Safe Plans and Suicidal Thoughts

INSHAPE NEWS MIND MATTERS

Peter Walker – Clinical Psychologist

In 2010, 2359 Australians lost their lives as a result of suicidal behaviour. This represented the 10^th most common cause of death for men that year. It has been estimated that up to 170 people attempt suicide in Australia every day. In spite of the obvious seriousness of the problem, there is little community education and awareness generated, especially when compared to other health problems such as cancer or heart disease.

What factors are associated with greater risk of suicide?

There area number of factors that put individuals at greater risk of attempting suicide. These are as follows:

Previous attempts and a family history of suicide.
Living in a rural area.
Being male, men account for nearly 80 percent of deaths, with a relatively young (30 -34 age group), being most ‘at risk.’
Suffering from mental illness, particularly mood disorders.
Enduring chronic pain.
Carrying out substance abuse.
Having low self-esteem and a reduced sense of control.
Suffering from guilt, shame and/ or a sense of hopelessness.
Living in poverty, or enduring financial difficulties and violence.
Enduring social exclusion, peer rejection and discrimination.

On the other hand, safe, socially connected and meaningful lives can act as protective factors against suicide. This is why it is important to try and connect with someone who is feeling these pressures and to talk about their issues.

What are the signs?

Friends and family can play an important role in helping those who have or are planning to engage in suicidal acts. If the person is at risk of suicide the presence of certain behaviours may represent an escalation in risk. These behaviours include the following:

Withdrawal from loved ones. The individual may start pushing people away.
Diminished self-care. A lack of concern with appearance and hygiene.
Loss of involvement in activities that were once pleasurable. Reduced engagement in previously valued activity.
Discussion of suicide, self-harm attempts or evidence of planning suicide.
Hopelessness, self-hatred and feeling trapped.

What you can do to help?

If the individual is at risk and exhibits signs that may suggest a possible escalation, it is important that friends and family are prepared and act. There are a range of strategies that can be employed to mitigate risk of suicide and to promote recovery. Plans that can be facilitated by friends and family of the ‘at-risk’ individual during the crisis, intervention and recovery phases of suicide prevention are as follows:

Be available and open – Encourage the person at risk to discuss their concerns openly. Ask calmly, but straightforwardly about suicide. Are they considering harming themselves? If so, how? Do they have the means to carry out the plan? It is important that the individual feels they have permission to discuss these issues openly without judgement or fear of offending. In this instance, it is much better to run the risk of overreacting than to under-react.
Be prepared, know what services and resources are available in your area – This will typically include the location and phone number of the local hospital and emergency department (ED), the local mental health crisis team, the individual’s mental health clinician’s details, which can include a mental health nurse, psychologist, case manager, and social worker, as well as an occupational therapist, general practitioner, and psychiatrist. Other relevant community resources are the community mental health centre and local non-government organisations. In New South Wales there is a government run state wide crisis line (1800 011 511) that can access and intervene with services if appropriate.
Assertively involve services – As difficult as it can be, it is essential to involve professional’s when dealing with situations that involve suicide. This may involve a friend or family member calling services themselves, even if this is against the expressed wishes of their loved one. In these situations it is most important that the individual be kept safe. At all times, however, services act in a way that promotes the least restrictive environment for the person. If you do not feel the individual is safe, ask them to accompany you to the local ED, call the local crisis team or call an ambulance.
Be an effective and resourceful listener – Throughout a crisis, being an open, kind and attentive listener can make all the difference. You should openly offer support and care. Using a sense of non-judgement, assist in exploring alternatives to the problems in the life of the individual contemplating suicide and alternatives to self-harm. Assist in identifying coping strategies and external support, while simultaneously validating the distress the individual is experiencing.

Professional Support

Experienced professionals utilise a range of different techniques that vary in intensity depending on their assessment of the situation. This can occasionally lead to hospital admissions but most often consists of regular therapy sessions with an initial focus on ensuring safety, providing support and considering alternatives to suicide. Some clinician’s seek commitment to a plan via contracting, although these remain controversial due to the current lack of clear efficacy in the scientific literature. Once the immediate crisis has been averted, treatment will often consider those psychological vulnerabilities that may have contributed to the person’s behaviour.

Peter Walker has over 12 years experience working as a clinical psychologist. He has worked in both public and private practice, having specialised in complex presentations. He established his private practice, Peter Walker & Associates, clinical psychologists, in 2002 as a service to provide psychological treatments for those experiencing difficulties with anxiety, depression and couples in distress. In addition, the practice was relatively unique in that it offered specialised treatments for those experiencing psychotic disorders and bipolar disorder. At the time Peter Walker & Associates was established the development of psychological treatments for these conditions was in its infancy and Peter was considered an innovator in this field. Peter provides clinical supervision for mental health practitioners, is a sought after presenter and has experience providing expert opinion in the media. In recognition of his experience treating mood disorders he has been asked to take on a role at the Black Dog Institute in 2013.

