A patient who has attempted suicide by taking a handful of ibuprofen (Motrin) is admitted to the mental health unit

Question

She had attempted suicide three times previously, each by overdose on over-the-counter medications, and in each case was found by family or peers in time to prevent her death, eventually being admitted to this mental health unit each time. Which of the following nursing responses would be most appropriate? a. Search her and her belongings for pills and other dangerous objects, then minimize the attention given to her by staff in order to reduce secondary gains.
b. When medically stable, confront her with her pattern of maladaptive coping, noting that the low lethality of her attempts suggests she is seeking attention.
c. Discuss with her family ways that they can reduce her attention-seeking suicide gestures by keeping all medications locked and not responding to histrionic behavior.
d. Place her on one-to-one observation because her history of previous attempts suggests she is at high risk of suicide; once medically stable, begin intensive psychiatric treatment.

Answer 1

A
Most people who complete suicide have made at least one previous attempt, and a history of prior attempts is one of the strongest predictors of future risk. Some attempts may appear unlikely to have succeeded from the outset if the means was of low lethality (e.g., choking oneself with socks wrapped around the neck) or because circumstances would have led to them being rescued before harm results (e.g., an attempt initiated in front of witnesses). Many lay people and some staff tend to interpret such unlikely-to-succeed attempts as meaning that the person "wasn't really serious about suicide", that it was a (so-called) suicide gesture. In fact, often a depressed or psychotic person simply is too cognitively impaired to plan well to succeed at suicide. Assuming that overdosage on over-the-counter (OTC) medications is a low-lethality means is contradicted by the fact that many OTC meds are quite lethal, including common ones such as aspirin and acetaminophen. Further, identifying a serious attempt as "a gesture" (not serious) can increase the risk of suicide if it is perceived as a challenge or if the person feels they or their attempt are being ridiculed or not taken seriously. The person may respond by intensifying efforts and may succeed in a subsequent attempt. Confronting her with claims that she is attention-seeking suggests a lack of understanding of suicidality, pharmacology, and risk assessment. Speaking with her family as noted indicates that staff do not understand suicidality and do not appreciate the actual degree of risk represented. Although restricting access to means is desirable, OTC meds are readily available in the world, so it is important to understand that locking those meds already in the house does not necessarily mean the patient will be safe.