SUICIDE AND SEVERE SELF HARM PREVENTION IN PRIMARY CARE. Dr Khalid Aziz Consultant Psychiatrist Barnet Dr Henry Andrews Consultant Psychiatrist Enfield Dr Leon Rozewicz Clinical Director Crisis & Emergency. Resilience?.
SUICIDE AND SEVERE SELF HARM PREVENTION IN PRIMARY CARE
Dr Khalid Aziz Consultant Psychiatrist Barnet
Dr Henry Andrews Consultant Psychiatrist Enfield
Dr Leon Rozewicz ClinicalDirector Crisis & Emergency
1. Individual Health and Well-Being - Sense of self, social skills, sense of purpose, emotional stability, problem-solving skills, and physical health.
2. Pre-Disposing or Individual Factors - Genes, gender and gender identity, personality, ethnicity/culture, socio-economic background, and social/geographic inclusion or isolation.
3. Life History and Experience - Family history and context, previous physical and mental health, exposure to trauma, past social and cultural experiences, and history of coping.
4. Social and Community Support - Support and understanding from family, friends, local doctor, local community, school, level of connectedness, safe and secure support environments, and availability of sensitive professionals/carers and mental health practitioners.
Myth: People who talk about suicide don’t die by suicide.
Fact: Many people who die by suicide have given definite warnings to family and friends of their intentions. Always take any comment about suicide seriously.
Myth: Suicide happens without warning.
Fact: Most suicidal people give many clues and warning signs regarding their suicidal intention.
Myth: People who are suicidal are fully intent on dying.
Fact: Most suicidal people are undecided about living or dying – which is called suicidal ambivalence. A part of them wants to live; however, death seems like the only way out of their pain and suffering. They may allow themselves to “gamble with death,” leaving it up to other to save them.
Myth: Males are more likely to be suicidal.
Fact: Men die by suicide more often than women. However, women attempt suicide three times more often than men.
Myth: Asking a depressed person about suicide will push him/her to kill themselves..
Fact: Studies have shown that patients with depression have these ideas and talking about them does not increase the risk of them taking their own life.
Myth: Improvement following a suicide attempt or crisis means that the risk is over.
Fact: Most suicides occur within days or weeks of “improvement” when the individual has the energy and motivation to actually follow through with his/her suicidal thoughts.
Myth: Once a person attempts suicide the pain and shame will keep them from trying again.
Fact: The most common psychiatric illness that ends in suicide is major depression, a recurring illness. Every time a patient gets depressed, the risk of suicide returns.
Myth: Sometimes a bad event can push a person to suicide.
Fact: Suicide also results from serious psychiatric disorders, not just a single event.
Myth: Suicide occurs in great numbers around holidays in November and December.
Fact: Highest rates of suicide are in April while the lowest rates are in December.
Suicide is a multi-determined phenomenon that occurs against a background of complex interacting biological, social, psychological and environmental risk and protective factors.
Despite the complexity of this phenomenon, suicide can be prevented.
“Ideation” – thinking about or planning for suicide
Third largest cause of death in Britain of premature mortality (after heart disease and cancer) (World Health Organization, 2000).
In 2007 there were still 7.9 suicides per 100 000 people - 4000 incidents/yr.
Younger people are more likely to die by suicide than older people.
Statistics show that in 16 to 24 year-olds, 5% have attempted suicide, compared with 2% of 65 to 74year-olds. However, the rate among people over 85 rises again
Men are five times as likely to die by suicide as women. (WHO - Global Burden of Disease: 2004 Update report (World Health Organization, 2008)
Of people in the UK who die by suicide, only about 25% were in contact with mental health services in the 12 months before the suicide
Although it is generally acknowledged that most had a diagnosis of a mental disorder at the time of their death (Bertolote & Fleischmann, 2002).
In some studies, the rate of a diagnosed mental illness of those who have killed themselves has been found to be more than 80% (Arsenault-Lapierreet al, 2004; Fleischmann et al, 2005; McManus et al, 2009).
Typical GP will see one suicide every five years on their list
One a year in a 10 000 group practice
No single assessment tool
Females more likely to attempt than males
Males more likely to die
Young and Old
Parental depression, substance misuse, suicide
Impulsive, aggressive or socially withdrawn
Poor problem solving ability
Mood disorders; bipolar, psychotic depression
Recent discharge from psychiatric hospital
Access to means (guns, drugs, tablets)
History of suicide attempts
How does the future look to you? What are your hopes?
Do you wish you could just not wake up in the morning?
Have you considered doing anything to harm yourself, or to take your own life?
Have you made actual plans to kill yourself? What are they?
What has stopped you from doing anything so far?
Can sometimes be a bizarre form of self-preservation.
Nevertheless it covers a wide spectrum of behaviour, with harmful physical effects
Person who repeatedly self-harms is at a higher risk of suicide.
The UK has one of the highest self-harm rates in Europe, reported at about 400 per 100 000 people (Horrocks et al, 2002).
It has been estimated that there are 170 000 self-harm presentations at hospitals each year in England (Kapur et al, 1998)
Self-harm has been quoted as one of the five top causes of acute hospital admissions, but this greatly underestimates the problem since many people do not attend hospital.
As with suicide, younger people are more likely to self-harm than older individuals. Of those who present at hospitals, two-thirds of patients who self-harm are under 35 of whom two-thirds are female.
Self-harm is poorly understood in society even among those who in their working lives as school teachers, pastors, social workers, housing officers, police, prison officers and even nurses and doctors encounter people who harm themselves.
People who harm themselves are subject to stigma and hostility.
May often be associated with the misuse of drugs or alcohol.
Rate of self-harm; more in women and girls than men and boys
Completed suicide is more prevalent among men and boys.
One could consider self-neglect as another form of self-harm
When people who repeatedly harm themselves through cutting or taking overdoses are helped to overcome these behaviours, eating disorders or other self-damaging problems may emerge.
Three basic steps:
1. Show you care
2. Ask about Self Harm/Suicide intentions or previous attempts.
3. Offer/Get/Encourage to get help
Living Is For Everyone. Fact sheet 6: Resilience, vulnerability, and suicide prevention. www.livingisforeveryone.com
International Association on Suicide Prevention- www.iasp.info
Clayton, J. Suicide Prevention: Saving Lives One Community at a Time. American Foundation for Suicide Prevention. www.afsp.org
Self-harm, suicide and risk: helping people who self-harm, Final report of a working group College Report CR158 June 2010, Royal College of Psychiatrists London
Dr Leon Rozewicz, Clinical Director, Crisis & Emergency Services, BEH MHT NHS Trust.