You would think that dealing with patients who are suicidal, dealing with those who have been bereaved by suicide, or dealing with the aftermath of a patient who has died by suicide, would increase awareness of when it is about to occur or make the feelings that arise easier to manage.
However, this is not necessarily true, and any occurrence has a devastating effect, especially when someone dies.
As nurses, we learn to recognise the signs that would suggest someone is suicidal – for example low mood, giving away possessions, hopelessness and no sight of a future in any discussions that you have with your patient.
“Nurses are encouraged to talk to their patients and ask them directly about suicidal ideation”
Nurses are encouraged to talk to their patients and ask them directly about suicidal ideation. Any awkwardness or fear the nurse may have about discussing suicide is concealed, with the awareness that discussing suicidal ideation does not plant the idea into someone’s mind. Nurses are aware that patients who are feeling suicidal generally feel a sense of relief when the nurse openly discusses suicidality and those patients who are not suicidal, generally reassure the nurse that they do not feel that way.
Sadly, however, some patients die by suicide, despite having had the opportunity to talk and divulge their thoughts and feelings. Those who die may have spoken about their feelings, yet a lot of the time they do not let people know when they are feeling suicidal. They hide their pain and suffering.
When discussed openly and asked the clear question – “are you feeling suicidal?”, “do they want to die?”, this often dissipates their plan or thoughts of suicide; but not always. Consequently, the feelings of guilt arise, and people feel blamed for not recognising the symptoms, for not doing enough or for not believing them.
No nurse wants their patients to die; they will do everything in their power to save a patient by virtue of nature. This is akin to a nurse giving basic life support to a patient who is experiencing a heart attack; the nurse will talk to the patient who is suicidal and will help them find reasons for living.
If this is not possible, the nurse would begin the process of potentially detaining the patient and maintaining their safety. Yet, when a patient dies by suicide, families and/or the media portray the inadequacy of mental health staff and services. The finger-pointing and blame can ruin the nurse as a person and as a nurse.
“Mental illness cannot be seen”
Pragmatically, there is only so much a nurse can do. They can look out for signs that may suggest a patient is suicidal and they can listen to their patients, but if the patient does not show any signs or discuss with the nurse how they are truly feeling, then there is no way of knowing if they would take their own life. Unlike someone who displays the symptoms of a heart attack, mental illness cannot be seen.
Ultimately, if the nurse had any inclination that their patient was suicidal, they would act on it and do everything that they could to maintain the safety of that patient. Above all, the nurse will always take their patient seriously if suicidal ideation is expressed.
Sarah Tait is lecturer in nursing at Swansea University