9.suicide With Traumatic PDF

Suicide Prevention With Disaster-
and Trauma-affected Clients
Cirecie West-Olatunji, Ph. D.

Xavier University of Louisiana
MHA Suicide Prevention Summit 2020 1

Learning Objectives
Acquire new knowledge about suicidality related to disaster- and

Acquire trauma-affected clients.
Increase awareness about how marginalized, vulnerable, and at-risk

Increase individuals are uniquely impacted by disasters and traumatic stress.
Augment Augment understanding of suicide prevention and intervention skills.
2
MHA Suicide Prevention Summit 2020
Suicide rates for disaster-affected clients
Suicide and Infectious Disease
Suicide Prevention & Intervention
Teletherapy & Telesupervision

Overview Disaster Mental Health Models
Culture-centered Theory and Social Justice
Counsellor Burnout
Recommendations

Suicide Rates Globally

Suicide Rates for Disaster-affected Clients
• Young adults are at higher risk to develop

psychological concerns (Riaz et al., 2015).
• Technological disasters cause significantly more
intense and enduring patterns of social, economic,
cultural and psychological outcomes than natural
disasters.
• Terrorism causes increased levels of post traumatic
stress disorder (PTSD) than natural disasters.
• Females suffer more after a natural disaster than their
male counter parts.

Suicide, Mental Health, &
Natural Disasters
A study following 1999 Taiwan earthquake found the affected population had
1.46 times increased risk of committing suicide.
The survivors of the 1999 Turkey and 2008 Wenchuan earthquakes, 2004
Tsunami, and Hurricane Katrina experienced significant psychological morbidity.
Following Hurricanes Katrina and Rita a prospective study found alcohol misuse
was more likely to occur in individuals with a previous history of trauma and low
income
Disasters may adversely impact on reproductive fertility and birth outcomes
• Adapted from: Crompton, Young, Shakespeare-Finch, & Raphael, 2018)
6
7
Suicide and Disaster-affected Clients
• Highly traumatic, especially for children

• Complicated grief issues
• Responses of survivors are often accompanied by
guilt and shame

In a 1998 study by Krug, Kresnow,
Peddicord, Dahlberg, Powell, Crosby, and
Annest, they reported that suicide rates
increased:
Suicide * in the four years after floods by 13.8%,

from 12.1 to 13.8 per 100,000 (P<0.001),
Rates for
Disaster-
* in the two years after hurricanes by 31.0%,
affected from 12.0 to 15.7 per 100,000 (P<0.001),
Clients and
* in the first year after earthquakes by

62.9%, from 19.2 to 31.3 per 100,000
(P<0.001)

Suicide and Infectious Disease
(such as COVID-19 aka coronavirus)
• Hospitalization with infection has been associated

with an elevated risk of suicide (Lund-Sorenses,
Benros, Madsen, et al., 2016)
• While activating the immune system can aid in
fighting the infection, immune activation may also
modify neurochemistry to cause individuals to feel
suicidal (Kaltwassser, 2019, July)

• Immediate supports
• Social supports
• Planning for the future
Buffers • Engagement with helper
• Core values/beliefs
• Sense of purpose

• Be Present/Engage
• Acknowledge suicidal thoughts
• Listen to understand
• Validate the feelings, the experience
• Evaluate hopelessness, burden and
disconnection
Interventions • Passive vs. Active Intent (methods
and timing)
• Evaluate Capability
• Evaluate “Buffers”
• Predict and Prepare
• Mobilize Resources
11
Social Distancing*
& Emotional Wellbeing
Stay mindful of your emotions (how are you feeling?, what are you
feeling?, where are you feeling it?)
Have a plan (what’s your “go to”? What coping mechanisms have you
identified? How to you restore comfort, emotional safety, and emotional
calm?)
Alternate between alone time and social time; maintain a balance
between alone time, such as reading a book, journaling, or meditating,
and social time, such as connecting via telephone, FaceTime, Skype, etc.
or face-to-face with co-habitants.
Avoid catastrophizing as a result of binging on news from television,
radio, social media, emails, etc.
Pay attention to your body; eat well with nourishing foods, stay
hydrated, and be creative about getting daily exercise.
• * = Social Distancing is used as a tool to minimize interactions in the spread of coronavirus (COVID-19)

