MODULE 10; crisis work, suicidal ideation & self-harm. Flashcards
distinguish between myths and facts about suicide and self-harm
Australia 2019 (12.9 suicides per 100,000 people). Males are at greater risk of dying by suicide than females (19.8 versus 6.3 suicides per 100,000 people for males and females, respectively). The median age of death by suicide in Australia is 44 years. In people aged 15 to 24 years, over one-third of all deaths are by suicide, making it the leading cause of death in this age group. Hanging, strangulation or suffocation is the most common means of suicide (AIHW, 2020). The second leading cause is poisoning by drugs, which is more common among females than males. By state, the highest suicide rates are in the Northern Territory, followed by Tasmania.Around the world, communities impacted by colonisation are at elevated risk of death by suicide. Despite unique social and cultural contexts, these communities all share ‘a profound and deep-seated loss of control over life and land’. Evidence has demonstrated that self-determination and agency within communities is associated with dramatically lower rates of youth suicide. In the field of Indigenous suicide prevention, self-determination means ‘control over the process of prevention, diagnosis and healing’ .
There is also a high correlation between deaths by suicide and psychiatric diagnoses. Multiple studies using psychological autopsy information as a background show that 90% of people who die by suicide are affected by one or more psychiatric disorders. Among the most common ones are:
Major depressive disorder
Bipolar disorder, in the depressive phase
Alcohol or substance abuse
Schizophrenia
Personality disorders e.g. borderline personality disorder.
Other studies have shown that suicide is not predictable in individuals. It affects people across cultures, incomes and educational levels. In short, there is no typical suicide victim; however, some groups experience a greater balance between risk and protective factors.
Most who have suicided, have talked about or given other hints re intention. Difficulty is in picking up on it.
MOst suicidals have “suicidal ambivalence”, partly want to life but suicide seems only way out.
Men 4 x more likely than women to suicide but women 3 x more likely to attempt.
Talking about suicide with a depressed operson does not increase their risk of attempting.
Many suicide attempts within days or weeks after “an improvement” because then have energy to carry out plan.
There is rarely purely 1 event that leads to suicide, usually several factors have contributed (although may have 1 more significant 1).
outline risk factors for suicide
important to remember risk and protective factors change over time. risk needs to be reviewed over time.
RISK FACTORS;
1.Psychiatric disorders;
Depression is most linked to suicide esp in combo with substance abuse.Bi-polars and schizophrenics also at risk. Often these conditions then combine with perceived or actual loss of control, to tip over into suicidal thoughts. 45-70% of suicides have an affective disorder.
2. Prior attempt at suicide-for those who attempt, 10% will suicide within 10 years. 2 or more attempts= greater risk.
3, Symptom Risk Factors; The following symptoms (esp if occurring during a major depressive episode), increase risk;
-Severe anxiety, as this may indicate energy or motivation toward action
-Anhedonia i.e. the ability to feel any pleasure in activities that used to be fun and stimulating
-Alcohol abuse, especially with increased consumption during episodes.
-Feelings of hopelessness, helplessness and -guilt
-Insomnia
-Increase in risk-taking behaviour
-Psychotic symptoms, especially in hospitalised depression
-Recent hospitalisation following an attempt
19% of people who die by suicide are in the middle of a psychotic episode, e.g. having delusions and/or hallucinations; exhibiting bizarre behaviour, or suffering from formal thought disorders.
Other long-term risk factors include major physical illness (especially recent); chronic physical pain; a history of childhood trauma, abuse or of being bullied; family history of death by suicide, or knowing of someone in school or community; and drinking and/or drug use. All of these are acute and long-term risk factors but are usually in the presence of major depression or other psychiatric illnesses. Research on family relationships and suicide rates also shows that these types of risk factors are closely linked to the two-factor solution—that is, depression plus personality of aggression or impulsivity. This also explains why women have more cases of depression but less suicide.
