 How is everybody doing? All good? Good by the grace of God. Everyone at... All of them. Good. Good. Lot of thumbs up. Quick recap. Do you remember what we did the last time? No. We didn't do about suicide. Grief and... Okay. Good. And we also did counseling of the abused, right? Yeah. Okay. So today we'll be doing the last topic. We've just chosen a few we haven't dealt with all, but just chosen important ones. And today we are going to be looking at suicide and how do we minister to those who may have suicidal thoughts or suicidal ideations. Okay. So have you come across anyone who's spoken about suicide? Have you come across anyone who has spoken about suicide? Yes. Yes. Yes. At some point. Sorry? Okay. Okay. They're contemplating suicide. Okay. So what about the students online? Have you all come across people that have had some ideations? Yes. Yes. Can you hear me? Hello? Yeah. I can hear you, but I can't. It's on. It's on. Okay. If you can put up your question on the chat right now, we can't hear you. Okay. So yeah. Any other students who've gone, who faced people who who have suicidal ideations in on the on the Manga online students, anybody? Okay. So what did you do when someone actually spoke to you about suicide? What did you all do? Louder. Louder. They were not serious. So what did you do? You didn't do anything. Okay. Okay. What did the rest of you all do? Okay. Alright. Loud. Loud. Loud. He committed. Is it? He attempted. And he passed away too. Okay. But someone you knew attempted. Okay. Nikhil. Transes. Nina. Sorry. You cried. You tried. Who? You tried to do. Okay. Alright. Okay. So it's important for us to know how to help what to do because you will come across at least once in your lifetime, someone who's probably sharing this feeling or this strong desire to commit suicide. Okay. But before we go there, before we actually talk a little bit about it, I'll just go through some questions just for your just just to just to have an get you all to have an idea about what you'll think. Okay. Suicide attempts are about seeking attention. Do you think it is to seek attention? So how do you differentiate? So my question is how do you know that someone is seeking attention or it is a genuine thing? How would you know? How they're attempting? You'll wait for them to attempt to see. Okay. So it is not true that suicide attempts are to seek attention. It is a cry for help. Okay. So even if there are what you explained about, you know, there's blackmailing or they are threatening or all of that, it's a cry for help. Someone is really asking for help. And that's why either they attempt or they may be talking about it or they're discussing about it. It's something that they it's a cry for help more than us looking at it as a seeking of attention. Okay. People who commit suicide are being selfish and think it is the easy way out. Jim, can you lower me? Okay. There's a lot of courage and a lot of there's a different level to come. Right. So it's not that come again. I'm not able to hear you. Can you speak up please? Yeah, now we can hear you. Sorry, I was just answering to this question of people who commit suicide are being selfish or think it's the easy way out. Just a minute, is it audible? Can you speak up again? Hello. Hi. Is it audible Jim? Sorry for interrupting. Sorry, just a little glitch here. Yeah, Ravili, go ahead. So I don't think so. It's being selfish but they do say that just because they don't want to face things out or people try to commit suicide which really is an impact on everybody around them including the close ones and other things. I'm not sure about that part. Okay. So think what you're bringing up is that because of what they're not able to bear is why they resort to an attempt. However, people on the outside think it's a very selfish act. That's what you meant to say. Alright. There is a clear reason for every suicide usually. Clear reason for every suicide. Okay. Very often there isn't a clear reason. Okay. It can be and I will come to that. Many times people just commit suicide as a symptom of depression because they are in clinical depression. One of the symptoms of depression is suicidal attempts or suicidal thoughts. Okay. Not necessary. There's not always a reason for depression. Depression can come. One is as a result of some, it's called, there are two factors something that's external and something that's very internal. External factors may be something that you see like a stress or some kind of a condition. But internal factors there may not be any specific reason. As a result of depression, people can commit suicide. So there isn't always a clear reason for every suicide. Okay. People are depressed and can give up their lives. Alright. Yeah. Yes. It can be. There can be certain events that may cause a person to feel a certain way that could like let's say low self-esteem, low confidence or a sense of worthlessness that can result in an attempt to suicide. So there can be the, so generally when you look at every kind of an illness or a disease it is, it has what do you say, sources in the enemy, right? The enemy uses something that we're already open to and can affect us a great way. So if you're as a person who keeps devaluing yourself, the enemy can use that against you to bring about these kind of issues also. So when there is an open door it's easy for the enemy to work in. Okay. Asking somebody whether they are suicidal and discussing whether they have a plan or method will simply give them the idea and increase their risk of