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ASSESSING RISK FOR Suicide & INTERVENING

ASSESSING RISK FOR Suicide & INTERVENING . Sue Eastgard, MSW sueeastgard@comcast.net 206 295 1038. Background: Pyramid of Suicidal Behaviors--U.S. 35,839 Suicides*. 572,000 Hospitalizations**. 752,000 Attempts Requiring Medical Attention**. 1,100,000 Suicide Attempts**. 8,700,000

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ASSESSING RISK FOR Suicide & INTERVENING

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  1. ASSESSING RISK FOR Suicide & INTERVENING Sue Eastgard, MSW sueeastgard@comcast.net 206 295 1038

  2. Background: Pyramid of Suicidal Behaviors--U.S. 35,839 Suicides* 572,000Hospitalizations** 752,000 AttemptsRequiring Medical Attention** 1,100,000 Suicide Attempts** 8,700,000 Seriously Considered Suicide** Source: * National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. (2009). Web-based Injury Statistics Query and Reporting System (WISQARS). Available from: www.cdc.gov/injury/wisqars/index.html. **Substance Abuse and Mental Health Services Administration, Results from the 2010 National Survey on Drug Use and Health: Mental Health Findings, NSDUH Series H-42, HHS Publication No. (SMA) 11-4667. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012.

  3. Suicide: the facts • In 2009, more than 35,839 people died by suicide in US • In 2009, 915 people in Washington State died by suicide and 3,707 hospitalizations for non-fatal suicidal behaviors • Medical Examiners designate cause of death and not all suicides can be clearly determined

  4. Who? When? Where? Why? • Who: highest risk group - Caucasian men, ages 20-29 & 40-59 • Where: Majority of suicides occur at home • Why: Often within 24 hours of a “crisis” • Why: Multiple factors lead to suicide • Depression, with a sense of hopelessness • Alcohol & substance abuse • Triggering events that lead to humiliation & shame

  5. HOW? Completed Suicides • Majority of completed suicides involve a firearm (51%), followed by • Suffocation ~ 23% • Poisoning ~ 18% • Jumping ~ 2% • Cutting ~ 2% • Other ~ 4%

  6. HOW? Attempted Suicide • Majority of hospitalizations as a result of a non-fatal suicide attempt involved poisoning (64%), followed by • Cutting ~ 16% • Suffocation ~ 0.3% • Firearms ~ 0.8% • Jumping ~ 0.5% • Other ~ 16%

  7. Case Vignette #1 • Male client – age 57 - with long history of depression and substance abuse • Non-compliant with prescribed medication • Attends AA meetings occasionally but also continues to drink • Estranged from wife and kids • Has recently seen PCP and learned that he should have his foot amputated as a result of unmanaged diabetes • Tells you that he is not going to have surgery and doesn’t see any reason to keep on living

  8. Case Vignette #2 • Female client – aged 32 – with a mental health diagnosis of borderline personality disorder • Frequently presents in your office – or calls on the telephone - with complaints and problems and wants you to solve them • Has made multiple suicide attempts in the past and has been hospitalized several different times; the most recent was March of 2012 • Divorced, with 2 children; not many friends and not currently employed • Current boyfriend has history of being physically abusive; is now threatening to break up with her

  9. SUICIDE: CONNECTING SHOW YOU CARE • Let the patient know that you are concerned • Talk about your feelings and ask about his or hers. • Listen carefully. “I’m concerned about you…about how you feel.” “Tell me about what’s making you so sad.” “I’m on your side…we’ll get through this.”

  10. Suicide: ASSESSMENT ASK THE QUESTION • Don’t hesitate to raise the subject. • Talking with the patient about suicide won’t put the idea in his/her head. • Be direct in a caring, non-confrontational way. Are you thinking about suicide? Have you thought about suicide in the past 2 months? Have you ever attempted to kill yourself?

  11. Suicide: ASSESSMENT • Current Plan: how prepared? • Pain: how desperate? • Resources: how alone? • + Prior Behavior: how familiar? • + Mental Health: how vulnerable?

  12. INTERVENTION OPTIONS & CHALLENGES • Non-directive, Directive, Cooperative • Confidentiality • Duty to warn

  13. Suicide: INTERVENTION • Personal warning signs. • Use internal coping strategies to reduce suicide risk. • Access social and family contacts who may help reduce suicide risk. • Contact appropriate professionals and agencies for help. • Safe environments. CONTRACTING A SAFEPLAN

  14. Suicide: Resources Crisis telephone hotlines: For clients and families: 206 461 3222 800-273-TALK (1-800-273-8255) For Professionals: 206 461 3210

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