>> I just wanted to welcome everyone to our Caps Counseling and Psychological Services Mason cares presentation. And this is to increase campus awareness, potential referrals and provide some education for suicide prevention and this is going to be the gatekeeper training. Again, this is being put on by Counseling and Psychological Services at George Mason University.

We want to welcome everyone to the presentation and also let folks know to please be respectful and recognize that this can be a very difficult topic for many. It's important to note that discussing suicide can be anxiety provoking and may prompt various emotional responses from each of you.

And based on statistics, it's likely that some people listening to this presentation may have lost a friend or family member to suicide or at some point, have contemplated suicide themselves. If need be, please feel free to stop the presentation or if needed, to take a break and come speak to us at CAPS if you have any questions about the presentation or if you're needing some support.

So slide four is looking at the training schedule. So we'll talk a little bit about a brief introduction, some reasons why people may commit suicide, some warning signs to be cognizant of as well as responding to people in distress. And as well, we wanna understand the process of making a referral to CAPS.

We're gonna do some role plays and some processing. We'll look at self harm and social media, and firstly, we wanna just touch why this is important and it's common for people to be effected by suicide. In fact, suicide is the second leading cause of death among college students, be curious to know if anyone can think of the first leading cause of death.

And have you got it? Okay, it's actually accidents so after accidents, suicide is the second leading cause of death among college students. And we know than more than 5% of college students have attempted suicide at least once in their life. And about 8 to 15% of college students have seriously considered attempting suicide.

And over half of college students have thought about suicide at least one time in their life. And really, this is why it's so important to increase awareness of how you can help individuals who are having suicidal thoughts. This information is coming from and from 2008 as well as from The Jed Foundation.

And so we wanna just give folks just some general introductory information about some of the important terms, so moving on to slide 5 where it says introduction, some terms that we wanna be paying attention to are suicidal ideation, suicide threat and suicide attempt. So suicidal ideation means thinking about suicide.

Suicide threat is stating in intent to kill one self. Suicide attempt is taking that to the next level on actually trying to kill one self. And I think It's important to differentiate between intentional self harm because intentional self harm may not be representative of suicidality. Intentional self harm is behavior related to self harm but there's an absence of intent to kill oneself.

A completed or successful suicide is the incorrect term to use. So we wanna be using suicide death or died by suicide which would be more appropriate. And then a survivor of suicide would be a friend or family member of the deceased. It's also important for us to differentiate between passive versus active ideation.

What passive ideation means is suicidal thoughts popping up for folks may be kind of thinking that there's no escape. There's no way out, that this is a thought that, man if I could if I could just kill myself or if I could only escape from this situation with suicide.

But that person has absolutely no plans, or intent, of acting on that thought or an intrusive thought about suicide. So really, it's passive is just the thoughts with no plan, no intent, no means to act on that. Whereas active ideation is, well, I'm having that suicidal thought and I'm planning on killing myself.

And this is how I'm I gonna do that and my intent is I'm definitely gonna do it and I have the means to do it. So we really wanna pay attention to whether or not this ideation is passive or active. It's really important to seek support for both passive and active ideation.

Likely someone with active ideation would be referred to the hospital to make sure that they're safe. And at the end of the day, we really just wanna make sure that all members of our Mason community are safe. So something else we wanna think about is why do people attempt suicide?

You can think to yourself if suicide has affected you personally or a member of your family or friend or extended family, and thinking about maybe what that person was going through and if they did attempt suicide or complete suicide thinking about likely the amount of pain that that person was in and thinking that suicide was maybe the only option that they had.

Moving on to slide seven. We wanna think about all of the different reasons why someone might attempt suicide. At 65%, the number one reason is relief from emotional or physical pain, at about 65%. Other issues that have come up are problems with romantic relationships, problems at school. Friend problems, family problems, financial problems, as well as alcohol and drug use issues.

