1998 Biennial Convention1998 Biennial Convention“Uniting Nurses: One Strong Voice”“Uniting Nurses: One Strong Voice”

June 27, 1998 Session 003June 27, 1998 Session 003

“Suicide Prevention Strategies for

Families and Consumers”

American Psychiatric Nurses AssociationPhyllis M. Connolly PhD, RN, CSPresidenthttp://www.apna.org

OverviewOverview Quality mental health care consist of four

main elements: prevention, early detection, treatment and education. This session, including a mini teaching activity, will provide you with an increased understanding of the content, skills and methods of suicide prevention teaching for families and consumers with psychiatric disorders.

ObjectivesObjectives Discuss the statistics of suicide in persons with psychiatric

disorders. Describe the myths related to suicide. Identify the relevant theoretical frameworks which guide

the teaching of families and consumers. Examine the components and methods of teaching and the

specific content for teaching. Analyze culturally sensitive approaches to teaching

ethnically diverse families and consumers. Participate in teaching simulation exercises. Compare a family fire/disaster and emergency medical

plan with a plan for possible suicide prevention.

Suicide: 8th leading cause of Suicide: 8th leading cause of death in USdeath in US

90% associated with mental & addictive behaviors

Highest rates for elderly white males Firearms account for 60% of all suicides

across all ages Substance abuse found in most Family violence and physical & sexual abuse

increase risk

Persons with schizophreniaPersons with schizophrenia

10% -13% commit suicide

Leading cause of premature death

18% - 55% will make a suicide attempt

Depressive DisordersDepressive Disorders

Up to 15% requiring hospitalization eventually die by suicide

10% - 15% of untreated persons with bipolar I commit suicide

Risk FactorsRisk Factors

History of suicide attempts Hopelessness Physical illnesses Family history of substance abuse Caucasian race Male gender

Risk Factors ContinuedRisk Factors Continued

Advanced age Presence of psychotic symptoms Living alone Unemployment Depression Substance abuse Relapse

Having a positive supportive Having a positive supportive and helpful relationship with and helpful relationship with a mental health provider may a mental health provider may reduce the risk of suicide.reduce the risk of suicide.

Suicide MythsSuicide Myths People who think about suicide must be

crazy Talking about suicide may give a person the

idea If a person really wants to kill themselves

there is nothing you can do People who talk about suicide never follow

through

Identifying TriggersIdentifying Triggers Alcohol and/or drugs Stopping psychotropic medications Lack of sleep Increased stress: losses, changes,

interpersonal relationships Increased anxiety Reactions to prescription /over the counter

drugs Nutritional imbalances Medical conditions

Interventions: Step 1Interventions: Step 1

Check out your concerns--ask the person If the person says “YES,” stay calm--take a

deep breath Ask the person what their thoughts are like--are

they hearing voices If, Yes, get the person to a suicide or crisis

center immediately

Interventions: Step 2Interventions: Step 2

Determine if they have a plan What exactly do they intend to do How will they do it When will they do it

If the plan is lethal, concrete, specific, and available, get them to a suicide or crisis center immediately

Interventions: Step 3Interventions: Step 3

If no plan, ask about medications taken within the last 24 hours ask about any over the counter medication ask about alcohol/street drugs

Interventions: Step 4Interventions: Step 4

The person should be seen by a mental health professional as soon as possible

Call the primary therapist or case manager If unable to contact the therapist, call the

crisis help line for a referral

Suicidal gesturesSuicidal gestures

Get the person to the nearest hospital or emergency service as soon as possible

You may need to call 911 Stay calm Stay with the person, unless you have been

the targeted person who may have failed to meet the person’s expectations

Assessment at Crisis CenterAssessment at Crisis Center

Hospitalization may be needed Medications Identifying precipitating factors Assessing for medical problems Facilitating feelings of hope Facilitating sense of competency & efficacy

Someone needs to stay with Someone needs to stay with the person at all timesthe person at all times

The person is experiencing strong feelings of abandonment, loneliness, guilt and hopelessness

Adaptive Problem SolvingAdaptive Problem Solving

Assist with basics Living arrangements Food availability

Identify past coping mechanisms

Identify person(s) available in the support system

Competency & EfficacyCompetency & Efficacy

Set achievable short term goals

Encourage & give positive feedback

Family & support persons are critical in providing positive feedback

In Home SupportIn Home Support

Family can be instrumental providing basic critical components in reestablishing the person’s equilibrium.

