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katysara


Moderator

Posted Sat Oct 10th, 2009 11:11am Post subject: What to do in a suicide crisis

COPYRIGHT KATY SARA CULLING 2010
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In response to a question asked of me I realised we have no formal information about what to do if someone is in a suicide crisis - even applied to yourself if necessary though that is harder. By crisis I mean imminent risk, not someone saying they are thinking about it at some later date. Here is what to do in a suicide crisis followed by some risk factors (just some, the most common, there are more) that show someone may be in one.

~KSx

In a SUICIDE CRISIS, WHAT YOU SHOULD DO NOW (be this a friend or you acting on your own behalf):

1. Do not leave the suicidal person alone, or be alone if you are suicidal.

2. Trust your instincts, follow these procedures listed below, as it is better to get help and be safe than to leave it and regret it for years.

3. Talk to them about your concerns and listen. Do not be afraid to ask questions. This will not “put ideas into their head,” or make the person become suicidal if they are not already.

4. Do not be judgemental. For example, do not say, “How could you want to kill yourself and upset me so much?” The suicidal person will probably feel guilty about this already, and will certainly feel too bad to cope with judgemental comments. They will be highly emotive, but not rational, and may overreact. You will be emotional; that is natural; but you have to be the strong one, and think before you speak.

5. Do not promise confidence about what they tell you because if you need to seek outside help, breaking this promise will spoil your relationship, and might mean that on a future suicide crisis, the person is not honest with you.

6. Determine if the person has a specific plan to carry out the Suicide. The more detailed the plan, the greater the risk. For example, do they plan to use a gun; have they already purchased a gun; is it loaded and ready; is it near by? Does the person plan to overdose; have they bought alcohol to help them; have they decided what to use; have they purchased or saved up pills they want to use? Are the pills all ready popped out of the container ready to swallow?

7. If you can do it without leaving the person alone, remove any means of attempting suicide that you can think of such as guns, knives, drugs or medications. Certainly remove any dangerous items the person has with them.

8. It is better that the suicidal person does not drive, especially not alone.

9. Do not try to counsel the person yourself: if you recognise these signs, you must get professional help.

10. Take them to their general practitioner for an emergency appointment, or a psychiatric hospital to be assessed, or even an emergency department of a hospital if you are suitably alarmed. It is better to assume the worst and act accordingly, than have a dead friend or relative.

11. Be proactive. The person you care about might be deliberately unhelpful to the professionals trying to help. Explain your concerns to the doctors, and offer evidence, especially of a suicide plan if you have it.

12. If the suicidal person resists all help, get it anyway. If you cannot make them go with you to get themselves help, speak to the professionals yourself, and if necessary the person can be assessed at home or brought by force to be assessed. Then they might be sectioned (hospitalised involuntarily) for their own safety.

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Risk Factors for a Suicide Crisis.

Eighty percent of people who plan to commit Suicide give signs of their intended action. These signs (not all have to be present; indeed one is quite enough) you can recognise in yourself or a loved one, indicative of a Suicide crisis necessitating professional help for yourself or a loved one, are:

Precipitating Event.

Almost any recent life event that is upsetting to you/the person involved. (If you are protecting someone else, keep in mind that something you don’t consider important or ‘bad’ might feel catastrophic to them). Common examples include bereavement, possibly even a friend’s Suicide, events such as the break up of a marriage or relationship, being diagnosed with a terminal illness, or loss of a career, bullying, doing badly at school or university exams, being raped or attacked, or not getting into the university of choice. Or it might be suddenly realising that you/they are ruthlessly trapped in an illness, such as Anorexia that has been ongoing without your full awareness, or suddenly deciding that you/they will never recover from something like Depression.

Intense moods in addition to Depression.

Usually people who commit Suicide do it with desperation. This might include desperation to resolve a situation such as ongoing illness where death represents closure. Also common are one or more of the following: torment, guilt (e.g. for hurting people left behind), anxiety, anger, a sense of abandonment and above all, hopelessness that anything positive can happen ever again.

Changes in emotional behaviour.

Intense moods may be present, but do they change? A colleague, friend, loved one, or you yourself, may begin acting in ways that seem unusual. Someone usually content suddenly being sad and withdrawn. The classic example to be wary of is a person who has been Depressed, maybe for a long while, suddenly cheering up and being happy. They won’t tell you that this is because they have made the decision to end their life and hence suffering, giving them some sense of peace. (You may also be able to notice these happening to you if you are suicidal).

