Youth Suicide: Starting the Conversation

Presented by Maureen Brogan and Wendy Sefcik##

This presentation will provide an overview of the scope of youth suicide, who may be at risk and what we can all do to prevent our youth from dying by suicide. It will be an open and honest conversation about the second leading cause of death for youth. Participants will leave with a better understanding of what to look for and how to have open and honest conversations about a very important topic that impacts many. Maureen Brogan Coordinator for the NJ Traumatic Loss Coalition and Wendy Sefcik, Chair of the NJ Youth Suicide Prevention Advisory Council will be the presenters.

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2:22 Ms. Sefcik serves as chair for the New Jersey Youth Suicide Prevention Advisory Council, as a New Jersey Chapter board member for the American Foundation for Suicide Prevention, as a member of the Morris County Stigma Free Task Force and is employed as a suicide prevention co-ordinator for Bergen County. Wendy lost her 16 year old son, TJ, to suicide in 2010. 2:52 Ms. Brogan is a licensed professional counselor with over 20 years’ experience working with individuals, families and groups around issues such as trauma, grief, bereavement, loss and abuse. Trauma and crisis response is her specialty. Suicide prevention is another area of expertise, Maureen Brokenness Member of the New Jersey Youth Suicide Advisory Council and contributed to the New Jersey State Plan on the Prevention of Youth Suicide. It is my great pleasure, now, to hand off the presentation to Maureen and Wendy. 3:27 Thank you, good evening, everyone. We’re going to start with the next slide, because when D&I, And that was a wonderful introduction, I appreciate it. But I want to start off by saying, other than what we do, and how we are in the world. 3:43 We’re real people that have a passion for this work, but we identify very differently sometimes in how our resumes read. 3:54 And I guess that’s how we want to start the day of being like, we just want to keep it real. 3:59 We know that all of you have various roles, whether, for me, it’s wife, mother, besides being like a suicide awareness, master trainer and a trauma expert, and I think that’s what we want you to keep in the back of your mind today, as we go through the next hour. That we all come in with our own stories. We all have our own narrative. We all probably been touched by suicide in some shape or form. So we want this to be like a non-judgemental learning experience. But really, the most important part is like, hopefully you will see Wendy and I, it’s just real people who are very passionate about this work, but it’s the work that we do. 4:36 But we’re like real people and we’ll go through steps in a little bit. 4:44 Those stats are real. 4:46 So that’s why we start with this slide and then Wendy is going to share next little bit about, know, who she is in the world. 4:56 Next. 4:59 Yes, I, as Maureen said, in addition, you know, to the work that I’m doing, number one I was brought to this work because I lost my 16 year old son, TJ, to suicide. Prior to that, really suicide was not on my radar and after losing TJ. I really felt compelled to figure out what had happened. And I have to tell you, I now look at myself as a community member, because I believe that we all have a role in suicide prevention. And I know that as community members, whatever walk of life, that you enter this webinar with, whatever your knowledge is, I hope that you’re going to leave, knowing that as a member of a community, We all have a role to play in suicide prevention, and you can really have an impact. 5:47 If you advance the slide, please. 5:50 Suicide can be a very sensitive topic to discuss, but talking about suicide is critical to its prevention, and we are so grateful to each and every one of you for joining us to start this important conversation. We’re going to start with a very, very short video, which hopefully is really going to get you thinking when it comes to kids. You could roll the video, please. 7:00 SEC. 7:00 We’re having technical difficulties, hopefully, Kelly and Barb, you’re aware of that. 7:12 OK, I didn’t realize it wasn’t playing, I’m hearing it just fine on my end pages. 7:21 We may have to skip the video and just provide the link for another term. That’s OK. Mori. Maureen, will pick up and she’ll, she’ll let you know, because now I’m sure that you have that burning question. What was a video about? It was only NaN and moreno. It’ll give you a little bit of an idea of what it was that we were trying to illustrate. If you can move to the next time, usually, we share that slide and you’ll have the link to the video. Because what it is, it’s young people in their own words, like sharing things that in the real-world really don’t happen. 7:57 Like, so with the video is showing like kids sharing that they’re depressed, asking for help, saying they might be part of the LGBTQ community, and then the last slide is said, no team, ever. So really what it is is, it’s what we like them to share with us, But in the video points out that, you know, these are not really forthcoming conversations, we have to draw out of our kids. So we’d like sharing that video from the Mayo Clinic, and we’ll send you that link as well. So, for today, though, what we really hope to accomplish is, hopefully you’ll have some increase awareness about youth suicide in general, being able to recognize some of the warning signs, some of the risk factors, also to Wendy And I will explain as well. Sometimes warning signs mean things and sometimes they don’t and that’s why it’s so important to have a conversation. Also to risk factors, not one size fits all. So we really want to get to the part today were, how do we start? 8:55 this really important, but yet sometimes very difficult conversation? 9:00 So I also, at the start of any program when it comes to suicide prevention, always say to the audience, like, not only thank you for being here, but thank you for paying some courageous because not many people put themselves out there and I think we can save many more lives if we are willing and confident that we can put ourselves out there. So, that’s also will fall into what are we as individuals, whether it’s a mom, a teacher, you know, a friend, neighbor. 9:28 What roles do we play in suicide prevention And also importantly, leaving you with resources. Because never do we want you to feel alone. Just like we never want our young people to ever feel alone. 9:41 New Jersey’s really, I think orchard it in a way that we have a lot of resources. And sometimes we’re not always good at sharing those resources. So tonight, we want that to be a little bit too about sharing those resources. Next. 9:55 When we’re having conversations about suicide, it’s really important to model appropriate language so that we don’t perpetuate the stigma of suicide or other mental health conditions. We want to avoid using phrase the phrase committed suicide, as it can have a really negative connotation. Instead, we encourage the phrase, died by suicide, and did his or her life, or killed himself or herself. 10:23 When talking about suicide and suicide attempts, we want to avoid referring to attempts as completed, or failed, successful. Not only is it unnecessary. These words imply judgement. Instead, we encourage the use of phrases such as suicide attempt suicide, and death by suicide. When suicide is talked about safely and accurately, we can help reduce the likelihood of its occurrence. We want to change how society understands mental health and suicide, because we, when we open up and have important conversations, we can all save lives. 11:04 Maureen is going to talk to you a little bit about statistics, if you advance the slide, please. 