Jay Spence – Clinical Psychologist and PhD Candidate

Who wouldn’t want to keep another safe from the self-destructive thoughts of suicide? To support another through the darkest time in their life is a very human thing to do; however, what you may not know is that it is might be impossible to tell if someone will attempt suicide.

Suicide screening is where people use all kinds of methods like questionnaires and interviews to try to tell if someone is at serious risk of committing suicide. There are dozens and dozens of techniques, but very few of them work well. Plus, those that do are not very accurate.

How do we know this? Findings on suicide screening are based on three systematic reviews that were published in the last decade. A systematic review is where a group of scientists read through all the research papers on a topic like suicide prevention. They look at all the individual findings together and come up with a conclusion based only on the facts they have. Reviews are important in research because they offer the best chance to really understand what works and what doesn’t for something as important as suicide prevention.

One of these reviews said that almost all of the screening tools for suicide were inaccurate with the exception of the ‘Beck Hopelessness Scale’ and the ‘Scale for Suicidal Ideation.’ Even these scales were not particularly good at being able to tell if someone would harm themselves. Although all three reviews said that there were lots of screening tools that were promising for children, adolescents and adults, there was no conclusive evidence to say that they work. This isn’t saying that none of them work, only that we don’t know yet.

One of the reviews listed all of the things that mean that people are at higher risk of attempting suicide. These include:

1. Have they attempted to hurt themselves before?

2. Are they depressed?

3. Do they have schizophrenia or psychosis?

4. Do they have a history of mental health problems?

5. Are they drinking a lot?

6. Are they unemployed or very sick?

7. Are they young adults or teenagers?

Unfortunately, individuals that are within these groups are more at risk than other people. These issues also mean that people are more at risk of self-harm, such as cutting, burning or hurting themselves, as well as suicide.

Safety planning is still important because it gives people tools and resources to get through very difficult periods of depression. Just because we can’t tell who might attempt suicide doesn’t mean that we shouldn’t try to help people who are thinking about suicide by offering them whatever we can. The hallmark of suicide is loss of hope. Unfortunately, the brain chemistry and thinking caused by depression mean that many suicidal people can’t comprehend hope until they get proper treatment. At those times keeping people safe may be what’s needed. There are people that can help with this including local mental health teams, GPs, psychologists and psychiatrists. The best place to start is by calling Lifeline (13 11 14) to talk to someone about the resources available in your area.

Jay Spence is a Clinical Psychologist and PhD candidate who specialises in adult and adolescent mental health. He was joint recipient of the Gold Prize at the Australian and New Zealand Mental Health Service Achievement Awards (2010) and of the St Vincent’s Health Australia National Invention and Innovation Award (2010) and was the recipient of the 2011 New South Wales Institute of Psychiatry Fellowship. He has published numerous papers on the treatment of post-traumatic stress, social phobia, and panic, as well as generalized anxiety and transdiagnostic anxiety processes. He held a conjoint lecturer position at the University of New South Wales from 2009 to 2011, lecturing on the treatment of anxiety and depression. He is currently completing a PhD on internet-based interventions for post-traumatic stress disorder (PTSD). He is developing these treatments as part of the Centre for Emotional Health at Macquarie University because PTSD is the most prevalent anxiety disorder in Australia. However, many people do not have access to effective treatments. He sees patients in private practice in Darlinghurst, Sydney.

Phil Owens – Leading Australian Hypnotherapist and NLP Practitioner

In any given person, suicide risk is not fixed but changeable. Under periods of increased personal stress, the potential for suicidal crisis increases. Although there is no way to predict who will die of suicide, recognising and responding to the clear warning signs is critical.

Data suggests that less than 3.5 percent of the population will have suicidal thoughts, with only 0.01% actually dying of suicide. While suicide has a low prevalence in the community, it is important to note that its outcomes on surviving family, friends and communities can be devastating.

Warning signs are specific symptoms or behaviors that a person demonstrates or expresses that may indicate an increased risk to suicide. In particular, anxiety, physical agitation, sleep problems and poor concentration, as well as hopelessness, social isolation, and excessive or increasing use of alcohol or drugs. These are all factors that could indicate greater risk of suicide. Key static risk factors regarding suicide include reported previous suicide attempt by themselves or a family member, and history of mental illness.

On the other hand, a series of potential protective factors have been identified. These can include stress-management skills, religious beliefs that increase the stigma of suicide, and frustration tolerance, along with a sense of responsibility to family or friends, a healthy network of social supports, and positive therapeutic relationships. Protective factors diminish in importance when a potentially suicidal person is placed under increased stress, which can simply overwhelm them. This is especially true when the person is in an intoxicated, impulsive or in a uninhibited state.

The difference between suicidal thought and death by suicide is large. Individuals are usually assessed by being observed and interviewed. In particular, specific questions (safe-t model) are used to determine the level of potential risk. The aim of any assessment is to identify the following:

Does the person have suicidal intent?
Do they have a specific plan?
Do they have the means to carry it out (the pills, weapons, which is relative to their plan)?
Have there been previous attempts or rehearsals?
What outcome are they after, death or rescue?
Identification of risk factors and warning signs.
Identification of coping potential.

