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Kings Hospital Palmerstown 25th February 2010 Presented by Brid Carroll.

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Presentation on theme: "Kings Hospital Palmerstown 25th February 2010 Presented by Brid Carroll."— Presentation transcript:

1 Kings Hospital Palmerstown 25th February 2010 Presented by Brid Carroll

2  Suicide is death resulting from a intentional, self-inflicted act  Suicidal behaviour comprises both suicide and acts of self-harm that do not have a fatal outcome. ◦ Described as attempted suicide ◦ Suicide attempt (deliberate) ◦ Self-harm ◦ Para-suicide  Behaviour intended to result in death carries (high suicidal intent)

3  Denial of burial (Christian churches)  No honour bestowed (Jewish tradition)  Grave crime )Islam)  Decriminalised in UK and Wales in 1961  In Ireland in 1993  Never a felony in Scotland – less stigma  Seen as: heroic, honorable and a duty, an act of patriotism, punished as a mortal sin, crime or sign of madness  Today we see it as a multi-caused condition

4 Suicide figures by Year and Gender Year Male Female Total 2003 386 111 497 2004 406 87 493 2005 382 99 481 2006 379 81 460 2007* 378 82 460 2008* 332 92 424 *2007 and 2008 figures are subject to revision as some undetermined deaths may be recorded as suicide following a coroner’s inquest.

5  Change in religious beliefs  Breakdown in family life  Media influence  Multiple losses  Adolescence as a time of change  Celtic tiger existence- consumer-driven, ‘status’ is all important  ‘Role status’  Males: absence of romantic interpersonal relationships, change in status with job loss, lack of money  Females: hopelessness, depression and low self- esteem, isolation

6  Gender  Mental disorders  Alcohol and substance abuse  Hopelessness  Impulsive and/or aggressive tendencies  History of trauma or abuse  Bullying  Some physical illnesses  Family history of suicide  Previous suicide attempt  Shame

7  Job or financial loss  Relational or social loss  Easy access to lethal means  Local suicide clusters  Lack of social supports  Stigma associated with seeking help  Glamorising of suicide in media  Internet addiction  Marital status  Recent bereavement  Poverty- social status  Sexual orientation

8  Strong family connections  Good problem-solving skills  Good coping skills  Employment  Positive life attitude  Supportive schools/communities  Effective clinical care  Support for seeking help  Restricted access to lethal means of suicide  Cultural and religious beliefs

9  Strive for closeness but fear intimacy  Rebel against control but want direction and structure  Push the limits but see limits as a sign of caring  Not given autonomy but expected to act maturely  Highly self centred, self-conscious and preoccupied with their world but society puts huge demands on them  Asked to face and accept reality but are tempted by many avenues of escape  Have to think of the future but there is a strong urge to live for the moment and enjoy life

10  Searching for identity  Developing values for life  They can be extremely lonely  Struggle between dependence and independence is central  Time of decision making  Sexual conflicts  Pressure to succeed  Peer group pressure is great

11  Mask fears with rebellion  Cover their dependency by exaggerating their new autonomy  Moody, negative and rebellious  Use drugs and drink  Blame instead of taking responsibility  Drop out or strive to reform society  Try to find meaning over sense of uselessness  Prepare for a future that is uncertain

12  To experience success to build confidence  To recognise and accept feelings  Need to communicate their thoughts, feelings and beliefs to significant others  Need approval  Need trust to make decisions  Need faith and support of caring adults  Need guidelines and limits  Need to develop identity over role confusion

13  Good communication  Acknowledgement  Respect  Information  Inclusion  Security  Safe space to express feelings  Explore choices

14  Being present to them  Listen to them  Hear what they are not saying  Give them time to unfold their struggles  Perhaps they will communicate to another adult who can support  Be proactive rather than reactive  Listen to the silence  Avoid aggression

15  Loss of interest in the daily activities  Loss of appetite and the ability to sleep  Regressive behaviour  In bereavement:  Imitation of the person who died  Constant statements of wanting to be with the dead  Withdrawal from friends  Difficulties in school  Persistent self blame  Over activity  Risk taking behaviour  Suicidal thoughts  Self harming

