The Prevention and Management of Suicide in Clients and Carers Receiving Palliative Care in Australia.

Michele Watson, PsychologistMelbourne City Mission Palliative Care

Incidence of Suicide

risk of suicide is high with physical illness

especially so when depression is present

rates of completed suicide are low (Filiberti et al. 2001).

What contributes to suicidal ideation?

fear of losing independence, particularly in patients who had a strong character

uncontrolled pain or the fear of uncontrolled pain

fear of suffering

disinhibition, confusion and delirium

exhaustion and fatigue

Depression – feelings of hopelessness, helplessness

withdrawing from friends and relatives

adverse physical consequences of treatments

when no further treatment available or contact with health care

system reduces (Filiberti, 2001).

Bereavement and suicidal ideation

bereaved people are at greater risk of suicidality compared to

nonbereaved

especially when; partner has died, perception of low levels of

social support, being female

although rate of completed suicides typically higher in bereaved

men (Stroebe et al., 2005).

complicated grief significantly heightened risk (Latham, 2006).

Policy Development

policy and procedures were required for all staff encountering clients and/or carer’s thinking of suicide

existing policy was limited

specific procedures were required for each discipline

staff safety and debriefing needs considered

there was little evidence in the literature to guide the working party

significant challenges due to the diversity of training and skill level amongst team members

Training for staff

In 2012 all staff completed a 3 hour session in SafeTALK -

suicide first aid intervention training.

followed up by a refresher of the same session in 2014

key clinical staff are trained in ASIST, an applied suicide

intervention skills training program

Principles of the SafeTALK Training

most people thinking of suicide want help and find ways to invite

help

invitations are often missed, dismissed or avoided

the best way to find out is to ask the person directly

asking about suicide will not give someone the idea

anyone can have thoughts of suicide

The SafeTALK Model

LISTEN for invitations

ASK: “When someone talks like this they are sometimes thinking

about suicide.Are you thinking about suicide?”

KEEP SAFE

CONNECT

Resources

Find information about safeTALK at

www.livingworks.com.au

Discipline Specific Action Plans

administrative staff receiving calls from distressed clients/carers

volunteers visiting client’s homes, calling bereaved carers

nursing staff phoning or visiting client’s homes during office hours and afterhours/weekends

counsellors, pastoral care and massage staff phoning or visiting clients

LISTEN• Listen for invitations – moody, burden, escape,

withdrawing, desperate, no purpose, hopeless, pain & suffering, shame, loss.

KEEP SAFEKEEP SAFETransfer caller to a counsellor:Transfer caller to a counsellor:

SAYSAY: “: “We need extra help. I want to We need extra help. I want to connect you with someone who can help connect you with someone who can help you keep safe. Please do not hang up.you keep safe. Please do not hang up.””

ASK • “What’s your last name?”

•“Your telephone number?”•“Where are you at the moment?”•“When someone speaks like this, they are sometimes thinking about suicide - are you thinking about suicide?”•If YES… Who is with you right now?

IF YES – ALERTDo not put caller on hold. Alert nearby staff member:

“SUICIDE RISK – client’s name.... Counsellor needed to take call now”

REPORT & DEBRIEFREPORT & DEBRIEF

• Report the call to the Office Manager.

• Look after yourself - call the Employee Assistance Program on 1300 361 008 24/7 for critical debriefing by phone.

IF NO – TRANSFER CALL

• To a Counsellor, explaining client is distressed but not suicidal.

•If no counselor available, ensure client is contacted later that day.

Action Plan – Administration Staff

LISTENAsk “what’s been happening?” Listen for invitations - moody, burden, escape, withdrawing, desperate, no purpose, hopeless, pain and suffering, shame, loss.

TOP PRIORITY IS YOUR SAFETY•Assess your safety, if you don’t feel safe, leave the home.•Call the office when you get to your car and report situation.

ASK “When someone speaks like this, they are sometimes thinking about suicide - are you thinking about suicide?”

IF THEY ANSWER NO

Continue listening and ask the person if they would like a counsellor to call them later that day or the next day to see how they are feeling.

ASSESS what’s needed:

Medical review? PCU/psychiatric admission? Counselling – How urgently?

Carry out assessment and develop plan of care.

DEBRIEF

Look after yourself and speak to the Team Leader. If you would like to speak to a counsellor, call the EAP on 1300 361 008 24/7 for critical debriefing by phone.

IF THEY ANSWER YESASK: “How would you do it?”SAY: “Ok let’s get you some help”.ASK (as appropriate): Have you taken something”. Arrange to remove the means, involve family members in this.

ASSESS CLIENT’S SAFETYIf safe to remain with client:•If you think the person is in imminent risk of suicide and they are resisting removing the means call 000 and report to Police. •If necessary engage other health professionals. •If client does not agree to this, strongly recommend they speak to a Lifeline Counsellor, call Lifeline on 13 11 14.

REPORTTell the client “I’m going to be here a while I just need to let the office know”. Call the Team Leader and report situation.

Action Plan – Nursing and Medical Staff

Rapid Plan Team

the need for a Rapid Plan Team identified

key roles identified to form the RPT

a comprehensive checklist developed

to examine the particular issues and develop plan of care

Final Policy and Procedure

specific action plans developed for each discipline

mandatory training in suicide ‘first aid’ for all staff was endorsed

advanced training in suicide intervention skills introduced for key

clinical staff

rapid plan team and checklist developed

Management of Completed Suicide

process outlined for when organisation is notified of completed

suicide by client or carer.

process developed for instances when a staff member finds a

client/carer who has completed suicide

process includes formation of Rapid Plan Team to manage

process.

Positive Outcomes

increased suicide awareness amongst staff

staff feel more equipped to deal with clients and carers thoughts

of suicide

training has debunked myths about suicide

overall staff more confident in talking about suicide

Conclusion

more research is needed into the rates of completed suicide in

bereavement

the new policy & procedure will be piloted within the organisation

and reviewed after 6 months

the need for suicide prevention and management procedures

has been identified by other community organisations

current policy may be shared by broader community

Questions.