Suicide Risk

Prepared By: Rosemary Belfiore, Melanie Carvalho, & Samantha Richardson

TRC 302Professor; Dr. Babatunde Oyapero

Suicidal Thoughts Are thoughts about how to kill

oneself, which can range from a detailed plan to a fleeting consideration and does not include the final act of killing oneself.

(Medical News Today, 2014))

Understanding Suicidal Thoughts Suicide is a complex issue involving

numerous factors and should not be attributed to any one single cause.

People who experience suicidal thoughts and feelings are suffering from tremendous emotional pain.

Suicide is not about a moral weakness or a character flaw.

Individuals considering suicide feel as though their pain will never end and that suicide is the only way to stop suffering.

Understanding Suicidal Thoughts Cont…

People often associate suicide risk with the overall brain function, but it is more focused on the human emotions.

Right side of the Frontal Lobe, affects the social cognition which then affects the individuals feelings.

The Amygdala and Limbic system are the emotion centers and motivational portion of the brain.

(Marusic & Van Heeringen, 2003)

Factors of those at risk of committing suicide; Mental illness:Depression, schizophrenia, mood disorders,

substance abuse, bipolar disorder

Marital breakdown: Single, divorced or widowed individuals have

a higher rate for suicide related to married couples.

Lacking financial need:Financial or legal difficulties Employment/retirement difficultiesRelocation stresses

(Canadian Mental Health Association, 2014) (Statistics Canada, 2012) (Web MD, 2014)

Factors of those at risk of committing suicide cont..Declining physical health:Decline in ability to carry out daily tasks. Loss of independenceExample: Some people are discouraged to go on with

everyday life when they struggle to get through daily activities. The life they led before the declining physical health had a higher quality of life. Some people with cancer do not want to go through the process of chemotherapy and decide to attempt suicide.

Major loss: If someone has a family member, friend or significant

other that was always there for them and provided the support they needed, when they pass it can be extremely difficult to deal with. (Family Caregiver Alliance, 2006)

Factors of those at risk of committing suicide cont…

Absence of social support:If there is no family or friends to provide

support, one may feel alone in daily life.

Personality: Personality disorder, Emotional instabilityPoor coping skills, introversion

Family History:Of suicide, suicide ideation and mental

illness

Warning Signs The Association of Suicidology developed this tool that can help in detecting if a person is at risk of suicide:

(Sharing Hope & Resiliency, 2014)

Canadian Statistics In 2009 there were 3,890 suicides in Canada, a rate of 11.5

per 100,000 people.

More than 90% of the public who commit suicide have a mental or addictive disorder

Deaths by suicide, it should be noted, reflect only a small percentage of suicide attempts. It is estimated that for every completed suicide there are as many as 20 attempts.

Although males are more likely to die from suicide, females are three to four times more likely to attempt it.

This discrepancy may be due to the fact that females tend to use less fatal methods, such as poisoning (most common cause of self-harm hospital admissions)

Whereas, males tend to use more violent methods such as hanging and firearms.

(Statistics Canada, 2012)

Canadian Statistics Cont…Over the past ten years, the most

common methods of suicide in Canada has been hanging 44%, which includes strangulation and suffocation.

Followed by poisoning 25%, and firearm use 16%

(Statistics Canada, 2012)

Applying the Therapeutic Recreation Process with individuals with Psychological Disorders

Background Information

Amanda Clarke, 24 years old has been omitted to a psychiatric hospital after she attempted to commit suicide (poisoning).

It was then discovered that Amanda has a mental illness (Schizophrenia) that has caused her to have consistent suicidal thoughts and intentions over the past year.

This mental illness (Schizophrenia) has caused her to experience disturbed thinking, hallucinations, and social withdrawal.

Her decrease of self-esteem, shame, and high anxiety has been noticed.

It has also been noted that Amanda feels as though she is a burden and often rejected by others.

Due to her unstable state of mind she is often impulsive, agitated, and aggressive towards others.

Her Doctor has prescribed antipsychotic medication to help with the hallucinations of the voices she hears in her head.

Throughout Amanda’s life she has been very artistic and passionate for music.

