Suicide Prevention Strategies and Risk Management

The provided document is a detailed compilation of resources related to suicide prevention strategies and risk management. It includes a systematic review of suicide prevention strategies, practical tips for busy primary care physicians, and information on clozapine treatment for suicidality in schizophrenia. Additionally, it covers risk factors for suicide after bariatric surgery and higher expression of serotonin 5-HT2A receptors in postmortem brains of teenage suicide victims.

Managing
suicide risks

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Table of Contents
Introduction............................................................................................................... 2
Evidence’s used.......................................................................................................... 2
Suicide Issues............................................................................................................ 4
Promotion for suicidal............................................................................................ 7
Change Management Model........................................................................................... 8
Conclusion.............................................................................................................. 12
References.............................................................................................................. 13

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Introduction
Suicide is one of major concern in the society. It is most commonly seen in the young
age group between twelve to thirty five years. World Health Organization researched that
approximately seven hundred thousand people risk their own lives by attempting to suicide
annually. Risking precious life is not worthy but they generally commit suicide due to sense
of burden, sense of emotional pain, fearing from negative impacts or hopelessness from life.
They commit suicide because they do not find any reason to live and think their lives are full
of pain (Wasserman, 2016). Thus various assessments methods are used to competency of
suicidal cases. The purpose is identifying the risks and treating them to provide a solution. To
reduce high risk suicide factors and provides a safety management (Neovius, et.al, 2018).
Committing suicide requires a lot of determination and a person to be strong enough
to take pills or inject poison in the body. But it is researched that suicidal overcome the fear
of death and harm themselves. A person is ready to bear the pain and is comfortable to take
the step to end their life (Bertolote and Fleischmann, A., 2015). But it is important to control
this act and save the life. With assessment comes the necessity for management. Some
sources like National Suicidal Prevention Lifeline is available and confidential can be
reached by calling or texting anytime from anywhere (Reyes‐Portillo, et. al , 2018). Other
than that there are various behavioural groups that provide support in suicidal cases.
Evidence’s used
The research is done from Journals as well as articles from Goole scholar. These data
are very helpful as they provide feasible strategies to cope up from suicidal causes.
According to the Journal of ambulatory care management, suicide is mainly caused due to
chemical imbalances in the brain, addition of some drugs or bad habits, alienation, chronic

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pain or guilt. People in this kind of situation feels entirely alone and thinks that no one
understands them, thus understanding the patients would build a positive trusted relationship.
Thus seeking and understanding the patients feeling and problems form his/her perspective
would help them to be friendly and became stable (Pandey, et. al, 2012).
The American journal of public health states that the patients should be comfortable enough
so that it shares every detail in order to provide appropriate treatment. Thus it is essential to
access the potential of patient to monitor the suicide attempts, to act on the situation by
prescribing to mediation course that may encourage patient as well as family member to
dispose the thought of suicide. This journal provides appropriate information so that suicidal
cases could be resolved.
In the perception of journal of mental health evidence it is important to take care of the
physical environment in which patient live by inspecting and evaluating the environment to
guarantee that environment is safe and free from all negative impact. Focusing on the idea of
suffering helps in building ways to spread hope in the people’s life. After listening to the
feelings, safety steps are taken to keep them safe and away from the danger of suicide. Apart
from that risk factors are mitigated among individuals by various training session that
increases the awareness of suicide loss and its prevention. Alters are mitigated to stops the
thinking of committing suicide (Steele, et. al, 2018). Thus managing the risk helps in
facilitating the link between friends and family for future help.
According to Journal of the American Psychiatric Nurses Association, Depression is an
illness which takes the step of committing suicide. If depression is high it may lead to other
problems like mental disorders or any psychiatric services (Aloba,et. al, 2018). Other than
that government has taken many steps to change the mind set of people. By organizing

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certain programs for the betterment of people and have launched many websites that support
the patients which advise patients to quit the thought of suicide.
According to the National Crime Record it was stated that suicidal behaviour is due to large
number of complex causes like suffering of poverty, unemployment issue, and defeat from
loved ones, quarrels or breakdown in relation problems. Social isolation and some mental
disorders such as depression play a central role in a suicide cases. This journal provided very
meaningful information so that awareness is created in the society for improvement.
These evidences are very feasible, meaningful and appropriate as they helped to know what
the suicidal causes are and how risks need to be managed.
Suicide Issues
Suicide means person thinking to end their life. People try to attempt suicide doesn’t
seem to end their life purposely but have difficult feelings which force them to commit
suicide. Suicide behaviours are not a physiatrist disorder but it is a coping method. Generally
there are people who express thoughts or exchange their thoughts about ending their life to
overcome with the pain and problems (Fazel, et. al, 2014). They lose hope to live and are
unable to find can reason to live their life. Two methods can be used to cope up with this
problem that it assessment and a positive working relationship with the patient. It is Suicide is
a growing problem in the society which is continuously increasing day by day, especially in
teens. Suicide is not a painless action and requires a lot of struggle to take this step. The idea
of suicide is also been glamorizes by advertisements and the issue cannot be left unnoticed.
Various issues that have risen due to suicide are:

