MHM Magazine

stigma around depression and mental health emergencies which fortunately is slowly decreasing with several NGOs’ help Dealing with such patients can be emotionally and professionally draining. Values and beliefs around suicidality should also be considered as healthcare providers must take note of their own verbal and non-verbal behaviour and reactions towards the patient. SUICIDE LANGUAGE GUIDE (This is taken directly from SADAG - South African Depression and Anxiety Group - all acknowledgements to them) DO SAY DON’T SAY WHY ‘died by suicide’ ‘took their own life’ ‘successful suicide’ ‘un ’suc- cessful suicide’ Because it suggests suicide is a desired outcome. No one wins if someone dies by suicide dies. ‘took their own life’ ‘died by suicide’ ‘committed suicide’ ‘commit suicide’ Because it as- sociates suicide with crime ‘increasing rates’ ‘higher rates’ ‘suicide epidemic’ ‘failed suicide’ Because it sensationalises suicide ‘suicide attempt’ ‘non-fatal attempt’ ‘failed suicide’ ‘suicide bid’ It means that someone hasn’t died, they are still alive and there is an opportunity to get them help. So not dying by suicide is not a fail Refrain from using the term suicide out of context ‘political suicide’ ‘suicide mission’ Because it is an inaccurate use of the term ‘suicide’ SADAG Project Manager, Krystle Kemp, reminds us that someone who has a mental illness is not defined by their mental illness. The person ‘struggles with depression’, rather than he/she is depressed. As SADAG describes, “We don’t say that someone who has cancer “is cancer”, rather they have been diagnosed with cancer. Major depression and bipolar disorder (or any of the above stated problems) are illnesses, just as is hypertension and diabetes. Suicidal ideation and an attempt to take his/ her life is a desperate attempt to end the pain or situation that the person is in. Medical treatment may not have worked anymore, and such patients are often in total despair. HOW TO MANAGE PATIENTS WHO FEEL SUICIDAL OR HAVE ATTEMPTED TO TAKE THEIR LIVES THROUGH SUICIDE Health Care Providers who are inclined towards psychiatry may be tempted to counsel the patient in the emergency centre/ ambulance; however this is neither the time nor space to do so. Emergencies’ unpredictability as well as the healthcare provider’s short encounter with the patient (normally) is unfortunately unsuitable to ‘counselling’. However, the following principles apply to any healthcare provider dealing with a patient who has attempted to take their life or patient who is experiencing suicidal ideation/threat/attempt. 1. Where at all possible, attempt to keep such patients away from the mix of physical trauma, medical emergencies, and even death. 2. Show empathy. Convey sincere concern. Really listen, try to understand things from their perspective. 3. Make regular eye contact and refer to the person by name. 4. Be patient. Allow the patient time to digest what is happening around them. 5. Take on a non-judgmental attitude and avoid criticism. Avoid telling the patient what he/she should do or should have done as this can be seen as criticising. 6. Attend to these patients frequently, even if it’s just to check they are okay or need a cup of tea/water (where not contra-indicated) and tissues etc. It’s extremely important to know where your patient is at all times. 7. When able, sit quietly with the patient, especially if they are extremely emotional (crying) – silent moments are okay. The patient may feel more comfortable or be trying to deal with their feelings at that time. 8. Validate emotions: reinforce that crying/distress is ‘normal’ to experience in such a situation. 9. Ensure the area is safe. ECs are areas with equipment that could be lethal (such as defibrillators) as well as drugs and equipment that could inflict great harm/death. 10. Avoid giving (uncalled-for) advice. 11. Keep the family up to date with developments and reassure them as much as possible. A FAMILY’S REAL EXPERIENCE … Having myself been a patient who has attempted to take my life, my family has experienced the difficulty to get the necessary medical care for me. This was an extremely traumatic experience for them. As they recall the situation my family took me to a local government- based EC. Once at the EC, triage was never applied (I had overdosed) and eventually my family took me home after hours of waiting in the EC’s waiting room. I could have died (although that is what I wanted at the time). In retrospect this should NEVER have happened. Private hospitals can also assist patients in these situations and should be used where at all necessary and affordable (through medical aid or other means). IN CONCLUSION Healthcare providers are in the privileged position to assist those in crisis, whether it is physical or psychiatric. It’s important to acknowledge that many South African healthcare facilities, Emergency Centres, and hospitals’ pressure experienced by healthcare providers are not always conducive to dealing with psychiatric emergencies. However, may this guideline be a reminder to deal with suicidal patients with utter respect and non-judgmental. They require empathy during their medical crisis as does any other person with any medical/traumatic emergency. References available on request. 28 | MENTAL HEALTH MATTERS | 2023 | Issue 5 MHM