Self harm and suicide Flashcards
Prevalence of suicide?
- Over 700,000 people take their own life each year
- 115 people die by suicide in the UK every week- 75% of those deaths being male
- 1/15 people attempt suicide
What is the prevalence of self harm?
- 1/14 people self harm
- 10% of young people self harm
What is suicide?
- Intentional self-inflicted death
- Most common cause of death in men under 35
Most common methods of suicide?
Hanging
Which MH conditions increase the risk of suicide?
- Bipolar disorder
- Depression
- EUPD
- Anorexia
- Substance abuse
- Past self harm/suicide attempts
Demographics of suicide?
- Completed suicides in UK have ratio 3:1 M:F
- Males choose more violent methods e.g. hanging and women choose less violent e.g. overdose
- Highest rates are in the elderly
- widows > divorced> single > married
- Higher ratesin unemployed and retired
- Worldwide, suicide rates are higher in spring and summer
Risk factors for suicide?
Evidence base is weak, 50% of suicides take place in people who are ‘low’ risk
* Male
* history of deliberate self harm
* alcohol or drug misuse
* history of mental illness e.g. depression and schizophrenia
* history of chronic disease
* advancing age
* unemployed
* socially isolated/living alone
* being unmarried/divorced/widowed
If a person has attempted suicide, what factors are associated with another attempt at a later date?
- efforts to avoid discovery
- planning
- leaving a written note
- final acts such as sorting out finances
- violent methods
Protective factors for suicide?
- family support
- having children at home
- religious belief
A patient has undergone deliberate self harm/ attempted suicide. What would you ask them in your assessment?
Before the act
* What precipitated it
* Was it planned or impulsive
* When did the feelings and events leading up to the act start
* Did they carry out any last acts e.g. suicide note, finances
* Did they take any precautions against discovery e.g. closing curtains, locking doors, waiting until no-one was home
* Were there any drugs/acohol involved
DURING
* What method was used
* Intention behind the act
* What were they thinking/feeling during the act
* Did they intend to end their life
AFTER
* Who found them/ did they go to a&E themselves
* How did they feel when help arrived
* How do they feel about the attempt now
* How do they feel now
* Do they still want to harm themselves
* If they went home now would they be safe not to do it again?
* Is there anything to live for
* Any coping strategies
* If they were to feel this way again what would they do differently
**Specific questions
Past psych history
Past medical history
Medication hx
Fhx
Shx
**
What specific questions would you ask if the patient had taken an overdose?
What medication or medications did the patient take?
Where did the patient get the medication from?
How much of the medication did the patient take?
What did the patient take the medication with?
What did the patient think that amount of medication would do?
What made the patient decide to take the medication/how long had they been thinking about taking an overdose for?
What did the patient do after taking the medication?
How did the patient get to the hospital?
Specific questions to ask about cutting?
Where are the cuts?
How many cuts are there?
How deep are the cuts?
How did the patient feel whilst they were cutting?
How did the patient feel when they saw blood?
What was the patient hoping the cutting would do?
Risk assessment for someone who has attempted suicide?
- do they need to be admitted?
- Risk to self? assess suicide risk as above
- Risk to others? harming others. driving, dangerous delusions/ halluications?
Risk factors for self harm?
- Witnessed DSH: environmental/genetic, learned/copycat behaviour
- Biological e.g. abnormalties in serotonin release
- Developmental: poor early care, phsyical, emotional and sexual abuse, parental separation
- Peer relations: conflicts, bullying, poor interpersonal skills
- Psychological: Identity problems, low self- esteen
- Antisocial behaviour: conduct disorder, impulsivity, substance misuse