11:09 And, again, as we mentioned earlier, when we’re talking about statistics, we’re also talking about lives, and I think sometimes being in the field of suicidology, the numbers become so important, but yet, they’re never as important is, like, taking that individual, and what role that individual had, and that was, like a loved person. 11:33 Suicide is the second leading cause of death, nationally, and in New Jersey, for our young people. 11:41 So ages 10 to 14, in 20 18, 605 deaths, then 15 to 26,211, which capture or later high school and our college age students, and then are aging out into the real world, or into the workforce. 11:58 In New Jersey, we happen to be either the 49th or the 50th, lowest state lowest rate. 12:06 And again, you think about it. Well, that’s all well and good. No, but you can’t stop there and just be satisfied that, you know, our New Jersey, well, we’re in a state that has the lowest rate. Because this is really impacting our classrooms. It’s impacting our families. It’s impacting our community. 12:23 So, we did want to just say, too, that this is really representing, like, every hour and 17 minutes, There’s a young person that has taken their own life, and I think, you know, think about that, again, in people in the time that work together today with lost another young person. 12:39 So, we’re going to move on to some additional statistics to give you an idea of this scope. 12:48 So, also, too. We have people that are dying by suicide, but also to looking at people also attempt suicide. 12:58 So, these are just some data points. I don’t want to get all caught up in it. But, every day, approximately 3000 youth in our high schools attempt suicide. So, that means they have had the ideations, and they actually went as far as making a plan. 13:11 So, in the field to, we’re looking at it, going, how do we have these conversations that we can intervene between the time that they’re thinking of it, and the time that they actually make a plan? 13:24 So, again, it’s just really reiterating, again, the second leading cause of cause of death. 13:35 So we’re also just going to, I don’t know if you’ve ever heard of this, but it’s the Youth Risk Behavior Survey, and now we have recent 2019 data. 13:43 This is a survey that goes out to various schools throughout the country. 13:50 What’s really great about this survey is that it’s self report, and this is not like adults saying, Oh, I think this is what the kids are thinking, or, This is what I heard them say. This is their own self report, Anonymous, and this is what they are saying. 14:04 This is what our middle school kids and sixth, seventh and eighth grade are telling us, 22% of them reported that they seriously contended considered. suicide. 14:15 Seriously thought that in the middle school, that life was not worth living anymore, and that they were in so much pain that maybe that was an option. 14:24 17% reported that they made a plan, about how that, what they would do. 14:31 Then, on 11% of our middle, school, students have actually self reported that they’ve made an attempt. 14:39 What’s important about this data, too, is, with the self report, is, sometimes we think we have all the answers, because shouldn’t we be able to tell attempts by hospital data, or emergency room visits? But this is not the same as self report, because many times an attempt doesn’t necessarily bring you to the emergency room. 15:01 So, this is a self report, so we actually view this as more accurate, like from the mouths of babes to be like, this is really what they’re saying. This is what I’m thinking, this is what I’m feeling. No charge. 15:11 Now, with our high school students, what they’re saying is 31.5% had said that they felt sad or hopeless 17.2%, they’ve said they’ve seriously considered suicide. 15:25 13.6 have made a plan like how they could end their lives. 15:31 Then also, to deal with our high school students, 7.4% are saying they’ve attempted to point front of students who attempted, have resulted being treated by a doctor or nurse. So sometimes you’ll hear that 2.4% is what we think is the accurate number, but really, it’s 7.4%. So when you think of those numbers, and you think of a high school, or do you think of a classroom? 15:58 I don’t want anyone to think like everyone’s thinking of it, but we need to pay attention to it, because it’s there. And I know at the dramatic loss, coalition, a lot of times, we have our little elephants, that we have the kids toss around. Because we say, Why aren’t we talking about the elephant in the room, when they have an opportunity to self report the report it? But somehow, we’re sending the message, Like, don’t talk about it, unless it is anonymous. 16:20 So we have to do a little better job of saying, like, it’s OK, and we need to have these open conversations, not just conversations where you self report, when no one’s gonna, when no one’s going to know what to you. So we have some work to do, still in the nation and the state as well. 16:36 But move on to the next slide. 16:41 It’s really important when we’re talking about teens, right, that we address the idea of social media. So a lot of times, people want to instantly say, social media is awful. This is the reason for all the problems with kids. And, unfortunately, social media is here to stay. So we really have to look at both sides of it, And there really are pros and cons to social media, just like there are the most things in life. So, let’s start with the positive. 17:08 We know that social media does provide support for marginalized populations. It does create it eliminates geographic barriers for kids. And air, there also is a lot of awareness raising and educational opportunities via social media. A lot of people who have struggled, we have a lot of even people out there that the kids really relate to, that share their stories, talk about it, and share how they can get help, and what they can do, those really positives. It’s also provides an opportunity to partner with suicide prevention programs, and it is a way for kids to stay connected. Sometimes, we wish they would connect in other ways, but we do have to look at, It does allow for connectivity, and then, of course, we do have to look at some of the negatives. 17:56 There can be this opportunity to create these virtual friendships, and we know that that is not the same as real life relationships and being able to sit in a room with somebody and have a conversation. So that’s something we want to consider, and we want to talk to our kids about that there is a difference. Also, with the idea of bullying can be relentless, cyberbullying. Kids cannot get away. Homes are no longer the safe place back in the day. You came home from school. If you had the bully at school, you can come home, you are safe, but hits homes are no longer necessarily the safe place from bullying. They can be bullied relentlessly on social media, so we have to pay attention to that and have conversations about that. 18:42 The risk of media contagion, unfortunately, often suicides are covered in a sensationalized manner which can put those struggling at even greater risk. 18:51 So it’s important that we’re aware of what our kids are seeing and hearing on social media, and then unfortunately there is this ability to search online for information about suicide, which would include looking for ways, looking for methods. And we just heard a few weeks ago, there was actually somebody that recorded his own suicide attempt. So these are the types of things we need to be aware are happening. We need to make sure that we’re talking to our kids and have an awareness of what they may be seeing on social media, so we need to talk about it. Always remember that one of the greatest myths of suicide is talking about it will plant the seed, our kids know about suicide. We need to talk to them about it. 19:36 Moving on to the next slide. 