AMBER BALDET: I'm Amber Baldet,
and I'm going to be presenting
tactics to you.
I'm going to give a quick intro
at DEF CON
a PT or hacking cars and then we
So first off, I would
dissonance for you.
My main goal here
So trigger warning, this
and mental health and that might be
If you feel uncomfortable in any way,
in the room that have been affected
or have made attempts themselves
If you feel uncomfortable, feel free
We won't judge you at all.
So I will be also be speaking a lot
And that is no way meant to say this
Your experience may vary.
If you want to have
we'll be able to do that after the fact.
So today what we're going to go
We have risk analysis framework which
how to identify clues and warning signs
indicate some brewing crisis, how
threat assessment.
So this is how
determine how to make
So, if something is low risk,
to tackle it differently than someone
to get immediately to some sort
cover volunteer and first responder
is really where my training comes from,
But the main point there
the type of people that
to know how the real people do it.
So I will show you lots and lots
But none of that is required
a successful intervention.
There's very few things that are needed
Also just listen
out in the community.
This isn't the type of talk you need
or research so you can actually
Although there is that much research
The goal is to make it
and usable immediately as possible.
Also we'll cover how to talk
This is an important topic
So active listening, question phrasing,
et cetera: So hopefully we'll pick
Who am I and why am I standing there.
I work
Had is not what I do full time.
Some of what I do involves info sec
Nothing you want to hear me talk
with girls who code must
is QPR institute training.
Question, persuade, refer, that's
they teach autopsy responders.
They have a bunch
and I got involved with them
Which is the same thing as you
the numbers we see posted everywhere
I group you on IRC.
and I'm the kind
up the phone and talk
I have no problem throwing my heart
on the Internet.
So we have
more used to reading the cadence
down than maybe other people don't
So we might be stronger responders
So that's why I got involved.
But I ended
with it because it turned out I wanted
Not exclusively but it
in being able to understand and talk
It turns out now that everyone has
So they're all on IM.
And the people that contact
from the Internet or from Reddit
They're just regular people so I decided
the skill set and bring it directly
So that we can you know,
I'm going to touch everyone.
No.
In that sort of way.
Whew!
If we good get everybody here
they can then tell somebody,
And it's the kind of thing you can do
And people find suicide fascinating.
It's that morbid idea to learn
So it's actually really easy knowledge
I can't give you the official
theory, the basic course
So I had to make a title for DEF CON.
So, if you want your certification.
Every time I freaked
to shut up and do it and thank you
of them are here (Applause.) So how
This is the most depressing slide
I have a unicorn chaser.
There were two suicides
up that affected me.
I come from a family of brilliant artists,
out these people are prone
So, when my mother was diagnosed
she was going to follow the same path.
So I kind of took the nerd
to learn everything I possibly could
And that's how I ended up volunteering.
And why I'm here and she's fine now,
Thanks, mom.
Right around the time I was doing this
the Aaron Swartz situation happened
If you're from the previous track,
of Aaron's suicide earlier this year.
And what surprised me was that
people in the community who reached
they were worried about their friends.
They don't know what to do,
and wanted resources
of red flags for me.
Contagion is a very well known effect
When someone high profile dies.
So it's actually based it's called
on a book
It detailed a suicide at a writing desk
it that they banned the book.
You see this in clusters
The Godzilla is Mount Mihara which
in to trap him is based
has been presence of hundreds
So San Francisco
familiar with our cultural attachment
So we're doing it wrong when it comes
There are standards which I've taken
to social media published
of encourage you
whether it's in our community or not,
they don't quite get right.
We want
suicide is never the result
There might have been a trigger,
into a crisis situation, but don't wake
That's not what happens.
If you look at the first bullet point there,
and slashed out.
That's because it would be great
if all of us could stop saying committed
That is not clinically accurate.
It's a throwback
which does not exist in a majority
And people say clinically died
Killed themselves, a whole variety
other words you can use that don't
and don't refer
don't need.
We also want to point out that suicide
long history of problems.
Generally not making it seem
I guess Maybe we could do that
So it's not just Aaron.
These are computer science suicides
of course would be when we would see
And before that,
We're probably a lot more familiar
because they tends
It's prevalent in the highly gifted
That said, the vast majority
by suicide don't have Wikipedia pages.
So while it's nice
in our research, really this
across every demographic.
I will say though that you probably
a Nobel prize for chemistry.
(Laughter) So I'm just going
And then we're going to leave
of the presentation.
