Student Psychological problems and dealing with Suicide

November 2013Dr V Wessels

PSYCHOLOGICAL PROBLEMS: WHY STUDENTS?

• Pre-existing psychiatric diagnosis• Environmental stressors

– Finance– Social adapting– “Workload”

• Substance abuse• Relationship issues• Lack of support• Immaturity – still finding themselves

QUICK DEPRESSION CHECK: PHQ 9

Over the last 2 weeks, how often have you been bothered by the following:

Not at all

Several days

More than half the days

Nearly every day

Little interest or pleasure in doing things 0 1 2 3

Feeling down, depressed or hopeless 0 1 2 3

Trouble falling or staying asleep, or sleeping too much 0 1 2 3

Feeling tired or having little energy 0 1 2 3

Poor appetite or over eating 0 1 2 3

Feeling bad about yourself or that you are a failure and have let people down

0 1 2 3

Trouble concentrating on things example watching tv or reading 0 1 2 3

Moving or speaking so slowly that others could have noticed, or the opposite, fidgety

0 1 2 3

Thoughts that you would be better off dead, or that you would hurt yourself

0 1 2 3

PHQ 9

• Good tool for people not in the medical profession

• Score greater than 5: consider depression

• More than 4 ticks in 2 and 3 column (1 of which must be first or second question)

SUICIDE - STATS

• In South Africa there are 23 suicides a day, and 230 attempts

• 20% of students have had suicide thoughts• 8% deaths in SA• Highest cause of death in students second to

accidents• Poisoning / Overdose most frequent in

unsuccessful attempts• Hanging most common ins successful

suicide, then shooting, gassing, burning, and jumping

• 90% of people that commit suicide have a psychiatric problem, 60% depressed

BE AWARE: WARNING SIGNS

• Talks about committing suicide/ death• Has trouble eating or sleeping• Big changes in behaviour• Withdraws from friends or social activity• Loses interest in work/ hobbies/ personal

appearance• Prepares for death by making a will or final

arrangements• Gives away prized possessions• Has attempted suicide before• Takes risks• Has had severe loss recently

SUICIDE

Everyone reacts to a traumatic event in their own way, and reactions can change from day

to day, or even from moment to moment

Suicide is an unpredictable event

• PREVENTION

• RESPONSE

• POST INCIDENT – Patient care– Debriefing – Trauma Counselling

PHASES IN MANAGEMENT

PREVENTION

• Awareness• Access to support

– Formal (psychologists, Help Lines, Support groups)– Informal (extra-curricular activities / Sport, peer groups)

• Identify and modify stressors where possible• Teach life skills

RESPONSE : UNSUCCESSFUL ATTEMPT

• Safety First (Fire arms, blades, heights, poisons)• Remain calm and be assertive but not challenging• Do not ridicule• Do not lie (if at all possible)• Seek medical treatment – if necessary involuntary within the

scope of the Mental Health Care Act

EMERGENCY MANAGEMENT OF MENTAL ILLNESS

TABLE 1

MAJOR SIGNS AND SYMPTOMS OF MENTAL ILLNESS

· Abnormal mood (inappropriately sad or happy)· Confusion / disorientated · Hallucinations· Delusions· Incoherent speech and strange behaviour not due to another identifiable medical reason· Anxiety / agitation not due to another identifiable medical reason

EMERGENCY MANAGEMENT OF MENTAL ILLNESS

TABLE 2

APPROPRIATE MENTAL HEALTH CARE FACILITIES

· All Provincial Hospital Emergency Units· All Community Healthcare Centres· Any clinic that has a trained Mental Health Care Practitioner

MENTAL HEALTH CARE ACT 17 OF 2002

32. A mental health care user must be provided with care, treatment and rehabilitationservices without his or her consent at a health establishment on an outpatient or inpatientbasis if-

(a) an application in writing is made to the head of the health establishmentconcerned to obtain the necessary care, treatment and rehabilitation servicesand the application is granted;(b) at the time of making the application, there is reasonable belief that the mental health care user has a mental illness of such a nature that-(i) the user is likely to inflict serious harm to himself or herself or others; or(ii) care, treatment and rehabilitation of the user is necessary for the

protection of the financial interests or reputation of the user; and(c) at the time of the application the mental health care user is incapable of making an informed decision on the need for the care, treatment and rehabilitation services and is unwilling to receive the care, treatment and rehabilitation required.

MENTAL HEALTHCARE ACT 17 OF 2002

33. Application to obtain involuntary care, treatment and rehabilitation

34. 72-Hour assessment and subsequent provision of further involuntary care, treatment and rehabilitation

EMERGENCY MANAGEMENT OF MENTAL ILLNESS

Pt displays signs or symptoms of mental illness(see table 1)

Pt resists or refuse treatment

Pt an immediate danger to

himself, others or property

No management as an

emergency mental health patient required

Transport patient to appropriate Mental Healthcare facility(see table 2)

Consult with SMO. Advise family to seek elective mental health care from the nearest appropriate Health Care Facility

Request SAPS assistance. If

pt armed do not approach

until SAPS on scene

SAPS on scene?

