Running Head: CLC Health Issue Analysis: Suicide 1
Running Head: CLC Health Issue Analysis: Suicide 1
Running Head: CLC Health Issue Analysis: Suicide 1
July 1, 2018
CLC HEALTH ISSUE ANALYSIS: SUICIDE 2
2017). This has a lasting effect on family, friends, and communities (National Institute of Mental
Health [NIMH], n.d.). As this discussion will demonstrate, increasing rates of suicide occur
within all socioeconomic statuses, genders, ages, and ethnicities (WHO, 2014). However, in
most instances, it fails to be the focus of public health concerns. While many studies have
information regarding suicide and how it can be prevented, the taboo and stigma surrounding
suicide continues. Due to this, people frequently fail to ask for help or are left alone. In the
events when individuals do ask for help, services required most often arrive too late.
In addition to the mainstream suicide discussion, this document will also explore the
death, is the practice of physicians providing medications intended to end life for terminally ill
patients. These patients, who must be competent and of sound mind, make the choice to
consume the medication at a time they have chosen, ultimately resulting in death (Quill, 2018).
The acts associated with PAD, lead to death at the will of an individual, which allows for further
discussion on this topic as it relates to suicide. Ethical dilemmas posed by this practice are
The overall discussion regarding suicide, will provide a history of the problem in the
United States (US) and globally. It will further include US funding initiatives, and how the US
compares to other countries with universal health care, as well as, exploration of the scope of the
problem, population disparities, past and present initiatives, public and private programs, ethics,
and religious and cultural considerations of the problem. Finally, this document will conclude
with how the nursing profession impacts this global health problem both now and in the future.
CLC HEALTH ISSUE ANALYSIS: SUICIDE 3
Although suicide is often linked with several risk and protective factors, as an individual
action, it fails to have a specific reason. Suicide can take place as a reaction to several biological,
psychological, interpersonal, environmental, and societal pressures interrelated with one another.
This happens most often over time rather than impulsively (Stone, Bartholow, Crosby, Davis,
Individuals experience pressures from society which could include loss of a job, financial
or work stress, being a victim of violence, having a poor support system, and feeling helpless. To
some, what is perceived as normal can place others at risk for suicide. The biological and
psychological factors that play a role may include depression, hopelessness, lack of self-worth,
and the inability to appreciate themselves. On various occasions, individuals fail to ask for help
due to feelings of shame and having difficulty realizing they have a mental illness. Other
circumstances that can place a person at risk for suicide may include having a family member
who committed suicide, mental illness, substance abuse, having certain health conditions, and a
At times, those who want help live in communities devoid of health care and medical
aide, leaving them unable to attain much needed psychological attention and medication. Instead,
there is access to unsafe media portrayal of suicide and availability of attaining lethal means.
While not all people who are depressed or have other risk factors attempt suicide, it is important
to have resources available to assist people going through difficult times, and seek to prevent the
In some cases, protective factors may help to prevent individuals from committing
suicide. Environmental protective factors include, having access to effective treatment and health
CLC HEALTH ISSUE ANALYSIS: SUICIDE 4
care, having a supportive community, and access to social institutions. Personal protective
factors include having strong family support, being able to connect with other individuals,
having good self-esteem, possessing problem solving and coping skills, and strong religious and
cultural beliefs which discourage suicide (Suicide Prevention Resource Center [SPRC], n.d.).
Many remember the 1950’s as a decade of great conflict and economic growth, but few
knew the high rate of suicide. Suicide was major issue that prompted the United States (US) to
provide funding for the first suicide prevention program, opening the Public Health Service in
additional centers were created. In 1966, the Center for Studies of Suicide Prevention (later the
Suicide Research Unit) was created at NIMH within the National Institutes of Health (NIH). This
was followed by the creation of national nonprofit organizations dedicated to the cause of suicide
In 1987, the American Foundation for Suicide Prevention (AFSP) was created by a group
of individuals witnessing a disturbing increase of suicide deaths over the previous forty years.
