1998 Biennial Convention “Uniting Nurses: One Strong Voice” June 27, 1998 Session 003

1. 1998 Biennial Convention“Uniting Nurses: One Strong Voice”June 27, 1998 Session 003 “Suicide Prevention Strategies for Families and Consumers” American Psychiatric Nurses Association Phyllis M. Connolly PhD, RN, CS President http://www.apna.org

2. Overview Quality mental health care consist of four main elements: prevention, early detection, treatment and education. This session, including a mini teaching activity, will provide you with an increased understanding of the content, skills and methods of suicide prevention teaching for families and consumers with psychiatric disorders.

3. Objectives • Discuss the statistics of suicide in persons with psychiatric disorders. • Describe the myths related to suicide. • Identify the relevant theoretical frameworks which guide the teaching of families and consumers. • Examine the components and methods of teaching and the specific content for teaching. • Analyze culturally sensitive approaches to teaching ethnically diverse families and consumers. • Participate in teaching simulation exercises. • Compare a family fire/disaster and emergency medical plan with a plan for possible suicide prevention.

4. Suicide: 8th leading cause of death in US • 90% associated with mental & addictive behaviors • Highest rates for elderly white males • Firearms account for 60% of all suicides across all ages • Substance abuse found in most • Family violence and physical & sexual abuse increase risk

5. Persons with schizophrenia • 10% -13% commit suicide • Leading cause of premature death • 18% - 55% will make a suicide attempt

6. Depressive Disorders • Up to 15% requiring hospitalization eventually die by suicide • 10% - 15% of untreated persons with bipolar I commit suicide

7. Risk Factors • History of suicide attempts • Hopelessness • Physical illnesses • Family history of substance abuse • Caucasian race • Male gender

8. Risk Factors Continued • Advanced age • Presence of psychotic symptoms • Living alone • Unemployment • Depression • Substance abuse • Relapse

9. Having a positive supportive and helpful relationship with a mental health provider may reduce the risk of suicide.

10. Suicide Myths • People who think about suicide must be crazy • Talking about suicide may give a person the idea • If a person really wants to kill themselves there is nothing you can do • People who talk about suicide never follow through

11. Identifying Triggers • Alcohol and/or drugs • Stopping psychotropic medications • Lack of sleep • Increased stress: losses, changes, interpersonal relationships • Increased anxiety • Reactions to prescription /over the counter drugs • Nutritional imbalances • Medical conditions

12. Interventions: Step 1 • Check out your concerns--ask the person • If the person says “YES,” stay calm--take a deep breath • Ask the person what their thoughts are like--are they hearing voices • If, Yes, get the person to a suicide or crisis center immediately

13. Interventions: Step 2 • Determine if they have a plan • What exactly do they intend to do • How will they do it • When will they do it If the plan is lethal, concrete, specific, and available, get them to a suicide or crisis center immediately

14. Interventions: Step 3 • If no plan, ask about medications taken within the last 24 hours • ask about any over the counter medication • ask about alcohol/street drugs

15. Interventions: Step 4 • The person should be seen by a mental health professional as soon as possible • Call the primary therapist or case manager • If unable to contact the therapist, call the crisis help line for a referral

16. Suicidal gestures • Get the person to the nearest hospital or emergency service as soon as possible • You may need to call 911 • Stay calm • Stay with the person, unless you have been the targeted person who may have failed to meet the person’s expectations

17. Assessment at Crisis Center • Hospitalization may be needed • Medications • Identifying precipitating factors • Assessing for medical problems • Facilitating feelings of hope • Facilitating sense of competency & efficacy

18. Someone needs to stay with the person at all times The person is experiencing strong feelings of abandonment, loneliness, guilt and hopelessness

19. Adaptive Problem Solving • Assist with basics • Living arrangements • Food availability • Identify past coping mechanisms • Identify person(s) available in the support system

20. Competency & Efficacy • Set achievable short term goals • Encourage & give positive feedback • Family & support persons are critical in providing positive feedback

21. In Home Support Family can be instrumental providing basic critical components in reestablishing the person’s equilibrium. • If the person is not hospitalized they should not be left alone • Establish support system: Family, friends, church members, roommates • Psychiatric home care may be provided

22. Facilitating Hope • Provide a supportive climate • Facilitate a hopeful perception • Help the person to restructure the situation • Assist the person in making plans • Assist the person in taking action, and establishing goals for living

