WEEK 6: SUICIDE Flashcards

1
Q

Avoid Stigmatising Terminology

A
  • Committed suicide
  • Successful suicide
  • Completed suicide
  • Failed attempt at suicide
  • Unsuccessful suicide
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2
Q

Use Appropriate Terminology

A
  • Died by suicide
  • Suicided
  • Ended his/her life
  • Took his/her life
  • Attempt to end his/her life
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3
Q

SUICIDE

A
  • A deliberate taking of one’s life
  • Death must be recognised as being due to suicide rather than natural causes
  • It must be established via coronial inquiry that the death resulted from a deliberate act of the deceased with the intention of ending their own life
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4
Q

SELF HARM

A
  • Deliberate causing physical harm to oneself
  • Often this is done in secret without others knowing, can include cutting, biting, burning, hitting, scratching, or picking skin to other parts of the body
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5
Q

SUICIDAL IDEATION

A
  • Thoughts, ideas or plans a person has about causing their own death (active or passive)
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6
Q

WHY DO PEOPLE SELF HARM?

A
  • Often used to try and control difficult and overwhelming feelings or to gain some kind of relief from emotional pain
  • May be used to express anger, to feel ‘something’ or communicate a need for help
  • E.g. Range of problems- feeling isolated; being bullied; current or past physical, sexual or emotional abuse/neglect; difficulty getting along with family members/friends; relationship breakdown; loss of someone close
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7
Q

SELF HARM IN AUSTRALIA

A
  • Difficult to estimate rate→ - Evidence suggests that less than 13% of young people who self harm will present for treatment
  • Lifetime prevalence rates are higher, 17% females and 12% males aged 15-19 years and 24% of females and 18% of males ages 20-24 years report self harm at some point in their life
  • Rates for females hospitalised as a result of intentional self harm out number males across all age groups
  • Rates of self harm for aboriginal australians are about 2.5 x higher (males) and 2 x higher (females) than the general population
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8
Q

SUICIDE

A
  • People with mental disorders are at increased risk of self harm and suicide (depression, bipolar disorder schizophrenia, borderline personality disorder)
  • Chronic medical illnesses are also associated with increased suicide risk (cancer, HIV, diabetes, CVA, head and spinal injury)
  • Environmental and behavioural factors can increase suicidal risk (isolation, recent loss, lack of social support, impulsivity, unstable lifestyle)
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9
Q

SUICIDE IN AUSTRALIA

A
  • Remains the leading cause of death for Australians aged between 15-44
  • In 2012 suicide accounted for 1.4% of all deaths worldwide (15th leading cause of death)
  • 2014→ approx 75% of people who died by suicide were males and 25% were females. Suicide was the 10th leading cause of death for male
  • Almost twice as many people died from suicide in Australia than in road related transport deaths
  • Suicide rates significantly higher in Aboriginal and Torres Strait Islander people
  • For every death by suicide, it is estimated that as many as 30 people attempt. 65000 suicide attempts are made per year
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10
Q

METHOD OF SUICIDE

A
  • In 2013- most frequent method of suicide was hanging, strangulation and suffocation (55.2%)
  • Followed by poisoning by drugs (13.8%) and poisoning by other methods (8%), firearms (6.5%), remaining deaths from drowning jumping and other methods
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11
Q

PREVENTION AT A NATIONAL SCALE: INDIVIDUAL LEVEL

A
  • Appropriate and continuing care after leaving EDs
  • High quality treatment (CBT and DBT) including online treatments
  • Training of GPs
  • Training of front line staff
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12
Q

PREVENTION AT A NATIONAL SCALE: POPULATION BASED

A
  • Community suicide prevention awareness programs
  • Reducing access to lethal means
  • Responsible suicide reporting by the media
  • School based peer support and mental health literacy programs
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13
Q

RISK ASSESSMENT

A
  • Ultimately, accurate prediction of suicide is impossible, this is attributed to a range of factors such as but not limited to;
  • Peoples shame and secrecy around suicidal preoccupations
  • Means of detection are not sensitive enough to quickly changing mental states
  • Suicide risk assessment is enhanced by:
  • An effective approach involves a therapeutic relationship
  • Suicide risk management must focus on short term prevention, not just long term prediction
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14
Q

SUICIDE RISK ASSESSMENT

A
  • Formal process by health professionals to gauge a person’s short term, medium and long term risk for suicide
  • Checklists developed and used in MH services and ED- important to remember assessing for suicide risk requires more care and thought than completing a checklist or assessment tool
  • There is no clinical assessment tool that predicts with total certainty whether or not a person will attempt suicide- need to make a reasonable decision based on available evidence/ information
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15
Q

SUICIDE RISK ASSESSMENT: RISK FACTORS

A
  • Suicide risk is dynamic and fluctuating
  • Risk factors are potential indicators of risk, however, tools that screen for risk factors are not sensitive or specific enough to be reliable in clinical practice

