NoSI
Verified Psych NP/Nurse Prescriber
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I do wish a mental health expert would weigh in here but here’s what I think. Depression, generalized anxiety, it’s stuff many deal with. But when it progresses to idealization of suicide : that one is tough to pick up on. IMO once the sufferer decides upon that escape route, they can be focused and cunning. The last thing they want is to be thwarted. Remember the case of Kristin Westra in Maine? Several years ago? She was asked, mere hours before, iirc, if she felt suicidal. She smoothed everything over. She expressed she’d be fine.
What should her husband have done differently?? Would my intuition have been any better? Doubt it. Bless him, he’s a victim who will never be the same.
To me it’s a catch-22. The loved one , even if they have fears, certainly doesn’t want to plant ideas by insisting that, yes, I believe you ARE suicidal!
I guess it just breaks my heart to imagine the agony of self-reproach the family goes thru, and yet so often it’s not deserved or fair. And God forbid any finger pointing. As if the loss and the shock wasn’t enough to endure.
All just my opinion from a heart that cares.
Thank you for your thoughtful post. I don't consider myself an expert, but will give it a try. I have worked in psychiatric nursing my entire nursing career and now practice as a Psychiatric Nurse Practitioner and see outpatients for medication management and work in a general medical hospital on the psychiatry consult service team.
To answer your question about the predictability of suicides... I would say that nobody can, including the most experienced mental health provider. We can assess for risk factors, warning signs, current symptoms etc. all we want, but in the end we have have to go by what the pt tells us. If the pt denies active suicidal ideation, plan, and intent, he or she is not holdable for involuntary hospitalization under "imminent risk to self". Just like you said, if a person has made up their mind, they say whatever they need to in order to be able to carry out their plan. It becomes their focus. We often call family members for collateral information in the hospital/ED setting and sometimes we can justify putting a pt on a hold and hospitalize based on collateral info. Over the past several months, i cleared 2 pts for discharge from the hospital that were back within days after they overdosed. Thank goodness they were minor overdoses, but I felt and still feel terrible everytime it happens. We have 2 Psychiatrists and 2 NPs on the team and it has happened to all of us. So to sum this up, if someone is determined to attempt/complete suicide there really is no realistic way of stopping them because nobody can be watched 24/7 for extended periods of time. Our inpatient psych hospitalizations are also so short that it is unlikely that a newly prescribed medication has fully kicked in by the time of discharge. Average lengths of stay in the inpatient psychiatric setting is 3 to 5 days and medications like our SSRIs that target depression and anxiety can take 6 to 8 weeks to fully kick in. And, most importantly, a large percentage of individuals that complete suicide are also not under the care of a mental health speciality provider.
Please let me know if you have any questions. Sorry if this seems like a disorganized post. Been walking and thinking/typing at the same time.