Sa fe ty Pla ns fo r Risk o f Suic ide : Putting the Pe rso n in - PowerPoint PPT Presentation

Sa fe ty Pla ns fo r Risk o f Suic ide : Putting the Pe rso n in the Drive r’ s Se a t to a Sa fe De stina tio n

Susa n K impe r, MSN, RN-BC DI RE CT OR OF PSYCHI AT RI C ME DI CI NE NCH HE AL T HCARE

DI SCL OSURE ST AT E ME NT T he pre se nte r ha s no c o nflic ts o f inte re st to disc lo se .

Ob je c tive s As a re sult o f this tra ining the pa rtic ipa nt will b e a b le to :  De sc rib e a t le a st 4 risk fa c to rs a nd 4 pro te c tive fa c to rs tha t sho uld b e ta ke n into a c c o unt whe n fo rmula ting risk fo r suic ide .  I de ntify the use o f the a c ro nym I S PAT H WARM in the de ve lo pme nt o f wa rning sig ns fo r the pa tie nt’ s sa fe ty pla n.  De sc rib e the CASE mo de l fo r a sse ssing suic ide risk.  De sc rib e a nd de mo nstra te the use o f the sa fe ty pla n fo r suic ide risk.

T he Jo int Co mmissio n NAT I ONAL PAT I E NT SAF E T Y GOAL # 15 (2018)  T he or ganization ide ntifie s c lie nts at r isk for suic ide .

De finitio n o f Suic ide 6  Suic ide is “a n a c t o r o missio n is a suic ide if a pe rso n inte ntio na lly b ring s a b o ut his o r he r o wn de a th, unle ss the de a th (a ) is c o e rc e d o r (b ) is c a use d b y c o nditio ns tha t a re no t spe c ific a lly a rra ng e d b y the a g e nt fo r the purpo se o f b ring ing a b o ut de a th” (Be a uc ha mp, 1996).  Suic ide is the a c t o f killing yo urse lf, mo st o fte n a s a re sult o f de pre ssio n o r o the r me nta l illne ss. (Ame ric a n Psyc ho lo g ic a l Asso c ia tio n 2017)  Suic ide is de fine d a s de a th c a use d b y se lf-dire c te d injurio us b e ha vio r with inte nt to die a s a re sult o f the b e ha vio r. (NI MH 2017) 9/ 17/ 2018

SUI CI DE ST AT I ST I CS 2017 Suic ide is the 10 th le a ding c a use o f de a th in the U.S. in 20167. (NIMH) 2 nd le a ding c a use of de a th in the U. S. for e n a nd a dole sc e nts . c hildr T he re a re b e twe e n 25 a tte mpte d suic ide s fo r e ve ry suic ide de a th. (NIMH 2016) Bo rde rline pe rso na lity diso rde r pa tie nts ma y e xhib it no n suic ida l injury b e ha vio rs e .g . he sita tio n ma rks o f c utting mo st c o mmo n physic a l finding s. 464,995 pe o ple visite d a ho spita l fo r injurie s due to se lf-ha rm b e ha vio r in 2016 (o ne in 12 fo r e ve ry pa tie nt who die d b y suic ide .) 50% to 75% o f a ll pe o ple who try to die b y suic ide te ll so me o ne a b o ut the ir inte ntio n. So urc e : Ame r ic a n F ounda tion for Suic ide Pr e ve ntion we bsite 2017

Suic ide Sta tistic s 2017 Mor tality All suic ide s Rate s have inc r e ase d in the last de c ade Numb e r o f de a ths: 44,965 (2016) De a ths pe r 100,000 po pula tio n:  1990-2000=10.4  2017 13.42 US  2017 13.92 F L Age : Ra te o f de a th b y suic ide is hig he st fo r middle a g e me n ( white in pa rtic ula r) So urc e : Ame r ic an F oundation for Suic ide Pr e ve ntion we bsite 2017

SUI CI DE RAT E S BY AGE Source: American Foundation for Suicide Prevention website 2017

SUI CI DE RAT E S BY RACE / E T HNI CI T Y Source: American Foundation for Suicide Prevention website 2017

SUI CI DE ME T HODS Source: American Foundation for Suicide Prevention website 2017

T he Se c re t L a ng ua g e o f Suic ide  Pa tie nts who a re thinking a b o ut o r fe e ling tha t the y wa nt to die b y suic ide ha ve a ve ry diffic ult time te lling o the rs.  78% o f pa tie nt who a re a ske d if the y pla n to hurt the mse lve s de ny. (APNA 2016)  I de ntifying a pa tie nt who is suic ida l is de sc rib e d b y Dr. Sha wn Christo phe r She a a s simila r to putting the putting pie c e s o f a jig sa w puzzle to g e the r. Yo u ha ve to ha ve a ll the pie c e s a nd the y ne e d to b e uprig ht o n the ta b le . (She a 2002)  T he y fe e l a la c k o f b e lo ng ing a nd ho pe le ssne ss. (Jo ine r 2005)  25% o f suic ide s o c c ur in a no n-b e ha vio ra l he a lth se tting a nd the ro o t c a use re ve a ls a la c k o f pro pe r a sse ssme nt.( NI MH 2017)

T hings to Re me mbe r is a Patie nt is At Risk for Suic ide Remember that a patient who is having suicidal ideation or who has attempted to die by suicide is in a lot of psychological pain. They are not thinking clearly. Listen to them empathically non-judgmentally. BE KIND. Report any suicidal statements or behaviors immediately to the whomever you need to report to. Take them to someone who can do a more thorough assessment. Remember when a patient is under the influence of alcohol or drugs they may at a higher risk to attempt to die by suicide because of impaired judgement. The goal of a suicide assessment is not to predict suicide, but rather to...appreciate the basis for suicidality, and to allow for a more informed intervention” – (Jacobs, Brewer, & Klein-Benheim, 1999, p. 6).

