Canadian Coalition for Seniors

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Canadian Coalition for Seniors Mental
Healthwww.ccsmh.ca

• Late Life Suicide Prevention Toolkit
• Funded by the Public Health Agency of Canada

• Dr. M.L. Donnelly
• Director, Division of Community Geriatrics
• Department of Family Practice
• Director, Division of Geriatric Psychiatry
• Department of Psychiatry,
• University of British Columbia

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Conflicts

• There are no conflicts

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Contributors

• Dr. Martha Donnelly, MD
• Head of the Division of Geriatric Psychiatry
• Department of Psychiatry
• University of British Columbia
• Dr. Marnin J. Heisel, PhD, C. Psych
• Assistant Professor
• Departments of Psychiatry and Epidemiology
  Biostatistics
• Schulich School of Medicine and Dentistry
• The University of Western Ontario
• Dr. Sharon Moore, RN, M.Ed., PhD, C. Psych.
• Associate Professor
• Centre for Nursing Health Studies
• Athabasca University, Alberta
• Charlene Foster, B.A.
• Trainer and Volunteer Coordinator
• London and District Distress Centre, Ontario

• Ian Ross, MSc
• Executive Director
• Crisis Intervention and Suicide Prevention Centre
• of British Columbia
• Joan Seabrook, M.Ed., S.O.
• Educational Consultant
• Survivor Chair,Canadian Association for Suicide
  Prevention
• Diane Yackel, M.A., F.T.
• Executive Director
• Centre for Suicide Prevention, Alberta
• Sherri Helsdingen, B.A.
• Project Manager
• Canadian Coalition for Seniors Mental Health
• Kimberley Wilson, MSW, BASc
• Executive Director

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Learning Objectives

• By the end of this workshop, you will be able to
• Recognize risk factors for suicide in older
  adults, resiliency factors and warning signs
• Perform a suicide risk assessment interview
• Develop your skills in risk management
  strategies for older patients with suicidal
  ideation

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Mortality Statistics

• Demographic risk factors include sex (Male), age
  (Older), and ethnicity (Caucasian/White).
• In 2004, 427 Canadians 65 died by suicide,
  including 319 men and 108 women.
• Men between 85 and 89 years of age had a suicide
  rate (26.8/100,000) that more than doubled the
  national average of approximately 13/100,00.
• Suicide mortality data underestimate true
  suicide rates, and do so differentially.

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2004 StatsCan Suicide Rates (per 100,000)
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Mortality Statistics

• The ratio of suicidal behaviour to deaths for
  older adults is between 1-41, while that for
  adolescents is as high as 200-3001
• Many older adults may end their lives by refusing
  food and/or needed medications however, these
  deaths are typically not officially deemed
  suicides
• Means of suicide differ by age, gender, and
  location.
• Detection of suicide risk in older adults is
  crucial interventions can then follow.

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Suicide Assessment Prevention for Older
Adults Risk Factors

• 1. Suicidal Ideation and/or Behaviour
• Prior suicidal behaviour (including suicide
  attempt), prior self-harm behaviour, previous
  expression of suicide ideation
• Feels tired of living and/or wishes to die
• Thinks about suicide, has suicidal wishes and/or
  desires
• Has a suicide plan/note
• 2. Family History
• Family history of suicide, suicide ideation,
  mental illness

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Suicide Assessment Prevention for Older
Adults Risk Factors

• 3. Mental Illness (can include)
• Any mental disorder, co-morbidity
• Major depressive disorder
• Any mood disorder
• Psychotic disorder
• Substance misuse disorder/addictions
• 4. Personality Factors
• Personality disorders
• Emotional instability
• Rigid personality
• Poor coping skills, introversion

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Suicide Assessment Prevention for Older
Adults Risk Factors

• 5. Medical Illness
• Pain, chronic illness
• Sensory impairment
• Perceived or anticipated/feared illness
• 6. Negative Life Events and Transitions
• Family discord, separation, death or other losses
• Financial or legal difficulties
• Employment/retirement difficulties
• Relocation stresses
• 7. Functional Impairment
• Loss of independence
• Problems with activities of daily living

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Suicide Assessment Prevention for Older
Adults Resiliency Factors

1. Sense of meaning and purpose in life.
2. Sense of hope or optimism.
3. Religious (or spiritual) practice.
4. Active social networks and support from family
   and friends.
5. Good health care practices.
6. Positive help-seeking behaviours.
7. Engagement in activities of personal interest.