Prior to the AFSP, a non-profit organization devoted to recognizing and preventing suicide
through education, research and advocacy failed to exist. AFSP created a society that focuses on
mental health by providing funding for scientific studies, educating the public regarding mental
health issues and how to prevent suicide. In addition, the AFSP supports policies which pertain
to suicide prevention and mental health issues, as well as providing support to people affected by
The NIMH summoned a mission in 1970 to discuss the status of suicide prevention in the
US, the findings were presented in the 1973 “Suicide Prevention in the 70s” report with
initiatives and directions to aid the problem. The Centers for Disease Control and Prevention
(CDC) created a violence prevention unit that brought public attention to a disturbing increase in
youth suicide rates. In response, the Secretary of the U.S. Department of Health and Human
Services (DHHS) established a task force on youth suicide. In 1989, DHHS analyzed the data
and published recommendations (Office of the Surgeon General, 2012 para 2).
In 2005, the U.S. Substance Abuse and Mental Health Services Administration
(SAMHSA) and the Mental Health Association of New York City (MHA-NYC) created Lifeline.
Lifeline works in suicide prevention by providing education, advocacy, and services. The
Lifeline chat is an online chat platform available 24-hours a day, seven days a week to assist
people in distress and with suicidal ideation (NIMH, 2017). A different way help may be attained
bridges throughout the U.S. (Draper, 2017). Thanks to many public figures, this information is
advertised.
Suicide is a major concern of premature death and public health issues having a
prolonged negative impact on individuals, families, and communities. In 1950, there were 13.2
deaths by suicide per 100,000 residents in the United States. In 2015, the suicide death rate
remained at 13.3 per 100,000 residents in the United States (Statista, 2018 para 1). The reasons
community, along with the resources provided by various organizations, the aim to prevent
suicide can be achieved by reducing risk factors and promoting protective factors.
CLC HEALTH ISSUE ANALYSIS: SUICIDE 6
Suicide is a phenomenon affecting all regions of the world, as well as each section of
society. Every 40 seconds a precious life is lost to suicide, claiming nearly 80,000 lives per year.
While suicide occurs in every age group, in 2015 it was the second leading cause of death among
15-29-year-olds. Although there is an established connection between suicide and mental health
disorders in high income countries, many suicides take place in a moment of crisis when the
individual is unable to cope with life stresses. In 2015, suicides in low and middle-income
countries constituted about 78% of suicides. Common methods for suicide include ingestion of
pesticides, hanging, and firearms. Other methods are also used which differ by population group.
In many countries there is a stigma connected to suicide, leading to many failing to seek help and
Globally the crude rate of suicide in 2016 was 10.6 per 100,000 people. WHO (2016) has
grouped the world into six regions to estimate suicide rates in different countries. In 2016, the
crude rate for both sexes per 100,000 people in the WHO regions are: Europe at 15.4, Southeast
Asia 13.2, Western Pacific 10.2, America 9.8, Africa 7.4 and Eastern Mediterranean 3.9. Among
European countries, Lithuania has the fifth highest suicide rate worldwide. Kazakhstan has the
10th highest, and Turkmenistan has the 14th highest suicide rate (WHO, 2018).
According to WHO, the adjusted death rates for 2017 ranked the US 47 out of the 183
countries studied, making the number 12.7 per 100,000 (World Health Rankings, n.d.). The CDC
(2016), Leading Causes of Death Reports, states that suicide claimed the lives of 45,000 people,
making it the tenth leading cause of death in the US. It also states, suicide was the second leading
cause of death among populations aged 10-34, and the fourth leading cause among populations
CLC HEALTH ISSUE ANALYSIS: SUICIDE 7
35-54. In addition, from 1999-2016, the suicide rate in the US increased by 28% from 10.5 to
13.4 per 100,000 (NIMH, 2018). The cost of suicide in the US accounts for $69 billion annually
Disparities
between age, race, gender and socioeconomic status. In addition to worldwide suicide rates being
the second most common cause of death among 15-29-year-olds, the rates are higher among
people over age 70. Completion of suicide is more common among men than women across the
globe. However, in high income countries, the suicide rate among men is three times that of
women (WHO, 2014). National studies have shown that suicidal behavior, especially suicide
methods, varies between countries depending upon its availability. A report in the WHO bulletin
states hanging was the common method of suicide used in most countries, with a rate of 90% in
men and 80% in women as noticed in Europe. In the US, firearms were the common method
used, while in Asian countries poisoning with pesticide was a major concern, and in Canada and
the United Kingdom women used poisoning with drugs as the common method. (WHO, 2011).
