How can pharmacists identify and support people who may be thinking about suicide?
Pharmacists are “primely positioned” to recognise when someone may be at risk of suicide and provide pathways of support, say researchers from the University of South Australia.
Suicide is the 13th leading cause of death in Australia, and 2017 saw a 9% increase in deaths by suicide compared with the previous year, they say.
Higher-risk groups in the Australian community include men aged 45-49 years, men aged >85 years, Aboriginal and Torres Strait Islander people, people of diverse gender, individuals with mental illness, those who have attempted suicide previously, and people who are bereaved by suicide.
Meanwhile, according to the ABS, 25% of the Australian population are accessing PBS-subsidised mental health-related prescription medications—for example, antipsychotics, anxiolytics, hypnotics and sedatives, antidepressants and psychostimulants.
“Pharmacists (in particular community pharmacists) come in contact with mental health consumers regularly and are more than capable of providing mental health first aid interventions,” write Hiba Kassir, Heather Eaton, Dr Monika Ferguson and Dr Nicholas Procter in the Journal of Pharmacy Practice and Research.
“While interacting with people, pharmacists are well-placed to observe signs of distress, a change in medication pattern or a change in mood or behaviour.
“The pharmacist can then make an approach to initiate gentle conversation with that person and to link them to further services.
“Through carefully considered engagement, it is possible for pharmacists to engage in sensitive and compassionate conversation.”
Kay Dunkley, Executive Officer at the Pharmacists’ Support Service, says pharmacists are “the most accessible health professionals and we also tend to see people on a regular basis when they come in to collect repeat prescriptions and regular medication.
“Some members of the public, who feel very isolated, also come into the pharmacy just to chat. There are people in our community who do not have anyone else beside us to talk to on a regular basis,” she tells AJP.
“Mental Health First Aid (MHFA) training is an excellent tool to assist pharmacists and staff identify someone who may be thinking about suicide and it also teaches how to ask questions such as ‘Are you thinking about suicide?’ or ‘Are you considering ending your life?’.
Most suicidal people do not want to die – they simply do not want to live with the pain. Openly talking about suicidal thoughts and feelings can save a life.
“It is important to ask the question directly and use unambiguous words. Terms like ‘harm yourself’ are not direct enough and could refer to cutting or other self-harm behaviours. Asking about suicide will never put the idea into someone’s mind, but will give them the opportunity to talk openly about thoughts of suicide.
“Be aware of the cues that may indicate someone is thinking about suicide. For example words such as ‘my problems will all end soon’ or ‘I won’t have to worry any more’ in the right context can indicate that someone is thinking of ending their life,” says Ms Dunkley.
MHFA instructor Jan Decomps said further signs a person may be suicidal include:
- Threatening to hurt or kill themselves
- Looking for ways to kill themselves: seeking access to pills, weapons, or other means
- Talking or writing about death, dying or suicide
- Rage, anger, seeking revenge
- Acting recklessly or engaging in risky activities, seemingly without thinking
- Feeling trapped, like there’s no way out
- Increasing alcohol and drug use
- Withdrawing from friends, family or society
- Anxiety, agitation, unable to sleep or sleeping all the time
- Dramatic changes in mood
- No reason for living, no sense of purpose in life
“Suicide can be prevented,” says Ms Decomps.
“Most suicidal people do not want to die – they simply do not want to live with the pain. Openly talking about suicidal thoughts and feelings can save a life.”
Ms Dunkley says: “As a pharmacist if we identify someone who is thinking about suicide, it is important to link them up to services which can assist them. If they do not already have links to mental health services, we can support someone by encouraging them to call one of the many telephone helplines. One strategy is to sit them down in the pharmacy and assist them to call the number immediately.”
She suggests the Suicide Call Back Service (1300 659 467) as they offer follow-up contact to those who are thinking about suicide, those who are supporting someone who is suicidal as well as those bereaved by suicide.
“This is a national service which is available 24/7 and is not just a one-off call but can provide ongoing counselling. They also offer online chat, video chat, an app and also assist people to develop a suicide safety plan.”
Why undertake Mental Health First Aid training?
Mental Health First Aid (MHFA) teaches participants how to assist people who are developing a mental health problem, experiencing a worsening of an existing mental health problem, or in a mental health crisis, until appropriate professional help is received or the crisis resolves, says Ms Decomps.
“This includes identifying the most common mental illnesses in Australia, and their signs and symptoms; looking at the most effective interventions for those illnesses; and learning how to approach a person you believe may be experiencing a mental health problem. Courses are delivered by an Accredited Mental Health First Aid Instructor,” she says.
Pharmacists should undertake MHFA training as they “are widely available and free-to-access healthcare professionals, and of course mental health forms part of the health spectrum,” says Ms Decomps.
“With one-in-five Australians experiencing a mental health issue within the previous 12 months, a large number of pharmacy patients are living with a mental illness.
“Added to this, as we know, pharmacy is a stressful profession; so that one-in-five Australians obviously includes pharmacists and pharmacy staff,” she says.
“Learning how to spot the signs and symptoms of a mental health issue, and how to approach the person, and where to recommend they go for professional help are useful tools in the pharmacy environment – but also life in general.”
Taking care of yourself
Dealing with someone who is suicidal can be very stressful and as pharmacists we need to be aware that any encounter with someone who is thinking about suicide can impact on our own wellbeing, Ms Dunkley points out.
“After an encounter with someone who is suicidal allow some time for reflection as soon as possible and consider debriefing with someone if you feel that you need to talk about what has happened,” she says.
“The debriefing does not have to be immediate. The Pharmacists’ Support Service is able to provide support and debriefing to any pharmacist, pharmacy intern or student after a stressful incident, including supporting someone who is suicidal.
“The Suicide Call Back Service can also offer support if you have been dealing with someone who is suicidal. As pharmacists we need to also practice self-care and prioritise our own wellbeing in order to be able to look after others.”
Lifeline Australia (Crisis Support and Suicide Prevention): Call 13 11 14 or visit https://www.lifeline.org.au/
Pharmacists’ Support Service: PSS is available every day of the year between 8am and 11pm EST on 1300 244 910. https://www.supportforpharmacists.org.au/
Suicide Call Back Service: Call 1300 659 467 (24/7) or visit https://www.suicidecallbackservice.org.au/
Mental Health First Aid Training: https://mhfa.com.au/
The standard MHFA course is 12 hours long, and is delivered face to face: https://mhfa.com.au/courses/public/types/standardedition4
There is also a blended (e-learning + face to face) course specifically designed for pharmacists: https://mhfa.com.au/courses/public/types/blendedpharmacy