Suicide Survivorship Ciara Warden, LISW Who Am I?

• University of Nebraska at Omaha, GASSW: Faculty; Admissions Chair; BSSW Coordinator • Specialize in education, awareness, outreach, and grief & loss. Adult mental health and crisis • Bachelor’s degree from Kansas State University in Psychology and Women's Studies • Master’s degree in Clinical Social Work from the University of Kansas • Co-owner of Clear Mind Therapy, LLC • From Crescent, IA area • I have a long term partner (8 years) named Shawn, two beautiful little boys, Declan age 4 and Camden, age 2 • survivor

BEST FOR You 2 ORGANICS COMPANY Who Are You?

BEST FOR You 3 ORGANICS COMPANY Why I Do This Work: My Boys My Family Language & Data

BEST FOR You 6 ORGANICS COMPANY ” “Lived Experience or “Suicide Survivor” Attempt Survivor”

Someone who has attempted Thinking about, considering, or suicide and survived Someone who has lost someone planning for suicide they care about to suicide Avoid “Successful & Passive vs. Active Unsuccessful”

7 “Commit” vs. “Died by/of”

Reducing stigma

Use: “Died by/of”

8 While this data is the most accurate we have, we estimate the numbers to be higher. Stigma surrounding suicide leads to underreporting, and data collection methods critical to need to be improved significantly. 123 #10 25 22+

Each year 44,965 Suicide rates Suicide is the tenth For every On average, 22 (or Americans die by increased from leading cause of completed suicide, more) U.S. soldiers suicide; an average 1999 through 2017, death in the U.S. 25 people attempt complete suicide of 123 people with greater Homicide is #16 each day dying by suicide annual percent each day increases after 2006

Centers for Disease Control and Prevention (CDC) Data & Statistics Fatal Injury Report for 2016. “7 of 10 are Men” “Highest in Middle Age” “Firearms: Over Half”

White males accounted for 7 of The rate of suicide is highest in Firearms account for 51% of all 10 in 2016 middle age; white men in suicides particular

Also very high in American Indian and Alaskan Native men

Centers for Disease Control and Prevention (CDC) Data & Statistics Fatal Injury Report for 2016. 11

Understanding Suicide: LGBTQIA+ Spectrum

Studies to date have not given us good answers about the relationship between sexual orientation/gender identity and suicide

Sexual orientation or gender identity is not recorded on the death certificate, the primary source of data on national mortality

Many recent studies, however, have reported that those who identify on the Trans/Queer spectrum report higher rates of suicide attempts

17 17 From a Suicidal Person’s Point of View

• A suicidal person’s life is in crisis • A suicidal person sees suicide as the solution to his/her problems or emotional suffering • Suicidal thinking may seem rational • Many suicidal people are ambivalent (both want to live and want to die) • Suicide is often an act of communication My Story

BEST FOR You 19 ORGANICS COMPANY Ciara G. Warden

» Born in Bellevue, NE » Lived in Louisiana & Iowa » Could be categorized as an “average” childhood » Youngest of three siblings » Typically presented quiet, sensitive, introverted, creative, and morbid

BEST FOR You ORGANICS COMPANY The Calm Before the Storm: Depression

» Began in early middle school » Sexual abuse: Age 12 » Often felt emotionally isolated, separated, lonely, and “different” » Maintained a solid social group and peer acceptance » Became a perfectionist » Immersed self in arts, writing, school, and athletics

BEST FOR You ORGANICS COMPANY “That's the thing about depression: A human being can survive almost anything, as long as she sees the end in sight. But depression is so insidious, and it compounds daily, that it's impossible to ever see the end.” ― Elizabeth Wurtzel, Prozac Nation

BEST FOR You ORGANICS COMPANY The Storm: College

» Moved out of state: Kansas State University » Craved independence and connection » Extreme stress of transition, identity confusion, and relationship conflict » Failed therapy and medication » Severe depression and suicidal thoughts » Numbing: Emotional disassociation and substance abuse

BEST FOR You ORGANICS COMPANY The Storm: College

» Looking back, my warning signs included: • Dramatic increased use of alcohol • Acting recklessly • Erratic sleeping and eating habits • Feelings of: Having no reason to live, being a burden to others, feeling trapped, unbearable emotional pain, irritability, guilt, embarrassed, ashamed, and hopeless • Looking for and researching ways to kill myself

BEST FOR You ORGANICS COMPANY The Depression Experience

“I didn’t want my picture taken because I was going to cry. I didn’t know why I was going to cry, but I knew that if anybody spoke to me or looked at me too closely the tears would fly out of my eyes and the sobs would fly out of my throat and I’d cry for a week. I could feel the tears brimming and sloshing in me like water in a glass that is unsteady and too full.” ― Sylvia Plath “What’s depression like?” “It’s like drowning. Except you can see everyone around you breathing.”