In the US, the global statistics are transferable. In addition, in 2016 the highest suicide
rate was in middle aged white men, accounting for seven out of 10 suicides. Among the different
races and ethnic groups Caucasians had the highest rate of suicide, followed by American
Indians and Alaskan Natives. Asians, Pacific Islanders and African Americans had a much lower
Contributing factors of suicide are complex and encompassing mental disorders such as
depression, alcohol abuse disorders, and inability to deal with life stresses (i.e. financial
problems, chronic pain/illness, and problems in relationships). In addition, people who have
CLC HEALTH ISSUE ANALYSIS: SUICIDE 8
experienced loss, disaster, conflict, violence, or abuse along with a sense of isolation, tend to
have suicidal behaviors. Lastly, there are high incidences of suicide among vulnerable groups
such as refugees, migrants, those within the LGBTQ community, and prisoners (WHO, 2018).
Prevention Efforts
World Suicide Prevention Day is observed on the 10th of September each year, and is
organized by the International Association of Suicide Prevention and co- sponsored by WHO. It
provides an occasion for joint efforts to raise awareness about suicide and its prevention in all
parts of the world. According to the WHO Mental Health Action Plan of 2013-2020, the global
target of all WHO member states, is to decrease suicide rates by approximately 10% in all
countries by 2020. The 2008, WHO Mental Health Gap Action Program focuses on suicide
Within the US, there are many national organizations and federal agencies offering
valuable resources, information, funding, and training. The NIMH conducts research on suicide
and its prevention, and has a website providing information and resources. The National Center
for Injury Prevention and Control (NCIPC) provides valuable resources and statistics on suicide,
its risks, and prevention. NCIPC’s revised national policy for preventing suicide emphasizes the
role of every citizen in protecting their friends, family and colleagues from suicide. Non-profit
Suicidology (AAS) and AFSP, help prevent suicide by funding research and promoting public
awareness, and educational programs and resources for professionals (SAMHSA, n.d.).
across the nation. In 2014, they announced 14.5 million dollars would be awarded to eight
programs. Six of the eight programs were state run, the other two consisted of the Choctaw
The Action Alliance for Suicide Prevention (AASP, 2018) is a partnership, “bringing
together senior leaders from public and private sectors to collectively advance our nation’s
suicide prevention efforts” (min 0.52). Since this is a public-private partnership, they receive
funding from both public and private sectors including. Funding comes from organizations such
as SAMHSA, NFL, Johnson & Johnson, Facebook, CDC, The Joint Commission, Vietnam
prevention centers did not exist prior to 1958. From 1958-1966, there was one center in Los
Angeles, California. In 1966 the NIMH established a center for studies of suicide prevention.
During the time from 1966 to the mid-1990s, several non-profit organizations formed. NIMH
created a task force for suicide prevention, the CDC began to increase awareness, and DHHS
created a task force for at risk youth. The movement picked up momentum when in the mid-
1990s, family survivors began to push for national strategies resulting in two Congressional
Resolutions. Overall, from 1958-1991, there were 13 notable movements addressing suicide,
with a large growth noted from 1991-2011 and the formation of 38 notable movements during
that time. (Office of the Surgeon General; National Action Alliance for Suicide Prevention; US
Department of Health and Human Services [OSG, NAASP, & DHHS], 2012).
CLC HEALTH ISSUE ANALYSIS: SUICIDE 10
The AASP has developed an initiative called Zero Suicide, and set a goal to reduce
suicide 20% by 2025 utilizing three priorities. The first priority is increasing awareness and
action within healthcare systems (AASP, 2018). The second, is increasing awareness within each
community, and the third addresses “changing the conversation” (AASP, 2018, min 3:33). This
initiative is likely the largest of its kind. However, there is a number of programs run and/or
The impact of insurance coverage on mental health can sometimes be a driving force in
receiving mental healthcare. In some cases, however, it can be a very large deterrent depending
on insurance coverage, deductibles, and premiums. For this section the author contacted Priority
Health, a large supplier of health insurance through the private sector, as well as via Priority
Health Medicaid, and the Market Place. In a phone interview, a customer service representative
confirmed that all private sections of insurance provided has mental health coverage for
inpatient, outpatient, and substance abuse. Participants are subject to pay the deductible before
insurance coverage is applied. Those with Priority Health Medicaid may receive outpatient
the local DHHS via the local community mental health department. Without DHHS certification
that hospitalization is necessary, the participant will not receive inpatient treatment. Mental
health coverage through the Marketplace is determined by whether the participant is purchasing
health insurance coverage via the private or public health sector within Priority Health.
