Documenting a patient’s risk of suicide is just as important to making a diagnosis and taking care of patients as is evaluating their vital signs.

So says a group of cross-disciplinary experts who are working to keep patients safe and keep healthcare providers from being sued for medical malpractice.

Thoughtful decision-making during the patient intake process that would help categorize that patent’s risk of suicide is only one component, however. Another is the timely documentation of this risk assessment.

The group is lobbying for balanced judgments of suicide risk to be added to the skills, knowledge, attitudes and abilities of each healthcare provider, across disciplines. Increased training can help providers in making these judgments and documentation through the process can only add to overall patient care.

Why it’s important that suicide risk assessments are documented

Patient safety is the number one priority when it comes to documenting suicide risk assessments (SRAs). Adequate documentation is also conveyed to clinicians, researchers, attorneys, a jury, or judge showing that a healthcare facility provided a certain level of care. When documentation is routine and adequate, it:

• Alerts other health care providers of the risk
• Provides indicators of treatment progress
• Serves as a checklist for treatment and care

As a procedure, documentation is widely recognized and endorsed across all healthcare settings.

By making SRA documentation routine, healthcare professionals may be able to identify suicide ideation and levels of risk in patients. In addition, patterns and spikes in suicidal behavior may be identified, allowing for early intervention and treatment.

In addition, SRA documentation showing that a suicide risk is identified, acknowledged, and addressed can mitigate liability in the event of a medical malpractice lawsuit.

When healthcare facilities fail to document an SRA and any care that was provided, they may be found liable in the event of a patient’s death or injury – even if they provided quality care. Lack of evidence, may suggest to a jury that healthcare providers didn’t meet an adequate standard of care.

What should SRA documentation include?

There are several areas that should be covered when documenting an SRA. Most importantly, this should include:

• Suicide risk factors
• Suicide ideations
• Plans and intent
• Self-harm or other alarming behavior
• Protective factors

The components included in SRA documentation should include:

• Informed consent
• Information collected from a biopsychosocial perspective
• Formulation of risk and rationale
• Treatment plans and consultations

An assessment should never be fixed, but should rather be treated as a process spanning several risk factors. An initial assessment may only reveal some risk factors, but other factors may be unveiled through further assessment and treatment. For that reason, no conclusions should be made.

Addressing insufficient training among mental health providers

We’ve established the importance of documenting SRAs, as well as the components involved. This practice can only be carried out by mental health providers with adequate training in suicide risk assessment and management.

Unfortunately, many mental health providers aren’t adequately trained to properly document SRAs. For this reason, documentation is often either absent or missing crucial details regarding patient assessment.

In one study of 339 clinical psychologists, nearly 80 percent didn’t document patients’ access to firearms. In another study of 488 veterans with a history of depression, 244 died by suicide – 70 percent of whom had no documented SRAs on file. Another study among veterans found that patients with documented SRAs (including high-quality safety plans) were less likely to experience documented suicidal behavior in the years following treatment than those with low-quality documentation.

In 2012, the National Strategy for Suicide Prevention recommended updates to suicide prevention training for healthcare professionals across the US. As of 2017, there were 43 states that had a suicide prevention plan in place – two of which had policies “mandating and encouraging” suicide prevention training among healthcare professionals. Eight of those states mandated suicide prevention education and five states only encouraged it.

Lost a loved one to suicide? Demand justice now!

While mandated suicide prevention training is a step in the right direction, it’s critical that healthcare professionals are adequately trained and prepared to provide life-saving intervention. Lacking such training or overlooking potential risk factors can be dangerous for patients.

If a patient is at risk of dying by suicide, it’s crucial for facility staff to provide adequate monitoring and take preventive measures as needed. If you’re loved one died by suicide because the healthcare professionals who treated him or her failed to assess suicide risk and provide intervention and documentation, it’s important that you discuss this matter with an experienced, compassionate Texas suicide lawyer. The Law Offices of Skip Simpson is dedicated to helping families find answers and pursue justice. We offer free and confidential consultations. You can contact us online or call (214) 618-8222.