12
Use of Teletherapy
Cognitive rehabilitation and cognitive-behavioral
therapy using smartphone apps has been shown to be
beneficial (Baumel A, Correll CU, Hauser M, Brunette M, Rotondi A, Ben-Zeev D, et
al., 2016)
In a study conducted in the UK, teletherapy was found

to be as effective in reducing PTSD symptoms as in-
person interventions among veterans (Turgoose, Ashwick, &
Murphy, 2017).
The results of a recent study indicated that, for clients

with eating disorders (ED), the application of
evidence-based teletherapy interventions by a
teletherapy-trained therapist led to significant
improvement of ED symptoms (Spoch & Anderson, 2019)

Online Clinical Supervision*
Set Clear Expectations & Goals for Telesupervision
A range of options for online clinical supervision should be utilized,
responding to individual learning needs, accessibility of technological
tools, etc.
Online clinical supervision should be embedded in pedagogical principles of
counselling and psychotherapy.
Telesupervision protocols should not supersede a strong supervisory
relationship
Be ready to deal with technology challenges and have a back up plan
Availability of supervisor between clinical supervision sessions can
enhance the supervisee’s perception of the effectiveness of supervision
Adhere to responsible use of technology (using a secure platform,
maintaining confidentiality for client and supervisee, ensuring safety)
Revisit and evaluate the supervisory process and relationship
frequently using informal and formal mechanisms
• *=Adapted from Martin, Kumar, & Lizarondo, 2017)

14
Superficial Reassurance
Avoidance of Strong Feelings
Professionalism
TEN MOST Inadequate Assessment of Suicidal Intent
COMMON
ERRORS Failure to Identify Precipitating Event
DURING Passivity
SUICIDE
INTERVENTION Insufficient Directedness
(Adapted from Neimeyer &
Pfeiffer, 1994)
Advice Giving
Stereotypic Responses
Defensiveness

o Crisis Intervention Models
o Psychological First Aid
o Culture-centered Disaster Counselling
Disaster Mental Health Models

crisis intervention techniques,
cognitive-behavioral exercises,
Crisis
eye movement desensitization Interventions
and reprocessing (EDMR), and
psychopharmacological
treatment.

•Psychological First Aid is an evidence-
informed model utilized in disaster response
Psychological to assist those impacted in the hours and early

First Aid
days following emergency, disaster, and
terrorism (Uhernik, & Husson, 2009).

STEP 1 Awareness: participants recognize that they bring their own biases
into the environment
STEP 2 Respect: participants recognize that community members have

Culture-centered equally valid realities and funds of knowledge
Disaster Mental
STEP 3 Context: participants acknowledge the sociopolitical context
Health
Counseling STEP 4 Integration: participants integrate knowledge into clinical
conceptualization
(C-DMHC)
Training Model STEP 5 Empowerment: participants are able to appropriately intervene
with empowerment as the goal
(West-Olatunji,
2010) STEP 6 Praxis: participants formulate advocacy action
STEP 7 Transformation: participants integrate the experience into their

own personal and professional identities

Facilitates counsellors’ efforts
to reach out to culturally
diverse individuals and
communities.
Culture-
centered Enables counsellors to better
Theory conceptualize and intervene
with culturally diverse clients.
and Social
Justice
Promotes awareness,
knowledge, and skills in order
to prevent cultural
encapsulation (Pederson,
1991; Sue & Sue, 2008).

•The presence of burnout
may potentially affect the
counsellor, the work
setting, and the client.
(Wilkerson & Bellini,
2006)
Counsellor
•Researchers need to be
Burnout able to educate
counselling professionals
about the risk factors,
symptoms, and effects of
burnout.

•Over the past decade,
scholars have examined
the concept of burnout
within specific counselling
specialty areas:
Counsellor
•–school counsellors (Wilkerson,
Burnout 2009; Wilkerson & Bellini, 2006)
(cont.)
•substance abuse counsellors
(Wallace, Lee, & Lee, 2010)
•rehabilitation counsellors
•(Garske, 2007; Templeton & Satcher,
2007)

Recommendations
Include suicide risk assessment and intervention strategies as core elements of
Include training and practice (Moutier, 2014).
Restrict Restrict lethal means.
Provide Provide increased and enhanced quality of support in the aftermath of suicide.
Reach out to the family, friends, and colleagues of suicidal individuals as, in
Reach out some cases, it can trigger more attempts in the aftermath of suicide.
Take Take social action to speak out and encourage others to do so.

