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WORLD MENTAL HEALTH DAY 2019

PRESENTATION OF THEME
BY MRS. SUMAM, ASSISTANT PROFESSOR, SGNC
WORLD MENTAL HEALTH DAY 2019

OCTOBER 10

THEME SUICIDE PREVENTION


SUICIDE

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A CRY FOR HELP
Definitions
 Suicide: (Self murder) Self-destructive behaviour
with conscious intent to kill self

 Parasuicide: deliberate act to end life, but intent


unclear

 Self-harm or self-mutilation: no conscious intent


to commit suicide

 Both groups have serious risk of completed suicide


ATTEMPTED SUICIDE

 any act of self damage with self destructive


intention however vague or ambivalent is an
attempted suicide
 if the person dies of the act it is suicide
otherwise attempted suicide
 most common psychiatric emergency
 any attempt without any intention of dying
but only to threaten or manipulate is
parasuicide
One million suicides in the
world, 100,000 suicides in
India,
10,000 suicides in Kerala
annually

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 PUDUCHERRY REPORTED THE HIGHEST
SUICIDE RATE AT 36.8 PER 100000 PEOPLE
FOLLOWED BY SIKKIM ,TAMIL NADU AND
KERALA.
 INDIA HAD THE THIRD HIGHEST FEMALE
SUICIDE RATE 14.7 IN THE WORLD
Suicide in Kerala

 Kerala’s Rate was about 3 times


India Average (32.0/1 lakh)in
2016
 National Rate - 11.2/1 lakh
 Kerala was the Suicide Capital of
India for the 8th consecutive time
in 2016 11
Suicide in Kerala

NOW Kerala contributes 10.1% of


all suicides in India, while its
population contributes only 3.4%.

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Age distribution of Suicide Victims

%
35
30
25
20 30.94 28.56
15 19.36
19.9
10
5 1.21
0
Years
Upto 14 15 - 29 30 - 44 45 - 59 Above 60

Middle aged out number younger and older in


suicide 13
Job Profile (2002)
Unemployed 19.77

House wife 14.81

Farmer 15.63

Private employees 4.82

Business 6.6
Kerala accounts for 3.4% of India’s population
Govt. employees 2.95 but has 16% of Unemployment status of the
nation.
Student 2.87

Professional 3.19

Retired 1.4

Others 27.96

% 0 5 10 15 20 25 30
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Marital Status
Married outnumbered Unmarried in Kerala.
Reverse is true in Western Countries

5.9 Married

18.7
Unmarried

Widow/widower/seperated/
divorced
75.4

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Methods Adopted

Hanging 3300
980

Insecticides
1437
449

Other poisons 1231


383

Self-immolation 135
335

384 Male
Drowning
326
Female

Others
678
130

0 500 1000 1500 2000 2500 3000 3500

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Causes of Suicide

Family problems 1610


690

Financial problems 1000


135
1080
Physical illness
423

Mental illness 694


319 Male
10
Unemployment
89 Female
48
Love failure
37
39
Failure in exam
50
1344
Others
493

% 0 200 400 600 800 1000 1200 1400 1600 1800

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Role of Psychiatric Illness

 80-90 % suffers from a psychiatric


illness at the time they die
 45-70 % suffers from depression

The month immediately after discharge


is a particularly high-risk period

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Medical Illnesses with High
risk
 AIDS
 Epilepsy
 Temporal Lob Epilepsy
 Head injury
 Peptic ulcer disease
 Spinal cord injuries
 Gastro Intestinal cancers
 Delirium Tremens

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Biological Factors

 Reduced Serotonin function impulsiveness


 suicidal behaviour
 Persons often impulsive in nature
 Heritable trait
 Family history of suicide- independent of
psychiatric diagnosis

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Risk Factors-SADPERSONS Acronym

 S – Sex
 A –Age(>45)
 D –Depression
 P –Previous attempts, Family History
 E –Ethanol abuse
 R –Rational thinking lost
 S –Social supports lacking
 O –Organized planning
 N –No spouse
 S –Sickness

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Management

1. High Risk Category


 Immediate admission to psychiatric hospital
 Involuntary admission via MHA
 Containment in closed ward
 ECT for urgent cases, step-wise management of
underlying cause
Management Ctd..

