after an attempt-suicide

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Make safety a priority for your relative recovering from
                                                           Remember that safety cannot be guaranteed by
                                                           anyone—the goal is to reduce the risks and build
                                                           supports for everyone in the family. However, it is
                                                                                                                                                        Ultimately, please reach out for help in supporting your
                                                                                                                                                        family member and yourself through this crisis. See the list
                                                                                                                                                        below of hotlines, information, and support organizations
                                                                                                                                                                                                                                                       AFTER A
a suicide attempt.                                                                                                                                      to help you and your family member move forward with
                                                           important for you to believe that the safety plan can
Research has shown that a person who has attempted                                                                                                      your lives.
                                                           help keep your relative safe. If you do not feel that it
to end his or her life has a much higher risk of later                                                                                                  Remember that the emergency department is open 24
                                                           can, let the emergency department staff know before
dying by suicide. Safety is ultimately an individual’s                                                                                                  hours a day, 365 days a year to treat your family member,

                                                           you leave.                                                                                   if the problem continues and if your family 2,3 member’s
responsibility, but often a person who feels suicidal
                                                           Maintain Hope and Self-Care—Families commonly                                                medical team is unavailable to provide the needed care.
has a difficult time making good choices. As a family
member, you can help your loved one make a better          provide a safety net and a vision of hope for their
choice while reducing the risk.                            suicidal relative, and that can be emotionally exhausting.                                   2
                                                                                                                                                          Contact Alcoholics Anonymous at 212-870-3400 or Contact Narcotics Anonymous at
                                                                                                                                                        818-773-9999 or Contact Al-Anon (or Alateen for youth) at 757-563-1600 or
                                                           Never try to handle this situation along—get support                               
Reduce the Risk at Home—To help reduce the risk                                                                                                         3
                                                                                                                                                            To learn more about ACT, contact NAMI at 1-800-950-NAMI (6264) or
of self-harm or suicide at home, here are some things      from friends, relatives, and organizations such as the
to consider:                                               National Alliance on Mental Illness (NAMI), and get