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Suicide Assessment Prevention for Older
Adults Warning Signs

• Remember IS PATH WARM?
• I Ideation
• S Substance Use
• P Purposelessness
• A Anxiety/Agitation
• T Trapped
• H Hopelessness/Helplessness
• W Withdrawal
• A Anger
• R Recklessness
• M Mood Changes
• From the American Association of Suicidology
  (AAS) website (www.suicidology.org).

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Suicide Assessment Prevention for Older
Adults Key Questions

• 1. Ask about their feelings
• Do you feel tired of living?
• Have you been thinking about harming yourself
  and/or ending your life?
• Have you been thinking about suicide?

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Suicide Assessment Prevention for Older
Adults Key Questions

• 2. Ask about a suicide plan
• Have you thought of specific ways of hurting
  yourself or ending your life?
• Have you made any specific plans or preparations
  (giving away possessions, tying up 'loose ends')?
• Have you asked someone to help you end your life
  or join you in death?
• Do you have access to lethal means like a gun or
  other implements?
• Have you collected pills in order to take an
  overdose?
• Have you started to put a suicide plan into
  action?

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Suicide Assessment Prevention for Older
Adults Key Questions

• 3. Ask about their reasons to live
• What has kept you from harming yourself?
• Who or what makes life so worth living that you
  would not harm yourself?
• What other questions could you ask?

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Suicide Assessment Prevention for Older
Adults Risk Management

• Immediate Risk Management
• 1. Do not leave the person alone until you have
  arranged for the involvement of another
  appropriate care provider or source of
  protection.
• 2. Establish an immediate safety plan that
  includes
• family support
• homecare support
• 24-hour (or in-home) care providers
• police intervention (if needed)

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Suicide Assessment Prevention for Older
Adults Risk Management

• Immediate Risk Management (Cont.)
• 3. Consider care needs
• emergency services
• telephone and/or in-person crisis/distress/support
  services
• mental health services
• medical services
• social service providers, community supports
• 4. Ensure that follow-up care is arranged.
• 5. Where possible, restrict access to lethal
  means.

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Suicide Assessment Prevention for Older
Adults Risk Management

• Ongoing Risk Management
• 1. Address underlying issues
• medical illness
• mental health problems
• social problems, concerns, transitions
• environmental factors
• 2. Continually re-assess suicide risk,
  resiliency, and warning signs.
• 3. Continue to build and sustain the therapeutic
  relationship.
• 4. Look for ways to foster hope and enhance a
  sense of meaning in life.

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Suicide Assessment Prevention for Older
Adults Risk Management

• Ongoing Risk Management (Cont.)
• 5. Develop a safety plan that includes
  after-hours support.
• 6. Read and continually review CCSMH National
  Guidelines and other appropriate treatment
  guidelines.
• 7. Work within a culturally competent model of
  care.
• 8. Work within an inter-disciplinary care model
  where possible
• Develop relationships with mental health teams
  for support and on-going follow-up.
• Be aware of community resources and referral
  sites/processes.

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Suicide Assessment Prevention for Older
Adults Treatment Management

• Treatment and Management Suicidal Seniors
• Foster hope in clients who are suicidal
• Assist in finding and maintaining meaning
  purpose in life
• Attend to the therapeutic relationship
• Work in a team setting - dont work alone
  (collaborative care)
• Consult colleagues, keep detailed notes, use
  crisis services
• Restrict access to lethal means
• Mental health outreach

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Workshop

• In video case, what other approaches could doctor
  have taken in initial assessment?
• Define high, medium and low risk situations
• Set up management strategies for high, medium and
  low risk cases
• Discuss family involvement in case