Any spoken or written communication suggesting the person might soon commit Suicide.

Many people give clues about what they are thinking of doing, perhaps with the last remains of hope that someone might help, or in order to say goodbye to people, even asking for unconscious permission. They might say something like “I might not be around.” Some people say things quite obvious but sometimes it is more discreet, such as saying that other people would be relieved if they were to die, but not actually saying that they will die or are planning to die. Some people write a Suicide note, or similar and leave it where is might be found. These might even be on the computer.

Definitive Actions.

Writing a will, giving away special, treasured items, buying a gun, buying drugs, and/or buying lots of alcohol. Effectively putting one’s affairs in order, purchasing items with which to commit Suicide and/or things to help them manage to kill themselves such as alcohol or drugs.

Self-destructive behaviour and decline.

A decline in personal behaviour and in level of functioning. This can be at home, socially or at work. You/the person might get angry, upset, drink more, use recreational drugs, overuse prescription drugs and/or behave strangely. Note that such self-destructive behaviour might actually cause a precipitating event such as loss of a driving license for driving whilst drunk, or losing a job due to reduced capability, thus adding to the suicide crisis.

Recovering from Depression.

When people are very depressed they often do not have the energy to put together and carry out a realistic, lethal suicide plan. When you/they have begun to feel a little better, you/they feel slightly more energetic but still depressed. This extra energy can cause you/them to put their suicide plan in to action. I assume this is applicable to psychiatric disorders other than depression, but concurrent depression is highly likely in these.

Release from psychiatric hospital.

Many suicides take place shortly after a person has left the relative safety of a psychiatric ward. This is because the person may be pretending to feel better to get out and commit suicide. Or they may have more energy due to partial recovery (see reason above), or actually they cannot cope with their life when released, particularly if hospitalised for a long time. At this time family or friends are vital and should be aware of this risk and do anything appropriate to prevent it. Checking, or even watching whilst medication is being taken (particularly if it is dangerous in overdose) is a good example. That tip saved my life.
Inpatient Suicides account for up to 16% of deaths, which may seem like a large number of people, until you consider that many of the most at-risk people will be found in a psychiatric hospital population. Psychiatric wards are often busy, understaffed, and some people “slip through the net” in this way, when checks that should be made are not, or people manage to escape. Escape from many psychiatric wards is not difficult if one is determined.
Many suicides occur when patients are allowed leave from the ward, be that for an hour or much longer. The time people are most at risk, and when most suicides take place, is when they have just recently been discharged from psychiatric in-patient care; 24% of deaths are found in people who had been discharged in the previous three months. In most cases, as you might expect, medical staff believed the person to be at low risk. In some instances (like for myself), patients are released despite being high risk; this is because they are not benefiting from, or being kept safe by, hospitalisation.

Reckless behaviour, “Russian roulette type behaviour.”

Driving dangerously, wasting or giving away money, not caring about things that were once important to you/the person. Even up to playing Russian roulette or behaviour you could liken to playing Russian roulette such as reckless abandonment, cycling like a mad woman in and out of cars and buses in Oxford. This behaviour can include a lack of concern for the future, such as taking up smoking despite understanding the associated risks, because you/that person feels that they have no future to worry about.

Self-Harm.

Additional self-harm, (cutting, burning, overdoses, etc.) which might be of escalating frequency and/or severity with respect to how dangerous and life threatening it becomes.

Return of psychiatric symptoms after a period of recovery.

Veterans of psychiatric illness will recognise the return of an illness that they consider too awful and painful to experience again.

Physical illness, particularly if painful and or terminal.
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COPYRIGHT KATY SARA CULLING 2010

I am an administrator on this site.

"Having a great intellect is no path to being happy."
~ Stephen Fry

See my website: www.katysaraculling.com

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marzgirl


Member

Posted Sun Oct 18th, 2009 8:37pm Post subject: What to do in a suicide crisis

Thank you for this.

