Practical 2

Introduction-
Definitions-
1. Suicide is death caused by injuring oneself with the intent to die.
2. “Death caused by self-directed injurious behavior with any intent to die as the result
of the behavior”

Advantages and disadvantages of suicide screening-

Advantages:

1. Identification of Risk: Suicide screening can help identify individuals at risk of

suicide or self-harm. This early identification allows for timely intervention and
support, potentially preventing a tragic outcome.

2. Access to Support Services: Screening can connect individuals with mental health
resources and support services, providing them with the help they need to cope with
their struggles.

3. Reducing Stigma: Implementing suicide screening programs may contribute to

reducing the stigma associated with mental health issues. By acknowledging and
addressing suicide risk openly, it becomes easier to discuss mental health concerns
and encourage individuals to seek help.

4. Prevention Efforts: Screening can be a crucial component of broader suicide

prevention efforts, allowing for targeted interventions and the implementation of
preventive measures.

5. Data Collection and Research: The data collected through suicide screening
programs can contribute to research efforts aimed at understanding the factors
associated with suicide risk. This information can be used to develop more effective
prevention strategies.

Disadvantages:

1. False Positives and Negatives: Suicide screening tools may produce false positives
(indicating risk when it's not present) and false negatives (failing to identify
individuals at risk). This can lead to unnecessary anxiety for some individuals or
result in overlooking those who genuinely need help.

2. Ethical Concerns: There are ethical considerations related to privacy and consent.
Some individuals may be uncomfortable with the intrusive nature of certain screening
questions, and there is a risk of violating individuals' rights in the absence of proper
ethical guidelines.
3. Limited Predictive Accuracy: Predicting suicide risk is challenging, and screening
tools may have limited accuracy in identifying those at risk. The complexity of human
behaviour and mental health makes it difficult to develop highly accurate predictive
models.

4. Resource Allocation: Implementing widespread suicide screening programs

requires resources. There may be concerns about whether these resources could be
better allocated to other mental health initiatives or interventions with proven efficacy.

5. Potential for Stigmatization: Being identified as at risk for suicide may lead to
social stigmatization or discrimination. This could result in reluctance on the part of
individuals to participate in screening programs due to fear of the consequences.

It's essential to approach suicide screening with sensitivity, incorporating ethical

considerations, ongoing evaluation, and a commitment to providing appropriate
support and care for individuals identified as at risk.

Suicide screening in schools, primary care, and emergency departments. –

Suicide screening in schools, primary care settings, and emergency departments is
crucial for identifying individuals at risk and providing timely interventions. Here are
some considerations and approaches for suicide screening in these different settings:

Schools:

1. Training for School Staff:

- Provide training for teachers, counsellors, and other school staff to recognize signs
of suicidal ideation or risk factors.
- Educate staff on creating a supportive and non-stigmatizing environment.

2. Anonymous Reporting Systems:

- Implement anonymous reporting systems for students to share concerns about their
peers.
- Encourage students to report any signs of distress they observe.

3. Regular Mental Health Education:

- Include mental health education as part of the curriculum to reduce stigma and
increase awareness.
- Teach coping skills and stress management techniques.

4. Access to Mental Health Professionals:

- Ensure that schools have access to mental health professionals who can conduct
assessments and provide support.

Primary Care:
1. Screening Tools:
- Use standardized suicide risk assessment tools during routine check-ups.
- Incorporate questions about mental health and suicide risk into regular health
assessments.

2. Training for Healthcare Providers:

- Train primary care providers to recognize warning signs of suicide and conduct
risk assessments.
- Provide education on how to communicate with patients about mental health
concerns.

3. Integration with Electronic Health Records:

- Integrate suicide risk assessments into electronic health records to facilitate
information sharing among healthcare providers.

4. Referral Pathways:
- Establish clear referral pathways to mental health specialists for individuals
identified as at risk.

Emergency Departments:

1. Routine Screening Protocols:

- Implement routine suicide risk screening protocols in emergency departments.
- Train emergency department staff to identify and respond to individuals at risk.

2. Crisis Intervention Teams:

- Develop crisis intervention teams within emergency departments that include
mental health professionals.