suicide. So basically if you are someone whether they are suicidal and whether they have a plan, you're simply putting ideas in their mind and it will increase their risk of suicide. That's what it means. What do you think? Unknowingly the idea will come. Okay. Alright. So research has shown that it is important to ask and by asking you're actually helping them to open up whatever they are feeling or they are going through. It's a misconception to think that if you ask them, then they will it's like this when we talk about with young teens, you tell them about drugs or you tell them about premarital sex. So people say that if you talk to them about it, they will feel like doing it. That's not true. It's not true, right? It is you're building their awareness about that so that they're careful. So similarly here, you are asking them. Remember I said suicide is a cry for help. So when you ask them how are you feeling? Do you feel like killing yourself? Have you had thoughts or plans of suicide? It actually helps them to open up. Okay. So asking about suicide is actually a good thing. It is important to ask about that. Okay. People who talk about suicide won't do it. Okay. So you cannot you may not be able to really like there may be certain times that people do keep saying okay, I'm gonna go die. I will go die. You do this, I'll go die, right? But there can be chances that they may act on it. They may act on it. Impulsively they could act on that. Okay. Suicide is a purely personal decision. There is a manipulation Okay. You mean the instances around can you're saying push them into okay, right? So okay, I leave it at that. We will probably talk about that later. Okay. People who really want to kill themselves are beyond help. So people who want to commit suicide are actually beyond help. Not at all, right? And that's why we are actually talking about this because sorry, be upbeat when you respond to a depressed person or someone that is be happy. You know act as of your life is joyful when you're talking to a depressed person. That's what it says. Okay. All right. Those are some things for depression but I want to get back to okay. So just a couple of terms that we need to understand. Okay. One is yes, suicide which is the act of killing oneself. All right. That's what intentionally that is someone intentionally wants to die the para suicide attempt is a person can cause injury or harm to themselves but it's non fatal that is it doesn't come to a place of dying like they may take some kind of medication or they may inject themselves with certain drugs so much so that it's not a pure suicidal attempt. It's called a para suicidal attempt which is non fatal that is they know that nothing's going to happen but nevertheless they attempt some kind of ingestion or something that causes some kind of an injury to self. Okay. Self harm self harm is the deliberate attempt to harm or destroy the body with actually no intent of killing that is maybe cutting you know beating oneself injuring one body but not with an intent to kill but because to release or relief pain. Okay. So let's just look quickly at what is suicide. It is the second leading cause of death. Like we said it's the act of taking one's own life many people who commit suicide commit because of depression or some kind of a mental disorder. Alright so it's a good percentage it's almost like a 60% of people actually commit suicide when they are depressed that is clinical depression or mental disorders like too much of alcohol too much of substance or drugs all of that can lead to a suicidal attempt. Okay. So major reasons for suicide is one major psychiatric illness which is like I said depression or even schizophrenia can actually cause a person to commit suicide. Drug use or substance that is alcohol, drugs all of that can lead a person to commit suicide. Impulsivity that is you know doing things without thinking taking spot on decisions that is another reason why people commit suicide or they feel that they're not able to cope at all with the kind of struggles that they're going through. Okay. There can be significant losses that is you know maybe a loss of a job loss loss of a significant loved one maybe other kind of things that they've attached themselves to and lastly one of the reason for suicide is a cry for help getting someone to see what they are feeling and what they are struggling for. Okay. So here are some warning signs of suicide how do you know someone would probably commit or you know are showing symptoms are showing signs of suicide now remember that please don't just take one of these behaviors and say okay you have this that means you're going to commit suicide that's not the point right you're looking at a more collective number of items in this so one is like we said depression so in depression some of the symptoms of depression are here the negative view of self a sense of hopelessness or no hope for the future feeling alone being isolated drastic changes in mood and behavior and also self harm like cutting behaviors all of these are also symptoms of depression so someone may have depression but will have these symptoms additionally you could see that there is you know they keep talking about how they are a burden to others that you know that they're an extra mouth to feed or they are a person who the entire family or the entire whatever community can live without okay they may frequently talk about death keep talking and discussing about death they may engage in risky behaviors like they may go on fast car