19:40 I just want to have another word about bullying and suicide because we do hear about that very, very often that somebody may have been bullied to death. They killed themselves because of bullying, and it is absolutely true that there is a relationship between bullying and suicide. 19:58 The bullies are also at a higher risk research shows that those bullied and those doing the bullying are actually at a very high risk. Bullying is a problem that absolutely has to be dealt with, but it’s not thought it’s thought that bulletin alone without other intersecting factors will not create suicide. We know, unfortunately, that many, many kids are bullied. And, fortunately, many of those kids do not take their lives. We have to remember that hurt. People hurt. So, we have to take care of everyone, and deal with the underlying risk of bullying. But don’t make suicide so simple, to think that it can come down to one thing. 20:42 If you just advance to the next slide, please, we want to remember that suicide is a very complex health issue, just like their warning signs and risk factors for other health crisis, like cardiac arrest, we can learn the warning signs and risk factors that can help us to stop people from dying by suicide. Prevention can start early, far in advance of the problem, or prevention can occur closer to the time of crisis. So let’s start by looking at some of the risk factors, Maureen. 21:14 So when we talk about risks, risk factors to in it very beginning was alluding to that. Just because someone, there’s a risk factor, again, suicides, not a cause and effect. 21:27 So we’re gonna look at some things, have put someone as possible, higher risk. And also to, a friend of mine once told me, What was you, Wendy, said, You know, people have risk factors for heart disease or diabetes. And yet, the risk factors, They never quite reach the point where they become diabetic, or they have heart disease, it just means that they were at higher risk. So, when we’re talking about risk factors, These are characteristics or conditions that increase like the chance a person may take their life. But again, going back to that, everything is so individualized. 22:03 Which I think is another reason that suicide is just so complex and researchers have been trying for decades and decades to figure out, like, what is it? You know looking for that? What can we do differently? 22:16 And I think it’s because it’s so complex and so layered and so individualized that risk factors are kind of like, OK, so we’re gonna go over a few like Health, Historical, Environmental, just to give you an idea of maybe, I should pay attention to this a little more. So, we’re gonna start off with something like with three different categories on the next slide. 22:41 So, when we talk about like health risk factors, there are some biological and psychological medical conditions. Usually, you hear mental health, that can increase the risk of suicide. 22:54 What’s really interesting is, there was a time when we would say, in the field, 90% of people who die by suicide have a mental health condition. 23:05 Mmm hmm. 23:06 We’re starting to move a little weight away from that, especially that strong 90%. 23:11 If someone has a mental health condition, Yes, do we want, are they at higher risk, possibly, but we’re also seeing, I sit on the Child fatality Review Board for the state of New Jersey. We’re reviewing cases of young people who have taken their own lives, and we’re saying, It doesn’t appear that there wasn’t mental health condition. So, I say that, to say that it’s a risk factor. But it’s, sometimes, there have been deaths by suicide where there wasn’t a mental health condition. So, again, it’s just something that we do want to put on our radar to be, like, Hey, possibility a higher risk, also do if someone has a serious chronic health condition. A lot of research will also say that’s because two of just being in the physical pain can also just transfer over to, like, emotional and psychic pain. 23:57 In the field of suicidology, too, we say people don’t really want to die. 24:02 It’s not a death wish as, much as it is to get out of the pain that there. 24:09 They, people who take their own lives, heart and severe, emotional, psychological pain. 24:17 And that’s the other reason, too. We’re looking at chronic health conditions, if you’re physically leaving, Living in pain. 24:23 Again, those people who are living in the entire lives will never even have a suicidal ideation. It’s just something we want to put on our, on our radar with chronic pain and health conditions. And also to a lot of research now is being done on serious head injuries. So those are other things, too. So if you’re hearing about people that have had either accidents or concussions, just something that we want to say, hey, this. This may be someone that we just want to put on our radar for a little bit. And we’ll talk a little bit more about. It’s almost like the perfect storm of risk factors with warning signs and triggers. So, again, nothing is easy about this full night’s conversation. So, more more to come with, the other risk factors. 25:09 So what if you look at some, if there’s a family history, these are historical risk factors. Debate to is, is there something generic about it, or is it also too if there’s a family history of suicide? Is it the exposure? 25:22 Because in the field were saying like exposure to us at suicide? Make someone at higher risk. So there’s a lot of research going on. Is it because of nature versus nurture? Like what’s going on for that person? Watch their abuse and neglect a history of trauma. And also really pay attention to our young people that if they’ve made an attempt, they fall in a higher risk of attempting again. 25:52 So we want to, and sometimes you’ll hear a bit as well. 25:55 Watching are young people, actually anybody who’s been discharged from a hospital setting because they are at higher risk. They were hospitalized because an attempt and especially magical and they still stick with this two week period afterwards, to really carefully monitor someone who’s been hospitalized in that two week period and that transition, and you’ll hear about other world to, again, transitions. That’s another risk factor, not historical. 26:23 And also, too, sexual orientation. 26:27 It’s the environment, And I always like to stress this thread, It’s not because of anyone sexual orientation that puts them at risk. It’s, are they in an environment that’s not respectful or accepting of that? That’s what becomes the risk factor. Because if someone’s in a situation where they’re being embraced for who they are, and they’re supported, it doesn’t necessarily follow the risk factor anymore, because there’s not that rejection, There’s had acceptance, there’s that support. Then we also want to look at some of the environmental factors that could lead to higher risks. 27:02 These are the things are like, what’s going on in the world around us. one of the most important ones is access to lethal means. Some people will actually say that New Jersey has a lower rate, if not the lowest rate, in the country, because I’m are strict gun laws. So, some people are saying it’s harder to get like your hands on a weapon and that’s one of the most lethal means. So, that’s a risk factor if someone can get their hands on something or they can actually take their life. 27:32 So, we always tell people that are in law enforcement, Know, if you’re if your child struggling, to really make sure that gun is locked up if you’re a hunter, please make sure that that’s You know, properly put away, because of the lethality of it. 27:48 Another environmental factor, which we had mentioned briefly too, was like the exposure. 27:53 And in the contagion pachter, contagion is really a phenomenon. That happens with adolescence. Not so much with adults in the adult world. 