Suicide awareness and prevention

1. Suicide Awareness
and Prevention

2. Learning
Topics
Definitions
Suicide Risk
Assessment
Risk Factors
Protective
Factors
Communicating
with the Patient
Hand off
Communication
Immediate
Safety Needs

3. Definitions
 Suicidal behavior: A spectrum of activities related to
thoughts and behaviors that include suicidal thinking,
suicide attempts, and completed suicide.
 Suicidal attempt: A potentially self-injurious behavior for
which there is evidence that the person probably intended
to kill himself or herself; a suicidal act may result in
death, injuries, or no injuries.
 Suicidal ideation: self-reported thoughts of engaging in
suicide-related behavior
 Suicide: death from injury, poisoning, or suffocation
where there is evidence that a self-inflicted act led to the
person’s death

4. Suicide Gesture and Behaviors
Suicide Gesture: similar to a suicide attempt except there is NO attempt to kill
one’s self.
Suicide behaviors encompass a broad range of acts, including suicide attempts,
gestures, threats, and suicidal thoughts.
People who try to commit suicide are often trying to get away from a life
situation that seems impossible to deal with. Many who make a suicide attempt
are seeking relief from:
 Feeling ashamed, guilty, or like a burden to others
 Feeling like a victim
 Feelings of rejection, loss, or loneliness
Most suicide attempts do not result in death. Many of these attempts are done in
a way that makes rescue possible. These attempts are often a cry for help.
Some people attempt suicide in a way that is somewhat non-violent, such as
poisoning or overdose. Males, especially elderly men, are more likely to choose
violent methods, such as shooting themselves. As a result, suicide attempts by
males are more likely to be completed.

5. Suicide Risk Assessment
A standardized tool for assessing a patient’s risk for suicide is conducting during the Intake.
The four variables we measure are:
THOUGHTS PLANS MEANS ABILITY

6. Risk Factors
Risk factors can include
recent loss, new chronic
or terminal diagnosis,
divorce, job loss, death
of a family member or
friend, legal issues,
substance abuse, and
prior history of suicide
attempts.

7. Is the patient a risk?
Risk for suicide is not a yes or no finding.
There are levels of risk depending on the
patient’s current life situation, mental status,
and periods of crisis.
The assessment looks at both Risk and
Protective Factors.
A Risk Factor may be a recent job loss
A Protective Factor may be family support

8. Key Risk
Factors
Four key risk factors increase the
likelihood for suicide:
Mental health problems, such as
depression
Substance abuse or increased alcohol
use
Situations that seem
“hopeless” to the
patient
Relationship difficulties
Serious work problems
Serious legal trouble
Serious financial trouble
Traumatic events
Suicide behaviors,
such as:
Previous suicide attempts
or suicide gestures
Hints or talk about suicide

9. Symptoms
of
Depression
Change in
appetite,
unwanted weight
loss or gain
Change in sleep
habits
Decreased
productivity, poor
performance
Decreased sex
drive
Difficulty
concentrating or
remembering
Expressed
feelings of
inadequacy or
worthlessness
Loss of energy,
slowed speech,
and muscle
movement
Loss of interest in
usually
pleasurable
activities
Negative thoughts
about the future
or the past
No apparent
pleasure in
response to praise
or rewards
Tearfulness or
crying

10. Protective
Factors
One strategy to prevent suicide is to
reduce risk factors or strengthen and
increase protective factors, such as:
 Belief that it is OK to get help
 Early intervention by the
command
 Good problem-solving and
coping skills
 Optimistic outlook
 Positive attitude about getting
help early
 Positive family and social
support
 Spiritual support

11. Communicating with Patients
 Inquiry about suicide risk needs to be communicated in
a clear and straightforward manner (“Are you having
thoughts of harming yourself?”)
 Avoid the use of indirect questioning such as “You aren’t
suicidal are you?” or “You aren’t having thoughts of
harming yourself”?)
 Assess for passive thoughts (“The world would be better
off without me.”) versus active thoughts (“I am going to
take that bottle of pills when I get out of here.”)
 Don’t be afraid to ask the questions. It is important to
directly ask the patient/individual served if he or she is
suicidal and/or has a plan. Often patients/individuals
served who are suicidal will be relieved that someone
asked.

12. Communicating with Patients
 Remember that patients/individuals served will not
normally volunteer the information that they are feeling
suicidal, therefore it is important to ask.
 Avoid using statements such as “Patient did not voice
any suicidal thoughts.” Be sure to reflect that you
queried the patient/individual served (for example, “He
denied having any suicidal thoughts.”).
 Anxiety and agitation are key indicators of suicide risk,
as are high energy levels, impulsivity, and sleep
deprivation.
 Suicide risk assessments should be conducted on a
regular basis—not just on admission. Other times to
consider reassessment include change of status, change
of diagnosis, prior to a home visit, and prior to
discharge.

13. Communicating with the Patient
DO:
Ask the patient if he/she is thinking about
suicide
Actively listen to what he/she has to say
Acknowledge his/her talk, behavior, and
feelings
DON’T:
Debate whether suicide is right or wrong
Discuss whether feelings are good or bad
Lecture the person on the value of life

14. Communicating with the Patient
DO:
 Let the patient know you care and
understand
 Discuss and care about what is troubling
him/her
 Maintain good eye contact and give your
undivided attention
DON’T:
 Encourage him or her to do it
 Act shocked—this will put distance
between you

15. Handing Off
Communication
Handoff communication is
important when discussing the
patients.
All information needs to be
shared, even information that
staff do not think is significant to
share.
(For example, “The patient was
smiling and participated in
activities all day but cried all
evening. He refused to talk to
staff. He was in his room all
night. Refused to participate in
any activities.”)

16. HAND OFF COMMUNICATION
DO:
Communicate this to the Nursing team
immediately.
Document your interactions with the
patient for the Clinical and Medical, and
for following shifts.
Be sure to assess if the patient has any
items that may be a ligature risk.
DON’T:
Don’t leave the
patient alone, or
leave the facility
without
communicating!
Don’t be sworn to
secrecy!

17. Immediate Safety Needs
When a patient/individual served has been
identified as a suicide risk based on the
assessment criteria develop and implement a
treatment plan (identified needs, indices for
progress, and interventions) to address
safety needs.
Define the levels of observation, e.g. 1:1,
close observation.
Monitor consistency of the implementation of
observation procedures.

18. Immediate Safety Needs
Be sure to assess accessibility of items with which the
patient/individual served may harm himself or herself.
 Have the patient/individual served use plastic eating
utensils, and have staff responsible for counting each piece
after the patient/individual served finishes a meal, no
matter what level of observation he or she has been placed
on.
 Review the contraband policy of the organization and the
standardized list of contraband items.
 Develop standardized monitoring requirements for specific
items (for example, “Hair dryer use re-quires staff
supervision.”)
 Visitors have all gifts and personal items for the
patient/individual served verified by staff prior to giving.
 When the environment cannot be easily corrected, consider
creating one safe area in which to place patients, or utilize
clinical interventions such as close monitoring.