[16] Suicide

Question 1

What is suicide?

Answer 1

Suicide is a fatal act of self-harm initiated with the intention of ending one’s own life

Question 2

What is attempted suicide?

Answer 2

The act of intentionally trying to take one’s own life with the primar aim of dying, but failing to succeed in this endeavour

Question 3

What is a risk assessment in a psychiatric context?

Answer 3

Assessing the risk of self-harm, suicide, and/or risk to others

Question 4

What are some protective factors against suicide?

Answer 4

• Children at home
• Pregnancy
• Strong religious or spiritual beliefs that suicide is immoral
• Strong social support
• Positive coping skills
• Positive therapeutic relationship
• Supportive living arrangements
• Life satisfaction
• Fear of the physical act of suicide
• Fear of disapproval by society
• Responsibility for others
• Hope for the future

Question 5

What are the clinical risk factors for suicide?

Answer 5

• History of DSH or attempted suicide
• Psychiatric illness
• History of childhood sexual or physical buse
• Family history of suicide or suicide attempt in first-degree relatives
• Medical illness

Question 6

How much does a history of DSH increase the risk of suicide?

Answer 6

50-100x compared to general population

Question 7

What psychiatric illnesses increase the risk of suicide?

Answer 7

• Depression
• Schizophrenia
• Substance misuse
• Alcohol abuse
• Personality disorder

Question 8

What features of a medical illness increases the risk of suicide?

Answer 8

• Physically disabling
• Painful
• Terminal

Question 9

What are the socio-demographic risk factors for suicide?

Answer 9

• Male gender
• Age between 40-44
• Unemployment and low socioeconomic status
• Certain occupationals
• Access to lethal means
• Low social support, living alone, or institutionalised
• Marital status - single, widowed, seperated, or divorced
• Recent life crisis, e.g. bereavement, family breakdown

Question 10

How much more likely are men to commit suicide than women?

Answer 10

3x

Question 11

Why are male suicide attemps more likely to be successful?

Answer 11

Because they are more likely to be violent

Question 12

What occupations are at an increased risk of suicide?

Answer 12

• Vets
• Doctors
• Nurses
• Farmers

Question 14

What characteristics do individuals who are suicidal usually have?

Answer 14

• Preoccupation with death
• Sense of isolation and withdrawal from society
• Emotional distance from others
• Distraction and lack of pleasure
• Focus on the past
• Feelings of hopelessness and helplessness

Question 15

How is suicide investigated?

Answer 15

• History
• MSE
• Medical investigations according to the method, e.g. drug levels
• Questionnaires - Tool for Assessment of Suicide Risk, Beck Suicide Intent Scale

Question 16

What information can help you determine the risk of suicide in terms of how serious the attempt was?

Answer 16

• Was a note left behind?
• Was the attempt planned or impulsive?
• Had they attempted to avoid discovery?
• Was help sought afterwards?
• Violent method?
• Were they any final acts, e.g. sorting out finances, writing a will

Question 17

How should a suicidal patient be managed acutel?

Answer 17

• Ensure safety
• Medically stabilise if they have attempted suicide
• Risk assessment
• Admission to hospital or observation in a safe place
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Question 18

How should a patients safety be ensured after a suicide attempt?

Answer 18

Immediate action should include removing means for suicide and ensuring the safety of the patient and others

Question 19

When is admission to hospital or observation in a safe place indicated?

Answer 19

If the individual poses a high and immediate risk of suicide

Question 20

When might the Mental Health Act be required after a suicide attempt?

Answer 20

If the patient refuses help and there is evidence of mental illness

Question 21

How should a suicidal patient be managed on a more long-term basis?

Answer 21

• Psychiatric treatment
• Involvement of the Crisis Resolution and Home Treatment team on discharge
• Consider referral to secondary care, or outpatient and community treatment
• Implement prevention strategies

Question 22

When should referral to secondary care be considered in suicidal patients?

Answer 22

• Suicidal ideation clearly stated
• Underlying psychiatric illness is severe
• Lack of social support
• Presentation change for an individual who has repeatedly self harmed

Question 23

When might Crisis Resolution and Home Treatment team be instrumental?

Answer 23

In providing support immediately following discharge

Question 24

Who might outpatient and community treatment be more suitable for in suicidal ideation?

Answer 24

Those with chronic suicidal ideation, but no history of previous significant suicide attempts

Question 25

What is required for management of chronic suicidal ideation in an outpatient and community setting to be successful?

Answer 25

A strong support network and easy access to outpatient and community facilities

Question 26

Give some individual suicide prevention strategies

Answer 26

• Detect and treat underlying psychiatric disorders
• Urgent hospitalisation under the Mental Health Act
• Involvement of Crisis Resolution and home treatment team

Question 27

Give some population level suicide prevention strategies

Answer 27

• Public education and discussion
• Reducing access to means of suicide, e.g. encouraging patients to dispose of unwanted tablets, safer prescribing, safety rails at high places
• Easy, rapid access to psychiatric care or support groups, e.g. Samarians (who provide emergency 24 hour support)
• Decreasing social stressors, e.g. unemployment and domestic violence
• Reducing substance misuse