Transcript Suicide Prevention - University of Kansas Medical Center

Suicide Prevention
Signs, Symptoms, and Solutions
There is but one truly serious philosophical
problem, and that is suicide. Judging whether life is
or is not worth living amounts to answering the
fundamental question of philosophy. All the rest -comes afterward. These are games; one must first
answer.
ALBERT CAMUS An Absurd Reasoning
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French author, journalist & philosopher (1913-1960)
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Mick Jagger, nominated for a Golden Globe for his music in "Hotel Rwanda" arrives with L'Wren Scott for the 62nd
Annual Golden Globe Awards on Sunday, Jan. 16, 2005, in Beverly Hills, Calif.
(KEVORK DJANSEZIAN/AP)
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ANDREW RYAN
The Globe and Mail
Published Friday, Mar. 28 2014, 10:07 AM EDT at http://www.theglobeandmail.com/life/celebrity-news/the-a-list/lwren-scott-leaves-9-million-estate-to-mickjagger-and-nothing-to-her-siblings/article17716501/ Accessed March 28, 2014.
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49-year-old L’Wren Scott was found dead in her Manhattan
apartment on March 17. The New York City medical
examiner determined that “she killed herself by hanging.”
“According to public records, Scott’s personal estate was
worth approximately $9 million” ANDREW RYAN The Globe and Mail
Published Friday, Mar. 28 2014, 10:07 AM EDT at http://www.theglobeandmail.com/life/celebritynews/the-a-list/lwren-scott-leaves-9-million-estate-to-mick-jagger-and-nothing-to-hersiblings/article17716501/ Accessed March 28, 2014.
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Beautiful and elite, this celebrity fashion designer’s world
crashed
The day after Scott’s death, Jagger wrote on his website,
“I am still struggling to understand how my lover and best
friend could end her life in this tragic way. We spent many
years together and had made a great life for ourselves.
She had great presence and her talent was much admired,
not least by me ... I will never forget her."
www.mickjagger.com Accessed April 4, 2014
We ask …
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How can this happen?
How can someone make a decision against
life?
Stunned loved ones wonder what they
missed, what they could’ve done, left behind
to feel guilt, shame, bewilderment.
American individualism?
Or are communal values the priority?
Suicide
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Blue collar, white collar, rich, poor, homeless
Men more than women (women make more
attempts)
Caucasian and Native Americans (more than
African-Americans and Asians)
Firearms most commonly used, followed by
hangings
Suicide affects our community
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Causes and reflects immeasurable pain, suffering,
and loss to individuals, families, and communities
nationwide.
For every suicide more than 30 others attempt
suicide annually
Each attempt and death affects countless other
individuals.
Family members, friends, coworkers, and others
suffer the long-lasting consequences of suicidal
behaviors.
SAMSHA 2012 National Strategy Overview at
http://www.surgeongeneral.gov/library/reports/national-strategy-suicideprevention/overview.pdf. Accessed April 4, 2014.
Cultural and Historical Aspects
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Honor/shame
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Western Judeo-Christian culture
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Some religious and cultural traditions sanction suicide
(Islamic sects, Hindu widows, Japanese disgrace, Chinese
political corruption) Use of insecticides
Common Era church leaders concerned by high rates of
suicide related to martyrdom. St Augustine’s City of God
proscription
Romans
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initially accepted suicide but later outlawed all manners of
reducing the population
England and colonial United States
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England and colonial U.S.
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King Edgar proclaims goods of a person who dies
by suicide are forfeited.
Henry de Bracton (13th century jurist) declares
suicide a crime
17th century suicides considered criminal even if
there was evidence of mental illness
This history provides the backdrop for our
modern perspectives of suicide
IOM,2002. Reducing Suicide pp 24-5.
