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Crisis intervention for suicidal patients

Crisis intervention for suicidal patients. Dr. Saman Yousuf 17 June 2011. Risk assessment and crisis management (if there is suicide risk) are covered in the same interview Crisis management: Keeping a person safe in short term (usually the next 72 hours)

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Crisis intervention for suicidal patients

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  1. Crisis intervention for suicidal patients Dr. Saman Yousuf 17 June 2011

  2. Risk assessment and crisis management (if there is suicide risk) are covered in the same interview • Crisis management: Keeping a person safe in short term (usually the next 72 hours) • Crisis prevention: Enabling a person to stay safe in the future (i.e long term)

  3. Aims • Reduction of immediate risk of suicide by: • Diffusing emotional distress • Addressing immediate problems • Ensuring safety • Providing immediate support • Identifying and employing coping mechanisms

  4. Diffusing emotional distress • Explore feelings and emotions • Encourage hopefulness • Bolster self-esteem • Build trust and confidence to ensure effective management of crisis

  5. Ensuring safety • Identify likely means of lethality – the ‘A-test’ What is acceptable to the person What is available to the person • Removing or restricting the means of lethality Safety and with least distress • Utilising safety protocols for removal or restriction of dangerous weapons

  6. Providing appropriate support • Identify who is best able to provide support Professionals Family and friends Community network Is the person comfortable with the kind of support being suggested? • Ensure support is available and accessible During the night At weekends On holidays

  7. Family, friends and community support • Can provide better support than professionals IF - Agreeable to become involved - Informed of the risk / offered support - Given guidance when/if situation worsens • Careful consideration before engaging teenagers and immature people • Parents of teenagers and children may become overprotective and judgmental

  8. Coping mechanisms • What has worked in the past? • What stopped the person from committing suicide? • New self-help coping mechanisms IMPORTANT: Working on coping mechanisms should not take place until the patient is safe, supported and no longer in distress

  9. Revisiting assessment • Suicidal intent (frequency and severity of thoughts) • Plan • Measures to prevent detection

  10. CASE SCENARIOS

  11. Crisis prevention • A structured action plan to be formed with the patient • Modifiable risk factors  strategies • Psychiatric illness  referral to psychiatrist for treatment • Psychosocial stressors  Social worker • Regular follow-up: frequent till suicidal ideation / behavior subsides and then interval between follow-ups can be gradually increased

  12. Example of a positive action plan (structured plan) • When I am upset and thinking about suicide, I’ll take the following steps: • Do not drink, or, if I am drinking, stop drinking • Sit down and take 50 deep breaths • Try to do things that help me feel better for at least 30 minutes (e.g., taking a walk, listening to music) • Contact one of my significant others and talk to them about our joint interests • If the thoughts persist, I will call someone I can trust and seek for help at xxxx-xxxx • If nothing has improved, I can ring up 999 or go to the A&E department

  13. Evidence based treatments

  14. What doesn’t work… • Hospital admission vs. discharge • Inpatient behavior therapy vs. Inpatient insight-oriented therapy • 9 antidepressants vs. placebo • 10 long-term therapies vs. one short term therapy • 2 intensive intervention plus outreach vs. Standard aftercare • Problem-solving therapy vs. standard aftercare • Home-based family therapy vs. standard aftercare

  15. What seems to work…

  16. Cognitive model for suicide mode:

  17. Replication in Australia Carter GL et al 2005 BMJ;331:805; Carter GL et al 2007 Br J Psychiatry;191:548-53.

  18. No effect found: New Zealand Ref: Beautrais et al 2010 Br J Psychiatry 197, 55–60

  19. Summary • There are relatively few randomized clinical trials for treatments for suicidal behavior. • Standard of care interventions such as inpatient and anti-depressants do not have strong support. • Psychotherapy – particularly CBT and DBT seems to have some supportive findings. • Simple and basic interventions. i.e., caring letters, alone have support.

  20. When a suicide occurs… Despite best efforts at suicide assessment and treatment, suicides can and do occur in clinical practice Approximately, 12,000-14,000 suicides per year occur while in treatment To facilitate the aftercare process: • Ensure that the patient’s records are complete • Be available to assist grieving family members • Remember that confidentiality still exists • Seek support from colleagues / supervisors

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