"Darkness cannot drive out darkness; only light can do that. Hate cannot drive out hate; only love can do that."
~Martin Luther King Jr.~

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Tug498


Member

Posted Wed Nov 18th, 2009 10:19pm Post subject: What to do in a suicide crisis

Hello everyone,

have read through many of these posts with great and sympathetic interest (though I appreciate you may not want any sympathy). I have a very close uncle with borderline personality disorder and a well developed case of Post Traumatic Stress Disorder which was triggered by 20 years in the police. He is first and foremost a wonderful and talented man without whom my life and that of many others would be insufferably dull but who has the odd little episode necessitating the rather exciting kicking down of doors!
As a Paramedic and mental health specialist I felt compelled to post -perhaps in a little unstructured a manner - in order to offer a little advice for patients, relaitves, friends and, most importantly, to offer an apology.
Katysara's advice above is excellent and is clearly the result of well researched evidence and - I would guess - personnal experience. I would add just one thing by way of advice and this is specifically for friends/relatives who may well be feeling bewildered, confused, frightened and helpless in the most unfamiliar of circumstances whilst faced with potentially critical life events.

- In the UK, the provision of immediate mental health care can be disjointed, inconsistent and you may feel abandoned especially when out of hours care offers no clear and obvious pathway to getting help. I write this, not to disillusion but to prepare you. DO NOT give up, persist, shout, demand and persuade.

- When you are concerned about someone or yourself you MUST decide if you think the person is in immediate risk from themselves based on your knowledge of them as a person. If you think they are at immediate risk then SEEK HELP immediately. By this I mean if you think they are going to attempt suicide or serious self harm phone the ambulance service or the police or, if you are lucky enough to have access to one and have the number, the local mental health crisis team. Whatever you do, decide quickly how serious you think the event is and GET HELP. Do not worry about wasting emergency services time or wondering if it is the right thing to do. We would rather be called and not needed than not called then needed. If someone is with a patient suffering a mental health crisis the job of helping them does become easier for the professionals involved and allows the patient a familiar person when confronted though they may be angry at you for getting help against their wishes. Secondly, if someone has confided in you that they are considering or have planned suicide this is a good thing, though appreciably concerning, and you should listen. Often, in my experience, simply listening to and offering impartial and honest discussion to people on a simple level does a huge amount though I entirely defer to my more learned colleaugues on this forum if I am incorrect.

This leads - almost - neatly to my apology. As a Paramedic a significant porportion of the emergecny calls I have attended have been mental health related. I always treat my patients with compassion, humility, understanding, honesty and, where necessary, frankness and a little humour (though I always worry my jokes may be enought to tip people over the edge). This is consistent behaviour on my part irrespective of the response from the patient which is not often rational and rarely represents their true personality when altered by whatever affliction they are suffering from. However, I have watched, with undisguised disgust and horror, many of my colleagues and other health care professionals treat individuals suffering from episodes of deepest emotional trauma with disdain and indifference beleiving them to be "putting it on" or wasting their time. This, I feel, is brought about by the pointless, ill-conceived, thoughtless, reactionary and plain stupid manner in which NHS staff are managed and governed leading to a general institutional depression which prompts, but does not excuse, a certain erosion in emotional underatanding. It is also excacerbated by a small army of inebriated, blubbering, self indulgent, immature idiots phoning us constantly because their boy/girl friend has left them and the parents wont buy them a pony/playstation. Leads to pre-conceived assumptions I'm afraid.
To cut a very long and tedious story short I wish to apologise if your quest to find help either as a patient or relative actually worsens the situation rather than makes it better. The vast majority of helath care professionals are extraordinary people and you WILL find the help you need and please, please persist if it doesnt go quite right the first time or you suffer a bad experience. The help is out there. Honest
Good luck and if anyone wnats some help and cant seem to find it anywhere else I am always happy to listen or expostulate rubbish anytime. Take care and kindest regards. Tug


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katysara


Moderator

Posted Thu Nov 19th, 2009 8:26pm Post subject: What to do in a suicide crisis

Thanks for that Tug, really helpful and interesting. Personally I have always been well treated by paramedics, when conscious, it was the consultant that treated me badly - I'm sure there are good and bad examples everywhere.

KSx

I am an administrator on this site.

"Having a great intellect is no path to being happy."
~ Stephen Fry

See my website: www.katysaraculling.com

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Tug498


Member

Posted Thu Nov 19th, 2009 9:57pm Post subject: What to do in a suicide crisis

My pleasure to post. I hope it provides some help. A nice quote I have always found a little puizzling but strangely endearing is one from Robert Browning which goes
"for sudden the worst turns the best to the brave".