Yet over the last millennium the
associations still very similar
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Serious mental illness
 Depression, Schizophrenia, Bipolar Disorder,
Personality DO
Alcohol and substance abuse
Medical co-morbidities
 Head trauma, neurological d/o, HIV, cancer
Childhood loss
Loss of a loved one
Fear of humiliation
Economic dislocation
Insecurity
IOM, 2002. Reducing Suicide p 21
Emotional and Economic costs in U.S.
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Suicide outnumbers homicides by 2:1 now
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>38,000 per year; >1 person every 15 minutes
Suicide outnumbers death from AIDS
Suicide outnumbers deaths from war
Lost productivity; $11 billion to 25 billion
The loss in terms of emotional, spiritual life is
beyond calculation
Contagion
Stigma makes it worse
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Suicidal behaviors are often met with silence
and shame
Families of suicide victims often experience
the same
The stigma of suicide can be a formidable
barrier to providing care and support to
individuals in crisis and to those who have
lost a loved one to suicide.
SAMSHA 2012 at
Suicide is a serious public health problem
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1958 U.S. Public Health Service first suicide
prevention center
1966 Center for Suicide Studies (NIMH)
1980s CDC task force; youth violence
1990s World Health Organization concern
1996 Prevention of Suicide: Guidelines for the
Formulation and Implementation of National
Strategies by the UN and WHO
1998 Private/public partnerships respond
Federal commitment Healthy People 2010 to reduce
rate to 6/100,000 (1/2 current)
The 1999 Surgeon Generals Call to Action
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David Satcher MD
Reduce the suicide rate to 6 by 2010
Begin educational efforts for suicide
prevention, target mental illness while
program being developed
Followed by the 2001 National Strategy for
Suicide Prevention published by U.S. DHHS
and Public Health Service.
The Public Health Approach
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Public health model
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Define the problem--surveillance
Identify causes--risk and protective factor
research
Develop and test interventions
Implement intervention
Evaluate effectiveness
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Effectiveness is difficult to measure; no control, no
placebo group, may take decades
National Strategy for Suicide
Prevention
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“The National Strategy provides a framework
that helps communities to devise their own
broad-based empowering strategies for
reducing suicides. It employs the public health
approach, which has helped the nation
effectively address problems as diverse as
tuberculosis, heart disease, and unintentional
injury.”
http://www.surgeongeneral.gov/library/reports/national-strategysuicide-prevention/index.html
http://www.samhsa.gov/nssp
http://www.actionallianceforsuicideprevention.org/NSSP
The Assumption
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The approach assumes that raising general
public awareness about the extent to which
suicide is a problem, and about the ways in
which it can be prevented, can reduce suicide
and suicidal behaviors.
The Second Wave is now here
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The initial 2001 publication was by the
National Institute of Mental Health (NIMH)
The 2012 National Strategy is a joint effort by
the Office of the U.S. Surgeon General and
the National Action Alliance for Suicide
Prevention (Action Alliance), intended to
guide prevention activities the next 10 years.
Important achievements the past 10 years
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Garrett Lee Smith Memorial Act
Creation of the National Suicide Prevention
Lifeline (1-800-273-TALK/8255)
Partnership with the Veterans Crisis Line
Establishment of the Suicide Prevention
Resource Center (SPRC)
Clinician trainings, community members,
collaboration between public and private
sectors.
Activity in the field of suicide prevention
has grown dramatically since the National
Strategy was issued in 2001
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Government agencies at all levels
Schools
Nonprofit organizations
Businesses
A Plethora of Organizations are involved!
