Self harm beliefs exercise Please help. In pairs read the following - PDF document

Self harm beliefs exercise Please help…. In pairs read the following statements: • …some fellow students with their 3 rd year • Self-harm is attention seeking behaviour • The majority of people who commit suicide are mentally ill project on self harm … • Asking a person if they are suicidal can put the idea into their mind • It is interesting and relevant … • Self cutting relieves tension • Please email the Self Harm Research Group • People who talk about suicide never do it to take part • All suicidal people are depressed • Only teenage girls self cut shrgnotts@googlemail.com • If a person has made up their mind to commit suicide then Or speak to one of the team in the break/after there is nothing that you can do about it the lecture Decide whether you agree, disagree or are unsure … 4 Lecture 1: Aims and objectives Self-harm and suicide This lecture aims to address the following questions Dr Ellen Townsend - How are suicide and deliberate self-harm defined? NB. Full slides available to download: Wpsyc/Practicals/Clinical - What are the main trends, methods and risk factors? - Can suicidal behaviour be prevented? - What psychological factors are associated? - What psychological models exist to explain? 2 5 Overview of lectures Definition issues Lecture 1 Attempted suicide Suicide • Suicidal behaviour and prevention • No universally agreed definition • Deliberate self-harm (DSH) and attempted suicide: (Hawton and • Importance of psychological variables in • “Intentional taking of one’s van Heeringen, 2001). life”… understanding suicidal behaviour • Attempted suicide (O’Carroll et al., 1998) • “A conscious act of self-induced annihilation, best understood as a Lecture 2 multidimensional malaise …” • Parasuicide (Kreitman, 1977) (Shneidman, 1985) • Assessment of suicidal patients • Interventions for suicidal behaviour • Self-harm (habitual or not?) • INTENTION IS KEY 3 6

Why? Suicide stats • Coroners suicide verdict – Note left – Method obvious • Doubt? = Accidental/open verdict • Inconsistent – protect families (shame/stigma) • Suicide rates are UNDERESTIMATED Sylvia Plath, 31 Kurt Cobain, 27 Gas asphyxiation Gunshot 7 10 ONS Suicide rates by age and sex No one cause 91-07 • Multidimensional malaise (Leenars, 1996) • Psychological factors important – crucial – Psychological pain, hopelessness etc • Tipping points – Culmination of multiple factors – Can be anything – Relationship problem common 8 11 Method of suicide Suicide statistics (England and Wales 1999) 2% • UK 2%  2005, 5,671 suicides (adults aged 15 and over) 0% 2% 19% 18% 20%  ¾ male 4% 44% • Suicide - 79 minutes (UK & Rep. Ireland) 7% 12% 4% 41% • Suicides > RTA deaths 25% Females Males • E.g. Suicides 2003 = 4,605 vs 3,508 RTA deaths Drug ingestion Jumping Other Hanging Drowning 9 12 Firearms CO

Groups at recognised increased risk of suicide The incidence of attempted High risk group Estimated % of total suicides suicide (deliberate self harm) magnitude of in England/Wales increased risk Psychiatric patient - current or ex (in x10 50% patient and outpatient) • 170,000 cases per year UK (general hospital History of attempted suicide (DSH) x10-30 30-47% presentations) • A top 5 cause for medical admission for both Contact with psychiatric services 6- 25% 12 months before death men and women (UK) Patients in 4 wks following discharge x200 (male) 10-15% • No nationwide routine monitoring from psychiatric hospital x100 (female) • Oxford Monitoring System for Attempted Alcoholics x20 15-25% Suicide – established 1976 – Bristol, Manchester (2-3 years of monitoring) Drug misusers x20 Family history of suicide 4% 13 16 Factors in suicidal behaviour Clinical Personal Social • Depression: Unipolar • Genetic factors/family • Availability of and bipolar history methods • Alcoholism & • Significant dates • Unemployment substance abuse • Personality disorders • Memory biases • Media reporting • Schizophrenia • Hopelessness & future • Social support and directed thoughts isolation • Problem solving • Suicide ideation • Cognitive rigidity • Life events • Suicide intent • Impulsivity • Civil unrest • Abuse • Perfectionism • Repetition • Biological factors 14 17 Method of DSH Case example: PD WHO EU Multi-centre study (Schmidtke et al, 1996) • PD’s suicide: depressed & hopeless (clinical) • Female rates higher than males • In unbearable psychological pain (personal) • Most attempts ‘non violent’: Self poisoning • UK paracetamol • Mainly self-poisoning: 64% males, 80% females • Couldn’t cope with break-up (social) • Cutting: (mostly wrists): 17% males, 9% females • Alcohol, as (a) part of method, (b) preparation, • Limited coping strategies (personal). (c) long term risk factor – 22-26% at time of attempt – 44-50% in 6 hours before attempt (Hawton et al 1997/98) 15 18