Selected References
•Debbaut, K., Krysinska, K., & Andriessen, K. (2014). Characteristics of suicide hotspots on
the Belgian railway network. International Journal of Injury Control & Safety Promotion,
21(3), 274–277. https://doi.org/10.1080/17457300.2013.825630
•Moutier, C. (2014). Tactics of the War on Suicide. Depression & Anxiety (1091-4269),
31(12), 961–963. https://doi.org/10.1002/da.22345
•Riaz, M. N., Malik, S., Nawaz, S., Riaz, M. A., Batool, N., & Shujaat, J. M. (2015). Well-
Being and Post-Traumatic Stress Disorder due to Natural and Man-Made Disasters on
Adults. Pakistan Journal of Medical Research, 54(1), 25–28. Retrieved from
http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=102056010&site=ehost-
live&scope=site
•Tsujiuchi, T., Yamaguchi, M., Masuda, K., Tsuchida, M., Inomata, T., Kumano, H., …
Mollica, R. F. (2016). High Prevalence of Post-Traumatic Stress Symptoms in Relation to
Social Factors in Affected Population One Year after the Fukushima Nuclear Disaster. PLoS
ONE, 11(3), 1–14. https://doi.org/10.1371/journal.pone.0151807
•West-Olatunji, C., Henesy, R., & Varney, M. (2014). Group work during international
disaster outreach projects: A model to advance cultural competence. Journal for Specialists
in Group Work, 40 (1), 38-54.

Contact Information
Cirecie A. West-Olatunji, Ph. D.

Professor/Director,
XULA Center for Traumatic Stress Research
Counseling Program (LIB 519)
Division of Education and Counseling
Xavier University of Louisiana
1 Drexel Drive, Box 59
New Orleans, LA 70125
email: colatunj@xula.edu
phone: (504) 520-5392
fax: (504) 520-7909
Website: www2.xula.edu/ctsr

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Suicide Prevention With Disaster-

and Trauma-affected Clients

Cirecie West-Olatunji, Ph. D.

MHA Suicide Prevention Summit 2020 1

Acquire new knowledge about suicidality related to disaster- and

Increase awareness about how marginalized, vulnerable, and at-risk

Augment Augment understanding of suicide prevention and intervention skills.

Suicide and Infectious Disease

Suicide Prevention & Intervention

Teletherapy & Telesupervision

Culture-centered Theory and Social Justice

MHA Suicide Prevention Summit 2020 3

MHA Suicide Prevention Summit 2020 4

• Young adults are at higher risk to develop

MHA Suicide Prevention Summit 2020 5

Disasters may adversely impact on reproductive fertility and birth outcomes

• Adapted from: Crompton, Young, Shakespeare-Finch, & Raphael, 2018)

Suicide and Disaster-affected Clients

• Highly traumatic, especially for children

MHA Suicide Prevention Summit 2020

Suicide * in the four years after floods by 13.8%,

* in the first year after earthquakes by

MHA Suicide Prevention Summit 2020 8

• Hospitalization with infection has been associated

MHA Suicide Prevention Summit 2020 9

MHA Suicide Prevention Summit 2020 10

MHA Suicide Prevention Summit 2020

In a study conducted in the UK, teletherapy was found

The results of a recent study indicated that, for clients

MHA Suicide Prevention Summit 2020 13

MHA Suicide Prevention Summit 2020

Avoidance of Strong Feelings

MHA Suicide Prevention Summit 2020 15

o Psychological First Aid

o Culture-centered Disaster Counselling

Disaster Mental Health Models

MHA Suicide Prevention Summit 2020 17

informed model utilized in disaster response

Psychological to assist those impacted in the hours and early

terrorism (Uhernik, & Husson, 2009).

MHA Suicide Prevention Summit 2020 18

STEP 2 Respect: participants recognize that community members have

STEP 7 Transformation: participants integrate the experience into their

MHA Suicide Prevention Summit 2020 19

MHA Suicide Prevention Summit 2020 20

MHA Suicide Prevention Summit 2020 21

MHA Suicide Prevention Summit 2020 22

Restrict Restrict lethal means.

MHA Suicide Prevention Summit 2020 23

MHA Suicide Prevention Summit 2020 24

Cirecie A. West-Olatunji, Ph. D.

MHA Suicide Prevention Summit 2020 25

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