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Department of Health and
Human Services
Centers for Disease Control
National Institutes of Health
and NIMH
Department of Defense
Dept of Veterans Affairs
A Big push the last 10 years
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American
Foundation for
Suicide Prevention
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Suicide Awareness
Voices of
Education
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American
Association of
Suicidology
Social Media is a piece of this cooperation
Public/Private organizations are involved
now
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Action for Alliance
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>200 National Leaders
Private organizations and entities
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Facebook
Universities of Chicago, Rochester, Calgary
Entertainment Industries Council
Mental Health Association of San Francisco
National Organization of People Against Suicide
Samaritans USA
Suicide Awareness Voices of Education
Jason Foundation
Jed Foundation
Henry Ford used in Sedg Co
School-Based Prevention Programs
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http://www.afsp.org/
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SOS Signs of
Suicide® Prevention
Program (SOS)
http://www.mentalhealthscreening.org/programs
/youth-prevention-programs/sos/
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The SOS High School Program is the only schoolbased suicide prevention program listed on the
Substance Abuse and Mental Health Services
Administration’s National Registry of Evidencebased Programs and Practices that addresses
suicide risk and depression, while reducing suicide
attempts. In a randomized control study, the SOS
program showed a reduction in self-reported suicide
attempts by 40% (BMC Public Health, July 2007).
USD 259 Yellow Ribbon
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Evaluation of pre/post program surveys
Improvement in knowledge and confidence in
engagement in help seeking behaviors
May be especially useful for middle school
boys
No harm
International Drive
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International Association
for Suicide Prevention
http://www.iasp.info/index
.php
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http://www.who.int/en/
Spin off policies and programs
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Access to weapons; Firearms, packaging meds
Mental Health programs
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APA’s Vision for Mental Health System
The President’s New Freedom Commission
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The Interim Report of the President’s New Freedom
Committee On Mental Health caution the nation about the
impending mental health catastrophe if the attitude of
denial and neglect continues unchanged
APA Suicide Treatment Guidelines
Population based studies/Centers/Youth resiliency
The 2012 National Strategy for Suicide
Prevention is a joint effort
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The Office of the Surgeon General
The National Action Alliance for Suicide Prevention
(Action Alliance, NAASP)
4 strategic directions/13 goals/60 objectives
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Creating supportive environments and promoting healthy
empowered families and communities
Enhancing clinical and community preventive services
Promoting available and timely treatment and support
services
Improve suicide prevention surveillance collection,
research, and evaluation SAMHSA 2012 NSSP Overview
National Strategy for Suicide Prevention
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A Awareness of the problem and risks
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I
Intervention to solve the problem
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Now under Healthy and Empowered Individual,
Families, and Communities
Spread against 3 strategic directions
M Methodology to monitor the populations at
risk
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Expanded to include surveillance and program
evaluation
Our Duck Pond
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State of Kansas Suicide Prevention Task
Force asked Sedgwick County members to
start a local task force
The Suicide Prevention Task Force became
a Coalition in 2009
A recent local addition of the American
Foundation for Suicide Prevention
Key gatekeepers
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Teachers and school
staff
School health
personnel
Clergy
Police officers
Correctional personnel
Supervisors in
occupational settings
Natural community
helpers
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Hospice and nursing
home volunteers
Primary health
providers
Mental healthcare and
substance abuse
treatment providers
Emergency healthcare
personnel.
2001, DHHS. NSSP p78
I. Define the Problem
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Surveillance of suicide attempts is fraught
with concerns about nomenclature, accuracy
in reporting, lack of systematic or mandatory
reporting
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Educated and not so educated guesses. KS
counties
Definitions lacking-population differences
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Assisted suicide is a “separate issue”-should not
be included in the rate
Various agencies utilize different data
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Death certificates
Coroner reports
Data may be gathered by county of residence
or by site of death
Field reporters obtain the personal data and
interview the families
Suicides are tracked by using a Rate
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No. of suicides per 100,000 persons
Overlaps other injury data (ODs, MVAs)
The Rate:
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Is influenced by economic, spiritual, political
factors
An indicator of a country’s health, hope, stability,
and culture.
10th on the list of U.S. Health Indicators
Comparing Suicide Rates
Nine of the 10 highest suicide rates
worldwide are in Europe. The average
suicide rate in Europe is 13.9
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Rates as high as 30.7 in Lithuania (41.9 in 2001;
males at 73.8), 21.5 in Hungary (43 in 1999),
and 18.5 in Finland and 18.4 in Slovenia.
