Transcript Understanding & Assessing Suicide In-service

Assessing Suicide
Adapted from: National Institute of Mental Health (http://www.nimh.nih.gov/health/publications/suicide-in-
the-us-statistics-and-prevention/index.shtml). Guidelines for Identification, Assessment, and Treatment Planning
for Suicidality Developed by the Suicide Risk Advisory Committee of the Risk Management Foundation of the
Harvard Medical Institute in 1996.
Suicide is a major, preventable public
health problem. In 2007, it was the tenth
leading cause of death in the U.S.,
accounting for 34,598 deaths.
 The overall rate was 11.3 suicide deaths
per 100,000 people. An estimated 11
attempted suicides occur per every
suicide death.
 Almost four times as many males as
females die by suicide.
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Statistics
Older Americans are disproportionately
likely to die by suicide.
 Of every 100,000 people ages 65 and
older, 14.3 died by suicide in 2007. This
figure is higher than the national average
of 11.3 suicides per 100,000 people in the
general population.
 Non-Hispanic white men age 85 or older
had an even higher rate, with 47 suicide
deaths per 100,000.
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Statistics continued
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Men and the elderly are more likely to have fatal attempts than
are women and youth.
Depression and other mental disorders, alcohol and other
substance abuse and separation or divorce. Depression and other
mental disorders, or a substance-abuse disorder (often in
combination with other mental disorders). More than 90 percent
of people who die by suicide have these risk factors.
Family history of mental disorder, violence , abuse, or substance
abuse
Family history of suicide
Firearms in the home, the method used in more than half of
suicides
Incarceration
Exposure to the suicidal behavior of others, such as family
members, peers, or media figures.
A previous suicide attempt is among the strongest predictors of
subsequent suicide.
Most suicide attempts are expressions of extreme distress,
not harmless bids for attention. A person who appears
suicidal should not be left alone and needs immediate
mental-health treatment.
Risk Factors
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What form does the patient’s wish for suicide
take? For example escape fantasy, ideation, or
intent?
What does suicide mean to the patient?
Is the patient able to engage in a therapeutic
alliance?
Has the patient just lost or is anticipating losing
an essential sustaining relationship?
Has the patient lost or is anticipating losing
his/her main reason for living?
How far has the suicide planning process
proceeded?
Have suicidal behaviors occurred in the past?
Questions to Assess Suicide
Is there any family history of suicide?
 Does the patient’s mental status enhance
potential for suicidality?
 Is the patient expressing despair, hopelessness?
 Does the patient’s physiologic state increase
potential for suicide? (e.g. physical illness,
delirium, intoxication, organicity)
 Are there recent stressors in patient’s life?
 Is patient vulnerable to painful affects such as
loneliness, self-contempt, shame, despair?
 What are the patient’s capacities for selfregulation and coping?
 Is the patient able to participate in treatment?
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Questions to Assess Suicide
continued…
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People who talk or joke about death or killing
themselves are not the ones who actually commit
suicide. At least 80% of people who commit suicide give
definite warning signs through verbalizations or behavior.
Only a small percentage of people commit suicide without
any communication to others.
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Suicide happens without warning. Suicide is not a
spontaneous activity. It is most often the result of longterm, gradual, decompensation and erosion of coping
mechanisms.
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Most suicidal people are certain they want to die.
Most suicidal people do NOT want to die, but rather they
want an escape from what they experience as unbearable
pain. People who consider suicide do not see any
alternatives and suicide becomes for them the only
conceivable solution.
Common Misperceptions about
Suicide
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The suicide rate is highest during winter holidays. Suicide
rates in the United are consistently higher in the late spring and
fall.
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Sudden, unexplained recovery from a profound depression
with suicidal ideation indicates that a suicidal crisis is
over. Some people who have committed to killing themselves
appear happy and at peace right beforehand, perhaps from the
belief that their pain will be ending. Many people who make a
failed suicide attempt make a subsequent attempt within 90 days
after the diminution of a profound depression-apparent
“recovery” could be the mobilization of resources to carry out a
suicidal intent.
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Once a person has been suicidal, s/he will always consider
suicide as an option when a crisis arises. Most suicidal
people are suicidal only 1 time in their lives. Approximately 8% of
people who attempt suicide are completers.
Common Misperceptions about
Suicide
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Suicide is more prevalent among the wealthy. Suicide rates are higher
among lower socioeconomic cohorts. However, by profession, groups at the
highest socioeconomic levels (physicians, attorneys and business executives)
also have high rates of suicide. Overall, suicide rates for whites exceeds those
for persons of color, but among whiles living in ghettos, the rates are
comparable.
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Most suicidal people leave notes. While almost all suicidal people
communicate their ideation and/or intents directly or indirectly by verbalization
or behaviors, most do not leave suicide “notes.”
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Suicide is the act of a psychotic, severely mentally ill individual. Data
reveals that the majority of suicide completers are people who have suffered
Major Depressive Disorder, but are not otherwise severely mentally ill and
certainly not psychotic.
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If someone appears determined to kill themselves, there is nothing
anyone can do about it. Self-destructive episodes are usually limited to
approximately 24 hours, with some acute episodes lasting only moments. Most
suicidal people are ambivalent about dying so accurate identification and active
intervention focused on getting a person through the acute phase can save a
life.
Common Misperceptions about
Suicide
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If you think someone is suicidal, do not leave him or her alone. Try to get
the person to seek immediate help from his or her doctor or the nearest
hospital emergency room, or call 911. Eliminate access to firearms or
other potential tools for suicide, including unsupervised access to
medications.
Research shows that older adults and women who die by suicide are likely
to have seen a primary care provider in the year before death, improving
primary-care providers' ability to recognize and treat risk factors may
help prevent suicide among these groups.
Specific kinds of psychotherapy may be helpful for specific groups of
people. When a patient is considered at risk for suicide they should be
evaluated by a mental health professional.
Medications can be helpful in improving symptoms of depression, pain,
and anxiety that can lead to severe depression, hopelessness, and
suicidal thinking.
Comprehensive assessment and documentation of suicidal expression,
thoughts, behaviors is a key component in providing ongoing care. Please
see Suicide Assessment Form adapted for Harvest by Michelle Kieras,
LCSW.
Interventions