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Presented by: Carmen Loucks, BScPhm Candidate
HOW TO SAVE A LIFE:SUICIDE PREVENTION IN PHARMACY
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Why You Should Care• http://www.youtube.com/watch?v=2199PPD8fRw
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Why I Chose This Topic
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What would you do…?• Conducting a MedsCheck with Mr. ST
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Outline •Why pharmacist should play a role
• Assess the risk of a suicidal patient
• Intervene appropriately with a suicidal patient
• Identify available resources
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WHY PHARMACISTS SHOULD PLAY A ROLE
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Why Pharmacists?• Accessible, available, knowledgeable
• “Gatekeepers”
• Trusted by patients
• Frequent monitoring
• Nonadherence to antidepressants
• Method of choice = drugs
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ASSESS THE RISK OF A SUICIDAL PATIENT
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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.
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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
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Who is at higher risk?
Patient A (Male) or Patient B (Female)
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Who is at higher risk?
Patient A (Elderly) or Patient B (Young)
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Who is at higher risk?
Patient A (Married) or Patient B (Single)
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What to Look ForBehavioural Clues:
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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”
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Protective Factors • Children at home
• Pregnancy
• Religious faith
• Employment
• Social support system
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INTERVENE APPROPRIATELY WITH SUICIDAL PATIENTS
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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!
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Initial Contact• Step #1 – Find a private place
• Step #2 – Allocate the necessary time
•Step #3 – Listen!!!
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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?”
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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?”
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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?”
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Risk Level
Low
• Some ideation• No plan
Mod
• Ideation• Vague plan but no immediate plans
High
• Ideation• Specific plan and timeframe established
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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)
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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”
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Risk Factors• Male• Major depressive disorder• Job loss• Verbal clues
Protective Factors• Married• Kids at home• No previous suicide attempts
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Mr. ST’s Risk
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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
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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..”
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Mr. ST’s Risk
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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
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IDENTIFY AVAILABLE RESOURCES
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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
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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
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True or False•Doctors, pharmacists and veterinarians have higher than average suicide rates.
TRUE
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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
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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
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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!!!
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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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