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Isabella Suero-Stackl

on 21 May 2014

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Suicide and Self-Harm Risk Assessment and Interventions for Immigrant and Refugee Youth
4) Learn about concrete interventions to utilize with youth in your programs.
Migration and Refugee Services
Did you know
Risk and Protective Factors
Protective Factors
Access to mental health services
Family and community support (connectedness)
Resiliency- sense of hope
Coping skills and help-seeking behavior
Cultural and religious beliefs that discourage suicide and support instincts for self-preservation
Suicide and Self-Harm
Bhutanese Refugees
Youth and Suicide
Latina Youth and Suicide
Myths and Facts
Thank you !
Increased Supervision
Removal of possibly harmful objects
If you believe a child is at imminent risk of committing suicide or self-harm:
Do not leave the person alone.
Notify your supervisor.
Call 911 or take the person to an Emergency room.
If possible remove pills, weapons, anything lethal.

Talk about it!
Listen and ask questions
Don't make assumptions
Be non-judgemental
Safety Planning
Mental Health Services

Isabella Suero-Stackl, LICSW

May 20, 2014 2:00pm to 3:30pm EDT
Isabella Suero-Stackl, LICSW

Risk factors
(characteristics more likely to be present among those who attempt suicide)
Family history of suicide
Family separation
Family history of child maltreatment
Previous suicide attempt(s)
History of (untreated) mental disorders, clinical depression
History of alcohol and substance abuse
Feelings of hopelessness
Impulsive or aggressive tendencies
Cultural and religious beliefs
Local epidemics of suicide
Barriers to accessing mental health treatment
Loss (relational, social, work, or financial)
Physical illness
Easy access to lethal methods
Unwillingness to seek help because of stigma

Death caused by self-directed injurious behavior with any intent to die as a result of the behavior.
Suicide attempt:
A non-fatal self-directed potentially injurious behavior with any intent to die as a result of the behavior. A suicide attempt may or may not result in injury.
Suicidal ideation:
Thinking about, considering, or planning for suicide. "
, also called
, is the act of deliberately harming your own body, such as cutting or burning yourself. It's typically not meant as a suicide attempt. Rather, self-injury is an unhealthy way to cope with emotional pain, intense anger and frustration.
Sample Safety Plan for Self-Harming/ Suicide:

• Things I can do to feel better when I feel sad or anxious, or when I think I am going to harm myself:
• People whom I can call when I need help:
1. Name_____________________________________________Phone____________________________
2. Name_____________________________________________Phone____________________________
3. Name_____________________________________________Phone____________________________
• Professionals or community agencies I can contact during a crisis:
1. Name___________________________________________
2 Name___________________________________________
3. Emergency 911
4. Suicide Prevention Lifeline Phone: 1-800-273-TALK (8255)
Sponsor/Foster Parent :
• Things I can do to support <Name of child>
1. _________________________________________
2. _________________________________________
3. _________________________________________
• Objects I will remove from the home that may pose a risk to the child:

Child Signature: ________________________________________Date:______
Caretaker Signature: ______________________________________Date:________
Create a written plan with child and care giver
Plan should include
Emergency contacts
Coping mechanisms identified by child
Resources: people, community agencies
Agreement not to self-harm or commit suicide
The plan should be written in the child's first language
4 Key Questions To Ask:
1. PLAN:
Do you have a suicide plan?
Do you have what you need to carry out the plan (pills, gun, rope, etc.)?
3. TIME:
Do you know when you would do it?
Do you intend to commit suicide?

Low Risk:
Some thoughts, no plan.
Moderate Risk:
thinking about it but not sure about how, when, where.
Imminent Risk:
if child answers yes to any of the 4 questions.
Observe behaviors and physical signs:
Scars, such as from burns or cuts
Fresh cuts, scratches, bruises or other wounds
Broken bones
Keeping sharp objects on hand
Wearing long sleeves or long pants, even in hot weather
Claiming to have frequent accidents or mishaps
Spending a great deal of time alone

Myth 5:
People who self-injure want to die.
Fact 5:
Self-injurers usually do not want to die. When they self-harm, they are not trying to kill themselves—they are trying to cope with their pain. In fact, self-injury may be a way of helping themselves go on living. However, in the long-term, people who self-injure have a much higher risk of suicide, which is why it’s so important to seek help.
No-Suicide Contract

I,____________________, hereby agree that I will not harm myself in any way, attempt suicide, or die by suicide.