Additionally, to consider sexual assault and relationship violence. And a suicide attempt may often be a combination of many of these factors. Moving on to slide eight. We want to think about multicultural considerations. And in 2014, an average of 20 veterans died from suicide each day. Additionally, veterans accounted for 18% of all deaths from suicide among US adults.

While Veterans constituted 8.5% of the US population. So approximately 66% of all Veteran deaths from suicide were the result of firearm injuries. I think it's also important to remember how many veterans we serve At Mason and that we have a lot of resources for veterans on campus. So if you are a veteran of if you know a veteran that's struggling and needing some support, please do tell them to come into CAPS.

We would love to support them and provide them with community resources if need be, and other resources on campus. Additionally, I wanna touch on a stat from 2015 from the American Association of Suicidality where there were a number of reported deaths by suicide based on ethnic and racial groups for that year, where the white population was coming in at 39,796.

So that's at about 15.8%. The black population at 2,504. So that's at about 5.6%. Latinx at 3,303. So again, at about 5.8%. Native American at about 577 and the rate is about 12.6%, and Asian Pacific Islander at about 1316. So the rate of about 6.6% and we also really wanna pay attention to the diversity of students on our campus at Mason, and how a number of different cultural considerations.

And familial considerations must be taken into account that mental health is gonna look different for everyone and suicidality is gonna look different for everyone. So really wanting to be mindful of the unique life experiences of folks and other obstacles that maybe in place for some folks, and not for others.

And in thinking about that, we really wanna pay attention to Increased risk for our LGBTQ plus populations for suicide. And we also ought to pay attention to our trans young adults and they may be related to the possible experience of stigma, prejudice, discrimination related to sexual orientation or gender identity.

And religiosity may serve as a protective factor against suicidal behaviors in young adults. And moving on to nine, which is warning signs. So what to look for? And then slide ten, we're thinking about warning signs in terms of two tiers. So tier one with being threatening, looking or talking and writing.

And then tier two as an acronym that we've come up with called is path warm and I'll get into that in a second. But really, when thinking about tier one as I mentioned the threatening, looking or talking and writing, what to look for is someone threatening to hurt or kill themselves.

Someone looking for ways to kill themselves, such as seeking access to pills, weapons or other means or maybe someone talking or writing about death or dying or suicide. And when thinking about the second tier as I mentioned is path warm, we really want to touch on all of these different as you can see in slide 11 content from each of the letters.

So I stands for ideation and S stands for substance use. P stands for purposelessness. A stands for anxiety. T stands for trapped. H stands for hopelessness and this is a really big one when we're assessing for suicidality is indication of hopelessness. Similarly with W as withdraw. So folks are withdrawing from activities that maybe they normally engage in or from relationships all are important things to be considering.

Getting to A. A stands for anger. R for recklessness and M for mood change. Really, the more of these that are present, the more concern you'll have for that person. I would say that all of these, in fact, require attention individually. However, the more that are present, the more concerning the situation is.

And kind of a rule of thumb is that if a person has ideation or two or more of these, we really wanna connect them with CAPS. So please make that referral. Again, CAPS is in suite 3129 here in Student Union Building 1 or sub 1 and we have on call crisis folks available during business hours as well as after hours.

Again, if someone's worried about a friend that they have, they can call CAPS to get advice and to see what CAPS recommends them to do. Again, I wanna also be clear that without a release of information from a client, there's no way that CAPS can provide information on that client's behalf.

However, if there's a release of information, then we will be able to provide that information. But then also we can advice in hypothetical situations with staff, faculty or students. So I think there are a lot of options for getting information. As I mentioned, the office hours for CAPS are 8:30 to 5 on Monday, Thursday and Friday and 8:30 to 7 on Tuesdays and Wednesdays.

But after 5, it's by appointment only. So you'd have to have an appointment with the provider that you're seeing. And moving to slide 12. So we really wanna think about responding to individuals in crisis and try to come up with some conversations that would be helpful to have.

