Caring for someone who is suicidal
Transcript
MATUA RAWIRI WHAREMATE - CULTURAL ADVISOR, MENTAL HEALTH FOUNDATION OF NEW ZEALAND
I think the major thing is to ensure that there is a dialogue where we get to understand what they’re thinking, what they’re doing. I know that I’ve had that personal experience with my son.
To be able to talk through with that individual as to – this is a good thought, this is not a good thought – and to be able to have that conversation is important, and being able to say you are an important member of our family. And when the wairua tells you, or when the voice tells you to do this, that will deem you unsafe; then I need to warn you and tell you, because after all we do love each other and care for each other as well.
JUDY BAILEY
A suicide attempt is a frightening experience for a partner, a friend, or a family member. A person who’s attempted suicide is at increased risk of dying by suicide in the future, so some form of treatment is essential. This may include therapy, medication, or a stay in hospital for a while.
People who’ve attempted suicide will undergo a risk assessment by a clinical professional which involves a lot of questions about a person’s thinking.
DR SUNNY COLLINGS - CLINICAL PSYCHOLOGIST, UNIVERSITY OF OTAGO
How long they’ve been thinking about it, what sort of thoughts they were having, how often they’d been thinking about it; was there a plan? If there is a plan, what is the plan? What are all the details around the plan; you really want to know that; you want to know what was the method, what was the likelihood that the person had easy access to the means to do it using that method, and what was the likelihood that somebody would interrupt or discover them.
You’d want to know if they’d had... made an attempt previously; you’d want to know if they know of other people who have tried to take their lives. Do they have a current mental illness that needs quite active management, and that would be a very common scenario, and most commonly it’s a depressive illness.
JUDY BAILEY
Positive questions are also asked.
DR SUNNY COLLINGS
What’s stopping you from doing it? Are there some things that have meant that you haven’t done it up till now?
The good thing about getting that information is that helps you identify some things that you might be able to get the person to work with as leverage for keeping them safe.
JUDY BAILEY
If a person is not hospitalised after a suicide attempt, they may be sent home.
DR SUNNY COLLINGS
If you thought it was high-risk, then sending somebody home to be by themselves isn’t very smart. They should probably have company, and that might mean somebody coming to stay with them, or it might mean them going to stay with somebody else.
And you know it’s ok to say to a person ‘I’m sorry that you don’t like me asking this question, but I’m worried about you and I’m going to ask you this question – have you been thinking about harming yourself’. It’s got to be ok for a carer to really say that at any time.
JUDY BAILEY
Making the home environment a safe place is a high priority.
DR SUNNY COLLINGS
Really be thoughtful and use your commonsense. If there are things around that you think could endanger the person if they used them, then its best to think about how you can get rid of them.
If there are, you know, cords and extension cords and ropes and things lying around, it would be good to get rid of those. People who present to ED with self-harm are quite commonly intoxicated, and particularly with alcohol. You’d want the support person to encourage the person at risk not to go drinking.
If you have a firearm in the house you need to make sure that the firearm is locked away, that the bolt is away from the firearm, and that the ammunition is locked somewhere else and the person doesn’t know where the key is. You know, there are people who regret not doing that.
Obviously the medication; you need to know where the medication is, and if you’ve got old tablets lying around in the bathroom cupboard you need to get rid of those.
JUDY BAILEY
For a person that may be on medication following a suicide attempt, this can present a practical problem.
DR SUNNY COLLINGS
Sometimes you can get prescriptions given in just measured amounts, you know, like a week at a time, so that they haven’t got, you know, three months worth of medication lying around. There are different ways you can do it, and you just... you need to work in with the people and work out the best way for them.
JUDY BAILEY
Monitoring the person’s mood changes and responses is particularly important at the early stages of treatment.
DR SUNNY COLLINGS
One of the issues with medication is it can take, you know, two weeks to really start to have any clinical effect; it’s important to keep seeing the person in that two weeks, so at least keep contact with them if... for the clinician; and that’s something useful, I think, for family and support people to know – that it’s not sufficient just to prescribe a medication for somebody who’s been suicidal and then get them back in two weeks.
JUDY BAILEY
A sudden improvement in the person’s mood during this time should be seen as a potential warning sign.
DR SUNNY COLLINGS
When a person’s resolved to kill themselves they sometimes feel lighter. If, you know, if it was a pretty sudden turnaround in a person who had been quite actively suicidal, and nothing, you know, it was perhaps early in treatment, you wouldn’t want to assume that it was a treatment response.
JUDY BAILEY
Sometimes you may need support to start having these conversations. You can call help lines such as the Samaritans, or Lifeline, or an organisation like Supporting Families. You can also asked your loved-one’s clinician for advice.
DR SUNNY COLLINGS
I would encourage people to, you know, negotiate with the person that they’re supporting to be allowed to come along to an appointment and maybe, you know, come in for the last five minutes and, you know, ask some questions and get some information.
JUDY BAILEY
If a person’s deemed to be at high risk they may have to spend time in a Mental Health Unit. Much like Intensive Care Units, the experience of visiting a loved-one here is quite different to an ordinary hospital ward.
DR SUNNY COLLINGS
Mental Health Units are usually quite busy places, and the people in them aren’t very well. It’s important that families, in particular, have some expectation of that.
JUDY BAILEY
When it comes time to be discharged, carers should be part of the planning process with their loved-one and their clinician to help build a bridge to recovery. Whether its contributing around the home, or negotiating a return to work; being active is important.
DR SUNNY COLLINGS
It’s also important for carers not to hover. Sometimes it can be useful for the carer to maybe have a discussion with a mental health professional about, you know, ways of being helpful, ways of being supportive that don’t involve the patient experiencing hovering.
That can make people feel really anxious, and just as if they’ve got no sort of space, and especially if they’ve been in an in-patient unit, one of the things they’re probably looking forward to is having a bit of space.
JUDY BAILEY
If you’d like more information about caring for someone who’s suicidal, visit www.spinz.org.nz. If you want advice or support, you can contact a branch of Supporting Families in your area.