The other one i very much like is by the diminutive Pete Conrad, the commnader of Apollo 12 and the third man to walk on the moon when he took his first steps on the face of the moon:

" YIPPEE. It may have been a small one for Neil but it sure was a big one for me"
History is a funny thing. Anyway dont want to detract too much from the thread so take care and thanks. Love and hugs. Tug


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michael


Member

Posted Tue Dec 1st, 2009 11:52pm Post subject: What to do in a suicide crisis

kinda a late reply but just wanted to thank Tug for posting that. It's so great to hear how a first-responder feels about suicidal situations. you really seem to understand what's going on, and if i were in distress, it'd be a blessing to have someone like you show up.

"HELLO I'M TACTILE !" is an anagram of my name

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richy ...................


Member

Posted Thu Dec 31st, 2009 3:23am Post subject: What to do in a suicide crisis

i say thease things to my self every day and i can feel things getting worse ive just watch a program on telly and i think i need to speak to someone . after 25 years of drugs drink and a rollercoaster life i can feel the anchors givin again and i dont know if im mentally ill or just a lazy stupid fool who enjoys drugs and drink and would be putting more of a strain on the nhs ect so im just gonna plod on till something bigger happens or maybe ill go on the jeremy pile show


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karen_r


Member

Posted Fri Mar 19th, 2010 6:10am Post subject: What to do in a suicide crisis

thank you so much for that i will def be getin my mum,dad,husband and sister (my 4 rocks)to read this thread...i had tears in my eyes thinking about the lengths i go to when i am organising myself for suiside... getting kids looked after,buying cut throat razor blades or saving my pills for a while i even shaved my legs once :S god knows why i thought that was important!i make sure my kids wont find me i have even written a manual for my husband on what days the kids have p.e class and swimming lessons ...how to tie the girls hair up and making sure they are always neat and tidy for school its amazing how my brain manages all that as when i am in a depressed episode i can hardly move off sofa for days on end! saying that the mixed episodes are always my most at risk if you like! ....oh that was a wee rant lol

I am not Bi-Polar I have Bi-Polar Disorder! Would you call someone with Cancer, Cancer??

Oh and yes i have taken my meds...i'm just havin a bloody bad day!

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katysara


Moderator

Posted Sat Mar 20th, 2010 2:47pm Post subject: What to do in a suicide crisis

I get mixed episodes too, and they are the most dangerous state psychologically a person can be in. 1 in 5 commit suicide... I gave it a damn good try on... let's say more than one occasion.

KSx

I am an administrator on this site.

"Having a great intellect is no path to being happy."
~ Stephen Fry

See my website: www.katysaraculling.com

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Slinki


Member

Posted Tue Apr 13th, 2010 11:26pm Post subject: What to do in a suicide crisis

Like Tug I too work front line for the ambulance service, and like Karen I also have Bipolar Disorder - I am not Bipolar.

I also am horrified with the behaviour of a minority of my station collegues when attending self harm and psychiatric incidents, like Tug I appologise to patients, families and friends who feel they have been let down. Please don't judge the rest of us from one bad egg. In an attempt to open up the subject I have now made most of my co workers aware of my condition and have recieved great support and interest about Bipolar Disorder. Just as well really as a couple of weeks ago I arrived for work slightly shall we say hypomanic - or "Tigger on speed" as I was told. I had a great crew mate for the duration of the cycle who looked out for me and my behaviour whilst being tigger on speed, and is still looking out for me now I am dealing with the depression side of things.

Anyway, back to topic; lets be honest, crisis is so easily the end game for many. As already stated 1 in 5 Bipolar patients in crisis achieve suicide, thats a higher rate than Schizophrenia! Please dont ignor the signs. There is some great advice above, but the bottom line is Get Help. Ambulance, Police, NHS Direct, out of hours GP's, walk in centres, and if you have the number the community crisis teams are all options which should start the ball rolling for you.

Like Tug, and has to be said most of my co-workers and emergency service staff arround the country, we would "rarther be called and not needed than not called then needed". (like that phrase Tug I shall with permission use it again). Slinki xxx


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katysara


Moderator

Posted Wed Apr 14th, 2010 12:21pm Post subject: What to do in a suicide crisis

I have never had anything but the best of care from ambulance staff, indeed they saved my life on at least one occasion when they found me dead but did not give up and I was revived. The same visit, A&E staff were pissed with me for some reason (attempting suicide?) and dumped me half naked, uncovered and unconcious into a bed.