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Suicide is the step taken by individuals, thinking they are not good enough for the society.
People’s action to commit suicide requires lot of strength to tolerate high pain of harming
themselves. They intentionally heal themselves by burning, cutting or take some poisons pills
to deal with the distress in their life (Heron, 2012). People generally commit suicide due to
various reasons;
Depression- Most common reason of suicide is people are depressed. Depression is a
suffering caused by lack of confidence. Majorly students are depressed by not achieving great
heights of success in their carer or due to emotional pain having family issues or lack of love
from their loved ones (Pitman, Osborn and Erlangsen, 2014). This issue can be resolved in a
feasible manner as depression is not hard to be resolved. It can be treated by keeping the
person happy. By giving positive vibes and making the individual feel confident about his/her
life. Showing the reasons to live and motivating one can help to come out from depression.
Psychotic- Psychotic is related to a suffering of an individual in which they are mentally
disturbed for any unintelligible reason. They are suffering from failures in every field of their
life which leads to thinking of committing suicide. This is hard to be resolved than depression
(Pitman, Osborn and Erlangsen, 2014). This is one of the effective methods and it could be
used to overcome the stress by providing them mediation which will help them in bringing
mental piece in their life. Sometimes they need hospital treatment to boost their self-
destruction healthy lifestyle.
Impulsive- Often some people are addicted to drugs and alcohol which leads to unpredictable
suicide as they are not in their senses. There aggrieve nature after being high force them to
take such actions. The decision to commit is based on the motivation by the presence of a
painful terminal illness in their lives and having no hope of reprieve exist (Pitman, Osborn
and Erlangsen, 2014). This need to be managed as it leads to risking their own lives when

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they are not in their senses. This could be controlled by reducing excessive consumption of
drugs and alcohol.
(source:https://www.camh.ca/en/hospital/health_information/
a_z_mental_health_and_addiction_information/suicide/Documents/
sp_handbook_final_feb_2011.pdf)
Thus it can be concluded that reasons of suicide are rising day by day. Thus proper steps need
to be taken in the society to manage the risk of death. Not only people who look depressed
commit suicide there are various people who are successful in their life go through the
thought of committing suicide. Many organisations are present to prevent suicide cases and
provide recovery from the thought of suicide. Suicide is uncommon and usually happens
without any warnings. The major symptoms of committing suicide can be seen by the sight of
depression or anxiety, by significant loss in their live like loss of job or loss of loved ones,
other than that personal crisis or life stress that increases an intellect of isolation in their lives

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leads to loss of self-esteem or loss of social support (Yip, et. al, 2012). For these triggers of
medication is helpful as it provides exposure to healthy and happy life. Suicide is a not a
disease and is preventable with proper assistance and a series of guideline for reducing the
stigma of suicidal behaviour (Shaffer, et. al, 2010).
Excessive sadness or unexpected mood swings, feeling of hopelessness, extra sleeping hours,
changing in personality and unusual behaviour leads to reckless of suicide. It need to be
prevented by taking proper treatment for depression and by building support network that
will help to come out from depression (Cochran and Mays, 2010). If the patient is suicidal
various things that are observed are: unbearable pain that may be any physical pain or
psychological pain, patients talking about killing oneself or finding reason to die these are the
signs of depression, patient expressing the feeling of being trapped and there is no hope to
live, thinking that they are burden to the society, mood swings or showing rage of killing
themselves. One of the difficult things about suicide is its spectrum ranges from low to
immediate high (Alaimo, Olson and Frongillo, 2012).
Promotion for suicidal
Promotion is used as it is the major concern for the whole community for detection
and prevention suicide cases among the people. Assessment is the only way to determine the
risk of suicide chances. Assessment involves knowing about background conditions of an
individual as well as their behaviours. Thus assessment helps in making judgment about the
steps need to be taken to avoid risks, which would be helpful in making effective clinical
decisions (Griffith, 2012). A framework is developed that contains all the key treatments
and methodologies that need to be taken. Thus the clear and concise document helps in
making clinical decisions. The aim of this framework is to adopt a practise style to reduce the
suicide risks by building an appropriate plan by reviewing the risk of an individual (Barbui,
Cipriani and Geddes, 2018). Suicide is not a casual thing to be overlooked but it is necessary

