Page 84 - Retail Pharmacy Magazine October 2020

82 CPD ACTIVITY FROM PAGE 81 • Occupational type/status. • Neurological-genetic factors. Levels of mental distress among communities need to be understood less in terms of individual pathology and more as a response to relative deprivation and social injustice, which erode the emotional, spiritual and intellectual resources essential to psychological wellbeing. (Wilkinson 1997; Pickett 2006; World Health Organisation Europe 2009). Recent research emphasises it is not poverty per se, but relative disadvantage that impacts adversely on the mental wellbeing of individuals, families and small communities that have fewer economic, social and environmental resources. Stigma relating to people with a mental illness can be reinforced, often unintentionally, through derogatory language and the perpetuation of myths that at-risk persons are ‘simply attention seeking’. All community members must actively discourage such behaviour, as stigma acts as a barrier to prevention and help-seeking efforts. Signs of vulnerability and potential suicide intent Experiences of suicide are always personal and contextual. This means that what could upset and make a person vulnerable is variable. The impact of an event or emotion for an individual may vary from one day to the next. It’s therefore important to not jump to conclusions when the following signs are noticed, but rather use these as a catalyst to initiate a conversation and a better understanding of the person’s situation. Signs of vulnerability and potential suicide include: • Change in energy or activity levels. • Difficulty concentrating. • Changes in appetite. • Sleeping problems or nightmares. • Feeling anxious, fearful, or angry. • Headaches, body pain, or skin rashes. • Overreacting to situations. • Withdrawing from others. • Difficulty in decision making. • Risk taking behaviour. • Increased use of alcohol, tobacco or other drugs. • A sense of hopelessness and helplessness and actively talking about having a plan to kill oneself. Mental health frameworks Theoretical models can inform prevention and intervention initiatives. It’s important to develop services and interventions that target: • Primary prevention. Development of resilience, self-efficacy, meaning and purpose, and social connectedness (the wellbeing phase). • Secondary prevention. Addressing the background or predisposing factors and predisposing negative events through eliminating or ameliorating their presence and/or impact (the premotivational phase). • Early intervention. To respond to the emergence of suicidal thinking and behavioural intention formulation (the motivational phase). • Crisis intervention. To respond and intervene at the behavioural intention/behaviour gap (the action or volitional phase). The World Health Organisation (WHO) optimal pyramid for mental health services provides insight into levels of care relating to people living with a mental illness (Figure 1). This model shows that the largest and least costly areas of care are self-care and informal care in the community. Both forms of care rely on general members of the community and those in any human services setting: • Having the knowledge and skills to take action to maintain or improve their mental health and wellbeing. • Being able to assist others who may need emotional and psychological support. These early interventions don’t require the expertise to diagnose a person’s mental illness, but rather the ability to recognise the early signs that a person is or could be vulnerable given their context, and recommending self-care strategies and/or initiating early conversations to support the vulnerable person to develop an action plan to address their concerns, and/or seek expert assistance. Community pharmacists are ideally positioned to provide these forms of early care. Thomas Joiner’s theory of suicide consists of three components that together lead to suicide attempts. According to the theory, the simultaneous presence of thwarted belongingness, perceived burdensomeness and a capability for suicide produce the desire to suicide, which is denoted by the three intersecting circles in Figure 2. Figure 2. Joiner TE (2007). ‘Why People Die by Suicide’. Harvard University Press, US. Joiners Suicide Theory Thwarted Belongingness “I am alone.” Desire for Suicide Capability for suicide Perceived Burdensomeness “I am a burden.” Figure 1. The WHO Service Organisation Pyramid for Optimal Mix of Mental Health Services. “I am not afraid to die.” Suicide or Near-Lethal Suicide Attempt A key point Joiner makes is that suicide is rarely an impulsive, ‘spur of the moment’ action. That is, the vast majority of people who die by suicide have planned the event in detail. On the other hand, impulsivity as a personality trait is a well-documented risk factor for serious suicidality. The literature often implies that a key mechanism associated with RETAIL PHARMACY • OCT 2020