Assessment must include

  • Detailed evaluation of suicidal behaviour and ideation
  • Full psychiatric assessment
  • Determination of the psychosocial circumstances
  • If possible, assessment should include family members
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16
Q

RISK FACTORS FOR SUICIDE: INDIVIDUAL

A
  • Family history of suicidal behaviour
  • Mental illness: mood disorders, schizophrenia and other psychotic disorders, and substance related disorders
  • Previous history of suicidal behaviour
  • Childhood and adult trauma
  • Low coping potential
  • Hopelessness
  • Aggression and impulsivity
  • Worry and rumination
  • Psychological pain
  • Neurobiological and genetic factors
  • Drug and or alcohol use
17
Q

RISK FACTORS FOR SUICIDE: SOCIO- CULTURAL / SITUATIONAL

A
  • Indigenous status
  • Exposure to suicidal behaviours through sensationalist reporting by the media
  • Access to and availability of lethal means of suicide
  • Unemployment or financial crisis
  • Stressful life events
  • Relationship breakdown
  • Poor social networks
  • Social isolation, lack of social support
  • Imprisonment
  • Bereavement
18
Q

GROUPS WITH INCREASED RISK OF SUICIDE

A
  • People living in socioeconomically deprived conditions, including unemployed and homeless people
  • People living in rural and remote areas
  • Aboriginal and Torres Strait Islander people or communities
  • People in the justice system and immediately after release from prison
  • People with lived experience of mental illness
  • People with a history of previous suicide attempts
  • People who use alcohol/drugs
  • People dealing with trauma in the workplace, including first responder (e.g. police, paramedics) and former defence force personnel
  • People bereaved by suicide
  • People from the LGBTI community
  • Men
19
Q

PROTECTIVE FACTORS

A
  • Previous help seeking behaviour
  • Strong dependable social supports, significant and stable relationships (family, friends, significant others) children under 18 years living at home
  • Stable employment and accommodation
  • Prolonged abstinence from substances
  • Effective coping and problem solving skills, positive values and beliefs, hopefulness
  • Availability of effective treatment, positive engagement with services, therapeutic alliance evident, awareness of early warning signs, concerns about effect of suicide on others
  • Restricted access to lethal means
20
Q

CORE NURSING SKILLS FOR BEING WITH THE PERSON IN CRISIS

A
  • Remain calm and regulate your emotions
  • Put aside own judgement and biases
  • Consider your non-verbal communication- convey calmness, portray empathy and acceptance
  • Use active listening and effective communication (empathic and genuine concern and support and compassionate)
  • Therapeutic engagement is key in responding to a person at risk of suicide
  • Speak with and consult senior colleagues
  • Never agree to secrecy with a consumer
21
Q

SUICIDE: WHAT MUST I DO? –> ASK

A
  • If you think someone might be suicidal, ask them directly; ‘are you thinking about suicide’
  • Don’t be afraid to do this, it shows you care and will actually decrease their risk because it shows someone is willing to talk about it
  • Make sure you ask directly unambiguously
22
Q

SUICIDE: WHAT MUST I DO? –> LISTEN AND STAY WITH THEM

A
  • If they say yet, they are feeling suicidal, listen to them and allow them to express how they are feeling
  • Don’t leave them alone, stay with them or get someone else reliable to stay with them
23
Q

SUICIDE: WHAT MUST I DO? –> GET HELP

A
  • Seek the attention of your colleagues and progress your concerns up the chain of command. Consult senior staff
24
Q

TALKING ABOUT SUICIDE

A
  • Asking about suicide does not make a person suicidal- can be a relief for someone to be asked in a simple and direct way
  • While we might find it challenging & uncomfortable to ask about suicide, we need to hear people’s stories
  • Most people don’t want to die, they just want their pain to stop
25
Q

WHAT DO I DOCUMENT?

A
  • Distress→ nature and level/meaning and motivation. Is the person rational?
  • Mental state→ At risk (hopelessness, despair, shame, psychosis)
  • History→ Felt like this/ harmed self before? Details, circumstances, etc.
  • Intent→ Level of determination; is it an impulsive or planned act?
  • Current plan→ Lethality? Are plans in place? Specific details? How realistic?
  • Access→ Access to lethal means? Is method irreversible? Knowledge?
  • Others safety→ Is there a risk to others? Are children safe?
  • Coping→ Is there coping potential and capacity? Are there supports?
26
Q

SUICIDE AND LANGUAGE

A
  • Suicide is no longer a crime, so we should stop saying that people ‘commit’ suicide
  • We now live in a time when we seek to understand people who experience suicidal ideation, behaviours and attempts and to treat them with compassion rather than condemn them
  • Part of this is to use appropriate, non- stigmatising terminology when referring to suicide