Early Detection of Suicide risk

Physical changes

Major changes to sleeping patterns – too much or too little
Loss of energy
Loss of interest in personal hygiene or appearance
Loss of interest in sex
Sudden and extreme changes in eating habits – either loss of appetite or increase in appetite
Weight gain or loss
Increase in minor illnesses

Conversational signs

No future – “What’s the point? Things are never going to get any better”
Guilt – “It’s all my fault, I’m to blame”
Escape – “I can’t take this anymore”
Alone – “I’m on my own … no-one cares about me”
Damaged – “I’ve been irreparably damaged… I’ll never be the same again”
Helpless – “Nothing I do makes a bit of difference, it’s beyond my control”
Talking about suicide or death
Planning for suicide

Behaviours

Alcohol or drug misuse
Fighting and/or breaking the law
Withdrawal from family and friends
Quitting activities that were previously important

Pre suicidal Behaviour

Self-harming
Putting affairs in order (giving away possessions, especially those that have special significance for the person)
Writing a suicide note or goodbye letters to people
Uncharacteristic risk-taking or recklessness (for example driving recklessly)
Unexplained crying
Emotional outbursts

Pre suicidal Emotions

Sadness
Anger
Shame
Desperation
Disconnection
Hopelessness
Worthlessness
Powerlessness
Loneliness
Isolation

Guideline for Mental Health professionals to deal with suicidal clients

How to begin a conversation about suicide?

Evidence shows that the relationship between the Professional and the patient can often be one of the most important factors in reducing self-harm ideation. A significant factor may include the professional’s genuine concern and willingness to discuss the client’s emotional issues. Some reassuring statements like: ‘I think it is my job to make sure that you’re doing fine and I have been having some concerns that things are not be going so well for you at the moment. Is it okay that we talk a little about how you are doing and feeling?’

At times it can be daunting asking direct questions about suicide and mental illness for fear of upsetting the person, stigmatizing your patients, or feeling that you might put ideas in their head. But it is the first step to providing support by talking about it. By being calm, non-judgemental, and empathetic, a Professional provides the space for a client to openly discuss their thoughts. They can be encouraged to tell their story, outline their stresses, provide information about their history, and describe their current suicidal thoughts. Asking about suicide is imperative. During the evaluation, obtaining the history of the frequency and intensity of the suicidal thinking, history of suicide attempts, patient’s psychiatric history and medical history, overall mental state, and level of support will determine the overall risk and the subsequent management plan required. However, it is important to remember that just asking about suicidal ideation does not ensure that accurate and complete information will be received. Some example questions are highlighted below.

Risk Assessment Questions

Go through the following questions with the person. If they are at high risk of suicide, seek immediate help by calling the police or ambulance. With their permission, take the person to the emergency department of the nearest hospital.

Dealing with patients who might be at risk of suicide

If patients disclose symptoms, thoughts or feelings that might indicate a mental illness, mental health issue or suicidality, some things that might help you work positively with your patients, are to:

Normalise the patient’s feelings
A useful analogy … ‘I have nothing to wear.’ ‘But you have a closet full of clothes.’ To the outsider, what may seem like an irrational feeling is very real and rational for the person experiencing it. It is the same for those suffering from anxiety. To the outsider, it might look like that the person has a good life (i.e., a great job, lots of friends). However, a crippling fear of one thing renders all others as inconsequential. While anxiety might be seen as an irrational feeling by an outsider, it might be completely rational to the person.
Making them important
Talk about mental health issues, mental illness and mental disorders as being separate to the person, not as defining them. When talking to patients about mental health issues, the language that you use can really impact how the person thinks and feels about themselves. Avoid labelling the client of any mental condition but understanding their problem.
Instil hope

Professionals might focus on the individual by:

Identifying his/her strengths, talents, interests and limitations
acknowledging his/her rights to full partnership in all aspects of their recovery
promoting the rights of people to make choices regarding their own desired goals and outcomes
projecting a belief in the inherent capacity of the individual to recover.

While it can be the case for some people, recovery in a mental health context doesn’t necessarily mean being rid of all symptoms or returning to function without the symptoms first presented (as it might be for a person recovering from influenza or a chest infection, for example). Rather, a person’s sense of self might include the mental illness but is not determined by it. Their recovery process is fostered by components of hope, self-identity, meaning in life and responsibility.

Steps of safety planning

Therapy and No suicide contract

This document contains a Therapy Contract, which is a mutual agreement between the client and the therapist which ensures that the therapy will be performed in a good, safe, and professional manner and highlights the responsibilities of the therapist towards the client as well as the client’s responsibilities during the therapeutic relationship. This is also significant to ensure transparency during the professional relationship.
Please read through the contract carefully as it provides the practical side of coming through the therapy. It will also give you an idea of how the therapy works.