Suicide Prevention Workshop 2006 Department of Psychiatry Queen Mary Hospital Kwong Chung Man
2005 H.K. Suicide Statistics • 967 completed suicide • male:female = 1.9:1 • Suicide rate = 12.69 • 349 age 60+ (29.4%) • The highest age group 70 • 50.9% jumping from height • 22.4% hanging • 19.4% unemployed • 17.3% mental illness (n=167)
Inpatient suicide Attempted Suicide Completed Suicide Deliberated Self Harm
Misconceptionsabout suicide • People who talk about suicide won't really do it • Anyone who tries to kill him/herself must be crazy • If a person is determined to kill him/herself , nothing is going to stop him/her. • People who commit suicide are people who were unwilling to seek help • Talking about suicide may give someone the idea
Characteristics of inpatient suicide • The time of suicide • Appear to be improving • Advance warning • No established relationship
Common errors of suicide intervention • Superficial reassurance • Avoidance of Strong Feelings • Inadequate assessment of suicide intent • Passivity • Advice giving
Suicide risk assessment • Why? • Who? • When? • Where? • What? • How? Continuous Assessment Suicide Risk Level
Interview Focus • Suicidal intent and lethality • Dynamic meanings and motivation for suicide • Presence of a suicidal plan • History of suicidal behaviour • Physiological, cognitive & affective states • Coping potential • Epidemiological risk factors
Inquire suicide thought & plan • Genuine • Acceptance • Use progressive & specific questions • Ask the detail of method, plan, and perceived lethality • Facilitate ventilation of feeling Improving your listening skill
Interview questions • Level 1"Do you ever think life is not worth living?" • Level 2"Do you ever think about harming yourself?" • Level 3"Do you have a plan?" • Level 4"Do you have access to the (e.g. drug)?"
Identify suicide risk factors • Previous suicidal attempt • Recent loss & stress • Inadequate social support • Unemployed or retired • Alcohol & drug dependence • Putting Affairs in order • Over 60, Male, Chronic illness
Symptoms of depression • Persistent sad or "empty" mood. • Hopeless, helpless, worthless feeling • Substance abuse. • Fatigue or loss of interest in ordinary activities • Disturbances in eating and sleeping patterns. • Irritability, increased crying, anxiety • Difficulty concentrating, or making decisions. • Thoughts of suicide; suicide plans or attempts. • Persistent physical symptoms or pains
Danger signs of suicide • Talking about suicide. • Preoccupation with death. • Statements about hopelessness or worthlessness. • Suddenly happier, calmer. • Loss of interest in things one cares about. • Visiting or calling people one cares about. • Making arrangements; setting one's affairs in order. • Giving things away. • Risk taking or Self destructive behavior.
The Golden Rule • “The most reliable assessment is the one made by an experienced practitioner.” • Not by any single test, examination, observation, etc.
Nursing care of suicidal patient • Take environmental precautions • Establish therapeutic relationship • Provide emotional support • Assist to solve the precipitating problem • Provide adequate observation & supervision to prevent self-harm
Good Nursing Care • Attending to patient’s basic needs • Having time for patient • Being with patient • Listen to patient without prejudice • Accepting patient’s feelings • Communicating hope to patient
Do you agree? Good Nursing care can make the difference between life and death for suicidal patients.
Conclusion • Take the danger signs seriously • Assess suicide risk adequately • Prevent self-harm promptly • Work as a team collaboratively Suicide Prevention is Everyone Responsibility
Reference • Leenaars, A. et al. ed. (1994). Treatment of Suicidal People. Washington: Taylor & Francis. • Ritter, S. (1989). Manual of Clinical Psychiatric Nursing: Principle and Procedures. Bethlem Royal and Maudsley Hospital. • The Samaritan Befrienders Hong Kong 1989-2005 • Annual Report. • The 1989-2004 Hong Kong Coroners' Report.