3. Collaboration with Mental Health Services:

- Establish strong connections with local mental health services for prompt follow-
up and continuity of care.

4. Safety Planning:
- Develop safety plans for individuals identified as at risk, including strategies for
managing crises and accessing support.

General Considerations:

1. Cultural Sensitivity:
- Ensure that screening tools and protocols are culturally sensitive and consider
diverse backgrounds.

2. Community Collaboration:
 - Foster collaboration between schools, healthcare providers, emergency
departments, and community mental health services.

3. Public Awareness Campaigns:

- Conduct public awareness campaigns to reduce stigma and encourage help-
seeking behaviour.

4. Policy Support:
- Advocate for policies that support mental health services in schools, primary care,
and emergency departments.

Remember that suicide screening is just one component of a comprehensive suicide

prevention strategy. Ongoing education, support services, and community
involvement are also essential elements in creating a holistic approach to mental
health and suicide prevention.

Applications of suicide screening-

Suicide screening has various applications across different sectors, as early
identification of individuals at risk is crucial for providing timely intervention and
support. Here are some key applications of suicide screening:

1. Clinical Settings:
- Primary Care:
- Identify individuals at risk during routine health check-ups.
- Incorporate suicide risk assessments into standard health assessments.
- Enable early intervention through referrals to mental health specialists.

- Emergency Departments:
- Screen individuals presenting with mental health concerns or suicidal ideation.
- Implement protocols for crisis intervention and immediate support.
- Facilitate referrals to mental health services for follow-up care.

- Psychiatric Hospitals and Clinics:

- Continuously assess patients for suicide risk.
- Tailor treatment plans based on ongoing risk assessments.
- Collaborate with outpatient services to ensure continuity of care upon discharge.

2. Educational Institutions:
- Schools and Colleges:
- Identify students at risk through regular mental health education and screenings.
- Implement anonymous reporting systems for students and staff.
- Provide counseling and support services for at-risk students.

- University Health Services:

- Offer mental health screenings during routine health check-ups.
- Establish a supportive environment for students through counseling services.
 - Provide resources for stress management and coping strategies.

3. Workplace Settings:
- Employee Assistance Programs (EAPs):
- Integrate mental health screenings into EAP services.
- Provide resources and support for employees struggling with mental health
issues.
- Train supervisors and HR personnel to recognize signs of distress.

- Occupational Health Clinics:

- Incorporate mental health assessments into occupational health evaluations.
- Develop strategies to address workplace stressors and promote mental well-
being.
- Establish protocols for referrals to mental health professionals.

4. Community Health Programs:

- Community Health Clinics:
- Integrate suicide risk screenings into community health programs.
- Collaborate with local mental health organizations for comprehensive care.
- Raise awareness about mental health through community outreach.

- Public Health Campaigns:

- Conduct public awareness campaigns to reduce stigma.
- Educate communities about recognizing and responding to signs of suicide risk.
- Provide information about local mental health resources.

5. Correctional Facilities:
- Prison and Jail Health Services:
- Implement suicide risk assessments during intake and regularly thereafter.
- Provide mental health services for incarcerated individuals.
- Develop re-entry programs with mental health support for released individuals.

6. Telehealth and Digital Platforms:

- Online Mental Health Platforms:
- Incorporate suicide risk assessments into telehealth services.
- Provide resources and support for individuals accessing mental health care
remotely.
- Ensure privacy and confidentiality in digital mental health services.

Suicide screening is a valuable tool in a range of settings, and its applications can
contribute to a more comprehensive and integrated approach to mental health care and
suicide prevention. It is important to tailor screening methods to the specific needs
and characteristics of each population and setting.
Demographic details-

Name- B. M.

Age- 23 years old

Gender- Male

Marital status- Unmarried

Educational Background- M. Tech. (Bio. Tech)

Occupation- student

Family Structure- Nuclear family

Sexual orientation- Straight

Family tree-

Ordinal Position- First born

Mother’s occupation- Government employee

Mother’s Edu. Background- BSc. Chemistry(Hons)

Father’s occupation- Employee in Sun pharma Co.

