Page 83 - Retail Pharmacy Magazine October 2020

UNDERSTANDING SUICIDE AND EARLY PREVENTION STRATEGIES Marion Wands Marion is the CEO of ConNetica, an enterprise dedicated to advancing mental health and reducing suicide through effective leadership, change management and learning. ConNetica, established in 2007, has completed more than 300 mental health and suicide prevention assignments. Marion designs and delivers ConNetica’s evidence informed and practical resilience and suicide prevention programs, including ‘Conversations for life’ and ‘Stronger smarter yarns for life’. Inquiries: mwands@connetica.com.au Visit: connetica.com.au Contributor: John Mendoza, Executive Director Mental Health and Prison Health Services, Central Adelaide Local Health Network. LEARNING OBJECTIVES After completing this CPD activity, pharmacists should be able to: • Describetheprevalenceofmental health and suicide in Australia. • Describelifeeventsandsocial determinants that contribute to mental illness. • Describeproblemsolvingand communication strategies that focus on mental health and suicide prevention. • Identifyskillstobettersupport people who may be experiencing a personal crisis. • Identifysuitablereferrals,support options and resources at local and national levels. 2016 Competency Standards: 2.3, 2.4, 3.6. Accreditation Number: A2010RP3 (Exp: 30/09/2022). Opening thoughts “Once we recognise that suicide is not exclusively a ‘scientific problem’ we will be in a much better position to recognise its moral, political and cultural dimensions and develop prevention approaches that reflect this complexity.” Professor Jennifer White, Vancouver Island, British Columbia, Canada. “People choose suicidal acts when they see them as the best way of ending an unbearable situation or getting the changes they desire.” World Health Organisation “While a suicide attempt is a moment in time, it’s part of an episode of living (and maybe dying). The episode continues after the attempt. Put another way, attempting suicide is a punctuation mark; it’s not the story!” Dr Eric D. Caine – ‘Looking beyond ‘risk factors’ in the evaluation of people who are seriously suicidal’. Plenary presentation, IASP World Congress, Beijing, September 2011. “Although there have been many advances in understanding suicide risk in recent decades, our ability to predict suicide is no better now than it was 50 years ago. There are many potential explanations for this lack of progress, but the absence, until recently, of comprehensive theoretical models that predict the emergence of suicidal ideation distinct from the transition between suicidal ideation and suicide attempts/suicide is key to this lack of progress.” Professors Rory O’Connor and Olivia Kirtley, Suicidal Behaviour Research Lab, University of Glasgow, 2018 Introduction to suicide and intentional self-harm Suicide is a preventable cause of death that is a complex, multifaceted and dynamic phenomenon. It is the leading cause of death for men and women up to the age of 44 years. In 2018, 3046 Australians died by suicide, more than double the number of people who die by road accidents. About three times more men than women die by suicide, and among our indigenous peoples the suicide rate is about double that of non-indigenous people per 100,000. Despite the increase in development and publication of suicide prevention strategies, suicide rates remain stagnant or continue to rise in most developed nations. Suicide is a response to overwhelming conditions, both personal and contextual. Recent events such as the bushfires and Covid-19 pandemic and their impact further exacerbate people’s experiences of not being able to cope with their situation and can lead to experiences of suicide. In April 2020, the Australian Bureau of Statistics found that two in three people surveyed in NSW and Victoria (67 per cent) reported feeling concerned or very concerned about their personal health due to the spread of Covid-19, and just over half of surveyed Queenslanders (52 per cent) and South Australians (53 per cent) reported the same levels of concern. Intentional self-harm is deliberate injury of body tissue without suicidal intent. Self-harm should be seen as a distinct behaviour from suicide, though the two may co-occur. Suicide prevention and self- harm mitigation are global public health priorities that require urgent attention. Indigenous suicide The rate of suicide among indigenous Australians is consistently double the rate for non-indigenous Australians and in some regions (such as the Kimberley region of Western Australia) much higher. Indigeneity itself is not a risk factor for suicide, but the effects of colonisation, compounded over time, contribute to significantly higher rates of suicide within indigenous populations across the globe. The complex erosion of culture, happening steadily over time, necessitates culturally specific and sensitive approaches to suicide prevention that go deeper than mere gatekeeper training. Suitable programs must address the impact of colonisation and promote and empower indigenous people’s communities. Risk factors and social determinants Risk factors for suicide can be related to individual, social and contextual variables, for which there is no clear ‘check list’ to determine whether an individual is likely to die by suicide. Risk factors are made up of distal factors (eg, impulsivity) and proximal factors (eg, negative life events). Most often, a combination of risk factors contributes to the onset of suicidal thinking and behaviour (STB). Risk factors that may predispose an individual to STB include: • Adverse childhood experiences. • Mental illness. • Experiences of stigma relating to one’s mental illness/culture/sexual identity. • Adverse life events such as job loss. • Financial difficulties. • Poverty. • Sexual/physical abuse. • Natural disasters. • Living in rural and remote geographical locations with limited access to services and supports. • Low levels of educational attainment. • Natural disasters and climate change. TO PAGE 82 RETAIL PHARMACY • OCT 2020 CPD ACTIVITY 81 2 CPD CREDITS