SUICIDE PREVENTION
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This illustrated lecture is for students new to the field of mental health. The case studies are also available separately, each having a description.
This is not available on YouTube and we ask that you use the resource in a sensitive and appropriate way in teaching. For a wider discussion about the use of media when considering this topic please review the advice given by the Samaritans here.
The programme begins with the placement of suicide in the politics of health. It is a behaviour or perhaps also thought of as a symptom and in the presentation, we see it in three very different clinical situations.
Here are two messages to consider: It is much harder to predict than you might think. “Check-lists are a waste of time.” Discuss.
Leading on from that, it is not possible to stop all suicides. As a professional in the field you cannot avoid the subject. General management principals can and do make a difference.
The Case Studies are from the lecture “Suicide – Why Do It?” They are presented in a way that makes them suitable for use in a live lecture situation, on-line or in person.
Suicide is among the ten leading causes of death and, in the UK, the third most important to life years lost after coronary heart disease and cancer. In young males, it is the second most common form of death after accidents. All categories of psychiatric illness carry an increased risk. Drug and alcohol misuse patients have increased risk.
Risk factors include male, older age group, living alone, previous attempts, agitation and impulsivity, insomnia, impaired memory, self-neglect and hopelessness. Other factors include social class, type of employment, and bereavement in childhood. Suicidal behaviour clusters in families. It is possible that there are biological factors at work (a suicide gene), but this may just be related to the underlying diagnosis.
Factors of self-harm favouring suicidal intent over deliberate self-harm include: Isolation, timing, precautions to avoid intervention, suicidal note, anticipatory action, and dangerousness of attempt.
Management can be challenging, and issues include a lack of clinical resources, patient and family factors, staff conflict, and difficulties in assessing and monitoring risk. Always err on the side of caution and discuss with the family. Have a back-up plan and, at the least, a follow-up assessment by somebody. Admission for a few days can be good as a place of safety and to offer the opportunity for a more considered assessment period.
At least be aware of high-risk patients and these include: those who live alone and those who have a bleak future and feel hopeless.
It is difficult, and even when you have done everything right, with impeccable, legible notes and completed risk management forms, it will still happen.
This presentation is mainly about the progress of one patient with a serious chronic mental illness. The format is that of a recorded teaching session, intercut with interviews of the patient and her mother. There are some profound thought provoking moments.
The session invites comment on the most pressing clinical objectives, which are quality of life and optimal treatment. We hear of the history of overdose and bizarre behaviour. The students discuss risk and possible psychosocial causes, including drugs and alcohol. There is concern because the risky behaviour is escalating. The management options are discussed, including in-patient care and the use of community resources.
Further personal and family information is now presented and the audience are invited to consider how this influences their assessment.
Tracy now talks about her daughter’s death and the group discuss how professionals should respond by being being honest and not defensive, listening and visiting early. There is general discussion about guilt, different personality styles and how this affects the way individuals cope. It is recognised that all care is imperfect.
And perhaps that would be the end of the programme but it continues and we hear that her son Stephen has been killed in a road accident. This information leaves the teaching group stunned and there is discussion about unbearable grief and how it must be overwhelming for family and friends.
Some while later we were able to record a follow-up interview with Tracy and we hear how she is beginning to cope with her grief.
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