Father’s Edu Background- BSc. Chemistry(Hons)

Geographical location- Mumbai

Socio- economic status- middle Class.

Case History- The participant is 23 years old unmarried male currently studying in post-
graduate program in Amity University Mumbai. The participant does not have past
Psychiatric and medical history and he was calm and relaxed while conducting the test and
taking case history.

The participant does not majorly have any suicidal ideation now but he was having it in the
past when he lost hopes because of the physical injury, he got his leg fracture and was not
able to play football as he is a football player. But there was an attempt and non-suicidal self-
injury (NSSI).

Now he is doing well in his life and academics, he is having good relationships and a good
social support and now he is hopeful towards his future job as he has done the required hard
work for it. He is also a district level swimmer and he have achieved after the prolonged
injury he have had. He is the one how does not easily lose hope and gives it a try till last.

He had a relationship in which the partner cheated on him, and he was broken emotionally
but still recovered from that trauma quickly and it does not bother him anymore and now
going in his life well. He was a very cheerful person, but his past made him little supressed it
does not bother him anymore, but he does not feel that much cheer in his life now.

So after his negative experiences in life he had some thoughts to kill himself, he use to stare
at window whenever he have some depressed mood to go and jump out of it or even
whenever he sees a knife to cut the vein but didn’t do it yet as he have a good coping and
support from everyone.

Materials required-

Patient Health Questionnaire 9 (PHQ 9), Columbia Suicide Severity Rating Scale (CSSRS),
and Stationery

Procedure-

The participant was taken in the room where the lighting was controlled and asked to sit in
the comfortable position and the rapport was established and the case history was taken, and
the instructions were made out clear and after assuring that the participant have understood
the instruction and the required stationary was provided and then asked to solve the test.

Precautions-

1. The lab should be free of noise and there should not be any disturbance.

2. The seating arrangement should be comfortable.

3. Enough time should be given.

4. The norms should be followed while conducting the test.

Conduction- The conduction has done in a well-lit room, rapport was established and
the case history was taken. The participant was instructed on how to solve the test and
 was given the booklet and on the completion of the test the responses were noted then
scores were calculated using the manual.

Observations- The participant seemed very neat calm and relaxed at the time of
rapport building, taking case history and test conduction. He was confident at the time
of taking the case history and conduction of the test.

Interpretation-

Total Score Depression Severity

1-4 Minimal depression
5-9 Mild depression
10-14 Moderate depression
15-19 Moderately severe depression
20-27 Severe depression

CSSRS-

Yellow color- Low Risk

Orange Color- Moderate Risk

Red Color- High Risk

Scores-

PHQ-

Scores Obtained Interpretation

14 Moderate depression

CSSRS- In the CSSRS Conduction it was found that there is a moderate risk for suicide as
the participant tick on the orange colour.
Discussion –
The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD
diagnostic instrument for common mental disorders. The PHQ-9 is the depression module,
which scores each of the 9 DSM-IV criteria as “0” (not at all) to “3” (nearly every day). The
PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-
gynaecology clinics. Construct validity was assessed using the 20-item Short-Form General
Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty.
The participant is 23 years old unmarried male currently studying in post-graduate program
in Amity University Mumbai.
The scores we have got is 14 says that the participant is having moderate depression in which
there are suicidal ideation but still held back himself because he is having good support, and
the participant is not very healthy. There are ideations of suicide which is congruent with the
case history also. He is doing well in his life and has less sense of fulfilment and having good
bond with everybody as of now but he is a neurotic personality which is also a high risk of
suicide as an individual can do it anytime having any depressed or anxious episode.
As we have got a moderate score on the Patient Health Questionnaire 9 (PHQ 9) We had to
conduct the Columbia Suicide Severity Rating Scale (CSSRS), in which also it was found out
that the participant have a moderate suicidal ideation as he tick on the orange part on the
scale which indicates the moderate ideation which was congruent with the case history.

Conclusion- The purpose of the test was to know that are there any suicidal ideations or no
and we have found that there are moderate suicidal ideation, and the participant is not very
healthy.
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