At our small psychiatric hospital I'm often tasked to talk to med students about suicide prevention. Few, if any, like a recent third year student, have had any exposure to suicide in class. There seems to be more of a literature about med students as victims of suicide than as future care providers to suicidal patients. Haywood et al. offer some guidance (http://www.tandfonline.com/doi/abs/10.1080/01421590701753542?journalCode=imte20). Other sources?
Hi Tony,
Unfortunately, I agree that there is a lack of med. specific resources in this area. We teach our second year med. students about suicide in their introduction to psychiatry block, and I have scavenged through the psychology, counselling and social work literature to try and find what I can (e.g. Article Personal and Professional Factors and Suicide Intervention Skills
, http://psycnet.apa.org/record/2013-09417-001)
I think it most important that all medical students understand the key indicators that show an increased probability that a patient will commit suicide. They need to understand this both for their own clinical practice and for safeguarding purposes. The type of indicators I have in mind are
- talking about committing suicide
- talking about specifics - e.g. means, timing
- feeling they have nowhere to turn and that the position is hopeless
- lack of protective factors
They are well set out in many classic texts on the subject. I don't think there is any need to go to med student specific resources because this literature is not specific to medicine but to all who practice with vulnerable people.
I don't have a ready reference to hand, but there is a considerable literature within clinical psychology regarding suicide and assessing its risk, as previous replies have suggested.
As some general points which you may well already be aware of:
Suicidality is often assessed along a spectrum of (1) the occurrence and frequency of suicidal ideation (i.e., thoughts about and/or images of killing oneself); (2) the possession of practical plans, including any access to lethal means; and (3) a stated intention to commit suicide and/or a history of past attempts.
Frequently included as part of an assessment is asking a client straightforwardly how likely they feel it is that they might harm themselves. Therapeutic rapport and sensitivity is of course called for on the part of the therapist, but many clients actually end up welcoming that sort of straightforward discussion.
When speaking with clients about suicidality I often find it helpful to bear in mind (and where appropriate, share with the client) two somewhat divergent facts:
- many people who commit suicide have already attempted it before, at other times in their life - a history of prior attempts is a definite risk factor;
- and, on the other hand, many people who survive suicide attempts are, within a matter of months, typically quite grateful that they did not succeed.
A great preponderance of suicide attempts occur during times that persons' cognitive processes are impaired - namely, in depression, when they literally see themselves, others, and the world differently than they do when they're not in a depressive episode. And it is extremely common within a depressive episode to have thoughts like "I wish I wasn't here", as well as fantasized images of ending one's life. Both normalizing the occurrence of that kind of ideation (which can range from vague to specific), while also educating a client of the difference between ideation and actual planning (with the latter being a significant red flag), can of course be helpful to the client. And knowing when an active intervention is called for, as someone evidences an imminent danger of self-harm, and the steps for enacting that intervention (viz., an involuntary hold), is of course a required skill of a healthcare provider.
The medical students should learn the basics of logotherapy where an instantly reachable goal can be at hand by means of a discussion. Thinking about a short-term goal- completing something at hand first- thinking about an other person, something that for a moment "transcends" the person's sense of hopelessness. A doctor used to suggest that a girl should go and sit down in a church for 15 min before she again tried her suicide (The doctor was not a believer).
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