Russian Federation rate in 1998 was 35.5.
http://www.who.int/topics/suicide/en/
2002, IOM. Reducing Suicide p 35
Who Crunches the Numbers?
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National Suicide Prevention Resource Center
CDC utilizes Injury and Violence Data
National Violent Death Reporting System
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Model: National Highway Traffic Safety
Administration’s system for motor vehicle deaths
National Violent Death Reporting
System (NVDRS)
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Harvard-designed to collect information on
homicides and suicides and firearms deaths
Based on FARS and the National Violent Injury
Statistics System (NVISS)
Testing at 10 sites-information from death
certificates, coroner/medical examiner reports,
police Uniformed Crimes Reports, crime laboratories
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Expected to allay irregular quality of data available through
the coroner system
Currently collects data in only 18 states
Comparisons
Suicide Rates per 100,000
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Sedg 11.2
Co.
11.1
12.3
12.0
13.4
11.6
14.6
12.2
13.5
13.6
KS
10.8
12.7
12.8
13.6
13.2
13.8
13.6
12.5
13.6
14.1
USA 10.7
11.0
10.9 11.1
11.0
11.2
11.3
11.8
12.0
12.4
11.0
12.3
16.5
Despite efforts at prevention the last 15
years …
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The suicide rate has actually increased
Despite the use of antidepressants and
improved healthcare and mental healthcare
Despite the economy
Despite our rich heritage and freedoms
Is this an indication of whether our programs
are working or not?
Public health program concerns
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Anti-smoking, cancer screening, AIDs prevention can
point to success in lives saved
Suicide rate however has increased in the U.S.
The risk factors for suicide have a wide distribution, are
large in number, have a high prevalence, and inherent
challenges that make mounting large scale prevention
programs difficult.
Societal targets (limiting access to lethal means,
improving community detection and treatment) have as
yet been unsuccessful in achieving a reduction
Baker SP, 2013
The Disconnect
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1990s—The Decade of the Brain
Suicidality has a life apart from mental illness
No professional has been able to consistently
predict individuals’ suicide
Mental health tools have been unproven in
terms of affecting suicidality
The association of suicide with mental
illness …
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Is a “conundrum”
80-90% of people who commit suicide have
“depression”
95% of mentally ill do not suicide (6-15% of
depressed patients commit suicide, 7% with
alcohol dependence, 4% with schizophrenia)
(IOM p394)
My Friend
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Middle-aged Vietnam veteran who struggled
with PTSD from childhood trauma, alcohol
abuse, and depression
Was hospitalized after cutting his wrists in a
suicide attempt when I first met him.
Struggled with his pain for 10 more years,
while in and out of treatment at VA MHC
Died of an overdose on his medications and
alcohol in his 50s
People who commit suicide
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Frequently do not tell others or professionals
Are not identifiable on individual basis
Are frequently different from those with parasuicidal behavior and frequent attempts
Are from widely varying populations (young
divorced male versus dialysis patient refusing
treatment)
IOM 2002 Reducing Suicide
“The stark facts”
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Jan Fawcett MD:
“Suicide isn’t predictable in individuals;
Preventive efforts aren’t very effective;
Suicidal communications aren’t often made
by patients to physicians or counselors;
Denial of suicidal intent doesn’t mean a
patient won’t do it”
IOM 2002 Reducing Suicide
II. Identify Causes
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Risk factors:
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Acute: anxiety, panic attacks, recent alcohol
Chronic factors: demographic info
First year post discharge
Traditional risk factors did not predict for year
one—but did for years 2-10
Protective factors:
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Resiliency
Social support
Theories
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Social theories Charles Durkheim
Freud: Anger turned inwards
Aaron Beck Hopelessness
Biology
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Low serotonin and impulsivity
Brain serotonin bounces back very high right
after suicide attack
No genetic tests are helpful as of yet
SYMPTOMS
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SHORT-TERM RISK FACTORS
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Loss (loved one, relationship, job, pride, health)
Hopelessness
Anxiety
Agitation and Impulsiveness
Intoxication with alcohol or substances
LONG-TERM RISK FACTORS
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Elderly caucasian male who drinks
The 4 Rs
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Relief of pain—emotional and/or physical
Rejoining a lost one
Reality testing loss (voices, command
hallucinations, God’s desire)
Revenge
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“Some people think that if we just get suicidal
people into treatment we’d prevent suicide.