2. Lower Risk Group


 Ongoing supportive psychotherapy
 Regular review mental state and risk
 Contractual agreement
 Medication to alleviate distress
 NB: TCA’s in o/d
Goals to Reduce Suicide

 Promote awareness that suicide is a public health


problem that is preventable
 Develop broad-based support for suicide prevention
 Develop and implement strategies to reduce the stigma
associated with being a consumer of mental health,
substance abuse, and suicide prevention services
 Develop and implement suicide prevention programs
 Promote efforts to reduce access to lethal means and
methods of self-harm
 Implement training for recognition of at-risk behavior and
delivery of effective treatment
 Develop and promote effective clinical and professional
practices
 Improve access to, and community linkages with, mental
health and substance abuse services
 Improve reporting and portrayals of suicidal behavior,
mental illness, and substance abuse in the entertainment
and news media
 Promote and support research on suicide and suicide
prevention
 Improve and expand surveillance systems
 Help line no

 Suicide prevention clinics

 24 hr availability

 ”suicide survivor’’
Adolescent Suicide:
Prevalence; Circumstance; and
Conditions of Recognition
Suicide in Adolescents
 Researchin
Suicide shows that most adolescent
Adolescents
suicides occur after school hours and in the
teen’s homes
 Most adolescent suicides are precipitated
by interpersonal conflict
 Within a typical high school classroom, it is
likely that three students (one boy and two
girls) have made a suicide attempt within
the last year.
Identity Confusion
 Erickson Developmental Stage-
Learning Identity Versus Identity
Confusion (Fidelity)

Learning Intimacy Versus Isolation


(Love)
The Teenage Brain

 Adolescence is a time of
profound brain growth.
 Greatest changes to the
brain that are responsible
for impulse control,
decision making, planning,
organization, and emotion
occur in adolescence
(prefrontal cortex).
 Do not reach full maturity
until age 25.
What do teens deal with?
 Increased school pressures as they progress
through higher grades

 Possibly first romantic relationships

 Exploring increased independence and identity

 Experimenting with substance use

 Puberty and Hormone fluctuation

 Bullying
Peer Problems

 Several studies have found


relationships between suicidal
behavior and social isolation,
sexual orientation, and peer
rejection.

 70% of suicide completions and


attempts occur following the loss
or conflict with family and peers.
Sexual
Identification
 Lesbian, Gay, and Bisexual youth
are 1 ½ - 7 times more likely to
have reported ideation.
 LGB Youth in multiple studies are
found to be 3-4 times more likely
to attempt suicide.
 58% of LGB youth who had
attempted suicide reported they
really hoped to die vs. 33% of
heterosexuals who attempted and
reported really hoping to die.
 Have elevated risk factors and
lower protective factors
Bullying:
3 defining characteristics:
1. Intentional—behavior is
deliberately harmful or
threatening
2. Repeated—a bully
targets the same victim
again and again
3 .Power Imbalanced—a
bully chooses victims he
or she perceives as
vulnerable
Cyberspace

CYBERSPACE is the new


environment where "
youth are forming
communities.
Cyber bullying
 93% of teens ages 12-17 are on
the Internet.
 75% of teens own a cell phone.
 A typical teen sends about
>100 text messages a day.
 Most teen cell phone users
make just 1-5 calls per day.
 82% of online teens ages 14-17
are on social network sites
What makes Cyberbullying
different?
 Distance
 24/7
 Multiple methods
 Text messages;
video clips; Websites;
Social Media; IM;
Emails; Chat rooms
 Anonymous
 Expanded Audience
Bullying effects
 Withdraws socially; has few or no
friends.
 Feels isolated, alone, and sad.
 Feels picked on or persecuted.
 Feels rejected and not liked.
 Complains frequently of illness.
 Doesn’t want to go to school; avoids
some classes or skips school.
 Brings home damaged possessions
or reports them “lost.”
 Cries easily; displays mood swings
and talks about hopelessness. Has
poor social skills.
 Talks about running away/suicide.
Bullying risks for suicide:
 Both victims and
perpetrators of bullying are
 Verbal at a higher risk for suicide
 Physical than their peers. Children
who are both victims and
 Relational perpetrators of bullying are
at the highest risk
 One study found that
victims of cyberbullying
had higher levels of
depression than victims of
face-to-face bullying
SUICIDE: Myth or Fact

 Confronting a person about suicide will


only make them angry and increase the
risk of suicide.