participants receiving Medicaid may have access to inpatient mental health treatment, but only if
CLC HEALTH ISSUE ANALYSIS: SUICIDE 11
a DHHS worker deems it necessary. The pitfall here is that many who need inpatient
hospitalization are denied services while others who abuse the system are almost always
approved. The author experienced this as an employee at one of the largest freestanding mental
health hospitals in the country, Pine Rest Christian Mental Health Services. There are many
patients that know exactly what to say to receive services. This number increases especially
among the homeless population in the winter. Some might believe the homeless individual to be
suicidal. However, upon admission and receiving a meal and warm bed, the patient’s lack of
attendance in group therapy, personal therapy, and dedication to their care reveals the true nature
of their intentions. During this time, many who need services, are unable to receive them due to
In addition, while those with private insurance may have coverage, often the lack of
ability to pay the deductible is a deterrent to receiving care. Since financial stress is a
contributing factor for contemplation of suicide, the added stress on a patient is clearly unhelpful
(Foster, 2011). To truly address the growing problem with suicide and mental health problems,
there is a great need for improvement to accessing services both financially as well as bed
availability.
Outcome Comparison
The crude rate of suicide per 100,000 people in the US in 2016 was 15.3, in comparison
with the global average of 10.6 (WHO, 2018). Since the data compares rates per 100,000 people,
it is fair to generalize these numbers across populations regardless of size. Taking this into
account, the country with the lowest rate of suicide is Antigua and Barbuda (A&B) with 0.5
(WHO, 2018). In comparing the US and A&B, it is worth mentioning that A&B does have free
universal health care (WHO-AIMS, 2009). The WHO-AIMS (2009) report details the mental
CLC HEALTH ISSUE ANALYSIS: SUICIDE 12
health services available in A&B. This includes free access to any medications needed to treat
mental health disorders. In addition, those in need of mental health services can access healthcare
through community services, hospitals, primary care offices, and community residential
facilities.
In comparison to other countries, the mental health services in A&B is sparse. There is no
mental health policy or plan in the country, and only four percent of the total cost of healthcare is
spent on mental health (WHO-AIMS, 2009). One might even call the mental health system there
primitive as the definition of a person suffering with mental illness is “any epileptic, idiot,
imbecile, feeble-minded person; and a moral defective person” (WHO-AIMS, 2009, p. 15). If
medical professionals are to come to a complete understanding of the low suicide rates in A&B,
more exploration is necessary. Access is affected by many things with the two notable factors
being availability of services and financial barriers. Given the scant resources available, there are
variables potentially affecting the low suicide rates, which could be unrelated to universal
healthcare.
Physician-assisted death (PAD) was initially legalized in Oregon, in 1995. More recently,
Washington passed legislation on the practice in 2008. This was followed by Vermont in 2013,
California in 2015, Colorado in 2016, Washington DC in 2017, and lastly Hawaii in 2018. As
controversial as this topic proves, there are continual attempts to challenge the legalization of
PAD. However, since there are so few states holding legislation in this area, data is scarce. Most
studies are conducted based on Oregon’s data since this was the initial state of legalization.
