28 PROFESSIONAL
Supporting nurses to ask about suicide
Nurses have the skills required , says Dr Annessa Rebair
I f you are a nurse educated before the 2018 NMC undergraduate standards 1 ( when the competencies of assessing and responding to a suicidal person was the sole domain of the mental health nurse ), there is a good chance you have not received education in suicide awareness and prevention . The literature informs us that nurses struggle to have conversations about suicide , but suicide is everyone ’ s business . A 2018 report by the National Confidential Inquiry into Suicide and Safety in Mental Health 2 revealed two-thirds of people who take their life are not in touch with mental health services , challenging the myth that suicide is purely the remit of those services . So , how can nurses engage in conversations about suicide ? They already have the skills to have difficult conversations – they do this every day – and understand the principles of compassionate communication that are inherent in commencing and holding a conversation about suicide .
Engaging with personal struggle with suicide Like any other difficult conversation , it is imperative to start with our own thoughts , fears and feelings in relation to the subject matter . What are our emotions , judgments , cultural influences and biases ? Research reveals negative attitudes among nursing staff working with suicidal people . 3 , 4 , 5 These affect the intention of engagement with the person in need .
Engaging with the suicidal person There are a number of programmes and websites that have excellent resources , education , and training packages ( see Resources ). One of these , PAPYRUS , was referred to f or the conversation starters and safety plans below .
The mnemonic TALK is helpful to remember when engaging in conversations about suicide :
T = Talk It is okay to talk about suicide , it reduces stigma and can support the person towards recovery . Research shows it can be a huge relief for them to share their thoughts .
A = Ask Be direct – ask the person : ‘ Are you thinking about suicide ?’ By using the word suicide , you are telling the person it is okay to talk openly about their thoughts with you . If your intuition tells you suicide could be an option for the person , ask the question . This can be a scary conversation for the suicidal person and for the nurse on the precipice of asking the question and fearing what to do with the response . Another approach is to ask : ‘ Sometimes when people feel as you describe , they think about suicide . Is it like this for you ?’ There is no evidence asking about suicide leads to suicide .
L = Listen If someone is suicidal , listen to what they need to say and allow them to express their feelings . Use prompts such as : ‘ It sounds as though things are really hard at the moment . Can you tell me a bit more ?’ or ‘ It must be so painful for you to feel like there is no way out . I want to listen and help .’ People carry stories that brought them to this point ; be curious and ask open-ended questions to keep them talking , such as : ‘ Tell me more about that .’
Summarise what the person has said to show you have understood and encourage them to keep talking . Showing care and compassion is essential for engagement and a meaningful encounter .
K = Keep safe Reassure the person they are not alone , and you can look for support together . Express this by saying : ‘ It ’ s not uncommon to have thoughts of suicide . With help and support many people can work through these thoughts and stay safe . Let us do this together .’
If the person has shared that they have plans and are at immediate risk of death , follow emergency procedures and local policy and keep communicating with the person . Ask if there is anyone you can to contact to support them . If risk to life is not immediate , tell the person you care about their safety and that you can work together to make a safety plan . Ask questions such as : ‘ What will get you through this moment ?’ and explore situations that make the person safer . This means they are no longer alone with their thoughts . Be aware of useful places to signpost for help ( see Resources ) and agree follow-up if the person has known NHS input . Ask for help if needed during a conversation . It is okay to say : ‘ I want to help but I ’ m not sure , I ’ ll find out .’
Caring for self and each other Emotional demands on nurses are high when supporting suicidal patients . There may be limited emotional capacity , especially given current staff shortages and the pandemic . 6 Research reports nursing itself is a high-risk occupation for suicide 7 , so conversations about suicide could include our colleagues , although negative attitudes and stigma can prevent staff from speaking out . 8 Actively engaging in compassionate conversations about suicide with people we meet in care could encourage colleagues to speak out , look out for each other and reach out in times of deepest need .
Resources CALM 0800 585858 , 5pm to midnight every day . thecalmzone . net .
Papyrus – for under-35s 0800 0684141 , 9am to midnight every day . Text 07860 039967 . Email : pat @ papyrus-uk . org papyrus-uk . org Samaritans 116 123 ( 24 / 7 ). samaritans . org
SOS Silence of Suicide 0300 1020 505 , 8pm to midnight weekdays , 4pm to midnight weekends . sossilenceofsuicide . org
Student minds studentminds . org . uk / findsupport . html
Breathing Space ( Scotland ) 0800 838587 , Mon-Thurs 6pm-2am ; Fri 6pm-Mon 6am . breathingspace . scot C . A . L . L ( Wales ) 0800 132737 ; Text ‘ help ’ to 81066 , ( 24 / 7 ). callhelpline . org . uk
Lifeline ( NI ) 0808 8088000 ( 24 / 7 ). lifelinehelpline . info
NHS in England Find a local NHS urgent mental health helpline bit . ly / 3gNV2Vl Stay Alive App bit . ly / 3gNzCHW
Free education for staff zerosuicidealliance . com
Dr Annessa Rebair is a senior lecturer in mental health nursing at Northumbria University , Newcastle
Online
Go to bit . ly / 2X0QHHT for the article with references nursinginpractice . com Autumn 2021