• Asking someone directly about


suicidal intent lowers anxiety, opens
up communication and lowers the
risk of an impulsive act
Myth or Fact

•Those who talk about suicide don’t do


it.

• People who talk about suicide may


try, or even complete, an act of
self-destruction.
Myth or Fact

•If a suicidal youth tells a friend, the


friend will access help.

•Most young people do not tell an


adult
SUICIDE- Risk Factors, Warning
Signs, Protective Factors

•Risk Factors- characteristics that will may it more


likely that an individual will consider, attempt, or
die by suicide

•Warning Signs- behaviors that indicate signs of


immediate risk

•Protective Factors- characteristics that make it


less likely that individuals will consider, attempt,
or die by suicide.
Risk Factors- IS PATH WARM

 Ideation
 Substance Abuse
 Purposelessness
 Anxiety
 Trapped
 Hopelessness
 Withdrawal
 Anger
 Recklessness
 Mood Changes
Problems that increase Suicide Risk

 Prior suicide attempts


 Mental health disorders
 History of trauma or abuse
 Family history of suicide
 Lack of social support
Situations that increase
suicide risk
•Major physical illnesses
•Losses
•Bullying
•Easy access to lethal
means
•Local clusters of suicide
Warning Signs:
 Acquiring a gun or stockpiling pills
 Talking about wanting to die or kill oneself
 Impulsivity/increased risk taking
 Giving away prized possessions
 Self-destructive acts (i.e., cutting)
 Increased drug or alcohol abuse
 Talking about no reason to live
Protective Factors
•Treatment for MH/SA, physical disorders
•Increased access to interventions
•Restricted access to highly lethal means
•Strong connections to family and community support
•Strong problem-solving and conflict resolution skills
•Cultural and religious beliefs that discourage suicide and
support self-preservation.
Indirect or “Coded” Verbal
Clues:
 “I’m tired of life, I just can’t go on.”
 “My family would be better off without
me.”
 “Who cares if I’m dead anyway.”
 “I just want out.”
 “I won’t be around much longer.”
 “Pretty soon you won’t have to worry
about me.”
What to Do for the
Individual
Take it seriously
Almost 80% of all suicides had
given some warning of their
intentions
Ask Directly
If you think that someone is suicidal,
ask them about it
Tips for Asking the Question
 If in doubt, don’t wait, ask the question
 If the person is reluctant, be persistent
 Talk to the person alone in a private setting
 Allow the person to talk freely
 Give yourself plenty of time
 Have your resources handy; QPR Card, phone numbers,
counselor’s name and any other information that might help

Remember: How you ask the question is less


important than that you ask it
What to do – Be Genuine
Be Genuine
•Listen and don’t show shock or disapproval

•Show that you care, it is more important


than saying “the right thing.”

•Avoid trying to explain away the


feelings…(saying things like “you have a lot to
live for” or “you are just confused right now”)
What to Do

Stay There
 Don’t leave them alone.
Seek Help -Be actively involved
in seeking professional help
Plan for Safety

 KEEP SAFE Agreement


 Safety Contact (s)
 Safe/no use of alcohol and
drugs
 Link to resources
 Disable the suicide plan
 Link to services
 Plan for Life
Potential Assessments

 Patient Health Questionnaire Modified for


Teens (PHQ-9 Modified)
 12-18 years of age
 Less than five minutes to complete and score
 Adolescent Suicide Assessment Protocol
(ASAP-20)
 Semi- structured clinical interview
 Addresses 20 items associated with suicide risk

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