Globally, PAD is an accepted practice. In the Netherlands, PAD and euthanasia have been in
CLC HEALTH ISSUE ANALYSIS: SUICIDE 13
practice for over thirty years (Quill, 2018). This section will further explore the ethical dilemmas
Ethical Considerations
When discussing nursing ethics, there are four main principals to consider: non-
maleficence, beneficence, autonomy, and justice. Autonomy is respecting the individual desires
of the patient, despite disagreement and supports the concept of informed consent (Virtual
Campus for Public Health [VCPH], 2018). In applying the principle of autonomy to this
population, the nurse is ensuring appropriate information and education is provided. In this way,
patients are equipped with tools and resources to make a decision. An additional ethical principal
In applying deontology, ethics are concerned with what one does, not the consequence of
their action (Shakil, 2018). It is a situation where a potentially immoral act is done to achieve a
good outcome. For example, if one was to shoot an intruder, they would be protecting their
family. In this case, shooting the intruder was the immoral act being done to ensure good. In
relation to PAD, the nursing code of conduct states, to do no harm. It further speaks of moral
obligation to follow rules and principals and provides a guide for nurses related to what should
be done and what should be sought (Nursing World, 2015). A nurse faced with addressing PAD,
may feel conflicted because of their duty to do no harm, and PAD is providing the means for a
In an effort to address and remove this disparity, utilitarian ethics can be applied.
Utilitarianism is an opposing theory to deontological ethics. The utilitarian aims for the greatest
happiness or best consequence and has a justification for any action taken in meeting that goal
(Shakil, 2018). Consequentialism considers the end consequence of the action even when the act
CLC HEALTH ISSUE ANALYSIS: SUICIDE 14
is not morally good (Shakil, 2018). In this case, the greatest number of people includes the
patient and family. Is the family supportive of their loved one's decision? If not, is there a way
they could be supported as their family member seeks to complete suicide? Utilitarianism would
be applied to address providing support to the family so they are prepared to provide support to
the patient.
The ANA Code of Ethics for nurses with interpretative statements, sets the foundation for
the nursing profession and provides assistance for making decisions with ethical issues. Of the
nine provisions, four of them can be appropriately applied to the ethical issues surrounding PAD.
Provision 4 provides the nurse with the authority, accountability and responsibility for practicing
nursing. It further extends to nurses, authority to make decisions, and is consistent with the
obligation of health promotion and providing optimal care to patients. In applying the 6th
provision to practice, nurses may act alone, or in collaboration with others to maintain an ethical
environment in the workplace. This environment must assist in providing safe and quality
healthcare. In provision 8, the nurse is collaborating with health professionals and the
community to reduce health disparities, promote health diplomacy, and protect human rights.
Finally, provision 9 integrates social justice into nursing care and health care policy, and
instructs the nurse to articulate values and maintain integrity of the profession (Nursing World,
2015).
The influence of culture on mental health and suicidal thoughts plays a significant role in
how patients receive and process their emotions. This demonstrates the importance of
understanding cultural influences when treating and preventing suicidal ideations and mental
CLC HEALTH ISSUE ANALYSIS: SUICIDE 15
persons, cultures, religions, age, or socioeconomic status. Researchers argue that conversation
regarding cross-cultural differences, is not helpful in overall understanding of the issues. With
the vast number of cultures globally, even the most solid understanding of diversity will not
prove helpful in the few moments or hours a clinician has, to assess risk in patients. In addition,
within the US alone, there are subcultures within the larger American culture wherein each has
its own set of risk and protective factors. Attempting to understand each one is not possible in
this short section. Therefore, the new perspective on this lies in understanding “psychological
For complete satisfaction of this section however, there will be a brief discussion
regarding universal risk and protective factors. According to the Institute of Medicine Board on
Neuroscience and Behavioral Health (IOM-BNBH, 2001) “countries with low suicide rates tend
to be predominantly Catholic or Muslim, are typically relatively youthful, have strong social
control networks, more extended family ties, and explicit proscription of suicide” (p. 8). In
contrast, “high suicide rate countries have higher rates of depressive disorder, high levels of
alcohol consumption, often apart from rituals or food intake, a greater relative proportion of an
older population, more social isolation, more cognitive rigidity and inflexibility” (IOM-BNBH,
2001, p. 8). By understanding what universals are present rather than the vast differences, there
can be more successful implementation of interventions that will impact larger populations. This
experience within mental health, there were two major ways patients with suicidal thoughts were
CLC HEALTH ISSUE ANALYSIS: SUICIDE 16
affected by religion. The first was that religion was a protective factor and prevented the patient
from carrying out their suicidal thoughts. The second was that patients often experienced and
lack of connection with their peers of the same religious sect. This section will take a brief look
Martinez (2014) provides the most comprehensive overview of religious views toward
suicide, this author could find. According to this resource, the Catholic Church views suicide as a
mortal sin while the Judeo-Christian strongly discourages the act. For these, religion can be a
protective factor, on the other hand it could also be the factor that discourages treatment. In some
parts of Japan, suicide can be an honorable act depending upon the situation and method of
suicide. Islam tends to quote a section of the Quran which states “do not destroy yourselves.”