For clinicians who want the best advice on documenting a suicide assessment, I recommend “The Practical Art of Suicide Assessment: A Guide for Mental Health Professionals and Substance Abuse Counselors, (2011) by Dr. Shawn Christopher Shea.  See Appendix A: “How To Document A Suicide Assessment.”  If you follow the advice of Appendix A lives will be saved.

Young people across the United States are among the most vulnerable when it comes to suicide risks. In fact, it is the second most common cause of death among youth ages 10-19 – taking more than 85,000 lives from 1975-2016.

A Nationwide Children’s Hospital study posted in JAMA Network indicates that the suicide rate among girls ages 10-14 was “three-fold” from 1999-2014, according to Forbes.

The study pulled data from the Centers for Disease Control and Prevention (CDC) showing the need to scrutinize the increased suicide rates among young females – especially suicide by suffocation or hanging. Historically, females had higher rates of only contemplating or attempting suicide, while males had a higher rate of actually dying by suicide.

“Overall, we found a disproportionate increase in female youth suicide rates compared to males, resulting in a narrowing of the gap between male and female suicide rates,” said Donna Ruch, PhD and lead author of the study, in a press release.

Youth suicide and its connection to social media

The development and socialization of young females, as well as the prevalence of social media among tweens and teens, is considered a risk factor that should be scrutinized. The prevalence of social media has raised some concerns regarding how it impacts the mental health of adolescents.

Excessive use of social media not only inhibits the ability of children and teens to develop a healthy social life, it opens the door for exclusion and cyberbullying.

“Kids text all sorts of things that you would never in a million years contemplate saying to anyone’s face,” said Dr. Donna Wick, a clinical and developmental psychologist.

In addition, Dr. Catherine Steiner-Adair attributes the risk to low self-esteem to the need for adolescent females to compare themselves to others.

“Girls are socialized more to compare themselves to other people, girls in particular, to develop their identities, so it makes them more vulnerable to the downside of all this,” she said.

For adolescents in general, acceptance and “being liked” is a monumental part of their identity. Adolescent females mostly care about their appearance and may spend hours scouring through photos to decide which ones to post on social media. Simply not getting enough “likes” in comparison to someone else, or receiving negative comments, can be enough to make adolescent girls feel alienated.

Behaviors and warning signs to watch out for

It’s important that parents monitor what their children do on social media. Feelings of hopelessness or being excluded can manifest in ways that may seem rather subtle.

There are several behaviors and warning signs that may indicate contemplation of suicide, according to Healthline.

These include:

• Making threats or comments about taking own life
• Socially withdrawing from friends, family, and community
• Abusing alcohol or drugs
• Engaging in aggressive, impulsive, or reckless behavior
• Exhibiting dramatic mood swings, anxiousness or agitation
• Talking, writing or thinking about death
• Expressing feelings of hopelessness, loneliness, or being trapped
• Giving away possessions

Adolescent years can be a difficult time, especially among females. It may be difficult to see their point of view and why the need for social acceptance is so important for teenagers – it’s an inevitable a part of their development and identity.

Parental involvement simply isn’t enough to curtail the suicide rate among teens. Suicide prevention takes cultural change and awareness in our schools and communities.

The Law Offices of Skip Simpson not only seeks to promote such awareness in our culture but treat cases of adolescent suicide with the utmost care and help families find answers. If you have lost a loved one to suicide, we’d like to discuss your matter with you. You can contact us online to schedule a free case evaluation.

According to the Centers for Disease Control and Prevention, the suicide rate in the United States has increased by 33 percent from 1999-2017 and suicide takes an average of 40,000 lives per year. The rate among children and teens, however, is even higher.

The CDC said death by suicide among children ages 10-17 his increased by 70 percent between 2006-2016.

Following a slew of deaths by suicide among children – including an eighth-grade boy and 8-year-old boy from Cincinnati – adolescents are being taught how to identify the warning signs of suicide in their health classes.

