WEEK 6: SUICIDE Flashcards
(26 cards)
1
Q
Avoid Stigmatising Terminology
A
- Committed suicide
- Successful suicide
- Completed suicide
- Failed attempt at suicide
- Unsuccessful suicide
2
Q
Use Appropriate Terminology
A
- Died by suicide
- Suicided
- Ended his/her life
- Took his/her life
- Attempt to end his/her life
3
Q
SUICIDE
A
- A deliberate taking of one’s life
- Death must be recognised as being due to suicide rather than natural causes
- It must be established via coronial inquiry that the death resulted from a deliberate act of the deceased with the intention of ending their own life
4
Q
SELF HARM
A
- Deliberate causing physical harm to oneself
- Often this is done in secret without others knowing, can include cutting, biting, burning, hitting, scratching, or picking skin to other parts of the body
5
Q
SUICIDAL IDEATION
A
- Thoughts, ideas or plans a person has about causing their own death (active or passive)
6
Q
WHY DO PEOPLE SELF HARM?
A
- Often used to try and control difficult and overwhelming feelings or to gain some kind of relief from emotional pain
- May be used to express anger, to feel ‘something’ or communicate a need for help
- E.g. Range of problems- feeling isolated; being bullied; current or past physical, sexual or emotional abuse/neglect; difficulty getting along with family members/friends; relationship breakdown; loss of someone close
7
Q
SELF HARM IN AUSTRALIA
A
- Difficult to estimate rate→ - Evidence suggests that less than 13% of young people who self harm will present for treatment
- Lifetime prevalence rates are higher, 17% females and 12% males aged 15-19 years and 24% of females and 18% of males ages 20-24 years report self harm at some point in their life
- Rates for females hospitalised as a result of intentional self harm out number males across all age groups
- Rates of self harm for aboriginal australians are about 2.5 x higher (males) and 2 x higher (females) than the general population
8
Q
SUICIDE
A
- People with mental disorders are at increased risk of self harm and suicide (depression, bipolar disorder schizophrenia, borderline personality disorder)
- Chronic medical illnesses are also associated with increased suicide risk (cancer, HIV, diabetes, CVA, head and spinal injury)
- Environmental and behavioural factors can increase suicidal risk (isolation, recent loss, lack of social support, impulsivity, unstable lifestyle)
9
Q
SUICIDE IN AUSTRALIA
A
- Remains the leading cause of death for Australians aged between 15-44
- In 2012 suicide accounted for 1.4% of all deaths worldwide (15th leading cause of death)
- 2014→ approx 75% of people who died by suicide were males and 25% were females. Suicide was the 10th leading cause of death for male
- Almost twice as many people died from suicide in Australia than in road related transport deaths
- Suicide rates significantly higher in Aboriginal and Torres Strait Islander people
- For every death by suicide, it is estimated that as many as 30 people attempt. 65000 suicide attempts are made per year
10
Q
METHOD OF SUICIDE
A
- In 2013- most frequent method of suicide was hanging, strangulation and suffocation (55.2%)
- Followed by poisoning by drugs (13.8%) and poisoning by other methods (8%), firearms (6.5%), remaining deaths from drowning jumping and other methods
11
Q
PREVENTION AT A NATIONAL SCALE: INDIVIDUAL LEVEL
A
- Appropriate and continuing care after leaving EDs
- High quality treatment (CBT and DBT) including online treatments
- Training of GPs
- Training of front line staff
12
Q
PREVENTION AT A NATIONAL SCALE: POPULATION BASED
A
- Community suicide prevention awareness programs
- Reducing access to lethal means
- Responsible suicide reporting by the media
- School based peer support and mental health literacy programs
13
Q
RISK ASSESSMENT
A
- Ultimately, accurate prediction of suicide is impossible, this is attributed to a range of factors such as but not limited to;
- Peoples shame and secrecy around suicidal preoccupations
- Means of detection are not sensitive enough to quickly changing mental states
- Suicide risk assessment is enhanced by:
- An effective approach involves a therapeutic relationship
- Suicide risk management must focus on short term prevention, not just long term prediction
14
Q
SUICIDE RISK ASSESSMENT
A
- Formal process by health professionals to gauge a person’s short term, medium and long term risk for suicide
- Checklists developed and used in MH services and ED- important to remember assessing for suicide risk requires more care and thought than completing a checklist or assessment tool
- There is no clinical assessment tool that predicts with total certainty whether or not a person will attempt suicide- need to make a reasonable decision based on available evidence/ information
15
Q
SUICIDE RISK ASSESSMENT: RISK FACTORS
A
- Suicide risk is dynamic and fluctuating
