communicating with unique populations: suicide prevention

suicide

death caused by self-directed injurious behavior with the intent to die as a result of the behavior

suicide attempt

non-fatal, self-directed, potentially injurious behavior with intent to die as a result of the behavior

-- among individuals with non-fatal suicide attempts, roughly 40% do not come to medical attention

-- in 2022, 1.6 million adults attempted suicide

-- each year, there are 30 suicide attempts for each suicide death

suicidal ideation

thinking about, considering or planning suicide

-- in 2022, 3.8 million adults made a plan for, and 13.2 million adults seriously thought about suicide

-- more than 50% of individuals do not receive mental health services

suicide: epidemiology in the U.S.

- in 2022, over 49,000 persons died by suicide, making it the 11th leading cause of death

- among individuals that die by suicide:

-- firearms (55%)

-- suffocation (25%)

-- poisoning (12%)

-- other (8%)

- there is 1 death by suicide every 11 minutes

suicide rate disparities: gender

- The annual rate of suicide per 100,000 individuals was 4 times higher in males than in females in 2022

- Males make up 50% of the population, but nearly 80% of suicides

- annual rate of nonfatal suicide attempts, and suicidal ideations are comparable for females and males

suicide rate disparities: sexual orientation and gender identity

- youth who identify within the LGBTQ community are 4 times more likely to think about, plan for, and attempt suicide than their cisgender and heterosexual peers

- lesbian, gay and bisexual young people who come from families that reject or do not accept them are over 8 times more likely to attempt suicide than those whose families accept them

- Each time an LGBTQ person is a victim of physical or verbal harassment or abuse, they become 2.5 times more likely to hurt themselves

Mental Health First Aid (MHFA)

- a course that teaches you how to identify, understand, and respond to signs of mental illnesses and substance use disorders

- provides the skills you need to reach out and provide initial help and support to someone who may be developing a mental health or substance use problem or experiencing a crisis

- takes the fear and hesitation out of starting conversations about mental health and substance abuse problems

MHFA: The Action Plan

ALGEE

A

Assess for risk of suicide or harm

L

Listen nonjudgmentally

G

Give reassurance and information

E

Encourage appropriate professional help

E (second)

Encourage self-help and other support strategies

Assess for risk of suicide or harm: warning signs

- talking or writing about death, dying, or suicide

- seeking ways to kill themselves

- directly or indirectly threatening suicide

- hopelessness

- recklessness

- withdrawing

- dramatic mood changes

- loss of purpose

- feeling trapped

- demonstrating rage

- increasing alcohol/drug use

- anxiety, agitation, unable to sleep, or sleeping all the time

assess for risk of suicide or harm: individual

- previous suicide attempt(s)

- mental illness

- alcohol and substance abuse

- hopelessness

- impulsive or aggressive tendencies

- loss (relational, social, work, or financial)

- illness or disability

assess for risk of suicide or harm: relationship

- family history of suicide

- history of abuse, neglect, or trauma

- lack of social support and sense of isolation

assess for risk of suicide or harm: community

- local clusters of suicide

- lack of access to healthcare

assess for risk of suicide or harm: societal

- easy access to lethal means

- stigma associated with asking for help

- cultural and religious beliefs

- exposure to others who have died by suicide

assess for risk of suicide or harm: protective factors

- access to mental healthcare

- being proactive about mental health

- limited access to lethal means

- feeling connected to family and community support

- problem solving and coping skills

- cultural and religious beliefs that encourage connecting and help seeking, discourage suicidal behavior, or create a strong sense of purpose

assess for risk of suicide or harm: questioning

- ask an open, non-threatening question about the patient's current mood and affect

- How are you doing today? You look like you might be more discouraged than I've seen you lately

- Help me understand why you feel this way

- ask directly whether the person is suicidal: Are you having thoughts of suicide? Are you thinking about killing yourself? if yes to either then:

- have you decided how you are going to kill yourself?

- have you decided when you will do it?

- have you collected the things you need to carry out your plan?

assess for risk of suicide or harm: if the person is suicidal

- stay with them

- keep them safe

- help the person identify past supports

- connect them with resources

- involve them in decision making

- call law enforcement immediately if the person has a weapon or is behaving aggressively

- do not:

-- use guilt and threats to try to prevent suicide

-- dare them to do it

-- agree to keep their plan a secret

listen nonjudgementally

- key attitudes to make the person feel respected, accepted, and understood

-- acceptance

-- genuineness

-- empathy

- key nonverbal skills to show you are actively listening

-- attentiveness

-- comfortable eye contact

-- open body posture

-- being seated

-- being seated

-- sitting next to the person rather than directly opposite

-- do not fidget

give reassurance and information

- be open and honest

- stay calm and attempt to put the person at ease

- tell the person you care about and want them to help them

- understand that symptoms are an expression of distress or part of an illness

- have realistic expectations

- offer consistent emotional support and understanding

- give the person hope for recovery

- provide practical help

- offer credible information

helpful things to say:

- You are not alone in this. I am here for you.

- You may not believe it, but the way you're feeling will change

- I may not be able to understand exactly how you feel, but I care about you and want to help

- when you want to give up, tell yourself you will hold off for just one more day, hour, minute - whatever you can manage

unhelpful things to say:

- tell the person to "snap out of it"

- act hostile or sarcastic

- blame the person for their symptoms

- adopt an overinvolved or overprotective attitude

- tell the person to do what they would normally do

- trivialize the person's experiences

- belittle or dismiss the person's feelings

- speak with a patronizing tone

- try to "cure" the person

encourage appropriate professional help

- types of professionals

-- doctors (primary care physicians)

-- psychiatrists

-- social workers, counselors, and other mental health professionals

- types of professional help

-- talk therapies

-- medication

-- other professional supports

encourage self-help and other support strategies

- journal

- pray

- relaxation

- meditation

- exercise

- join support group

- avoid self-medicating

- family, friends, faith, and other social networks

summary

1. ask an open, non-threatening question

2. if suspicions strong, ask a direct question

3. if suicidal thoughts present, ask about plan

4. if patient has plan, notify family members and/or physician and do not leave them alone

5. withhold lethal amounts of medications

6. help them connect

7. stay connected