Tag: suicide

Review: Risk Management with Suicidal Patients

by Midnight Demon, posted in depression, mood disorders, suicide, suicide attempt

Review: Risk Management with Suicidal Patients

I found this book very easy to read in laymen terms. It was a short book but held important information for clinicians to protect themselves from liability and malpractice should a client/patient die by suicide.

The authors stressed that this was more an outpatient issue than an inpatient issue, least that is my interpretation. This holds true in the day an age where inpatient psych admission are short and not very helpful. In fact, there has been more suicides post discharge or during an admission than there has been outpatient deaths. I would quote where I got this but unfortunately, I don’t have it handy. It has been my nemesis to remember information but not the source.

The information about inpatient suicide care is a little outdated for the current time period even though the book was written in 1996. The important points are to have a standard of care that protects the client/patient from him/herself as well as the clinician taking care of the said client. The general rule is to seek supervision where appropriate or consultation with other clinicians that have more experience in the field of suicide and not to have more than at least 2 at high risk clients.

Suicide research and treatment has come a long way since 1996. More safety protocols have been created as well as safety planning that promote a life worth living. I highly recommend this book to any clinician in the field of mental health and dealing with the suicidal patient, even though there has been some things that need to be updated.

Bongar, B., Berman, A. L., Maris, R. W., Silverman, M. M., Harris, E. A., & Packman, W. L. (Eds.). (1996). Risk Management with Suicidal Patients. New York, New York: Guilford Press.

Purpose

by Midnight Demon, posted in Bipolar Disorder, blogging, chronic physical pain, depression, mood disorders, suicide

Purpose

Everyone needs a purpose in life. It is what drives us. But sometimes when we are very depressed and feeling worthless, our purpose might not be so clear cut. We often think while depressed, that people will be better off without us, that we don’t matter. This may lead us to become suicidal. And then our true purpose is lost to us. All we think about is death because we have no purpose to go on living. It’s especially precarious after we lost the ones we love due to illness, divorce or if we lost our job. What does it mean to go on after so much loss?

In therapy, therapists often try to give us a life worth living. But what does that mean if we have no purpose for being? It often hurts too much to go on living. Sometimes there are protective factors that keep us here, like family, friends, or children we love and wouldn’t want to hurt with our death. It’s difficult to balance this when you feel so damn low and want to end the pain so badly. It tears at you night and day to go on living in this pain.

My sense of purpose is construed. Others can see that I have one but most times, I don’t see it in myself. It’s hard going on without something to keep me going. I often wonder why I am here. I should be dead three times over, yet I still exist. I am tired of just existing. There is so much I want to do yet I am hindered due to my disabilities. I am often frustrated and suicidal, not a good combo. My depressions are severe and debilitating. My chronic physical pain is as well. I can’t work anymore. I don’t have any friends that are close by that I talk to on a regular basis. I have my online friends, without whom, I think I would feel totally alone, trapped in my room. My therapist and psychiatrist think I am a writer. But since my father’s illness and subsequent death, I have not written much. I had this blog to keep me going, as a challenge to myself to write something every day. Sometimes, I would write two to three times a day. But it’s hard work. Some days it is easier to write than others.

My blog gives me a purpose you can say. I write and get feedback. Most times I don’t but I know the readership is there because I am a stats freak. I watch my numbers go up every day. Sometimes it’s the same blog that gets read several times, and that is ok. My purpose has been fulfilled if it helps someone to understand what it is like living with chronic depression, suicidality, and physical pain.

done nothing I wanted to do

by Midnight Demon, posted in Bipolar Disorder, blogging, chronic physical pain, depression, mood disorders, suicide

Done nothing I wanted to do

After I wrote my previous blog, I played with my bibliography program, entering the book that I was going to start reading as well as exporting the citation of the article that I want to get when I become a member of AAS again. I let my membership lapse because it was and is expensive. I mostly was a member so I could get the journal and still be somewhat connected with the field. After I entered all this information, it kind of made me tired. Data entry is not my strong point. I know people that love inputting stuff in worksheets but it has never been my thing. I should have taken a nap but I wasn’t really tired like I am now. Then I tried reading the chapter I wanted to read and I couldn’t even open the book. My mind kept on fixating on other things. I also could not get into a reading mood, which didn’t help.

Then I thought of typing up the stuff I wrote while in the hospital just to get it out of the way. I became paralyzed. I just couldn’t get off my bed to get to my backpack to retrieve the notepad. I didn’t want to read what I wrote. I didn’t want the “movie” to start over again. So I did nothing. I watched a couple of Friends episodes. They weren’t really funny but I laughed at some parts.

I have been fighting cramps in my side the past few hours. I took an Ativan and you would think that would cause me to nap and settle down, but nope. It took care of the cramps but nothing else. I did start to get tired around 1800 but that is my normal sleepy period. Every day I fight the tireds at that particular hour. I don’t know why. But I know that if I fall asleep, I am up all night. So I fight it at least until I take my night meds. Then I can go to bed. I think I am going to take my night meds early tonight because I feel like a piece of shit. I have done nothing, nothing at all, and it is bothering me. It is making me feel suicidal that is how bad I feel. I texted my therapist. I didn’t get a response back. I really wasn’t expecting one back. I wish she would acknowledge some of my texts so I know that she read them. But nope. I don’t have that kind of text relationship with her.

