Suicide and Self-Injurious Behavior West Coast University NURS 204

Self-Destructive Behavior Definition: – Maladaptive measures a person uses to restore inner equilibrium when overwhelmed or unable to cope with stressful life events

Suicide  Definition:  The willful act of ending one’s own life

Suicide A significant public health problem in the United States In 2008 Every 18 minutes, a life is lost to suicide Eleventh leading cause of death 32,000 completed suicides More men than women die from suicide

Suicide - continued Social variables Ethics Ignorance Embarrassment Shame Fear of being labeled

Suicide - continued Demographic variables All demographic groups Highest rates Young adults aged Non-Hispanic whites Age 65 and older Non-Hispanic white men over 65

Suicide - continued Clinical variables 90% of individuals who commit suicide have a psychiatric illness 50% are under active psychiatric or mental health care Lack of close relationship Lack of personal freedom

Suicide - continued  Not a random act  Has a message and a purpose  S econdary to a terminal illness  Feeling like a burden to others  An untenable family situation  An untenable personal situation  Self-punishment for unacceptable behavior

Suicide Risk Factors Psychiatric disorders Alcohol or substance use disorders Male gender Increasing age Race Religion Marriage Profession Physical health

Biological Factors Suicidal behavior tends to run in families Low serotonin levels are related to depressed mood

Psychosocial Factors Freud – aggression turned inward Menninger The wish to kill The wish to be killed The wish to die Aaron Beck – central emotional factor is hopelessness Recent theories – combination of suicidal fantasies and significant loss

Cultural Factors Protective factors African Americans Religion, role of the extended family Hispanic Americans Roman Catholic religion and importance of extended family Asian Americans Adherence to religions that tend to emphasize interdependence between the individual and society

Societal Factors Oregon’s Death with Dignity Act of 1994 –terminally ill patients allowed physician-assisted suicide Netherlands – nonterminal cases of “lasting and unbearable” suffering Belgium – nonterminal cases when suffering “constant and cannot be alleviated” Switzerland – assisted suicide legal since 1918

Assessment: Overt Statements “I can't take it anymore.” “Life isn't worth living anymore.” “I wish I were dead.” “Everyone would be better off if I died.” It's okay, now. Soon everything will be fine.” “Things will never work out.” “I won't be a problem much longer.” “Nothing feels good to me anymore and probably never will.” “How can I give my body to medical science?”

Lethality Assessment Attempt to predict likelihood of suicide Direct communication with client about intent Consideration of lethality of proposed suicide method Evaluation of client’s ability and intent to act on idea or plan Is there access to the planned method? People with definite plans for time, place, and means are at high risk.

Assessment Tools: SAD PERSONS Scale Uses 10 major risk factors to assess suicidal potential 1.Sex (male)6.Rational thinking loss 2. Age 25 to 44 or7. Social supports lacking 65+ years or recent loss 3.Depression8. Organized plan 4. Previous attempt9. No spouse 5. Ethanol use10.Sickness

Nursing Diagnosis Risk for self-directed violence Risk for suicide Risk for self-mutilation Powerlessness Hopelessness Ineffective coping Low self-esteem

Outcome Identification Acknowledge self-harm thoughts Admit to use of self-harm behavior if it occurs Be able to identify personal triggers Learn to properly identify and tolerate uncomfortable feelings Choose alternatives that are not harmful Attempt to identify stressors

Levels of Intervention Primary – activities that provide support, information, and education to prevent suicide Secondary – treatment of the actual suicidal crisis Tertiary – interventions with the family and friends of a person who has committed suicide to reduce the traumatic aftereffects

Interventions Talk about suicide openly and directly. Take any threat seriously Do not make unrealistic promises such as, “Don’t worry, I won’t let you kill yourself.” Encourage the client to continue daily activities and self-care as much as possible Be nonjudgmental, have a caring attitude Review the safety of the environment Pharmacological intervention Implement suicide precautions

Suicide Precautions Client safety is priority Suicide precautions Can be instituted without a physician’s order, but psychiatric consultation must be obtained as soon as possible Precaution level dependent on threat to client’s safety

Suicide Prevention Take any threat seriously. Talk openly and directly. Institute appropriate level of precautions. Be mindful of objects that can be used for self-harm.

Suicide Prevention - continued Determine if a contract is needed. Consistently observe the client. Develop a care plan. Encourage hope. Encourage self-care.

Suicide Prevention - continued Perform a physical examination. Be mindful of needs of client and family. Monitor personal feelings. Work with other team members. Help client identify and develop protective factors.

Suicide Prevention - continued National Suicide Prevention Initiative First coordinated effort of resources and culturally appropriate services between all levels of government and the private sector Suicide Hotlines and Crisis Centers Network of crisis centers in communities around the world dedicated to suicide prevention National Suicide Prevention Lifeline:

Partner with Family Foster education. Involve family in discharge planning. Provide emergency contact numbers. Provide information on community and local resources.

Case Management Case managers ensure that planned therapeutic linkages occur once client has been discharged Community-based care Home care Survivors of suicide Family and friend survivors Child and adolescent survivors Staff survivors of client suicide