how to save a life: suicide prevention in pharmacy
Post on 19-Jan-2016
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Presented by: Carmen Loucks, BScPhm Candidate
HOW TO SAVE A LIFE:SUICIDE PREVENTION IN PHARMACY
Why You Should Care• http://www.youtube.com/watch?v=2199PPD8fRw
Why I Chose This Topic
What would you do…?• Conducting a MedsCheck with Mr. ST
Outline •Why pharmacist should play a role
• Assess the risk of a suicidal patient
• Intervene appropriately with a suicidal patient
• Identify available resources
WHY PHARMACISTS SHOULD PLAY A ROLE
Why Pharmacists?• Accessible, available, knowledgeable
• “Gatekeepers”
• Trusted by patients
• Frequent monitoring
• Nonadherence to antidepressants
• Method of choice = drugs
ASSESS THE RISK OF A SUICIDAL PATIENT
True or False• The majority of people who commit suicide have a
mental disorder..
TRUE
About 90% of suicidal patients have a diagnosable mental disorder.
Risk Factors•Depression•Previous suicide attempt• Alcoholism• Schizophrenia• Painful and chronic conditionsEpilepsySpinal or head injuries and strokeCancerHIV/AIDSOther (ie. diabetes, MS)Difficulty walking, seeing and hearing
Who is at higher risk?
Patient A (Male) or Patient B (Female)
Who is at higher risk?
Patient A (Elderly) or Patient B (Young)
Who is at higher risk?
Patient A (Married) or Patient B (Single)
What to Look ForBehavioural Clues:
What to Look ForVerbal Clues:“I want to kill myself” “I want to die”
“I’ll never get out of it”
“They’d be better off without me”
“I have made my will”
Protective Factors • Children at home
• Pregnancy
• Religious faith
• Employment
• Social support system
INTERVENE APPROPRIATELY WITH SUICIDAL PATIENTS
True or False• People who attempt suicide do not want to
talk about it.
FALSEThe best way to find out if your patient has suicidal thoughts is to ask them!
Initial Contact• Step #1 – Find a private place
• Step #2 – Allocate the necessary time
•Step #3 – Listen!!!
What to AskTo determine their current mental state:
• “Do you feel sad?”
• “Have you ever felt that life was not worth living?”
• “Did you ever wish you could go to sleep and just not wake up?”
• “Have things ever reached the point that you’ve thought of harming yourself?”
What to AskTo determine their plan:
• “How likely do you think it is that you will act on them in the future?”
• “Have you made a specific plan to harm or kill yourself?” (If so, what does the plan include?)
• “Is the means readily available to you?”
• “When are you planning to do it?”
What to Ask…To determine what their support system is:
• “What things would lead you to feel more (or less) hopeful about the future?”
• “What things in your life make you want to go on living?”
Risk Level
Low
• Some ideation• No plan
Mod
• Ideation• Vague plan but no immediate plans
High
• Ideation• Specific plan and timeframe established
Suicide Risk Assessment Scales• No evidence to support using only summary scores to determine acute risk
• Predictive value is low BUT the actual content covered by the questions is important
• Useful for pharmacists:SAD PERSONSTASR (Tool for Assessment of Suicide Risk)
Back to Mr. ST• 46-year-old male• Married 23 years• 3 kids at home
• Major depressive disorder, Hypertension• No previous suicide attempts• No suicidal plans• Celexa 20mg daily, Apo-Hydro 25mg
daily, Altace 10mg daily• Lost his job• Struggling financially
• “I don’t know what to do, I don’t think I’ll ever get out of it”
Risk Factors• Male• Major depressive disorder• Job loss• Verbal clues
Protective Factors• Married• Kids at home• No previous suicide attempts
Mr. ST’s Risk
How to Manage Low Risk PatientOffer emotional support
Encourage the person to talk openly in order to resolve suicidal feelings
Cast doubt
Refer the person to a mental health professional or a doctor
Meet at regular intervals
Mr. ST Returns• 1 year later• Divorced, not living with his children• Celexa increased dose• Still unemployed• Drinks 4-5 drinks/day
• Came to the pharmacy to get his medications, asking you to dispense a larger quantity• After probing, admits he will use the
drugs to kill himself• Timeframe <48h
• “The world is better off without me If you don’t give the meds to me, I have rope at my house..”
