Suicide and self-harm Flashcards
Where is suicide in deaths of young men and in ‘years of potential life lost’?
1st. 3rd behind CHD and cancer.
Give 5 reasons that someone may want to commit suicide.
Form of protest avoiding shame alleviating mental/physical pain rest from unyielding illness only way out
What does mental illness do to the risk?
Increases it.
What does prev. self harm or attempted suicide do to risk of suicide
increases it 50-100x
How do men and women tend to commit suicide in general?
Men tend to be violent (guns, hanging)
Women tend toOD
Give the relative risks for relationship status’.
Married < single < divorced < widowed
What occupation is it most common in?
Unemployed. In employed people it is more common amongst unskilled workers. Prisoners have high rates.
On an MSE, give things that would indicate risk to self or others.
Mood: Low, suicidal thoughts/plans/intent
Thoughts: Persecutory delusions
Perception: Persecutory hallucinations
Insight: Lack of it, self-neglect.
Give the ‘before’ ‘during’ and ‘after’ questions for a suicide risk assessment.
Before: Why now? Planned? Any final acts? Try to hide your body? Tell anyone
During: What method? Why this? Alone? Where? What was going through your mind in the moment? Did you want to die? What did you do straight after?
After: Who found you? How did you get here? How do you feel now (hopeless)? If you were to go home, what would you do? What would stop you from another attempt? Will you accept treatment?
Other than the before during and after questions for a suicide risk assessment, what else should be included in the assessment for suicide?
PPH (previous attempts), screen for depression, PMH, FH, social history (important for RF): living situation, occupation, alcohol, drug use?
Give some specific OD and cutting questions to ask.
OD: What? Where did you get it? How much? Why this? Alcohol used? Take anything else?
Cutting: Why? How many and where, how deep? How did you feel whilst cutting? How did you feel when you saw your blood? What did you want the cutting to achieve?
Give 3 measures of management for ‘low’ ‘medium’ and ‘high’ risk suicide patients each.
Low: D/c to GP, crisis numbers, OOH service. Medium risk: IAPT, community mental health team, substance misuse teams. High: D/w senior. Home treatment team? Admit (last resort!)
What is self harm?
Self-poisoning or injury, regardless of the apparent purpose.
Where does the UK rank in terms of self-harm?
1st in europe
How common is self harm and how often are relapses?
Of those who have done it, 15% repeat in a year and 25% in 4 years.
Which gender is self-harm more common?
Females 4x more likely
Give five reasons why someone may self harm
Communicating a message or gaining power by escalating conflict (especially after an argument with partner)
emotional immaturity
inability to cope with stress are important. Offers a release from psychological pain by replacing with physical pain
In short term it can be rewarding and addictive.
Give 8 risk factors for self harm
Witnessing it: FHx, learned behaviour from friends/social media. Developmental: Neglect in early life. Child abuse. Parental separation.
Psychological: low self-esteem, identity problems.
Peer relations: conflicts, bullying.
How should self-harm be managed?
Address physical needs first. All need psych assessment. Focusing on: Initial risk management (risk of suicide, need for admission), ongoing risk of subsequent self-harm, relevant biopsychosocial issues
What should you do if a patient decides to leave against medical advice?
Decide if a lack of capacity or significant mental illness - ?MHA
NB can break confidentiality to gain information but not to give it.