BEST FOR You ORGANICS COMPANY The Suicidal Trance

“But when hope finally dies, people no longer see or hear anything outside their own minds – the tight spiral of thought that tells them to die. While this shift may occur just moments before a suicide attempt, it can be months or years in the making.” – Richard A. Heckler, “Waking Up, Alive: The Descent, The Suicide Attempt… and the Return to Life”

BEST FOR You ORGANICS COMPANY The Suicidal Trance

» “The story of suicide begins with loss or trauma, an unbridgeable sense of alienation, and a deep need to hide one’s pain. Withdrawal begins and then deepens. Eventually, the person who was once here is no longer present. She may still live in our homes and eat at our table, but she only goes through the motions of living. Hiding behind a façade, the person is isolated, and vulnerable to the urgings of the suicidal trance. Unchecked, the trance draws him or her to one fatal choice.” Richard A. Heckler, “Waking Up, Alive: The Descent, The Suicide Attempt… and the Return to Life

BEST FOR You ORGANICS COMPANY Suicidal Ideation: Condition vs. Catalyst

» Sophomore year of college » Returned home for spring break » Recent long-term relationship break-up » Contemplating suicide for extensive period of time (condition) » “Validation” during conflict (catalyst)

BEST FOR You ORGANICS COMPANY Suicide Attempt

» Thought-out & precise » Overwhelming feeling of “peace and clarity” » Viewed as completely “logical and rational” » Very lethal » Very powerful » Was somehow found and transported to hospital

BEST FOR You ORGANICS COMPANY Waking Up Alive (It’s a book too. Check it out. By Richard A. Heckler)

» Waking up alive. Waking up angry. » Feelings of depression magnified with elements of resentment, humiliation, shame, and resistance » Mental fog and “going through the motions” » “Putting on a face” » Still contemplating suicide

BEST FOR You ORGANICS COMPANY The Defining Moment

» Conversation with unit’s psychiatrist » Recognition of attempt’s lethality » Validity of purpose • Questioned what I was going to do with “my 2nd chance at life” • Sparked a spiritual awakening and powerful intrinsic motivation

BEST FOR You ORGANICS COMPANY Attaining Wellness: Recovery

» Was not easy! » Sorting out school » Began taking therapy more seriously » After many medications, I found a proper prescription and dosage » Basic self-care: Sleeping, eating, working through emotions, and knowing my warning signs (being mindful)

BEST FOR You ORGANICS COMPANY ▪ What We Know: ▪

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▪ How do I care for someone who just attempted?

» Listen. Validate. » Drop all judgement » Some may have made an impulsive decision and feel embarrassed, shame, guilt, etc. » Talk about it » Educate » Be gentle » Continue suicide assessment; often the threat is not over » Talk to family about patient’s mental health, as you would physical

BEST FOR You 34 ORGANICS COMPANY What you can say to help: What NOT to say:

» It’s all in your head. » We all go through times like this. Buck-up! » You’ll be fine. Stop worrying. » Look on the bright side… » Just snap out of it. » Stop acting crazy. » What’s wrong with you? » Shouldn’t you be better by now? » You have so much to live for, why would you want to die?

BEST FOR You ORGANICS COMPANY Resources

» Suicide Prevention Lifeline: 1-800-273-8255 » HOPE 4 IOWA Crisis Call Line: 844-673-4469 » Trevor Project – Suicide Hotline for Trans/Queer Spectrum Youth: 1-866-488-7386 » http://teenshealth.org/teen/ » Kim Foundation: http://www.thekimfoundation.org/ » American Foundation for Suicide Prevention: www.asfp.org

BEST FOR You ORGANICS COMPANY Thank You Ciara Warden 402-980-4305 [email protected] www.unomaha.edu