Mr. ST’s Risk
How to Manage a High Risk Patient Stay with the person
Gently talk to the person and remove the means of suicide (ie. pills, knife, rope etc.)
Make a suicide prevention or “no-harm” contract
Contact a mental health professional or doctor immediately
Arrange for ambulance and hospitalization
Inform the family and enlist support
IDENTIFY AVAILABLE RESOURCES
Crisis Lines• Distress Centre: Distress line, 24/7 Crisis Line
Canadian Mental Health Association/Waterloo Region Branch
• Ontario Association of Distress Centreswww.dcontario.org
• Ontario Suicide Prevention Network
www.ontariosuicidepreventionnetwork.ca
Useful Resources INTERNATIONAL• World Health Organization (WHO)
http://www.who.int/mental_health/prevention/suicide/suicidepreve
nt/en/index.html
Guidelines for Primary Health Care Workers 2009
NATIONAL• Canadian Association for Suicide Prevention (CASP)
www.suicideprevention.ca
Guidelines September 2009• Centre for Suicide Prevention (Alberta)
http://suicideinfo.ca/Library/Resources.aspx• Canadian Patient Safety Institute (CPSI) and Ontario Hospital Association
http://www.patientsafetyinstitute.ca/English/toolsResources/SuicideRisk/Documents/Suicide%20Risk%20Assessment%20Guide.pdf
Suicide Risk Assessment Guide 2011
LOCAL
Waterloo Region Suicide Prevention Strategy 2006-2011
True or False•Doctors, pharmacists and veterinarians have higher than average suicide rates.
TRUE
Professionals Health Program• Offer advice, help, and support to physicians, pharmacists and veterinarians and members of their families who may have substance abuse disorders and/or psychiatric disorders
• OPA Website Membership Support
Please Visit My Website Ever wondered…
• What you would do if you received a prescription for a lethal dose of secobarbital
• About medications used to treat suicide
• What a suicide cluster is and what can be done about it
http://www.howtosaveapatientlife.weebly.com
Summary• Pharmacists frequently come in contact with the public and are ideally positioned to monitor for depression and nonadherence to antidepressants
• Important to be able to identify individuals at risk of suicide
• Use probing questions to determine whether the individual is low, moderate or high risk
•Remember that most patients contemplating suicide WANT to talk about it!!!
References • Vincent, P. (2013, January 10). Suicide Prevention in Pharmacy. Powerpoint
lecture presented at Professional Development Week in Montreal.• World Health Organization (2000). Prevention Suicide: A Resource for Primary
Health Care Workers. Geneva, SZ. • Perlman CM, Neufeld E, Martin L, Goy M, & Hirdes JP (2011). Suicide Risk
Assessment Inventory: A Resource Guide for Canadian Health care Organizations. Toronto, ON: Ontario Hospital Association and Canadian Patient Safety Institute.
• Ontario Association of Distress Centres. www.dcontario.org.• Ontario Suicide Prevention Network. www.ontariosuicidepreventionnetwork.ca• Centre for Suicide Prevention (Alberta)
http://suicideinfo.ca/Library/Resources.aspx• http://www.psychpage.com/learning/library/counseling/suicide.html• Lenard, H. (2006). Waterloo Region Suicide Prevention Strategy. Waterloo, ON:
Waterloo Region Suicide Prevention Strategy Planning Group. • Professionals Health Program. http://php.oma.org/• OPA Website. http://www.opatoday.com/index.php/membership/support-
services.html
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