Working with someone who is suicidal

Question 1

What is suicide?

Answer 1

The acting of Dying by harming yourself on purpose.

Suicide is a global problem with approximately one million deaths world-wide each year

Question 2

What is the framework for a suicide risk?

Answer 2

SAD PERSON’S ESCAPE

Question 3

What does the ‘S’ mean? (1)

Answer 3

Sex: more males die by suicide, but many more females attempt suicide

Question 4

What does the ‘A’ mean? (2)

Answer 4

Age: highest risk groups are those aged 15-24 years and those over 60 years

Question 5

What does the ‘D’ mean? (3)

Answer 5

Depression: present in as many as 70% completed suicides

Question 6

What does the ‘P’ mean? (4)

Answer 6

Previous attempt: 10-20% of those who have made a previous attempt will die by suicide

Question 7

What does the ‘E’ mean? (5)

Answer 7

Ethanol and drug abuse: 25-50% consume alcohol before taking their lives

Question 8

What does the ‘R’ mean? (6)

Answer 8

Rational thinking is impaired: 10-15% of people with schizophrenia die by suicide.

Question 9

What does the ‘S’ mean? (7)

Answer 9

Support networks: isolation, loneliness, disrupted family/whanau, family history of suicide

Question 10

What does the ‘O’ mean? (8)

Answer 10

Organised plan: presence of a plan with means to carry this out

Question 11

What does the ‘N’ mean? (9)

Answer 11

No spouse: people who live alone, are divorced or separated, or recently bereaved

Question 12

What does the ‘S’ mean? (10)

Answer 12

Sickness: 25-70% of people who died by suicide had a debilitating medical illness and a concurrent mental illness

Question 13

What does the ‘E’ mean? (11)

Answer 13

Experiences of adversity: humiliation, social and educational disadvantage, poor relationships with parents, being in trouble with the law

Question 14

What does the ‘S’ mean? (12)

Answer 14

Sexual abuse: people who have experienced all forms of abuse and neglect are at greater risk

Question 15

What does the ‘C’ mean? (13)

Answer 15

Co-morbidity: 90% of people who die by suicide suffered from an associated mental illness at the time of their death

Question 16

What does the ‘A’ mean? (14)

Answer 16

Anxiety disorders (particularly panic disorders)

Question 17

What does the ‘P’ mean? (15)

Answer 17

Personality disorders (particularly ASPD and BPD)

Question 18

What does the ‘E’ mean? (16)

Answer 18

Event: In youth, an identified stressful event preceded 70-97% of suicides

Question 19

What is the nursing role when working with someone who is suicidal?

Answer 19

• Assess for suicide risk
• Assess mental state
• Promote safety
• Explore precipitants
• Promote alternative coping strategies

Question 20

Assess for suicide risk means?

Answer 20

• 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

Question 21

Assess mental state means?

Answer 21

Assess frequently and regularly

Be sensitive to changes in the person’s mental state

Remember to collect objective and subjective data

Question 22

How can you promote safety?

Answer 22

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

Question 23

How can you promote alternative coping strategies?

Answer 23

Assess protective factors

Work with person to reframe situation

Build on persons strengths
Identify effective coping strategies

Question 24

What do you not do when someone is suicidal?

Answer 24

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

Question 25

What do you do when someone is suicidal?

Answer 25

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

Question 26

What are some questions you could ask?

Answer 26

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