Cincinnati Public Radio’s Cincinnati Edition features an audio interview with three school officials: Culture and Safety Manager Dr. Carrie Bunger of Cincinnati Public Schools, Public Information Officer Tracey Carson of Mason City Schools, and Assistant Professor Dr. Jennifer Wright-Berryman of the University of Cincinnati College of Allied Health Sciences School of Social Work – all of whom are familiar with the devastation of suicide.

The ripple effects

Suicide among children and teens can devastate school peers, as well as an entire community. One concern expressed by school officials is contagion. It’s a “ripple effect” that can lead to more than one suicide within a community. According to U.S. News & World Report, teens ages 15-19 are the most susceptible to contagion after being exposed to suicide.

In the interview, Carson discusses the contagion effects of suicide:

“There is no worse day than the day that you come in and you call your staff together to share that your student has died by suicide. It’s just truly one of the worst things that happens in a school community, but it ripples out, because when we have a young person who dies by suicide, it doesn’t just end at school. It impacts an entire community.”

Providing social and emotional support to grieving students

When addressing death by suicide, school officials must be explicit about what happened, while accommodating the emotional needs of those who are affected. It starts with identifying those students who are grieving and prompting teachers, counselors, and other school faculty to provide support.

It is important that school districts avoid prolonged memorials of a student who died by suicide.

“To impact contagion, to romanticize, and for those students, for the living, that may be at that cusp of ‘I’m feeling a level of despair’,” Bunger said. “It is something that we have been very mindful of in terms of honoring the living and making sure that we are providing proactive strategies to help support those students that are with us and coming through the school walls.”

Identifying the signs and providing early intervention

According to Wright-Berryman, there are several suicide red flags school faculty and students can watch out for. The primary cause of suicide among children and teens is the feeling of being excluded and isolated.

The signs often include:

• Sudden behavior changes
• Sudden substance abuse
• Social isolation
• Academic failure
• Academic success (in some cases)
• Social media activity that raises red flags
• Giving away prized possessions
• Suddenly quitting a sports team, musical activity, or other extracurricular activity
• Talking about suicide or self-harm

According to the school officials in the interview, children and teens who are suicidal are most likely to reach out to their peers rather than adults. Giving students the tools they need to identify the warning signs and to refer their peers to adults is critical.

Part of the problem among children and teens, as well as in society at large, is the cultural view of intervention. There seems to be a social stigma surrounding mental health that deters many individuals from seeking help.

We expect our school systems and communities to promote a culture of suicide awareness and early intervention. If the signs are there, it’s up to responsible parties to intervene, if they can. They should be held accountable. That’s why it’s important for a child’s loved ones to contact suicide lawyer Skip Simpson for a free consultation.

We’ve heard the ceaseless debate over whether or not cannabis is safe for adults. With many states legalizing its use for recreational purpose, some adults enjoy the benefits of cannabis-based products in their leisure time.

However, adolescents using cannabis can suffer from adverse psychological effects that manifest in early adulthood. The common notion about cannabis is that it can’t cause any health complications because it’s all-natural, but this is misconceived. Studies have found a link between adolescent cannabis use and increased risk of developing depression, anxiety, and psychosis in early adulthood – all of which increase the risk of suicide.

Tetrahydrocannabinol (THC), the active ingredient in cannabis, can have a psychoactive and mood-altering effect on young people, many of whom haven’t reached full brain development, as reported by scientists at the Research Institute of the McGill University Health Centre (RI-MUHC) and McGill University in a study dubbed Association of Cannabis Use in Adolescence and Risk of Depression, Anxiety, and Suicidality in Young Adulthood.

How prevalent is cannabis use among adolescents?

Evidence points to adolescent cannabis use as a factor in the growing rate of depression among teens and millennials. In fact, the Blue Cross Blue Shield Association analyzed medical claims data from 2013 to 2016 and found a 63 percent increase of depression among teens and a 47 percent increase among millennials.

The National Institute on Drug Abuse (NIH) cites 2018 data from the University of Michigan regarding marijuana use among American adolescents in grades 8, 10, and 12. Nearly six percent of 12^th graders reported using cannabis on a daily basis. That amounts to about one in 16 high school seniors with a significant habit.