28:03 But it’s when there has been a death by suicide, one of the reasons the TLC call them to help schools. Specific. 28:11 There was a concern that other youth who are vulnerable, who have been exposed to this, it puts them at higher risk because of this exposure. It’s the same thing with the family members, as well. We’re also looking at, is, is there a prolonged stress or toxic stress? Or is there a stressful life event that’s happening right at this particular time? And also, too, I would just caution you to be, like stressful life event. 28:41 It’s what the person thinks is a really stressful life event. 28:45 Sometimes, as adults, we’re a little too quick to try to either fix it, or minimize it, to be like, what’s the big deal? It was a break up your amine or OK. It’s bullying that kids just mean, they’re a jerk. 28:58 And, we sometimes don’t mean to because we just don’t want us to getting work getting pain. So, sometimes, more, minimize some other stressful life events. So, we just want to make sure we’re having conversations to see happen, debut it because of its debut. It is really stressful than we have to take it seriously that it is stressful. And also to transitions, mutations of all types. 29:22 Human beings, are creatures of habit. We like predictability. We like me, I know that it goes A, B, C, D, there’s something to be said of elegant knowing: what’s next. So transitions can be a difficult time for a lot of people, including ourselves. Think about like you know, when you get married, it which is very joyful for the most part, I hope I hope those of you that are married or so joyful. 29:47 But it’s a transition there’s still an anxiety about it but like what ifs, bit transitions for our young people in particular, we’re really paying attention to the transitions that are to either moving, changing schools. We’re we’re especially with the TLC looking at hey, what about our elementary kids, are now transitioning to middle school, middle school and high school? i-school out to the workforce or to college. 30:12 We know that transitions are really difficult That was also to one of the things that we’re concerned about with this pandemic. 30:19 The predictability factor kind of went out the window and our transitions don’t resemble our transitions and our transitions that some had ceremonies attached to them didn’t happen. 30:32 This last year, which made transitioning even more difficult for some people, because they didn’t feel like they have that brochure, transitions could also mean sometimes to transition and say, if people are actually our young people are going through. 30:49 There a transition in their sexual, you know, I mean, like, whether it’s their identity or actually going through transitioning that you’re here with with our transgender youth. So, sometimes you hear that transitioning part as well. 31:02 So, those are my summary of some of the risk factors of just kind of putting people into, um, different groups and I don’t mean to just like pinhole, everybody, but then Wendy is going to explain a little bit more about the importance of if we know the risk factors, what are the signs? So, Wendy, thanks. 31:23 So, the difference between there’s a difference between risk factors and warning signs, we need to look for both. Risk factors that Maureen just covered tend to endure over time, maybe, across somebody’s entire life. Warning signs are observable signs that signal that suicidal risk may be imminent. So it’s really important to pay attention to both. If you see warning signs, you want to make sure that you reach out to the person that you’re concerned about immediately. You don’t want to wait. You do want to reach out. Suicide, warning signs are typically displayed in three main ways that we can observe: talk, behavior, and mood. So the next slide is going to tell us about what we can observe on talk as a warning sign. Many people who are suicidal talk about ending their lives, maybe subtly, maybe directly, maybe indirectly. 32:16 A person might say it outright, they may joke about it, but you need to take it seriously every time, especially kids. They really may just kind of throw it off as a joke, but you want to take it seriously, have a conversation. Some people might say things like, Oh, you know, what’s the point? You know, I, there’s, There’s no reason to deliver, You know what, I’m just, no good, You know, I’m just a burden. You would all be better off without me. They may talk about feeling overwhelmed or, morning talked about the idea of this unbearable pain. So if they talk about being an unbearable pain, or were complaining about pain, often you want to pay attention to them. Any things like being trapped? A lot of these are things especially in light of what we’re all dealing with with the covert pandemic, you know, this isolation being, you know, having to stay home. You want to hear what people are saying and maybe react, not panic. 33:11 Just have conversations. The next warning sign that we want to look into is Behavior. What behaviors can we look at? Suicide can display certain behaviors, that And what you really want to look for are behaviors that are not characteristic for the individual. So, that’s why it’s hard. We can go over a long, long list, and I will, but, what you want to do is you really want to pay attention. Is that typical for the individual? 33:39 Some of the things you want to be on the lookout for as an increased use of alcohol or drug use, trouble sleeping or sleeping too much, this is something you might not be aware of with kids, but if you see, you know, your child, you know, having a hard time getting up in the morning, and they used to pop right out of bed, You, know, falling asleep in school. Those are the types of things that tell you, maybe they’re not sleeping, right. What’s going on eating? 34:04 Are they eating too much or not eating enough? Again, it’s it’s a change in their typical behavior withdrawing from activities, especially activities previously enjoyed, a kid who you couldn’t get off of the sports field and suddenly says, you know, I don’t know if I want to play anymore. Kid, who’s really active in theater. You know what, I’m not going to go out for the play this year. That’s a reason to have a conversation. And you really want to look at if they’re isolating themselves from family and friends. We know that many, many of our teens really love to live with their friends. They want to be with their friends all the time. If they’re suddenly pulling away from their friends, maybe you want to have a conversation. You also want to be on the lookout, you can see this, if you do, you know, you see something that they may have been looking for, maybe they’re searching online for ways to kill themselves looking for you. Know, how can I buy a gun, how can I do this? You want to observe that, you want to react to it. 34:59 And also, giving away possessions, you know I don’t need this anymore, maybe giving something to a sibling or a friend that was a prized possession. You really want to be aware of those. And as I said, with these warning signs, it’s not about observing them and waiting, it’s about observing them and starting the conversation sooner rather than later. 35:22 Next slide, please. 35:25 The next thing that we want to look at as a warning sign is mood. And a lot of these are things that you would expect, right? You would see maybe depression, apathy, rage, irritability, impulsivity, humiliation and anxiety. I want to, you know, go back to that anger. A lot of times when we think of suicide and we think of depression, we think of sadness that a lot of times particularly with our youth, we might see irritability and that might be a sign that is missed because you see a kid that’s just angry and irritable all the time. And you’re not thinking he’s, he’s not acting say he’s mad. Well, that could be a sign that something’s going on, we all have ups and downs in our mood. 36:10 But if there’s a change in mood that’s going on for days and weeks at a time, it’s a sure sign, something might be going on. Somebody may be in pain internally, and we need to have a conversation. 