BUILDING BARRIERS TO SUICIDE:

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1 BUILDING BARRIERS TO SUICIDE: Mr. F 78 yo male CAD, HTN, CABGx5 Depression? PCP of course you re depressed, your old Sig for anti depressant <2 months later death by carbon monoxide Death certificate CAD Statistics A major, hidden but preventable public health problem death every 15 minutes #1 injury mortality in the USA more people die by suicide than MVC 2 nd leading cause of death in youth (an increase in 50% from ) 1

2 Almost as many police officers die by suicide as in the line of duty 8 25 attempts for every death by suicide More than half of all suicides are completed with a firearm Suicide rates are higher in spring Economic Burden The economic cost of suicide death in the U.S. is estimated to be $34 billion annually. Non fatal injuries due to suicide attempts cost an estimated $3 billion annually for medical care. Another $5 billion is spent for indirect costs, such as lost wages and productivity. Demographics Males = 4x death by suicide Females = more suicide attempts Highest in Caucasian and Native American Higher in rural areas Unemployment is a risk LGBT youth Living alone, single increases rates 2

3 Major Risk Factors Untreated/under treated mental illness Substance abuse Previous suicide attempt Access to lethal means Losses History of trauma or abuse Exposure to death by suicide Death of child Concurrent medical disorder/chronic pain Suicide Behavior Attempt Interrupted Attempt Aborted Attempt Preparatory Acts Rehearsal Terms to Avoid: Completed suicide Failed attempt Parasuicide Successful suicide Suicidality Nonfatal suicide Manipulative act Suicide gesture Suicide threat 3

4 Acceptable Terms: Attempted Suicide Died by Suicide Protective Factors Effective clinical care for mental, physical and substance use disorders Strong connections Skills in problem solving Restricted access to lethal means Screening A critical opportunity for prevention Many who die by suicide see their PCP in the month prior to their death 45 % of Adults 70% of Older Adults 4

5 Ideation Substance Abuse Purposelessness Anxiety Trapped Hopelessness Withdrawal Anger Recklessness Mood Changes Warning Signs: IS PATH WARM? Columbia Suicide Severity Rating Scale Initially designed for an NIMH funded suicide study The C SSRS is the only screening tool that assesses the full range of evidence based ideation and behavior items, with criteria for next steps (e.g. referral to mental health professionals); thus, the C SSRS can be exceptionally useful in initial screenings The C SSRS has been administered several million times and has exhibited excellent feasibility no mental health training is required to administer it but does require training. The Language of Suicide Morbid ruminations I wish I were not around, dead or not here Non specific active suicidal thoughts I ve thought about killing myself 5

6 Active suicidal ideation without plan/intent I thought about taking an overdose but I never made a specific plan and I would never go through with it Active suicidal ideation with some intent to act, but without specific plan Active suicidal ideation with specific plan and intent Management Managing one s own reaction to suicide Reconciling the difference (and potential conflict) b/w the clinicians goal to prevent suicide and the clients goal to eliminate psychological pain via suicide Managing the Suicidal Patient Imminent Risk = Medical Emergency! ER 911 Safety check 6

7 Managing the Suicidal Patient If risk is not imminent/severe Therapeutic Rapport Eliminate risk factors Strengthen reasons to live Develop safety plans /distress tolerance strategies Address substance abuse Post Prevention Family/Friend Increase risk for depression Monitor for warning signs Special care of children Support groups Post Prevention Clinicians Frequently feel stress akin to that of losing a parent Guilt EAP 7

8 Pearls Suicide thoughts indicate the person s pain exceeds their coping abilities Don t be afraid to ask! Human foibles Sometimes the only thing you can say is I m sorry Human Beings not Human Doings Explain studies are inconclusive regarding FDA black box warnings causative vs associative Don t think about a white bear Caution with TCA 8