YES

YES

YES

YES

NO

NO

NO

NO

MANAGING THE VIOLENT PATIENT

ENSURE THE SAFETY OF ALL STAFF INVOLVED AS WELL AS THE PATIENT AS FAR AS POSSIBLE Ensure patient is not armed. If armed, allow the SAPS to disarm the patient prior to any physical intervention by health care staff.

Exclude reversible causes of aggression especially Hypoxia and pain

Attempt to calm patient through friendly but assertive conversation. Do not insult or lie.to patient.

Aggression /

Violence resolved?

Aggression /

Violence resolved?

NO

NO

YES

YES

MANAGING THE VIOLENT PATIENT

PHYSICAL RESTRAINTStaff members to remove spectacles and loose clothing items like ties.Ensure escape route (eg door) is behind staff and not the patient.Assign one person to each limb and one to the head.Restrain patient on his side preferably using strong leather restraints (do not use thin straps or material that can cut or chafe)Tie arms on the same side, but apart to avoid loosening.Tie legs to opposite sides.Do not partially restrain patient.Ensure access to an injection siteMonitor patient – DO NOT leave unattended

SEDATIONAdminister1. Haloperidol 5mg PO / IMI / IVI and / or2 .. Lorazepam 0.5 - 4mg IMI / IVI or3 . Diazepam 10mg PO/ IVI or rectal

Is ALS / Dr

available with sedatives?

TRANSPORT TO APPROPRIATE HEALTHCARE

FACILITYMonitor patient regularly

NO

NO

YES

RESPONSE : SUCCESSFUL ATTEMPT

• Safety First (Fire arms, blades, heights, poisons)• Seek medical on scene asssessment - urgent (may be

salveagable)• Preserve evidence• Activate law enforcement • Notification

– Authorities– Campus Management– Family

• Trauma Support– Responders– Friends and family– Anybody else who needs

TRAUMA : COMMON REACTIONS EXPERIENCED

• Emotional Responses

• Cognitive (Thoughts) Responses

• Behavioral Responses

• Physical Responses

EMOTIONAL RESPONSES

• Panic and fear• Shock• Highly anxious, active response or a

seemingly stunned, emotionally-numb response

• Feeling as though he/she is “in a fog” • Denial or inability to acknowledge the

impact of the situation or that the situation has occurred

• Dissociation, in which he/she may seem dazed and apathetic

• May express feelings of unreality• Intense feelings of aloneness

• Hopelessness• Helplessness• Emptiness• Uncertainty• Horror or terror• Anger• Hostility• Irritability• Depression• Grief• Feelings of guilt

COGNITIVE (THOUGHTS) RESPONSES

• Impaired concentration • Confusion• Disorientation • Difficulty in making a decision • A short attention span • Vulnerability • Forgetfulness • Self-blame • Blaming others • Thoughts of losing control• Hyper vigilance/very alert• Recurring thoughts of the traumatic event

BEHAVIORAL RESPONSES

• Withdrawal

• “spacing-out”

• Non-communication

• Changes in speech patterns

• Regressive behaviours

• Erratic movements

• Impulsivity

• A reluctance to abandon property

• Seemingly aimless walking

• Pacing

• An inability to sit still

• An exaggerated startle response

• Antisocial behaviours

PHYSICAL RESPONSES

• Rapid heartbeat• Elevated blood pressure• Difficulty with breathing• Shock symptoms• Chest pains• Cardiac palpitations• Muscle tension and pains• Fatigue• Fainting• Flushed face• Pale appearance

• Chills• Cold clammy skin• Increased sweating• Thirst• Dizziness• Vertigo• Hyperventilation• Headaches• Grinding of teeth• Twitches• Gastrointestinal upset

FOUR MAIN GOALS IN CRISES COUNSELING

• To help the person cope effectively with the crisis situation and return to his or her usual normal level of functioning.

• To decrease the anxiety, apprehension and other insecurities that may be present during the crisis and after it passes.

• To teach crisis-management techniques so the person is better prepared to anticipate and deal with future crises.

• To help the client learn valuable life lessons through dealing with the trauma aftermath.

TRAUMA DEBRIEFING PHASES

• Introductory phase• Fact Phase• Feeling Phase• Symptom Phase• Teaching Phase• Re-Entry Phase• Closure• Follow-up

CLOSURE

• Every person needs closure about events in their lives.

• Closure with trauma takes time and should be taken week for week.

• The coping skills will help with getting closure faster.

QUESTIONS