What Is the Least Painful Way to Commit Suicide

Lethal ways are items or deportment that might exist used in a suicide attempt that are likely to result in death. Lethal means can be divided into two chief categories: tearing and irenic methods. Violent methods can include firearms, cutting or piercing with a abrupt object, hanging, jumping from loftier places, or stepping in front of a train or other vehicle. Irenic methods include ingestion of pesticides, poison past gases, suffocation, and overdose. Access, availability, and social acceptability of sure suicide methods and some location-specific factors such as access to firearms or alpine buildings can factor into the choice of a lethal means (Sunday & Jia, 2014).

Objects Used in Suicide Attempts

Household gun ownership rates are a pregnant positive predictor of both homicide and suicide. A substantial proportion of Americans—over 50% in some states—live in households with guns and may non need to buy a new firearm to carry out a vehement deed (Swanson et al., 2015). More than half of male person suicides are firearm-related (NCHS, 2016).

Although individuals who own firearms are not more than likely than others to have a mental disorder or to have attempted suicide, the risk of a death is higher amidst this population considering individuals who attempt suicide using a firearm are more than likely to die in their attempts than those who use less lethal methods.

The utilize of firearms is particularly prevalent among veterans, with approximately 41% of female and 68% of male suicide deaths resulting from a firearm. Poison is the second-near common means of suicide among female veterans while suffocation is the second-nigh common cause of decease among male veterans (USDVA, 2016a).

Substances Used in Suicide Attempts

Among heart-aged adults (aged 35 to 64) poisoning (predominantly drug overdose) is the leading cause of suicide death amidst females and the tertiary leading cause for males. Suicide attempts (and suicide deaths) among middle-aged adults take increased in contempo years, which underscores the importance of understanding risk factors for suicide in this age group (Tesfazion, 2014).

Near all drug-related emergency section visits involving suicide attempts among eye-aged adults involve prescription drugs and over-the-counter medications. About half of visits involve anti-feet and insomnia medications, a third involve hurting relievers, and 22% involve antidepressants. Amidst middle-aged adults, more than than a tertiary of all drug-related ED visits involving a suicide attempt as well involved booze, and 11% involved illicit drugs (Tesfazion, 2014).

Inert gas asphyxiations using helium have been on the increase in the United States. The increasing familiarity with this gas is partly the reason for the rise in suicide by helium. Helium suicides have also been publicized on internet websites as simple and painless. More than formal recommendations regarding suicides with inert gas asphyxiations demand to be developed as well every bit restricting admission to helium (Hassamal et al., 2015).

The most frequent "other" suicide methods for females are falls and drowning. For males, the most frequent "other" methods are falls and cutting or piercing (NCHS, 2016). Although falling from buildings or bridges is a relatively small-scale percentage of suicide attempts, information technology is very often lethal (Hemmer et al., 2017)

For both females and males, near a quarter of suicides in 2014 were attributable to suffocation (includes hanging, strangulation, and suffocation), an increment over previous years (NCHS, 2016). The high prevalence of asphyxiations can exist attributed to the widespread availability of ways for hanging. Currently, there are no formal proposals on how to reduce asphyxiation suicides. Research indicates that those who attempted suicide by hanging viewed it equally a quick, simple, and painless expiry. One fashion to reduce hanging suicides would be to challenge perceptions of hanging as a quick, simple, and painless suicide method (Hassamal et al., 2015).

Suicide Deaths, past Method and Sexual practice: United states of america, 1999 and 2014

Source: NCHS, National Vital Statistics System, Mortality.

Talking About Lethal Means

Individuals experiencing significant distress or who have a contempo history of suicidal behavior should non take easy access to ways that may be used in a suicide attempt. This includes access to firearms, weapons, medications, illicit drugs, chemicals used in the household, other poisons, or materials used for hanging or suffocation.

Healthcare providers are in a unique position to ask about lethal means. Providers accept the opportunity to brainwash patients and families about safe firearm storage and access, likewise equally the appropriate storage of alcoholic beverages, prescription drugs, over-the-counter medications, and poisons. Many healthcare providers avoid these discussions or ask about lethal means only when a patient is identified every bit being at a very high gamble for suicide.

Nearly Lethal Means—A Nurse Practitioner'south Guidance

One time y'all accept identified that your patient is at gamble for self-harm, try to identify any lethal means that your patient might be able to admission once he or she leaves your office. Enquire straight questions: "While you're in this dangerous menstruum, may I call your partner or family member and inquire them to remove the guns or poisons from the business firm?"