drives you know doing things that are risky like maybe injecting very many drugs swallowing many medication or you know doing some kind of risky sports that could without safety harnesses all of that risky behaviors when they engage in risky behaviors other things that you could see is when they give things away maybe when they give their possessions away when they write their will when they're writing their assets to somebody all of that could be indications making funeral arrangements right so they are making plans to ensure that once they die all the funeral all of that are set so these are some warning signs suicidal threats is again a warning sign of someone who can have an attempt of suicide okay so how do you make an assessment of someone who's committed who may want or who may think of suicide sorry my system is stuck okay right so here are some factors or what we call as a risk assessment you basically find out how likely someone may commit suicide okay so if you look at the acronym of it it's called the sad person right so the first thing that you look at is sex generally males are much more person to commit suicide than women alright so if they are a male there's a greater risk ages between 19 and 45 okay these are probably the times of the most stressful times of a person's life so that makes them more susceptible to suicide be the presence of depression if they have clinical depression that again becomes another factor for suicide P is previous suicide attempts if they have attempted any time before the likelihood that they will attempt again is kind of great E is ethanol which is alcohol or other substance use does the person use alcohol or other drugs as a sense of coping R is rational thinking loss they are not able to think rationally think logically not able to see hope even sometimes they may have everything set for them they may have a job they may have family they may have all things well but yet they are not able to think logically think rationally that's R S is social support lacking there aren't people around them that's there as their network or their support that again can be another factor or organized plan they have a plan they know when to die how to die what means they have to use when they're going to do it which place they have a huge plan and N is generally if they're unmarried or single and they do not have a spouse it again a spouse or family that causes greater factors for a suicidal attempt did you follow this yes yeah okay any questions up till now so we will quickly look at how do we identify how to identify someone who has a suicidal attempt I'm going to show you a video I don't know if this is going to if you all will be able to hear it but I'm going to try now this is can you hear it you can put on the can the students hear it could you hear it when I played it oh is it no okay they can't hear so what's the way for us to hear it's on it's on the okay then I'll just share the video later no it's on it's embedded on my okay I'll do one thing I'll put this up on the stream you can watch it later okay so there'll be two videos one is just to understand a little bit about what depression is and the other video will be on how to how to talk to someone who is suicidal okay so we'll probably I can maybe share it at a later time on the stream okay all right so what we're looking at is to find out again how do you identify how do you understand what is it that you can see as issues or as changes that have that show you that a person is suicidal okay so here are some quick slide it into four there are certain physical symptoms there are certain behaviors thoughts and certain feelings okay now the thoughts and the feelings are things you can't see but things that you may need to ask things that you can find out as you're talking to them so some of the physical symptoms that you may notice is they have difficulty sleeping they feel a sense of tiredness and you will you can see that they may not be eating and actually speaking about how they feel so run down they feel sick okay certain behaviors that will be noticeable is they will be withdrawn from others now this is in general there can be exceptions even to this okay people may be normally you may be noticing people who are normal but yet could attempt alright but this is in general a large percentage of people will show these symptoms they don't get things done they stop having interest in enjoyable activities there is a difficulty in actual concentration in paying attention in doing what they are generally doing in life okay there may be increased alcohol or drug use at a point of time the thoughts that they may be thinking is generally self depreciating or thoughts that are very condemning like nothing good ever happens to me my future is bleak I'm worthless I'm a failure these are all negative views or negative thoughts that they may be engaging in the predominant feelings would be feeling sad being very overwhelmed frustrated feeling feeling a sense of depression these are all symptoms that you will notice okay now if you look at their negative views it generally will follow three areas the negative view of themselves negative view of the world of others and negative view of the future okay so what is negative view of oneself I am not good enough I am worthless I am inadequate negative view about the world you know nobody loves me or nobody thinks I'm worth it everyone it would be better that I didn't live because everyone will be happy because I feel so worthless I am worthless I can't do