Mental Health Suicide

Suicide

is the voluntary act of killing oneself. It is a fatal, self-inflicted destructive act with explicit or inferred intent to die. It is sometimes called suicide completion.

Myths about Suicide

• Suicide only affects individuals with a mental health condition.

• Most suicides happen suddenly without warning.

• People who die by suicide are selfish and take the easy way out.

• When people become suicidal, they will always be suicidal.

• Talking about suicide will lead to and encourage suicide.

Facts about suicide

• Many individuals, and met al illness are not affected by suicidal thoughts, and not all people who attempt or die by suicide have mental illness.

• Warning signs, verbally or behaviorally, precede most suicides.

• Typically, people do not die by suicide because they do not want to live.

• People die by suicide because they want to end their suffering.

• Active suicidal ideation is often short term and situation specific.

• Although suicidal thoughts can return, they are not permanent.

• Talking about suicide not only reduces the stigma but also allows individuals to seek help, rethink their opinions, and share their story with others.

Suicide Risk Factors

• Family history of suicide

• Family history of child maltreatment

• Previous suicide attempt(s)

• History of mental disorders, particularly clinical depression

• History of alcohol and substance abuse

• Feelings of hopelessness

• Impulsive or aggressive tendencies

• Cultural and religious beliefs (e.g., belief that suicide is noble resolution of personal dilemma)

• Local epidemics of suicide

• Isolation, a feeling of being cut off from other people

• Barriers to accessing mental health treatment

• Loss (relational, social, work, or financial)

• Physical illness

• Easy access to lethal methods

• Unwillingness to seek help because of the stigma attached to mental health and substance abuse disorders or to suicidal

Ideation

Taking or writing about death, dying, or suicide

threatening or talking of wanting to hurt or kill self

looking for ways to kill self: seeking access to firearms, available pills, or other means. 

Substance abuse 

Increased substance alcohol or drug use

Purposelessness

No perceived reason for living no sense of purpose in life.

Anxiety

agitation unable to sleep, ot sleeping all the time

Trapped

Feeling trapped like there is no way out

Withdrawal

from friends family and society

Anger

Rage uncontrolled anger, seeking revenge

Recklessness

acting reckless or engaging in risky activities seemingly without thinking

Warning signs of suicide

hopelessness and mood change

INTENT TO DIE

1. Have you been thinking about hurting or killing yourself?

2. How seriously do you want to die?

3. Have you attempted suicide before?

4. Are there people or things in your life who might keep you from killing yourself?

SEVERITY OF IDEATION

1. How often do you have these thoughts?

2. How long do they last?

3. How much do the thoughts distress you?

4. Can you dismiss them or do they tend to return?

5. Are they increasing in intensity and frequency?

DEGREE OF PLANNING

1. Have you made any plans to kill yourself? If yes, what are they?

2. Do you have access to the materials (e.g., gun, poison, pills) that you plan to use to kill yourself?

3. How likely is it that you could actually carry out the plan?

4. Have you done anything to put the plan into action?

5. Could you stop yourself from killing yourself?

Interventions for Those at Imminent Risk

reconnecting the patient to other people and instilling hope, restoring emotional stability, and reducing suicidal behavior and ensuring safety.

Ensuring Patient Safety

Helping patients develop strategies for making safer choices when distressed is an important goal. Nurses caring for patients who are emerging from the initial hours and days of a suicide attempt can support the patient and focus on managing suicidal urge and developing protective strategies. As the nurse connects with the patient, together they can create a list of personal and professional resources that can be used when the individual is in crisis 

Inpatient Safety Considerations.

When hospitalization is considered the best option to ensure the safety of the patient, the nurse has the responsibility for providing a safe, therapeutic environment in which human connection, instilling hope, and changing suicidal behavior can occur. Inpatient suicides do occur.

Interventions for Intermediate and Long-Term Risk

Patients who are suicidal may need ongoing preventive interventions. The risk varies with the genetic, psychiatric, and psychological profile of the patient and the extent of their social support. Discouragement and hopelessness often persist long past the suicidal episode. Episodes of hopelessness should be anticipated and planned for in the patient's care. Patients should be taught to expect setbacks and times when they are unable to see much of a future for themselves. They should be encouraged to think of times in their lives when they were not so hopeless and consider how they may feel similarly in the future. Helping patients review the goals they already have achieved and at the same time set goals that can be achieved in the immediate future can help them manage periods of discouragement and hopelessness.

Psychological Risk Factors

Psychological pain, internal distress, low self-esteem, and interpersonal distress have long been associated with suicide.  Childhood physical and sexual abuse is linked to suicide, suicide ideation, and parasuicide.

Cognitive risk factors include problem-solving deficits, impulsivity, rumination, and hopelessness. Impulsivity, anger, and reduced inhibition increase the risk of suicide.

Recent purchase of a handgun increases the risk of self-harm

Social Risk Factors

Social isolation is a primary risk factor for suicide. Social distress leads to despair and can be caused by family dis-cord, parental neglect, abuse, parental suicide, and divorce.

Social distress can prevent the patient from accessing the support necessary to prevent suicidal acts. Other social factors associated with suicide risk include economic deprivation, unemployment, poverty, knowing someone who has died by suicide (especially if this person was a family member), and lack of access to behavioral health care

Gender

Males have a suicide completion rate nearly four times that of females. White males account for 70% of completed suicides, with middle-aged

Sexuality

(LGBTQI community is at increased risk for suicide. An estimated 1.8 million LGBTQI young people seriously consider suicide each year, with LGBTQI youth nearly five times as likely to attempt suicide compared with heterosexual youth. In lesbian, gay, and bisexual older adults, there are high levels of inadequate general health disability

Race and Ethnicity

Rates of suicide among American Indian/Alaska Native (AI/AN) people and White people are highest, at 22.2 and 17.5 per 100,000, respectively. Lower suicide rates are found among Asian/ Pacific Island individuals (7.1 per 100,000), Hispanics (7.3 per 100,000), and Black (7.4 per 100,000) populations