But we’re not good at it”
More than 50% of suicides occur while
patients are in active treatment
69% of patients do communicate intent to a
spouse, with friends, or coworker … “so we
damn well better talk to the significant others
--and believe what they say”
IOM 2002 Reducing Suicide
III. Develop and Test
IV. Implement Interventions
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Yellow Ribbon and school-based programs
Air Force Program
Suicide scales: Scale for Suicide Ideation
(Beck 1979), Suicide Intent Scale (Beck
1974), Beck Depression Inventory, HAM A,
Beck Hopelessness Scale
Scales often have high FN and FP rates,
poor positive predictive value
SADPERSONS Scoring for Suicide Risk
SADPERSONS Scoring for Suicide Risk
S Sex = male 1 point
A Age > 45 or <19
1 point
D Depression / hopelessness 2 points
P Prior attempts / Psychiatric illness
1 point
E Excessive Alcohol / Drugs 1 point
R Rational thinking loss
2 points
S Separated widowed or divorced
1 point
O Organized or serious attempt 2 points
N No social support
1 point
S Stated future intent 2 points
Score > 9 = high risk and probable need for inpatient intervention
Score > 6 = moderate risk and need for psychiatric consultation
Score < 6 = low (but not no) risk
V. Evaluate Effectiveness
The global suicide rate may not be such a
good indicator of effectiveness of
interventions
Breaking down populations
Preventable versus non-preventable suicide
Response may be seen in one year, may take
decades
Cohort effects
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Sedgwick County 2012 Suicide Rates
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83 Suicide deaths in Sedgwick County
Rate of 16.5 deaths per 100,000
Highest rate seen in the 12 years that we’ve
been tracking local data
Suicide Prevention Hotline
316-660-7500
24 hours/ 7 Days per week
Methods
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Use of firearm is consistently most common
method, followed by hanging and overdose
Rate per 100,000
United
States 2010
Sedgwick
County 2010
Sedgwick
County 2012
Firearm
6.3
6.8
8.5
Hanging/Suffoc
ation
3.1
3.0
5.4
Overdose
2.1
2.2
2.2
Sedgwick Co. Method of Suicide 20082012
Health History in Sedgwick County
Suicides
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History of mental illness was noted in
approximately 50% of suicides --Depression,
bipolar disorder, substance abuse
27% have history of prior suicide thoughts or
attempts
Significant medical issues noted in 40% of
suicides
72% suicides in Sedgwick County had
alcohol or drugs in their system
Changing times/changing trends
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In the 1980s and 1990s most concerns were for
young black males (injury) and older white males
(suicide rate 90)
Males ages 15-25 were a high risk group, now down
(element of hope?)
The recent increase in the 45-65 year old group is
seen nationwide as well as locally
This group of middle aged persons may reveal
mixes of substance use, medical problems,
relationship ills, and job losses as stressors. It may
also reflect a lack of resilience in this cohort, and a
cultural outlook that promotes suicidality or
hopelessness. It may be the pain treatment culture
promoted in the medical community
New Waves
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Pain control culture
Narcotics
What effect does cannabis have?
