• Suicidal ideations are very rarely if ever attention-seeking strategies. Take all threats of suicide seriously.
  • Sudden improvement in mood after a suicide risk or suicide attempt does not necessarily mean that the patient is getting better. Sometimes mood improves after a patient has decided to commit suicide, because they see it as a way to end the pain.
  • Early warning signs of a potential suicide attempt include: The recent suicide, or death by other means, of a friend or relative; history of previous suicide attempts; preoccupation with themes of death and dying; talking about wanting to die or to kill oneself; looking for a way to kill oneself (lethal means); talking about feeling hopeless or having no purpose; talking about feeling trapped or being in unbearable pain; talking about being a burden to others; increasing substance abuse; acting anxious, agitated, or reckless; sleeping too little or too much; withdrawing or feeling isolated; showing rage or talking about seeking revenge; and displaying extreme mood swings.
  • Evidence suggests that the propensity for suicide may be hereditary. This may be due to genetics, or environment, or a combination of both. Suicide tends to run in families.
  • Suicide was the tenth leading cause of death for all ages in 2013.
  • Firearms are the most common lethal means among males committing suicide.
  • Poisoning (drug overdose, etc.) is the most common lethal means among females committing suicide. Preliminary studies seem to indicate that as firearms become more prevalent in our society, more women are committing suicide with firearms, but for now poisoning is still the most common lethal means on average among females.
  • Purpose, Plan, and Intent (PPI) is a quick way to determine risk of suicide. “Purpose” means a current active suicidal ideation as opposed to occasional infrequent thoughts about death and dying. “Plan” means that the patient has given thought as to lethal means, opportunity, and to how to obtain lethal means (for example, buying a gun or gaining access to an overdose of pills). “Intent” indicates that the patient is seriously demonstrating an active plan to commit suicide, such as writing a suicide note, giving away possessions, or acting on a plan to obtain lethal means.
  • Although “no harm” contracts have fallen out of favor because research demonstrates that they are not effective, a Suicide Prevention Action Plan can help reduce risk. This is because such a plan contains a plan to remove lethal means, an identified support network, and positive affirmations (reasons to live).
  • If a parent or other guardian/caretaker of a minor child refuses to engage in suicide prevention planning, a report to Child Protective Services is warranted, as this could constitute abuse/neglect.
  • Likewise, if the guardian of a vulnerable adult who is suicidal refuses to engage in suicide prevention planning, a report to Adult Protective Services is warranted, as this could constitute abuse/neglect of a vulnerable adult.
  • Crisis appointments take precedence over all other behavioral health appointments. If you work extensively with this population, you may wish to include such a statement in your intake paperwork so that your patients will be informed that you may have to cancel their non-crisis appointment to deal with a crisis.
  • “If they’re drowning, don’t try to teach them how to swim” means that if you have a patient in a full crisis mode, asking a lot of questions can escalate their fight or flight response. In a crisis, use PPI to determine level of risk, refer to emergency services (i.e., the emergency room or in-patient treatment), and save the full assessment until after the crisis is over.
  • If still in doubt about the risk of crisis after the PPI assessment, the Suicide/Homicide Ideation Decision Flowchart contained within the course materials helps to do a brief and accurate suicide risk assessment.
  • Escalations of problem thoughts and behaviors (suicide risk thoughts and behaviors) are often hard to keep from spiraling out of control into a crisis situation without specific measures being taken. That is why de-escalation strategies are so important.
  • De-escalation is important during suicide risk assessment so that the situation isn’t exacerbated. A quick and simple method of de-escalation during a crisis is “LEAP,” which stands for “Listen, Empathize, Agree, and Partner.” Listen to what your patient is actually saying, respond empathically (as opposed to sympathetically, which can be seen as patronizing), agree with their viewpoint on the situation without agreeing with their suicide plan, and partner with the patient to create a safety plan.
  • Medical and mental health professionals are not the only effective intervention for suicide. Sometimes all it takes is a person willing to listen. This is why support groups are so effective. Build support for your patient by linking them to community resources or friends and family.

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