So when you're asking about suicide, you wanna use direct questions, including the words suicide and killing yourself. Realize the importance of helping the individual feel understood. And in doing that, if the individual is feeling suicidal, being direct will help him or her to feel understood. And when responding, we wanna think about using close-ended questions.

So questions which can be answered with either a yes or no. So are you thinking about killing yourself? Maybe probing questions could be asking followup questions when a response is not fully understood to elicit more information like could you please tell me more about XYZ that you had just said?

And then if it is indicated that the person is suicidal, we wanna paraphrase. We wanna restate what that individual has just said. So this is what I thought I heard, did I understand this correctly? Really clarifying that you have, in fact, heard that and we wanna think about how were having this conversation.

So really, initiating dialogue in a non-judgmental way. So starting by telling your friend how much you care about them or asking your colleague, or roommate, or teammate, or peer. To be honest about their mental and emotional state, just saying, are you okay? And investigating further as you feel comfortable.

Is there something going on that you'd feel comfortable sharing with me? And tell them that some of their behavior has been concerning. Be specific. You really haven't been acting like yourself, or you've appeared different to me for X, Y and Z, right? And asking directly, are you thinking about suicide?

Think if you take home nothing else from this presentation, making sure to ask the question. Are you thinking about suicide is the most important. So moving to slide 13, again, feeling understood is they key here. So we wanna be simple, basic, and direct. Asking directly with suicide or killing yourself is part of the question.

Making sure that it's in the context of the things that you've observed and that worry you, asking the person directly if they're gonna hurt themselves is not the same. Questions should be simple and direct. So are you thinking about suicide? And we wanna wait and give them a chance to respond.

Are you thinking about killing yourself? Really wanna give that person a chance to respond, and it likely is gonna feel uncomfortable asking somebody that. It feels weird, it feels silly, it feels uncomfortable. However, it is so important that we ask this question. And by asking that direct question, usually we're gonna get a yes or no answer.

So the answer is yes. Following that with a probing question of, could you please tell me more about that? We also wanna consider paraphrasing. This is what I heard. I heard you say, yes, you are thinking about killing yourself. And if this is during the day, we can walk this person over the cops and cops can take it from there.

And if its after hours, we wanna make sure that we get Mason Police on the phone, and they're in person for support. So when we pause to take a second to think about the conversation, we really wanna be initiating this dialogue in a non-judgmental way. We wanna start by telling this person how much we care about them.

We wanna ask them to be honest about their mental and emotional state and reassuring them that it may be hard to talk about this particularly when they are in this space. We wanna investigate further, as much as we are comfortable. But we wanna tell them that this specific behavior that they're exhibiting has us concerned.

And kinda being specific, potentially, with examples. And then as we said before, asking directly. So really asking that question of, are you thinking about suicide? In terms of investigating further as you're comfortable, maybe something like is there something going on that you'd feel comfortable sharing with me or telling them that some of their behavior has concerned you?

You really haven't been acting like yourself and being specific in terms of I've noticed that you've started giving away belongings that have been really important to you in the past, and I'm worried about that, I'm worried about you. And then asking directly, are you thinking about suicide? So, if the response is yes, we wanna make sure that we have follow-up questions like do you have a specific plan or date in mind?

And we wanna let them know that I really care about you. I'd like to get you help, get you connected with some support. You wanna let them know, for people who are often suicidal believe they're beyond repay. So we wanna let them know that you don't deserve to die.

I care about you. I'd like to help you heal. I'd like to help get you connected to some support. Again, if this is during business hours, we wanna encourage them to call CAPS or let you call and walk with them to CAPS immediately. And again, if this is after hours encouraging them to call Mason Police or let you call Mason Police with them immediately, something along the lines of let's find someone who can help.