23. Concept of Newness Discovery • Creativity Resources Insight Plans Outcomes Facilitating Hope

24. Crisis Intervention Deep breathing Self talk Time out Visualization Leaving the situation Talking to someone Music Prevention Diet & nutrition Exercise & physical activity Self-help groups Having fun Playing Massage Progressive relaxation Assertiveness training Stress Management

25. Care for Support Person • Stay calm • Get support for yourself • Utilize formal mental health professionals or spiritual guides • Utilize the Alliance for the Mentally Ill • 800- 950-6264 • Once the person is stable and restored, debrief the incident with them

26. You should have an emergency plan for handling a suicide gesture or ideation.

27. Theoretical Frameworks • Crisis Intervention • Orem’s Self-care • Knowles, Adult Learning • Yalom, Group Theory • Carl Rodgers, student-centered

28. Knowles Assumptions: Adult Learners • Desire and enact toward self-directedness as they mature • Experiences are rich resource for learning • Awareness of specific learning needs generated by real life • Competency based and wish to apply knowledge to immediate circumstances

29. Teaching Families & Consumers: Suicide prevention • Assessing the learners including culture • Identifying specific content • Developing teaching objectives • Developing learner outcomes • Instructional planning • Implementation • Evaluation

30. Belief Systems: Health & Illness World View Illness/ disease Health Ethnic group Hispanic Americans Black Americans Native Americans Asian Americans White Americans

31. Teaching Designs • Learner-Development • Topic Centered • Distance Education Telecommunication

32. Discussion Lecture Role Play Questioning Skits Simulations Audiovisual CAI Web Resources APNA & links http:www.apna.org Suicide Helpline http:www.grohol.com/helpme.htm KEN http:www.mentalhealth.org NDMDA http://www.ndmda.org Instructional Techniques

33. Selected Bibliography Aguilera, D. C. (1994 ). Crisis intervention: Theory and methodology (7th ed.).St. Louis: Mosby-Year Book. Babcock, D., & Miller, M. (1994). Client education: Theory and practice. St. Louis: MO.. Campinha-Bacote, J. (1994). Cultural competence in psychiatric mental health nursing: A conceptual model. Nursing Clinics of North America, 29(1), 1 - 9. Cowan, C. F., & Bowie-Guillory, J. A. (1995). Teaching patients with low literacy skills In B. Fuszard, Innovative teaching strategies in nursing 2nd ed.) (pp. 231 - 241). Gaithersbrg, MD: Aspen.

34. Selected Bibliography Depression Guideline Panel (1993). Depression in primary care: Volume 1, Diagnosis and detection. Clinical practice guideline, Number 5. Rockville, MD. U. S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research. AHCPR Publication No. 93-0550. Depression Guideline Panel (1993). Depression in primary care: Volume 2, Treatment of Major Depression. Clinical practice guideline, Number 5. Rockville, MD. U. S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research. AHCPR Publication No. 93-0551.

35. Selected Bibliography Falvo, D. (1994). Effective patient education (2nd ed.). Gaithersburg, MD: Aspen. Hoff, L. (1995). People in crisis: Understanding and helping (4th ed.). San Francisco: Jossey-Bass Publishing. Jack, R. (1992). Women and attempted suicide. Hillsdale, NJ: Lawrence Erlbaum Associates, Publishers.Knowles, M. S. (1980). The modern practice of adult education: From pedagogy to andragogy (2nd ed.). New York: Cambridge University Press. Moller, M., & Murphy, M. (1997). The three R’s rehabilitation Program: A prevention approach for the management of relapse symptoms associated with psychiatric diagnoses. Psychiatric Rehabilitation Journal, 20(3), 42 – 48.

36. Selected Bibliography Palmer-Erbs, V., & Anthony, W. (1995). Incorporating psychiatric rehabilitation principles into mental health nursing. Journal of Psychosocial Nursing, 33(3), 36 – 44. Palmer-Erbs, V., & Manos, E. (1997). New thoughts on promoting collaborative partnerships with consumers, survivors, and family members. Journal of Psychosocial Nursing, 35(1), 3-5. Silverman, M., & Maris, R. (Eds.). (1995). Suicide prevention toward the year 2000. New York: Guilford Press.