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 10 24 (an increase in 50% from 2006 2010) 1
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
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
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
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. http://www.cssrs.columbia.edu/ 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
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
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
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