Our community is busy trying to help
prevent suicide
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Via Christi Assessment Center
Via Christi hospitals
Other hospital ERs
ComCare
MHA
Private practitioners
Law enforcement
EMS
Community Impact of Suicidal
Ideation/ Attempts
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Sedgwick County 911 Dispatch calls
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2,179 Suicide attempts
295 Suicide threats
816 Mental health emergencies
COMCARE Crisis Intervention Services
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5,586 Crisis Assessments
61,156 phone calls
Weakness in emergency management
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Involves the shortage of mental health
specialists in general hospital ED
Enhanced training of ED physicians may help
Increasing patient access to mental healthcare
Implementation of advances in clinical
medicine is often a slow process
Offson M, Marcus S, Bridge J, Viewpoint: Focusing Suicide Prevention
on Periods of High Risk. JAMA. March 19, 2014, Volume 311, Number
11. 1107-1108.
The Risky Post-hospitalization Period
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The period immediately following discharge from a
psychiatric hospital poses an extraordinarily high
risk of suicide--especially the first week. Qin P 2005.
Roughly 1/3 (39%) of all suicides in the first year
after hospital discharge have been found to occur
in the first 28 days. Goldacre M 1993
¼ (24%) of all suicides occur among patients who
are within 3 months of discharge from a
psychiatric hospital. Appleby L, 1999
Interventions for the post-hospital
discharge period
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Clinical interventions, programs, and policies
targeting protecting patients from suicide
during the period following discharge are
needed.
An observational study from the United
Kingdom reported implementation of a 7-day
follow-up after psychiatric hospital discharge
was associated with a decline in suicide rates
from 24.8 to 19.5 annually during the 3-month
period following discharge. While D, 2012
U.S. and local clinical practice
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Improvement needed in patient transitions
from inpatient to outpatient psychiatric care.
Nationally only about ½ of psychiatric
inpatients receive any outpatient mental
healthcare during the first week following
hospital discharge and only 2/3 receive care
during the first month. NCQA DATA 2013
Problems with outpatient compliance (Lincoln
et al, pending)
Addressing critical links in mental health
care system will not replace other
interventions
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Hotlines
Screening programs
Crisis counseling services
Public education campaigns
Offson 2014
WHERE DOES THAT LEAVE US
NOW?
Organizational Restructuring
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Revision of the Strategy for Suicide
Prevention
A Prioritized Research Agenda for Suicide
Prevention by NAASP
“A Prioritized Research Agenda for Suicide
Prevention: An Action Plan to Save Lives”
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http://actionallianceforsuicideprevention.org/si
tes/actionallianceforsuicideprevention.org/file
s/Agenda.pdf
3 years in production, after observations that
prioritizing research into other diseases
helped to advance the science in those
areas.
Developed 6 key questions
Where we are at now: 6 Key Questions
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Why do people become suicidal?
How can we better detect/predict risk?
What interventions are useful?
What services are most effective?
What interventions outside healthcare
settings reduce suicidality?
What new research infrastructure is needed?
Levin, A. “Clinical and Research News: Suicide Experts Identify Six Questions To Guide
Research in Next Decade”. Psychiatric News, Vol 49, No 6, March 21, 2014. p 13.
Our little world; Sedgwick County
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Educate the public so that family and friends
will pick up on the signs of risk and
encourage treatment
Educate gatekeepers, seminars
Evaluate the programs already in use
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Yellow Ribbon school program
Bookmark distribution
Annual run
Survivors of Suicide annual teleconference
Local prevention groups
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Sedgwick County Suicide Prevention
Coalition
American Foundation for Suicide Prevention
National Association for the Mentally Ill
Private foundations
Recommendations in SCSPC
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Continue efforts to collect data from a variety of
sources to assess impact of Coalition activities
Increase integration efforts with primary care,
pastors and business
Target high risk neighborhoods
 Focus groups to identify neighborhood needs
and targeted prevention efforts
 Create Neighborhood Advisory Committees
Community workshops to educate providers
about local resources, promote dialogue among
groups
Prevention measures; what you can do
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For information about suicide,
a Survivors of Suicide
Handbook, the Cluster
Response Plan or upcoming
events, go to
www.sedgwickcounty.org
(Living, Health and Welfare,
Suicide Prevention)
American Association of
Suicidology www.suicidology.org
American Foundation for
Suicide Prevention www.afsp.org
Suicide Prevention Hotline 660-7500 24 Hours/7 Days a
Week
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LISTEN, LISTEN, LISTEN
Prevent access to firearms,
monitor all medication use,
and be aware of potential
weapons
Don't promise to keep their
comments of suicide a secret
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Help them get help by talking
to a family doctor, counselor,
or clergy or by calling the
Suicide Prevention Hotline.