Furthermore, I agree that I will take the following actions if I am ever suicidal:

1) I will remind myself that I can never, under any circumstances, harm myself in any way, attempt suicide, or die by suicide.

2) I will call 911 if I believe that I am in immediate danger of harming myself.

3) I will call any or all of the following numbers if I am not in immediate danger of harming myself but have suicidal thoughts (please list names, phone numbers, addresses, and any other relevant contact information below):

1-800-SUICIDE -- 24-hour suicide prevention line that can be called from anywhere in the U.S.

Culturally and linguistically appropriate services
Community-based services
Groups, individual, family counseling

Coping skills
According to the CDC:

Suicide is the third leading cause of death for youth between 10 and 24

A nationwide survey of youth in grades 9–12 in public and private schools in the United States found that:
16% of students reported seriously considering suicide,
13% reported creating a plan,
8% reported trying to take their own life in the 12 months preceding the survey.
Sense of lack of belonging
References and Resources
University of Texas at Austin School of Social work: Luis H. Zayas, Ph.D. "Latinas Attempting Suicide"
Study looked at Adolescent Development,
Culture and Cultural Traditions, Family Functioning as contributing Factors
Latinas ages 12-17 at higher risk for suicide
attempt than other youths
U.S.-born Latinas at higher risk than foreign born
Family support was key protective factor
Resettled Refugees Are
Commonly Diagnosed With:
Case Example 1:
Recently entered a URM Program on the East Coast
Trafficking Victim
Coming home from school every day and going straight to her room
Always wearing long sleeves, even in warm weather
Does not want to talk to anyone

Assessment: What is going on with Maria?
Intervention: How can you help?

Case Example 2:
Bhutanese adolescent has been in the US for almost a year
Started drinking recently
Does not know many other Bhutanese refugees in the area
Just got his work permit but has not been able to find a job

Case Example 3:

13 year old boy from Eritrea
Just arrived from an overseas refugee camp
Was going to be resettled with his older sister, but she was kidnapped two months ago and he does not know if she's alive
Gebrehiwot told his clinician that when he found out about his sister's kidnapping he thought about killing himself

Assessment: What kinds of question should you ask Gebrehiwot to assess any risk for suicide?
Community support, psycho-education, mental health services, linguistically and culturally appropriate services, gate keeper/screening programs, toolkits:
Is Sonam at risk for suicide or self-harm? Why?
What might be some appropriate prevention strategies?
1) Lean about how suicide and self-harm affects immigrant and refugee youth.
2) Gain an understanding of the risk and protective factors.
Participants will :
3) Learn definitions of suicide and self-harm and the difference between the two.
Major depression (5-15%)
PTSD (10-40%)
Panic Disorder
Rates even higher for children and
PTSD (50-90%)
Major Depression (6-40%)
Higher suicide rate than national average (31.5 in 100,000 vs 11.1 in 100,000)
High rates of suicide reported by ORR and IOM:
Resettled Bhutanese in the US:
16 between 2009 and 2012
Bhutanese refugees in camps in Nepal
67 suicides and 64 attempts between 2004 and 2010
Investigation by Refugee Health Technical Assistance Center (RHTAC) and the Centers for Disease Control and Prevention (CDC) found common factors in reported suicides:
Most unemployed men
Post-migration difficulties
No long-standing community for support (began arriving in 2007)
Family separation
Cultural beliefs (e.g., belief that suicide is noble resolution of a personal dilemma)
Physical presence
Increased communication
Snapping a rubber band
Red marker
Progressive muscle relaxation
Safe place exercise
Deep breathing
Explore other options with child
Myth 1:
Asking a person to talk about suicidal thoughts will likely cause an act of self-injury.
Fact 1:
Discussing suicide openly lets someone know you care and take them.
Myth 2:
People who attempt suicide or self-harm are just trying to get attention.
Fact 2:
Most suicidal people are ambivalent about dying. They see death as a way to end a painful life. A suicide attempt may really be a cry for help. People who self-harm generally do so in secret. They aren’t trying to manipulate others or draw attention to themselves. In fact, shame and fear can make it very difficult to come forward and ask for help.
Myth 3:
Suicide is generally committed without warning.
Fact 3:
Very few suicides occur without warning. Warning signs are presented verbally or through behaviors
Myth 4:
Improvement in emotional state means a lessened risk of suicide.
Fact 4:
If someone who has been contemplating suicide suddenly seems happier, do not assume the danger has passed. A person, having decided to end his/her life, may “feel better” because a sense of relief after having made this decision.
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