Her physician has referred her to therapeutic recreation for evaluation and treatment.

Theory of Intervention Aristotelian Good Life Model (AGL)

Goal: Empower clients to overcome constraints that arise from illness, disability, oppression, etc.

Helps client to attain happiness

Promotes individual freedom and responsibility

Why we chose this model:o Help improve self-esteem, and help manage her

behaviourso It will help her overcome her suicidal thoughts

Help her feel happier o Give her a sense of freedom, as she will realize her

illness does not control her life

(Oyapero, 2014)

Assessment ProcessSelf Report Method:

We gathered data from interviews, questionnaires, and surveys.

The process is getting data directly from Amanda. One on one session with the client ask:

About their feelings: Do you feel tired of living? Have you been thinking about harming yourself

and/or ending your life? Why do you feel this way? Do you have any form of support from family

members, friends? About reasons to live

Who or what makes life so worth living that you would not harm yourself?

What are some leisure activities that you enjoy engaging in before these suicidal thoughts occupied your mind? (Oyapero, 2014)

Assessment Process Cont…

Observation:We observed Amanda behaviour in an

unobtrusive way. That way she was unaware that we were observing her.

Secondary Data Source: As TRS we also collected sources other then

directly from Amanda. We obtained this from family members, health

records, other professionals, and team documentation.

This allowed us to get an understanding of Amanda’s social and personal history, upbringing, dislikes, likes and etc.

Get information that Amanda may be holding back

(Oyapero, 2014)

How to assess if someone is at risk for suicide

1. Assess for suicide risk factors.2. Assess for suicide warning signs (IS PATH

WARM).3. Assess for psychological resiliency.4. Assess collateral information from the client

through assessment forms as well from secondary data (medical chart, family members, other providers).

5. Develop an action plan. 6. Seek consultation and/or assistance from

other professionals if you do not have specialized training in certain areas.

Assessment Form SAD PERSON Measures to see if the client is at a risk of committing suicide.

Looks at demographic, behavioural and psychosocial risk factors.

Rank each factor from 1 to 10, with 10 being the highest risk for suicide, anything above 5 is the suggested level for hospitalization

S = Sex A = Age D = Depression P = Previous attemptE = Ethanol abuse R = Rational thinking loss (psychosis)S = Social support lacking O = Organized suicide plan N = No spouse S = Sickness (chronic/severe)

(Goy, Hirdes, Martin, Neufeld & Perlman, 2011)

(Therapeutic Recreation Directory, 2014)

(Therapeutic Recreation Directory, 2014)

(Therapeutic Recreation Directory, 2014)

(Therapeutic Recreation Directory, 2014)

Planning • Plan is to implement an expressive art therapy

program.

• The plan for this program takes place about 3-4 times a week and last for a minimum of 6 months.

• It will help Amanda express her feelings through visual arts, acting/drama and music.

o This can help Amanda reduce any stress, while boosting her self-esteem.

• Immediate risk management

• Do not leave the person alone until you have arranged for the involvement of another appropriate care provider or source of protection

Planning Cont…

Short Term Goal:Amanda is willing to participate in the activity and she

is showing interest that she wants to improve as an individual.

Socializing in daily life and support groups. Specific goal = make a few friends from the

expressive art group and talk about common interests.

Long Term Goal:Be able to express emotions without being agitated Increase her self-esteem by being content with

herself

Planning Cont…

Discharge Goal: Improve quality of life by getting rid of suicidal

thoughts from her mind

Objectives:After 4 months in the expressive art class,

Amanda will: Have the confidence to bring a family member to

participate in the activity with her Be motivated and voluntarily participate in an

activity with increased self-esteem Talk with the TRS about the positive and negative

outcomes after taking part in the expressive art therapy.

Treatment and ManagementFoster hope in clients who are suicidal

Assist in finding and maintaining meaning and purpose in life

Attend to the therapeutic relationship

Work in a team setting – don’t work alone (collaborative care)

Consult colleagues, keep detailed notes, use crisis services

Restrict access to lethal means

Mental health outreach

Implementation of Expressive Art Therapy

Allow for Amanda to be creative in expressing her self artistically, resolve issues, mange her behaviours and feelings, reduce stress and improve self-esteem and awareness.