NIH researchers also found that cannabis use through vaping increased from 2017 to 2018. Among adolescents:

• 2.6 percent of 8^th graders reported vaping marijuana in the past month – a 59.7 percent increase from 2017
• 7 percent of 10^th graders reported vaping marijuana in the past month – a 62.7 percent increase from 2017
• 7.5 percent of 12^th graders reported vaping marijuana in the past month – a 50.6 percent increase from 2017

The emotional and psychological risks

The study was a meta-analysis of 11 international studies involving 23,317 individuals. Researchers found that marijuana use can affect mental health in adolescents who didn’t previously suffer from mental illness.

In addition, the study found that around 25,000 Canadians and 400,000 Americans ages 18-30 suffered from depression related to cannabis use during adolescence. Symptoms of depression included anxiety, suicidal thoughts, and suicide attempts.

While the likelihood of adult cannabis use resulting in depression is moderate, the condition is widespread among younger users.

Prevention measures

One conclusion of McGill researcher Dr. Gabriella Gobbi was that advocacy groups need to educate adolescents on the dangers of using cannabis while the brain is still in development.

With society being affected by such a driver of mental illness, early intervention is critical. It’s not enough to reiterate hackneyed anti-drug slogans that have proven to be ineffective over the years. Teenagers need more parental involvement. In addition, they need more emotional support from school counselors and faculty.

If you have lost a loved one due to a suicide that could have been prevented, suicide lawyer Skip Simpson understands the pain and devastation you may be going through. He is dedicated to helping families seek answers and justice. Contact the Law Offices of Skip Simpson today for a free consultation. We are here to help.

People who die by suicide don’t always give warnings or show signs of suffering. They can appear healthy to others while concealing emotional pain, mental illness, or a personality disorder. According to Harvard Health, those who take their own lives often do so due to:

• Episodes of depression, psychosis, or anxiety
• A major loss in life
• A major life event that leads to stress or isolation
• Social isolation or loss of social support
• Changes in mood due to illness or medication
• Exposure to suicidal behavior in others

When suicide comes as a shock

The New York Post reports that a young woman from Manhattan, who worked as a dietitian, died by suicide after hanging herself in her West Village apartment.

Prior to her death, the woman posted a suicide note and apology to her mother online. In the opening line of the note, she said, “I have written this note several times in my head for over a decade, and this one finally feels right. No edits, no overthinking. I have accepted hope is nothing more than delayed disappointment, and I am just plain old-fashioned tired of feeling tired.”

Police were called for a wellness check after concerned co-workers reported that she didn’t show up for work. Another suicide note was found in a folder in her living room.

Like many suicides, the death of this young woman came as a shock to those that knew her. She clearly lived a life considered ideal by most people. She had a good career, social life, and seemed otherwise to be in good health.

So how do you recognize when a loved one or friend is suffering? How do you pick up on the subtle signs of potential areas of concern in someone who appears well on the surface?

When you casually ask “how are you doing?”, be alert to answer when your gut tells you something may be amiss. Don’t be afraid to talk to your loved ones and others for whom you really care about sensitive subject matters.

Overcoming the stigma

Many people who suffer from these feelings avoid expressing them or reaching out to others for help, not just because they don’t want to reveal their own vulnerabilities, but because they don’t want to burden others.

When an individual takes his or her own life, it can leave loved ones and friends with a sense of guilt, that there was something they should have done to prevent it.

At times suicide notes, when they are left, give us a glimpse into what research has shown. Psychology Today cites research into the notes left by both those who attempted suicide and those who died by suicide.

Among those who died by suicide, the most common factor was a sense of burden on other people. In addition, they had a history of being impervious to physical pain such as violently engaging in extreme sports, receiving multiple tattoos and body piercings, shooting guns, and fighting. They are typically not afraid of enduring the pain and intense emotions that come with completing the act.

Creating culture of suicide prevention

Not all individuals who die by suicide exhibit the same patterns of behavior or express the same signs. Suicide prevention shouldn’t merely be approached when we notice signs of suffering in a friend or loved one. It must become an active conversation in our culture. Those suffering from mental and emotional illness should be able to seek help without the fear of facing social stigma.