So in America someone dies
In China it's every two minutes.
Overall we're talking
death in the United States.
That's way ahead of homicide, cancers,
And most critically for us and not
but just briefly you're demographically
We can do this by a show of.
Hands.
How many men fall between 15 and 24?
For you guys, this
Behind accidents and homicide.
How about 25 and 34.
Hey, that's almost all of you.
It's second for you.
Second only to accidental death
If you look at 45 54 bracket,
but we start to lose people
the data that way.
Skews the data that way.
Twice the number of homicides
More than half
Women are three times as likely
by men are four times as likely to die
That largely has to do not
That's you choose pills which you think
men tend
have high lethality.
So goodness.
You're going to make me drink,
(Applause) All right.
Can I borrow the microphone
You know the drill.
We have a tradition we decided
up somebody from the audience.
But we need somebody who
I like you.
You have to answer trivia question.
Do you know
Excellent,
at DEF CON.
Come on up.
AMBER BALDET: I'm taking this
Your time is up now.
How is it going so far?
She doing okay?
(Applause).
All right.
Now let's talk about clinical things.
I'm segue independent.
So all right.
We're going to skip over most
I want to make you aware that this talk
of diagnosis that I would be remiss not
of diagnosis here I'm sure we're aware
at the bottom.
Harm reduction is great
Sobriety is very heavily indicated
of mental health management program.
That's because harm reduction works
but you accidentally die.
So, if death is your end game,
We won't go
but most importantly pay attention
They're most common.
If you look
this kind of outlines the number
if you're classified within one
that your chance or your likelihood
So obviously,
of off the charts.
But also, depression,
all of these are heavily indicated.
Of what you might not see on there
at the bottom that I added
is all these other medical illnesses.
People think there's
who are medically ill are more likely
It's very small.
Not statistically relevant and autism
Okay.
So within our community,
in our community but everywhere
So within our community, I kind
of a few archetypes
about it that might happen.
So I'll sleep when I'm dead.
I'm too busy crushing it.
This to me typifies
They have something called "the
And that's that basically mania
Depression is stigmatized.
There's youth and burnout.
Chronically underinsured.
Drug use is trivialized.
There's overlap
That might match what, you know.
that's a witch's brew
Just because I'm paranoid doesn't
Sounds like underdiagnosis
If you look at this in regular population,
to find
if you work in some
They don't really understand you.
They don't understand
And they might not be able
what is actually an acceptable level
for the things that you're involved in.
You might also be more likely open
which can be a problem.
So, if you want to learn more
these are some
if you are a heavily creative type,
about manic depression in artists
a good thing, touched by fire
All of this stuff is on the CDs
So for us, if we self diagnose,
Ph.D.s in psychology
and we go online, we tend
of like we'll post a forum post
but not we don't have one
to get away from that.
So this is the online intervention that
30% of college
We get a lot higher retention rate
It's more anonymous
Mostly they don't track you just
because they really don't know how
Kind of hinders their ability
Efficacy is equivalent with hotline.
Training is great.
Good resource.
But like I mentioned earlier your pairing
So we're bringing it to you.
Now what's the difference
like to fall a friendtervention,
The person comes to you,
they want to tell you their problems.
They assume that you know what
There's enforced anonymity,
to give them your name or have
In a friendtervention you may need
and that can harm your friendship.
Maybe you start to lose credibility.
The ultimate end game is not
unless you want
No, you want to get them
So we need to get people
through really accepting professional
It's very hard
because a lot
in the past with people that didn't
didn't work.
The medication
a lot better, 60 80%
you find the right therapy it
down and you have to trust
of work yourself.
So we need
to seek help
and responding
How are we going to identify risks?
There's a few clues you want
Direct verbal cues, this
If I don't get a boyfriend soon,
Obvious, often encoded as jokes.
Keep your eyes out for that.
Indirect, I'm tired of life,
off without me,
to worry about me.
These are big red flags
throw out there to see
to them.
Behavioral.
Maybe they just seem depressed.
That's kind of important.
If they get their affairs in order,
if they were into drugs or alcohol
huge red flag.
Situationally trigger events.
Lose a job or relationship you're
you're suddenly being prosecuted
these things are huge,
So you want to watch for red flags
So take them all seriously
If somebody is talking about suicide,
Not true.
If you're talking to someone
to put the idea in their head,
if you're that worried about your friend,
about it themselves.
Seize the day.
This is a big wall of text,
But it's to take away
is how you form
This is something you carry
So it doesn't really change day to day.
