Canadian Coalition for Seniors’ Mental Health www.ccsmh.ca Late Life Suicide Prevention Toolkit Funded by the Public Healt...
Contributors <ul><li>Dr. Martha Donnelly, MD </li></ul><ul><li>Head of the Division of Geriatric Psychiatry </li></ul><ul>...
Learning Objectives <ul><li>By the end of this workshop, you will be able to: </li></ul><ul><li>Demonstrate a basic unders...
Mortality Statistics <ul><li>Demographic risk factors include sex (Male), age (Older), and ethnicity (Caucasian/White). </...
2004 StatsCan Suicide Rates (per 100,000)
Mortality Statistics <ul><li>The ratio of suicidal behaviour to deaths for older adults is between 1-4:1, while that for a...
Suicide Assessment & Prevention  for Older Adults:  Risk Factors <ul><li>Q: What are the risk factors for suicide? </li></ul>
Suicide Assessment & Prevention  for Older Adults:  Risk Factors <ul><li>1. Suicidal Ideation and/or Behaviour </li></ul><...
Suicide Assessment & Prevention  for Older Adults:  Risk Factors <ul><li>3. Mental Illness (can include) </li></ul><ul><li...
Suicide Assessment & Prevention  for Older Adults:  Risk Factors <ul><li>5. Medical Illness </li></ul><ul><li>Pain, chroni...
Suicide Assessment & Prevention  for Older Adults:  Resiliency Factors <ul><li>Q: What are some of the resiliency  (protec...
Suicide Assessment & Prevention  for Older Adults:  Resiliency Factors <ul><li>Sense of meaning and purpose in life. </li>...
Suicide Assessment & Prevention  for Older Adults:  Warning Signs <ul><li>Q: What are the warning signs that    someone is...
Suicide Assessment & Prevention  for Older Adults:  Warning Signs <ul><li>Remember “IS  PATH  WARM?” </li></ul><ul><ul><li...
Suicide Assessment & Prevention  for Older Adults:  Key Questions <ul><li>Q: What questions do I ask? </li></ul>
Suicide Assessment & Prevention  for Older Adults:  Key Questions <ul><li>1. Ask about their feelings </li></ul><ul><li>Do...
Suicide Assessment & Prevention  for Older Adults:  Key Questions <ul><li>2. Ask about a suicide plan </li></ul><ul><li>Ha...
Suicide Assessment & Prevention  for Older Adults:  Key Questions <ul><li>3. Ask about their reasons to live </li></ul><ul...
Suicide Assessment & Prevention  for Older Adults:  Risk Management <ul><li>Immediate Risk Management </li></ul><ul><li>1....
Suicide Assessment & Prevention  for Older Adults:  Risk Management <ul><li>Immediate Risk Management (Cont.) : </li></ul>...
Suicide Assessment & Prevention  for Older Adults:  Risk Management <ul><li>Ongoing Risk Management </li></ul><ul><li>1.  ...
Suicide Assessment & Prevention  for Older Adults:  Risk Management <ul><li>Ongoing Risk Management (Cont.) </li></ul><ul>...
Suicide Assessment & Prevention  for Older Adults:  Treatment & Management <ul><li>Treatment and Management: Suicidal Seni...