For many years, the Law Offices of Skip Simpson has witnessed the hold this stigma has on our society. Our firm seeks to help families and friends find closure and answers. If you lost a loved one due to suicide, we would like to discuss your matter and explore your legal options.

Perhaps the individual who died by suicide didn’t receive appropriate medical care prior to his or her death. Perhaps a thorough investigation into events leading up to the individual’s death could reveal other factors. Contact us today to find out what we can do for you.

If you know someone who lost a loved one due to suicide, you’re not alone. According to the Centers for Disease Control and Prevention (CDC), there were approximately 47,173 suicides in the United States in 2017.

Suicide is often viewed as a taboo subject that many people would rather keep quiet about to avoid invoking more grief. This can cause a friend or loved one to feel abandoned during a troublesome time.

What you say to a friend or a loved one who is grieving may not always provide comfort. Self Magazine says finding the words isn’t easy and offers these tips that might help. Read more here.

Knowing what to do when dealing with a family member or someone else considering suicide can be overwhelming for anyone involved. Unfortunately, this issue doesn’t seem to be going away anytime soon. Recent data from the Centers for Disease Control and Prevention (CDC) shows a continued increase in suicide rates over the last 18 years.

That’s why organizations like the Suicide Prevention Resource Center are constantly searching for solutions aimed at preventing people from dying by suicide. One of the latest approaches includes talking about “lethal means counseling,” or safety in a health care setting.

What is lethal means counseling?

Elly Stout, director of the Education Development Center for the Suicide Prevention Center, recently wrote about the importance of reducing the lethal means in health care settings as an effective suicide prevention method.

Lethal means are anything commonly used by someone to end their life, such as medications or guns. Stout wrote that there’s “significant evidence of effectiveness” when it comes to “lethal means counseling in health and behavioral health care settings.”

“It’s up to all of us to promote these conversations as a critical part of safer suicide care around the country,” Stout wrote.

In addition, lethal means counseling should be a “key part of safety planning, which is a collaborative process between patients or clients and clinicians to create a written list of coping strategies and supports to use when suicidal thoughts arise,” Stout wrote.

What is an effective safety plan?

Along with removing lethal means from someone seeking help for suicide prevention, many health care workers and clinicians who deal with such issues believe that creating a safety plan can be an effective tool for someone at risk of suicide.

The Suicide Prevention Resource Center created a video outlining the importance of creating a collaborative safety plan. Such a plan should “identify specific behaviors, actions, and situations that help them stay safe,” according to the center’s website.

“It needs to be clear to the patient that this is something that’s being done collaboratively with them,” Vince Watts, MD, MPH, director, VA Interprofessional Fellowship in Patient Safety, VA National Center for Patient Safety, said in the video. “It’s really them identifying things that help them and then the staff trying to write those down, maybe give hints from their prior experience with other patients. But the patient safety plan is not something the staff would come up with. It’s something that the patient comes up with.”

Health care facilities need to take suicide prevention seriously

Attorney Skip Simpson has seen over and over again what happens when medical facilities do not take proactive steps to prevent deaths by suicide. When patients come to a hospital, the first priority should be to make sure they are in a safe environment. Removing lethal means is a critical step in that direction.

Seeking help for suicide prevention is difficult enough. The least hospitals can do for patients who do so is to remove risks from their environment.

You may have seen him on Saturday Night Live, cracking jokes and sporting a jokers’ grin. You may have heard of him in the tabloids after a highly public split with pop sensation Ariana Grande. And, if you are familiar with the trademarks of borderline personality disorder, you aren’t surprised by the whirlwind romance that came to an abrupt end.

Pete Davidson has taken the internet’s attention once again after the end of the relationship, but this time with a series of words on Instagram that brought out just how deadly the disorder can be.

“I really don’t want to be on this earth anymore.
I’m doing my best to stay here for you but I actually don’t know how much longer I can last.
All I’ve ever tried to do was help people.
Just remember I told you so.”