Enquire permission and bear witness concern in a non-judgmental way—this is more likely to elicit information from your patient. You can continue by saying "I want to let y'all know that I appreciate and am honored that y'all've shared your thoughts with me. I'grand simply concerned that you may go once more to a place of despair when you exit and I'm thinking of your safety."

Endeavor to establish and maintain trust with your patient—if you think the person is at risk, at that place is no reason to cover your business organization or to prevarication.

Restricting Access to Lethal Means

Means restriction involves techniques, policies, and procedures designed to reduce access or availability to means and methods of deliberate self-harm. Amidst suicide prevention interventions, reducing access to highly lethal means of suicide has a strong prove base of operations and is at present considered a fundamental strategy to reduce suicide expiry rates (Betz et al., 2016).

Lethal means restriction can include:

• Complete removal of a lethal method
• Reducing the toxicity of a lethal method, for case, reducing carbon monoxide content emissions from vehicles
• Interfering with physical admission, for example, using gun locks or placing barriers on bridges
• Enhancing safety, for example, encouraging at-risk families to remove lethal suicide means from the habitation
• Reducing the appeal of a more than lethal method, for example, changing the perception of hanging as a quick and painless expiry.(Hassamal et al., 2015)

The majority of suicide attempts are transient and the time between contemplating suicide and the endeavour is less than v minutes for many attempters. Success or failure depends on what method is readily bachelor (Hassamal et al., 2015).

Restricting access to firearms is of item importance because a suicide attempt using a firearm is fatal most 90% of the time. Patients with access to firearms at dwelling house might be considered at particularly loftier take chances for discharge to home, given that firearm access is a risk cistron for suicide (Betz et al., 2016).

While access to firearms and other lethal means does not mandate psychiatric admission, restricting access to firearms is a central component of dwelling condom planning that should be addressed with all patients being discharged. Prophylactic storage of firearms and other lethal means has been associated with less take chances for suicide among adults and youth, and lethal means counseling in EDs might affect storage behavior (Betz et al., 2016).

Reducing access to potentially toxic medications is also important but can be a claiming, given that many of the medications used to treat mental disease tin be toxic in an overdose. In one sample, 60% of patients reported currently taking at to the lowest degree one medication for an emotional or psychological problem, and medication overdose was the suicide method most unremarkably reported equally having been considered (Betz et al., 2016).

Access to other lethal means of suicide—such equally sharp objects or supplies for hanging—is also difficult to control given their widespread availability for other purposes. Installing bridge barriers or otherwise restricting access to pop spring sites may prevent deaths, depending on specific local weather.

In times of crunch or during stressful transitions, research indicates that:

• The interval between deciding to deed and attempting suicide tin be every bit brusque equally 5 or x minutes.
• People tend not to substitute a dissimilar method when a highly lethal method is unavailable or difficult to access.
• Increasing the time interval betwixt deciding to human activity and the suicide attempt by making it more difficult to access lethal ways, can exist lifesaving. (Rock et al., 2017)

If a lethal method is not immediately available, the crunch will oft laissez passer, and the person may never attempt suicide. It is important to understand that most people who attempt suicide once and survive, never attempt again. Putting time, distance, and other barriers between a person at risk and the most lethal means tin make the difference betwixt life and decease (WSDOH, 2016).

For patients at highest adventure, make certain firearms are inaccessible. For patients at intermediate to high acute risk, discuss the possibility of condom storage of firearms with the patient and family. When possible, limit access to medications that carry risk for suicide, at least during the periods when patient is at acute risk. This may include prescribing limited quantities, supplying the medication in cicatrice packaging, providing printed warnings nearly the dangers of overdose, or ensuring that currently prescribed medications are controlled by a responsible party. Also provide data on how to secure chemical poisons, especially agricultural and household chemicals, to prevent accidental or intentional ingestions. Many of these chemicals are highly toxic.

Restricting Access to Suicide Hotspots

Suicide hotspots, or places where suicides may take identify relatively easily, include tall structures such as bridges, cliffs, balconies, and rooftops; railway tracks; and isolated locations such as parks. Efforts to forbid suicide at these locations include erecting barriers or limiting admission to preclude jumping, and installing signs and telephones to encourage individuals who are considering suicide to seek help (Rock et al., 2017).

