Presentation attended [[25-02-2022]] Looking at completed #suicide cases last two years. #data # Time Based Factor - What is the trend of suicide rate ? Certain month? - Is it related to COVID control measures? Very difficult to draw any conclusion, so many factors. # Treatment Journey Different themes - Initial Consultation - Varied presentations. - No conclusive pattern, or observations. - Challenges in Care - Patient Related Factors - Patient withdrawn/vague/not forthcoming - Sometimes we don't really know the patient. - Strong sentiments of stagnation and falling behind peers/siblings - Getting patients motivated and overcoming their reluctance - Lack of insight - Strong desire to cut down medications - Social difficulties - Occupational difficulties - Family related Factors - High expectations for recovery - unspoken secrets, leave important points unspoken. -- (==then why didn't we ask when we sense there is unspoken issues??==) - Family's difficulty in terms of accepting the diagnosis - Treatment Team Factors - Change of treatment team member - ==Not generalisable. Because there are many cases with change of team meber but no suicide. == - N=10, but 50% have at least 1 change of MDT members. - Limited time with EPIP, and limited time during consultations - Other Factors - Social issues, COVID etc. Disrupted EPIP. - Last Consult (Conventionally, we are thought that those are unwell commit suicide) - Condition of patient - 77.8% seen last consult as well and no symptoms. - Patients were well by and large at the last consult. (Thus we are unable to pick up any signs) - Were there accompanied? - Maybe there were minimising? But 8 out of 9 patients were accompanied by someone at the last consult. No corroborated history to indicate that patient was unwell. - Time Gap between consult and suicide - ![[Screenshot 2022-02-25 at 12.57.35 PM.png]] - Significant developments during the Time Gap - No worrying/negative developments that the team was aware of despite monitoring and check ins - 2 cause with legal issues that might have precipitated # Response to suicide 1. Shock and Disbelief 2. Concern for other treating members 3. Look though medical notes to try to look for anything that we may have overlooked 4. Sense of guilt # Impact on Practice - What changes to clinical work ![[Screenshot 2022-02-25 at 1.03.18 PM.png]] - Similar finding of disillusion in papers. # Deficits in Care? - Generally no after M&M reviews. # Coping with the news # Thoughts about support - rendered to interviewee - Done well - MDT share the grief - Small group M&M - Support from Peers - Culture of no blame - Given time and space to process grief - Support group - What can be done better? - More can be done to support doctors - - Some members not comfortable sharing their emotions at M&M - prefer informal group (different people need different things) - # Thoughts about support - Rendered to Family # Making Sense (Why the person commit suicide?) ![[Screenshot 2022-02-25 at 1.12.57 PM.png]] - How do survivor make sense of suicide? - Impact of illness? #psychosis takes away time from the patient's life, and they realised they have lost so much due to illness. #depression [[Depression]] #grief #loss #existentialism ![[Screenshot 2022-02-25 at 1.17.36 PM.png]] - Even the best of our efforts, we are not in control. # Thoughts - ![[Screenshot 2022-02-25 at 1.19.34 PM.png]] - Risk Prediction Algorithms are derived from those who attempt but survive. - Maybe there is a difference between those who completed and those attempted suicide. - Negative feelings are inevitable. Part of the job as a caregiver. ---- # Discussions - 5% life time. Psychosis about 10% (higher risk then population) - Rapport - More attention to new patient we take over - Support for doctors. But don't know how - SOPs? ---- After attending this presentation... # So What? - Are there any themes to detect suicide? Maybe, maybe not. # So what? - Ideas: The more of the above factors equal higher risk score? what should we focus on? what can we do different? # So what? --- #suicide [[202009101947 Reading notes Asking useful questions. Suicide]] [[20210526 How Norway is offering drug-free treatment to people with psychosis BBC News]]