Page 85 - Retail Pharmacy Magazine October 2020

suicide is a ‘spur of the moment’ decision in response to an adverse life event. The relationship between impulsivity and suicide is complex. The Integrated Motivational Volitional (IMV) model of suicidal behaviour (Figure 3) describes the biopsychological context in which suicidal ideation and behaviour may emerge (pre-motivational phase), the factors that lead to the emergence of suicidal ideation (motivational phase) and the factors that govern the transition from suicidal ideation to suicide attempts/ death of suicide (volitional phase) (O’Connor and Kirtley, 2018). The IMV model has been further extended in the ‘Integrated Wellbeing- Motivational Action model (IWMA) of suicidal behaviour and prevention.3 IWMA (Figure 4) represents an emerging paradigm that can explain the progression from consideration of suicide (based on an accumulation of risk factors) to the behaviour of suicide. The IMWA model takes account of the developments in understanding the personal and contextual journey from wellbeing to suicidal behaviour and the evidence on systems approaches to suicide prevention. It represents the next generation of suicidal behaviour models based on the ideation to action framework and three-step theory of suicide and attempts to more clearly distinguish between the development of suicidal thinking and the factors that govern behavioural enactment. (O’Connor & Kirtley, 2018; Klonsky & May, 2015; Joiner, 2005). The model adds the wellbeing dimension and incorporates the theory and evidence on developing wellbeing, social connection and resilience to reduce the incidence of suicide. Analysis of protective factors Resilience plays a key role in maintaining mental wellbeing, particularly in response to adverse life events and traumatic experiences. Resilience is a process, rather than a personality trait. Associated resilient behaviour, thoughts and actions can be learned and developed. Social connection has been found to play a key role in increased life expectancy and resilience. Digital technologies present another area of innovation for suicide prevention. These include the development and use of online and mobile technologies to: • Promote self-agency. • Promote mental wellbeing. Figure 3. The Integrated Motivational Volitional model of suicidal behaviour (Mendoza, J. 2018). Figure 4. Integrated Wellbeing-Motivational Action model of suicidal behavioural and prevention. CPD ACTIVITY 83 • Prevent suicide. • Monitor emotional states. • Facilitate intervention in a crisis • Provide clearer pathways to care. • Provide postvention support. Provision of and access to quality mental healthcare that is integrated and includes cross-sector health and community professions working together to deliver care in a non- stigmatised and respectful manner has been shown to reduce suicide rates. Access to mental healthcare includes: • 24-hour crisis care. • Assertive outreach. • Seven-day follow up. • Frontline clinical staff training. Pharmacists play an important role in supporting individuals with advice on appropriate use of their prescribed mental health medicines and having early conversations that promote self-care and facilitate informal care. Effective collaboration between pharmacists and GPs can further improve the provision of mental health services. Imminent risk of suicide prevention strategies The three most effective imminent risk of suicide prevention strategies are reported to be: • Reducing access to lethal means. • The continuation of contact with persons discharged from acute mental health. • Implementation of emergency call centres. Multi-level, complex interventions seek to promote individual, family and community connectedness. Assessing suicide risk Assessing suicide risk using standardised measurement is complex. Evidence suggests that screening for suicide risk in adolescent and adult populations, and with psychiatric inpatient populations, provides very little clinical benefit. Simple checklists should be cautioned against, particularly given the complexity of suicide risk. An open dialogue and flexible approach based on motivational theory for uncovering suicidal ideation and intent has TO PAGE 84 RETAIL PHARMACY • OCT 2020