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Suicide Prevention Toolkit Bcagcp Conf

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M Donnelly Presentation March 6-7 2009

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Suicide Prevention Toolkit Bcagcp Conf

  1. 1. Canadian Coalition for Seniors’ Mental Health www.ccsmh.ca Late Life Suicide Prevention Toolkit Funded by the Public Health Agency of Canada Dr. M.L. Donnelly Director, Division of Community Geriatrics Department of Family Practice Director, Division of Geriatric Psychiatry Department of Psychiatry, University of British Columbia
  2. 2. Contributors <ul><li>Dr. Martha Donnelly, MD </li></ul><ul><li>Head of the Division of Geriatric Psychiatry </li></ul><ul><li>Department of Psychiatry </li></ul><ul><li>University of British Columbia </li></ul><ul><li>Dr. Marnin J. Heisel, PhD, C. Psych </li></ul><ul><li>Assistant Professor </li></ul><ul><li>Departments of Psychiatry and Epidemiology & Biostatistics </li></ul><ul><li>Schulich School of Medicine and Dentistry </li></ul><ul><li>The University of Western Ontario </li></ul><ul><li>Dr. Sharon Moore, RN, M.Ed., PhD, C. Psych. </li></ul><ul><li>Associate Professor </li></ul><ul><li>Centre for Nursing & Health Studies </li></ul><ul><li>Athabasca University, Alberta </li></ul><ul><li>Charlene Foster, B.A. </li></ul><ul><li>Trainer and Volunteer Coordinator </li></ul><ul><li>London and District Distress Centre, Ontario </li></ul><ul><li>Ian Ross, MSc </li></ul><ul><li>Executive Director </li></ul><ul><li>Crisis Intervention and Suicide Prevention Centre </li></ul><ul><li>of British Columbia </li></ul><ul><li>Joan Seabrook, M.Ed., S.O. </li></ul><ul><li>Educational Consultant </li></ul><ul><li>Survivor Chair, Canadian Association for Suicide Prevention </li></ul><ul><li>Diane Yackel, M.A., F.T. </li></ul><ul><li>Executive Director </li></ul><ul><li>Centre for Suicide Prevention, Alberta </li></ul><ul><li>Sherri Helsdingen, B.A. </li></ul><ul><li>Project Manager </li></ul><ul><li>Canadian Coalition for Seniors’ Mental Health </li></ul><ul><li>Kimberley Wilson, MSW, BASc </li></ul><ul><li>Executive Director </li></ul><ul><li>Canadian Coalition for Seniors’ Mental Health </li></ul>
  3. 3. Learning Objectives <ul><li>By the end of this workshop, you will be able to: </li></ul><ul><li>Demonstrate a basic understanding of the epidemiology of late-life suicide; </li></ul><ul><li>Be aware of the risk factors for suicide, as well as protective factors; </li></ul><ul><li>Identify suicide warning signs; </li></ul><ul><li>Initiate life-saving conversations about depression and suicide risk using key questions to assess for suicide risk; </li></ul><ul><li>Be familiar with late-life suicide risk assessment and clinical intervention strategies; </li></ul><ul><li>Integrate components of the CCSMH Late Life Suicide Prevention Knowledge Translation Toolkit into clinical care. </li></ul>
  4. 4. Mortality Statistics <ul><li>Demographic risk factors include sex (Male), age (Older), and ethnicity (Caucasian/White). </li></ul><ul><li>In 2004, 427 Canadians 65+ died by suicide, including 319 men and 108 women. </li></ul><ul><li>Men between 85 and 89 years of age had a suicide rate (26.8/100,000) that more than doubled the national average of approximately 13/100,00. </li></ul><ul><li>Suicide mortality data underestimate “true” suicide rates, and do so differentially. </li></ul>
  5. 5. 2004 StatsCan Suicide Rates (per 100,000)
  6. 6. Mortality Statistics <ul><li>The ratio of suicidal behaviour to deaths for older adults is between 1-4:1, while that for adolescents is as high as 200-300:1 </li></ul><ul><li>Many older adults may end their lives by refusing food and/or needed medications; however, these deaths are typically not officially deemed suicides </li></ul><ul><li>Means of suicide differ by age, gender, and location. </li></ul><ul><li>Detection of suicide risk in older adults is crucial ; interventions can then follow. </li></ul>