36:24 Maureen’s going to talk to you a little bit more so that you can try to bring down all these risk factors in warning signs and really understand what can we do. 36:35 So, risk factors. So, we know there are certain groups for certain things, that we’re looking for the warning signs. Actually, things that we can observe to say. 36:44 But then, we also want you to think that there are some critical cues things said: OK, we can’t look the other way now. And this is what when you started talking about too is when people are talking about or making plans for suicide. 37:01 That’s a critical care. 37:03 And Wendy had mentioned that research has shown that most people share even change their plan. 37:10 So, that’s like when it comes like, OK, this is critical. 37:14 Also, too, I do want to caution everyone, as well as among clinician by, um, education. 37:22 And what I’ve done for years, is, it worked with a lot of schools at times where they would say, Ah, they talk about it all the time. 37:30 Know, like, it almost became like a minimizing. I’m like, of course, she’s saying she’s gonna kill herself with, Wendy had said that. 37:38 Every time we hear it, it’s like, we still have to take it so seriously, I’m gonna ask people to think about it. 37:46 If it’s attention seeking, which I’ve heard people saying like, Oh, it’s only attention seeking. There’s some reason that they’re going that far and obviously, they’re in need of some kind of attention. So again, like a critical Q that we need to like address this. Have more conversations. Try to get the youth to share a little bit more with us, also to, if they’re expressing hopelessness about the future. 38:08 If they just are feeling like things were never going to get better, like what’s the use? That’s more like the language, you know, no matter what I do, it always comes out this way or I don’t get ahead. 38:20 If they’re actually displaying some of their emotional pain or distress, the good thing about the display is that we can see it. 38:29 What we’ve also found from the child fatality review board is that we have some kids. 38:35 Really good at faking it. 38:38 They’re like faking it until they make it there in a lot of pain and they’ve become re still putting that smile on their face. 38:47 Almost like an impostor. 38:48 So we may see the display of the shift figure an overwhelming pain, but also too, if you feel like, hey, this has been a really rough time for them, and they may be in a lot of pain. 39:01 That’s another time when we have to have the conversation, because, like I said, we have a lot of youth that are not demonstrating and showing it, whether it’s in their face or the way they’re behaving, I’m still going to school. And they still might be getting A’s. And they’re still laughing, and there’s total life of the party. But, if you have reason to believe that they still underlying might be in some emotional distress, and want to say, tell me more, apps, are pointed out. Wendy had also said to a few here: that they’re saying like, they’re a burden. 39:31 Like when you hear like, my family would be better off without me, my teammates would be better off without me. The world would be better off without me, on really something that we want to hone in on sooner rather than later. 39:45 When they also had said to you about the eating and sleeping habits, and again, we’ve talked about all the time, it’s knowing your child’s baseline. 39:54 It’s like, what’s normal? What was their way of being in the world? Because they don’t know the one normal, but what was like their routine? What was their way of being in the world? And we see drastic changes from that way of being in the world. 40:08 Also to extreme anger, um, no, I said to him like it really is. 40:14 Anger is a powerful emotion. 40:18 So, all of us have gotten angry at times, but the good thing about Anchor is wanted to sign, that we usually don’t ignore as much as, sometimes the isolation, or the withdrawal, because you can’t ignore it. Always. But, if it’s extremely want to try to figure out what what’s underlying what’s going on, or that person, at, that time, I think the hardest part about not being judgemental about it. I had someone say to me, once like, You know, It’s really a good sign, if your kid can be angry at home. And I’m like, oh, it doesn’t feel so good, happened in angry kid at home. But, that means that they feel comfortable and supported there, that it’s OK to show that. So, if you’re seeing that at home, or if you’re in a school system, or if you see it in your Boy Scouts or your team for something like that. It might actually be a sign that this kid is really struggling, but this is the place where they feel safe to tell that, that anger out. 41:14 So, although we don’t necessarily like being surrounded by anger, really view it as, I think this may be a cry for help. 41:23 And also to, like we had said, looking at those uncharacteristic behavior changes, so, we can move forward. 41:38 What we had said, too, is that we went over a whole bunch of things. 41:42 You’re like, yeah, that’s a lot to remember. And you don’t need, like, a maybe you want a little cheat sheet of, like, what should I be looking for? What were the warning signs that they said in the field? What we’ve found is that it’s really helpful, if we just think, like, is platform. 41:58 And if you look at this slide, too, it’s talking about like, is there ideation? Is their substance abuse? You know, do they express that? There’s no purpose? Do they seem anxious or trapped are hopeless? Do you see that there’s a withdrawal, some anger or rich taking behaviors, which I don’t think we addressed before, but we definitely want to pay attention to if there’s recklessness or risky behavior, like phone caution to the wind, and mood changes? So, in the field, we’ve actually said to when we’re talking with a young person, to be like, is path more. And just looking at some of these help us to be like, hey, maybe there is something more going on. 42:38 So we kinda named this presentation about starting conversation. So how do you start a conversation about suicide with your team, or a team that’s in your life, or in your community? 42:51 Know, some of these things, or they’re just gonna make, It’s just common sense You. You want to find a nice, private, quiet place to talk. This probably isn’t a conversation that you want to start. If you’re in the middle of your kitchen, and you have the phone ringing, and the dog barking, and, you know, other kids running in an hour. 43:11 You’re gonna find it, a quiet, comfortable, place, that you can have a peaceful conversation, and you want to make sure that you have time time to really listen in case this is the time that this team wants to open up and start this conversation. You want to really be able to listen. There’s a great saying, right? We were given two ears and one mouth. It’s become really one of my favorite phrases because it really makes a lot of sense. 