It was actually an A&E consultant who mistreated me the worst on another occasion - though he suddenly changed his tune when he found out I was in my final year studying for a PhD in medicine there in Oxford. First he tried to send me away whilst suffering from hypovolaemic shock and with 2 arteries exposed - just covered with a bandage that became drenched in blood in seconds. It was only when I TOLD him what treatment I needed that I got it, even then he tried (and succeeded) to cause maximum pain by using a big needle, injecting the lignocaine (anaesthetic) fast (which makes it hurt more) and into my wounds, not numbing the sides of skin to be sutured. Thankfully a kind nurse gave me more lignocaine, but she had to ask his permission and he didn't like it...

I so wish I had written down his name I would have made a complaint.

ksx

I am an administrator on this site.

"Having a great intellect is no path to being happy."
~ Stephen Fry

See my website: www.katysaraculling.com

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laineybl


Member

Posted Thu May 20th, 2010 2:04pm Post subject: What to do in a suicide crisis

i can usually cope with the downs- i adjust my life as best i can.
i can usually cope with the ups- i adjust my life the best i can.
i can't cope with the ups and downs when they roller coaster me around in seconds from one to the other and back and forth and up and down and upside down and downside up.
i'm intelligent, articulate and a fucking waste of space.
i have responsibilities and people who love me and i can't bare for anyone to see me out of control.
i have to be in control of my emotions and feelings and behavior at all times and when i can't keep up the image of indestructible, tough as old boots, "i'll do it let me help you i can take it" me i just PANIC.
you can't see me like this- you won't like me any more if you see who i am inside.
i have to be good while all the time i'm bad inside. bad thoughts of a bad person.
i try so hard to be who i should be but always end up the person i hate.
the thing that hurts the most is having to hide me inside.
control control control.
"control yourself!" "you're not a child now you know!" "fuck off then!" "how the hell am i supposed to help you if you won't tell me what's wrong!" "now you are just being silly!" "oh will you just get a grip!"
just some time to be me. to be cared for while i work out or hide from my demons.
up down up down up down.......................................down down down down down.............can't let anyone see me like this where can i hide? nowhere cos nowhere is safe but what if i get stuck in nowhere?


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katysara


Moderator

Posted Thu May 20th, 2010 3:35pm Post subject: What to do in a suicide crisis

I answered this same post on the introductions thread!

I am an administrator on this site.

"Having a great intellect is no path to being happy."
~ Stephen Fry

See my website: www.katysaraculling.com

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Flowerpot


Member

Posted Wed Oct 27th, 2010 6:35am Post subject: What to do in a suicide crisis

Seeing as this is a thread for suicide resources, there's a really great website here: http://www.metanoia.org/suicide/

That website saved my life, no joke.


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John Steed


Member

Posted Fri Oct 29th, 2010 10:07pm Post subject: What to do in a suicide crisis

laineybl said:i can't cope with the ups and downs when they roller coaster me around in seconds from one to the other and back and forth and up and down and upside down and downside up.
i'm intelligent, articulate and a fucking waste of space.
i have responsibilities and people who love me and i can't bare for anyone to see me out of control.
i have to be in control of my emotions and feelings and behavior at all times and when i can't keep up the image of indestructible, tough as old boots, "i'll do it let me help you i can take it" me i just PANIC.
you can't see me like this- you won't like me any more if you see who i am inside.
i have to be good while all the time i'm bad inside. bad thoughts of a bad person.
i try so hard to be who i should be but always end up the person i hate.
the thing that hurts the most is having to hide me inside.
control control control.
"control yourself!" "you're not a child now you know!" "fuck off then!" "how the hell am i supposed to help you if you won't tell me what's wrong!" "now you are just being silly!" "oh will you just get a grip!"
just some time to be me. to be cared for while i work out or hide from my demons.
up down up down up down.......................................down down down down down.............can't let anyone see me like this where can i hide? nowhere cos nowhere is safe but what if i get stuck in nowhere?

For the first time I've seen a post where I feel EXACTLY the same.


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