Dr. Saman Yousuf 17 June 2011. Risk assessment and crisis management (if there is suicide risk) are...

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Dr. Saman Yousuf 17 June 2011

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Page 1: Dr. Saman Yousuf 17 June 2011. Risk assessment and crisis management (if there is suicide risk) are covered in the same interview Crisis management:

Dr. Saman Yousuf17 June 2011

Page 2: Dr. Saman Yousuf 17 June 2011. Risk assessment and crisis management (if there is suicide risk) are covered in the same interview Crisis management:

Risk assessment and crisis management (if there is suicide risk) are covered in the same interview

Crisis management: Keeping a person safe in short term (usually the next 72 hours)

Crisis prevention: Enabling a person to stay safe in the future (i.e long term)

Page 3: Dr. Saman Yousuf 17 June 2011. Risk assessment and crisis management (if there is suicide risk) are covered in the same interview Crisis management:

Aims

Reduction of immediate risk of suicide by:

- Diffusing emotional distress

- Addressing immediate problems

- Ensuring safety

- Providing immediate support

- Identifying and employing coping mechanisms

Page 4: Dr. Saman Yousuf 17 June 2011. Risk assessment and crisis management (if there is suicide risk) are covered in the same interview Crisis management:

Diffusing emotional distress Explore feelings and emotions

Encourage hopefulness

Bolster self-esteem

Build trust and confidence to ensure effective management of crisis

Page 5: Dr. Saman Yousuf 17 June 2011. Risk assessment and crisis management (if there is suicide risk) are covered in the same interview Crisis management:

Ensuring safety

Identify likely means of lethality – the ‘A-test’

What is acceptable to the person

What is available to the person

Removing or restricting the means of lethality

Safety and with least distress

Utilising safety protocols for removal or restriction of dangerous weapons

Page 6: Dr. Saman Yousuf 17 June 2011. Risk assessment and crisis management (if there is suicide risk) are covered in the same interview Crisis management:

Providing appropriate support

Identify who is best able to provide support

Professionals

Family and friends

Community networkIs the person comfortable with the kind of support being suggested?

Ensure support is available and accessible

During the night

At weekends

On holidays

Page 7: Dr. Saman Yousuf 17 June 2011. Risk assessment and crisis management (if there is suicide risk) are covered in the same interview Crisis management:

Family, friends and community support

Can provide better support than professionals IF

- Agreeable to become involved

- Informed of the risk / offered support

- Given guidance when/if situation worsens

Careful consideration before engaging teenagers and immature people

Parents of teenagers and children may become overprotective and judgmental

Page 8: Dr. Saman Yousuf 17 June 2011. Risk assessment and crisis management (if there is suicide risk) are covered in the same interview Crisis management:

Coping mechanisms

What has worked in the past?

What stopped the person from committing

suicide?

New self-help coping mechanisms

IMPORTANT: Working on coping mechanisms

should not take place until the patient is safe,

supported and no longer in distress

Page 9: Dr. Saman Yousuf 17 June 2011. Risk assessment and crisis management (if there is suicide risk) are covered in the same interview Crisis management:

Revisiting assessment

Suicidal intent (frequency and severity of thoughts)

Plan

Measures to prevent detection

Page 10: Dr. Saman Yousuf 17 June 2011. Risk assessment and crisis management (if there is suicide risk) are covered in the same interview Crisis management:

CASE SCENARIOS

Page 11: Dr. Saman Yousuf 17 June 2011. Risk assessment and crisis management (if there is suicide risk) are covered in the same interview Crisis management:

A structured action plan to be formed with the patient

Modifiable risk factors strategies

Psychiatric illness referral to psychiatrist for treatment

Psychosocial stressors Social worker

Regular follow-up: frequent till suicidal ideation / behavior subsides and then interval between follow-ups can be gradually increased

Crisis prevention

Page 12: Dr. Saman Yousuf 17 June 2011. Risk assessment and crisis management (if there is suicide risk) are covered in the same interview Crisis management:

Example of a positive action plan (structured plan) When I am upset and thinking about suicide, I’ll take the

following steps:

Do not drink, or, if I am drinking, stop drinking Sit down and take 50 deep breaths Try to do things that help me feel better for at

least 30 minutes (e.g., taking a walk, listening to music)

Contact one of my significant others and talk to them about our joint interests

If the thoughts persist, I will call someone I can trust and seek for help at xxxx-xxxx

If nothing has improved, I can ring up 999 or go to the A&E department

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Page 16: Dr. Saman Yousuf 17 June 2011. Risk assessment and crisis management (if there is suicide risk) are covered in the same interview Crisis management:

What doesn’t work…

Hospital admission vs. discharge Inpatient behavior therapy vs. Inpatient

insight-oriented therapy 9 antidepressants vs. placebo 10 long-term therapies vs. one short term

therapy 2 intensive intervention plus outreach vs.

Standard aftercare Problem-solving therapy vs. standard aftercare Home-based family therapy vs. standard

aftercare

Page 17: Dr. Saman Yousuf 17 June 2011. Risk assessment and crisis management (if there is suicide risk) are covered in the same interview Crisis management:

What seems to work…

Page 18: Dr. Saman Yousuf 17 June 2011. Risk assessment and crisis management (if there is suicide risk) are covered in the same interview Crisis management:
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Page 22: Dr. Saman Yousuf 17 June 2011. Risk assessment and crisis management (if there is suicide risk) are covered in the same interview Crisis management:

Cognitive model for suicide mode:

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Replication in Australia

Carter GL et al 2005 BMJ;331:805; Carter GL et al 2007 Br J Psychiatry;191:548-53.

Page 29: Dr. Saman Yousuf 17 June 2011. Risk assessment and crisis management (if there is suicide risk) are covered in the same interview Crisis management:

No effect found: New Zealand

Ref: Beautrais et al 2010 Br J Psychiatry 197, 55–60

Page 30: Dr. Saman Yousuf 17 June 2011. Risk assessment and crisis management (if there is suicide risk) are covered in the same interview Crisis management:

Summary

There are relatively few randomized clinical trials for treatments for suicidal behavior.

Standard of care interventions such as inpatient and anti-depressants do not have strong support.

Psychotherapy – particularly CBT and DBT seems to have some supportive findings.

Simple and basic interventions. i.e., caring letters, alone have support.

Page 31: Dr. Saman Yousuf 17 June 2011. Risk assessment and crisis management (if there is suicide risk) are covered in the same interview Crisis management:

When a suicide occurs…

Despite best efforts at suicide assessment and treatment, suicides can and do occur in clinical practice

Approximately, 12,000-14,000 suicides per year occur while in treatment

To facilitate the aftercare process:

Ensure that the patient’s records are complete Be available to assist grieving family members Remember that confidentiality still exists Seek support from colleagues / supervisors


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