A meta-assay examining the impact of suicide hotspot interventions implemented in combination or in isolation, both in the Us and abroad, found reduced rates of suicide. For example, after erecting a barrier on the Jacques-Cartier Bridge in Canada, the suicide rate for jumping from the bridge decreased from nearly ten suicide deaths per twelvemonth to about 3 deaths per year. Moreover, the reduction in suicides past jumping was sustained even when all bridges and nearby jumping sites were considered, suggesting little to no deportation of suicides to other jumping sites. Further evidence for the effectiveness of bridge barriers was demonstrated past a report examining the touch of the removal of safety barriers from the Grafton Span in Auckland, New Zealand (encounter box) (Stone et al., 2017).

Unintended Consequences—The Grafton Bridge

In 1996, afterwards having been in identify for 60 years, safety barriers to prevent suicide past jumping were removed from Grafton Bridge in Auckland, New Zealand. The barriers were reinstalled in 2003.

Removal of barriers was followed by a fivefold increase in the number and rate of suicides from the bridge. Since the reinstallation of barriers, there accept been no suicides from the bridge. This natural experiment shows that safety barriers are effective in preventing suicide: their removal increases suicides; their reinstatement prevents suicides.

Source: Harvard School of Public Health, 2017.

Public spring sites are well-suited for suicide prevention, given that a great number of suicides are often limited to a few structures. At these hotspots, substantial suicide preventive furnishings tin can be achieved by a few prevention efforts. Well-nigh interventions for suicide prevention on bridges are of a structural nature (Hemmer et al., 2017).

Did You Know. . .

The Aurora Bridge in Seattle had the second highest suicide death cost in the Usa (backside the Gold Gate Bridge). In 2006 emergency telephone call boxes and signs with a suicide hotline number were installed on the bridge. Suicides continued to occur at an average of about v per year until a fence was installed in 2011. In the xviii months afterward, simply ane suicide occurred (Draper, 2017).

Designer view of the Aurora Bridge Argue suicide barrier in Seattle prior to its construction in 2010. Source: Washington Land Department of Transportation.

Some interventions to prevent jumps from hotspots or other methods of suicide are non feasible for bridges. Although blocking access roads to hotspots have been shown to deter suicide jumps, this is non a viable measure for most bridges. There is testify that the number of suicides by carbon monoxide poisoning in public parking lots has been reduced by installing aid signs. However, no studies exist that evaluate the effectiveness of assist signs as the sole intervention when used on bridges or other jumping sites, although they are widely installed (Hemmer et al., 2017).

Some research has shown that, if in addition to aid signs, emergency helpline phones are directly bachelor on bridges, the phones are used on a regular basis. Another research project establish that, in combination with increased police presence, emergency helplines led to a subtract in the number of suicides at the Sunshine Skyway Bridge in Florida (Hemmer et al., 2017).

Condom Storage Practices

Safe storage of medications, firearms, and other household products can reduce the chance for suicide by separating vulnerable individuals from easy access to lethal ways. Such practices may include teaching and counseling around storing firearms locked in a secure place, unloaded and dissever from the armament; and keeping medicines in a locked cabinet or other secure location away from people who may be at run a risk or who have made prior attempts (Rock et al., 2017).

In a case-control study of firearm-related events identified from 37 counties in Washington, Oregon, and Missouri, and from 5 trauma centers, researchers found that storing firearms unloaded, carve up from armament, in a locked place or secured with a safety device was protective of suicide attempts amidst adolescents. Further, a systematic review of clinic and customs-based education and counseling interventions suggested that the provision of safety devices significantly increased prophylactic firearm storage practices compared to counseling alone or compared to the provision of economical incentives to acquire condom devices on one's ain (Rock et al., 2017).

Pharmacists and customs healthcare and mental wellness providers play a disquisitional part in encouraging rubber storage of potentially lethal products. For pharmacists and mental wellness providers, medications are of particular concern because of the potential for abuse, adventitious poisonings, and use in suicide attempts. Safer Homes Suicide Aware recommends:

1. Lock upwards prescription medications.
2. Limit the supply of in-home, over-the-counter medications.
3. Return unused medications.
4. Dispose of medications in cat litter or coffee grounds and identify in the trash. (Safer Homes Suicide Enlightened, n.d.)