16  What we know: ◦ There is no typical suicide victim ◦ No absolute reasons for suicide ◦ No predictive warning signs ◦ Always multi dimensional ◦ Prevention must involve many approaches ◦ Most people do not want to die ◦ Ambivalence exists until the moment of death ◦ If you reduce the risk factors you reduce the risk ◦ If you enhance the protective factors, you reduce the risk factors

17 One or more risk factors most strongly associated with suicidal behaviour, such as: ◦ A prior suicide attempt ◦ History of self-harming ◦ Suicidal ideation and threats of suicide ◦ Exposure to suicide or suicide of a friend or family member ◦ Detailed plan for a suicide attempt (when, where, how) ◦ Access to lethal means, especially firearms

18  Depression lasting longer than two weeks  School performance problems; learning problems; dropping out of school  Serious family fights and conflict, outrageous, abusive, or unpredictable behaviour by parents  Loss of interest in personal appearance  Alcohol and other drug use and abuse  Isolation, alienation from family, peers  High number of serious stressful events, transitions and losses  Involvement in risky behaviour

19  To seek help  To escape from an impossible situation  To get relief from a terrible state of mind  To try to influence some particular person  To show how much they loved someone  To make things easier for others  To make people sorry  To frighten someone or to get their own way  To make people understand how desperate they were feeling  To find out whether they were really loved  To do something in an unbearable situation  Loss of control  Desire to die

20 Copyright Brid Carroll 2008 Risk taking thoughts and behaviours Suicidal ideations Suicidal threats Suicide attempt Suicide Suicide-related behaviours Suicide acts

21 Panic- feeling inadequate Fear – what if it happens anyway? Frustration – don’t need this right now Anger – how dare you do this to me Resentment – I’m feeling manipulated Helpless – How can I help? Hopeless – I don’t see any other choice Conflicted – I don’t have the right to stop them Troubled – my personal values make it impossible to help

22  Education  Education of partners  Discussing death and suicide as part of school curriculum  Community awareness programs  Awareness of intervention programmes  Awareness of gatekeeper programmes  Where do we refer?  Know what our local resources are

23  Deal with your feelings – name accept express  Adjust your attitude – optomist/pessimist  Discover your choices – what can change?  Accept imperfection – we all make mistakes  Give yourself a break – promote self care  Take one step at a time - prioritise  Be kind to yourself – be positive  Plan ahead – time, energy and tools  Ask for help – support helps

24  Adolescents who talk about suicide do not attempt or complete suicide  Talking about suicide can plant the idea in the minds of at-risk teens  The only one who can help a suicidal adolescent is a counsellor or mental health professional  If an adolescent wants to complete suicide there is nothing anyone can do to prevent it.

25  Hopeless: “Things will never get better”. “There is no point in trying.”  Helpless: “There is nothing I can do about it.” “ I can’t do anything right.”  Worthless: “Everyone would be better off without me”. “I’m not worth your effort”.  Guilt, shame, self hatred: “What I did was unforgivable”  Pervasive sadness  Persistent anxiety

26  Explore the signs  Ask about suicide  Listen to the reasons for dying and living  Review the risk  Contract a safe-plan  Follow-up on commitments

27  Suicidal thoughtskeep safe, safety contacts, no use of substances, link to resources  PreparedDisable the plan  Desperateease the pain  AloneLink to resources  FamiliarProtect against danger, (past attempt)support past survival skills  Vulnerablelink to health worker

28  Don’t glamorise the death  Treat like another death  Support the bereaved network  Use it as a teaching moment  Observe those who are bereaved - as coping can be more difficult at milestone events or anniversary time  Bereaved families of suicide should be linked to professional services for support

29  Mindfulness refers to a particular way of paying attention to our experience in any given moment. It is a capacity within each of us for moment-to-moment, non judgemental awareness that can be very liberating.  It does not seek to change what we are feeling and thinking as much as to become curious about it and to hold it in awareness rather than running from it, or acting on it.

30  National Office of Suicide prevention  IAS Irish Association of Suicidology  Suicide Resource offices  Console  Turning the Tide on Suicide  You are not Alone booklet  “Echoes of Suicide” Edited Siobhan Foster- Ryan and Luke Monahan, Veritas  “Cultivating Suicide” Caroline Smyth, Malcolm Mac Lachlan and Anthony Clare, Liffey Press.


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