Objectives Participant will be able to explain the phenomenology and - PDF document

10/3/2016 Assessment & Management of Suicide Risk in a Non ‐ Psychiatric Setting Inga Giske, MSN, RN ‐ BC Nurse Manager Acute Inpatient Psychiatry Providence St. Vincent Medical Center October 15, 2016 Objectives • Participant will be able to explain the phenomenology and prevalence of suicide • Participant will be able to identify risk factors and warning signs of suicide • Participant will be able to complete a basic screening for suicidal thinking and behaviors • Participant will be able to identify where to find additional resources on suicide for both clinicians and patients Terminology/Definitions • Self ‐ Directed Violence (SDV) – Behavior that is self ‐ directed and deliberately results in injury or the potential for injury to oneself • Suicide – Death caused by self ‐ directed injurious behavior with any intent to die as a result of the behavior • Suicide Attempt – A non ‐ fatal self ‐ directed potentially injurious behavior with any intent to die as a result of the behavior. – May or may not result in injury Source: https://www.cdc.gov/violenceprevention/pdf/self ‐ directed ‐ violence ‐ a.pdf 1

10/3/2016 Self ‐ Directed Violence Flowchart Source: https://www.cdc.gov/violenceprevention/pdf/self ‐ directed ‐ violence ‐ a.pdf Language Matters Unacceptable Terms → Acceptable Terms Completed Suicide → Suicide • Failed A � empt → Suicide A � empt or Suicidal Self ‐ Directed • Violence Nonfatal suicide → Suicide A � empt • Parasuicide → Non ‐ Suicidal Self ‐ Directed Violence or Suicidal • Self ‐ Directed Violence Successful suicide → Suicide • Suicidality → Suicidal Thoughts and Suicidal Behavior • Suicide Gesture, Manipula � ve Act, Suicide Threat → Non ‐ • Suicidal Self ‐ Directed Violence or Suicidal Self ‐ Directed Violence Source: https://www.cdc.gov/violenceprevention/pdf/self ‐ directed ‐ violence ‐ a.pdf National Suicide Prevalence Data • 10 th Leading Cause of Death in US – 42,773 suicides – Rate of 13.4  Rate calculated (number suicides/population) X 100,000 • 2 nd leading COD for age 15 ‐ 24 • 1 person suicides every 12.3 minutes • ~1.1 million adults attempt annually • 1 suicide attempt every 30 seconds • 3.4 males die by suicide for every female death by suicide • 3 female attempts for every male attempt Source: http://www.suicidology.org/Portals/14/docs/Resources/FactSheets/2014/2014datapgsv1b.pdf 2

10/3/2016 Oregon Data • 8 th Leading Cause of Death in 2014 – 782 suicides – Rate of 19.7  Rate calculated (number suicides/population) X 100,000 • 1 person dies by suicide every 11 hours • We rank 8 th in the Nation • In 2010 Suicide Cost $740,356,000 – Or, ~$1,080,811 per suicide death Sources: http://www.suicidology.org/Portals/14/docs/Resources/FactSheets/2014/2014datapgsv1b.pdf Washington County, Oregon Suicide Statistics released September 2016 https://afsp.org/about ‐ suicide/state ‐ fact ‐ sheets/#Oregon Means Matter Source: https://afsp.org/about ‐ suicide/suicide ‐ statistics / Impact of Suicide • For each suicide – 147 people are exposed (6.3 million annually) – 18 of those people experience a major life disruption • 750,000 survivors of suicide annually • Suicide costs the US ~$51 Billion Annually Sources: http://www.suicidology.org/Portals/14/docs/Resources/FactSheets/2014/2014datapgsv1b.pdf http://www.cdc.gov/violenceprevention/pdf/suicide ‐ datasheet ‐ a.PDF 3

10/3/2016 You Understand the Definitions and the Data But what is suicide, really? Suicide – What is it? • A multi ‐ factorial event – Psychiatric Illness & Co ‐ Morbidity – Neurobiology – Impulsivity – Hopelessness – Family History – Psychodynamics/Psychological Vulnerability – Suicidal Behavior – Life Stressors – Access to Weapons – Severe Medical Illness – Substance Use/Abuse – Personality Disorder/Traits Myths vs The Facts 4

10/3/2016 Myth vs Fact You shouldn’t ask people if they’re thinking about suicide because you might put the idea in their head • Asking people doesn’t give them the idea. • Asking does give them the opportunity to share their mindset and intentions with you. • Asking can give them hope that you care enough to ask and give them relief to share their burden. • Asking can help diffuse some of the tension that is causing their suicidal thoughts Source: http://www.suicide.org/suicide ‐ myths.html Myth vs Fact People who are suicidal definitely want to die • The vast majority of suicidal people do NOT actually want to die • They ARE in pain and want to stop the pain • They typically have a lot of ambivalence Source: http://www.suicide.org/suicide ‐ myths.html Myth vs Fact People who talk about suicide are trying to manipulate you • People are in pain and need help • An assumption of attempted manipulation is insensitive and ignorant • Most people who suicide talk about it first • Always take the talk seriously Source: http://www.suicide.org/suicide ‐ myths.html 5