We can set up an appointment together. I can even walk over with you, really wanting to get this person over to CAPS as soon as possible. So when it feels like it's getting over your head, we wanna consider making a referral. So we wanna contact Mason Police if the person is threatening immediate self-harm, maybe they are looking for ways to kill themselves, maybe they have the weapon accessible, or other means to harm themselves and threatening to use it.

Maybe they're threatening to kill themselves or they've engaged in a behavior that requires medical attention. I think all of these can be exacerbated by substances, by drugs or alcohol. So we wanna keep that in mind, too. We also wanna do our best to connect the student with CAPS if the person is talking or writing specifically about death and, or suicide, or they have suicidal ideation, or two or more of the first tier warning signs that we had discussed before.

Kinda moving onto slide 19. If the individual meets one or two criteria for IS PATH WARM, the acronym that we discussed before, and is not at risk for suicide. Again, we wanna express concern, suggest a meeting with a mental health professional. And explain the confidential nature of counseling, it's really, really important.

Again, we also wanna normalize concerns about counseling and seeking help and really acknowledge their courage. Here, on slide 20, we see some important referral contacts. So you can get a sense of some of these phone numbers again, Mason Police CAPS. The crisis link is a really important number, 1-800-784-2433, as well as the national suicide prevention lifeline, that 800-273-8255.

And then if the person doesn't feel like calling, the Virginia CrisisLink text line is another option. They can be reached by texting the word CONNECT to 85111. We're gonna move on to slide 21 and think about the role play. You're a 22-year-old student athlete who has recently been arrested for driving under the influence.

You went out drinking because your romantic partner recently ended your relationship. As a result of your drinking and legal concerns, you'll likely lose your athletic scholarship. In addition to being angry about your legal problems, you're also ashamed because you've been a very successful student athlete. You feel that everything is coming down on you at once and you feel hopeless about your future.

So this is a definitely challenging role play and a concerning situation. Let's try to think about this for a minute. You know what's coming up here is, of course, the substances, right? So, driving under the influence is very concerning. As well as the fact that this person is using substances to regulate a lot of the pain that they're feeling due to the recent breakup.

And then, thinking about potentially how this will impact academics, athletics, and then potentially losing the athletic scholarship. Again, we really want get this person to help because it seems like they are kind of at a breaking point for really going down the wrong path. And the statements of feeling like everything is coming down on you at once and feeling hopeless about your future, that is all indication of potential suicidality or suicidal ideation.

So, really wanna get this person to help as soon as we can. So moving on to slide 22 is social media, we know that about 90% of young adults use social networking sites. And you know we think about social media potentially being used in a healthy manner and also in an unhealthy manner and really it's dependent upon how it's being used.

Some healthy use of social media could be to increase connection, positive contagion, promoting exercise, healthy living, smoking cessation. Using it for support, normalizing that in fact I'm not alone. Then there's also some unhealthy uses. Thinking about cyber bullying or when it's used for comparison or envy purposes. Some negative contagion, you know when posts of self-injury or suicide or to retweet it or shared.

This is concerning and unhealthy use of social media can be associated with decreases in self-esteem, increases in risky behaviors like alcohol use, risky sexual behaviors, and disordered eating. I think it's important to note a study by the University of Missouri found that while Facebook can exert positive effects on well-being, it also can trigger envy among users and it can lead to depressed mood.

Facebook could be related to decreased subjective well-being and life satisfaction. And researchers also found Facebook to have a negative correlation with self-esteem as a result of increasing risky sexual behavior and presenting potential relationship conflicts with 31% of teens having fought with a friend because of something that happened online.

So as a result there's potentially decreased self esteem, increased envy and depression, as well as increases in anxiety. So these are all really important things to be thinking about with regard to social media. Moving on to slide 23, we wanna look into some social media warning signs, particularly hashtags of hashtag suicide and hashtag self-harm.

Messages may include wanting to die or kill oneself, feeling hopeless or having no reason to live, potentially being a burden to others or seeking revenge. Again, we really want to be paying attention to if something on our feed comes up where someone is expressing suicidality or self-harm in ways that they're suggesting wanting to die or kill oneself, feeling hopeless, or having no reason to be alive, feeling trapped or in unbearable pain.

