PENNSYLVANIA
OCTOBER 2018
P S YC H I AT R I S T NEWSLETTER OF THE PENNSYLVANIA PSYCHIATRIC SOCIETY
PRESIDENT’S MESSAGE Dear Colleagues, As you are well-aware, September was National Suicide Prevention Awareness Month. Over the last 20 years, suicide has become a major public health issue. It is the tenth leading cause of death in the United States. The number of individuals who die by suicide has been rising every year for the last 20 years. In 2016, around 45,000 individuals died by suicide in the United States. Most of these individuals either had a diagnosed or a diagnosable mental health disorder. It is also important to note that only a very small percentage of the individuals with mental health disorders die by suicide. We as psychiatrists are asked to screen for suicidality in different clinical settings. We are also well-aware that suicidality is a predictably unpredictable event. In addition, we are all aware of the risk and protective factors for suicidality. The risk factors are further divided into long and short-term risk factors. The long-term risk factors include: previous suicide attempts, family history of suicidality, Caucasian race, middle to old age, being single, having poor social support, drug and alcohol related problems, access to firearms, untreated or undertreated mental health syndromes. The short-term risk factors include: acute loss, acute stressors, intoxication, worsening of psychiatric symptoms. Similarly, the protective factors include: family and social support, access to mental health providers, compliance with any treatment recommendation, and religion to name a few There is a huge toll of suicide on the family members of the individual who died by suicide and their providers. No words can explain the loss of a loved one. Family members struggle and wonder how it could have happened and if they could have saved the life that was lost by doing something different. For a psychiatrist to lose a patient to suicide is a huge emotional and psychological toll. We question our decision making and competence, we struggle with the same questions that family members struggle with, ‘what did we miss?’ or ‘what could we have done?’. Suicide of a patient shakes our confidence.
by Ahmad Hameed, MD, DFAPA PaPS President
The majority of individuals who are having suicidal thoughts are willing to talk about their feelings and thoughts when asked in a nonthreatening manner. They are looking for help. Most of the time, we as mental health professionals are at the right place to talk to these individuals and help them. Our objective should be to reduce the incidence of suicide. As mental health providers, we need to be aware that screening for suicidality be part of our initial evaluation, subsequent follow-up, and discharge disposition. In addition to the psychiatric evaluation for lethality, there are numerous suicide rating scales that are available and can be used to screen for suicidality in different clinical settings. The risk for suicidality can be determined by judiciously combining the psychiatric evaluations and the available suicide rating scales. We must be mindful that the underlying psychiatric syndrome is aggressively treated and managed. Our ultimate objective is to bring our patients back to their baseline in terms of their symptoms and functioning (if possible). Similarly, acute events and stressors must be managed appropriately. Drug and alcohol related issues have to be managed aggressively. Access to firearms must be evaluated regularly. Appropriateness for the level of care can be questioned on each visit. If it is decided that individuals are treated in an outpatient setting, appropriate and timely follow-up appointments for med management, therapy, substance use and abuse treatment, and case management need to be made. Resources available in the community include the Suicide Prevention Lifeline (1800 273 TALK) and Crisis Text Line (741741). The Suicide Prevention Resource Center, American Foundation for Suicide Prevention, SAMSHA, and NIMH should be used to educate family members, patients and mental health professionals. Judicious use of crisis, local law enforcement and local emergency room is paramount in decreasing the incidence of suicide. Let’s join hands and make every effort to reduce the incidence of suicide in our communities.
Ahmad