It's about who you are and
of bag you've picked up.
Some of it might be changeable
at the bottom.
So maybe you moved
the sociopolitical climate
That might lower your risk.
One time I called this the lint
of life and people enjoyed that so I go
These are things you cannot get
to cope with them.
And then biologically, this
you are.
So this would be your mental illnesses,
That's the foundation
proximal risks.
So these are
about before.
This is the stuff that
they will say is why you killed yourself.
So it's a relationship crisis,
It's losing money.
It's whatever the event
But what's most important
It's your perceived level of loss,
And one interesting note
is any sort of risk or protective factor
Absolutely irrelevant.
A relative loss of financial stability
But having a lot of money does not
against suicide risk.
So as we move across the way,
of hopelessness which
the one thing we really want to try
We're trying to provide hope
That's the most important thing.
And then you have a wall of resistance,
pushing back, keeping you safe.
Once that's broken through,
So the resistance,
are pretty obvious, these are
we want to have all these things, again,
there's a few like the AA sponsor
of a meal mental health plan that
but positive therapeutic relationship
but you do want to check them
to people mentally and know
or whether they have somebody
Oh, my God,
be suicidal.
Here's the process.
You find a safe place to talk.
Set aside time.
Best face to face but it doesn't have
You build rapport and trust.
That's the talking to a human thing.
We'll cover that in a second.
You're going to ask
This is the most critical step
someone if they are thinking about,
are you feeling suicidal?
It's very important to ask this
You can kind of roundabout it
about not waking up" you don't want
We'll talk about different ways
This is the hardest step and
the most lives.
People are just waiting for someone
So once you ask the question
you just shut up and listen
While you're listening,
of their current situation based
in a second here.
And you're doing active listening.
So you're responding
you're asking relevant questions,
around things that you want to know.
But mostly just giving them space
And throughout that kind
you are determining
moderate risk, super high risk,
And then once you've determined
to implement
Most importantly or usually we want
like I mentioned before.
You don't want to stop
You want
on treatment and that
And then you want to follow up.
You don't want them to feel abandoned.
You want to check
is there and somebody cares.
Often people feel so crushingly alone
brighten their day and change their
I usually asked this question so I throw
What are my reporting obligations
Basically none.
Unless you're getting paid
If you're a teacher, social worker,
there are other obligations you'd know
But as a Good Samaritan,
you'll be fine.
Reverse
and somebody storms out and says
Z or whatever I'll kill myself,
to see them and and they go
or responsible in some way?
The answer is no, absolutely not.
You had nothing to do with it.
You can't control them.
There's usually lots of survivor guilt
But you don't have an obligation
If you know what to do, it's great
to talk about.
But it's most important that you get
and do it and activate
is Uma Thurman's do you listen
Or Vincent Vega's response.
That's how I explain active listening.
It's not from the still.
It's from the director's cut,
It's the important things.
So building rapport,
Ask one question at a time.
Give the person time to respond.
This is a little counterintuitive.
But, if you repeat back
it makes them feel understood
People in an acute suicidal state
they have blinders on.
Research has been done
or various cognitive skill tests that you
You can't see a variety of options
So your thinking is impaired
there's one way
So it's important to get people
it's like this now
Tell me how you feel.
Let me show you that I understand what
So say when you don't understand,
you don't.
They catch on to that very quickly.
And ask open ended questions,
So obviously the opposite
Active listening
That's the takeaway from this.
Yes, you may be filling
or thinking about what they say.
That's what people do all the time.
You're not manipulating an outcome.
And most importantly
to form cognitive functions,
arguments that you can step them
People do not respond
in that sort of state.
What you want to do is create
they can get through a crisis
will eventually end where
and they kind of get back
almost like if you're
drinking and you can't talk
You have to get them
confront their problem.
You can use cognitive behavioral
of the industry
and change their world view.
But you're not going to be able
is in the middle of a crisis.
Okay.
So separating feelings from states
This is actually a great slide
is something you can do on yourself
That you might not it's one
about you hear yourself say but,
it can actually start to change
the world.
So stop saying you are so many things.
I am lonely.
I am a mess.
I am angry.
Like it's a sense
and who you are.
When you introduce someone,
is the worst possible word
They are smart.
It means you accept this person
to change.
So, if you change that
but I could change that it might change
This gives you wiggle room
the way you think about things.
So it's a good tactic.
This slide is a slight deviation
But I just wanted to point out this
I'm so burned out.
