Awareness of potential problems and a strategy aimed at helping patients cope will assist in reducing the risk of self-harm, as Michelle Foster Earle, president of OmniSure Consulting Group, describes.
The US Centers for Disease Control and Prevention recently reported that the rates for the top 10 leading causes of death have decreased or held steady—except for the 10th leading cause of death in the US: suicide. Since 2011, the national suicide rate rose 2 percent to 12.6 suicide deaths per 100,000 deaths. This statistic concerns both healthcare providers and risk management experts.
OmniSure is a risk management consulting group that works with healthcare organizations to improve patient safety to prevent adverse outcomes. Over the years, OmniSure consultants have worked with providers to find ways to minimize the risk of suicide among patients. Doctors are generally busy focusing on physical problems, but they also should be willing to talk to their patients to explore whether they are depressed or, in some cases, even suicidal. When a provider is aware of warning signs and sees them in a patient, it’s important to know what to do and how to collaborate with behavioral health providers who, in turn, can play an important role in the patient’s overall treatment plan to ensure a safe and clinically sound outcome.
What should healthcare providers know about suicide risk? Research shows that white men between the ages of 45 and 64 are in the highest risk category. The next highest risk group is white elderly men aged 85 and older. Add alcohol use to those risk groups, and they are at a 50 to 70 percent higher risk for suicide than the general population.
Gregory M. White, MS, LMHC, CCHP, is a mental health consultant based in Seattle with more than 23 years of experience. White has talked with countless patients who have revealed their various triggers for becoming suicidal. “When people are faced with extraordinary circumstances—especially those that bring shame, guilt or humiliation—that can be the catalyst for going beyond simply contemplating suicide to completing it. Legal problems with potential jail time, financial problems, and relationships are significant contributing factors for people who may already be struggling to cope in other areas of their lives,” White explains. In many cases, there has been a gradual erosion process that culminates in what is commonly known as “the straw that broke the camel’s back”: relationships gone bad, loss of jobs and income, custody battles, home foreclosures, and the like. For example, a 41-year-old white woman was assessed by White after she had voiced the idea of suicide with a loaded gun. She reported that a longtime friendship had just ended and she couldn’t handle one more loss in her life. Even though she said she wished she had used the gun on herself, the more she talked with him, the more settled she became and was eventually able to identify one source of hope: her pets, who were waiting for her at home. She was able to contract for her safety (the gun having been removed) and agreed to follow up with a suggested mental health treatment plan.
White’s recommendation for doctors is to be aware of warning signs and refer patients to a specialist if necessary. If your patients report to you that they are facing a situation that seems insurmountable, talk with them, listen for indicators of hopelessness, and ask whether they have had any suicidal thoughts. Have a colleague in your corner who specializes in suicide risk and who can work with you to provide the care that is needed in these situations.
Another important risk factor is pain. In many cases, pain has a correlation to suicide risk in patients, and often patients’ poor health or chronic pain issues are the underlying cause for their suicidal thoughts. Large-scale studies show that at least 10 percent of suicides—and possibly as many as 70 percent—are linked to chronic illness or unrelenting pain, and up to 45 percent of individuals who committed suicide had visited their primary care provider within a month of their deaths. “I have routinely collaborated with medical providers regarding patient care, and I have found that health issues, often complicated by drug and alcohol use or the patient’s misuse of pain medication, were consistently part of the overall treatment plan and required frequent review and follow-up by both healthcare and mental health providers,” White says. If you suspect that your patients’ illness or pain is causing them to feel depressed and possibly suicidal, talk with them about their mood and ask whether they have had any suicidal thoughts. Consult with other professionals if you have any doubt about your patients’ psychiatric stability—leave no stone unturned when it comes to creating a treatment plan for your patients whose risk factors are high when it comes to race, gender, and age. The Anchor method White has devised an approach to reducing risk called ANCHOR Management of Suicide Risk, which includes six key components for managing suicidal patients.
Know your stuff when it comes to suicide risk. Learn how to identify static and dynamic risk factors. Learn about the significance of disorders and conditions that have strong correlations to suicide such as depression, chronic development complex trauma, bipolar II, and postpartum onset. Know what the common warning signs of suicide are and be mindful of your patient’s erosion process and precipitating events.
Know your patients, not just their disorders or conditions. Each patient is unique, and you will need to know how to navigate his or her idiosyncrasies. This includes cultural nuances, religious/belief systems and perceptions about whether he or she wants to live or die. Exploring the patient’s attitude and perceptions about living versus dying will help you in determining whether your patient’s risk is imminent, ambivalent or resilient.
Know yourself and how your life experience, coupled with your professional experience, can be a calming influence during a patient’s crisis. Rarely do doctors have all the answers, but you do have significant experience in helping others work through their issues, whether they be medical, psychological, or situational. Bring your confidence and calm demeanor into the conversation, and let patients know that you will do all you can to assist them in getting the help they need.
Know your options and have several tools in your toolkit that you can use. Depending on the patient, you will have to decide what type of approach is most helpful. For example, if your style is more direct and straightforward and your patient is more of an introvert, you might be successful in delivering information but not as adept at getting any in return. Cognitive behavioral therapy and dialectical behavior therapy models have excellent tools and techniques that have been proven to work in lowering suicide risk in some patients.
Know your attitude and how it affects others. Statements of hopelessness such as, “There is no solution to my problem,” have been found to be more predictive of suicide risk than a diagnosis of depression. So how do you communicate that you truly hope for the best for each and every patient? We have all experienced people who knew a lot of information but were uninspiring because they lacked conviction or any connection to our own stories. As the saying goes, “People don’t care how much you know until they know how much you care.”
Know your network and continue to update your resources so that you can make appropriate referrals for your patients that will help them establish positive support systems. This is an area that requires collaboration with the patient, the community, and other professionals.
In addition, encourage your patients to participate in their favorite hobbies or activities and stay connected with relationships that provide meaning for them. Encourage their involvement with things that are important to them, such as religion, special interest groups, or community volunteering.
If medication or talk therapy is indicated as part of the treatment plan, work with your patients to ensure that they receive quality care in those areas. Have them sign a release of information that will allow you to stay in the loop if you are not the one providing those treatments.
OmniSure is offering more information on managing the risk of patient suicide through a series of short, informational videos. The videos are available for viewing at http://www.omnisure.com/suicide-risk-reduction-tips/.
Michelle Foster Earle, ARM, is the president of OmniSure Consulting Group, a clinical risk management firm that is contracted by healthcare providers, insurance brokers, and medical professional liability programs to provide patient safety, employee safety, and loss prevention services through a nationwide network of consultants. She has authored numerous articles on various risk management topics and is a frequent speaker for medical and professional liability trade conferences.
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