Student Psychological problems and dealing with Suicide

1. Student Psychological problems and dealing with Suicide November 2013 Dr V Wessels

2. PSYCHOLOGICAL PROBLEMS: WHY STUDENTS? • Pre-existing psychiatric diagnosis • Environmental stressors • Finance • Social adapting • “Workload” • Substance abuse • Relationship issues • Lack of support • Immaturity – still finding themselves

3. QUICK DEPRESSION CHECK: PHQ 9

4. PHQ 9 • Good tool for people not in the medical profession • Score greater than 5: consider depression • More than 4 ticks in 2 and 3 column (1 of which must be first or second question)

5. SUICIDE - STATS • In South Africa there are 23 suicides a day, and 230 attempts • 20% of students have had suicide thoughts • 8% deaths in SA • Highest cause of death in students second to accidents • Poisoning / Overdose most frequent in unsuccessful attempts • Hanging most common ins successful suicide, then shooting, gassing, burning, and jumping • 90% of people that commit suicide have a psychiatric problem, 60% depressed

6. BE AWARE: WARNING SIGNS • Talks about committing suicide/ death • Has trouble eating or sleeping • Big changes in behaviour • Withdraws from friends or social activity • Loses interest in work/ hobbies/ personal appearance • Prepares for death by making a will or final arrangements • Gives away prized possessions • Has attempted suicide before • Takes risks • Has had severe loss recently

7. SUICIDE Everyone reacts to a traumatic event in their own way, and reactions can change from day to day, or even from moment to moment Suicide is an unpredictable event

8. PHASES IN MANAGEMENT • PREVENTION • RESPONSE • POST INCIDENT • Patient care • Debriefing • Trauma Counselling

9. PREVENTION • Awareness • Access to support • Formal (psychologists, Help Lines, Support groups) • Informal (extra-curricular activities / Sport, peer groups) • Identify and modify stressors where possible • Teach life skills

10. RESPONSE : UNSUCCESSFUL ATTEMPT • Safety First (Fire arms, blades, heights, poisons) • Remain calm and be assertive but not challenging • Do not ridicule • Do not lie (if at all possible) • Seek medical treatment – if necessary involuntary within the scope of the Mental Health Care Act

11. EMERGENCY MANAGEMENT OF MENTAL ILLNESS TABLE 1 MAJOR SIGNS AND SYMPTOMS OF MENTAL ILLNESS • Abnormal mood (inappropriately sad or happy) • Confusion / disorientated • Hallucinations • Delusions • Incoherent speech and strange behaviour not due to another identifiable medical reason • Anxiety / agitation not due to another identifiable medical reason

12. EMERGENCY MANAGEMENT OF MENTAL ILLNESS TABLE 2 APPROPRIATE MENTAL HEALTH CARE FACILITIES • All Provincial Hospital Emergency Units • All Community Healthcare Centres • Any clinic that has a trained Mental Health Care Practitioner

13. MENTAL HEALTH CARE ACT 17 OF 2002 32. A mental health care user must be provided with care, treatment and rehabilitation services without his or her consent at a health establishment on an outpatient or inpatient basis if- (a) an application in writing is made to the head of the health establishment concerned to obtain the necessary care, treatment and rehabilitation services and the application is granted; (b) at the time of making the application, there is reasonable belief that the mental health care user has a mental illness of such anature that- (i) the user is likely to inflict serious harm to himself or herself or others; or (ii) care, treatment and rehabilitation of the user is necessary for the protection of the financial interests or reputation of the user; and (c) at the time of the application the mental health care user is incapableof making an informed decision on the need for the care, treatment and rehabilitation services and is unwilling to receive the care, treatment and rehabilitation required.

14. MENTAL HEALTHCARE ACT 17 OF 2002 33. Application to obtain involuntary care, treatment and rehabilitation 34. 72-Hour assessment and subsequent provision of further involuntary care, treatment and rehabilitation

15. Pt displays signs or symptoms of mental illness (see table 1) NO No management as an emergency mentalhealth patient required YES Pt resists or refuse treatment NO Transport patient to appropriate Mental Healthcare facility (see table 2) YES Pt an immediate danger to himself, others or property NO Consult with SMO. Advise family to seek elective mental health care from the nearest appropriate Health Care Facility YES SAPS on scene? NO Request SAPS assistance. If pt armed do notapproach untilSAPS onscene YES EMERGENCY MANAGEMENT OF MENTAL ILLNESS