I NAPPROPRI AT E WORDS T O USE WHE N DE SCRI BI NG SUI CI DE  Co mple te d suic ide  Suc c e ssful suic ide  Unsuc c e ssful suic ide  Suic ida l g e sture / ma nipula tive a c t/ suic ide thre a t  F a ile d suic ide  Pa ra suic ide  Suic ida lity Appro pria te : die d b y suic ide o r trie d to die b y suic ide (APNA Advo c a te s fo r Ho pe Suic ide Risk Asse ssme nt T ra ining 2016)

SUI CI DE : PHE NOME NOL OGY (Phe no me no lo g y studie s c o nsc io us e xpe rie nc e a s e xpe rie nc e d fro m the sub je c tive o r first pe rso n 15 po int o f vie w i.e . wha t is it like to b e suic ida l o r wha t is it like to ha ve a re la tio nship with so me o ne who is wa nting to die b y suic ide ) 9/ 17/ 2018

Wha t Are So me Co mmo n T he me s with 16 Pa tie nts Who T rie d to Die b y Suic ide  “ I do not be long.”  “I am a bur de n.”  “My life will ne ve r c ha ng e . I t is just hope le ss ”  “Wha t’ s the po int o f living . I ’ ve ma de so ma ny mista ke s.”  “I t’ s to o la te fo r me .”  “Yo u do n’ t g e t b la me d fo r ha ving a physic a l pa in b ut if yo u try to kill yo urse lf b e c a use o f yo ur me nta l pa in e ve ryb o dy b la me s yo u a nd is a ng ry.  “T he y wo uldn’ t le t me se e my c hildre n like I wa s so me kind o f a da ng e ro us pe rso n.”  “I wa s to ld b y my pa sto r to find a no the r c hurc h.” 9/ 17/ 2018

Wha t Do Pa tie nts Sa y is He lpful 17  Validation : “Go o d fo r yo u fo r c o ming fo rwa rd. I t must ha ve b e e n diffic ult to a sk fo r he lp.  Non- judge me nt: “ She invite d me to te ll my sto ry. She didn’ t sa y I wa s c ra zy.”  L e tting me talk about it . “T he y we re so g re a t. T he y a c tua lly to ld me the y we re inte re ste d in he a ring wha t ha ppe ne d. Ope nly a nd witho ut fe a r. T his is hug e .”  Ask que stions: “I think the b e st re a c tio n wo uld b e if so me o ne a ske d me wha t I ne e de d a nd ho w the y c o uld he lp me .” 9/ 17/ 2018

WHAT ’ S GOI NG ON? Me nta l he a lth a sse ssme nt: L iste n to the ir sto ry, b ig pic ture , ho listic , ma y use sc re e ning to o ls a nd e vide nc e b a se d q ue stio ning Princ iple o f a sse ssme nt, o b se rva tio n, da ta c o lle c tio n:  T e ll the m yo ur purpo se , c re de ntia ls, b uild trust; find o ut who is in the ir life pe rso na lly a nd psyc hia tric a lly Pro c e ss o f a sse ssme nt:  Build ra ppo rt, use la ng ua g e e ng a g e me nt stra te g y, pa c e a nd fo llo w, o b se rve a nd de sc rib e , “ wha t the pa tie nt sa ys.”  Me nta l Sta tus e xa m: F o llo w APA pra c tic e g uide line s (2013)

E vide nc e Ba se d Sc re e ning T o o ls fo r Suic ide Risk Asse ssme nt in the L ite ra ture  Ac c o rd ing to the Suic id e Pre ve ntio n Re so urc e Ce nte r re vie w o f e xpe rt pa ne l summa rie s to o ls: mixe d re se a rc h find ing s o n the a b ility o f b o th sc re e ning a nd a sse ssme nt to a c c ura te ly pre d ic t who ma y b e a t risk o f suic id e b ut fo und tha t sc re e ning c a n b e he lpful in pre ve nting suic id e . ( SPRC 2012)  Suic id e risk a sse ssme nt ne e d s to b e tho ro ug h, pe rso n-c e nte re d , a nd simple . It ne e d s to inc o rpo ra te multiple a ppro a c he s to a sc e rta in a pe rso n’ s le ve l o f d istre ss a nd risk o f suic id e . (Pe a rlma n 2011 p.65)  PhQ-9 to o l fo r d e pre ssio n. (Spitze r 2015)  Co lumb ia Suic id e Se ve rity Ra ting Sc a le : CSSRS Asks spe c ific q ue stio ns re g a rd ing suic id e risk (Po sne r 2009)  Ask Suic id e Que stio ns (ASQ) Sc re e ning T o o l: Suic id e Risk Asse ssme nt Sc re e ning T o o l K it (2015)  he Suicide Risk Assessment Inventory: A Resource Guide for Canadian Health care Organizations. Toronto, T ON: Ontario Hospital Association and Canadian Patient Safety Institute has a list of all the risk assessment tools, authors, contact information, cost etc.

Suic ide Sc re e ning T o o l in a n E le c tro nic Me dic a l Re c o rd