Bape ote Se eye 2015 Stores semper (ec sinocporta | Femocsony ENP, pert (ie) 2015 ge Sembee ‘Orgenesion oH) Are there warning signs for suicide? Nicholas Proc A d Mc Suicidal behaviour can have profound and lasting impacts on the individual, as well as their family, friends, and the wider community. The aim of this article is to deepen nurses and midwives understandings of how the work they do intersects with the lives of people who are suicidal ka uson Suicide and suicidal behaviour are ‘major public health concerns (VASP, 2015}. Globally each year more than 800,000 people die by suicide (WHO, 2015) This corresponds to approximately one death by suicide every 40 seconds. Significantly suicide attempts and suicidal ideation are far more common than suicide deaths. The number of suicide attempters is believed to be up to 20 times the number of deaths by suicide In Australia some 2,500 people die by suicide each year (Suicide Prevention Australia, 2015), Suicide deaths are not limited to adults. Data from the Australian Human Rights Commission (2014) reveals that between 2007 and 2012, 333, children aged 4-17 years died due to intentional seltharm (64% male; 20% Aboriginal). OF these deaths, 81% were by hanging and 76% occurred at the young person's home. Much-needed attention is being given to preventing suicide across the lifespan (Suicide Prevention Australia, 2015b). Below is 2 consensus list of warning signs to indicate a young person might be at risk of suicide (Youth Suicide Warning Signs, 2013) 1. Talking about or making plans for suicide. 2, Expressing hopelessness about the future. 3. Displaying severe/overwhelming ‘emotional pain or distress. 4, Showing worrisome behavioural ‘ues or marked changes in behaviour, particularly in the presence of the warning signs above. Specifically, this includes significant + withdrawal from or changing in social connections/situations; + changes in sleep (increased or decreased) + anger or hostility thet seems out of character or out of context; + recent increased agitation or initabilty Warning signs have also been identified for adults. Recent findings from the BRIDGE-|I-MIX study (ECNP, 2015) reveal that ‘depressive mixed states’ - when a person is depressed, but also has excitation ~ often precede suicide attempts. The risk of attempting suicide is st least 50% higher for a person diagnosed with depression and experiencing any of the accompanying signs: 1. Risky behaviour (eg. reckless diving, promiscuous behaviour) 2. Psychomotor agitation (pacing around a room, wringing hands, pulling off clothing and putting it back on or other similar actions) 3. Impulsivty (acting on a whim, displaying behaviour characterised by litle or no forethought, reflection cor consideration of the consequences) Understanding warning signs {and implementing prevention strategies is clearly a much broader task than understanding and responding to mental illness Suicidal behaviour is a complex interaction of social, economic, personal and situational variables (Suicide Prevention Australia, 2015a) A gentle probing inquiry to support the person in distress is considered best practice; see www.youtube. com/watch?v=WdC3nhxA66U (UniSA 2015) Aso important are cultural ‘explanatory models specifically relating to how people from cultural and linguistically diverse backgrounds understand the concepts of mental distress; how they perceive themselves and those around them; how they ‘communicate distress; when, how and why they seek help; and what they perceive as a good outcome. Person-centred care at the time of responding to people demonstrating suicidal warning signsis critical. A person-centred ‘approach is concerned with human connectedness: the capacity for feelings to be received and Understood, and lives to be revealed (Procter eta. 2014). Being in despair in deep distress and frightened ‘may mean some people ruminate without openly discussing what is Con their mind (Nicolai et a. 2015) Rumination, a cognitive emotion regulation strategy, may increase the likelihood of selharming behaviour. Others struggle for words and may express themselves in ways that family, work colleagues, health professionals and even those who have previously been suicidal, are not familia. Simple steps such as speaking up when worried about someone, and learning how to start conversations around suicide are essential to responding to suicide warning signs (beyondblue, 2015} G Professor Nicholas Procter, RN MBA PhD is Professor and Chair: Mental Health Nursing at the University of South Australia G Dr Monika Ferguson, PhD is Research Associate, School of Nursing and Midwifery, University of South Australia Praha) PELE TEL) 1300 789 978 anmi.org.au November 2075,Volume 28,No.S 3