Any person who has worked in palliative care for a more than a month knows that many patients will express suicidal thoughts at some point. Many professionals get scared when this happens and somehow end up avoiding the issue or trying to convince the patient that this is not a good idea, knowing too well that once they leave, the patient will be left with life-threatening thoughts.
WHAT RESEARCH SAYS ABOUT SUICIDE IN PALLIATIVE CARE
A 2014 study published by Matthieu & Swensen suggests that hospice patients who have suicidal thoughts normally talked to someone they see on a regular basis about their thoughts. If you have regular contact with your patients and you are working towards having a trusting relationship, the likelihood is they will share their thoughts with you at some point.
In addition to this, it has been identified (Fairman et al, 2012) that 50% of patients who died by suicide whilst they were under the care of a hospice had emerging mental health concern and yet, they were not under psychiatric care. And believe it or not, in 60% of those cases ‘gatekeepers’ reported being aware of suicidal ideation and at the same time, suicide prevention measures were rarely taken.
Suicide is the “least discussed issue in hospice” (Csikai, 2004, p.74), and almost a third of social workers, 30% to be exact, admitted to have personally experienced a patient with active suicidal ideation.
I hope this information gets you a bit worried about how under the radar suicide goes in hospice settings. Don’t worry, I mean this in a good way. The fact that one third had met a suicidal patient and 60% were aware of it, but didn’t actually do anything about it tells us that this is because they actively or passively avoided the issue. My money is on the fact that this is because they didn’t know what to do about it. In other words, they were afraid.
I know in my personal experience that once one of your patients kills themselves, you have to live with this for the rest of your life and I would really like that you don’t find yourself in this situation.
YOUR DUTY IN PREVENTING SUICIDE
The good news is that actual successful suicide in palliative care is rare, but having suicidal thoughts or attempts is a scary, horrible thing to live with, both as a patient and as a professional.
Therefore, you have an obligation to do what you can to prevent this for your patients. You owe it to them.
It isn’t your responsibility to stop it all together, but it is your obligation to stop preventable suicide.
Going home after a day’s work and not knowing if your patient will still be there the next day is a hugely anxiety provoking thing.
TURN IT INTO AN OPPORTUNITY TO FORGE A DEEP CONNECTION
If you are familiar with any of my material, you will know that I am all for making your relationship with your patients meaningful. At the end of the day, I believe that is why you chose this career.
The likelihood is that you have sometimes experienced a deep, intimate encounter with a dying patient, where they open up to you and they let you right in. Perhaps, after a conversation with you, they have begun to feel differently and this has enormously benefited them and their families. Being able to have such influence at the end of somebody’s life is just amazing and nobody can really understand what I mean by this unless they have experienced in in some way.
Having easier, more meaningful exchanges with dying patients is probably something that any healthcare professional would sign up for, but there is another side to this particular coin.
I am talking about your patient’s disclosure of suicidal thoughts and/or feelings.
These can be incredibly disabling and terrifying for you as a professional. However, they don’t have to be.
To be honest, they are a bit scary and disabling even for an experienced professional. However, they don’t have to be THAT scary or disabling. In my opinion, they are only THAT scary or disabling due to a deep conviction that having such a conversation is a bad thing.
Let me rock the boat for you on this matter. What if it were a good thing?
If we consider that when people disclose suicide feelings and thoughts to you they are showing you something that was there all along, this can be an incredible relief for them. They are sharing something they have probably be holding by themselves for a very long time and the likelihood is that they feel terrified by it.
Now, knowing exactly what to do can empower you to face such conversation with no fear and this certainly changes the rules of engagement.
The truth is, you don’t need to reinvent the wheel when it comes to swimming in this sea of fear, confusion and despair that surrounds suicide. Knowing how to conduct a thorough suicide risk assessment is the key to navigating this gracefully.
You can download the following printable suicide risk assessment flow chart here benefit from the clarity of a simple and clear strategy from today.
However, mastering the specifics of a conversation at risk of suicide, you may need a more comprehensive training, such as my online workshop on Managing Suicide Risk. For more information, please visit:
One of the studies I cited earlier on (Matthieu & Swensen, 2014) found that suicide training in community hospice setting significantly affects measurable change in self-efficacy for those professionals attending it. In fact, since nearly all attendees had had previous experience of potentially suicidal individuals or people who had made suicide attempts, attendees wanted more training time devoted to suicide prevention.
This study concluded that suicide prevention training had increased awareness of the risk factors for suicide as reported by nearly 80% of participants.
You may be one of those people who know exactly what to do and say when you encounter a suicidal patient. If that is the case, congratulations.
However, if you are not and you find yourself struggling with this topic, please do something about it. There are various courses and articles out there. Please find them and give yourself different choices.
Most importantly, please don’t leave patients hanging on there. Even if you don’t know what to do about it, talk to a colleague or a line manager and make sure you document it carefully. Other professionals reading through the patient’s notes may benefit from knowing about this and an unnecessary accident may be prevented.
Csikai, E. (2004). Social workers’ participation in the resolution of ethical dilemmas in hospice care. Health and Social Work, 29(1), 67–76.
Fairman, N., Morrison, K., Ligon, K., Nelesen, R., & Irwin, S. (2012). A retrospective case series of completed suicides in hospice. Journal of Pain and Symptom Management, 43, 386–387.
Matthieu, M. M & Swensen, A.B (2014) Suicide Prevention Training Program for Gatekeepers Working in Community Hospice Settings. Journal of Social Work in End-of-Life & Palliative Care, 10:95-105.