Suicide awareness: CSP gives an accessible overview

Some health conditions increase a patient’s risk of suicide. Spotting the signs could help you save a life, says Daniel Allen


Men are three times more likely than women to take their own lives

Last year the CSP launched a document for CSP members on assessing patients’ risk of suicide and signposting them to more detailed resources. This clinical update summarises the document. For more information visit our website here. 
In 2013, 6,233 people over 15 years old took their own life, according to the Office for National Statistics. Most people who do so are not in contact with mental health services. Risk of suicide is often short-term and situation-specific. 
Suicide may be preceded by warning signs, or it may be done on an impulse.
This information provides key messages but is not intended as a management plan.

Physiotherapy context

In some contexts, physiotherapists may work with patients who are at greater risk of suicide than the general population because their condition impacts on known vulnerabilities and risk factors.
These contexts include long-term conditions, chronic pain, trauma and post-trauma, life-limiting conditions, unexpected catastrophic injuries, acquired brain and spinal cord injury, and mental health issues. 
Some people with these conditions may be having suicidal thoughts. While treating the patient, the physiotherapist may have an opportunity to notice distress, ask relevant questions and respond accordingly, potentially saving a life.
Detailed physiotherapy assessment and examination may identify verbal or behavioural cues indicating that the patient is experiencing difficulties and may be at risk of self-harm and/or suicide.

Key messages 

There is no single way to manage these situations. It is a matter of professional judgement. Your decisions may depend on the setting you work in, your role and your own skills and experience. But remember:
  • Your role is not to resolve the matter but to access the right care for the patient as soon as possible
  • Mental health conditions may affect any patient you work with
  • Maintain your own safety at all times
  • Use information gathered during your assessment to help access appropriate action
  • In an acute situation, seek advice from the key contact on the patient’s mental health crisis plan, but if they don’t have one, contact your local mental health crisis team or social services
  • For adult patients: consider providing details of local mental health services 
  • For child patients: consider whether a safeguarding referral/referral to children’s services is appropriate.
  • Clear records are essential. They help detail what has happened and assist other professionals.
  • Seek support for yourself as you may find it distressing.
Patient confidentiality and data protection do not mean that information cannot be shared in any circumstances.  If you honestly believe a patient is in danger, share as much information as necessary with another professional to protect the patient.

Things to look for

  • Phrases like ‘I don’t want to wake up’; ‘I wish I was dead’
  • Changes in mood or appearance 
  • Loss of interest, such as in hobbies or friends
  • Talking about or planning death; not taking medications; recent stressful events; inability to cope with pain. 

What to do

  • Don’t be afraid to ask questions
  • Be compassionate. Listen, don’t look shocked, don’t judge. Take it seriously
  • Explain you cannot keep this information to yourself
  • If the person has a social/key worker contact them
  • Encourage acceptance of help and support
  • Provide contact numbers, eg local crisis team
  • If under 18, stay with the young person, contact children’s services and social worker or key worker and possibly their family or carer
  • If there are immediate life-threatening risks call 999 

Key risk factors

Ninety per cent of patients who take their own life have a diagnosed psychiatric condition.
Certain factors are known to be associated with increased risk, including:
  • social factors such as unemployment, social isolation, poverty, family breakdown, imprisonment, bullying, loss of role, money
  • health factors such as drug or alcohol misuse or existing diagnosed mental health conditions, particularly depression and schizophrenia, chronic health conditions

Clinical considerations

  • Identify patients who have a mental health crisis plan in place before treatment starts. Where patients are known to be vulnerable, you should know what plans and support services are in place to help you assist your patient.
  • Identify behaviours that may indicate a patient is at risk of suicide. These are often highlighted as ‘yellow flags’.
  • Establish whether there is real and immediate danger to a patient’s life when the patient expresses suicidal thoughts.
  • Identify the appropriate person in your organisation to raise your concerns with and act swiftly.
  • Understand the limits of physiotherapy practice and your own scope of practice. 
  • Understand the limits of patient confidentiality in extreme circumstances and the need to share information quickly.
This feature is based on a recent CSP briefing and gives an accessible overview of a clinical issue of interest to all physio staff.

Daniel Allen

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