S.

NO TIME SPECIFIC CONTENT TEACHING AV EVALUATION

OBJECTIVES LEARNING AIDS
ACTIVITIES
1 2min Introduce the INTRODUCTION Student teacher
topic introduce the
Suicide is the model of psychiatric emergencies and is also the
topic
commonest cause of death among the psychiatric patients. Suicide is death
caused by injuring oneself with intent to die. DSH is an act of intentionally
injuring oneself, irrespective of the actual outcome.
An attempted suicide is an unsuccessful suicidal act with a nonfatal
outcome. It is believed that 2-10% of all persons who attempt suicide,
eventually complete suicide in the next 10 years.
A suicidal gesture, on the other hand, is an attempted suicide where the person
performing the action never intends to die by the act. However, some of these
persons may accidentally die during the act. Attempted suicide is more common
in women while completed suicide is 2-4 times commoner in men.

2 2min Define suicide MEANING Student teacher Define

explains about suicide?
A suicidal attempt is when someone harms themselves with any intent to end
suicide
their life, but they do not die as a result of their actions. Suicide is a type of
deliberate self-harm (DSH) and is defined as a human act of self-intentioned
and self-inflicted cessation (death). It ends with a fatal outcome.

Student teacher List down the

COMMON THEMES IN SUICIDE
3 2min List down the list down the common
common 1. A crisis that causes intense suffering with feelings of hopelessness and common themes in
themes in themes in suicide?
helplessness
suicide suicide
2. Conflict between unbearable stress and survival
 3. Narrowing of the person’s perceived options
4. Wish to escape (it can often be an escape, rather than a going-towards)
5. Often a wish to punish self and/or punish significant others with guilt

4 2min Describe the EPIDEMIOLOGY OF SUICIDE Student teacher Describe the

epidemiology describe the epidemiology
Suicide is among the top 10 causes of death in India and most other
of suicide epidemiology of suicide?
countries. According to the National Crime Records Bureau (NCRB), there of suicide
were 125,017 suicides in India, which is an increase of 1.95 over the previous
year. In India, the highest suicide rate is in the age group of 15-29 years. Some
of the highest numbers of suicide in India are reported from West Bengal
(11.9% of all cases), Tamil Nadu, Maharashtra, Andhra Pradesh and Karnataka.
These five states account for 56.2% of all suicides in the country.

5 2min Enlist the METHODS USED Student teacher

common enlist the Enlist the
In India (NCRB 2008), the commonest modes of committing suicide are
menthods used common common
ingestion of poison (34.8%) followed by hanging (32.2%), burning (about methods used methods used?
8.8%), drowning (about 6.7%), jumping in front of a train or another vehicle
(3%) and ‘alcoholism’ (1.2%). There were also about 3038 ‘dowry deaths’ in a
year in 2008. Men often tend to use more violent methods for suicide as
compared with women.

6 4min Explain the Student teacher Explain the

etiology of ETIOLOGY explain the etiology of
suicide etiology of suicide?
• Clients with psychiatric disorder e.g. Depression, Schizo, substance suicide
abuse, post-traumatic stress disorder, borderline personality disorder.
 • Chronic medical illness e.g. Cancer, HIV/aids, head and spinal cord
injury.
• Environmental factors e.g. Isolation, any recent loss, lack of social
support, unemployment, critical life events like death or a loved one,
divorce etc
• Behavioural factors.
• Impulsivity and unexplained changes from usual behavior.
• Unstable life style.

7 5min Explain the RISK FACTORS Student teacher Explain the

risk factors for explain the etiology of
suicide The risk of completed suicide increases in SAD PERSONS. It means etiology of suicide?
• Sex – male suicide

• Age – adolescents and age more than 40 years

• Depression – risk about 25 times more in depression than normal
• Previous history of suicidal attempts
• Ethanol – history of alcohol or drug dependence
• Rational thinking loss due to mental illness
• Severe illness – presence of severe disabling, painful or untreatable
physical illness
• Organized plan – suicidal preoccupation particularly, if a ‘suicide
note’ is written or detailed plans are made for committing suicide.
• No spouse – being unmarried, divorced, widowed or separated
• Social isolation
 SAD Person Scale
SCORE RISK OF SUICIDE
0-2 No real problems, keep watch
3-4 Send home, but check frequently
5-6 Consider hospitalization involuntary or voluntary, depending
on your level of confidence on follow-up
7 - 10 Definitely hospitalize involuntarily or voluntarily

