Risk assessment, suicide and prevention
Effective risk assessment and management for suicidal people is necessary to prevent unwarranted deaths. In North South Wales, the Suicide Risk Assessment and Management Protocols was established to address the rising cases of suicides. The document underscores the need for the health care professionals to identify and assist in managing the people at risks of committing suicide. This indicates a proactive system that shows government’s commitment to offering healthy and quality services to the people. Under the protocols, it is argued that the system depicts great ethical demands that seek to encourage the highest levels of human sanctity and integrity in the region. Notably, is the emphasis on competence and therefore acting to give people the required confidence in the whole framework through professionalism (Andrew 2008, pp. 102-105).
This forms the initial stage in the assessment and later management of the condition. Notably, about 90% of the people who die of suicide in NSW have diagnosable disorders. The risk factor detection is mostly assessed on the basis of the current personal risk factors that an individual is exposed to. These include ‘at risk’ mental status depicted by despair, agitation, hopelessness, shame and psychotic thought process. Besides, the recent attempt of suicide and interpersonal crisis like rejection and humiliation that acts as immediate signs of an individual at risk. Drug withdrawal, alcohol intoxication, and chronic pain or illness has also been identified to be part of the major causes of suicide. However, scholars have differed over the effectiveness of the later by claiming that it is the immediate environment that proceeds suicidal which leads to the action (NWS Department of Health, 2004, pp. 1-3).
According to the document, other factors like financial difficulties and employment, impending legal prosecution, and religious conflicts indicates possible contemplation of a person to commit suicide. Notably, these options are considered to be mostly out of desperation which is viewed by the individual as a long term indication of suffering after their cases are heard in the courts of law. At this point, the victim should be assisted urgently since the case deteriorates as time for the hearing draws nearer. To add to that, lack of social support and unwillingness to accept help by the people also acts as indicators in that most of the people especially the youths derive their identity from the society. Therefore their rejection serves as possible end of the road for them.
The protocol emphasizes on clear observation of early warning signs of depression which should be reported to the medical experts. Feeling of isolation, withdrawal and reduced verbal communication acts as a sign of an individual who has resigned off. Arguably, the early detection should be a direct combination of family members, workmates and community observation networks on each other to assist in establishment and latter management. Therefore, difficulty in sleeping, reduced appetite, and complains of pain that is not consistent with physical health should be taken with greater caution. Arguably, the initial detection is the most important step in the overall management of the problem since it is the start of the process. If well executed, it has been cited to have great capacity for reducing suicide in NSW (NWS Department of Health, 2004, pp. 4-7).
Preliminary suicide risk assessment
After an individual has been detected to be at risk a preliminary assessment is conducted by health officers waiting for further reference to specialized professional depending on then type and extent of risk. Notably, the identification previously given was very general and cannot be used for direct medical prescription. Similar to the previous process, this stage is very vital in that it determines the severity of the risk and nature to the individual. It is from this connotation that the risk factor extends its impacts to the society. The process is done through screening to ensure that the correct information is obtained (Andrew, 2008, pp. 112-115).
At this stage, the medical specialist evaluates the collateral medical information and extrapolates the sequence of events that led to that situation. Over 25% of the suicide cases are spontaneous and should be handled with much care. For the people under the age of 18 years, guardians and family members assistance is required to make the correct decision. Possible questions fielded include whether the person have ever tried to harm himself, thought of suicide or have any arms or lethal means? Effective judgmental at this stage is very necessary.
Brief psychiatric assessment
Unlike the previous system where the medical specialist examines and questions the victim, at this stage the specialist tends to answer various questions according to his findings. He therefore considers the victims history in relation to psychiatric problems in the past to determine whether it has any link with genetic inheritance or was related to environmental stress. By conducting this assessment, he is able to determine the coping skills and the overall ability to handle difficult situations. Use of maladaptive coping strategies and community support services support centers presence and utility is evaluated in relation to the case. This stage assists making the correct decision making.
