According to the World Health Organisation, suicide is responsible for approximately 2200 deaths per day, which amount to 800,000 deaths per year, or 1 death per 40 seconds (WHO, 2016). In addition, with every successful attempt there are many more attempted suicides. The highest suicide rate can be attributed to the elderly.
4/5ths of individuals who die from suicide have attempted to do it at least once before.
Whilst attempts are three times more often performed by women, men are three times more likely than men to complete it.
Some researchers claim that people with low levels of serotonin are up to ten times more likely to commit suicide than those with normal serotonin levels.
Other researchers claim that 25% of drivers who die in car accidents actually cause them subconsciously, hence the term ‘autocides’, meaning suicides in which individuals crash their cars with the aim of ending their lives.
Psychiatric In-Patient Suicide
Up to 0.4% of suicides take place in a mental health hospital.
Psychiatric inpatients are at particular risk for suicide. Studies show that the inpatients who are most at risk for suicide are those with affective disorders and schizophrenia. Precautions should be taken to reduce the risk of inpatient suicide, and following a suicide, the impact on the individual’s family as well as the other inpatients and staff should be considered.
Level 1 supervision is highly intrusive, but can also be therapeutic. Level 3 supervision is more related to care eg. to prevent falls, not just related to mental health. Based on past observations however, even constant supervision can fail at stopping or avoiding suicide.
Suicide Nursing Assessment
Suicide nursing assessment depth depends on the setting, ability and willingness of the person to provide information about previous and current mental health state, and availability of further information from other healthcare professionals in relation to the same person.
The SAFE-T card pictured below lists key risks and protective factors to be considered while evaluating the person’s suicide risk level. It provides guidance in conducting a comprehensive assessment and triage, risk estimation, and development of treatment plans and interventions based on the person’s mental health state.
Suicide enquiry should ideally include questioning about thoughts, plans, behaviours and intent in relation to suicide:
- Ideation: frequency, intensity and duration
- Planning: timing, location, lethality, availability, preparation
- Behaviour: past attempts, rehearsing, self injury
- Intent: how the person plans to carry out the act, whether the person believes the attempt will be lethal or injuring, and for what reason/s does the person think he should die
NOTE: In Malta, teenagers from 14 years up can ask for treatment even if parents refuse to accept that their child needs treatment, and this is possible thanks to the Mental Health Act.
Protective Factors
Protective factors that may help the person during contemplation phase include:
- ability to cope with stress
- religious/spiritual beliefs
- tolerance to frustration
- responsibilities eg. children and pets
- positive therapeutic relationships with healthcare professionals who can provide guidance and help
- social support eg. support groups or family help
Documentation
Documentation should include assessed risk level and the rationale behind the level assigned. It should contain interventions to reduce risk as well as plans for follow-up treatment. Psychotherapy, medication, treatment setting contact with others, and consultation with other past or present healthcare providers should be considered to reduce the possibility of suicide.
Are You Contemplating Suicide?
If you landed on this blogpost and you are contemplating suicide, please know that there are people who do care about you and your well-being. Please seek professional support. You can contact Richmond Foundation on 1770, Kellimni.com and Victim Support Malta.
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