May 2014
Critical Response AssociatesVolume 14 Issue 2

Welcome to our Spring newsletter. It has been a long winter here in Atlanta.


We at CRA have just recently all returned from our annual Meeting & Case Conference, in which all of us meet for 2 days to discuss our casework, educate each other, and hopefully have a little fun in the process (as can be clearly seen on the group photo below). Everyone was able to attend except for John, Doreen and Todd, who had either family or business obligations. This year, we met at the Paris Hotel in Las Vegas, and somehow did manage to get a little work in. It was a very rewarding and fun time for all of us.


I want to take this opportunity in this newsletter to introduce Dr. Doreen Marshall, our newest psychologist associate. I decided that the best way to introduce her is by having her write something about her specialty area - which is an extremely critical subject when addressing the issue of workplace violence and high-risk behavior. Doreen specializes in suicide prevention.


I cannot emphasize enough the importance of understanding suicide, identifying those at risk of suicide, and preventing such acts as absolutely critical elements in any Workplace Violence Program. When one thinks of Columbine, Sandy Hook, Navy Yard, Virginia Tech, etc., one cannot forget that these, and many others, were suicidal events. It would be safe to assume that the perpetrator in each of these did not first decide to kill others, and only then suddenly decide to conclude the event by killing themselves. One would have to assume that these individuals were suicidal before engaging in homicide.


This is not to imply that all of the estimated 1 million adults annually in the U.S. (according to the CDC) who attempt suicide represent a risk of hurting others as part of their attempt, but in order to successfully promote safety within our organizations for both those who are at risk for suicide and for others in their environment, we have to do a good job at identifying and assessing this particular risk.


Marc McElhaney, Ph.D.

Critical Response Associates




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Preventing Suicide in the Workplace 



While it can be very difficult to predict if or when an individual will attempt to take his or her own life, certain factors or behaviors can alert us to an increased risk for suicide.  These include, but are not limited to:

  • Expressing thoughts of suicide. Many individuals who ultimately end their own life have expressed their thoughts to someone in their lives, including coworkers.
  • Presence of depression, anxiety or other significant emotional distress. Managers need to be cognizant of the fact that having a diagnosis of depression or anxiety is associated with increased risk for suicide.
  • Excessive anger or rage. Many who have difficulty controlling their anger may also be also unable to control a suicidal impulse. 
  • Insomnia, appetite changes and social withdrawal may signify a worsening depression, or an increased risk of suicide.
  • Previous history of a suicide attempt or self-harm behavior, particularly if recent. Individuals who have attempted suicide in the past are at increased risk of attempting again.
  • Excessive or increased substance/alcohol use. Alcohol, in particular, may leave depressed individuals feeling more depressed when use increases.
  • Perceived burdensomeness. People at risk may feel that others would be better off if they were not around.
  • Hallucinations and/ or extreme paranoia. These symptoms can make it very difficult for someone to challenge their thoughts of suicide.
  • A critical event invoking shame, humiliation or loss of status in someone who is already vulnerable to suicide. As is often discussed by Dr. McElhaney, we should always be vigilant when a "high-risk individual is about to encounter a high-risk event".
  • A suicide by a close family member or friend may increase the risk to those who are vulnerable.

It is important that workplaces respond to the potential risk for suicide in their employees. Some suggestions for ways employers can respond to suicide risk include: 

  • Ask the question.  Hesitating to ask directly, "Are you thinking about ending your life?" is a barrier to prevention efforts. Chances are, if you have wondered if an individual is suicidal, they probably have been. Asking directly does not increase an individual's risk for suicide; it reduces it.
  • Show support to individuals who express suicidal thoughts. Take it seriously and let the person know you are concerned and interested in helping them get the help they need.
  • Provide a referral Directing the individual to an appropriate resource in a timely manner is vital. Consulting with CRA or your company's EAP can assist you in next steps. You may also want to provide the individual with the number to the National Suicide Prevention Lifeline 1(800) 273-TALK.
  • Follow up with that individual. While suicidal thoughts are typically fleeting, it is important to follow up with the individual to make sure they are connected to the resources they need.
  • Promote a workplace climate that addresses concerns as they arise. Since those in distress often share it with a coworker or colleague, having systems in place where individuals feel they can report it to the company without resulting in a punitive outcome can promote help-seeking and connect more individuals to the professional help they may need.


No workplace is immune to the risk of employee suicide, but taking steps to actively address potential risk and promoting a climate that supports help-seeking can help mitigate risk of dealing with this ultimate tragedy.


For more information, please consult the following websites:


The American Foundation for Suicide Prevention:


The American Association of Suicidology:



Doreen S. Marshall, PhD