The Prevention and Management of Suicide in Clients and Carers Receiving Palliative Care in Australia. Michele Watson, Psychologist Melbourne City Mission Palliative Care

Incidence of Suicide risk of suicide is high with physical illness especially so when depression is present rates of completed suicide are low (Filiberti et al. 2001).

What contributes to suicidal ideation? fear of losing independence, particularly in patients who had a strong character uncontrolled pain or the fear of uncontrolled pain fear of suffering disinhibition, confusion and delirium exhaustion and fatigue

Depression – feelings of hopelessness, helplessness withdrawing from friends and relatives adverse physical consequences of treatments when no further treatment available or contact with health care system reduces (Filiberti, 2001).

Bereavement and suicidal ideation bereaved people are at greater risk of suicidality compared to nonbereaved especially when; partner has died, perception of low levels of social support, being female although rate of completed suicides typically higher in bereaved men (Stroebe et al., 2005). complicated grief significantly heightened risk (Latham, 2006).

Policy Development policy and procedures were required for all staff encountering clients and/or carer’s thinking of suicide existing policy was limited specific procedures were required for each discipline staff safety and debriefing needs considered there was little evidence in the literature to guide the working party significant challenges due to the diversity of training and skill level amongst team members

Training for staff In 2012 all staff completed a 3 hour session in SafeTALK - suicide first aid intervention training. followed up by a refresher of the same session in 2014 key clinical staff are trained in ASIST, an applied suicide intervention skills training program

Principles of the SafeTALK Training most people thinking of suicide want help and find ways to invite help invitations are often missed, dismissed or avoided the best way to find out is to ask the person directly asking about suicide will not give someone the idea anyone can have thoughts of suicide

The SafeTALK Model LISTEN for invitations ASK: “When someone talks like this they are sometimes thinking about suicide.Are you thinking about suicide?” KEEP SAFE CONNECT

Resources Find information about safeTALK at

Discipline Specific Action Plans administrative staff receiving calls from distressed clients/carers volunteers visiting client’s homes, calling bereaved carers nursing staff phoning or visiting client’s homes during office hours and afterhours/weekends counsellors, pastoral care and massage staff phoning or visiting clients

LISTEN Listen for invitations – moody, burden, escape, withdrawing, desperate, no purpose, hopeless, pain & suffering, shame, loss. KEEP SAFE Transfer caller to a counsellor: SAY: “We need extra help. I want to connect you with someone who can help you keep safe. Please do not hang up.” ASK “What’s your last name?” “Your telephone number?” “Where are you at the moment?” “When someone speaks like this, they are sometimes thinking about suicide - are you thinking about suicide?” If YES… Who is with you right now? IF YES – ALERT Do not put caller on hold. Alert nearby staff member: “SUICIDE RISK – client’s name.... Counsellor needed to take call now” REPORT & DEBRIEF Report the call to the Office Manager. Look after yourself - call the Employee Assistance Program on /7 for critical debriefing by phone. IF NO – TRANSFER CALL To a Counsellor, explaining client is distressed but not suicidal. If no counselor available, ensure client is contacted later that day. Action Plan – Administration Staff

LISTEN Ask “what’s been happening?” Listen for invitations - moody, burden, escape, withdrawing, desperate, no purpose, hopeless, pain and suffering, shame, loss. TOP PRIORITY IS YOUR SAFETY Assess your safety, if you don’t feel safe, leave the home. Call the office when you get to your car and report situation. ASK “When someone speaks like this, they are sometimes thinking about suicide - are you thinking about suicide?” IF THEY ANSWER NO Continue listening and ask the person if they would like a counsellor to call them later that day or the next day to see how they are feeling. ASSESS what’s needed: Medical review? PCU/psychiatric admission? Counselling – How urgently? Carry out assessment and develop plan of care. DEBRIEF Look after yourself and speak to the Team Leader. If you would like to speak to a counsellor, call the EAP on /7 for critical debriefing by phone. IF THEY ANSWER YES ASK: “How would you do it?” SAY: “Ok let’s get you some help”. ASK (as appropriate): Have you taken something”. Arrange to remove the means, involve family members in this. ASSESS CLIENT’S SAFETY If safe to remain with client: If you think the person is in imminent risk of suicide and they are resisting removing the means call 000 and report to Police. If necessary engage other health professionals. If client does not agree to this, strongly recommend they speak to a Lifeline Counsellor, call Lifeline on REPORT Tell the client “I’m going to be here a while I just need to let the office know”. Call the Team Leader and report situation. Action Plan – Nursing and Medical Staff

Rapid Plan Team the need for a Rapid Plan Team identified key roles identified to form the RPT a comprehensive checklist developed to examine the particular issues and develop plan of care

Final Policy and Procedure specific action plans developed for each discipline mandatory training in suicide ‘first aid’ for all staff was endorsed advanced training in suicide intervention skills introduced for key clinical staff rapid plan team and checklist developed

Management of Completed Suicide process outlined for when organisation is notified of completed suicide by client or carer. process developed for instances when a staff member finds a client/carer who has completed suicide process includes formation of Rapid Plan Team to manage process.

Positive Outcomes increased suicide awareness amongst staff staff feel more equipped to deal with clients and carers thoughts of suicide training has debunked myths about suicide overall staff more confident in talking about suicide

Conclusion more research is needed into the rates of completed suicide in bereavement the new policy & procedure will be piloted within the organisation and reviewed after 6 months the need for suicide prevention and management procedures has been identified by other community organisations current policy may be shared by broader community

Questions.