43:39 We need to all do a better job of listening and hearing, and not, not listening to respond, but listening for listening sake. 43:50 We, as adults, very often want to fix things for kids. So, as they’re starting to tell us something, we’re already formulating a plan to fix it, but I really encourage you to simply listen to what the team is saying, What they’re trying to communicate to you without trying to come up with advice or something to fix it. You want to be able to express concern. And caring Maureen mentioned it before about kind of dismissing it. Oh, everyone goes through that, We want it. 44:18 just express concern and caring and try to use the phrase, Tell me more. Get them to keep talking. You want to be able to ask them directly about suicide. Don’t be afraid to say, Are you thinking of suicide? Are you thinking of killing yourself? And that’s something that I think his parents, even clinicians, you need to practice in front of the mirror. Before you practice, in front of a real-life kid, or a friend or a family member, you want to be able to say that in a non-judgemental manner. There’s a big difference between saying: are you thinking of killing yourself? 44:51 And you’re not thinking of killing yourself or you, because, the second question, asking it that way is telling them how you want them to respond. So, you really want to make sure you have the conversation in the right way. 45:04 Then, of course, you want to be able to encourage them if they are exhibiting any of these risk factors and warning signs, and have now in the conversation, led you to believe that they are thinking about suicide! You want to encourage them to seek mental health, treatment, and to be evaluated by a professional. This isn’t something that we have to handle alone, And we have a lot of great clinicians out there who are trained to deal with this, so you want to guide that team to mental health clinician. If in crisis, you think something’s going to happen right away, don’t be afraid to call 9 1 1 or go directly to an emergency room. 45:41 Advance the slide? Please. I just want to go into a little bit more detail about how this conversation might get going. 45:49 As I said before, you want to avoid minimizing feelings, and you want to use concrete observations, so you don’t you kick comes home from school. You’re just you know store this this webinar with Maureen an ISO. You just kid walks in and you say, look, are you killing yourself? 46:05 You want to, you want to be able to say, you know, I lately, I’ve noticed that you’re saying in your room a lot you haven’t been seeing your friends or you unhappy is something bothering you. So, you wanna try to open up the conversation. Right? So, you’re not telling them, you haven’t been going out with your friends. You have, you’re saying, I’ve observed, this is something I’ve seen and I’m concerned, Maybe you want to say, you seem really tired lately and I noticed, you know, I made your favorite dinner, you haven’t, you didn’t even touch it, you don’t seem to be eating, you know, lately. 46:38 Is something going on or you unhappily, Do you want to talk about it, can you tell me what is going on? And then you can even: you want to take that step further and you want to say: sometimes when people are feeling like you, they wish they were dead. 46:53 Or they think about killing themselves. Do you feel that way? How are you thinking of killing yourself? 46:59 And then if they do respond that they have, you do want to take that conversation further. You want to know, have they thought about how they would kill themselves. Do they have a plan? Do they know when they would do it? 47:12 And if they keep giving you information about this, that’s a sure sign that you need to take that child for a professional evaluation right away. If they have answered yes, that they are thinking of killing themselves. Yes. They have thought how they would do it. Yes, they have a plan. Yes, they know when they would do it. That’s not the time to say, I’m so glad we had the, we had this good talk. I see it in the morning. That’s the time to connect your child to a clinician, immediately, to get help right away, but that is how the conversation can go. And you need to be prepared for the conversation to go just that way. So don’t go into this, thinking, Oh, I’ll have that conversation. They’re not going there. I know, I know my kids, my kids, not thinking that way. You want, if they do respond that, yes, they have had this thought. 48:00 You want to be able to hear what they’re saying in a calm manner, because you don’t want them to shut down, and if you freak out, they’re going to shut down. So you want to keep, keep them talking. You want them to reach out. You want to be that trusted adults for your child or to a child in your community if you’re a clinician. If you’re a teacher, if you’re just somebody in the community, a gatekeeper is what we’d like to call, all of us were gatekeepers in the community. Be a trusted adult or a child. Listen to what they have to say without judgement, and don’t try to fix, try to help, try to lead them to resources of which we have many, and Maureen’s going to share some of the great resources that we have access to. 48:44 And part of the resource part, is: sometimes we don’t know, they exist, and other times, we are either ashamed that we need help. 48:55 And really, we’re doing a disservice to our young people by not modeling, that help seeking behavior is actually a strength, and it should never be viewed as weakness. So I also, as you being the trusted adults, also too, are constantly modeling that. 49:12 So sometimes it’s like, we have to model for them, that we ask for help. That sometimes things can seem a little overwhelming for us, and that we’re OK with asking for help. It’s setting the tone for them to be like, hey, everybody needs somebody at some point. We can always go it alone. So, so the next couple of slides are different resources that we really encourage people to explore more spend time with. 49:37 So, on the next slide, once I go to the next one as well, we will also, Kelly mentioned that she can get these out to you as well. Because I know you don’t have to sit there and jot them down real quick now. The Suicide prevention helpline, which you saw on the slide before. 49:56 Nice. 49:57 Helplines 24 7, and the Crisis Text Line. Because we know a lot of our young people, not even a young people. A lot of people now, like, would prefer to text, rather than actually speaking to someone. It’s just an easier way to communicate for a lot of people. So here in New Jersey, like you can, text either help to 7471 or in New Jersey. You can also type and J 2 7 4, 1741, and the crisis text line to we’ll connect them with other people who may be in this area that can then connect that person to additional resources if they felt that they needed to throw the conversation. 50:34 And also to hear on the state of New Jersey, the second floor youth helpline, which again, again, help blind people call second floor, or texting as well. Just second floor. For everything from like, I need help with my math homework, to my boyfriend, broke up with me, to I have a major math test tomorrow, too. I’m thinking about ending my life, so they’re trained to do everything. And therefore in between, whether it’s conflict, bullying, or just something to do with everyday life, or even to like, oh, it’s my girlfriend’s birthday. I don’t know what together. 51:08 So, it’s this line, where there’s a trusted adult on the other end, that can help just listen sometimes, and then also to maybe offer some Not necessarily advice, put that, just helping them come up with what, would work, for them. The other part that we always, I always encourage, what we do responses. 51:27 Ions are young people sometimes tomake and really take out your phones right now, neurons but all three of these. But put one of them in with your contacts and you may never needed but if I’m like. So think about it is, Hey, if you never need nothing, no judgement, you don’t need it, but what if a friend could use that, or the other thing about these helplines is someone’s name or answering it three in the morning. 51:55 You can have a trusted adult. 