SUICIDAL CLIENTS

• Suicide


  The culmination of self-destructive urges that have resulted from the client's internalizing his or her anger or a desperate act by which to escape a perceived intolerable psychological state of life situation
• Suicidal client


  The client may be asking for help by attempting suicide, seeking attention, or attempting to manipulate someone with suicidal behavior
• Causes of suicide


  • Biologic theories- genetic marker has been discovered for suicidal ideation
  • Psychosocial factors: A progressive failure to adapt, Feelings of alienation or isolation, Feelings of anger and hostility, A reunion wish or fantasy, A way to end one's feelings of hopelessness and helplessness, A cry for help, An attempt to 'save face' or seek release to a better life
• Suicide clues


  • Verbal clues: talking about death, Making comments that significant others would be 'better off without' the person, Asking questions about lethal dosages of drugs
  • Behavioral cues: writing forlorn love notes, Directing anger messages at a significant other who has rejected the person, Giving away personal items, Taking out a large life insurance policy
  • Situational clues: Unexpected death of a loved one, Divorce, Job failure, Diagnosis of malignant tumor/ serious illness
• Individuals at risk for self-destructive behavior

  • Clients with psychiatric disorders
  • Clients with neurologic disorders
  • Clients with medical illness
  • High- risk population: adolescents, ethnic minorities, homosexuals, elderly, divorced, widowed, unemployed, socially isolated persons
• Terminologies to describe the range of suicidal thoughts and behaviors

  • Suicidal ideation: a vague, fleeting thoughts about wanting to die
  • Suicidal intent: thoughts about a concrete plan to commit suicide
  • Suicidal threat: the expression of a person's desire to end his or her life
  • Suicidal gesture: intentional self-destructive behavior that is clearly not life-threatening but does not resemble an attempted suicide
  • Suicide attempt: self-destructive behavior by which an individual responds to ambivalent feelings about living
• Clues for suicidal intent

  • Talks about death, suicide, and wanting to be dead and appears to be in deep thought
  • Asks suspicious questions
  • Fears being unable to sleep and fears the night
  • Is depressed and cries frequently
  • Keeps away from others due to self-imposed isolation
  • is tense and worried and has a hopeless, helpless attitude
  • Imagines he or she has a serious physical illness
  • Feels very guilty about something real or imaginary or feels worthless
  • Talks or thinks about punishment, torture, and being persecuted
  • Is listening to voices
  • Suddenly seems very happy, without any apparent reason, after being very depressed for some time
  • Collects and hoards strings, pieces of glasses, a knife or anything that may be used
  • Shows an unusual amount of interest in getting his or her affairs in order
  • Has history of suicide attempts
• Nursing diagnoses


  • Risk for injury related to a recent suicide attempt and the verbalization, "Next time I won't fail"
  • Hopelessness related to diagnosis of terminal cancer as evidenced by the statement "I'd rather be dead"
  • Impaired social interaction related to alienation from others secondary to depressive behaviors
• Planning and implementation


  1. Evaluate the patient's degree of risk, noting warning signs, intent to harm self, concreteness of suicide plan, available resources

  2. Determine the presence of high-risk factors

  3. Determine the degree of resources, support system

  4. Take warning signs seriously

  5. Remove dangerous and potentially lethal materials or objects when possible

  6. Place the patient in a safe, protective environment and monitor closely and consistently or mobilize support

  7. Establish a firm but supportive relationship

  8. Encourage the patient to talk about stressors; feelings of pain, anger and anguish; and suicide plans

  9. Listen empathically

  10. Communicate your presence and desire to protect the patient from harming himself

  11. Be aware that suicide risk increases as depression improves

  12. Reinforce the patient's desire to resolve problems and to live

  13. Assist the patient with problem solving; break problems down to more manageable parts

  14. Teach family members about warning signs and encourage them to provide support

  15. Refer the patient for outpatient support