruptly doesn't get a consult you know work with her medical professionals on this we start to see dramatic behavioral changes in her she also did some odd things when we went into her apartment we found that she had bought like forty eight rolls of paper towels it was just bizarre there was just a lot you could tell that the thinking wasn't rational and that there was a lot of strangeness there it absolutely devastated o family as you can imagine so to lose her at the age of twenty she wasn't quite twenty six and that was fifteen years ago so you can see how this these effects are very long term on family so that was my sister when chrissy was diagnosed with depression it was kind of funny it's like oh here we go again the sister always doing something together right around that time i got diagnosed with having panic attacks and anxiety disorder so i had the flip side she had depression and i had anxiety and i started getting treatment for it and i have to confess i was often on treatment for two decades so i would take medications for a little while i do psychotherapy for a little while i'd feel better and i'd go off everything and i'd be ok for a few years and then find myself right back there again obviously after she died i had to get into some pretty aggressive treatment for myself i went through traumatic grief counseling and it was a very difficult experience but i got that i got through it i got better four years ago i wasn't on any treatment my husband and i were trying to get pregnant and my anxiety was starting to get way up i was approaching forty i know i look young i was approaching and i was getting very anxious we've been trying for two years and not having any luck so i started i didn't want to get back on medication even though i knew i needed to and that was pried the wrong decision and i also didn't go back into therapy or anything i just kept ploughing on and we thrust herself into fertility treatment i started getting more my own injections started having really really severe effects and gynecological problems the men in the room i won't spare spare you the details but you know there were a lot of bad things that came from that i ended up having to get a couple of surgeries and my anxiety just kept ratcheting up and after my second surgery i was told that i was not going to be able to have children and at that point my world came crashing down on me so not only was my anxiety way way up now suddenly for the first time in my life i knew what depression felt like and i was in a really bad place i didn't leave my room my bedroom for about three weeks flees his bathroom attached to it's that wasn't too awful my husband had to like sherpa food to me it was it was awful i went back onto a medication that i had been on before but it wasn't working for me well  and it was just it was terrible and i just kept getting worse and worse and worse i took time off work and i was the v p of v p at a company so i really didn't want to take time off of work but i had to so at that point once i stopped work and told them i was taking some leave that's when i started to just risk retreat into my room and didn't leave my room for three weeks i dropped about twenty five pounds before that i was about this week so it was very dramatic and awful and i started developing suicidal thoughts and i was definitely i can relate to this because i felt like i didn't know what else to do i was felt so trapped i felt like i was in so much pain and i recognized i even called resolve a crisis line and talked to them a couple times and finally after a few more days i realized that this was awful and i needed to do something about this so i went to the emergency room at western psych not knowing what to expect they sent me home with  admission into an intensive outpatient program that i went to three days a week it was group therapy plus individual therapy plus medication checks and all the stuff i learned so much so many amazing things through that i learned about mindfulness i learned about different ways to think and different ways to cope it wasn't just about the medication it was like the whole thing that taught me like a whole new way of living and that was four years ago and i haven't had a suicidal thoughts since then it's been my life has been great i'm able to get up here and talk to all of you great people about this so i really want to emphasize that it can't it's just because you have those thoughts at one point a thought is just a thought it doesn't mean that you have to take action on it and it doesn't mean you can't work hard to make it go away and there is hope it can be prevented i'm living proof so anyway that's just a little bit of my story so all the next story in case anybody has any questions and you know it's one of the thank you for your time