Risk factors for completed suicide and suicide attempts

SUICIDE ATTEMPTS COMPLETE SUICIDE
Females Males
Previous suicide attempt and Previous suicide attempt and
ideation ideation
Major or minor depressive disorder Familial psychiatric disorder and
Substance abuse completed suicide attempt
Antisocial behaviour Mood disorder – 60%
Undesirable life events Alcohol or drug abuse
Problems with parents, partners, Antisocial behaviour
school or work loss in males Acute life crisis
Sexual or physical abuse Disciplinary crisis/ dispute with
friend or parent
8 3min Enumerate the COMMON MISCONCEPTIONS ABOUT SUICIDE Student teacher Enumerate the
common Enumerate the common
misconceptions • People who talk about suicide do not complete suicide. common misconceptions
in suicide • People who attempt suicide really want to die. misconceptions in suicide?
in suicide
• Suicide happens without any warning.
• Once people decide to die by suicide, there is nothing you can do to
stop them.
• All suicidal individuals are mentally ill.
• Once a person is suicidal, he is suicidal forever.

MEDICO LEGAL ASPECTS

Under the Indian law, suicide and attempted suicide are punishable offenses.
Section 309 of IPC (Indian Penal Court) states that “whoever attempts to
commit suicide and does any act towards the commission of such offense, shall
be punishable with simple imprisonment for a term which may extend to one
year and shall also be liable to fine”. It was argued that the law esteems the lives
of men as not only valuable to their own possessors but also valuable to the
State which protects them and for the protection of which the State exists. The
State, therefore, had the right to prevent persons from taking their own lives.
However, it compounded the sufferings of a person who survived after a suicide
attempt by making him/her a punishable offender. The Section 309 of IPC was
repealed by the Supreme Court of India in 1994. However, in March 1996, a
five judge Constitution Bench of the Supreme Court again made the ‘attempt to
suicide’ a punishable offense. So, the Section 309 IPC continues to be valid at
present .
9 10min Describe the PREVENTION OF SUICIDE Student teacher Describe the
prevention of describe the prevention of
suicide prevention of suicide?
September is suicide prevention awareness month suicide
Warning signs of suicide
• Feeling like a burden
• Being isolated
• Increased anxiety
• Feeling trapped or in unbearable pain
• Increased substance use
• Looking for a way to access lethal means
• Increased anger or rage
• Extreme mood swings
• Expressing hopelessness
• Sleeping too little or too much
• Talking or posting about wanting to die
• Making plan for suicide

Five steps to help someone at risk

• Ask
• Keep them safe
• Be there
• Help them connect
• Follow up
 Helpful / harmful attitudes towards a suicidal parson
A suicidal individual feels relieved by
• Someone who will listen to them – some who has the time, who will
undivided attention in a non critical manner without trying to advice or
intrude.
• Somenone whom they can trust – someone who will treat them with
dignity and keep their confidentiality.
• Someone who shows care – someone whom they can approach, who
will offer empathetic and unconditional friendship.

A suicidal individual is disturbed by

• Rejection by fellow beings. Having someone to tuen to makes all the
difference.
• Advices. No one like to belectured about his/her own life.
• Criticism. Harsh judgemental attitudes can be very hurting.
• Interrogative approaches. Undue probing into affairs, seeking
explanation for past actions etc. can further increase their mental
stress.

MANAGEMENT OF THE SUICIDAL PATIENT

10min Explain the Student teacher Describe the
10 management of Once suicide is committed, it is obviously no longer treatable. The describe the prevention of
suicidal patient management of suicide, therefore, lies in preventing the act. This can be done prevention of suicide?
suicide
at suicide prevention centres, crisis intervention centres (both of these are not
available as yet on a large scale in India), psychiatric emergency services,
medical emergency services, social welfare centres (such as Samaritans,
Sanjivini, Maitri, Sumaitri, Be frienders International) or even at home of the
patient.
Some important steps for preventing suicide include:
1. Take all the suicidal threats, gestures and/or attempts seriously and notify a
psychiatrist or a mental health professional.
2. Psychiatrist (or a mental health professional) should quantify the seriousness
of the situation (a proper risk assessment) and take remedial precautionary
measures.
i. Inspect physical surroundings and remove all means of committing
suicide, such as sharp objects, ropes, drugs, firearms, etc. Also, search the
patient thoroughly.
ii. Surveillance, depending on the severity of risk.
3. Acute psychiatric emergency interview.
4. Counselling and guidance
i. To deal with the desire to attempt suicide.
ii. To deal with on-going life stressors, and teaching coping skills and
interpersonal skills.
5. Treatment of the psychiatric disorder(s) with medication, psychotherapy
and/or ECT. ECT is the treatment of choice for patients with major depression
with suicidal risk. It should also be used for the treatment of suicidal risk
associated with psychotic disorders. Follow-up care is very important to prevent
future suicidal attempts or suicide.
The general management of the suicidal individual is as follows.
Aggressively treat underlying Hospitalization if needed
disorder Medications
Psychotherapies
Hospitalization
Treat suicidality directly Safety plan development
Safety plan development
Stabilize risk and enhance protective
factors