- Risk factors are potential indicators of risk, however, tools that screen for risk factors are not sensitive or specific enough to be reliable in clinical practice
Assessment must include
- Detailed evaluation of suicidal behaviour and ideation
- Full psychiatric assessment
- Determination of the psychosocial circumstances
- If possible, assessment should include family members
16
Q
RISK FACTORS FOR SUICIDE: INDIVIDUAL
A
- Family history of suicidal behaviour
- Mental illness: mood disorders, schizophrenia and other psychotic disorders, and substance related disorders
- Previous history of suicidal behaviour
- Childhood and adult trauma
- Low coping potential
- Hopelessness
- Aggression and impulsivity
- Worry and rumination
- Psychological pain
- Neurobiological and genetic factors
- Drug and or alcohol use
17
Q
RISK FACTORS FOR SUICIDE: SOCIO- CULTURAL / SITUATIONAL
A
- Indigenous status
- Exposure to suicidal behaviours through sensationalist reporting by the media
- Access to and availability of lethal means of suicide
- Unemployment or financial crisis
- Stressful life events
- Relationship breakdown
- Poor social networks
- Social isolation, lack of social support
- Imprisonment
- Bereavement
18
Q
GROUPS WITH INCREASED RISK OF SUICIDE
A
- People living in socioeconomically deprived conditions, including unemployed and homeless people
- People living in rural and remote areas
- Aboriginal and Torres Strait Islander people or communities
- People in the justice system and immediately after release from prison
- People with lived experience of mental illness
- People with a history of previous suicide attempts
- People who use alcohol/drugs
- People dealing with trauma in the workplace, including first responder (e.g. police, paramedics) and former defence force personnel
- People bereaved by suicide
- People from the LGBTI community
- Men
19
Q
PROTECTIVE FACTORS
A
- Previous help seeking behaviour
- Strong dependable social supports, significant and stable relationships (family, friends, significant others) children under 18 years living at home
- Stable employment and accommodation
- Prolonged abstinence from substances
- Effective coping and problem solving skills, positive values and beliefs, hopefulness
- Availability of effective treatment, positive engagement with services, therapeutic alliance evident, awareness of early warning signs, concerns about effect of suicide on others
- Restricted access to lethal means
20
Q
CORE NURSING SKILLS FOR BEING WITH THE PERSON IN CRISIS
A
- Remain calm and regulate your emotions
- Put aside own judgement and biases
- Consider your non-verbal communication- convey calmness, portray empathy and acceptance
- Use active listening and effective communication (empathic and genuine concern and support and compassionate)
- Therapeutic engagement is key in responding to a person at risk of suicide
- Speak with and consult senior colleagues
- Never agree to secrecy with a consumer
21
Q
SUICIDE: WHAT MUST I DO? –> ASK
A
- If you think someone might be suicidal, ask them directly; ‘are you thinking about suicide’
- Don’t be afraid to do this, it shows you care and will actually decrease their risk because it shows someone is willing to talk about it
- Make sure you ask directly unambiguously
22
Q
SUICIDE: WHAT MUST I DO? –> LISTEN AND STAY WITH THEM
A
- If they say yet, they are feeling suicidal, listen to them and allow them to express how they are feeling
- Don’t leave them alone, stay with them or get someone else reliable to stay with them
23
Q
SUICIDE: WHAT MUST I DO? –> GET HELP
A
- Seek the attention of your colleagues and progress your concerns up the chain of command. Consult senior staff
24
Q
TALKING ABOUT SUICIDE
A
- Asking about suicide does not make a person suicidal- can be a relief for someone to be asked in a simple and direct way
- While we might find it challenging & uncomfortable to ask about suicide, we need to hear people’s stories
- Most people don’t want to die, they just want their pain to stop
25
WHAT DO I DOCUMENT?
- Distress→ nature and level/meaning and motivation. Is the person rational?
- Mental state→ At risk (hopelessness, despair, shame, psychosis)
- History→ Felt like this/ harmed self before? Details, circumstances, etc.
- Intent→ Level of determination; is it an impulsive or planned act?
- Current plan→ Lethality? Are plans in place? Specific details? How realistic?
- Access→ Access to lethal means? Is method irreversible? Knowledge?
- Others safety→ Is there a risk to others? Are children safe?
- Coping→ Is there coping potential and capacity? Are there supports?
26
SUICIDE AND LANGUAGE
- Suicide is no longer a crime, so we should stop saying that people ‘commit’ suicide
- We now live in a time when we seek to understand people who experience suicidal ideation, behaviours and attempts and to treat them with compassion rather than condemn them
- Part of this is to use appropriate, non- stigmatising terminology when referring to suicide
