Suicide and Deliberate Self Harm

Question 1

• The majority of people suffering from a psychiatric illness do not take their own life
• However, the majority of people who take their own life____1____
• Deliberate self harm is different from suicide but there is overlap _____2____
• Most people who deliberate self harm do _____3____

Answer 1

1. do have a major psychiatric illness
2. in those who die by accident from DSH or those trying to take their own life who do not succeed
3. not have a major psychiatric illness

Question 2

Are suicide rates higher in men or women? What may partly explain this?

Answer 2

higher in men
men tend to choose more lethal methods of suicide so their rate of completion of attempts is higher

Question 3

Majority of suicides are in what age?

Answer 3

middle age

Question 4

Suicide rates are higher in?

Answer 4

deprived areas
higher in urban areas vs rural areas

Question 5

Marriage is _____ of suicide

Answer 5

protective of suicide - but this may be because those who have a psychiatric illness are less likely to get married

Question 6

What occupations have higher rates of suicide, what is thought to be the reason?

Answer 6

Farmers, vets and doctors have higher rates of suicide and this is thought to be due to access to high end modes of lethality

Question 7

People who smoke ____

Answer 7

have higher rates of suicide, but this may be because smoking rates are high in psychiatric patients

Question 8

What specialities of doctors have highest rates of suicide?

Answer 8

anaesthetists, GPs and psychiatrists

Question 9

What is the effect of media reporting on suicide?

Answer 9

increased reporting, increases suicide
e.g. 13RW tv show increased rates, so did talk about Robin Williams death

Question 10

Rates of suicide by a particular method ___________

Answer 10

correlate very much with the availability of that particular method

Question 11

What is a suicide pact?

Answer 11

• This is an agreed plan between 2 or more individuals to die by suicide
• The plan may be to die together, separately or closely timed
• They are unusual and only 1/3 are completed

Question 12

What is murder suicide?

Answer 12

• An act in which an individual kills one or more people before or while killing oneself
• The other people haven’t consented to being killed

Question 13

Why is limiting access to a particular method of suicide important?

Answer 13

• Limiting access to a method of suicide is important because reducing suicide by one method does NOT result in a compensatory rise in other methods
• Restricting access leads to overall reduction, not everyone substitutes with a different method and those that substitute may choose a lower lethality method

Question 14

What help could you give those at risk of suicide?

Answer 14

hospital
crisis medication
action plan for when they have suicidal thoughts
suicide help apps that help with these action plans and links to organisations can phone for help

Question 15

What is the link between chronic illness and suicide?

Answer 15

• About 10% of suicides have a chronic or long term illness
• Contribution of those with a cancer diagnosis is actually quite small
• the highest rates tend to be in those with chronic, debilitating, dignity losing conditions such as MND and Parkinsons

Question 16

DSH can be thought of as a _____

Answer 16

maladaptive coping skill- physical pain to distract from distressing thoughts

Question 17

DSH is a different population from suicides and is most common in ________

Answer 17

women in early adulthood

Question 18

Most episodes of DSH are _____

Answer 18

self poisoning

Question 19

If DSH is bizarre it is more likely to be ______

Answer 19

a psychosis

Question 20

What are the strongest risk factors for suicide?

Answer 20

previous DSH or failed suicide attempt

Question 21

Methods to deal with DSH?

Answer 21

• Methods to deal with DSH can involve giving alternative methods
• If the pain is what helps then can recommend, holding cold ice cubes, elastic bands and chilly peppers, if the blood is what helps could recommend red pain or red dye ice cubes that you hold

Question 22

TCA overdose is treated with?

Answer 22

sodium bicarbonate

Question 23

Benzodiazepine overdose is treated with?

Answer 23

flumazenil

Question 24

Paracetamol overdose is treated with?

Answer 24

N-acetyl cysteine

Question 25

Suicide risk can be thought of in terms of ___________

Answer 25

thoughts, intentions, plans

Question 26

How much of the population in a week will have suicidal thoughts?

Answer 26

3-5% - these people dont then all need hospitalised

Question 27

What can be used to give a baseline suicide risk score?

Answer 27

SAD PERSONS SCORE

Question 28

Suicide risk assessment, before questions? (5)

Answer 28

• Was there a precipitant e.g. argument, bereavement
• Was the self harm planned or impulsive?
• Did the patient carry out any final acts e.g. suicide note, will terminating contracts?
• Were any precautions taken against discovery e.g. locking doors, curtains closed, home alone?
• Was alcohol used?

Question 29

Suicide risk assessment, during questions? (6)

Answer 29

• What method of self harm was involved?
• Was the patient alone?
• Where were they when they self harmed?
• What was going through their mind at the time?
• Did they think the self harm would end their life?
• What did they do straight after the self harm?

Question 30

Suicide risk assessment,, after questions? (9)

Answer 30

• Did they call anyone? A and E? Who found them?
• How did they feel when help arrived?
• How do they feel about the attempt now? Regrets?
• What is the patient’s current mood?
• Does the patient still feel suicidal?
• If the patient were to go home today what would they do?
• What does the patient think might prevent them from doing this again in the future?
• Does the patient feel there is anything to live for?
• Will the patient accept treatment?

Question 31

Screening for other mental health disorders in suicide risk assessment?

Answer 31

• Depression and Bi-Polar – “You are describing a period of feeling very low but have you ever had periods where you have felt the complete opposite and felt very high and elated?”
• Psychosis – “It might seem like an odd question but something we ask everyone, have you had any thoughts that aren’t your own or heard voices that other people can’t hear?”
• Anorexia – ask about diet and exercise