10/3/2016 Myth vs Fact People who suicide or attempt suicide are crazy • No, they are in pain • They likely have a diagnosable mental disorder with neurobiological causes which is treatable • New research is identifying genetic drivers of suicide Source: http://www.suicide.org/suicide ‐ myths.html Myth vs Fact People who attempt suicide and survive will not attempt again • Some people who attempt suicide will attempt again. • Past suicide attempts are a known risk factor for suicide Source: http://www.suicide.org/suicide ‐ myths.html Myth vs Fact Once a person decides to die by suicide, there is nothing we can do to stop them • Suicide can be prevented! • Most people do not necessarily want to die, they want to end their pain Source: http://www.suicide.org/suicide ‐ myths.html 6

10/3/2016 Myth vs Fact Suicide always occurs without warning signs • There are almost always warning signs! Source: http://www.suicide.org/suicide ‐ myths.html Risk Factors • Serious illness, or physical chronic pain • Previous suicide attempt • Hx of non ‐ suicidal self ‐ directed violence • Hx of trauma or loss • Social isolation or a pattern/hx of aggressive and antisocial behavior • Discharge within the past year from a psychiatric facility (greater risk within the first few weeks/months) Risk Factors • Access to lethal means • Perceived sense of being a burden on family, loved ones, or society • Profound sense of hopelessness and shame • Diagnosis of mental or emotional disorder, particularly depression or bipolar disorder • Alcohol and/or drug abuse 7

10/3/2016 Protective Factors • Able to identify reason(s) for living • Responsibility to family or others • Living with family • Supportive social network and/or family • Fear of death or dying due to pain and suffering • Belief that suicide is immoral and/or high spirituality • Engaged in work or school Warning Signs • I deation • S ubstance Abuse • P urposelessness • A nxiety • T rapped • H opelessness • W ithdrawal • A nger • R ecklessness • M ood Changes Source: http://www.suicidology.org/resources/warning ‐ signs Warning Signs of Acute Risk • Threatening to hurt self or kill self, or talking about wanting to hurt to kill self • Looking for ways to kill self, seeking access to means (firearms, pills, other methods) • Talking or writing about death, dying, or suicide, when these actions are out of the ordinary Source: http://www.suicidology.org/resources/warning ‐ signs 8

10/3/2016 Expanded Warning Signs • Increased substance (alcohol or drug) use • No reason for living; no sense of purpose in life • Anxiety , agitation, unable to sleep or sleeping all of the time • Feeling trapped ‐ like there's no way out • Hopelessness • Withdrawal from friends, family and society • Rage, uncontrolled anger , seeking revenge • Acting reckless or engaging in risky activities, seemingly without thinking • Dramatic mood changes • Giving away belongings Source: http://www.suicidology.org/resources/warning ‐ signs Suicide Risk Screening Suicide Risk Screening • SAMHSA recommends two suicide risk screening tools – Columbia Suicide Severity Rating Scale (C ‐ SSRS) – SAFE ‐ T Source: http://www.integration.samhsa.gov/clinical ‐ practice/screening ‐ tools 9

10/3/2016 C ‐ SSRS Source: http://www.cssrs.columbia.edu/scales_practice_cssrs.html C ‐ SSRS Training • Link to C ‐ SSRS FREE Screening Training Video – https://www.youtube.com/watch?v=Ted_gl ‐ UXi8 SAFE ‐ T • Pocket Card available free from SPRC with an app as well SAFE ‐ T Card • Guides clinicians through five steps which address the patient's level of suicide risk and suggest appropriate interventions Source: http://www.integration.samhsa.gov/images/res/SAFE_T.pdf 10

10/3/2016 You’ve Identified Risk What Now?? With The Patient • Manage your own reactions – Stay calm • Keep talking with the patient – Find about what’s personally driving their wish to die – Find out what’s keeping them alive – What has worked for them when they’ve felt like this before • Let them know you will help them get help • Reinforce that their safety is your priority and you are there to help the them keep themself safe Crisis Resources • National Suicide Prevention Life Line – 1 ‐ 800 ‐ 273 ‐ TALK (1 ‐ 800 ‐ 273 ‐ 8255) • Veteran Option press 1 • Text Crisis Line – Text START to 741 ‐ 741 • Oregon County Map with Mental Health and Crisis Line Numbers – https://public.health.oregon.gov/PreventionWellness/ SafeLiving/SuicidePrevention/Pages/cntymap.aspx 11