And it's another thing that really means
It's euphemistic and we all use it
I don't want to deal with it.
But you don't know.
It could mean anything.
So I called the beer therapy
a couple beers with people
out the "I'm so burned out."
And you talk
important than employer and everybody
If you dig down into that a little bit,
all the time.
Get somebody to express anger
Now that's more relevant.
If you can get under that and find
of that's making them feel that way,
and get them
will make them feel less burned out.
So you can probably read this one later
of extracting that information.
So bringing it
S question that I mentioned earlier why,
you're talking to your friend
You've assessed that they are at risk,
You think they trust you.
And now you're ready to ask.
So you can ask directly.
Some of the things that you said made
about suicide.
Am I right?
This is probably one
but you can figure it out for yourself.
Indirectly, have you ever wished that
with all this any more?
The point is you can actually practice
a statement that feels good for you.
It's really weird how difficult it
without it catching in your throat.
It's like when you first start talking
to ask someone about contraception
Like you might be able to just talk
or other settings,
and ask them a vulnerable question
You have to suck it up and do it and
about somebody, you need
Don't say this
Everything else there's not
people are concerned
like you're going to say
over the edge.
Don't worry about that.
But don't say you're not thinking
This is the worst.
First of all, you've delegitimized
if they actually are suicidality,
and you're asking
like you're basically saying don't bother
You're not going to get a yes
depending on their response,
is a screen shot of what's actually
This
that volunteers actually use
off all these boxes.
I know it's really little we're going
You don't have to check
to do a successful intervention.
This is just
everybody everyone loves.
So once you get a yes to this sort
a threat assessment.
So first, immediate state.
This is probably more relevant
up the phone.
If a suicide is already in progress,
You can't handle that yourself.
Are they currently under influence
Are methods nearby.
You usually can't convince somebody
there's a long trust building process
But eventually they will.
And also self harm is there self harm
Is it part of their world view?
Whatever.
That's the first triage that you do.
But we're going to assume
this critical.
Are you currently suicidal?
This is the meat we're looking for.
Are you having suicidal recently
is the buffer zone.
Was the person asked directly
We asked that.
If this current intent exists,
Do you have a method?
Do you have easy access to that?
So the more concrete someone's idea
Obviously if you say yeah, I'm going
and you have that gun
is and you have things in order,
if somebody says I have pills
but I just don't want to be here.
That risk is lowered.
Doesn't mean you walk away
Capability and desire is how strongly
to actually execute
So have you made prior attempts?
Remember the early graph
of future attempts.
Have you made rehearsals not quite
There's entire addiction underlying
to talk about.
It's like a safety blanket where people
problems don't exist any more.
Digging down to where
out of the fantasy world
You document what's wrong, why not?
Why not tomorrow?
Why not now?
What are the buffers?
You want to start eliciting
And who else is involved?
You don't want to try
So risk indicators, this is your desire,
This builds the profile.
This is where you find
or are they feeling lonely?
Do they feel like a burden
This is the core
you'll see.
Their intent would be again
you already called 911
This is a check box to some
describing before.
But just you kind of learn to kind
the various check boxes
of the various types of people.
Obviously all of our lives are individual
of categories, I guess.
And then your buffers.
Internal buffers always better than
If you can cope with stress.
Spiritual believes tend
If you have a purpose in life or
is a big one.
I remember talking to someone
and then they said well, God,
to have to do it differently
I was just like oh, okay,
so I guess risk lowered, good.
And then external
your community bonds,
We may feel isolated just
behind our computer every day.
But that doesn't mean that we're not
Doesn't mean we don't have people
have strong relationships,
and people that are there for us.
And then out comes and next actions.
This is the GTD portion
So you never walk away
without having your next actions
is responsible.
So you want
persuaded to accept assistance
a commitment to safety.
A commitment to safety
If you're going to let someone
This is where the person agrees
to not use drugs and alcohol.
And to not kill themselves
until you've had you know, more time
It's basically a safety bubble that they're
And it's critical
People are incredibly determined.
We cannot change their minds
There are people
ways to kill themselves when they're
It's best not to lock them
Sometimes it takes a while.
Here's a threat assessment.
At this point we've walked
You've got a good idea
on with the current situation,
And you're willing to make a call.
Is it high risk, moderate risk, low risk.
What's most important
on this one this is also
So you can kind of use it.
But generally, the people that you
to be high risk.
They probably won't even be moderate
When you do a friendtervention
or form,
like an ungodly life and death isn't
It's a nebulous idea they're having.
