West River Eagle

ASIST training offers one approach to suicide prevention



The statistics are sobering. In 2016, out of a population of a little more than three hundred and twenty million, there were nearly forty-five thousand completed suicides in the United States. Sixteen million more Americans had thoughts of suicide during that year. An unknown number of deaths could also have been unreported suicides, meaning deaths that were considered accidental (for instance, one-person car accidents) were actually suicides.

For the year 2018, in South Dakota, the statistics are just as striking. There were 163 officially reported suicides, 20 per 100,000 individuals. An individual takes his or her own life every 54 hours in the state and more than four times as many South Dakotans die by suicide annually than by homicide. It is the second leading cause of death for ages 15-44 and the fifth for ages 45-54. These numbers are likely far higher, however, as the state’s nine Indian reservations are not required to, and often do not, report their suicide statistics to the state government.

In an effort to compassionately address these disheartening state numbers, a program entitled ASIST (Applied Suicide Intervention Skills Training) presented its intensive interactive workshop in Pierre on Jan. 15 and 16. Describing itself as “suicide first-aid” in which it “teaches participants to recognize when someone may be at risk of suicide and work with them to create a plan that will support their immediate safety,” ASIST may be learned and used by anyone, not just health care, education and mental health professionals. 

This is important because, as the presenters emphasized, anyone can be at risk for suicide at any time and for any reason and often even one person demonstrating care and concern, and getting the suicidal individual to immediate safety, can be a lifeline.

The ASIST program utilizes a direct approach, believing strongly that “by encouraging honest, open and direct talk about suicide, ASIST helps prepare to discuss the topic with a person at risk.” This is especially important in helping to dispel the stigma that still surrounds much suicide and suicidal thinking; this stigma often prevents those with suicidal thoughts from talking about it and seeking help. This direct approach, then, allows the suicidal individual to feel more comfortable engaging in discussions with those who want to help.

The presenters, Julie Moore and Leah Barnes, made clear that most people who consider or complete suicide don’t truly want to die, they just want their pain to end. Often, those who are considering suicide won’t actually say so outright, but will indicate their thoughts through code words or phrases such as “I’m just so tired/exhausted,” “I just want to be done,” “I can’t keep doing this,” “If anything happens to me, promise to take care of ___,” “No one cares,” and “I don’t care.” These and many other code words are known as “invitations,” signs of distress that invite the hearer to talk further with the suicidal individual regarding their feelings and plans.

In the first section of the three-part “suicide first-aid” model ASIST presented, exploring these invitations played a large role. Entitled “Connecting with Suicide,” the first part involves recognition of the signs and code words, asking the individual specific questions regarding their intent to complete suicide, and exploring the answers to those questions. A critical aspect of this interaction is to demonstrate real care and compassion and not just appear to be going through the motions.

The second part, known as “Understanding Choices,” involves listening to the person and his or her story, helping to determine the reasons behind the suicidal thoughts. It’s important to take the time to truly listen to the person and give him or her time to share his or her story in his or her own way.

This will then make it easier to find what ASIST calls “the part of them that still wants to live,” what they still find important or what they would find hard to let go of. This will then lead to the critical “turning point,” an emotional moment marking the person’s recognition that he or she has something to live for. Once the person begins to share his or her story, and feels emotionally free to do so, it often doesn’t take long to reach this critical point.

The model’s third, and final part is known as “Assisting Life” and consists primarily of assisting the individual considering suicide in developing a safe plan, such as removing access to any ways or methods of which the person had mentioned using to complete suicide, as well as other suicidal temptations, and seeking immediate safety such as a hospital, doctor, psychiatric clinic, counselor, etc.

It is critical that this final part be seen all the way through and that those assisting the individual considering suicide recognize what they feel comfortable or trained to do or not do. For instance, if the helper feels capable enough to connect the person to available resources but not anything further, then that’s fine as long as the suicidal individual is actually connected to appropriate, professional resources.

ASIST emphasizes that, when using this model, the interaction may not always be this clear and straightforward, there may be continual back and forth between and among the three parts. It’s important not to expect immediate results, and to take the time to truly be with, and assist, the suicidal individual.

The ASIST model may not perfectly fit every circumstance. Anyone may be in a position to help an individual reconsider suicide as a way out, and while the ASIST model may not perfectly fit every circumstance, it has saved many lives.

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