Go to an emergency room
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Do not leave the person alone
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http://www.sedgwickcounty.org/comcare
/suicide_prevention.asp
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SUICIDE PREVENTION
If you or someone you know is talking
about suicide, please call the suicide
prevention hotline 24 hours a day/7 days a
week.
(316) 660-7500
Crisis Intervention Services (CIS) has been
the suicide prevention service for many years
in Sedgwick County. At CIS, priority is given
to callers who are at risk for suicide.
Suicide can be prevented. Some occur without
warning but most do give clues. Recognize the
signs and know how to respond.
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Observable signs of serious depression:
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Pessimism
Hopelessness
Desperation
Sleep problems
Anxiety, emotional pain and inner tension
Withdrawal from friends and/or family
Increased alcohol and/or other drug use
Recent impulsiveness and taking unnecessary risks
Threatening suicide or expressing a strong wish to die
Making a plan
Seeking access to pills, weapons or other means
Unexpected rage or anger
Stressful life events may precede suicide, such as intimate partner problems, other
relationship problems, loss of employment, housing insecurity, financial difficulties, legal
trouble and/or a history of medical illness.
Although most depressed people are not suicidal, most suicidal people are depressed. One
can help prevent suicide through early recognition and treatment of depression and other
psychiatric illnesses.
Be a link, save a life.
SCSPC 2012 Annual Report
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We always deceive ourselves twice about the
people we love — first to their advantage,
then to their disadvantage.
ALBERT CAMUS, A Happy Death
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Read more at http://www.notablequotes.com/c/camus_albert.html#QlzA2Qwjy
Ppv8crk.99
17 yo white female, distraught over the
breakup with her boyfriend
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Secretly goes to her family’s medicine cabinet and
downs a bottle of Tylenol and Benadryl, to “escape
the pain.” Is ready to die if that’s what it takes.
Gets sick to her stomach after several hours and
now remorseful, discloses to her mother what she
has done.
Is rushed to the ER, stomach is pumped but to no
avail; her liver fails from the toxin and doctors
determine the chance of a transplant is unlikely to
occur within the time period that she may still
survive.
The liver disease takes her life within the next few
weeks.
Lock all medications up. Especially OTCs
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Any small deterrent in a suicide attempt may
avert completion
Impulsive patients are often too distraught to
think of a plan of self harm, they simply reach
for anything easy.
Getting through this anxious distress will
often be met with a return of more logical
thinking.
18 yo white male recently hospitalized for
depression and suicidal ideations
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A result of a break up with his girlfriend.
The two reconciled while he was in hospital, his
suicidal thinking remitted, he was treated with an
antidepressant, and discharged improved to
outpatient care after a safety plan was established
with family
Two weeks later, while doing well, he borrowed a
gun to go hunting with friends.
Three days later his girlfriend broke up with him over
the phone. He used the rifle, still in his truck, to take
his life. Alcohol may have been a factor.
Firearm Safety: Means Restriction
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Firearms in the home are a risk factor.
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Never leave these at home unattended
Lock them away
Use the safety
Pistols in the home raise the risk 10-fold
Tell family and friends about the situation
Alcohol and substances increase the risk of
impulsivity of any type.
