What about Suicidal Thoughts

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suicidal and changing bad thoughts

What are the Wrong Thoughts, How to Make it Right?

According to the World Health Organization, suicide rates have been dropping around the world but in the U.S., suicide now ranks in the top 10 leading causes of death. Deaths from suicides also rose faster between 2016 and 2017 than in previous years, increasing four percent from 13.9 to 14.5 deaths per 100,000.  The 2017 increase was the largest since the data collection began in 1999. For the previous decade, between 2008 and 2017, suicide rates increased an average of 2 percent per year, a 22 percent total increase.

-https://www.tfah.org

This means that America’s suicide rates are getting worse and mental health is becoming more crippling. Americans are the leaders of health care spending and innovation but the care providers need to look at how our suicide situation is getting worse.

Why do people commit suicide? An important rhetorical question since the ultimate reasons (even with a note) is primarily unknown. The aftermath should still be analyzed because maybe it can prevent someone else from taking their own life, increase awareness, and make people wonder how to avoid or manage such situations in the first place. Here’s a small compilation of certain thoughts that needs to be further evaluated or can lead to self-harm:

People having thoughts to escape

These thoughts mainly affect children who are being bullied or victims of abuse and violence. It is important to ask about the home/school/work environment, or places where a person should generally feel protected. If a person does not feel safe, suicide is probably considered a means of survival (to obtain some type of relief). This distortion is possible because the fears of not escaping are similar to someone jumping out of the window in a house fire to survive, where the leap is better than catching on fire. When a patient is dealing with a harmful environment, assess the situation first. Abuse is a mandatory reportable offense and may require getting authority and protective services involved. Let the person know they’re not alone and help is available, give them hope, and redirect the thought process so they are aware of other options or outlets that don’t require something extreme.

A person wants to send a message or make a statement

An example of this is when people constantly feel misunderstood i.e. the LGBTQIA (lesbian, gay, bi, trans, queer/questioning, intersex, asexual) community and ultimately gets tired of feeling frustrated, hence they want to make an ultimate point once and for all.  In addition, they have to deal with rejection, stigmas and risk further isolation despite having an empowering community or social support. However, individually, many people continue to struggle with their sexuality/identity and feel like they’re dealing with multiple extremes; either their identity is very hidden and secretive or on the other side of the spectrum. When I have a patient from this category, I try to redirect their thoughts in terms of moderation and tranquility. This group, in particular, needs help with trying to restore balance because they’ve dealt with a lot of emotional and physical trauma. Assess for adverse childhood experiences and help them find healthier ways to manage their stress and improved their coping skills.

A person may feel so numb and desensitize that significant mutilation is no longer considered a threat

The people I think about in this category, have traumatic suicides i.e. jumping from high places, in front of traffic and trains, gunshot to major organs…etc. some may assume these people want a 100% success rate but in my opinion, they wanted to show the biggest cry for help and had the biggest red flags. As a care provider, assess for major changes in a person’s life or personality and develop a crisis plan, and be aware of the populations at the highest risk of suicides (by SAVE):

  • A history of mental disorders, especially mood disorders, schizophrenia, anxiety disorders, and certain personality disorders.
  • Alcohol and other substance abuse issues.
  • Impulsive and/or aggressive tendencies.
  • History of trauma or abuse.
  • Major physical or chronic illnesses.
  • Previous suicide attempt or a family history of suicide.
  • Recent job, financial or relationship loss.
  • Easy access to lethal means.
  • Local suicide clusters.
  • Lack of social support and a lack of health care, particularly mental health and substance abuse treatment.
  • Exposure to others who have died by suicide.

Thoughts of profound stress, disappointment, and grief…

Sometimes a traumatic event comes after a dramatic change in a person’s life i.e. dropping out of school, the death of a loved one, divorce, life-changing condition, accident, or injuries. Even good changes such as a new pregnancy, going to medical school, or becoming a CEO can cause great distress. Bottom line, some circumstances can affect a person for the rest of their life.  As a care provider, you already know to assess for changes and you can’t change the reality, but you can alter the emotions associated with them. Even if there are other concerns, consistently assess how a person is dealing with their greatest “life change” because the difficulties should be prioritized.  Sometimes, in order to cope with something significant, the person may have to be assisted in the form of the grief cycle and adjust to a new reality. The grief consists of the current stressor or denial while guiding the person towards a level of stability:

suicide and grief

Thoughts of how recovery and improvement is not possible or doesn’t matter

People who have multiple relapses or dealing with extreme situations i.e. a person lost 2 family members and just got diagnosed with cancer may struggle with improving their circumstances because the stressors are greater than what they feel is controllable. However, always try to give a patient hope, whether it’s related to an illness or not REMAIN POSITIVE, once again a person can control how they respond to circumstances. Discuss and highlight the patient’s resilient and protective factors. Empathize but set realistic goals and then guide them to a healthier path. People who are in a downcasted mood or situation need help with their self-esteem and need a healthy outlet to not internalize more pain and fall into despair.

Suicidal thoughts related to untreated mental illnesses (worsening fear, depression, and paranoia) or substance use

The problem with substances, including marijuana is how it alters a person’s perception. Instead of engaging in the environment and with people, chemical and neurological changes due to drugs or mental illnesses can alter one’s reality and lower their cognition skills. Therefore, the person may indulge in riskier behaviors or have distorted thoughts that can lead to having poor outcomes. The health provider can not prevent every suicide, but frequent assessments will help the practitioner get more comfortable with discussing such topics and bring greater awareness, so the most vulnerable populations can receive better treatment a lot quicker.

How to Talk

If you’re unsure whether someone is suicidal, the best way to find out is to ASK. You can’t make a person suicidal by showing that you care. In fact, giving a suicidal person the opportunity to express his or her feelings can provide relief from loneliness and pent-up negative feelings, and may prevent a suicide attempt.

Ways to start a conversation about suicide:

  • “I have been feeling concerned about you lately.”
  • “Recently, I have noticed some differences in you and wondered how you are doing.”
  • “I wanted to check in with you because you haven’t seemed yourself lately.”

Questions you can ask:

  • “When did you begin feeling like this?”
  • “Did something happen to make you start feeling this way?”
  • “How can I best support you right now?”
  • “Have you thought about getting help?”

What you can say that helps:

  • “You are not alone in this. I’m here for you.”
  • “You may not believe it now, but the way you’re feeling will change.”
  • “I may not be able to understand exactly how you feel, but I care about you and want to help.”
  • “When you want to give up, tell yourself you will hold off for just one more day, hour, minute—whatever you can manage.”

-by Helpguide.org

Protective factors

Even if someone displays both warning signs and risk factors, that doesn’t mean that they are beyond being helped. SAVE notes that having these protective factors in place can help a person to realize that they are not alone and things will get better, even if they’re in their darkest hour. Protective factors to promote are:

  • Having clinical care for mental, physical and substance use disorders.
  • Providing access to a variety of clinical interventions.
  • Restricting access to highly lethal means of suicide.
  • Having strong support through family and community connections.
  • Support through ongoing medical and mental health care relationships.
  • Skills in problem-solving, conflict resolution and handling problems in a nonviolent way.

-SAVE Notes

I’m not sure if I was completely clear but I definitely was not trying to offend or trigger anyone and wish there were better solutions…thanks for reading! Also see:

 

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