Crisis Intervention Abdullah AlSubaie F R C P

� Suicide is the process of purposely ending one’s own life. � Marital status � Unemployment � Low income � Mental illness � History of being � Personal history physically or sexually abused of suicidal thoughts, threats or behaviors � Family history of attempting suicide • How societies view suicide varies by culture, religion and the circumstances under which it occurs (JAMA, 2005). 2

Nearly a million people worldwide commit suicide each year. Suicide is the eighth leading cause of death in males in USA. Suicide is the 16 th leading cause of death in females in USA. It is the third leading cause of death for people 10 to 24 years of age in USA. Elderly Caucasian males continue to have the highest suicide rate (National Institute of Mental Health, 2007). 3

Self-mutilation is the act of deliberately hurting oneself without meaning to cause one’s own death. Examples of self-mutilation Cutting any part of the body, usually the wrists Self-burning Head banging Pinching Scratching (Palmer, pg. 283). 4

� Firearms are the most common means by which people take their life, accounting for nearly 60% of suicide deaths per year. � Other common methods �Asphyxiation (hanging, poisoning, or overdose) �Blunt force trauma �Jumping from a building or bridge �Stepping in front of a train/automobile �Slitting one’s throat/wrist �Drowning �Starvation �Electrocution (Qin & Mortensen, pp. 765 -768). 5

Medico-legal Center, Dammam, Saudi Arabia. The suicide rate for the entire population averaged 1. 1/100, 000 population per annum. The male-to-female ratio was 4. 5: 1. The highest suicide rate was among the age group from 30 to 39 years (44. 3%), followed by the age group from 20 to 29 years (32. 6%), and the lowest suicide rate was among the age group <20 years (1. 8%). 6

The rate in the group >60 years was also low (3. 2%). Immigrants formed 77% Asians 70% (43% are Indians). The most common means was hanging (63%), followed by jumping from heights (12%) and gun-shooting (9%); poisoning 6%. Increasing rate of suicide during the second 5 -year period compared with the first 5 -year period. 7

There are gender, age, ethnic and geographical risk factors for suicide, as well as those based on family history and mental health status. Ethnically, the highest suicide rates in the United States occur in non-Hispanic whites and in Native Americans. The lowest rates are in non-Hispanic blacks, Asians, Pacific Islanders, and Hispanics. Former Eastern bloc countries currently have the highest suicide rates worldwide, while South America has the lowest. 8

The majority of suicide completions take place during the spring (Cuellar, pg. 69). In most countries, women continue to attempt suicide more often, but men tend to complete suicide more often. The frequency of suicides for young adults has been increasing in recent years (Cuellar, pp. 70 -71). 9

Warning signs : the person making a will getting his or her affairs in order suddenly visiting friends or family members buying instruments of suicide like a gun, hose, rope or medications sudden and significant decline or improvement in mood writing a suicide note (JAMA, 2005). 10

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� It is a 10 -item scale to purports to screen for suicide risk. An individual is given one point for each item for which he or she screens positive: � Sex (male/female) � Age less than 19 or greater than 45 years � Depression (severe enough to be chronic) � Previous suicide attempt or psychiatric care � Excessive alcohol or drug use � Rational thinking loss: psychosis, organic brain syndrome � Separated, divorced, or widowed � Organized plan or serious attempt � No social support � Sickness, chronic disease (Osterweil, 2007). 12

� The assessment of suicide risk often involves an evaluation of the presence, severity, and duration of suicidal thoughts in the individual’s mental health evaluation. � Questions about family mental-health would include: � Anxiety � Depression � Mood swing � Bizarre thoughts � Substance abuse � Eating disorders � History of being traumatized (Osterweil, 2007). 13

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� Treatment of suicidal thinking or attempt involves adapting immediate treatment to the sufferer’s needs and support system. � Those who are hopeful and have a desire to resolve conflicts may need only a brief crisisoriented intervention Those with severe symptoms or less social support may need hospitalization and long-term mental-health services. � Vigorous treatment of the underlying psychiatric disorder is important in decreasing short-term and long-term risk (Qin & Mortensen, pp. 765768). 15

� Suicide prevention measures that are put in place following a psychiatric hospitalization usually involve mental-health professionals trying to implement a comprehensive outpatient treatment plan prior to the individual being discharged. � It is often recommended that all firearms be removed from the home due to the individual still having access to them even if they are stored and locked. � It is further often recommended that potentially lethal medication be locked up as a result of the attempt (Sher, pg. 667). 16

� People with suicidal thinking are encouraged to talk to a doctor or other health professional or religious leaders. � They can report to an emergency room or mental-health crisis center for help. � Other strategies include: �Having someone hold all medications �Removing any weapons from the home �Scheduling frequent stress-relieving activities �Avoiding the use of alcohol or other drugs �Getting together with others to prevent isolation (Sher, pg. 680). 17

Techniques for coping with suicide of a loved one include nutritious eating, getting extra rest, talking with others about ways to handle the painful memories. To help children and adolescents cope with suicide of a loved one it is important to ensure they receive constant interactions with supportive adults, and understanding their feelings as they relate to their age (Melhem & Day, pp. 1411 -1416). 18

Discussing suicide will provoke it Suicide runs in the family Suicide strikes only the rich Showing generosity and sharing personal possessions is showing signs of recovery Suicide is always impulsive It is a painless way to die Once suicidal, always suicidal Those who threaten it, don’t do it (Dr. A. Marshall, 2008). 19

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