The one on one interaction with the TR will involve Amanda, keeping a journal of how her day is going. (ie. Things that make her happy, sad, angry)

The physician will place Amanda Clarke on medication that is intended to control her mental illness (schizophrenia) hallucinations.

In order for this plan to be placed into process, Amanda needs to consent to participating.

May Activity Calendar – Expressive Arts Program – 2014   

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

      1 

Journal Writing

2

1:30 – 2:00: Expressive Dancing  Journal Writing + One on One session with therapist

3

Journal Writing

4 

Journal Writing

5

1:30-2:00: Expressive drawing using paint Journal Writing   

6

 Journal Writing  

7 

1:30-2:00: Making Sculptures  Journal Writing

8 

Journal Writing

9 

1:30-2:00: listening to music  Journal Writing + One on One session with therapist

10 

Journal Writing

11 

Journal Writing

12

1:30-2:00: Expressive drawing with nature

Journal Writing   

13 

Journal Writing

14 

1:30-2:00 Playing with Instruments  Journal Writing

15 

Journal Writing

16 

1:30-2:00: Painting with emotions (water colouring)  Journal Writing + One on One session with therapist

17 

Journal Writing

Evaluation Objectives were accomplished by the hard

work of Amanda

The secondary data sources assisted in the therapy by providing a deeper understanding of how to assist Amanda’s needs

Her parents were able to provide the support she needed and offer additional information that the TRS may not know.

Amanda is able to improve her emotional states and be aware of when to control her aggressive behaviour.

(Good Therapy, 2014)

References Canadian Mental Health Association. (2014). The Relationship between Suicide and Mental Illness. Retrieved November 12, 2014, from http://toronto.cmha.ca/mental_health/the-relationship-between-suicide-and-mental-illness/

Family Caregiver Alliance National Center on Caregiving. (2006, March). Caregiver Health. Retrieved November 12, 2014, from https://caregiver.org/caregiver-health

Good Therapy. (2014). Expressive Arts Therapy. Retrieved November 12, 2014, from http://www.goodtherapy.org/expressive-arts-therapy.html#

Goy, M., Hirdes, J. P., Martin, L., Neufeld, E., & Perlman, C. (2011). Suicide Risk Assessment Guide: A Resource for Health Care Organization. Ontario Hospital Association and Canadian Patient Safety Institute. Retrieved from http://www.oha.com/KnowledgeCentre/Documents/Final%20-%20Suicide%20Risk%20Assessment%20Guidebook.pdf

Marusic, A., & Van Heeringen, C. (2003). Understanding the Suicidal Brain. The British Journal of Psychiatry. Retrieved from http://bjp.rcpsych.org/content/183/4/282.full

Medical News Today. (2014, September). What are suicidal thoughts and what is suicidal ideation. Retrieved November 12, 2014, from http://www.medicalnewstoday.com/articles/193026.php

Oyapero, B. (2014). Adaptive Recreation and Leisure Activities in TR [Powerpoint Slides]. King City, ON: Seneca College, TRC 302.

References Cont…Oyapero, B. (2014). History and Definition of Therapeutic Recreation [Powerpoint Slides]. King City, ON: Seneca College, TRC 302.

Sharing Hope & Resiliency. (2014). Know Suicide Warning Signs. Retrieved November 12, 2014, from http://suicideprevention.ca/preventing/warning-signs/

Statistics Canada. (2012, July 25). Suicide rates: an overview. Retrieved November 12, 2014, from http://www.statcan.gc.ca/pub/82-624-x/2012001/article/11696-eng.htm

Therapeutic Recreation Directory, (2014). Therapeutic Recreation Forms and Formats. Recreation Therapy Assessment/Treatment Plan. Retrieved from http://www.recreationtherapy.com/forms.htm

Web MD. (2014, February). What is Schizophrenia? Retrieved November 12, 2014, from http://www.webmd.com/schizophrenia/what-is-schizophrenia