I also have been so lazy, I haven’t looked for the grief counselor’s card. I found my father’s GI doc’s card. I tossed that out. I won’t be needing her services again. I think I still have the note that the lab my father had his blood drawn in on my bureau. I have been meaning to toss it but I haven’t for whatever reason.

I bought a bunch of Ensure before I went into the hospital. Now that I have my appetite back, I am wondering if I should return them. I kind of don’t because they will be handy when I want to have something to “eat” but don’t feel like making myself something. Or on days when I don’t eat as much. Only time will tell if my appetite is here to stay or not. I could go on a liquid diet for a while to lose some more weight but that will be tricky. I would have to do math and I really am not up to it. I know if I drink at least 4 bottles, that is around 1400 calories, which is ideal for weight loss. I would just have to spread them out so I am not starving myself. I will run this idea by my psychiatrist and see what she thinks. She probably will not like it much but I really want to lose another fifteen pounds. I am so close to my target.

I am going to try the lidocaine cream on my Achilles lump just to see if it helps with the pain. It’s supposed to be odorless so I hope it doesn’t smell. My left ankle/foot is bothering me so I will be taking pain meds for it. I wish it helped with the lump pain but it doesn’t. I am guessing it’s because the pain is so acute and severe it just won’t touch it. Hopefully the lidocaine will.

Down Day

by Midnight Demon, posted in Bipolar Disorder, blogging, depression, mood disorders, suicide

Down Day

I went to Starbucks early this morning. I was hungry and wanted a latte. I should have rested as my thigh is still sore from the fall the other day but I didn’t want to stay at home all day. I wrote in my journal an update of what has transpired the past month as it has been a month since I last wrote in it. It was the day after I found out my father had a few days to a week to live. A lot has happened since then. After writing, I felt down. I really feel sad about things.

I came home because after writing, it was time to leave to catch the next bus home. Now I am in my room and I just feel this tremendous sadness. Things that I collected from my father’s apartment have been on my bed for the past few weeks. I finally placed them in an envelope so I wouldn’t see them anymore. I had a picture book of photos of my father’s family that I made him one year. I decided to keep it because I made it and it has some of my favorite photos in it. Just makes me sad that most of the people in the book are gone now, including my father.

I have to go out tomorrow and I don’t want to unless I can leave in my PJs. I don’t think I can do that, though I would love to. I will just wear my sweatpants rather than my jeans. I have the weekend to stay at home. And then I will have a busy Monday and Tuesday. I don’t think I am going to see my therapist next week. I will see her the following week. It’s strange not having anything to do with my father. It’s like I suddenly have all this free time again to do whatever I want to do. I have a couple of projects that I need to do in my room. One is clearing off my bed so I can change the sheets. There is one corner of my bed that just accumulates stuff. I don’t know how it happens and every time I change my sheets I swear to myself it won’t happen again. But it does. I don’t get it.

Last night, I stayed up pretty late, like 0330 late. I was watching NetFlix and I just couldn’t sleep after watching an episode of Friends. Then I went on Twitter and there was a guy that played in SG1 and the Beautiful Mind. I figured I would watch that movie as I haven’t watched it in a while. Turns out, you needed to be in the DVD club to get the DVD. I was so pissed. This is the second movie that I wanted to watch but couldn’t because it wasn’t available. I guess NetFlix is fine for TV shows but terrible for DVD. I am not spending an additional $8 a month for this club. I will take my DVD watch it, then cancel the service. If I want a DVD, I will buy it on Amazon.

I finally found out what chapter to read in the “Risk Management with Suicidal Patients” book that I bought several months ago. I plan on reading it this afternoon. I might blog about it later if it’s worthy of writing about. It’s a chapter on the ethical side of standards of care for suicidal patients. It’s something that I haven’t read before. Jobes talks a little about it in his book on Managing Suicidal Risk but I never paid that much attention because I am not a clinician. Yesterday on Twitter, there was a presentation of basically how to avoid malpractice suits. The key concept is, of course, good documentation. That is why I love the SSF (Suicide Status Form). It has all your documentation needs right there. There is no need, in my opinion, for more. The Risk management book has both inpatient and outpatient guidelines by pretty much the same authors. And these authors are the big wigs in the suicidology field.

I need to write a letter of thanks to the Hospice group for all they have done for us the day my father died. I have been meaning to write it for a while now but I had other things to take care of that I just haven’t gotten around to it. I have been meaning to call the grief social worker to talk to her but I don’t know what I did with her card. I’ll talk to my psychiatrist on Monday about talking with her, just to get her input. This has been really hard on me because of my depression issues. It’s hard to tease away the grief from the depression that I always feel.