If the person is not hospitalized they should not be left alone

Establish support system: Family, friends, church members, roommates

Psychiatric home care may be provided

Facilitating HopeFacilitating Hope

Provide a supportive climate Facilitate a hopeful perception Help the person to restructure the situation Assist the person in making plans Assist the person in taking action, and

establishing goals for living

DiscoveryDiscovery CreativityCreativity

Concept of NewnessConcept of Newness

ResourcesResources InsightInsight PlansPlans OutcomesOutcomes

Facilitating HopeFacilitating Hope

Stress ManagementStress Management

Crisis Intervention Deep breathing Self talk Time out Visualization Leaving the situation Talking to someone Music

Prevention Diet & nutrition Exercise & physical

activity Self-help groups Having fun Playing Massage Progressive relaxation Assertiveness training

Care for Support PersonCare for Support Person

Stay calm Get support for yourself Utilize formal mental health professionals or

spiritual guides Utilize the Alliance for the Mentally Ill

800- 950-6264 Once the person is stable and restored, debrief

the incident with them

You should have an You should have an emergency plan for handling emergency plan for handling a suicide gesture or ideation.a suicide gesture or ideation.

Theoretical FrameworksTheoretical Frameworks

Crisis Intervention Orem’s Self-care Knowles, Adult Learning Yalom, Group Theory Carl Rodgers, student-centered

Knowles Assumptions:Knowles Assumptions: Adult Learners Adult Learners

Desire and enact toward self-directedness as they mature

Experiences are rich resource for learning Awareness of specific learning needs

generated by real life Competency based and wish to apply

knowledge to immediate circumstances

Teaching Families & Consumers: Teaching Families & Consumers: Suicide preventionSuicide prevention

Assessing the learners including culture Identifying specific content Developing teaching objectives Developing learner outcomes Instructional planning Implementation Evaluation

Belief Systems: Health & IllnessBelief Systems: Health & IllnessMagico-Religious

Scientific/Biomedical

Holistic

Fate of worldundersupernaturalforces

Control byphysical &biochemical

Harmony,natural balance

Cause of illness,mystical

Cause/effectrelationship,pathogens

Diseaseimbalance, lawsdisturbed

Gift or reward Illnessprevention,meds, treatments

Environment,socioculturalfactors

World View

Illness/disease

Health

Ethnic group

Hispanic AmericansBlack Americans

White Americans Native AmericansAsian Americans

Teaching DesignsTeaching Designs

Learner-Development

Topic Centered

Distance Education Telecommunication

Instructional TechniquesInstructional Techniques

Discussion Lecture Role Play Questioning Skits Simulations Audiovisual CAI

Web Resources APNA & links

http:www.apna.org

Suicide Helplinehttp:www.grohol.com/helpme.htm

KENhttp:www.mentalhealth.org

NDMDAhttp://www.ndmda.org

Selected BibliographySelected Bibliography Aguilera, D. C. (1994 ). Crisis intervention: Theory

and methodology (7th ed.).St. Louis: Mosby-Year Book.

Babcock, D., & Miller, M. (1994). Client education: Theory and practice. St. Louis: MO..

Campinha-Bacote, J. (1994). Cultural competence in psychiatric mental health nursing: A conceptual model. Nursing Clinics of North America, 29(1), 1 - 9.

Cowan, C. F., & Bowie-Guillory, J. A. (1995). Teaching patients with low literacy skills In B. Fuszard, Innovative teaching strategies in nursing 2nd ed.) (pp. 231 - 241). Gaithersbrg, MD: Aspen.

Selected BibliographySelected Bibliography Depression Guideline Panel (1993). Depression in primary

care: Volume 1, Diagnosis and detection. Clinical practice guideline, Number 5. Rockville, MD. U. S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research. AHCPR Publication No. 93-0550.

Depression Guideline Panel (1993). Depression in primary care: Volume 2, Treatment of Major Depression. Clinical practice guideline, Number 5. Rockville, MD. U. S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research. AHCPR Publication No. 93-0551.

Selected BibliographySelected BibliographyFalvo, D. (1994). Effective patient education (2nd ed.).

Gaithersburg, MD: Aspen.

Hoff, L. (1995). People in crisis: Understanding and helping (4th ed.). San Francisco: Jossey-Bass Publishing.

Jack, R. (1992). Women and attempted suicide.

Hillsdale, NJ: Lawrence Erlbaum Associates, Publishers. Knowles, M. S. (1980). The modern practice of adult education: From pedagogy to andragogy (2nd ed.). New York: Cambridge University Press.

Moller, M., & Murphy, M. (1997). The three R’s rehabilitation Program: A prevention approach for the management of relapse symptoms associated with psychiatric diagnoses. Psychiatric Rehabilitation Journal, 20(3), 42 – 48.

Selected BibliographySelected Bibliography

Palmer-Erbs, V., & Anthony, W. (1995). Incorporating psychiatric rehabilitation principles into mental health nursing. Journal of Psychosocial Nursing, 33(3), 36 – 44.

Palmer-Erbs, V., & Manos, E. (1997). New thoughts on promoting collaborative partnerships with consumers, survivors, and family members. Journal of Psychosocial Nursing, 35(1), 3-5.

Silverman, M., & Maris, R. (Eds.). (1995). Suicide prevention toward the year 2000. New York: Guilford Press.