Ending the message with a heart emoji and deleting his Instagram, the celebrity drew concern from all corners of the globe. Some blamed Ariana, his recent ex (who herself just lost a former boyfriend to drugs) as if women are rehabilitation centers for troubled men, and as if her decision to leave a relationship was worth blaming another death on. Pete Davidson was accounted for, unharmed. And he was speaking up. Approximately 5.9% of adults in the US has BPD, according to NAMI. It’s time we learned about it.

What is Borderline Personality Disorder?

Profoundly misunderstood by the healthcare community, BPD is not an abbreviation for bipolar disorder, which is a severe disorder mostly affecting moods, but is a personality disorder that can change someone’s very worldview. Often described as unpredictable (and also often co-morbid in those with bipolar disorder) this disorder takes life away from sufferers. They view things in extremes, their hobbies and interests can flip at a moment’s notice, and their lives are a rollercoaster of unstable relationships.

How they view themselves and others is a constantly changing, never settling process.

Thought to stem from childhood abandonment, abuse, unstable relationships or other adversity such as poverty or an unstable home, BPD is deadly and acts quickly. Symptoms may include:

• Chronic feelings of emptiness
• Inappropriate, intense anger
• Difficulty forming bonds and trusting
• Self-harming behavior such as cutting, picking, or substance abuse
• Recurrent suicidal thoughts or threats
• Dissociative feelings, feeling cut off from reality
• Sudden, severe mood swings
• Sudden, fast moving relationships that end just as quickly
• Pushing people away intentionally, only to cling to them

People with BPD are often vilified. Seen as abusive, uncontrollable and people to stay away from, Pete Davidson has done the community a sincere service by addressing his illness. He’s spoken about his time in rehab, in which he thought that drugs induced moments of blind rage and breakdowns which impaired his memory. After first receiving a diagnosis for bipolar disorder, and another mental breakdown, he was properly diagnosed with borderline personality disorder.

How different are bipolar disorder and BPD?

Pete had been tweeting his support for Kanye West in speaking about his mental health, which had been a hot topic as the celebrity stumbled through the political sphere and often seemed like a puppet to some. His internet presence made very little sense. His grandiose behavior and recent history with extreme debt seemed like red flags to some, but humor for others. Kanye spoke up finally about his history with a bipolar diagnosis, making a dent in the stigma against mental illness (especially for men, and men of color) and it had given Pete the courage to talk about his own struggles.

Bipolar Disorder and BPD can be housed in the same brain, creating what must only be a truly painful daily experience for a sufferer, but their key differences are:

• Shorter, more frequent mood swings for BPD-a bipolar person can be hypomanic or manic or exhibit depression symptoms for weeks to months, BPD exists on a constant swing
• BPD produces more feelings that have the sufferer question who they are, and a fear of abandonment. This severely affects familial bonds, close friendships and relationships
• Borderline is a personality disorder, affecting some parts of the brain separate from a mood disorder like bipolar. Recovery and maintenance can be different.
• Fear of abandonment and unstable personal relationships are more unique to BPD as a symptom, whereas bipolar patients can have them as a product of their disorder.

Suicidal Ideation and Passive Suicidal Thoughts

Many people with various mental health conditions exist in a permanent state of wanting death. This can take the form of an ideation, almost like a yearning daydream, or a reoccurring thought that the sufferer simply wants life to end. This may not be accompanied by a plan or action, or even self-harm, but as a welcome intrusive thought that has made itself home among day to day activities.

Imagine every waking moment gagged by wanting life to end. Every anniversary dinner, every birth of a child, every morning coffee is dull and flat because you are alive and hate every moment of it. This is merely another symptom of BPD that is incredibly hard to control, as it can occur in any mood. Living in the public light has given Pete Davidson the opportunity to do several things that put a dent into the stigma around mental illness: ask for help, voice his feelings, and freely share his diagnosis while lifting up another performer.

