Thursday, May 29, 2014

REFERRING A SUICIDAL PERSON


The usual sources of support available are:

  1. family
  2. friends
  3. colleagues
  4. crisis centers
  5. health care professionals.

How to approach the resources?

  • Try to get the permission of the suicidal person to enlist the support of the resources, and
       then contact them.
  • Even if permission is not given, try to locate someone who would be particularly Sympathetic to the suicidal person.
  • Talk to the suicidal person beforehand and explain that it is sometimes easier to talk to a stranger than a loved one, so that he or she does not feel neglected or hurt.
  • Talk to the resource people without accusing them or making them feel guilty.
  • Enlist their support in the actions to be taken.
  • Be aware of their needs also.
When to refer when the person has:
  • psychiatric illness;
  • a history of previous suicide attempt;
  • a family history of suicide, alcoholism or mental illness;
  • physical ill health;
  • no social support.

How to refer
 The  counsellor  must take the time to explain to the person the reason for the
       Referral.
  • Arrange for the appointment.
  • Convey to the person that referral does not mean that the health worker is washing his
  • or her hands of the problem.
  • See the person after the consultation.
  • Maintain periodic contact



THINGS TO DO AND NOT TO DO-while handling suicidal clients



Things to do

  1. Listen, show empathy, and be calm;
  2. Be supportive and caring;
  3. Take the situation seriously and assess the degree of risk;
  4. Ask about previous attempts;
  5. Explore possibilities other than suicide;
  6. Ask about suicide plan;
  7. Buy time - make a contract;
  8. Identify other supports
  9. Remove the means, if possible;
  10. Take action, tell others, get help;
  11. If the risk is high, stay on line with the person.
  12. Discourage the Behavior.
  13. Keep communication channels open
  14. Talk about the negative and long-term effects.
  15. Teach (quick) relaxation/breathing
  16. Teach anger management
  17. Teach to evaluate consequences.
  18. Talk about the need for sharing this information with near/dear ones
  19. Make the client understand that monitoring by parents or counselors is essential for early recovery.

Things not to do

1.      Ignore the situation;
2.      Be shocked or embarrassed and panic;
3.      Say that everything will be all right;
4.      Challenge the person to go ahead;
5.      Make the problem appear trivial;
6.      Give false assurances;
7.      Swear to secrecy;
8.      Leave the person alone
9.      Do not prescribe medication.
10.  Do not punish or reprimand harshly.
11.  Do not moralize or made person feel guilty. 
12.  Help him to think of it as a problem needing help.
13.  Assertively say ‘No’ to client’s demands for taking drugs like cough syrup, pills etc. to relieve anxiety or improve concentration.
14.   Even short-term, temporary relief with the help of these drugs should be highly discouraged





Few Tips to Handle Suicide ---in helpline ---


The client who is calling is seriously considering us as the last resort and hence it is important to be careful and helpful. A lot many suicides are impulsive while others are well planned. Impulsive clients are likely to decide on the spur of the moment. Hence it is important to buy time.

Common feelings in suicide

  • A crisis that causes intense suffering and feeling of hopelessness and helplessness.
  • Conflict between survival and unbearable stress.
  • Narrowing of patient’s perceived options.
  • A wish to escape (it is an escape rather than a going-towards).
  • To punish self and/or to punish others with guilt.
 Indicators for increased chance for suicide

  • Withdrawal Behavior for few days
  • Mention of suicide repeatedly.
  • Suicide note
  • Changes in eating and sleeping patterns
  • A history of serious psychological problems.
  • A history of impulsive, poorly controlled and destructive Behavior.
  • A history of continuing academic problems and learning difficulties.
  • Adjustment difficulties with family, school, peer.   

HOW TO ASSESS THE RISK OF SUICIDE 
When the counselor suspects that suicidal behavior is a possibility, the following factors need to be assessed:
  • Current mental state and thoughts about death and suicide;
  • Current suicide plan - how prepared the person is, and how soon the act is to be done;
  • The person’s support system (family, friends, etc.).
  • The best way to find out whether individuals have suicidal thoughts is to ask them.
  • Contrary to popular belief, talking about suicide does not plant the idea in people’s heads.
  • In fact, they are very grateful and relieved to be able to talk openly about the issues and questions they are struggling with
Helping suicidal Client

  • Establish rapport
  • Allow the client to narrate his/her own story
  • Use age appropriate language
  • Tactful questions. Avoid leading questions e.g. “you don’t want to kill yourself”
  • Obtain detailed description of any suicidal plan ask about availability and lethality
  • Smooth movement from one topic to another

Interventions

  1. Communicate that people do get through this – there are other people who feel as badly as he/she feels now.
  2. Advise the client to give himself/herself some time e.g., “I will wait 24 hours before I do anything”.  Or a week.  Suggest that feelings and actions are two different things – just because you feel like harming / killing yourself, doesn’t mean that you have to actually do it right this minute.
  3. Periodically, keeping in touch over the phone will reduce the intent of ending their lives. Counseling needs to be practical and useful.
  4. Long lectures with a moralistic tone are not advised. These make the already depressed student guiltier and his intent stronger.
  5. The client should be advised to contact a professional counselor as soon as possible. If not efforts should be made to encourage him to meet his teachers or school counselors or talk to his parents. The more he talks about his problems to various people; he is likely to feel much better.
  6. A client who is severely depressed and expresses absolute helplessness about future is more at risk than a client who talks about casual things. 
  7. No medicines should be prescribed over the phone

Suicide fiction and fact



Suicide - Fiction and Fact
FICTION
FACT
1
People who talk about suicide do not commit suicide
1
Most people who kill themselves have given definite warnings of their intentions  
2
Suicidal people are absolutely intent on dying
2
A majority are ambivalent
3
Suicide happens without warning
3
Suicidal people often give enough indication
4
After a crisis, improvement means that the suicide risk is over
4
Many suicides occur in a period of improvement when the person has the energy and the will to turn despairing thoughts into destructive action
5
Not all suicides can be prevented
5
Majority are preventable
6
Once a person is suicidal, he/she is always suicidal
6
Suicidal thoughts may return but they are not permanent and in some, it may never return