Suicide Prevention Workshop

2006

Department of PsychiatryQueen Mary Hospital

Kwong Chung Man

Global Suicide Rates(per 100 000 population)

1950-1995, WHO

1989-2004 H.K. Suicide Rate, SBHK

10.5

11.7

13 12.7

10.7

12.4

9.2

12.812.6

13.5

14.7 15

16.917.2

12.712.512.6

9101112131415161718

89 90 91 92 93 94 95 96 97 98 99 '00 '01 '02 '03 '04 '05

2005 H.K. Suicide 2005 H.K. Suicide StatisticsStatistics

967 completed suicide967 completed suicide male:female = 1.9:1male:female = 1.9:1 Suicide rate = 12.69Suicide rate = 12.69 349 age 60+ (29.4%)349 age 60+ (29.4%) The highest age group The highest age group 7070 50.9% jumping from height50.9% jumping from height 22.4% hanging22.4% hanging 19.4% unemployed 19.4% unemployed 17.3% mental illness (n=167)17.3% mental illness (n=167)

Suicides in Hospitals (1)

The Number of Suicides in Hospitals (1989 - 2004)

19

323736

242629

8 811 9 11

8 85 5

0

5

10

15

20

25

30

35

40

45

89 90 91 92 93 94 95 96 97 98 99 '00 '01 '02 '03 '04

Suicides in Hospitals (2)

The Percentage of Suicides in Hospitals (1989 - 2004)

4.64.9 4.9

3.83.5 3.7

11.3 1.3

1 1.20.8 0.8

0.4 0.4

3

-1

0

1

2

3

4

5

6

89 90 91 92 93 94 95 96 97 98 99 '00 '01 '02 '03 '04

%

Inpatient suicide

CompletedSuicide

AttemptedSuicide

Deliberated Self Harm

Misconceptionsabout suicide

People who talk about suicide won't really do it

Anyone who tries to kill him/herself must be crazy

If a person is determined to kill him/herself , nothing is

going to stop him/her.

People who commit suicide are people who were

unwilling to seek help

Talking about suicide may give someone the idea

Characteristics of inpatient suicide

The time of suicide Appear to be improving Advance warning No established relationship

Common errors of suicide intervention Superficial reassurance Avoidance of Strong Feelings Inadequate assessment of suicide intent Passivity Advice giving

Suicide risk assessment

Why? Who? When? Where? What? How?

Continuous Assessment Suicide Risk Level

Interview Focus

Suicidal intent and lethality Dynamic meanings and motivation for suicide Presence of a suicidal plan History of suicidal behaviour Physiological, cognitive & affective states Coping potential Epidemiological risk factors

Inquire suicide thought & plan

Genuine Acceptance Use progressive & specific questions Ask the detail of method, plan, and perceived

lethality Facilitate ventilation of feeling

Improving your listening skill

Interview questions

Level 1"Do you ever think life is not worth living?"

Level 2"Do you ever think about harming yourself?"

Level 3"Do you have a plan?"

Level 4"Do you have access to the (e.g. drug)?"

Identify suicide risk factors

Previous suicidal attempt Recent loss & stress Inadequate social support Unemployed or retired Alcohol & drug dependence Putting Affairs in order Over 60, Male, Chronic illness

Lethality of suicide methods

Extremely high High Moderately High Moderately Low

Jumping from a height Hanging Asphyxiation: CO poisoning Strangulation Suffocation Drowning Car crash Self-incineration

Paracetamol Tricyclics Lithium Anticonvulsants Opiates Corrosives

Natural gas Benzodiazepines with alcohol Phenothiazines Aspirin Coarse cutting

Delicate cutting Benzodiazepines

Symptoms of depression

Persistent sad or "empty" mood. Hopeless, helpless, worthless feeling Substance abuse. Fatigue or loss of interest in ordinary activities Disturbances in eating and sleeping patterns. Irritability, increased crying, anxiety Difficulty concentrating, or making decisions. Thoughts of suicide; suicide plans or attempts. Persistent physical symptoms or pains

Danger signs of suicide Talking about suicide. Preoccupation with death. Statements about hopelessness or worthlessness. Suddenly happier, calmer. Loss of interest in things one cares about. Visiting or calling people one cares about. Making arrangements; setting one's affairs in order. Giving things away. Risk taking or Self destructive behavior.