51:56 And they might be sleeping, or they might be your school counselor or your coach, and you may not be able to reach them by 2 or 3 or 4 in the morning. Someone’s going to answer the crisis text line or the suicide help line, at those hours as well. 52:12 I also wanted to share with you about the importance of this. Helplines is, I have one class to it, in one gentleman, a young, a young kid said. 52:22 My guess. I guess there must be a lot of people that need help at times. because he’s like, I don’t think they would create all of these like hotlines and helplines if people didn’t need help at times. So part of it was that it was validating to be like, yes, we all need help. And he was absolutely correct. If people don’t need to talk to people or 2 or 3 in the morning. If people didn’t need that extra text or someone staying with them while they were going through a hard time, we wouldn’t need these lines. So that’s another story for me, too, that I said, these are powerful. So we’re gonna go through a couple of more, so we can get to some questions and answers. 53:00 This, also, to Preventing suicide. It’s a toolkit for high schools. This is through the SAMHSA. So, this is the federal government that a lot of our schools here in New Jersey have these on their bookshelf, and it’s part of like prevention intervention, and then suppose expansion guidance. So, we’re just sharing that as a resource, and I really encourage you, because Kelly’s going to send it to you and at the Suicide Prevention Resource Center is taking some time. 53:25 It just, know, Google, and look it up, the website, the web pages are there. See what they have to offer, because there’s so much, we’re giving you a snapshot. These are now are like resources that have hundreds and hundreds and hundreds, if not thousands, of additional resources and pages of things written and guides that you could use. So when you have a little more time, I really encourage you, if you’re interested in this topic, and for all different populations, different ages. So, when you’re looking for something, you’re gonna find it either in SAMHSA or this Suicide Prevention Resource Center. 54:02 So, we’re gonna move on to a few more resources, still. 54:06 I told you there weren’t a lot here, New Jersey and nationally. 54:12 I hope that this is not a new concept to you. 54:15 I hope, if you have children in the schools, you have heard of SEL, social emotional learning, which is really, and this is to the castle website, who were considered by the experts, the gurus in the field who have been doing this for decades. Before cell was popular, they were doing it. 54:32 It’s a really talking about how do we, before we get to the academic side of school, how do we help kids socially and emotionally learn the skills that they need to thrive, not only survive, because that’s needs to be addressed for the academic part of us. Someone once said to me, it’s like, we need to talk about a hierarchy. Like we need, our kids need to feel safe. Our kids need to feel validated before the learning can happen. Incurred a lot of this over the summer, especially with the pandemic and the return to school. Like people were just being honest to be like every child is coming in here with their own story, their own narrative and you need to address this pandemic done for them emotionally and socially disconnectedness during a pandemic. 55:26 Before we get to the math and the reading not saying that that’s not important. It is important. But this needed to come first. I’m happy to say that a lot of New Jersey schools didn’t take that, and I’m still hearing that they’re still on the social emotional Learning Port, Although there is pressure for the academic side. 55:45 So if you haven’t heard of it, I would, you know, also, to see what your schools are doing. 55:50 And this is one of the pages to the traumatic loss Coalition. You shake hands out when we do responses or when we have people inquire to us about, hey, what resources are out there. 56:01 And again, we’ll send this to you, because all of these resources, again, have all the sub categories and other resources that they can connect you to. So, whether it’s about trauma, whether it’s the Center for Disease, CDC, the World Health Organization, as well as our local one, like the Hopeline. and Society for Prevention of Teen, Suicide. So you’ll get this, But I really, again, encourage you, to, like, hey, Google, Google it. 56:31 Hit their website. See what they have to offer. 56:34 Reach out to them if you have questions. We know how difficult this conversation is. So we’re thrilled that the … Coalition, when someone reaches out to us asking for more information is we’re just so psyched that someone’s like, OK, they’re willing to go there. 56:49 So those were just some more resources that we wanted to share with you to also validate that you’re not alone either. 56:56 So now we’re going to go into some any questions or comments. And I know kelly’s been monitoring, I guess. 57:05 Do an egg. 57:08 Thank you very much. Maureen and Wendy. Sorry, yeah. Yeah, so that’s OK, no problem. Thank you very, very much to both of you for that excellent, informative, and very helpful presentation. We have a few minutes, and we can take some questions. So, type them in if, if you have a question, and I’ll start with one here. You talked about starting a conversation, and we all know that. Adolescents, in particular kids, it’s difficult to talk, we’ll talk to. So, what if I try to have a conversation with my child, and they won’t talk? What can I do? 57:56 I think one of the best things we can do is, is to be available, and to be willing to stop whatever we’re doing. When they want to talk, is they don’t always want to talk when it’s convenient. My 23 year old came home today, and I was preparing for this presentation tonight, and I was getting dinner ready. And I was working on, like three other things. And he walked in the door, and, you know what he, he wants to talk. And it was not a convenient time for me. But, guess what? I put the phone down, shut the computer down. And he really just wanted to tell me about his day, something happened that he wants to tell me about, and something happened with his girlfriend that he wants to tell me about. 58:36 And, I listened. I took those few minutes. They don’t always want to talk, and we want to. So, I think the best advice I can give you on that is to just be available, and be cognizant. That, a lot of times, we’re really busy, it’s not that we don’t love, and that we don’t care, but our minds in a million different places, and when it comes to our teens, and when they want to have the conversations, we need to be willing to have them. And if you have, you know, try to open a conversation, and it’s just not the right time. That doesn’t mean it’s one and done, you know, try again at a different time when maybe they’re more open to that conversation. 59:12 Then, one day, I’d also add, too, is that sometimes, as adults, we need to get over ourselves, too, and maybe even throw it out there. 59:22 It’s like, I’m concerned about you, or I noticed this, and I’m here, but you don’t want to talk to me. Is there someone else? Is there another trusted adult in your world that you do feel comfortable talking with it, because it doesn’t have to be me, as your mom, who just your teacher, as a therapist? 59:41 So, I think part of it, as well as, is saying, like, is there someone else or to talk about trusted adults? 59:47 I always encourage people to have a conversation with her, with young people in their lives, to be, like, who are cooler five, what you can start off with two, But who are like, ultimately, five trusted adults in your life? 59:59 You would feel comfortable that you’re, those are your go to people. 1:00:04 So, having that conversation as well, because sometimes it’s not going to be us that they want to speak with. Having that in advance, I think, is helpful. That’s a good question. 