Crisis Intervention Abdullah Al-Subaie F.R.C.P (C)

 Suicide is the process of purposely ending one’s own life.  Marital status  Unemployment  Low income  Mental illness  History of being physically or sexually abused  Personal history of suicidal thoughts, threats or behaviors  Family history of attempting suicide How societies view suicide varies by culture, religion and the circumstances under which it occurs (JAMA, 2005). 2

 Nearly a million people worldwide commit suicide each year.  Suicide is the eighth leading cause of death in males in USA.  Suicide is the 16th leading cause of death in females in USA.  It is the third leading cause of death for people 10 to 24 years of age in USA.  Elderly Caucasian males continue to have the highest suicide rate (National Institute of Mental Health, 2007). 3

 Self-mutilation is the act of deliberately hurting oneself without meaning to cause one’s own death.  Examples of self-mutilation  Cutting any part of the body, usually the wrists  Self-burning  Head banging  Pinching  Scratching (Palmer, pg. 283). 4

 Firearms are the most common means by which people take their life, accounting for nearly 60% of suicide deaths per year.  Other common methods  Asphyxiation (hanging, poisoning, or overdose)  Blunt force trauma  Jumping from a building or bridge  Stepping in front of a train/automobile  Slitting one’s throat/wrist  Drowning  Starvation  Electrocution (Qin & Mortensen, pp ). 5

 Medico-legal Center, Dammam, Saudi Arabia.  The suicide rate for the entire population averaged 1.1/100,000 population per annum.  The male-to-female ratio was 4.5:1.  The highest suicide rate was among the age group from 30 to 39 years (44.3%), followed by the age group from 20 to 29 years (32.6%), and the lowest suicide rate was among the age group <20 years (1.8%). 6

 The rate in the group >60 years was also low (3.2%).  Immigrants formed 77%  Asians 70% (43% are Indians).  The most common means was hanging (63%), followed by jumping from heights (12%) and gun-shooting (9%); poisoning 6%.  Increasing rate of suicide during the second 5-year period compared with the first 5-year period. 7

 There are gender, age, ethnic and geographical risk factors for suicide, as well as those based on family history and mental health status.  Ethnically, the highest suicide rates in the United States occur in non-Hispanic whites and in Native Americans.  The lowest rates are in non-Hispanic blacks, Asians, Pacific Islanders, and Hispanics.  Former Eastern bloc countries currently have the highest suicide rates worldwide, while South America has the lowest. 8

 The majority of suicide completions take place during the spring (Cuellar, pg.69).  In most countries, women continue to attempt suicide more often, but men tend to complete suicide more often.  The frequency of suicides for young adults has been increasing in recent years (Cuellar, pp ). 9

 Warning signs :  the person making a will  getting his or her affairs in order  suddenly visiting friends or family members  buying instruments of suicide like a gun, hose, rope or medications  sudden and significant decline or improvement in mood  writing a suicide note (JAMA, 2005). 10

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 It is a 10-item scale to purports to screen for suicide risk. An individual is given one point for each item for which he or she screens positive:  Sex (male/female)  Age less than 19 or greater than 45 years  Depression (severe enough to be chronic)  Previous suicide attempt or psychiatric care  Excessive alcohol or drug use  Rational thinking loss: psychosis, organic brain syndrome  Separated, divorced, or widowed  Organized plan or serious attempt  No social support  Sickness, chronic disease (Osterweil, 2007). 12

 The assessment of suicide risk often involves an evaluation of the presence, severity, and duration of suicidal thoughts in the individual’s mental health evaluation.  Questions about family mental-health would include:  Anxiety  Depression  Mood swing  Bizarre thoughts  Substance abuse  Eating disorders  History of being traumatized (Osterweil, 2007). 13

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 Treatment of suicidal thinking or attempt involves adapting immediate treatment to the sufferer’s needs and support system.  Those who are hopeful and have a desire to resolve conflicts may need only a brief crisis- oriented intervention Those with severe symptoms or less social support may need hospitalization and long-term mental-health services.  Vigorous treatment of the underlying psychiatric disorder is important in decreasing short-term and long-term risk (Qin & Mortensen, pp ). 15

 Suicide prevention measures that are put in place following a psychiatric hospitalization usually involve mental-health professionals trying to implement a comprehensive outpatient treatment plan prior to the individual being discharged.  It is often recommended that all firearms be removed from the home due to the individual still having access to the them even if they are stored and locked.  It is further often recommended that potentially lethal medication be locked up as a result of the attempt (Sher, pg. 667). 16

 People with suicidal thinking are encouraged to talk to a doctor or other health professional or religious leaders.  They can report to an emergency room or mental-health crisis center for help.  Other strategies include:  Having someone hold all medications  Removing any weapons from the home  Scheduling frequent stress-relieving activities  Avoiding the use of alcohol or other drugs  Getting together with others to prevent isolation (Sher, pg. 680). 17

 Techniques for coping with suicide of a loved one include nutritious eating, getting extra rest, talking with others about ways to handle the painful memories.  To help children and adolescents cope with suicide of a loved one it is important to ensure they receive constant interactions with supportive adults, and understanding their feelings as they relate to their age (Melhem & Day, pp ). 18

 Discussing suicide will provoke it  Suicide runs in the family  Suicide strikes only the rich  Showing generosity and sharing personal possessions is showing signs of recovery  Suicide is always impulsive  It is a painless way to die  Once suicidal, always suicidal  Those who threaten it, don’t do it (Dr. A. Marshall, 2008). 19

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