Suicide Prevention Month 2023

• This month is suicide prevention month, and this article will help you learn the early warning signs of suicide to watch out for as a nurse.
• Understand which groups are at the highest risk for suicide and what signs nurses can expect to see in patients struggling with suicidal ideation.
• Know how to build a Crisis Intervention Plan to protect your patients and even fellow nurses who may be at risk.

September is suicide awareness and prevention month, and nurses play a key role in the assessment and prevention of suicide among their patients. Let us discuss suicide warning signs for different age groups, additional resources and education for nurses, and suicide risk among nurses themselves.

Early Warning Signs of Suicide

As a nurse, it is important to recognize the early warning signs a patient may be contemplating taking their own life. As a nurse, you should:

• Observe changes in the mood and behavior of your patients.
• Help patients recognize that the underlying cause of their physical problems may be due to depression or another mental health condition.
• Let patients know that there are alternatives to feeling depressed and assist them in finding services that can relieve their pain.

Patients who are considering self-harm may try to reach out to you directly or indirectly. Rarely will patients immediately volunteer the information they are thinking of harming themselves. Instead, they may describe their concerns in terms of physical symptoms.

Some imminent suicide warning signs include:

• Talking about suicide or death
• Giving direct verbal cues such as “I wish I were dead.” and “I’m going to end it all.”
• Giving less direct verbal cues such as “Who cares if I’m dead anyway?”
• Isolating themselves from friends and family
• Expressing the belief that life is hopeless or meaningless.
• Giving away cherished possessions
• Exhibiting sudden and unexplained improvement in mood after being depressed or withdrawn.
• Neglecting their appearance and hygiene

These signs are especially critical if the patient has a history or current diagnosis of a psychiatric disorder such as depression, alcohol or drug abuse, bipolar disorder, or schizophrenia.

What Age Groups Are at the Highest Risk of Suicide?

Age is also a factor when it comes to risk factors for suicide. Elderly patients are at an increased risk of dying by suicide. This is typically due to an undiagnosed mental illness associated with suicide such as depression or suffering from a medical condition or terminal illness that includes chronic pain.

Nurses should pay special attention to older patients who:

• Stockpile medications
• Buy a gun.
• Give away money and possessions.
• Take a sudden interest in religion or lost interest in religion.
• Fail to care for themselves or perform basic hygiene.
• Withdraw from relationships.
• Fail to thrive even after medical intervention.
• Schedule appointments for vague symptoms

Adolescents are also at an increased risk of dying by suicide. School nurses or other nurses working with adolescents should be aware of these warning signs:

• Volatile mood swings or personality changes
• Self-mutilation
• Involved in abusive relationships (physically or emotionally).
• Physical appearance deterioration
• Depression
• Gender identity struggles
• Fixation with violence
• Eating disorders

Recognizing the warning signs of both high-risk age groups is the first step in preventing suicide. As a nurse, your response to any warning signs should be focused on patient safety, providing empathy and support, and ensuring that the patient receives the mental health or social services needed to reduce the patient’s risk.

Assessing Suicide Risk

Asking difficult questions can assist in assessing the suicide risk of the patient. These questions often include:

Self Harm Care

Immediate action by the nurse is vital if you have any reason to believe that the patient is in imminent danger or poses a danger to themselves.

Immediate action should also be taken when warning signs are combined with any of the following risk factors:

• Past incidents of suicidal behavior or self-harm
• Family history of suicide
• History of psychiatric disorder or abuse of alcohol or drugs
• Patient expressed a wish to die.
• Any evidence of current psychiatric disorder

Crisis Intervention Plan

As mentioned above, the nurse’s role in suicide prevention and managing mental health crises is very important. If your place of employment does not have a crisis intervention plan or does not provide training for crisis intervention, advocate for the implementation of a clear crisis intervention plan.

A crisis intervention plan consists of steps set forth by your employer to inform their employees what they should do in a crisis including a mental health crisis. Ensuring that all members of the healthcare team know what to do in a crisis helps to empower nurses and keep patients safe from self-harm.

Mental Health First Aid

In addition to a crisis intervention plan, taking additional courses on suicide prevention may be helpful. Mental health first aid is another option for those wanting additional knowledge and certification on mental health crisis intervention. I can attest this course is incredibly helpful and informative as I became certified in 2020.

Finding yourself in a mental health emergency can be an overwhelming and stressful experience, especially if you do not specialize in mental health or psychiatric nursing. This course will assist you in feeling better equipped when faced with a patient in mental distress and guide you in improving the situation.

The mental health first aid course will explain what you need to do in a crisis until help arrives. You will learn about early warning signs of mental illness, how to communicate well, and where to find professional mental health help in your local community for the patients you care for.

In a mental health first aid training course you will learn about mental health problems and disorders including:

• Depression
• Mood disorders
• Substance abuse disorders
• Trauma
• Anxiety disorders
• Psychosis

You will also learn how to deal with the following mental health crisis situations:

• Traumatic events
• Panic attacks
• Self-harm
• Severe psychotic states
• Effects of drug and alcohol abuse
• Aggressive behavior

The course will teach you how to provide mental health first aid by using the ALGEE action plan. ALGEE is:

• Approach, assess, and assist with any crisis. Assess the risk of suicide or harm and look for signs of trauma and high anxiety.
• Listen to the person non-judgmentally.
• Give the person reassurance, support, and information.
• Encourage the person to seek appropriate professional help.
• Encourage the person to seek self-help and other support strategies.

Who should take Mental Health First Aid?

This course is not just for nurses, it is also beneficial for social workers, police officers, teachers, youth workers, and counselors.

Participating in this course will equip and ensure you are better prepared to help someone in crisis. The more people who participate in this course, the greater the impact on reducing suicide.

Suicide and Crisis Hotline

Another resource that is important for patients to be informed about is the Suicide and Crisis Hotline. The hotline was implemented in 2005 and is formally known as The National Suicide Prevention Lifeline. The hotline number is 988.

The Suicide and Crisis Hotline provides 24/7 free and confidential support for people in distress. It provides prevention and crisis resources for individuals considering suicide. An individual may call for themselves or for someone they are concerned about.

What about nurses and their suicide risk?

Although nurses are health professionals that play a key role in preventing suicide among their patients, nurses are also at an increased risk of suicide themselves. Being a nurse is a high-stress career, and although rewarding, nurses face several challenges.

The following list includes factors that increase suicide risk among nurses:

• Exposure to repeated on-the-job trauma.
• Scheduling long, consecutive shifts
• Repeated requests for overtime
• Workplace violence or bullying
• Inadequate self-care
• Financial stressors
• Access to and knowledge of lethal substances
• Stress
• Feeling unsupported in their role
• Work/life conflict

Unfortunately, there is still a stigma around asking for help. Normalizing mental health conversations is a crucial factor in reducing suicides among nurses and the general public. Nurses have been at a higher risk of suicide than the general public for many years.

Now the added stressors of social unrest, nurse shortages, and the aftermath of the pandemic increase that risk. There are no known fool-proof ways to prevent all nurse suicides, however, we can learn ways to reach nurse colleagues in a dark place of depression to reduce the risk of a nurse acting on suicidal thoughts.

The Bottom Line

In conclusion, suicide is an epidemic and does not discriminate against any race, age group, or career. Everyone has the potential to fall victim to depression or suicidal thoughts at some point in their lifetime.

Knowing the risks and providing early intervention will aid in suicide prevention. While we may not be able to stop every suicide, we can dramatically decrease the incidence rate by being well-educated on the topic and taking quick and appropriate action.

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