Tag: suicide prevention

September is National Suicide Prevention Month

September is National Suicide Prevention Month. The 988lifeline website has many resources for getting the word out about the importance of not missing any opportunities to help prevent suicide.

In fact, there is a recently published article entitled “Multiple Missed Opportunities for Suicide Risk Assessment in Emergency and Primary Care Settings.” A few of the important take home points:

  • “Screening for suicide risk, while a critical step in potentially preventing death or injury by suicide, is fraught with additional challenges centering around the poor sensitivity and specificity of many of the screening tools. The widely used PHQ-9 question about suicide has poor sensitivity and specificity. A much better screening tool we recommend is the Columbia-Suicide Severity Rating Scale Screener which can be administered by both clinicians and non-clinician individuals who have been trained in its use.
  • So called “no harm contracts” are best avoided and, instead, replaced with approaches that emphasize joint planning that more respectfully builds upon patients’ innate resiliency to self-soothe, build upon one’s protective factors and reduce those risk factors that are modifiable, and problem-solve ways to create a series of “what-if” scenarios of what to do if suicidal feelings start to intensify
  • Firearms are the leading means of fatal suicides in the U.S. Effort to ensure patients at risk for suicide do not have access is critical
  • There is a bidirectional and undoubtedly complicated relationship between substance use and suicide.”

Thoughts on Suicide Risk Assessment

I know the term “suicide risk assessment” sounds very clinical. That’s because I did it for many years as a consultation-liaison psychiatrist in the general hospital.

The human part of it was using the suicide safety plan, which I got from the Centre for Applied Research in Mental Health & Addiction (CARMHA). You can download it yourself and adapt it by writing in the National Suicide Prevention Lifeline: 988 Suicide and Crisis Lifeline. That’s because the phone numbers on the form are specific to Canada.

Most often I interviewed patients in the intensive care units, where they were admitted after a suicide attempt. The interviews were very short if they refused to talk to me or were still delirious—often the case.

If they were awake and able to converse, the interviews were often pretty long. One way to connect with the patient was working on the safety plan together. I was often able to tell whether they were sincere or not by the level of detail they gave me about support persons they could get in touch with or things they could do to help them cope with whatever was troubling them.

A lack of detail in the plan, or refusal to work on some parts of it were areas of concern. If there were comments about friends, pets, or pastimes that spontaneously led to laughter (yes, that happened occasionally!), I was more confident that the patient was able to look toward the future and make specific plans for staying alive.

There is healthy debate about how useful specific suicide risk assessment scales are for predicting and preventing suicide. They are an essential part of the computerized medical records now, whatever anyone thinks of their reliability at predicting imminent suicide. I never used no-suicide contracts because well before the time I entered professional practice, most experts agreed that they don’t prevent suicide.

What was more useful for me as a clinician was to sit down at the patient’s bedside and, after getting the details about what the patient actually did in the suicide attempt and the events connected with it (along with a comprehensive and thorough history), I would get the safety plan from my clipboard, hold it up so they could see it and say, “Now let’s work on this; it’s your safety plan.”

I can’t tell you how often working on those plans, frequently for more than half an hour, led to laughter as well as tears from the patient. When it worked, meaning the relationship between us deepened, I sometimes did not find it necessary to admit the person to the psychiatric ward. While this occasionally alarmed the ICU nurses, things usually turned out fine later.

September is Suicide Prevention Awareness Month

September is Suicide Prevention Awareness Month (SPAM). This spam is good. Here’s a link to the National Alliance on Mental Illness (NAMI) website on SPAM. And see the message below from University of Iowa President Barbara Wilson. We can all use this well-being toolkit as well.