• Guns are high risk and the leading means of death
                                                           professional input whenever possible. Use the                                                    TO LEARN MORE ABOUT SUICIDE                                                                   A Guide for Taking Care of
                                                           resources on the back pages of this brochure, the
                                                                                                                                                            AND TO GET HELP, CONSIDER THE
  for suicidal people—they should be taken out of the
  home and secured.
                                                           Internet, family, and friends to help you create a                                                                                                                                               for Your Family Member
                                                           support network. You do not have to travel this                                                  FOLLOWING RESOURCES.
• Overdoses are common and can be lethal—if it is          road along.                                                                                                                                                                                          after Treatment in the
  necessary to keep pain relievers such as aspirin,                                                                                                         In a crisis, contact:
  Advil, and Tylenol in the home, only keep small                                                                                                           1-800-273-TALK(8255);                                                                            Emergency Department
                                                           MOVING FORWARD                                                                                   TTY:1-800-799-4TTY(4889)
  quantities or consider keeping medications in a
                                                           Emergency department care is by nature short-term and
  locked container. Remove unused or expired                                                                                                                                                                                                                  Suicidal thoughts and actions
                                                           crisis oriented, but some longer-term interventions have                                         National Suicide Prevention Lifeline
  medicine from the home.                                                                                                                                                                                                                                    generate conflicting feelings in
                                                           been shown to help reduce suicidal behavior and                                                  A 24-hour, toll free crisis hotline that links callers
• Alcohol use or abuse can decrease inhibitions and        thoughts. You and your relative can talk to the doctor                                           to a nearby crisis center. The Lifeline accepts                                                  family members who love the
  cause people to act more freely on their feelings.       about various treatments for mental illnesses that may                                           calls from non-English speakers.                                                             person who wishes to take his or
  As with pain relievers, keep only small quantities of    help to reduce the risk of suicide for people diagnosed                                                                                                her own life. That is why this
  alcohol in the home, or none at all.                     with illnesses such as schizophrenia, bipolar disorder, or                                                                                                                                     guide was developed for you. It
                                                           depression. Often these illnesses require multiple types                                         FOR MORE INFORMATION ABOUT
Create a Safety Plan—Following a suicide attempt,                                                                                                                                                                                                             will give you some important
a safety plan should be created to help prevent another    of interventions, and your relative may benefit from a                                           SUICIDE AND MENTAL ILLNESS:                                                                      points on how to take care of
attempt. The plan should be a joint effort between         second opinion from a specialist.
                                                                                                                                                            American Association of Suicidology                                                          yourself and your family member
your relative and his or her doctor, therapist, or the     If your relative abuses alcohol or other drugs, it is also                                                                                                                                    following a suicide attempt and it
emergency department staff, and you. As a family                                                                                                            A resource and education organization dedicated
                                                           important to seek help for this problem along with the                                                                                                                                            will provide resources to help
member, you should know your relative’s safety plan                                                                                                         to the understanding and prevention of suicide.
                                                           suicidal behavior. Seek out a substance abuse specialist.
and understand your role in it, including:                                                                                                         or call 202-237-2280.                                                                    you move forward.
                                                           Contact your local substance abuse treatment provider
• Knowing your family member’s “triggers,” such as         by calling 1-800-662-4357 or visiting                                                            American College of Emergency
  an anniversary of a loss, alcohol, or stress from, or contact groups like
                                                                                                                                                            Physicians (ACEP) A national medical
  relationships.                                           Alcoholics Anonymous (AA) or Narcotics Anonymous
                                                                                                                                                            society committed to advancing emergency
                                                           (NA) to help your loved one; Al-Anon may be a good
• Building supports for your family member with                                                                                                             care through continuing education, research,                                                        
                                                           resource for you as a family member.2 If it is available in
  mental health professionals, family, friends, and                                                                                                         and public education. or call                                                                     Toll Free 1-877-315-6855
                                                           your area, an integrated treatment program like
  community resources.                                                                                                                                      1-800-798-1822.
                                                           Assertive Community Treatment (ACT) may provide                                                                                                                                                            Developed by the U.S. Department
• Working with your family member’s strengths to           better outcomes that traditional care for some severely                                          American Foundation for Suicide                                                                               of Health and Human Services
  promote his or her safety.                               ill individuals.3
                                                                                                                                                            Prevention Dedicated to advancing the
                                                              Contact Alcoholics Anonymous at 212-870-3400 or Contact Narcotics
• Promoting communication and honesty in your              Anonymous at 818-773-9999 or Contact Al-Anon (or Alateen for youth) at 757-563-       public’s knowledge of suicide and its prevention.
                                                           1600 or To learn more about ACT, contact NAMI at 1-800-950-NAMI
  relationship with your family member.                    (6264) or                                                             or call 1-888-333-AFSP.
                   W HAT H APPENS                                                  IN THE                          E MERGENCY D EPARTMENT ?
                                                                                                                     who may have information. Emergency department                                                                                      have a clear understanding of what will take place
GOAL                                                      Finally, a doctor may assess in more detail the actual
                                                                                                                                                                                                                                                         over the next 3-10 days, while a court decides on
                                                          suicide attempt that brought your relative into the        personnel should try to contact the medical profes-
The goal of an emergency department visit is to get                                                                  sionals who know the situation best before making                                                                                   the next steps for treatment.
                                                          emergency department. Information that the treat-
the best outcome for the person at a time of crisis–                                                                 decisions.
                                                          ment team should look for includes the presence of                                                                                                                                             If your relative has a hearing impairment or does
resolving the crisis, stabilizing the patient medically
                                                          a suicide note, the seriousness of the attempt, or a       Other important information about your relative’s                                                                                   not speak English, he or she may have to wait for
and emotionally, and making recommendations and
                                                          history of previous suicide attempts.                      history to share with the emergency department staff                                                                                someone who knows American Sign Language or an
referrals for follow-up care or treatment. There are
                                                                                                                     includes:                                                                                                                           interpreter. It is generally not a good idea to use a
several steps in the process, and they all take time.       Inform the emergency department                          • A family history of actual suicide – mental health                                                                                family member to interpret in a medical situation.
When someone is admitted to an emergency depart-            personnel if your relative has:                             professionals are taught to pay attention to this                                                                                If the emergency department’s treatment team,
ment for a suicide attempt, a doctor will evaluate                                                                      because there is an increased risk in families with
                                                             • Access to a gun, lethal doses of medications,                                                                                                                                             the patient, and you do not feel hospitalization is
the person’s physical and mental health. Emergency                                                                      a history of suicide.                                                                                                            necessary, then you should all be a part of developing
                                                               or other means of suicide.
department staff should look for underlying physical                                                                 • Details about your relative’s treatment team –                                                                                    a follow-up treatment plan. In developing a plan,
problems that may have contributed to the suicidal           • Stopped taking prescribed medicines.                     a recent change in medication, the therapist is on                                                                               consider the following questions:
behavior, such as side effects from medications,             • Stopped seeing a mental health provider                  vacation, etc. This information is relevant for emer-
untreated medical conditions, or the presence of               or physician.                                            gency department staff because if they do not feel                                                                                Questions Family and Friends Should Ask
street drugs that can cause emotional distress. While                                                                   hospitalization is best, they need to discharge your                                                                               About the Follow-up Treatment Plan
                                                             • Written a suicide note or will.                          family member to a professional’s care.
emergency department staff prefer to assess people
                                                                                                                                                                                                                                                         Ask your family                Ask the treatment
who are sober, they should not dismiss things people         • Given possessions away.                               • If the person has an Advance Directive1, review this
                                                                                                                                                                                                                                                         member: It is important        team: This includes the
say or do when intoxicated, especially comments about        • Been in, or is currently in, an abusive                  with the emergency department treatment team. If                                                                                 to be honest and direct with   doctor, therapist, nurse,
how they might harm themselves or others.                      relationship.                                            you have a guardianship, let them know that as well.                                                                             your questions and answers.    social worker, etc.