Finding Hope

Though Ariana Grande begged fans to “be gentle” with her ex after he cited online bullying as a trigger for his disorder, Davidson has been publicly struggling. Ironically, that publicity has reached thousands diagnosed with the disorder, thousands more wondering if they’ll soon join statistics. Men especially are not encouraged to show mental “weakness” and too often live in a culture that would rather see them dead than in therapy.

Pete Davidson, Kanye West and many others are challenging that. Davidson himself wrote:

“I’ve spoken about BPD and being suicidal publicly only in hopes that it will help bring awareness and help kids like myself who don’t want to be on this earth…to all those holding me down and seeing this for what it is – I see you and I love you.”

Currently, the go-to therapy method for addressing BPD is DBT-dialectical behavioral therapy. Unlike CBT or cognitive behavioral therapy, which helps people identify  and change core beliefs and behaviors, DBT is skills-based.  Learning how to cope, and learning how to live, are two things that some patients may need to learn.

Offering a message of hope from such a large platform to anyone struggling with their mental health or suicidal thoughts is something that an entire massive online audience needed to hear. Thank you, Pete Davidson for your humor, entertainment, and helping your brothers and sisters of the world in a way only you could do. Don’t go anywhere; we desperately need you.  You are giving folks hope where there was none, and left us laughing too. What a gift to us.

Mental Healthcare for Healthcare Workers

Nurses take our lives into their hands daily. Thousands of patients pass through bustling hospitals waiting to address their various ailments with one of the world’s most in-demand professions. Doctors rely on them, clinics and hospitals can’t operate without them. Nurses deserve our appreciation, gratitude, and proper access to mental healthcare to address their own needs.
Suicide is an epidemic among healthcare workers, especially nurses. Long hours on their feet, limited breaks, and plenty of time spent in a stressful environment away from anything of comfort may be a necessary part of the profession, but it is costing them their lives.

The Picture of a Nurse

The words that the American Journal of Nursing use to describe the suicide epidemic among nurses are cold and stale. The prevalence is described as “disturbing.” Its study is “inadequate.” Often, we see nurses roles outlined as being overworked, yet never without a smiling face in a crowded waiting room. However, they are under mass amounts of stress. A medical environment, and partially one that could contribute to medical errors such as “never events”, surgical errors, and other forms of malpractice, often carries severe emotional stressors such as:

• Being a witness to human death and dying
• Inadequate equipment
• Excessive Workload
• Ethical conflicts
• Inadequate breaks

Many nurses are falling into “Nurse fatigue”, which can directly affect the quality of their work. In turn, using caffeine or energy drinks/pills to make it through another double, another night shift on less than 4 hours of sleep severely impairs mental health. One study showed that: “Sleep loss is cumulative and by the end of the workweek, the sleep debt (sleep loss) may be significant enough to impair decision making, initiative, integration of information, planning and plan execution, and vigilance.”

The problems faced at work caused by a lack of sleep and stress do not simply end there.

A balance of work, life, and death

Over 44,965 people died by suicide in 2016, making it the 10^th leading cause of death in the nation. There were 395,000 self-inflicted injuries and 1.3 million suicide attempts. Nurses were often at the forefront of helping save lives, processing attempts in the emergency room. But how many of us have brushed off scars as patient-inflicted injuries, or teary, sullen eyes as “hazards of the job” while under a nurses care?

Not even the CDC has cared to accurately measure the dangers nurses face. They have families, a demanding job, and little time for solace during their long shifts. Risk factors for nurse suicide include:

• Past attempts
• Mood disorders
• Access to means, such as prescription medication, sharp implements and toxic substances
• Feelings of inadequacy in their role
• A lack of culture that promotes safety and wellness (especially in mental health)

Without hard data to determine how many nurses fall victim to a lack of action in a culture of silence, we must focus on prevention. A study on workplace wellness reported that nurses felt cared for when their leaders saw them as whole people, not simply a tool in the workplace. To an employee already facing an uphill battle with mental health, this could be the difference between life and death.

Workplaces need to show nurses that they are just as valuable when they become patients as they are as workers. They need compassion, suicide screenings, positive reinforcement and shorter shifts with proper breaks so a lack of sleep doesn’t affect their mental health further.