  7. 7. Suicide Assessment & Prevention for Older Adults: Risk Factors <ul><li>Q: What are the risk factors for suicide? </li></ul>
  8. 8. Suicide Assessment & Prevention for Older Adults: Risk Factors <ul><li>1. Suicidal Ideation and/or Behaviour </li></ul><ul><li>Prior suicidal behaviour (including suicide attempt), prior self-harm behaviour, previous expression of suicide ideation </li></ul><ul><li>Feels tired of living and/or wishes to die </li></ul><ul><li>Thinks about suicide, has suicidal wishes and/or desires </li></ul><ul><li>Has a suicide plan/note </li></ul><ul><li>2. Family History </li></ul><ul><li>Family history of suicide, suicide ideation, mental illness </li></ul>
  9. 9. Suicide Assessment & Prevention for Older Adults: Risk Factors <ul><li>3. Mental Illness (can include) </li></ul><ul><li>Any mental disorder, co-morbidity </li></ul><ul><li>Major depressive disorder </li></ul><ul><li>Any mood disorder </li></ul><ul><li>Psychotic disorder </li></ul><ul><li>Substance misuse disorder/addictions </li></ul><ul><li>4. Personality Factors </li></ul><ul><li>Personality disorders </li></ul><ul><li>Emotional instability </li></ul><ul><li>Rigid personality </li></ul><ul><li>Poor coping skills, introversion </li></ul>
  10. 10. Suicide Assessment & Prevention for Older Adults: Risk Factors <ul><li>5. Medical Illness </li></ul><ul><li>Pain, chronic illness </li></ul><ul><li>Sensory impairment </li></ul><ul><li>Perceived or anticipated/feared illness </li></ul><ul><li>6. Negative Life Events and Transitions </li></ul><ul><li>Family discord, separation, death or other losses </li></ul><ul><li>Financial or legal difficulties </li></ul><ul><li>Employment/retirement difficulties </li></ul><ul><li>Relocation stresses </li></ul><ul><li>7. Functional Impairment </li></ul><ul><li>Loss of independence </li></ul><ul><li>Problems with activities of daily living </li></ul>
  11. 11. Suicide Assessment & Prevention for Older Adults: Resiliency Factors <ul><li>Q: What are some of the resiliency (protective) factors? </li></ul>
  12. 12. Suicide Assessment & Prevention for Older Adults: Resiliency Factors <ul><li>Sense of meaning and purpose in life. </li></ul><ul><li>Sense of hope or optimism. </li></ul><ul><li>Religious (or spiritual) practice. </li></ul><ul><li>Active social networks and support from family and friends. </li></ul><ul><li>Good health care practices. </li></ul><ul><li>Positive help-seeking behaviours. </li></ul><ul><li>Engagement in activities of personal interest. </li></ul>
  13. 13. Suicide Assessment & Prevention for Older Adults: Warning Signs <ul><li>Q: What are the warning signs that someone is at risk for suicide? </li></ul>
  14. 14. Suicide Assessment & Prevention for Older Adults: Warning Signs <ul><li>Remember “IS PATH WARM?” </li></ul><ul><ul><li>I Ideation </li></ul></ul><ul><ul><li>S Substance Use </li></ul></ul><ul><ul><li>P Purposelessness </li></ul></ul><ul><ul><li>A Anxiety/Agitation </li></ul></ul><ul><ul><li>T Trapped </li></ul></ul><ul><ul><li>H Hopelessness/Helplessness </li></ul></ul><ul><ul><li>W Withdrawal </li></ul></ul><ul><ul><li>A Anger </li></ul></ul><ul><ul><li>R Recklessness </li></ul></ul><ul><ul><li>M Mood Changes </li></ul></ul><ul><ul><li>From the American Association of Suicidology (AAS) website (www.suicidology.org). </li></ul></ul>
  15. 15. Suicide Assessment & Prevention for Older Adults: Key Questions <ul><li>Q: What questions do I ask? </li></ul>
  16. 16. Suicide Assessment & Prevention for Older Adults: Key Questions <ul><li>1. Ask about their feelings </li></ul><ul><li>Do you feel tired of living? </li></ul><ul><li>Have you been thinking about harming yourself and/or ending your life? </li></ul><ul><li>Have you been thinking about suicide? </li></ul>