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to build strategies that would reduce the risk. Like seeking proper care treatment and building
a good relation with the health professional could somewhere reduce the chances of risk. It is
important to engage the people in social networks of society. As social support from family,
friends or peer helps in removing the thinking of ending their lives (Mann, et. la, 2015). Thus
getting support from dear ones reduces the thought of suicide and becomes manageable.
For managing the suicidal risk, change management model is used which refers to
identification of patient’s behaviour by proper assessment and treatment of the individual
who is having suicidal behaviour. Various approaches like Collaborative Assessment and
Management of Suicidality(CAMS) are introduced that is implemented to provide therapies
to patents for evaluating the risk of suicide and then developing a proper suicidal plan that
would be helpful for reducing suicide chances (Finnegan, Selwyn and Langhinrichsen-
Rohling, 2018) .
Change Management Model
Lewin defined that to make a successful change in the process there are various phase first by
understanding why change need to be done and then re-examining all the change and making
the consecutive changes. There are three stages: unfreezing, changing and refreezing.
The first phase of change management model is preparing for change in which various
management strategies are defined and plan is changed accordingly by developing a model.
Like whenever a patient is suffering from the risk of suicide, the conditions are reordered to
manage the risk of suicide. It is important to explain the risks of suicide to patients so that
patient is aware about the risk of committing suicide. Once it is known that patient is
suffering from the symptoms of suicide it is important to arrange regular follow ups in order
to track the mental stability of the patient and monitor the current circumstances (Brown,
Bruce and Pearson, 2010).

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The second phase is managing the changes by taking the actions and implementing the plan.
Various steps taken to implement the plan are:
Detection- Health workers plan a dominating role in detection of suicide risks. Whenever
suicide risk has been detected an appropriate service is adopted to deal with the risk.
Primary Assessment- The Suicide Risk Assessment is used to assist all areas in the society
that clinicians have proper care facilities for the patients. The individual suffering from
suicidal symptoms needs to be taken care by clinical guidelines (Meltzer, et. al, 2013). There
are various steps to improve the health behaviours like short antipsychotic medications
secessions which lower the depression rate in the patient. Primary Assessment means
understanding the physical condition of an individual, checking on the tendency of drug
consumption or previous suicide attempts.
Comprehensive Assessment- In this detail analysis of an individual is done by compressive
study of mental health issues like psychiatric assessment, psychosocial assessment and a
detailed suicide risk assessment is done (Meltzer, et. al, 2013).
Regular Assessment- It is an on-going process that means it needs to be monitored on
continuous basis (Meltzer, et. al, 2013). Regular assessment helps in tracking the complete
behavioural changes in an individual.
Thus it is true that an effective plan supports and provides a treatment to patients who are at
risk of suicide. A risk evaluation is a straight forward conversation between the patient and
the doctor regarding the suicidal plans and thoughts. The only motive is to make patient
conformable so that they discuss suicide plans openly so that consecutive measures could be
taken (Shaffer and Craft, 2010). The conversation is helpful as it helps in managing the risk
by getting the complete information about patient’s current mental state and the reason of

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stress that is contributing to the suicidal risk. Some patients open up easily while other may
take time. Thus there are several tools used for complete risk assessment, these tools help to
collect information in a brief manner. It is a strong and a reliable method to manage the risk.
The third phase of change management model is reinforcing the changes by analysing the feedback
and minimizing the diagnose gap. It is true that managing risk of suicide is difficult but still
actions need to be taken to minimize the risk factors.
1. Recognizing Risk Factors- There are several events in which person could be
analysed on their suffering. Checking the family issues of person’s life that may directly help
in knowing the victim of the problem. If a person is suffering from any loss or pain will view
the suicide as a solution to end the pain. Listening to their problem verbally helps in planning
in a better way (Bongar and B.M.E., 2010). Listening to the person will help in knowing their
emotions and the pain they are going through. There behaviours are helpful is knowing them
deeply by accessing their intent.
2. Supporting the Person- Supporting the suicidal person mentally is important by
keeping them happy (Bongar and B.M.E., 2010). Making them positive about all the life
accepts. Pushing them to interact with people or encouraging them to attend some
motivational conferences which would help them to be confidence and find the motive to live
a healthy life. It would be beneficial for them to remove all the negative thoughts. Physical
exercise is one of the steps that could be adopted, as it keeps the patient healthy and positive
(Lambert and Fowler, 2010).
3. Setting safe Plan- Setting an advance safety plan to reduce the suicide attempts can be
done by encouraging them to follow the therapies and take proper treatment (Lambert and
Fowler, 2010). Apart from that frequently check-ups are important as it helps in be sure that
the person is well.