Identifying a person that may be at risk of suicide can be complex, as often the person will not engage in full or truthful disclosure about their plans. Connection of the person to a properly trained resource — medical, counselling or psychological — is critical to ensure they are properly evaluated and supported.

Often individuals at higher risk of suicide during their treatment will be encouraged to negotiate ‘safety plans’ with their clinicians. This will only occur in more chronic scenarios, as individuals at acute risk will be managed much more directly, with hospitalisation, for example. A safe-plan is a pre-arranged strategy that the individual can follow when they determine a higher level of stressors or behaviours that could lead to them being at greater risk. Many of the items in such a plan are pre-emptive, including ensuring all potential weapons or support items are not available, without supervision. Stress-management processes are taught, abstinence or reduction of alcohol or drugs is encouraged and identification and deployment of supportive resources including regular ‘check-in’ buddies and scheduling medical appointments, are organised. They will often include ‘what to do’ strategies in the case of increased personal stress.

Safe-plans are a useful way of enhancing the ‘protective’ factors for an individual. This does not mean that they will not be overwhelmed by dynamic stresses, but they can improve the opportunity for the individual to have a clear strategy for navigating through these stresses when they emerge.

If you consider someone you know to be at risk of suicide, connect them to trained resources. Try to amplify the protective factors and get them to a clinician or specialist service that can assist them.

Philip Owens is owner and director of Reflective Resolutions and is a leading Australian hypnotherapist and NLP practitioner based in Melbourne, Australia. Using scientifically validated and pragmatic approaches, Philip is a passionate about creating lasting change in and for his clients.

Working in his clinic with individuals and also with corporate clients, Philip’s international experience, state of the art training and processes have led to successful and happy clients all over the world. Focusing on the issues of modern life, Philip routinely works with clients presenting with anxiety, fears and phobias, addictions, traumas, weight loss, insomnia and smoking cessation’.

Dr Joann Lukin – Sport and Performance Psychologist

Wondering about the purpose of living and considering whether or not to continue with life are thoughts that are contemplated by more people than you may think. And whilst there are a number of people who contemplate suicide, it is a smaller percentage that takes steps towards committing suicide. That aside, the feelings associated with depression and other mental conditions can feel overwhelming and highly distressing. Any concerns about someone with thoughts of suicide, should be taken seriously by family members, friends, and the person themselves.

Feeling suicidal is a distressing experience and there are a number of things that can help you to get through the feelings to help yourself. These include the following:

Talk to someone, a friend, a counselor or a phone crisis line.
Be with someone whilst you are experiencing those feelings.
Set smaller, realistic goals, on an hour-by-hour basis.
Look after yourself, eat well and exercise.
Avoid alcohol and drugs.
See a mental health professional.

A further strategy that can be helpful to cope with some of these feelings, is to put a suicide safety plan in place. The plan is a set of instructions that you will follow to help you become safe. In order for you to create your plan well, you should do the following:

To get your plan underway, talk to someone you trust – a friend, a family member, psychologist or doctor.
If you can, make your plan whilst you are feeling well. Write the plan down and keep it in a place where you can find it easily should you need it.
Think about the places and thoughts that might precede suicidal thoughts for you. For example, ‘When I am reminded of my previous relationship, I think suicidal thoughts.’
Identify the things you can do that may distract or calm you during suicidal thoughts. For instance, listen to music, go for a walk, take a bath or ring a friend.
Develop a list of reasons why you want to live. It can become very easy to get caught up in the negativity of suicidal thoughts. Shifting your focus to things that make you feel more positive can be very helpful, such as children, family and spirituality.
Develop a list of those people, personal and professional that you can ring. Include on the list when you can call them, such as the friend you can ring at any time day or night, your counselor who is available during the working week, or the help line that you can ring 24/7.
Ask yourself, “What do you need to do to make your environment safe?” Think about what might place you at risk. For example, if you have access to knives, or prescription medications. Enlist someone to help you remove them if you’re feeling suicidal or move yourself to another location until you feel safe.
If it still feels unsafe, get help. Ring 000 or go to your nearest emergency department. There are people who are ready and want to help you.

Dr Lukins is a psychologist who has specialised in sport and performance psychology for over 20 years. During that time, Dr Lukins has consulted individuals, teams, coaches, and organisations across the country. She is committed to the field of positive psychology — a scientific framework that studies human potential and happiness. The primary focus of her work is to assist clients to find strategies to achieve their goals and reach their potential. Joann’s work helps clients to understand what makes them be healthy, fulfilled and focussed on their personal well-being.

Disclaimer: The information published in this column is based on each of the author’s own professional and personal knowledge and opinion. This information and opinion is not intended to be a substitute for professional medical advice, diagnosis or treatment of any manner. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding any medical condition and consult a qualified medical professional before beginning any nutritional or exercise program. Never disregard professional medical advice or delay in seeking it because of something you have read on InShape News.