Build resilience in our children
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Problems come and go
Relationships come and go
Managing emotions can instill confidence and
security
There will be failures but it is not the end of
the world
STIGMA
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Is a way of deceiving ourselves, a way to
pretend that these things really do not exist in
the “real” or “normal” world
Denies the fact that we are all on the edge of
our own insanity
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Unforeseen tragedies
Unforeseen medical problems
Medications, supplements, substances
Unforeseen disasters
Bravery and Courage Required
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To address the addictions our loved ones
face
To address our loved ones that are
“enablers”
To be that freaky person that keeps the guns
locked up and the safety on, keeps the
medications locked up
To acknowledge we are all one step away
from the edge
Summary--Suicidality is a more complex
process than other public health concerns
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Biological, clinical, subjective, and social
factors—more complex than other “chronic
disease”
Prevention may be difficult to measure and
the suicide rate may not be the best indicator
of effectiveness
Evaluate education, policy and/or
technological changes and implement
effective interventions
My Opinion
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Educate families and friends
Reduce stigma for survivors
Limit access to means (Firearm Safety!!!)
Use caution with narcotics and substances
Don’t ignore the influence of cannabis
Monitor the suicide rate with an eye towards
an understanding of our society’s ills
Build resilience in our children
Stop the Silence Be a Voice for Life
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Man stands face to face with the irrational.
He feels within him his longing for happiness
and for reason. The absurd is born of this
confrontation between the human need and
the unreasonable silence of the world.
ALBERT CAMUS, The Myth of Sisyphus
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Read more at http://www.notablequotes.com/c/camus_albert.html#QlzA2Qwjy
Ppv8crk.99
References
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Baker SP, Hu G, Wilcox HC, Baker TD. Increase in suicide by
hanging/suffocation in the US. 2000-2010. Am J Prev Med.
2013;44(2):146-149.
Qin P, Nordentoft M. Suicide risk in relation to psychiatric
hospitalization: evidence based on longitudinal registers. Arch
Gen Psychiatry. 2005;62(4):427-432.
Goldacre M, Seagroatt V. Hawton K. Suicide after discharge
from psychiatric inpatient care. Lancet. 1993;342(8866):283-286.
Appleby L, Shaw J, Amos T, et al. Suicide within 12 months of
contact with mental health services: national clinical survey.
BMJ. 1999;318(7193):1235-1239.
References
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While D, Bickley H, Roscoe A, et al. Implementation
of mental health service recommendations in
England and Wales and suicide rates, 1997-2006: a
cross-sectional and before-and-after observational
study. Lancet. 2012;379(9820):1005-1012.
National Committee on Quality Assurance.
Improving quality and patient experience: the state
of health care quality 2013.
http://www.ncqa.org/Portals/O/Newsroom/SOHC/20
13/SOHC-web%20version%20report.pdf.Accessed
date
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Offson M, Marcus S, Bridge J, Viewpoint: Focusing Suicide
Prevention on Periods of High Risk. JAMA. March 19, 2014,
Volume 311, Number 11. 1107-1108
Sedgwick County Suicide Prevention Coalition 2012 Annual
Report (Nicole Klaus PhD) at http://www.sedgwickcounty.org/
comcare/reports/Suicide_Prevention_AR.pdf. Accessed April 6, 2014
“A Prioritized Research Agenda for Suicide Prevention: An
Action Plan to Save Lives” at
http://actionallianceforsuicideprevention.org/sites/actionalliancefo
rsuicideprevention.org/files/Agenda.pdf.
SAMSHA 2012 National Strategy Overview at
http://www.surgeongeneral.gov/library/reports/national-strategysuicide-prevention/overview.pdf.
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Reducing Suicide; a National Imperative. 2002 by
the National Academy of Science, National
Academies Press, 500 Fifth Street NW, Box 285,
Washington DC, 20055 http://www.nap.edu
Others:
http://www.surgeongeneral.gov/library/reports/nation
al-strategy-suicide-prevention/index.html
http://www.samhsa.gov/nssp
http://www.actionallianceforsuicideprevention.org/N
SSP
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http://www.who.int/topics/suicide/en/
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Offson M, Marcus S, Bridge J, Viewpoint: Focusing Suicide
Prevention on Periods of High Risk. JAMA. March 19, 2014, Volume
311, Number 11. 1107-1108.