Sophia Van Vuuren M.A. Clinical Psychology Registered Psychologist #1659 Burnaby Counselling Group

Transcription

1 Sophia Van Vuuren M.A. Clinical Psychology Registered Psychologist #1659 Burnaby Counselling Group

2 Take Hands to Fight Suicide

3 Burnaby Counselling Group BCG is a non profit, Christian Counselling Group in Vancouver. We provide Psychotherapy and Psychological assessments for Children, Teens, Adults, Families, Couples and Groups. We consult with clients with a wide range of mental health workplace, relational, spiritual, learning, cognitive, emotional and behavioural challenges. BCG is depended on Donations and Fundraising to provide Counselling and Psychological services to low income clients, couples and families.

4 I want to Kill Myself.. Life is not worth living anymore.. There is no hope for me, I want to die How can I make an end to this misery, called life? Will I go to hell if I kill myself? I feel like jumping in front of a train!! How do you respond to this statement? Ignore, Talk about something else? Tell C. about your bad day? Try to convince C. of all the Blessings in life to be Thankful for? Try to quote scripture Anxiety? Compassion? Listen with Empathy and ask Questions Your choice of response might save a life!!!

5 Suicide Statistics Higher prevalence in men ratio: 3/1 1 in 25 people attempt suicide in a lifetime (Canada) Females attempt suicide more often than males BC 500 deaths to suicide yearly Not all people who commit suicide express their suicidal intent Worldwide, more people die by suicide than from homicide and war

6 Suicide Statistics (cont.) 90% of clients who engage in suicidal behaviour, experienced a Major Depressive Disorder, Mental health issues, Schizophrenia, Psychotic episodes, Personality Disorder, Bi Polar Disorder or Addiction 80% of clients send out a warning signal no direct request for help Past Suicide attempts/hospitalization is the strongest predictor of possible future death by suicide. Past Suicidal Attempts!! Family History of Suicide

7 Statistics for Suicide (cont.) 80% of all firearm deaths are suicides BC Suicide second leading cause of death among young people aged years For every death by suicide there are about attempts Elderly rates for suicide have been consistently high for decades

8 Suicide Terminology Suicide Death from injury, with evidence that injury was selfinflicted with intention to kill himself/herself Suicidal Attempt with Injury Action resulting in non fatal injury evidence of self inflicted injury with intention to kill himself/herself Suicidal Attempt without Injury: Potentially self harming behaviour evidence on intention to kill himself/herself Para Suicide/Instrumental Suicide Related Behaviour: Self Injurious behaviour, without intention to kill himself/herself, with intention to attain some other goal, with or without injuries /fatal outcome

9 Suicide Terminology (cont.) Suicidal Threat: Verbal or non verbal communication of suicidal intentions Suicidal Ideation: Self reported thoughts of engaging in suicide related behaviour Suicidal Crises: Thinking, planning, intending or attempting suicide Suicide Pacts: Groups, contagious effect, media report Self Mutilation/Self Harming: Behaviours deliberate infliction of physical harm to own body without an intent to die as a consequence of behaviour

10 Myths About Suicide Suicide is generally committed without warning Suicide occurs around holidays: December low, May/September=highest Suicide always concurrent with depression symptoms Clients on medication for Depression is out of risk for suicide Suicide is only a teenage problem Self mutilation/cutting cannot lead to suicide

11 Myths about Suicide Most people leave suicide notes Don t talk about suicide, it might give people ideas Media publications about suicide are harmless All suicidal people want to die There is usually one cause for suicidal intent or completion Once depression lifts, it means lower risk of suicide Grief surrounding suicide is like any other grief

12 At Risk Population Male Adolescent/Elderly Living alone, isolate, minimum social connections and support Significant losses: loved one (teenagers),financial, job, social status, relationship disintegration/divorce, health, terminal illness, news of other suicide. Psychiatric Disorders Personality Disorders Alcohol and/or substance dependency Medical illness

13 At Risk Population (cont.) History of Suicidal attempts Family History of suicide Lowered Socio economic circumstances No Future orientation No Spiritual/Religious connections

14 How to be Empathic and skillful First Priority is to determine the Risk level for Suicide Remember you are not a professional, but you can be instrumental to saving this person s life by guiding them to the appropriate Professional sources of help. Ask the right Questions!! Pay attention to client safety as well as confidentiality of the information they share with you

15 Levels of Suicide Risk Lowest Risk Level motivate for Counselling sessions/assessment for Depression No suicidal thoughts / behaviour or talk, hopeless & helpless Low Risk Make emergency Counselling /Psychologist appointment for assessment Non suicidal, vague thoughts of death Elevated Risk Make emergency Counselling/Psychologist appointment and accompany client to appointment Suicidal thoughts/talk/behaviour vague, without a specific method/plan in mind, where, how? Highest Risk Take client directly to Emergency/RCMP/911 Suicidal thoughts, behaviour plan with specific method, what, where, how?