anything I'm not good for those others and negative view about the future I can never do anything right nothing good is going to come about my life so generally the views that they have about themselves others as well as the world comes from a negative place of mind okay clear right okay so what is it that you would notice a suicidal behavior when there is excessive sadness or moodiness they always actually talk about wanting to die or wanting to kill oneself okay they may talk about it and you know how fed up they are you know I wish I could just die or I wish while I was driving I could just die or you know I wish I didn't wake up in the morning so these are all negative talks about oneself about how they are feeling any kind of a trauma recent trauma or life crisis that has happened maybe it's something that is significant loss that's happened feeling hopeless or having no reason to live there isn't any even despite the fact that there may be other things around like there may be children they may be having a job they may be going through something significant they feel there is no reason to live feeling trapped having that sense of unbearable pain feel that they're a burden to others we spoke about this making preparations for their suicide I remember one person who you know who committed suicide he withdrew money from the bank put it into a kitchen box so that the family would have enough for the funeral you know because that's a box I think the wife generally opens for tea time and that evening so when everyone went out he committed suicide and you know there were some of these things that were already done he had written up a will he had sold some property kept the money in the bank so all of this came in through a whole lot of preparation as a result so making those preparations okay feeling anxious agitated or sometimes behaving recklessly there can be problems with their sleep they may be more isolated they may also be very irritable show anger show rage general seeking revenge so there are many of these symptoms that you may notice like I said all because you notice two or three of these symptoms it doesn't mean that you make a blanket understanding that they may want to commit suicide and that's why you need to ask that's why you need to always have conversations with people okay alright now what do you do when you're actually talking to someone there are some things you need to understand okay and this is what we called as a confidence for a let's say a conversation how do you have a suicidal conversation with someone the first thing is find out the risk factors what are the risk factors we spoke about earlier what did we say the risk factors are sad person yeah so you're trying to figure out how many of these fit into this category are they single you know are they having what age group are they are they in do they have depression do they have a social support are they on substance use all of this is what you will check to find out okay that's what we mean by suicide risk factors then the fact that their idea the you know suicidal ideation it can either be passive or it can be active what do you mean by passive and active what do you understand by the meaning of passive meaning of active correct they're not passive is where the thought may be there but there isn't anything that they're doing towards it but activists there is a yeah they are planning they're organizing something towards that so that's something you understand whether it's passive or whether it is active how do you how would you question someone to know if it's active or passive will you say are you actively thinking about it or are you passive what would you say okay what else what are you doing when you have those thoughts okay so ask how you can actually ask have you devised a plan is there a plan that you have have you thought about a plan okay so what you want to know is whether they have a plan right so okay this has been thoughts what have you done anything further that two things so that's what it's important to ask that they'll say yeah maybe I did two three things something so you know that it is a more active phase and an active one is what do you say more I won't say it is more dangerous but it's definitely something that is playing on their minds greater but the passive one could become very impulsive but then no time they may just try and do something without actually thinking about consequences okay what happened no both will be but passive you may not know yes they're not thinking like for example an active person may like google and see which is the best way to die right or they may look at okay if I choose this what could be the consequences that happen they're actually researching all of that someone passively may just at the spur of the moment may just do something without actually thinking how much it could affect them if it didn't if it didn't succeed and all of that they may not think about all of that that's what I meant by passive could tend to be that you know they're trying to attempt but not really have the mindset to do that but they're doing it at the spur of the moment and it can cause worse of problems they may not die but they can have other kind of complications okay then a suicide plan do they have a significant plan how they're doing it when they're doing it what they're doing it so again there was this person that I was seeing he had such an elaborate plan that he wanted to do it certain place okay so he had devised the place where he wanted to do it he had kept