b'|Suicide Prevention Workplan - Los Angleles |11 |12 The following is an excerpt from a narrative written by Lezine, D.A. & Whitaker, N.J., For the full narrative please visit Fresno County Community-Based Suicide Prevention Strategic Plan, 2018 at www.FresnoCares.org.Understanding How Risk Escalates Into Suicidal Thinking As part of conducting suicide risk assessments when someone calls the Early childhood experiences interact with genetics to inuence biology, and lifeNational Suicide Prevention Lifeline (800-273-8255), the crisis counselors try experiences also provide (or deprive) a person of self-esteem, self-worth, copingto get information about the elements of a suicidal crisis to judge the level of strategies, personal beliefs, health knowledge, access to resources, andrisk and decide on appropriate actions to take. The specic aspects of risk that exposure to trauma, among other inuences on memory and mental processing.were identied based on a review of the available research and theory about Many elds of study (e.g., biology, psychology, sociology) have produced theorysuicide are provided in the table below(Joiner T, Kalafat J, Draper J, Stokes H, Knudson and research that help explain how specic experiences and contextual factorsM, Berman AL, & McKeon R (2007).contribute to the type of hazardous environment that can generate a suicidal crisis. However, in nearly all cases the core concept is that increasing negativeNational Lifelife Suicide Risk Assessmentoutcomes lead up to a suicidal crisis. While the specic process varies based onDesire to Die Intent to Die Suicidal CapabilityBuffersthe theoretical model being used, there is often some critical threshold where aSuicidal thoughts Expressed intentPrior suicide attempts Immediate supportsperson is at maximum risk for contemplating suicide and then some experienceEmotional painSuicidal planning Prior suicide loss Social supportsHopelessnessGathering materials History of violenceFuture plansor occurrence (precipitating event) pushes the person past that threshold.HelplessnessMaking preparationsAvailable lethal meansCore beliefsSee self as a burdenIntoxication/substanceAmbivivalence aboutContemporary theory and research about suicidal thinking have identied severalon othersabuse dyingkey elements to focus on. Many of these are included in the Suicide RiskFeeling trappedMental illnessSense of purposeAssessment Standards used by the National Suicide Prevention Lifeline. WhileFeeling incredibly aloneExtreme agitationthe specic details of each persons story may be unique, a number of risk factors generally end up contributing to emotional pain and stress. ExperiencesResearch suggests that capability and access to means contribute to risk, and that result in feelings of defeat, humiliation, feeling like a burden to others orthen the main factors that determine whether a person will make a suicide intense loneliness may be especially critical. As a person spends more timeattempt concern the intent to act. Impulsivity (as a trait or state, such as with focused on the painful experience(s), he or she develops a desire to die tosubstance use) lowers the threshold for engaging in risky behavior, including escape from that unbearable distress (OConnor, Cleare, Eschle, Wetherall, &suicidal action. Fear of death and anxiety about pain act as barriers to action. Kirtley, 2016. On the other side are potential buffers that are related to aDetailed planning, visualization, and rehearsal can lower those barriers. person wanting to avoid dying (i.e., protective markers or factors). When theResearch has indicated that while some individuals engage in self-injury without feeling of entrapment and subsequent desire to escape become intense enough,an intent to die, the repetition can have the same impact as rehearsal and the person may become suicidal and actively seek ways to end life. This is oneincrease capability for future suicidal behavior. Thus, to accurately assess way to specify the internal process within the suicidal ambivalence period in thesuicide risk and determine an appropriate response, it is imperative to ask about Crisis Coping Theory, describing the factors that determine when a person maysuicidal thoughts as well as behaviors and intent.be suicidal during a crisis.The transition from Higher Risk to suicidal in the Suicidal Crisis Path The move from thinking to behavior in the Suicidal Crisis PathPrecipitating Event More likely to act:CapabilityEmotional andSuicidalSuicide AttemptImpulsivityMental Health Intent and planExperience withImitation/Contagionhealthcare Access to meansHopelessness OConnor, Cleare, Eschle, Wetherall, & Kirtley (2016). The Integrated Motivational-Volitional Model of Suicidal Behavior: An Emotional painHigher Risk Update. In: International Handbook of Suicide Prevention, 2nd. Edition. Hoboken: Wiley. Higher Risk Feeling TrappedFeel like a burdenIndicated byJoiner T, Kalafat J, Draper J, Stokes H, Knudson M, Berman AL, & McKeon R (2007). Establishing standards for the assessment Intense lonliness Warning Signs of suicide risk among callers to the National Suicide Prevention Lifeline. Suicide and Life-Threatening Behavior, 37(3), 353-365.Draft 3.3.2020 Not For Distribution Draft 3.3.2020 Not For Distribution'