How do you help your suicidal patients?

[medsandmargaritas]

I am a new grad in psych and my unit has a lot of suicidal/depressed patients. When they come up to me and say that they are having suicidal thoughts, I sometimes freeze on what to say. I try to help them use their coping skills but that doesn't always work. I was just wondering how the experienced psych nurses here react in those type of situations. Thanks!

[Mandychelle79, ASN, RN]

My next question is always What is your plan.... If it's to shoot self and no access to guns alert level drops a tad bit, if it's see that over there, I can break it and use it to slice my wrist open, yeah that person is told must stay in common areas, put on a higher observation level. I ask if they feel safe on the unit. I assess to see if what they are saying matches their behaviors... Depressed and suicidal but laughing with peers, playing games, etc. This is especially important when you have someone who knows how to work the system. As for what to say a lot of times I just listen. I may say is there anything that triggered those feelings.

[Davey Do]

When they come up to me and say that they are having suicidal thoughts, I sometimes freeze on what to say.

Your reaction is not uncommon when first experiencing this sort of situation, medsandmargaritas.

First, relax. Chances are, you're not going to say the wrong thing.

Then, remember: You are one part of a treatment team; a link in a chain. The well-being of the Patient is not totally on your shoulders.

Most Patients just want to express their thoughts and feelings. Use your verbal listening skills. Just ask questions and give responses that are appropriate and natural. Mandychelle gave some really good examples.

Make it known that you are acting in a professional capacity. The Patient may confide in you, however: anything they say may be confidentially documented and/or passed on to another member of the treatment team. Encourage the Patient to express themselves to other treatment team members , e.g. the Doctor and/or Therapist, as well.

The best to you medsandmargaritas!

[nurse lala, BSN, RN]

What a great question. Talking about suicide is important because by discussing painful feelings will usually lighten the emotional load.

The RN builds rapport and can help process the issues contributing to their circumstances.

Suicidal thoughts can be distressful or a source of twisted delight. In either case, an assessment is always warranted.

Ask these questions: How long have you had the thoughts? What triggered them? Do you have a plan? intent? Have you found a means? Do you have something to hurt yourself? Have you already done something to hurt yourself? Have you practiced? What has kept you from acting on your thoughts?

Then use this opportunity to process what triggered the thoughts. Help problem solve. Educate. Reinforce good choices, such as reporting the SI. Validate and normalize the experience. Come up with a plan to avoid the trigger to the suicidal thoughts. We need to reinforce strengths and this is an easy one.

Implement safety measures.

Communicate to key people.

Document.

[Davey Do]

Interestingly, these valid questions are almost verbatim of a portion of our initial psych assessment:

How long have you had the thoughts? What triggered them? Do you have a plan? intent? Have you found a means? Do you have something to hurt yourself? Have you already done something to hurt yourself? Have you practiced? What has kept you from acting on your thoughts?

I also ask them, before the initial assessment is completed, if they will commit to safety: Assure me they will do nothing to harm themselves or another. In the hundreds of admissions I've done working at this facility for 12 1/2 years, only one Patient refused to commit to safety. That Patient was put on a 1:1.

I would estimate that 99% of those Patients admitted for being a threat of self harm have no suicidal thoughts once they are on the unit. The ones that do have such thoughts describe them as "fleeting" or "not bad".

Now, I don't mean to make light of most Patients' threat of self harm. Although I've never experienced a suicide on my watch, their safety is my responsibility and I take every precaution with every Patient. And, I regularly remind the Patients that their safety is my responsibility...

Also: Our Staff routinely do an assessment every shift, enquiring of all psych Patients of their self harm status.

[Farawyn]

*Following*

As a HS Nurse with a (so far) brutal school year, chock full of legit suicidal kids, I'm interested in this thread.

Thanks, OP.

[Sifty]

Hi all. I would totally appreciate any advice in regards to this subject as well. I am a NM at a clinic in Cambodia. Recently I have had two self harming cases.

The one I had yesterday was a diazepam overdose. This patient had a long history of self harm from the marks on their body and admitted this. Medically -she was alright. Mentally - obviously not. Unfortunately there are very few resources in this country to deal with mental health and no laws that medical staff are able to use to hold people. So after repeated attempts to convince the patient to stay, with some success for a few hours. The patient demanded to be discharged, signed an AMA and away they went.

It's a very frustrating situation. When I was in Australia we could have held them for at least 24hrs to be properly assessed and would have the resources and specialists to assist. But here I have very little. I did have a psych consult on the way but that would have still been 3 plus hours till they arrived.

So what I am looking for is any strategies to try and convince people to stay so we can help them. Any suggestions would be greatly appreciated.