Being a burden to others, seeking revenge. In terms of other hashtags to look out for, we wanna look out for posts that are encouraging self-harm such as hashtag cutting, hashtag self-harm, hashtag suicide, or secret social media hashtags surrounding self-harm such as SUE. So S-U-E, or hashtag secret society 123.

Facebook, Instagram, Twitter, YouTube, Tumbler, and Pinterest have stated in their community standards or terms of use, that self-harm post are not allowed on their websites. However, the sites act only after the images have been posted. And employees are actively policing the site. But they also rely significantly on users to report a post if it's disturbing.

So we really wanna be paying attention to that. And moving on to slide 25. So what to do, right? So we wanna look for key phrases here. We wanna not be idle, we wanna be active. Well, we don't wanna ignore, but we do wanna stay calm and we do wanna do something, right?

We wanna report this, right? We wanna reach out to the person, we wanna reach out to the GMU campus resources. That would be Student Support & Advocacy, Counseling & Psychological Services, Residence Life, and GMU Police. And if the risk of harm is imminent and you cannot get a hold of campus resources, please call 911.

And if you're uncertain about imminent risk, please err on the side of caution and call the police. So moving on to slide 26, we really want to encourage folks to always take a screenshot of the concerning post. Each site or app has a specific way to screenshot. It's really crucial to have a copy of the content on your phone or your computer for reporting purposes.

We also always want to call the police if the post indicates imminent risk. For example, I'm gonna kill myself tonight. We wanna follow up with students support and advocacy and the social media site or app of interest and we always need to take the concerning post seriously. It can be difficult to tell a person's intent via a screen, so it's really important to take all concerning posts very seriously.

I'm moving on to slide 27. Again, these are some sites the Facebook Bullying Prevention Hub, the Facebook Family Safety Center, the Tumblr community guidelines. Most social media sites have a center which you can report concerns of self-harm. And these can typically be found by going to the help center of each social media site.

Again, some more information on reporting safety issues on social media. So, slide 29 references harm to others. We want to handle this in a similar manner to self-harm, by asking direct questions. Are you having thoughts of killing others? Whom and when, right? If students who are homicidal, they may also be suicidal.

So we wanna ask about both. Are you thinking about killing yourself or hurting anyone else? And there also is increased risk if a student also has suicidal thoughts, a history of violence, and access to weapons. So moving down to slide number 30. Again, all statements or posts that suggest intent to harm others should be taken seriously and immediately acted upon.

If a student expresses thoughts of harming others, we wanna call the Office of Student Support and campus police if there's an indication of imminent risk. And if you feel that there's imminent danger, please call 911. If the threats are made on social media, we wanna take a screenshot of the post and report the post to the appropriate social media website.

So moving to slide 31, some final words of wisdom. Number one, you're not a therapist. You're not a mental health professional. But that doesn't mean that you can't be involved in getting additional support for this student of concern. We really want to make sure to ask. Asking the questions we've spoken about before in this presentation.

We want to be direct in our questions regarding suicidality, suicidal intent, homicidal intent, and non-suicidal self-injury. Again, you are not alone. You have a team that you can consult with and that's supporting you. And that's Students Supporting Advocacy, Mason Police, and Counseling and Psychological Services. I think it's really important to maintain healthy boundaries, right?

And this kind of stuff can really impact people. So it's important to take care of ourselves and to engage in some self-care. So that concludes the presentation. Just wanted to thank you for your effort, and energy, and enthusiasm for keeping Mason a safe community supporting our students, faculty and staff here.

Again, wanted to remind folks of the Counseling and Psychological Services location, we're in Student Union Building one, so sub one in room 3129. Our phone number is 703-993-2380. You can reach us on the web at caps.gmu.edu. Thank you very much and have a great afternoon.