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4. Encourage Healthy Life- To prevent an individual from suicide it is essential to keep
them healthy. By planning their activities in such a way that they eat well, sleep well and
socialize. Playing certain sports help a person to remain fit and promotes an individual to
express instead of holding them. Suicide is a desperate attempt that is used by an individual
to escape from the hardships and sufferings that they think is not bearable (McDowell,
Lineberry and Bostwick, 2011). People are going through the feeling of self-loathing,
isolation and hopelessness; they think that relief from this feeling could be achieved by
committing suicide. Thus prevention from suicide is not a difficult task it could be done by
talking to people and making them feel positive by being supportive. Making safety plans and
providing proper treatment would help them to overcome from suicidal behaviour (Valente,
2012).
Other that using the change management model there is a huge involvement of users and
stakeholders by starting various services to reduce the suicide cases. Like various suicide
therapies are launched but it varies from person to person according to their age. Therapies
like
Psychotherapies – These are found to be favourable for individuals who have tried to attempt
suicide. Thus this helps in reducing the chances of committing suicide again. It basically
learns about the experience individual is facing, reasons of stress in their life is understood
through training session (Knox, et. al, 2015). Once the reason is classified proper actions are
taken to make the individual healthy and live a better life.
Medication- People are benefited by adopting medication process as it helps one to feel better
by generating positive vibes. Clozapine is a medication used to treat the one suffering from
schizophrenia (Knox, et. al, 2015). There are many individuals who are at high risk of
suicide are benefited from medication along with psychosocial intervention.

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Conclusion
It can be concluded that suicidal thoughts in the society are increasing day by day.
Suicidal behaviours are due to depressive disorders, anxiety or any personal disorders.
Factors that have increased suicide are unemployment, relationships difficulties or any legal
issues which leads to mental vulnerability. The signs that show a person is trying to commit
suicide is threating. People try to hurt themselves by looking the ways to commit suicide
because of these high suicidal cases among clients, clinician’s treatment are used to provide a
proper assessment and safety plans for treatment. The suicidal assessment undertaken by the
clinician’s identifies all the risk factors that contribute to suicide. Identifying all the proactive
measures helps in differentiating from those characteristics that cannot be modified. Detailed
inquiry from the patients helps in understanding patient’s wellbeing. The information gained
from the assessment helps in knowing the level of risk a client is going through so that safety
plan is planned accordingly to reduce the risk of suicide. Not only in our professional
existence but a complete scrutiny is required in our personal lives. One of the most important
and regular management is the risk of suicide which infect sounds like a crime and shall not
be left unattended. There are various standard care assessments available, that defines the
standard methods to avoid risk.

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References
Alaimo, K., Olson, C.M. and Frongillo, E.A., 2012. Family food insufficiency, but not low
family income, is positively associated with dysthymia and suicide symptoms in
adolescents. The Journal of nutrition, 132(4), pp.719-725.
Aloba, O., Awe, O., Adelola, A., Olatunji, P. and Aloba, T., 2018. Psychometric Adaptation
of the Beck Hopelessness Scale as a Self-Rated Suicide Risk Screening Instrument Among
Nigerian University Students. Journal of the American Psychiatric Nurses Association,
p.1078390318762054.
Barbui, C., Cipriani, A. and Geddes, J.R., 2018. Antidepressants and suicide symptoms:
compelling new insights from the FDA's analysis of individual patient level data. Evidence-
based mental health, 11(2), p.34.
Bertolote, J.M. and Fleischmann, A., 2015. A global perspective in the epidemiology of
suicide. Suicidologi, 7(2).
Bongar, B.M.E., 2010. Suicide: Guidelines for assessment, management, and treatment.
Oxford University Press.
Brown, G.K., Bruce, M.L. and Pearson, J.L., 2010. High‐risk management guidelines for
elderly suicidal patients in primary care settings. International Journal of Geriatric
Psychiatry, 16(6), pp.593-601.
Cochran, S.D. and Mays, V.M., 2010. Lifetime prevalence of suicide symptoms and affective
disorders among men reporting same-sex sexual partners: results from NHANES
III. American journal of public health, 90(4), p.573.

