Suicide, Violence and the Mental Health Act

Question 1

What is suicide?

Answer 1

The voluntary and intentional act of killing oneself. It is an action, not an illness. Aggression directed inwardly.

Question 2

What is parasuicide?

Answer 2

Gestures and attempts that are unsuccessful and of low lethality.

Question 3

What is suicidal ideation?

Answer 3

Thinking about and planning one’s own death.

Question 4

Which ethnicities are most effected by suicide?

Answer 4

Most common in caucasians and aboriginals.

Question 5

Which age groups are most likely to commit suicide?

Answer 5

Youth (15-24) and elderly (65+)

Question 6

Which gender is most likely to commit suicide?

Answer 6

Males (most successful). Females attempt more, but not as lethal.

Question 7

What are some risk factors of suicide?

Answer 7

Family disruption and dysfunction.
Childhood trauma or abuse.
Family or personal history of suicide.
Widowed, divorced, separated, single individuals.
Recent losses.
Alcohol use.
Physical illness, chronic pain.
Psychiatric disorders.

Question 8

What are the five levels of suicidal behaviour?

Answer 8

Ideation
Threats
Gestures
Attempts
Completed suicide

Question 9

How should suicide be assessed?

Answer 9

Observe behaviour
Assess risk factors
History from the patient
Information from family/friends
History of previous gestures or attempts.
Mental status exam
Physical exam
Nursing intuition

Question 10

What are some assessment criteria for assessing suicide?

Answer 10

Imminence (24 hours) vs non-imminence.

• immediate danger (specific time period)
• specific plan
• access to the means
• admission of wanting to die

Ideation vs. Intent

Severity Index for Suicide Risk

Question 11

What is a possible nursing diagnosis for a suicidal patient?

Answer 11

Risk for suicide/self-directed violence.

Question 12

What are the treatment goals for a suicidal patient?

Answer 12

Free from self harm/suicide ideation

Verbalizes desire to live, self-worth, goals, future plans

Contracts for safety

Mood improved

Spontaneous interactions

Effective coping, support system

Question 13

What are some nursing interventions we can do for suicidal patients?

Answer 13

Safety (put them in pajamas, closer to the nursing station, etc.)

Coping skills

Documentation

Question 14

What is done during the evaluation step of the nursing process with a suicidal patient?

Answer 14

Assessment is ongoing

Importance of crisis planning when well.

Question 15

What is the definition of anger?

Answer 15

An affective state experienced as the motivation to act in ways that warn, intimidate, or attack those who are perceived as challenging or threatening; temporary state of emotional arousal; strong and uncomfortable.

Question 16

What is the definition of aggression?

Answer 16

behaviours or attitudes that reflect rage, hostility, and

the potential for physical or verbal destructiveness

Question 17

What are some risk factors for violence?

Answer 17

Aggression learned, family role modeling

Alcohol and drug abuse

History of violence

Mental health disorders

Lack of coping skills

Medical conditions

Mental disabilities, low IQ

Question 18

What are some assessment criteria for violence?

Answer 18

Increase in motor agitation
Threatening verbalizations
Intensification of affect
Prior history of assaultive behaviour

Question 19

What are some examples of increased motor agitation in a potentially violent patient?

Answer 19

Pacing
Inability to sit still
Sudden cessation of motor activity

Question 20

What are some examples of threatening verbalizations in a potentially violent patient?

Answer 20

Retaliation towards those seen as threats.
Response to threatening visual/auditory hallucinations.
Response to delusional thinking.

Question 21

What are some examples of intensification of affect in a potentially violent patient?

Answer 21

Tense expression
Jumpiness
Elated expression

Question 22

What are some examples of prior history of assualtive behaviour in a potentially violent patient?

Answer 22

Has acted violently in the past
Has been violent under stress in the past
This is the single best predictor

Question 23

What are the four levels of crisis development in a violent situation?

Answer 23

1. Anxiety
2. Defensive/Anger and Hostility
3. Acting out
4. Tension reduction

Question 24

What are some signs that someone is at the “anxiety” level of crisis development? (violence)

Answer 24

Change, restless, excess energy, pacing, wringing hands, muttering

Question 25

What are some signs that someone is at the “defensive/anger and hostility” level of crisis development? (violence)

Answer 25

Verbal/nonverbal cues, screaming, swearing, loss of control.

Question 26

What are some signs that someone is at the “acting out” level of crisis development? (violence)

Answer 26

Total loss of control, physical assault.

Question 27

What are some signs that someone is at the “tension reduction” level of crisis development? (violence)

Answer 27

Emotionally drained, withdrawn, remorseful, apologetic

Question 28

What should the nurse’s response be at level 1 (anxiety) level of crisis? (violence)

Answer 28

Be supportive. Respectful, empathetic, listen, validate, reassure, encourage, help.

Question 29

What should the nurse’s response be at level 2 (defensive) level of crisis? (violence)

Answer 29

Directive.

Limit choices, be clear and calm, offer information, discuss consequences.

Question 30

What should the nurse’s response be at level 3 (acting out) level of crisis? (violence)

Answer 30

Non-violent interventions.

Offer PRN, utilize seclusion

Question 31

What should the nurse’s response be at level 4 (tension) level of crisis development? (violence)

Answer 31

Therapeutic rapport.

Review, talk about acceptable behaviour, consequences.

Question 32

What are the four criteria for involuntary admission criteria?

Answer 32

A patient must meet all four of the following criteria:

Is suffering from a mental disorder that seriously impairs his/her ability to react appropriately to his or her environment or to associate with others.

Requires psychiatric treatment in or through a designated facility.

Requires care, supervision & control through a designated facility to prevent risk of harm to self &/ or others.

Is not suitable as a voluntary patient.

Question 33

What are the involuntary patient’s right under the mental health act?

Answer 33

Hospital’s name and location

Reason for admission and hospitalization

Contact and instruct a lawyer or advocate

Regular reviews by a physician

Application for a review panel

Validity of detention determined in court

Apply to court for discharge

Second medical opinion

Question 34

What is a form 4?

Answer 34

Medical certificate (to hold someone in the psych ward involuntarily).

Question 35

What is a form 5?

Answer 35

Director’s consent (director or PCC is made aware that a patient is being held involuntarily on the unit).

Question 36

What is a form 6?

Answer 36

Renewal of form 4 (to extend the amount of time they can be held involuntarily)

Question 37

What is a form 7?

Answer 37

Application for a review panel (the patient has a right to this).

Question 38

What is a form 13?

Answer 38

Notification of rights (patient signs this when they are held involuntarily)

Question 39

What is a form 20?

Answer 39

Extended leave (they live in the community but they can be brought back to psych ward against their will if they meet certain criteria)