Week 6 - Self Harm and Suicide

Question 1

Risk Factors:

Answer 1

Social and Cultural factors

• Stressful life events / personal pressures
• Alcohol & Substance abuse

Question 2

At risk groups:

Answer 2

• Men
• Aboriginal and Torres Strait Islander people
• people in rural or remote communities
• people being treated for a mental illness in a mental health facility or who have been recently discharged from hospital
• people who have previously attempted suicide or who engage in self-harm
• people with alcohol and other substance use disorders
• people with a history of trauma or abuse
• people with a major physical illness

Question 3

Warning signs

Answer 3

• withdrawal
• isolation
• Depression
• behaviouralchanges (insomnia, weight loss)
• risk-taking or impulsive behavior(s)
• writing or drawing about death
• direct comments about death or suicide
• self-harm / repeated self-harming behaviour(s)
• a suicide plan
• collecting or purchasing the means for suicide
• finalisingaffairs (ie: will, transferring money into family members’ account)

Question 4

How do you find out if someone is suicidal?

Answer 4

1. Ask in a conversational, respectful and sensitive manner to allow for discussion
2. Listen and encourage & allow them to tell their story.
3. As they tell their story, take note:
   * Are they expressing sadness, anxiety or a sense of lowered
   mood?
   * Are they expressing hopelessness or helplessness?
4. If they are feeling hopeless, have they had any thoughts about death or suicide:
   - are they thinking about acting on them (intent)?
   - if they are thinking about harming themselves have they thought about what they might do (plan)?
   * assess access to means
   -how likely is it that they will hurt themselves and when are
   they thinking about doing it (immediate risk to safety)?
5. Ask if they have previously:
   -committed suicide
   -context & feelings
   -was anyone involved
   -outcome & feelings
   5.Ask if they have any plans to harm anyone
   * as certain if other people’s safety are also at risk
6. Ask if there is someone or something that prevents them from feeling or being suicidal (protectivefactors).
   * explore this and assess protective strength
7. Ask if there someone else they can talk to about the situation
8. Ask if they have tried to seek help

Question 5

Nursing Care – Immediate Interventions for the person who has attempted suicide in the Community

Answer 5

1. Contact Police/Ambulance
2. protect (remove lethal articles/means of self-harm) & stay with the consumer (if safe to do so)
3. management of physical injury as required/appropriate – First Aid (consider personal safety)
4. inform Community Mental Health Team of incident & seek immediate support (‘back-up’)
5. therapeutic communication and engagement
6. with emergency service(s), convey consumer to nearest hospital for physical and mental assessment and care
7. consider the application of the NSW MH ACT to facilitate involuntary transport and detention to Hospital
8. Undertake a mental health assessment if possible

Question 6

Protective Factors and suicide

Answer 6

These include:
 strong perceived social supports
 family cohesion
 peer group affiliation
 good coping and problem-solving skills
 positive values and beliefs
 Resilience
 Faith / Religion / Spirituality

Question 7

Most common forms of direct self-harm include:

Answer 7

• cutting
• scratching / picking
• burning
• pulling out hair
• hitting oneself
• overdosing on prescription or illegal drugs

Question 8

Nursing care for self-harm

Answer 8

Dialectical BehaviouralTherapy (DBT)

i. Mindfulness
ii. Emotional Regulation
iii. Distress Tolerance
iv. Interpersonal Effectiveness Skills for maintaining relationships
- Other Therapies:
i. Interpersonal Therapy (IPT)
ii. Problem Solving Therapy (PST)