Source: Safer Homes Suicide Aware Preparation Materials. Used with permission.

ED Calm

The Emergency Department Counseling on Admission to Lethal Ways (ED At-home) trained psychiatric emergency clinicians in a large children'southward infirmary to provide lethal means counseling and safe storage boxes to parents of patients nether age eighteen receiving care for suicidal behavior. In a pre-post quality improvement projection, researchers establish that at post-test 76% reported that all medications in the home were locked upwardly as compared to fewer than 10% at the fourth dimension of the initial emergency department visit. Amid parents who indicated the presence of guns in the home at pre-test (67%), all (100%) reported guns were currently locked up at post-examination.

Source: Rock et al., 2017.

Francoise Gets Help from Her Pharmacist

Francoise is a 45-year-old woman who was previously stable on medications (lithium) for bipolar disorder. She stopped filling her prescription for lithium about 3 months ago.

On the day the pharmacist is conducting screening, Francoise arrives at the Rite Aid Pharmacy with prescriptions for opioids and benzodiazepines from a different provider in a nearby boondocks. She appears nervous and agitated with evidence of thought disorder. She also smells of alcohol, which the pharmacist knows farther increases take chances of expiry—intended or unintended—from the combination of disturbed thought procedure along with certain medications and alcohol.

Screening

The Rite Aid Pharmacy uses the Patient Wellness Questionnaire two to screen clients for suicidal ideation and behavior. The screening is activated when a client has a sudden modify in medications, has a prescription from another pharmacy, is filling a prescription for high-risk medications, or when a customer's behavior causes staff concern. The pharmacist asks Francoise, "Over the last 2 weeks, how often have y'all been bothered by either of the following problems?

• Piddling involvement or pleasance in doing things?
• Feeling down, depressed, or hopeless?

Although actualization quite nervous and agitated, Francoise answers in the negative to each question.

What Should You Do?

The pharmacist is concerned that Francoise is denying or minimizing her feelings. Because of the combination of medications and behaviors, she is worried that Francoise is in acute danger. She decides to inquire some more directly followup questions. She uses another screening tool, the Emergency Medicine Network's EDSAFE Patient Safety Screener that she'south familiar with from working in a hospital-based pharmacy. She asks Francoise:

• Over the last 2 weeks, take you had thoughts of killing yourself?
• In your lifetime, accept you always attempted to kill yourself? If then, when?

Francoise says she feels fine and hasn't had any thoughts of harming herself. She says she did try to commit suicide in the past but refused to say when or how. She asks when she tin can become her prescriptions.

The chemist asks Francoise if she can contact a family member for additional information. She agrees. If Francoise had declined consent, HIPAA permits a clinician to brand these contacts without the patient's permission when the clinician believes the patient may exist a danger to self or others.

Because the pharmacist has a "duty to protect" her customer, she asks Francoise to wait with her in a individual room and directs a cashier to call her family. Francoise'south husband arrives speedily and agrees to accept his wife to the ED. The pharmacist follows upwardly with local emergency and learns that Francoise has arrived at the hospital and is being evaluated.

Discussion

Relapsing bipolar disorder places a person at increased take chances for suicide. Because Francoise stopped taking lithium and succeeded in getting prescriptions for a supply of medications from a different chemist's shop, she now had the means (and perhaps the motive) to self-harm. The chemist and her staff were able to help Francoise through a combination of engagement, screening, business, and a nonjudgmental attitude. They kept Francois in a safe environment under one-to-one observation until someone arrived to accept her to the hospital. The organization set up past the chemist's to flag loftier-risk mediations along with a screening protocol provided assist to a person in acute crisis.

Policy-Based Strategies

Policy-based strategies that restrict admission to lethal ways have led to positive results. For example, limiting access to suicide methods such as carbon monoxide has resulted in decreases in suicide by carbon monoxide. Brake of other suicide methods has besides shown positive results. The implementation of enhanced restrictions to purchase firearms in the District of Columbia led to reductions in firearm-related suicides (Hassamal et al., 2015).

Although this goal focuses on reducing admission to lethal ways among individuals at gamble, evidence for means restriction has come from situations in which a universal approach was practical to the unabridged population. For example, the detoxification of household gas in the Uk and discontinuation of highly toxic pesticides in Sri Lanka were universal measures associated with thirty% and l% reductions in suicide, respectively.

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