  17. 17. Suicide Assessment & Prevention for Older Adults: Key Questions <ul><li>2. Ask about a suicide plan </li></ul><ul><li>Have you thought of specific ways of hurting yourself or ending your life? </li></ul><ul><li>Have you made any specific plans or preparations (giving away possessions, tying up 'loose ends')? </li></ul><ul><li>Have you asked someone to help you end your life or join you in death? </li></ul><ul><li>Do you have access to lethal means like a gun or other implements? </li></ul><ul><li>Have you collected pills in order to take an overdose? </li></ul><ul><li>Have you started to put a suicide plan into action? </li></ul>
  18. 18. Suicide Assessment & Prevention for Older Adults: Key Questions <ul><li>3. Ask about their reasons to live </li></ul><ul><li>What has kept you from harming yourself? </li></ul><ul><li>Who or what makes life so worth living that you would not harm yourself? </li></ul><ul><li>What other questions could you ask?… </li></ul>
  19. 19. Suicide Assessment & Prevention for Older Adults: Risk Management <ul><li>Immediate Risk Management </li></ul><ul><li>1. Do not leave the person alone until you have arranged for the involvement of another appropriate care provider or source of protection. </li></ul><ul><li>2. Establish an immediate safety plan that includes: </li></ul><ul><li>family support </li></ul><ul><li>homecare support </li></ul><ul><li>24-hour (or in-home) care providers </li></ul><ul><li>police intervention (if needed) </li></ul>
  20. 20. Suicide Assessment & Prevention for Older Adults: Risk Management <ul><li>Immediate Risk Management (Cont.) : </li></ul><ul><li>3. Consider care needs: </li></ul><ul><li>emergency services </li></ul><ul><li>telephone and/or in-person crisis/distress/support services </li></ul><ul><li>mental health services </li></ul><ul><li>medical services </li></ul><ul><li>social service providers, community supports </li></ul><ul><li>4. Ensure that follow-up care is arranged. </li></ul><ul><li>5. Where possible, restrict access to lethal means. </li></ul>
  21. 21. Suicide Assessment & Prevention for Older Adults: Risk Management <ul><li>Ongoing Risk Management </li></ul><ul><li>1. Address underlying issues: </li></ul><ul><li>medical illness </li></ul><ul><li>mental health problems </li></ul><ul><li>social problems, concerns, transitions </li></ul><ul><li>environmental factors </li></ul><ul><li>2. Continually re-assess suicide risk, resiliency, and warning signs. </li></ul><ul><li>3. Continue to build and sustain the therapeutic relationship. </li></ul><ul><li>4. Look for ways to foster hope and enhance a sense of meaning in life. </li></ul>
  22. 22. Suicide Assessment & Prevention for Older Adults: Risk Management <ul><li>Ongoing Risk Management (Cont.) </li></ul><ul><li>5. Develop a safety plan that includes after-hours support. </li></ul><ul><li>6. Read and continually review CCSMH National Guidelines and other appropriate treatment guidelines. </li></ul><ul><li>7. Work within a culturally competent model of care. </li></ul><ul><li>8. Work within an inter-disciplinary care model where possible: </li></ul><ul><li>Develop relationships with mental health teams for support and on-going follow-up. </li></ul><ul><li>Be aware of community resources and referral sites/processes. </li></ul>
  23. 23. Suicide Assessment & Prevention for Older Adults: Treatment & Management <ul><li>Treatment and Management: Suicidal Seniors </li></ul><ul><li>Foster hope in clients who are suicidal </li></ul><ul><li>Assist in finding and maintaining meaning & purpose in life </li></ul><ul><li>Attend to the therapeutic relationship </li></ul><ul><li>Work in a team setting - don’t work alone (collaborative care) </li></ul><ul><li>Consult colleagues, keep detailed notes, use crisis services </li></ul><ul><li>Restrict access to lethal means </li></ul><ul><li>Mental health outreach </li></ul>

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