The treatment of suicide with empirical support is as follows.

Medications
Lithium
Antidepressants
Clozapine
Psychotherapies
CBT for suicide prevention
DBT
Family-focused treatment (as adjunct for bipolar disorder)
Other
Post-discharge contact (postcards, calls,
e-mails)
ECT
11 4min List down the ROLE OF NURSE Student teacher List down the
role of nurse list down the role of nurse?
• Initiate suicidal precautions role of nurse
• Remove harmful objects
• Do not leave the client alone
• Provide a non judgmental caring attitude.
• Develop a nonsuicidal contract that is written, dated, and signed and that
indicates alternative behavior at times of suicidal thoughts.
• Encourage the client to talk about feelings and to identify positive
aspects about self.
• Encourage active participation in own care.
• Keep the client active by assigning achievable tasks.
• Check that visitors do not leave harmful objects in the client’s room.
• Identify support system
• Do not allow the client to leave the unit unless accompanied by a staff
member.
• Continue to assess the client’s suicide potential.
STUDENT REFERENCE
• Townsend MC. Psychiatric and mental health nursing: Concepts of care in evidence based practice. 6th ed. Philadelphia: FA Davis and company;
(2009).208-9.
TEACHER REFERENCE
• Stuart WG. Principles and practices of psychiatric nursing. 9th ed. St. Louis Missouri: Mosby Publishers; (2009). 586-9.
• Ahuja N. A short textbook of psychiatry. 7th ed. NewDelhi: Jay Pee brothers medical publishers; (2011).221-9.
• Sadock JB, Sadock VA, Ruiz P. Kaplan and sadock’s comprehensive textbook of psychiatry. 9th ed. St. Louis Missouri: Lippincott Williams and Wilkins;
(2009).2734-42.
• Worret Holiday F. Psychiatric & Mental Health Nursing. 5th edition. St. Louis Missouri: Elsevier publishers; (2012). 220-5.
• Mohr K.W. Psychiatric & Mental health Nursing: Evidence based Concepts, Skills & Practice. 7th edition. China: Lippincott Publishers; (2009). 182-5.
• Tasman A, Kay J, Liberman JA, First MB, Riba MB. Psychiatry. 4th ed. Chichester: Wiley Blackwell publishers; (2015). 2492-512.
SUBJECT - Mental health nursing – II

TOPIC - Suicide prevention

DATE/TIME -

GROUP - B.Sc. Nursing 3rd year students

METHOD OF TEACHING - Lecture cum discussion

DURATION - 60 mins

AV AIDS - PPT, OHP, chart, pamphlet, leaflet, flannel board

LANGUAGE - English

NAME OF THE STUDENT TEACHER - Vaideeswari.K

NAME OF THE EVALUATOR - Mrs. Jaysri

GENERAL OBJECTIVES

At the end of the session, the students will gain in-depth knowledge and skill regarding suicidal prevention, its management and role of nurse and develop
a positive attitude towards the same and apply the knowledge in their practice.

SPECIFIC OBJECTIVES

At the end of the session, the student will able to

 define suicide
 explain the etiology of suicide
 enlist risk factors of suicide
 enlist the common themes of suicide
 list down the prevention of suicide
 explain the management of suicidal client
 enumerate the role of nurse
 CLASSROOM TEACHING ON
SUICIDE PREVENTION

SUBMITTED TO SUBMITTED BY

Mrs.Jaysri, Vaideeswari.K

Tutor, M.Sc. Nursing 2nd year,

CON – JIPMER CON-JIPMER