4. Socio-Demographic Risk Factors;
(increased risk with Depression);
-Males often choose more violent and lethal methods
-Older adults are more likely to use lethal means, and less likely to convey thoughts or plans
-Separated, widowed or divorced. Especially important when a male client
-Living alone
-Lack of actual or perceived social support
-Being unemployed or retired
-Recent losses of ability, status, loved ones
-Recent social withdrawal from support
-Improvement following hospitalisation
5.Environment;
Among the key environmental factors is the ease of access to lethal means and local clusters of suicide having a contagious influence. Multiple studies have shown that the availability of firearms; bridges without barriers; pills packed in large numbers instead of blister packs; toxic domestic gases; vehicle emissions and so on.
outline protective factors against suicide
Individual protective factors include things like being of good health mentally and physically; having a range of adaptive coping skills; managing or having limited use of intoxicating substances e.g. drugs and alcohol; levels of self-esteem, self-efficacy and self-control; having a sense of meaning and purpose, and being female.
The following are all social protective factors:
-Security: both physical and emotional
-Supportive social and family relationships
-Good communication skills
-No family history of suicide and, if present, positive adaptation to mental illness
The following are all environmental protective factors:
-Safe and secure living arrangements
-Financial security, employment
-Positive educational experience
-Limited exposure to environmental stress
-Access to support services
describe some strategies for working with clients who are suicidal or who self-harm.
If high risk, should have psychiatric evaluation in an emergency department; the availability of a concerned individual; potential hospitalisation and means restriction.
WARNING SIGNS;
-Talking about suicide and making a plan.
-Self-harming behaviour
-Prior suicide attempt(s)
-Finalising affairs e.g. organising a will
-Sense of helplessness and hopelessness
-Social withdrawal
-Ceasing activities
I-ncreased alcohol or drug use
-Uncharacteristic behaviour
-Many changes consistent with depression e.g. change in hygiene, personal appearance, physical apathy, changed eating patterns, general loss of interest.
It is important to be direct and non confrontational. Sympathise with reasons why feel suicidal without viewing as only option.
Is it important to remember that there is a difference between non-suicidal morbid ideation i.e. thoughts without specific content, and suicidal ideation, thoughts with specific content.
EVALUATING RISK LEVEL;
1. specificity-the more detailed the plan, the more risk.
2.Lethality-how quickly the planned action would produce death.
3.Availability-how quickly can the plan be implemented
4.Proximity-how close is nearest support/help resources.
5.Self-control;history of losing control or fear of losing control=greater risk.
6.Assessing intent;self report. 1= no intent. 10=total intent.
7. Decision-making;
Mild: suicidal ideation; no specific or concrete plans; few risk factors present; and many protective factors present.
Moderate: suicidal ideation; general plan exists; self-control intact; several reasons to live provided; no intent; some risk factors present; some protective factors present.
Severe: suicidal ideation is frequent and intense; suicide plan is specific, lethal and available; few nearby resources; self-control is questionable; intent appears absent, and there are many risk factors present.
Extreme: same as the severe category; clear intent to die by suicide; many risk factors present; and no protective factors present.
LOW-MODERATE RISK;
-able to be short term safe
-usually outpatient
-put a risk reduction/crisis management plan in place including who/how to contact
-focus on self-management plans. Might include behavioural activation, emotional regulation strategies and social support.
-check in regularly
-ensure cry for help is heard
HIGH RISK;
-imminent threat to life
-unable or unwilling to keep themselves safe
-aim to keep client with you or hand over to others
-contact relevant parties
-provide clear assessment of client’s risk level
-if inadequate social support, likely need hospital admission.
-beware of increased risk post hospitalisation, so ensure support etc services linked in and ongoing.
STAGES OF SUICIDE INTERVENTION
1. Connect with. Ask about/explore signs of distress/warning signs. Be direct about asking about suicide intentions.
2. Understand. Listen to full story. Empathise. Often the first step to being able to move forward, occurs when feel have been fully understood.
Look out for turning points-points where the person shows might want to live and highlight these. These can lead into a safety plan.
3. Form a safety plan. Remove or get others to assist in removing, any suicidal means. Remove meds/drugs, ask others for help. Assess and respond to mental health needs. Identify strengths and supports.
If there is no agreement, activate 24-hour monitoring. Involve the family, police welfare checks and the crisis assessment team (CAT). If there is an immediate risk of harm to self or others, activate the emergency responses and call for emergency services.