Nurses are people, just as mortal as anyone in the Emergency Room. Healthcare providers should take heed to care for their employees in order to keep beds empty, nurses happier, children with parents and most importantly: to save lives.

Nurses do so much for us. They deserve to have the favor returned.

Pet lovers have long believed that the companionship that comes with having a pet has real benefits from the owner. Now, a systematic review of research puts hard evidence behind that belief.

The review, led by Dr. Helen Louise Brooks of the University of Liverpool and published in BMC Psychiatry, suggests that pets do indeed provide benefits to people with mental health conditions.

A distraction, a sense of purpose, unconditional support – how pets benefit people at risk of suicide

Americans were estimated to have spent over $69.35 billion on their pets in the year 2017, reaching a new high. While the love for our furry friends is well acknowledged, their services can make the difference between life and death for some.

In the review, “pets were perceived as providing unconditional love and support” – something that people struggling with mental health issues often cannot get from friends and family. In the face of the often overwhelming challenges that come with living with a  mental illness, that level of love and support is invaluable.

Pet owners were also found to draw strength, self-worth and meaning from their pets. Multiple pet owners said that taking care of their pets gave them something to like about themselves. Another spoke directly about an experience with suicidal ideation: “The thing that made me stop was wondering what the rabbits would do.”

One of the most persistent myths about suicide is the idea that a person who is determined to die by suicide is inevitably going to do so. The reality is that the suicidal urge is an acute problem that does not last forever. Pets have been shown to provide an important distraction, a grounding that allows suicidal people to step outside their own thoughts and focus on caring for or interacting with the pet. That’s often enough to save a life.

Some pets, such as dogs, were also shown to force positive behavior from their owners. Simple acts necessary to dogs such as going outside, engaging with the community and participating in physical activity are all known to have significant mental health benefits. For a person struggling with depression or another mental health issue, the simple fact that the dog has to go outside is a powerful source of motivation. Many people that struggle with taking care of themselves often find solace in taking care of another.

Different animals serving different purposes

Hospitals frequently utilize the talents of therapy dogs, who offer calming presences and physical affection to patients in care. This unconditional love can make a world of difference to someone with a psychiatric disability, especially when navigating often cold and unfamiliar settings of an inpatient unit, especially to those who may not have any visitors otherwise.

Psychiatric service dogs come with their own set of legally protected regulations. Specially trained to assist one person, these dogs can enter areas that regular pets cannot (such as restaurants and establishments that have a “no pets” rule in place) and usually wear identifiers such as tags, collars and vests to let others know they are “on duty.”

Emotional support animals can include dogs and often do, but could theoretically be any animal that offers an ailing owner comfort in their time of need. Deeply attuned to their owners moods and behaviors, these animals can be allowed (with a “prescription” note from a psychiatrist) to live in places with a “no pets” policy and are protected under the ADA. However, they do not have the training of a service animal and are not allowed to enter the same spaces as designated service dogs.

The benefits of tackling mental health treatment with animal assistance are documented through research, and patients often feel more at ease with a furry companion than an all-too-often unfamiliar and anxiety inducing environment of a hospital.

Patients who disassociate or hallucinate can be calmed and grounded with animal intervention, whether it comes from a trained service dog or engaging tactile grounding techniques petting the family cat. Depression and anxiety can be calmed, and traumatic episodes can be interrupted by the unconditional bond between humans and pets or service animals.

Pets need to play a role in care plans for people at risk of suicide

While further research is clearly needed into the specific benefits of pet ownership and the types of interventions that are most effective, the evidence clearly shows that pets have an important role to play in mental health care. As one of the researchers pointed out, introducing pets is potentially a very powerful intervention because it invites patients to get involved in their own care, creating an opportunity to have an open discussion about what works best for the individual patient.

Obviously, not every patient will respond well to pets, but for those who do, having an animal companion can be the difference between life and death. This is an avenue of treatment that family members, friends and mental health professionals alike need to explore to make sure that people struggling with mental health problems have access to all of the resources and support they need.