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
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.
Objectives





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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.
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
Persons with schizophrenia
 10%
-13% commit suicide
 Leading
 18%
cause of premature death
- 55% will make a suicide attempt
Depressive Disorders
 Up
to 15% requiring hospitalization
eventually die by suicide
 10%
- 15% of untreated persons with
bipolar I commit suicide
Risk Factors
 History
of suicide attempts
 Hopelessness
 Physical illnesses
 Family history of substance abuse
 Caucasian race
 Male gender
Risk Factors Continued
 Advanced
age
 Presence of psychotic symptoms
 Living alone
 Unemployment
 Depression
 Substance abuse
 Relapse
Having a positive supportive
and helpful relationship with a
mental health provider may
reduce the risk of suicide.
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
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
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
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
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
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
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
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
Someone needs to stay with
the person at all times
The person is
experiencing strong
feelings of
abandonment,
loneliness, guilt and
hopelessness
Adaptive Problem Solving

Assist with basics
 Living
arrangements
 Food availability
 Identify
past coping
mechanisms
 Identify person(s)
available in the
support system
Competency & Efficacy
Set achievable short
term goals
 Encourage & give
positive feedback
 Family & support
persons are critical in
providing positive
feedback

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
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
Concept of Newness
Discovery
Resources
Insight
Creativity
Plans
Facilitating Hope
Outcomes
Stress Management

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
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-
 Once
950-6264
the person is stable and restored,
debrief the incident with them
You should have an emergency
plan for handling a suicide
gesture or ideation.
Theoretical Frameworks
 Crisis
Intervention
 Orem’s Self-care
 Knowles, Adult Learning
 Yalom, Group Theory
 Carl Rodgers, student-centered
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
Teaching Families & Consumers:
Suicide prevention
 Assessing
the learners including culture
 Identifying specific content
 Developing teaching objectives
 Developing learner outcomes
 Instructional planning
 Implementation
 Evaluation
Belief Systems: Health & Illness
MagicoReligious
Fate of world
World under
View
supernatural
forces
Cause of illness,
Illness/
disease mystical
Gift or reward
Health
Ethnic
group
Hispanic Americans
Black Americans
Scientific/
Biomedical
Holistic
Control by
physical &
biochemical
Harmony,
natural balance
Cause/effect
relationship,
pathogens
Illness
prevention,
meds, treatments
Disease
imbalance, laws
disturbed
Environment,
sociocultural
factors
White Americans
Native Americans
Asian Americans
Teaching Designs
 Learner-Development
 Topic
Centered
 Distance
Education Telecommunication
Instructional Techniques
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
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.
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.
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.
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.