Determination of suicide risk level
Notably, there is no documented rating that gives a value in the clinical assessment of suicides. Therefore, thorough assessment by the professionals remains the most valid estimation for the risk factor. To arrive to the most precise estimation, it is important that a combination of factors is evaluated as opposed to singular background consideration of the system. Though there is no correct risk rating for all the people, the medical experts classify the risk factors into High, medium, low or no foreseeable risk for the victim under assessment.
Arguably, risks in an individual are highly dynamic and demand reassessment with time. As a result, changeability should be established to determine the safe intervals for the risk assessment. This factors the changes in the main conditions that incited the problem. Suicide considerations due to unemployment and family struggles may subside with availability of new employment and stability in a family. Therefore, careful tracing of the system to ensure better management of the condition should be articulated (NWS Department of Health, 2004, pp. 6-8).
(b) Assessment confidence
As indicated earlier, there is no correct rating of suicide risk factor and is therefore entirely dependent on the clinician assessing the victim. As a result, confidence is paramount to making the correct decision. It is clear that majority of the cases and intrinsic aspects like social environmental stress and personal factors like impulsivity may be hard to categorize. However, the clinician should recommend further assessment to get more information and analyze the situation correctly. This explains the effectiveness and practicability of the Suicide Risk Assessment and Management Protocols in that all the clinicians are able to assess the victims with greater concern and consultations with relatives and family members.
(c) Consultations with colleagues
Professions are very diverse and require careful consultations with other specialists in the same or related fields. As indicated earlier, the action and management process is dependent on the clinician’s ability and capacity to make the correct assessment. Therefore, the protocol gives the overall autonomy to the specialists in making the decision. However, it calls for inclusive consultation with colleagues at all instances to develop new systems and ideas of addressing the problem. To ensure that consistency and cohesion is achieved, the involved parties are required to have direct access to the victim’s records of assessment and response to the strategy used (Ronald, 2009, pp. 69-75). To add to that, cultural specialists assist in determining authenticity of the victim’s progress.
Risk management involves use of the best possible means to reduce the level of possible harm to the person being assessed, to the public, and the medical attendants during the assessments. According to the protocol, the level of supervision should be heightened depending on the risk level classification. Where the person being assessed is at high risk of committing suicide, he should be kept under surveillance always. Besides, he should also be kept in areas cleared of all items that can be used to cause personal harm (for instance shoelaces, belts, ties, knives and firearms). To add to that, they should be detained in hospitals and away from the people to reduce the risk to themselves and others is greatly reduced. In case of suicide attempt, support should be given to the family and staff as a control measure of reducing further risks.
Risk management plan
According to the Suicide Risk Assessment and Management Protocols, people at risks should be managed through management plans under the general community health care centers. This assists in easing the burden to the families and the communities as well as reducing the overall risk to the victim and others. When an individual has been assessed to be at high risk to medium suicide risk, they should be referred to further medical attention with referral specialists who then develop a management plan with specialists taking key roles of caring the victim. Good therapeutic relationship should be established where the assessed victim links to the medical experts and opens to them for solution to their problems. As indicated earlier, the clinical experts should ensure that the management plan is unique and fits the depressing situation. A support person to follow the assessed person’s progress should be established as a direct contact person between the medical specialists and the victim. According to the protocol, the assessed person should be given vast time to rest and sleep to keep him away from the major stressing aspects. Notably, all the triggers of the suicide risks should be communicated to the caring parties for effective recurrence avoidance. Besides, the person should be subjected to frequent counseling and outdoor activities to assist in total change of his mental condition (NWS Department of Health, 2004, pp. 9-12).
Assessing the effectiveness of this method
Notably, the Suicide Risk Assessment and Management Protocols responded to the rising levels of suicide in North South Wales with promptness in addressing the situation. Arguably, the protocol acknowledges the complex nature of suicide and therefore gives the necessary autonomy in ensuring higher quality and decisive capacity to the specialists. Besides, the assessment gives clear guidelines and identification details that make it easy to identify at risk persons. To add to that, the stages setting of the system acts as a supportive system for determining the highly risky persons that require further address and the urgency of the cases.