16 Questions to Ask that can save lives? Sometimes people have thoughts about ending their life. Have you had these thoughts in the past or recently? Tell me if you had thoughts of harming yourself or of ending your life? Yes What did you think of doing? Did you think of any specific way of doing that? How often did you have these thoughts of ending your life? For how long have you been thinking these thoughts? Have you ever tried it before? When was the last time you felt that way?

17 Screening for Suicide Risk S: Sex A: Age D: Depression SAD PERSONS (Patterson, et al, 1983) P: Previous attempts, Major risk factor E: ETOH (alcohol), 20 50% R: Rational thinking loss S: Social support lacking O: Organized plan N: No spouse S: Sickness

18 Warning Signs Is Path Warm (QPR UBC) I: Ideation Plan, history, what, where when, how? Web searching/talk/writing about death/suicide S: Substance Abuse P: Purposeless ambivalence, doomed A: Anxiety T: Trapped egression fear of failure/shame/humiliation H: Hopelessness desperation, worthlessness, loss

19 Is Path Warm? W: Withdrawal from family, friends, social circle, conflict with family A: Anger rage, seeking revenge R: Recklessness risky/impulsive behaviour, sexual, drinking, extreme activities/medication M: Mood swings shifts between high and low, overwhelming, irrational depression

20 Screening for Depression SIGECAPS S: Sleep disturbance I: Interest reduced G: Guilt & self blame E: Energy loss, fatigue C: Concentration problems A: Appetite P: Psychomotor agitation/retardation S: Suicidal thoughts

21 Behavioural Risk Indicators Researching the Web, Blogs, chatrooms, Making a personal Will, Give personal items away, put finances in order Leaving a note Collect medication or knives or potentially lethal items. Buying a gun Level of impulse control? Taking part in risky/acting out behaviour drinking, drugs, driving, sexually risky behaviour, aggressive behaviour

22 Risk Assessment Has client expressed suicidal ideation? Frequency/intensity/sense of client s rational control or irrationality Is there a Plan the client intends to carry out? How specific, does the client has the means/ability and expectation to carry out the plan? firearms, medication. How readily can client carry out plan? Why does the client wants to commit suicide? Intensity of desire to die. Intensity of desire to express anger or distress to the living. Presence of voices or other factors telling the client to die? Escape emotional distress? Factors that would prevent client from suicidal attempt? Support factors, family, partner, religion, etc. Level of anxiety, distress, hopelessness, helplessness

23 Safety Plan High Imminent Risk Clients Indicators for Imminent Risk = High CONSULT WITH SUPERVISOR High or Imminent Risk Directive Approach Commitment to live for time period & commit to counselling (Drew, 2001, Kroll & Knudson, 2000) Client consent to release (limited) information to family/support person Coach support person high risk and need for close observation Client Consent for Voluntary Hospitalization Call Emergency at Vancouver General Hospital (VGH) Client accompanied by friend/family Taxi $30 Client refuse voluntary Hospitalization Call RCMP

24 Follow up Ongoing Monitoring and Support of client Determine whether client has a Professional and Social support Network Team Determine whether client is following up on regular weekly counselling Counsellor/Psychologist Determine whether client is taking medication Determine whether Family Doctor is informed and monitoring client s medication with bi weekly visits Determine whether client is consulting with Psychiatrist Determine whether client s family & social support are ongoing, informed and involved Determine whether client is making progress and moving out of the danger/high risk zone Continue maintenance check ins with client for 6 to 12 months

25 Case Example 1 A Fifty two year old male is threatening to shoot himself. He has been suffering from Depression for a few months, but did not consult his family doctor and has recently started drinking. He has recently been laid off from his job and he is worried about his financial situation. His father committed suicide. There is a family history of alcoholism. His wife seems supportive but passive and lacking insight about mental illness. He has two teenage children. He is a hunter with an extensive collection of firearms. He says he cannot bear the agony anymore and would like to finish the job.

26 Case Example 2 A twenty seven year old married female with anxiety and history of a depression. She has just heard that she failed her nursing exams and she discovered two days ago that her boyfriend of 4 years has been cheating on her with her best friend. She expressed suicidal thoughts of wanting to jump off a bridge just to spite both of them. She is crying constantly and started to use more alcohol. She is on medication for depression and walks around town late at night to try to feel better. She feels very emotionally overwhelmed, helpless and hopeless when she is alone in her apartment.