aside the money he had put the date okay so he had he was wrapping up his work accordingly so that's how serious the plan was and while we were talking I did understand that it was it was quite elaborate the plan so okay so then I tell you how do we minister when we do understand that there is a significant plan and the fourth is intent what is that intent is the intent just to and I want to kill myself or is it no I just want to you know by by doing this I just want to escape for a certain period of time or I just want to sleep so what is the intent of that so these are certain things that you will need to maybe ask ensure that you're keeping these communications open okay we won't go through that alright so if they have suicidal ideations the important thing is to ask directly okay it's good to use the word suicide when asking about suicide like you don't have to say do you want to do something right be direct or do you feel like harming yourself remember harming yourself is very different from suicide harming yourself is you must have known of how people when they are very very emotionally overwhelmed they may take some like blades or you know small kitchen knives and just just superficially slash themselves that's not to kill themselves it is actually to release the pain that they are feeling okay so it's not a very good coping mechanism but nevertheless that's something that they have done alright so ask about suicide like this is some one way that you can ask I ask everyone I meet with about suicide and so I'm going to ask you have you had any thoughts about death or about suicide so you ask directly or I've read that between 10 to 50% of teenagers have thought about suicide is that true for you okay so directly talking and directly asking alright okay now if they do say yes what would you say next why so if they do say yes students online what would you say next please allow the do you have any plans maybe try to understand for how long before you ask a question what do you do think back at your counseling skills yes Ravali can you hear me yeah we can hear you okay so I was saying that maybe ask them since how long you know for how long they have been getting these kind of thoughts if they say yes that they wanted to come in if they're thinking about suicide it's been how long they've been in these kind of thoughts these are all these are all questions towards finding out but I'm saying before all of that yes empathize how do you do that remember we spoke about responding to feelings someone is telling you that they are they want to die and you're going ahead and finding out the plan which is a good thing it's important but what do we do before that because they have to think of all the consequences because they are the last person so what will you think about so Anand you've gone way ahead I'm talking about someone is just saying I feel suicidal or you're saying you know do you want you've asked that question they said yes so how will you respond there go back to class 5, 6 we acknowledge the feelings what will you say you shouldn't judge them say that again you might think of this yes like for example I can't imagine the pain that you may be going through that made you think about this that we have understood what they're going through that's extremely important never lose sight of that when you're talking to someone who is either depressed or probably suicidal okay so don't forego that it is important to get that so next that you would do and which I think most of you said is explore the frequency, duration and intensity of the thoughts how frequent, how many times has this happened from how long and how intense is it right and what all has how long has this intensity been there okay so that's again very important to ask then you need to assess the plan which means you're talking very specifically about the plan can you tell me more about how you have thought about doing it right this is very important because you're helping them articulate and in most cases from what I have seen mostly people actually do talk people will actually tell you that is if they feel unjudged if they're not feeling judged they will tell you if you are open to listen they will actually tell you but if you close and how can you think of something like that don't be silly don't be stupid shake yourself out of it then they may not really bring about this but you need to assess the plan so specifics of the plan what are they going to do needality of the plan how are they trying to kill themselves and are they using a gun are they using a rope are they using injectables are they using medication are they going to go under the train what is the how lethal can it be availability of the means is this something that they've already bought and kept right the rope or the you know whatever material they have and how close is social support proximity means the closeness of other people are they other people in the house are they other people around them that can make this plan harder or easier right so this is something that you will need to check specifics of the plan needality that is would they you know how potent or how lethal you know the meaning of lethal that if whatever means they're using is it a quick thing to die availability and lastly proximity of the support system that there is alright we'll stop here any questions here and then maybe the next class we'll talk about how we can actually minister any thoughts here any questions okay let's stop for a 10 minute break we'll come back at 11 o'clock