1:00:14 OK, thank you. First, I wanna just make a note of a comment that someone made, says, I just wanted to mention that a perceived improvement in mood and or circumstances does not necessarily mean that a person is doing better. 1:00:30 Would you like to comment on that, That? that’s a fantastic. know, and really, you know, shame on Maureen. And I, we definitely should have mentioned that. I think I have that in my notes. You’re absolutely right. Because somebody that’s in pain and has been dealing with this for a long time, and maybe even having these thoughts, and all of a sudden they make a plan and they decide, you know what? This is all going to be over because I’m going to do something about it. They may all of a sudden perk up and seem to feel better, and maybe seem a little bit happier and a little bit more lighthearted. So, it’s what we said many times in this presentation it’s noticing changes in behavior. So, if somebody has been really in what you would imagine is a very depressed state, and very you know, isolating and all of a sudden, their mood just seems to change and it’s completely different, that’s still time to have a conversation. So, thank you very much for bringing that up, and that’s important to know. 1:01:30 OK, along similar lines, someone noted, sometimes a mood improvement gives them the energy and ability to finally follow through and end their lives. 1:01:40 And, again, I’m glad someone brought that up, is, that’s also true part of that. Which contributes to the two weeks that we had mentioned, like, after a hospital stay, is that, sometimes, after whether they were hospitalized and another back home, where they’re transitioning back, they’re actually feeling better. 1:01:58 Research has shown, like, truly, truly, very depressed people that are not moving, that are not getting out of bed, may not be able to kill themselves, because they can’t even physically get themselves to do it. 1:02:09 So then when people start to feel like, hey, I’m starting to feel a little better, we want to monitor that, because now they might actually have the capacity to the clarity to make a plan and the energy to carry it out. So again, if someone had been on our radar and again, we wanna be still excited that people are reporting feeling better. I think we just want to be cautious that, because we want them to be happy, again, we want them to be well. And sometimes we rush that. And this was a great comment as a reminder, to be like, hey, take it slow, let’s still cheap supporting, let’s still keep monitoring. Let’s still keep being there. Let’s keep having the conversation. 1:02:52 Because I think we want our kids to be OK. 1:02:54 So as soon as we see that China were like, oh, we got their back, we should, we should go slower. 1:03:02 OK, great, thank you. We have time for a couple of more questions. Someone asked, What if a student refuses to get help? 1:03:13 Well, it’s, it’s a, it’s a common question, and it is a challenge. But we do have to remember that we do have an opportunity, as long as our children are minors. And sometimes, and it’s true, you can lead a horse to water, but you can’t lead them to drink. But one of the things that We do find a lot of times with teens, they may say, I’m not, I’m not going, I’m not talking, but when they’re put in this situation, they very often will talk, and maybe not the first time, so it’s not, there’s not an easy solution to that, But It does require not. You. Again, it’s, it’s those conversations. I read a really great book called I’m Not Sick, I Don’t Need Help, and It was written by a Psychologist who whose brother was very mentally ill and needed help, and his, and this guy was a psychologist. He knew the answers, but his brother wouldn’t listen to him. 1:04:05 And then he realized it was how he was having these conversations, and with a couple of tweaks in how he approached his brother, his brother was, you know, realized I’m gonna hit empowered him and he wanted to get help. So, it’s not an easy solution, Maureen. 1:04:21 You may have some, some better tips, but, but it’s a challenge, and it’s, it’s something that you need to work on, and, and, and try to work through it mm. And part of it, too is therapists are awesome, but can be awesome. sometimes, to a caution parents. 1:04:39 When they’re looking for a child to say, it’s kinda like finding that perfect pair of shoes, it needs to be the right fit. 1:04:48 So sometimes, like, if you’re thinking about connecting them with a therapist, because you feel like it’s at that point, then, the role that concerns, that it’s not necessarily the first person that you call. 1:05:01 And I think it’s empowering to for young people, to feel like they have a voice. The last thing we want to do is, any of us, we don’t want to feel invisible. We don’t want to feel like we’re not heard. 1:05:13 So sometimes, it’s asking around, and, you know, you might take them. And the therapist, the first one wasn’t a good fit, and it’s re-assuring them to be like, OK, so I hear you that wasn’t a good fit. But let’s try something else. 1:05:26 And also, to having conversations, whether it’s with your school counselors as well, because besides therapy, there’s other things that can be very positive, that, you know, mindfulness and meditation and other things, what do they enjoy doing? Because that might be the start to them having more conversations. 1:05:49 OK, thank you. We have another question here, someone that says: I’m a peer with NAMI in Vancouver, Portland area. How can I reach out to the youth that are coming out to make sure that they are safe and make sure that they are not going to harm themselves? 1:06:07 Well, that’s really what this whole presentation was about. Thank you for the work that you’re doing. I’m a big fan of NAMI and all the work that you do, in fact, I just signed up for an anatomy conference here in New Jersey. So, it is not having these very direct conversations, you know, as appear to be comfortable. And I really encourage you to do a little bit more research on how to have these conversations, how to talk openly directly about it, and safely, right. We talked about the language, make sure you’re modeling the right language, and, and have these conversations If you’ve noticed things, if you’re a peer, there’s a lot of things. There’s a lot of movies and series. And books that talk about suicide. It might be an opportunity to have a conversation that way. So there there are many opportunities. But you want to make sure that you’re educating yourself, and you’re having the conversation safely. 1:07:08 No one wants to know what I think we are coming To the. Level. Surfaces and lakes. 1:07:54 Sometimes these spaces sometimes friends. And family are. Now that we can’t fix it. 1:08:21 OK, I don’t know what happened. Maureen, something happened with your audio. 1:08:24 That was a little difficult to hear, but, For sure. 1:08:30 Yeah, and it is getting a little bit late. So I think we’re going to stop here. And again, I want to thank Maureen and Wendy very, very much for your informative presentation. We appreciate it, and we appreciate all of you attending. Tonight, I’m gonna turn it back over to Kelly, who will wrap things up for the evening. 1:08:59 Thank you for joining our webinar, on Youth Suicide: Starting A Conversation. There is an Exit Survey, which we need everyone attending to fill out. The webinar blog is open now and available for the next seven days on the … website, for any additional questions that were not covered in tonight’s presentation, that website is WWW dot N J C T S dot org. 1:09:28 our next presentation is Pet Therapy Support Animals and Mental Health presented by Tricia Baker, and is scheduled for October 14th 2020. 1:09:48 Thank you, Maureen and Wendy for your presentation, and thank you everyone for attending tonight.