Suicide Prevention Improving Suicide Risk Assessment.
-
Upload
mary-cunningham -
Category
Documents
-
view
213 -
download
0
Transcript of Suicide Prevention Improving Suicide Risk Assessment.
Suicide Prevention
Improving Suicide Risk Assessment
Suicide Prevention: Background
Completed Suicides – 2004 Data Suicide the 11th leading cause of death Suicides accounted for 1.4% of all US deaths More than 32,000 suicides – 89 per day Toxicology in 13 states:
33.3% positive for alcohol 16.4% positive for opiates 9.4% positive for cocaine 7.7% positive for marijuana 3.9% positive for amphetamines
Suicide Prevention: Background
Suicidal Ideation and Attempts For Young Adults 15 to 24, one suicide for
every 100 – 200 attempts For Adults 65 and older, one suicide for every
4 attempts In 2005, 16.9% of US high school students
reported seriously considering suicide in the previous 12 months. More than 8% reported a suicide attempt during the same time frame.
Suicide Prevention: Disparities
Men Suicide at nearly 4 times the rate of women 78.8% of all US suicides Suicide is the 8th leading cause of death Age 75 and over have a rate of 37.4 Firearms are the most common method
Suicide Prevention: Disparities
Women Attempt suicide 2 to 3 times more than men Suicide is the 16th leading cause of death Women in their 40s and 50s have a rate of
8.0, the highest rate for women Poisoning is the most common method of
suicide for females
Suicide Prevention: Disparities
Suicide is the 2nd leading cause of death among 25 to 35 year olds
Among 15 to 24 year olds suicide accounts for 12.9% of all deaths annually
The suicide rate for adults 65 and older was 14.3
16.9% of students, grade 9 to 12 seriously considered suicide in the past 12 months
8.4% of students reported at least one suicide attempt in the past 12 months
Nonfatal Suicidal Behavior
In 2005, 372,722 people were treated in ERs for self inflicted injuries
In 2005, 154,598 people were hospitalized due to self inflicted injury
There is one suicide for every 25 attempted suicides
Nonfatal Suicidal Behavior
Among 15 to 24 year olds, 1 suicide for every 100 – 200 attempts
Among 65 and older 1 suicide for every 4 attempts
Risk Factors
Some risk factors are associated with suicide and a subset are predictive of completed suicide
Risk factors are not necessarily causal There is no validated method of adding up
numbers associated with risk factors to identify levels of suicide risk
Clinical assessment and judgment regarding risk of suicide must be documented
Risk Factors
Suicidal ideation, intent and/or means are NOT the sine qua non of assessing suicide risk
All predictive risk factors and protective factors should be identified and a formulation of suicide risk should be written
Risk Factors
Risk factors may be further categorized as modifiable or not modifiable Age, race, and gender are in the not
modifiable category Illness, grief, and social situation may be
modifiable Modifiable risk factors should be addressed in
treatment and safety planning for the individual in order to decrease risk of a completed suicide
Risk Factors
Family history of suicide Previous suicide attempts Local clusters of suicides Family history of child maltreatment History of mental disorders
Depression Schizophrenia Bipolar Disorder Obsessive Compulsive Disorder
Risk Factors
History of substance abuse Alcohol Mixed
Feelings of hopelessness Impulsive and/or aggressive tendencies Cultural and religious beliefs Isolation Barriers to accessing treatment Unwillingness to seek help due to stigma
Risk Factors
Physical illness Impacting relationships Impacting ability to work Cancer or other disabling or lethal illness
Loss Relationships Financial Work
Easy access to lethal methods
Protective Factors
Pregnancy Responsible for children under 18 Sense of responsibility to family Employed Living with another person Positive social support Positive therapeutic relationship Cultural and/or religious beliefs discourage
suicide
What Can We Do
“no suicidal ideation or intent” is not a suicide risk assessment Ask about other risk factors Ask about protective factors Ask how modifiable risk factors are being
addressed in the treatment plan Never accept “contracted for safety” as a
reasonable part of a safety plan (and never document this as part of your reason for believing the member to be safe)
What Can We Do
When talking with the member Ask about protective factors Ask about a safety plan and develop one if
needed Attempt to engage family and/or friends in the
safety plan and the attempt to get the member to a clinician for a full evaluation
Ensure urgent or emergent appointment
What We Can Do
Practitioners/Providers Adoption of a comprehensive suicide risk
assessment Educate about risk factors and protective
factors Refer to the VO Comprehensive Suicide Risk
Assessment for Prevention as a tool for documentation
Repeat the suicide risk assessment when circumstances change