Working with someone who is suicidal Flashcards
What is suicide?
The acting of Dying by harming yourself on purpose.
Suicide is a global problem with approximately one million deaths world-wide each year
What is the framework for a suicide risk?
SAD PERSON’S ESCAPE
What does the ‘S’ mean? (1)
Sex: more males die by suicide, but many more females attempt suicide
What does the ‘A’ mean? (2)
Age: highest risk groups are those aged 15-24 years and those over 60 years
What does the ‘D’ mean? (3)
Depression: present in as many as 70% completed suicides
What does the ‘P’ mean? (4)
Previous attempt: 10-20% of those who have made a previous attempt will die by suicide
What does the ‘E’ mean? (5)
Ethanol and drug abuse: 25-50% consume alcohol before taking their lives
What does the ‘R’ mean? (6)
Rational thinking is impaired: 10-15% of people with schizophrenia die by suicide.
What does the ‘S’ mean? (7)
Support networks: isolation, loneliness, disrupted family/whanau, family history of suicide
What does the ‘O’ mean? (8)
Organised plan: presence of a plan with means to carry this out
What does the ‘N’ mean? (9)
No spouse: people who live alone, are divorced or separated, or recently bereaved
What does the ‘S’ mean? (10)
Sickness: 25-70% of people who died by suicide had a debilitating medical illness and a concurrent mental illness
What does the ‘E’ mean? (11)
Experiences of adversity: humiliation, social and educational disadvantage, poor relationships with parents, being in trouble with the law
What does the ‘S’ mean? (12)
Sexual abuse: people who have experienced all forms of abuse and neglect are at greater risk
What does the ‘C’ mean? (13)
Co-morbidity: 90% of people who die by suicide suffered from an associated mental illness at the time of their death
What does the ‘A’ mean? (14)
Anxiety disorders (particularly panic disorders)
What does the ‘P’ mean? (15)
Personality disorders (particularly ASPD and BPD)
What does the ‘E’ mean? (16)
Event: In youth, an identified stressful event preceded 70-97% of suicides
What is the nursing role when working with someone who is suicidal?
- Assess for suicide risk
- Assess mental state
- Promote safety
- Explore precipitants
- Promote alternative coping strategies
Assess for suicide risk means?
- Suicidal ideation
- Suicide plan - do they have the means to carry out this plan, have they set a date
- Recent stressors
- Impulsivity and substance use
Assess mental state means?
Assess frequently and regularly
Be sensitive to changes in the person’s mental state
Remember to collect objective and subjective data
How can you promote safety?
Being with people – fosters the therapeutic relationship and promotes participation in living
Minimise environmental hazards
Levels of observation
On-going monitoring and documentation of mental state and suicide risk
How can you promote alternative coping strategies?
Assess protective factors
Work with person to reframe situation
Build on persons strengths
Identify effective coping strategies
What do you not do when someone is suicidal?
Dismiss threats of suicide or self-harm
Agree to keep a person’s suicidal ideation a secret
Feel pressured to have the right answer
Be judgemental or dismissive towards the person
Be afraid to ask the person whether they are thinking about suicide of self-harm
What do you do when someone is suicidal?
Act immediately if there is a risk
Provide opportunities for the person to speak openly
Demonstrate empathy and willingness to listen
Ensure safe environment for the person, yourself and others
Document carefully
Be aware of your own reactions and feelings
Keep within your role
What are some questions you could ask?
You’ve told me a bit about what is happening
Have you had thoughts of hurting yourself?
Have you ever tried to hurt yourself?
Do you ever have thoughts of hurting someone else?
In addition explore planning:
Ask about how (pills, hanging, weapons)
Ask about access (what pills have you got now)
Ask about a timeframe (when)
Ask if family/friends have died by suicide