ASSESSMENT                                                   • An upcoming anniversary of loss.                      You may want to get permission from the staff and
                                                                                                                                                                                                                                                         • Do you believe profes-       • Do you feel safe to
After emergency department staff evaluate your family                                                                your relative to sit in on your relative’s evaluation in                                                                               sionally that my family       leave the hospital, are
                                                             • Stated abusing alcohol or drugs.
member’s physical health, a mental health assessment                                                                 the emergency department to listen and add informa-                                                                                    member is ready to leave      you comfortable with
should be performed, and the physician doing the             • Recovered well from a previous                        tion as needed. Your role is to balance the emergency                                                                                  the hospital?                 the discharge plan?
exam should put your relative’s suicidal behavior into         suicidal crisis following a certain type              department staff’s training and the interview of the                                                                                • Why did you make the         • How is your relationship
context. The assessment will generally focus on three          of intervention.                                      patient with your perspective. The best emergency                                                                                      decision(s) that you did      with your doctor, and
areas:                                                                                                               department decisions are made with all the relevant                                                                                    about my family member’s      when is your next
                                                                                                                     information.                                                                                                                           care or treatment?            appointment?
1. What psychiatric or medical conditions are present?    WHAT THE EMERGENCY DEPARTMENT
                                                                                                                                                                                                                                                         • Is there a follow-up         • What has changed since
   Are they being or have they been treated? Are the      NEEDS TO KNOW: HOW YOU CAN HELP                            NEXT STEPS AFTER THE EMERGENCY                                                                                                         appointment scheduled?        your suicidal feelings or
   suicidal thoughts and behavior a result of a recent                                                                                                                                                                                                      Can it be moved to an         actions began?
                                                          Confidentiality and Information Sharing                    DEPARTMENT
   change, or are they a longstanding condition?          Family members are a source of history and are often                                                                                                                                              earlier date?
                                                                                                                                                                                                                                                                                        • What else can I/we do
2. What did the person do to harm himself or herself?     key to the discharge plan.                                 After your relative’s physical and mental health are                                                                                • What is my role as a           to help you after you
   Have there been previous attempts? Why did the         Provide as much information as possible to the             thoroughly examined, the emergency department                                                                                          family member in the          leave the emergency
   person act, and why now? What current stressors,       emergency department staff. Even if confidentiality        personnel will decide if your relative needs to be                                                                                     safety plan?                  department?
   including financial or relationship losses, may have                                                              hospitalized-either voluntarily or by a commitment.
                                                          laws prevent the medical staff from giving you informa-                                                                                                                                        • What should we look          • Will you agree to talk
   contributed to this decision? Does the person                                                                     If hospitalization is necessary, you can begin to work                                                                                 for and when should we        with me/us if your
   regret surviving the suicide attempt? Is the person    tion about your relative, you can always give them
                                                                                                                     with the receiving hospital to offer information and                                                                                   seek more help, such as       suicidal feelings return?
   angry with someone? Is the person trying to            information. Find out who is doing the evaluation and
                                                                                                                     support and to develop a plan for the next steps in                                                                                    retuning to the emer-         If not, is there someone
   reunite with someone who has died? What is the         talk with that person. You can offer information that                                                                                                                                             gency department or           else you can talk to?
                                                          may influence the decisions made for your relative.        your relative’s care. If involuntary hospitalization is
   person’s perspective on death?                                                                                                                                                                                                                           contacting other local
                                                                                                                     necessary, the hospital staff should explain this legal                                                                                resources and providers?
3. What support systems are there? Who is providing       If you ever again have to accompany your relative to
                                                                                                                     procedure to your relative and you so that you both
   treatment? What treatment programs are a good          the emergency department after an attempt, remember                                                                                                                                            Remember: It is critical for the patient to schedule
   match for the person? What does the individual         to bring all medications, suspected causes of overdose,    1
                                                                                                                      Advance directives are legal documents that allow someone to give directions for future medical care or designate another person
                                                                                                                                                                                                                                                         a follow-up appointment as soon as possible after
                                                          and any names and phone numbers of providers
                                                                                                                     to make medical decisions if one is unable to competently make such decisions. For more information, contact the National
                                                                                                                                                                                                                                                         discharge from the emergency department.
   and the family feel comfortable with?                                                                             Disability Rights Network (NDRN) at 202-408-9514 or

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