SUICIDE AND PARASUICIDE

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SUICIDE AND PARASUICIDE
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Points to Consider

• Young persons knowledge of lethality /
  associated health risks e.g. with Paracetamol
• Adolescence associated with the cognitive ability
  to feel the despair, make plans, and act upon
  them, but with accompanying weakness in
  appreciating the reality of their choices on self
  and other (e.g. family members)
• Adolescent suicide is on the increase possibly
  linked to growth of media pressure and the
  deterioration of the family (?Resolution of
  developmental stages interrupted) (BJP 2001)
• ALL ATTEMPTS REQUIRE A SERIOUS RESPONSE

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Beck suicidal intent scale

• 1. Isolation
• 2. Timing
• 3. Precautions against discovery and/or
  interruption
• 4. Acting to gain help during or after attempt
• 5. Final acts in anticipation of death
• 6. Active preparation for attempt
• 7. Suicide note
• 8. Overt Communication of intent before the event

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ASSESSING RISK OF SUICIDE

• Degree of Planning
• Intent to Kill
• Previous attempts a risk factor
• Presence of depression, especially if at the
  start of an episode (energy)
• Evidence of impulsivity
• Concurrent Substance abuse
• Concurrent Conduct disorder
• Family history of suicide
• Proximal presence of psychosocial stressor e.g.
  relationship break-up, bullying, parental
  separation
• Attempts at concealment
• Lethality of proposed methods
• Developmental stage lethal attempts almost
  exclusively restricted to adolescents
• There are no systematic socio-economic predictors
• Why should I trust that you wont go home and try
  to kill yourself?
• Inform parents risk of harm over-rides client
  confidentiality
• If in doubt, enlist a psychiatrist! Thats what
  they and their salaries are for

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How best to understand overdoses

• A cry for help?
• Attention-seeking?
• A message in a bottle?
• A frustrated communication
• Will be sorted by improved verbal communication
• The consequence of family disharmony?
• A pathological way of expressing feelings?