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Fazel, S., Wolf, A., Pillas, D., Lichtenstein, P. and Långström, N., 2014. Suicide, fatal
injuries, and other causes of premature mortality in patients with traumatic brain injury: a 41-
year Swedish population study. JAMA psychiatry, 71(3), pp.326-333.
Finnegan, H.A., Selwyn, C.N. and Langhinrichsen-Rohling, J., 2018. Actively integrating
suicide risk assessment into primary care settings. The Journal of ambulatory care
management, 41(2), pp.114-117.
Griffith, J., 2012. Suicide and war: The mediating effects of negative mood, posttraumatic
stress disorder symptoms, and social support among Army National Guard soldiers. Suicide
and Life-Threatening Behavior, 42(4), pp.453-469.
Heron, M., 2012. Deaths: leading causes for 2010. National vital statistics reports: From the
Centers for Disease Control and Prevention, National Center for Health Statistics, National
Vital Statistics System, 61(7), pp.1-94.
Knox, K.L., Litts, D.A., Talcott, G.W., Feig, J.C. and Caine, E.D., 2015. Risk of suicide and
related adverse outcomes after exposure to a suicide prevention programme in the US Air
Force: cohort study. Bmj, 327(7428), p.1376.
Lambert, M.T. and Fowler, D.R., 2010. Suicide risk factors among veterans: risk
management in the changing culture of the Department of Veterans Affairs. The journal of
mental health administration, 24(3), pp.350-358.
Mann, J.J., Apter, A., Bertolote, J., Beautrais, A., Currier, D., Haas, A., Hegerl, U.,
Lonnqvist, J., Malone, K., Marusic, A. and Mehlum, L., 2015. Suicide prevention strategies:
a systematic review. Jama, 294(16), pp.2064-2074.

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McDowell, A.K., Lineberry, T.W. and Bostwick, J.M., 2011, August. Practical suicide-risk
management for the busy primary care physician. In Mayo Clinic Proceedings (Vol. 86, No.
8, pp. 792-800). Elsevier.
Meltzer, H.Y., Alphs, L., Green, A.I., Altamura, A.C., Anand, R., Bertoldi, A., Bourgeois,
M., Chouinard, G., Islam, M.Z., Kane, J. and Krishnan, R., 2013. Clozapine treatment for
suicidality in schizophrenia: international suicide prevention trial (InterSePT). Archives of
general psychiatry, 60(1), pp.82-91.
Neovius, M., Bruze, G., Jacobson, P., Sjöholm, K., Johansson, K., Granath, F., Sundström, J.,
Näslund, I., Marcus, C., Ottosson, J. and Peltonen, M., 2018. Risk of suicide and non-fatal
self-harm after bariatric surgery: results from two matched cohort studies. The Lancet
Diabetes & Endocrinology.
Pandey, G.N., Dwivedi, Y., Rizavi, H.S., Ren, X., Pandey, S.C., Pesold, C., Roberts, R.C.,
Conley, R.R. and Tamminga, C.A., 2012. Higher expression of serotonin 5-HT2A receptors
in the postmortem brains of teenage suicide victims. American Journal of Psychiatry, 159(3),
pp.419-429.
Pitman, A., Osborn, D., King, M. and Erlangsen, A., 2014. Effects of suicide bereavement on
mental health and suicide risk. The Lancet Psychiatry, 1(1), pp.86-94.
Reyes‐Portillo, J.A., Lake, A.M., Kleinman, M. and Gould, M.S., 2018. The relation between
descriptive norms, suicide ideation, and suicide attempts among adolescents. Suicide and life-
threatening behavior.
Shaffer, D. and Craft, L., 2010. Methods of adolescent suicide prevention. The Journal of
clinical psychiatry.

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Shaffer, D., Garland, A., Gould, M., Fisher, P. and Trautman, P., 2010. Preventing teenage
suicide: A critical review. Journal of the American Academy of Child & Adolescent
Psychiatry, 27(6), pp.675-687.
Steele, I.H., Thrower, N., Noroian, P. and Saleh, F.M., 2018. Understanding Suicide Across
the Lifespan: A United States Perspective of Suicide Risk Factors, Assessment &
Management. Journal of forensic sciences, 63(1), pp.162-171.
Valente, S., 2012. Overcoming barriers to suicide risk management. Journal of psychosocial
nursing and mental health services, 40(7), pp.22-33.
Wasserman, D. ed., 2016. Suicide: an unnecessary death. Oxford University Press.
Yip, P.S., Caine, E., Yousuf, S., Chang, S.S., Wu, K.C.C. and Chen, Y.Y., 2012. Means
restriction for suicide prevention. The Lancet, 379(9834), pp.2393-2399.