However, the Suicide Risk Assessment and Management Protocols do not clearly address the issue of the high risk suicide persons in that they should be detained as they are given more medical attention at the hospital facilities. According to the Mental Health Act, 2001, the high risky suicide persons should be involuntarily detained to increase the overall recovery while ensuring maximum security to the public. To add to that, Section 31 and 32 of the Act provides for faster establishment of mental health commissions that are directly charged in ensuring the best strategies are offered to the high risk suicide persons (Government of Ire land, 2001). To add to that, the protocol is void of emphasis for the high and medium risk person’s recovery system. The coordination and response is entirely dependent on the contract person who may not have the capacity and fast response to emergencies. As established in section 3 part 50, 51 and 52, inspectors monitor the progress of the suicide risk persons regularly and can respond with urgency to the detained persons. It is therefore clear that in the above system Suicide Risk Assessment and Management Protocols should be upgraded to incorporate the involuntary detention system especially for the high risk and medium risk suicide persons.
Political will and funding consideration
Arguably, suicide risks require vast resources at all stages to ensure a cohesive flow of the system. From the initial stage of identification, it is necessary for careful cooperation and coordination between the community and the authorities to reduce the overall negative impacts to the society. Carl (2008) argues that suicides prevention receives about ten times less than the amount used to prevent road accidents. In the year 2007, €40 million was used in preventing road accidents while only €4.5 million was used for prevention of suicides in the country. Carl continues to lament that the government was lacking the necessary commitment to address the issues holistically. Families of the people who have attempted or committed suicides have often been sidelined in the overall process of rehabilitation. This has seen more suicide cases sprout wit time. As a result, the government should establish the correct criteria for preventing deaths through suicide by consideration of the whole process from identification to full recovery by the suicide risk patient.
Notably, coordination between the different arms of the government to articulate the prevention agenda in a cohesive format acts as the main test of the government’s commitment. As indicated in the risk management demands, all the systems of the government should be directly involved with the prevention and response measures installed to ensure faster distress calls are addressed to reduce the overall deaths from suicide. To add to that, the Irish government should raise the number of professionals involved with assessment and care of the suicide risk individuals in the country.
To effectively counter the effects and impacts of suicide in the country, it is important to consider the origin and occurrence of the action. Notably, the society acts as the medium upon which the stresses to contemplate suicide originate threatening the individual and the society too (Jim, 2007). The Irish Social policy therefore should incorporate the aspects of suicide management from the initial stages to the final level and give added outlook to the community. The community is the best placed entity to articulate change and supervisory systems for the whole system. Of greeter consideration should be assessment by the social policy of the main reasons behind the men being four times higher than women in contemplating suicide (Carl, 2008).
Similar to Australia, economic downturn has negatively affected all the sectors of the economy in Ireland. According to Carl (2008. pp. 4), the number of suicides were bound to rise with greater biting of the economic recession. Arguably, most of the companies resulted to downsizing as a major measure to cut down the overall costs. Irish Association of Sociology denoted that even as the down turn continues to ravage many countries economies, it was extremely important to secure the lives of the people. Therefore, the government should embark on a strong economic empowering system as a major consideration for reducing peoples stresses.
Tension arising from involuntary detention
According to the Mental Health Act 2001, high suicide risk people are supposed to be detained in the hospital to prevent possible harm to themselves and others in the society. Part 2, section 8 of the Mental Health Act 2001 describes the extent to which an individual should be considered for involuntary detention. Personality disorder, social deviance, and addiction to intoxicants give the mental health commission the overall authority to detain such a person without further consultation. Therefore, this detention is mostly administered without overall consultations with the parents. Over the last five years many people have complained of unnecessary detention of their colleagues and relatives in the hospitals. According to Dermot (2000, pp. 99-100), the overall consideration of the mental Health act was to encourage professionalism by providing for supervision of the system with ease for better coordination and articulation of the services. However, it eliminates the initial consideration of the guardians and family member’s decisions in determining the overall detention consideration. Notably, majority of the people prefer to take care of their patients at home as opposed to leaving them at the hospital premises. Most of the scholars have added their weight to the view claiming that recovery is better at home as the relatives and family members are used to their patients. To add to that, most of the high risk suicide people are likely to get hostile in strange environments a reaction which can be easily mistaken the doctors to be deterioration of the prior situation.
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