16. ENSURE THE SAFETY OF ALL STAFF INVOLVED AS WELL AS THE PATIENT AS FAR AS POSSIBLE Ensure patient is not armed. If armed, allow the SAPS to disarm the patient prior to any physical intervention by health care staff. Exclude reversible causes of aggression especially Hypoxia and pain Aggression / Violenceresolved? YES NO Attempt to calm patient through friendly but assertive conversation. Do not insult or lie.to patient. Aggression / Violenceresolved? YES NO MANAGING THE VIOLENT PATIENT

17. NO PHYSICAL RESTRAINT Staff members to remove spectacles and loose clothing items like ties. Ensure escape route (eg door) is behind staff and not the patient. Assign one person to each limb and one to the head. Restrain patient on his side preferably using strong leather restraints (do not use thin straps or material that can cut or chafe) Tie arms on the same side, but apart to avoid loosening. Tie legs to opposite sides. Do not partially restrain patient. Ensure access to an injection site Monitor patient – DO NOT leave unattended Is ALS / Dr available withsedatives? NO YES TRANSPORT TO APPROPRIATE HEALTHCARE FACILITY Monitor patient regularly • SEDATION • Administer • 1. Haloperidol 5mg PO / IMI / IVI and / or • .. Lorazepam0.5 - 4mg IMI / IVI or • . Diazepam 10mgPO/ IVI or rectal MANAGING THE VIOLENT PATIENT

18. RESPONSE : SUCCESSFUL ATTEMPT • Safety First (Fire arms, blades, heights, poisons) • Seek medical on scene asssessment - urgent (may be salveagable) • Preserve evidence • Activate law enforcement • Notification • Authorities • Campus Management • Family • Trauma Support • Responders • Friends and family • Anybody else who needs

19. TRAUMA : COMMON REACTIONS EXPERIENCED • Emotional Responses • Cognitive (Thoughts) Responses • Behavioral Responses • Physical Responses

20. EMOTIONAL RESPONSES • Panic and fear • Shock • Highly anxious, active response or a seemingly stunned, emotionally-numb response • Feeling as though he/she is “in a fog” • Denial or inability to acknowledge the impact of the situation or that the situation has occurred • Dissociation, in which he/she may seem dazed and apathetic • May express feelings of unreality • Intense feelings of aloneness • Hopelessness • Helplessness • Emptiness • Uncertainty • Horror or terror • Anger • Hostility • Irritability • Depression • Grief • Feelings of guilt

21. COGNITIVE (THOUGHTS) RESPONSES • Impaired concentration • Confusion • Disorientation • Difficulty in making a decision • A short attention span • Vulnerability • Forgetfulness • Self-blame • Blaming others • Thoughts of losing control • Hyper vigilance/very alert • Recurring thoughts of the traumatic event

22. BEHAVIORAL RESPONSES • Withdrawal • “spacing-out” • Non-communication • Changes in speech patterns • Regressive behaviours • Erratic movements • Impulsivity • A reluctance to abandon property • Seemingly aimless walking • Pacing • An inability to sit still • An exaggerated startle response • Antisocial behaviours

23. PHYSICAL RESPONSES • Rapid heartbeat • Elevated blood pressure • Difficulty with breathing • Shock symptoms • Chest pains • Cardiac palpitations • Muscle tension and pains • Fatigue • Fainting • Flushed face • Pale appearance Chills Cold clammy skin Increased sweating Thirst Dizziness Vertigo Hyperventilation Headaches Grinding of teeth Twitches Gastrointestinal upset

24. FOUR MAIN GOALS IN CRISES COUNSELING • To help the person cope effectively with the crisis situation and return to his or her usual normal level of functioning. • To decrease the anxiety, apprehension and other insecurities that may be present during the crisis and after it passes. • To teach crisis-management techniques so the person is better prepared to anticipate and deal with future crises. • To help the client learn valuable life lessons through dealing with the trauma aftermath.

25. TRAUMA DEBRIEFING PHASES • Introductory phase • Fact Phase • Feeling Phase • Symptom Phase • Teaching Phase • Re-Entry Phase • Closure • Follow-up

26. CLOSURE • Every person needs closure about events in their lives. • Closure with trauma takes time and should be taken week for week. • The coping skills will help with getting closure faster.

27. QUESTIONS