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Psychiatric Crisis The Greatest Gift We Give are Actions with Hope

Psychiatric Crisis The Greatest Gift We Give are Actions with Hope. Marty Martin-Forman, MSW ACSW LCSW Martin-Forman Consulting LLC marty44martin@gmail.com. Objectives. Discuss two reasons why suicide is a public health crisis Name at least three risk factors that contribute to suicide

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Psychiatric Crisis The Greatest Gift We Give are Actions with Hope

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  1. Psychiatric CrisisThe Greatest Gift We Give are Actions with Hope Marty Martin-Forman, MSW ACSW LCSW Martin-Forman Consulting LLC marty44martin@gmail.com

  2. Objectives • Discuss two reasons why suicide is a public health crisis • Name at least three risk factors that contribute to suicide • Name two factors important for assessing suicidal risk • Understand that the formulation of suicidal risk includes yesterday, today and tomorrow • Identify at least three suicide prevention resources to have on hand • Explore mental health apps and their symptom targets

  3. Psychiatric Crisis • Suicide • Self Harm • Behavioral response to psychosis (delusions or hallucinations) • Panic Attacks • Extreme Substance Use

  4. Suicide www.cdc.gov • 2016 nearly 45,000 Americans age 10 or older died by Suicide • It is the 10th leading cause of death in the US and one of three that continue to be on the rise • However it is the 2nd leading cause of death among people age 10-24 • From 1996 to 2017 Suicide rates increased dramatically; 29,199 to 47,173 • Range of increase was from 6% in Delaware to over 57% in ND • Twenty-five states had suicide rate increases of more than 30%, MO was one of them: only NV decreased • Suicide is rarely caused by a single factor

  5. Factors that Contribute to Suicide CDC 2015 study of 27 states • From NAMI’s web site, people who experience mental illness are at a higher risk for suicide accounting for 90% of those who die by suicide • Half of people who died by suicide did not have a known diagnosed mental health condition at the time of death • Other factors that contribute to suicide • Relationship problems or loss, substance misuse, physical health problems; and job, money, legal or housing stress Firearms were the most common method of suicide used by those with and without a known diagnosed mental health condition.

  6. How Did Suicide Become a Public Health Crisis?Benedict Carey, The New York Times • Effective prevention strategies are lacking and it remains difficult, perhaps impossible to predict who will commit suicide and it is extremely difficult for researchers to study • Access to guns – predominantly men use guns and are less likely to seek help • A profound indictment of our countries mental health system • Use of medication alone without counseling • Many who commit suicide receive little or no professional help and tell no one of their plan • Often the act is impulsive • Modern American society cultural script

  7. Whose Job Is It? In contrast to homicide, traffic safety, disease control, there is no one accountable to prevent death by suicide. No one gets fired if the number of suicides go up. It is shameful! We do not tolerate this in other areas of public health.

  8. Know the Risk Factors (AFSP) • Mental Health Conditions – depression, substance use problems, Bipolar d/o, Schizophrenia, personality traits of aggression, mood changes, and poor relationships, Conduct d/o, anxiety d/o • Serious physical health conditions including pain • Traumatic brain injury • Stressful life events- rejection, divorce, financial crisis, life transitions or loss • Exposure to another persons suicide or to graphic or sensationalized accounts of suicide

  9. Recognize Suicidal Warning Signs (WebMD) • Excessive sadness or moodiness • Hopelessness • Sleep problems • Sudden calmness • Withdrawal • Changes in personality and/or appearance • Dangerous or self-harm behavior • Recent trauma or life crisis • Making preparations • Threatening suicide.

  10. Assessing Risk • Manage your own reactions to suicide • Reconcile the difference (and potential conflict) between your goal to prevent suicide and the client’s goal to eliminate psychological pain via suicidal behavior • Maintain a collaborative, non-adversarial stance • Elicit ideation, current and past behavior, and plans • Make a clinical judgement of the risk that a client will attempt or complete suicide in the short and long term

  11. Formulation of Risk • Assess Risk Status • Long term risk factors • Impulsivity/self control (includes substance use) • Past suicidal behavior • Assess Risk State • Recent/present suicidal ideation, behavior • Identifiable stressors and events • Clinical presentation • Engagement and reliability

  12. Formulation of Risk: A Collaboration Risk Status and Risk State Coping Resources (Positive supports to stay alive) Potential Triggers ( If this happens………)

  13. Planning and Responding • Develop a crisis response plan • Have immediate, short, long-term plans • Work as a team • Follow up and be proactive • Have a response to crisis

  14. ASK According to the National Institute of Mental Health (NIMH) Director, Joshua Gordon, MD, PhD, “the most important thing to do is ask” if you are concerned that a loved one may be thinking about suicide.

  15. Options and Choices (copelandcenter.com) • WRAP – Wellness Recovery Action Plan • Empowering • Discuss….What if? What could I do?

  16. Collaborative Care (Positive Supports) • Person • Parent/spouse/significant other • Mental Health Professional • Physician • Resources

  17. Resources Must Be 0n Hand • Suicide Prevention Lifeline 1-800-273-TALK • www.suicidepreventionlifeline.org • Veterans Crisis Line 1-800-273-8255 • www.nimh.nih.gov • National Institute of Mental Health Resource Center • 1-866-615-6464 • Live Online chat • Email nimhinfor@nih.gov • Facebook, Twitter, YouTube

  18. Resources Must Be 0n Hand • afsp.org American Foundation for Suicide Prevention • nami.org National Alliance on Mental Illness • National Action Alliance for Suicide Prevention • National Strategy for Suicide Prevention • Take 5 To Save Lives • StopBullying.gov • Information on mental health apps

  19. Mental Health Apps • Helpful for anxiety, stress, depression, eating disorders, enhanced psychological well-being • Developed to address wait lists, empower consumers, extend behavioral health access, encourage wellness • Calm • Headspace • Moodnotes • Moodpath • Pacifica

  20. Mental Health Apps • SuperBetter • Anxiety Relief Hypnosis • Happify • Talkspace

  21. How to Help in a Suicide Crisis • Know the warning signs • Do not be afraid to talk about it. ASK • Make no deals. Keep no secrets. • Refer to someone who can help. • Don’t Wait Act Immediately!

  22. Bibliography • Assessing and Managing Suicide Risk: Core Competencies for Behavioral Health Professionals. Developed by Suicide Prevention Center Education Development Center INC. • Suicide—And A Reflection On Our Changing American Society, E. McCance-Katz, MD, PhD, Assistant Secretary for Mental Health and Substance Use. SAMHSA blog 01/24/2019

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