1. Contemporary Psychiatric-Mental Health Nursing Third Edition Contemporary Psychiatric-Mental Health Nursing Third Edition CHAPTER Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff 23 Clients at Risk for Suicide and Self-Destructive Behavior

2. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Self-Destructive Behavior Definition: –Maladaptive measures a person uses to restore inner equilibrium when overwhelmed or unable to cope with stressful life events

3. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Examples of maladaptive behaviors Suicide typical self-destructive or self- damaging behaviors include: 1- nail biting, 2-hair pulling, 3- self-mutilation, 4- driving recklessly, overeating, gambling, smoking, drinking to excess, and misusing drugs.

4. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Suicide Definition: –The wilful act of ending one’s own life

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6. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Box 23-1 Suicide Facts

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8. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff What are the factors that prevent individuals considering suicide from seeking help Social variables –Ethics –Ignorance –Embarrassment –Shame –Fear of being labeled

9. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Suicide (cont'd) Demographic variables –All demographic groups –Highest rates  Young adults aged 25–34  American Indian/Alaskan Natives  Age 45 and older  Non-Hispanic Whites

10. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Suicide (cont'd) Clinical variables –90% of individuals who commit suicide have a psychiatric illness –50% are under active psychiatric or mental health care –Lack of close relationships –Lack of personal freedoms

11. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Suicide - continued Suicide (cont'd) Not a random act Has a message and a purpose –Secondary to a terminal illness –Feeling like a burden to others –An untenable family situation –An untenable personal situation –Self-punishment for unacceptable behavior

12. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Box 23-4 Characteristics Most Closely Associated With Suicide

13. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Suicide Rates Gender –Males who are Native American, white non-Hispanics, African-Americans, Hispanics, and Asian/Pacific Islanders have slightly higher rates than females

14. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Suicide Rates (cont'd) Among all ethnic groups, alcohol use among adolescents was associated with increased suicidal behavior. Suicide and suicide attempt rates vary across different ethnicities.

15. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Biopsychosocial Theories Sociocultural theory –Deterioration in relationship with society –Self-inflicted death as honorable –Demographic characteristics

16. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Biopsychosocial Theories (cont'd) Interpersonal and intrapsychic theory –Suicide may result when people experience no close relationships with others or no personal freedoms and no hope of getting them. –Suicide is a dyadic event.

17. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Biopsychosocial Theories (cont'd) Biologic theory –Biologic and medical markers (Decreased central serotonergic function, reduced serum cholesterol levels, decreased platelet 5-HT, low cerebrospinal fluid 5-HIAA, and hypothalamic–pituitary–adrenocortical axis (HPA axis) dysfunction)

18. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff –Neurotransmitter receptor hypothesis  Errors in receptors for serotonin  Positron emission tomography (PET) –Genetics: a family history of suicide is a recognized marker for the increased risk of suicide, suggesting that there may be a genetic trait, which predisposes some people to suicidal behavior.

19. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Biopsychosocial Theories (cont'd) Cognitive theory: cognitive styles predispose individuals to suicidal behavior, such as –Dichotomous thinking –Constriction of thought –Ambivalence

20. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff People who are considering suicide are divided within themselves. They have two conflicting desires, to live and to die, which accounts for the fact that a suicidal person often takes lethal or near-lethal action but leaves open the possibility for rescue and intervention. Failing to intervene and provide life choices increases the person’s desperation, and death becomes the more focused choice

21. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff The effectiveness of cognitive– behavioral therapy (CBT) in moderating suicidal risk in people with multiple suicide attempts and significant mental disorders is a subject of current study.

22. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff 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

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24. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Box 23-6 Lethality of Suicide Methods

25. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff 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 –Maximum suicide precautions require closer observation and a more restrictive environment

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27. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Suicide Prevention assessment Risk factors: are the characteristics that are associated with suicide Protective factors: serves as buffers from suicidal thoughts and behavior

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29. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff 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.

30. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Suicide Prevention (cont'd) Determine if a contract is needed. Consistently observe the client. Develop a care plan. Encourage hope. Encourage self-care.

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32. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Suicide Prevention (cont'd) 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.

33. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Suicide Prevention (cont'd) 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

34. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Partner with Family Foster education. Involve family in discharge planning. Provide emergency contact numbers. Provide information on community and local resources.

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37. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Self-Awareness When working with suicidal clients, be aware of and monitor personal reactions to potentially life-threatening situation. Nurses must assess: –Personal feelings –Experiences –Conflicts –Memories

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39. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff 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

40. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Resources American Association of Suicidology –The American Association of Suicidology provides current information about suicide and suicidal behavior, research, treatment, resources, and educational resources.

41. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Resources (cont'd) American Foundation for Suicide Prevention American Foundation for Suicide Prevention –Visit this link to find current information from the American Foundation for Suicide Prevention about suicide and suicide prevention, survivors, research, support, and educational resources.

42. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Resources (cont'd) Friends for Survival –Friends for Survival, an organization of people affected by suicide, provides peer support services and seeks to educate the entire community regarding the impact of suicide.

43. Contemporary Psychiatric-Mental Health Nursing, Third Edition Carol Ren Kneisl Eileen Trigoboff Resources (cont'd) Suicide Awareness Voices of Education –Visit this Suicide Awareness Voices of Education link to find current information about suicide prevention, facts, danger signals, high-risk groups, hospitalization, and other relevant topics.