Can suicidal behaviour be prevented? Sex-specific suicide rates by mode of death: England & Wales Kreitman (1976) • Suicide is not an isolated event but a Females Males culmination of series of interactions …. hence 14 14 preventable ...??? 12 12 Total 10 10 Total – Treating suicidality 8 8 Non CO • preventing repetition (next week) 6 6 Non CO 4 4 – Availability of methods CO CO 2 2 0 0 55 57 59 61 63 65 67 69 71 55 57 59 61 63 65 67 69 71 19 22 Year Year Examples of effects of availability of methods • Coal gas story • Paracetamol legislation (Public Health Intervention) 20 23 Availability example 1: The coal gas story Availability example 2: Paracetamol overdose (Kreitman, 1976) Percentage of CO in domestic gas, UK 1955-74 14 140 1800 Oxford paracetamol overdose 1600 (units per million population) 12 120 1400 Sales of paracetamol rate per 100,000 10 100 1200 Percent CO (r = 0.86) 80 8 1000 800 60 6 600 40 4 400 20 200 2 0 0 0 1975 80 85 90 1955 1960 1965 1970 1974 Year 21 24

Paracetamol and Salicylate Pack Legislation Study Self-poisoning patients who took paracetamol Hawton, Townsend et al (2001) findings Hawton, et al., 1995; 1996 In year after legislation - reduction in: • Deaths – paracetamol self-poisoning Availability main reason for choosing 50 (63%) • Liver units • Admissions Premeditation • listings for transplantations < 1 hour 33 (41%) • actual transplants 1 - < 3 hours 26 (33%) • Non-fatal Paracetamol overdoses Suicidal intent (clinician’s assessment) 31 (39%) • the number of tablets taken per overdose • large overdoses 25 28 Paracetamol study follow-up Paracetamol legislation – (Hawton et al., 2004) September 16 th , 1998 • Examined longer term effects of legislation • Before: - 100 tablets - pharmacies • Conclusions - 24 tablets - non-pharmacy outlets – Smaller pack sizes sustained beneficial effects – Decreases in deaths, size of non-fatal • After: - 32 tablets - pharmacies (more at overdoses, liver unit admissions and transplants pharmacist’s discretion) – Some substitution to ibuprofen – but no - 16 tablets - non-pharmacy outlets mortality effects - Labelling changes 26 29 Potential analgesic availability in households Importance of psychology before and after the legislation Number of tablets Biological Environmental Suicidal behaviour Psychology Events Psychological processes are key mediators/moderators Purchases 27 30

Key psychological variables ‘Cry of pain’ model of suicidal behaviour ( Williams 1997, Williams and Pollock 2000) • Impulsivity • Dichotomous thinking • Psychological mechanisms in triggering suicidal crises. • Cognitive rigidity • Focus on setting conditions not consequences • Hopelessness and future thinking • Preceding stress events that signal “defeat” • Social perfectionism • Psychological processes which increase • Problem-solving vulnerability - which signal “no escape” • Autobiographical memory • Psychological processes that turn crises into suicidal crisis - that signal “no rescue”. 31 34 Cry of pain model Problem solving Suicide risk • Means-Ends Problem Solving Task (MEPS) PAIN • Item: Trying to make friends in a new Escape Biological neighbourhood – no friends at start 20 at end … Stress: Potential defeat & helplessness rejection script • “I wouldn't know what to do in that situation. I have always had someone to go out and make Rescue factors friends for me . I can't imagine what to do.” -Self e.g. abilities and skills - PSYCHOLOGICAL -Others eg. social support (Rated 1 - Not at all effective) 32 35 Why? MEPS performance 25 • We need to know not only “why suicide”, 20 but also 15 Relevant Means why no other solution was considered? Effectiveness 10 5 0 (Mark Williams) Suic Psychiat Cont 33 36