The Golden Rule

“The most reliable assessment is the one made by an experienced practitioner.”

Not by any single test, examination, observation, etc.

Nursing care of suicidal patient

Take environmental precautions Establish therapeutic relationship Provide emotional support Assist to solve the precipitating problem Provide adequate observation & supervision

to prevent self-harm

Nursing Supervision & Documentation

SupervisionLevel

Intervention Documentation

HighSO3

One-to-one 15-min check

Observation recordNurse’s Notes

ModerateSO2

Hourly Check 30-min Check

Observation recordNurse’s Notes

LowSO1

Hand-over, Mealtimes Checks

Nurse’s Notes

Good Nursing Care

Attending to patient’s basic needs Having time for patient Being with patient Listen to patient without prejudice Accepting patient’s feelings Communicating hope to patient

Do you agree?

Good Nursing care can make the

difference between life and

death for suicidal patients.

Conclusion

Take the danger signs seriously Assess suicide risk adequately Prevent self-harm promptly Work as a team collaboratively

Suicide Prevention is Everyone Responsibility

Reference

Leenaars, A. et al. ed. (1994). Treatment of Suicidal People. Washington: Taylor & Francis.

Ritter, S. (1989). Manual of Clinical Psychiatric Nursing: Principle and Procedures. Bethlem Royal and Maudsley Hospital.

The Samaritan Befrienders Hong Kong 1989-2005 Annual Report. The 1989-2004 Hong Kong Coroners' Report.

當事人： 畢竟你是甚麼人？你是醫生麼？你怎會知道我所經歷過的一切？你可能一向事事順境。

護士甲： 那麼，你正懷疑到底我是否明白你的感受。

護士乙： 你根本沒有給我機會，我也有艱苦的經歷，你並非唯一碰上逆境的人。

當事人： 你幹甚麼要那樣關心我？

護士甲： 我受過訓練去關心人，這是我的工作。

護士乙： 因為我認為你死會十分可惜，而且事情那麼糟，令我擔心你因而考慮自殺，你需要別人助你渡過關鍵時刻。

當事人： 我不能跟任何人談及我的情況，所有人都跟我對立。

護士甲： 那是錯的，只要你給他們機會，可能有許多人關心你的。

護士乙： 當沒有人可以信任時，要找幫助一定是十分困難了。

當事人： 我曾嘗試去見臨床心理學家一次，但是沒有甚麼幫助 .......... 我現在做甚麼都改變不了任何事。

護士甲： 你要從好的一面去看！總有一些事你可以做，去改善現況的，不是嗎？

護士乙： 唔，所以你覺得毫無希望，就連臨床心理學家也沒法幫你，但是有沒有任何人以前曾經對你有幫助的 ---- 也許一個朋友、親戚、老師或者是牧師？

當事人： 除此以外，最重要的是目前我的健康每況愈下，再沒有我的丈夫在旁照顧我，就好像是世界末日。

護士甲： 嘗試不那麼擔心，一切將會好轉的。

護士乙： 你一定覺得很孤獨，並害怕將會發生的事。

當事人： 沒有人明白我正經歷的那種痛苦，有時就好像我定要傷害自己，所以我割脈。

護士甲： 似乎你一直忍受痛苦，而割脈是趕走痛苦的唯一方法。

護士乙： 但你那麼年青，還有很多事情值得你活下去，你怎麼會想到自殺呢？

當事人： 很多人會這樣想，是否真的？我以為只有我會有這種可怕、邪惡的想法。

護士甲： 不是的，很多人都患有精神病，但在合格醫生適當治療下，其中一些病人可以痊癒的。

護士乙： 是真的，你並非唯一有自殺意念的人，而你亦可以像其他人一般，在幫助下渡過這危機。

當事人： 我很孤單，很累〈哭著〉，我再沒有其他出路了。

護士甲： 你似乎很孤單，很辛苦 ............ 你有否想自殺？

護士乙： 積極點，事情不會全都那麼糟。

23.

當事人： 我的精神科醫生說我精神緊張，你認為這是否我不對勁的原因？

護士甲： 我想知道你對精神緊張的看法，你對自己的問題感到怎樣？

護士乙： 我不太確定是否同意這診斷，也許你可以去做一些心理測驗，以作肯定。