So you're most likely statistically
So in that case, you want
to get them referral and then you can
If you do have
is a progression
through an ER system
involuntary commitment, it
We don't have enough time to deal
on that, I'm happy to talk about you.
But it varies incredibly based
It could be anything, honestly.
Some states have great systems,
the person in crisis
in getting better help.
You've established a commitment
You have a safe space
out for the next few hours
Enlist other people.
You want to keep them around,
from being alone.
You want to get them online resources
for the future, maybe.
But most importantly, you want
and also you can move towards
So this is kind of towards the end here,
of people haven't seen before,
of disappointing
of any mental health strategy
for yourself.
So a crisis plan
When you're not in a crisis.
You identify your personal triggers,
stuff that tells you personally that
Your goal is to start outsmarting your
brain is telling you that it needs
to stop.
It's actually very effective and one
out earlier on the slide
is called "how I stayed alive when my
and it's a story of a woman
she finally implemented this crisis plan.
She said she had printed out copies
and wall and given them to friends
and refused to do anything
and that's what finally got her
than constantly trying to refer
There's an example that's filled out.
And there's a blank template you can fill
So the crisis plan is really critical
And I don't know how to describe that.
I guess.
It really helps you have an range
I know we're rolling towards the end.
Tactical crisis,
to include toward the end
So you, 911, therapist, hotlines this
at if you want to get involved
There's channels on IRC.
There's subReddits.
Our suicide watch is a good one.
Our suicidology has
a few sites.
I tried to find some technically oriented.
I talked
and rose and died.
If anybody would like to talk about this,
the length
at source.
So there's just tons and tons
So it's it might be useful
down deeper and education
be your first line of defense to hand
Most of these organizations started
It's a nascent area of study surprisingly,
to our cultural things and these are
about all the other stuff that's here.
And I have questions.
So thank you.
I want to thank everybody
AMBER BALDET: Okay, clap.
Fine.
I want to thank everybody
about this and I want to feel
knowledge and outline these steps
out of here not depressed
about the change that we can make
So I'll do I mean,
up but I can do Q&A in here
Does anybody have like a counter.
Do they give me extra time
a counter up here,
Okay.
So does anybody have any questions
Yeah, go ahead.
AUDIENCE: Odd ethical sort
I'll skip over the details.
But a friend of mine she her life
She has got chronic mental illness
at the edge of homelessness.
This sort of thing.
AMBER BALDET: Your question
That's your question.
Right to die stuff, rational suicide.
There is absolutely a case for that.
It falls into a very different category
Generally, the tenets
terminal illness, support from friends
a general comfort that everybody feels
And in that case, I mean, personally,
At all.
But it's very different than people who
will and I should have the right
That may be the case.
But as we talked about before,
in the same way that it would normally.
Like I mentioned at the beginning
to completions, there's 15 attempts
That didn't mean that every person
No, it's a the vast majority
do not complete suicide and never try
about that.
If those people were to have
a different outcome,
whether or not people actually are
And that's the problem
and failed.
And also you're never going
You only have failed attempts.
So it doesn't really work.
So that tends
so we should also try to get rid
There's a mic there.
It's a meritocracy.
I have a couple family members that
about feeling suicidal and
but I feel kind of helpless
as a family member
Also what to do when they both
It's hard for me to know when
of the time regardless
to talk and talk and talk.
That's the emotional exhaustion
talking about.
The difference with being
is you have office hours
and cannot speak with people,
with your family even when they're not
I would say that the crisis plan
If you're a step
all the other steps have been completed
Did you already go walk your dog?
Did you already journal today?
Starting to take back your time you're
you're supposed to be level or two
It isn't always easy to enforce but,
like you're working with them
they call that it's valuable,
AUDIENCE: Thank you.
AMBER BALDET: Yeah.
AUDIENCE: I'm render man.
In February I went
with depression which many of us do.
We have a community we need
out and we've lost a lot
of people we haven't heard about.
And we need to have
within this community.
To destigmatize depression
out and you know taking that handed
AMBER BALDET: I completely agree
In a way we're progressively ahead
a little counterintuitive.
But because we're here,
the stigma perpetuates all of society.
Especially the mental health industrial
we have done some really terrible
We've we stigmatized it intentionally.
In the 1800s,
on religious grounds.
In England
from the person whose job it was
a death was a suicide because if it was,
and property to the crown
of the crown and the coroner.
And we're done.