(Martinez, 2014).
Impact of Religion
Being part of a religion or being spiritual is a principal value to people around the world.
More than 80% of people in the United States are religious or spiritual (Rasic, Belik, Elias, Katz,
Enns, 2008). For those religions whom consider suicide a mortal sin, those active within such
organizations are less likely to commit suicide. Religion is a form of social connection and
provides individuals with a sense of belonging. Most people that commit suicide suffer with a
lack of connection to others. Studies have shown that people with mental illness use religious
beliefs to cope with stress (Rasic, Et. Al., 2008). In addition, religion can also be considered a
For some individuals, their spirituality increases the likelihood that they will seek help
from their religious institution. This is sometimes seen as a way to clean the mind and soul from
evil thoughts. During this time, whether through prayer or conversing with someone representing
CLC HEALTH ISSUE ANALYSIS: SUICIDE 17
the religion, the individual may realize what is causing their stress. In these situations,
individuals may also realize better solutions and that death is irreversible. Frequently, those
belonging to a religious institution experience enhanced mental health by being social, which
reduces stress and depression. Therefore, the possibility of committing suicide may be decreased
Political Influences
increase in suicide rates. Studies confirm that during economic recession, loss of jobs, homes and
financial stability, may also lead to an increase in suicide (Stone et. al., 2017). While local and
presidential elections may prove to be a period of increased stress for the nation, there is no
advocate for funding to educate the public regarding mental health and suicide. In 2018, US
funding provided for mental health services such as substance abuse and public awareness was
Since firearms have been shown to cause the greatest number of suicide deaths, it is
important for public policy to focus on possible interventions (Kposowa, 2013). It is well known
that the second amendment of the United States constitution states, citizens have the “right to
bear arms.” While many people believe having a gun at home helps to protect against burglars
and trespassers, research indicates 52% of suicide was executed with a firearm (ProCon.org,
2018). It is for this reason; public policy should focus on reasonable interventions to protect
Practice Registered Nurses (APRNs), and other professionals have in addressing this issue. The
nursing profession past and present are considered the frontline in health care. Nurses are
afforded the opportunity to be the first to provide interventions for suicide prevention and
education (Bolster, Holliday, Oneal, & Shaw, 2015). According to Bolster et. al. (2015), it was
found that most whom have completed suicide had contact with a healthcare professional within
the previous month. WHO reports suicide is a preventable health concern. In addition, they
report suicide assessment and education on identifying suicidal behaviors, has the potential to
Over the years suicide assessment has been taken more seriously. Previously, there has
been a lot of discomfort related to suicide assessment. Studies have shown when nurses and other
health care professionals were properly trained in addressing suicide education and prevention,
learners are more comfortable in providing interventions (Bolster, et al., 2015). Currently there
are several tools and resources available for use in clinical or community settings which may
assist in identifying suicide risk. Over the years, resources have evolved to become more
inclusive as risk populations are identified through data (Healthy People, 2018). For example,
according to the CDC, over the past decade, bullying has become more of a cause for suicide in
youth. The CDC provides resources which aid in identifying bullying behavior and assessing
Under federal rules from the Health Insurance Portability and Accountability Act
(HIPPA) of 2006, insures are not allowed to deny coverage related to depression. Some
CLC HEALTH ISSUE ANALYSIS: SUICIDE 19
insurances deny claims for injuries related to suicide or attempted suicide, despite laws stating
denial is not allowed. Denial of coverage is made possible by source of injury exclusions,
described as injuries caused by activities such as risky recreational activities, often applied to
self-inflicted injuries (Andrews, 2014). These exclusions appear to be a loop hole in laws
leading to denial of claims. Nurses can advocate for policy which removes source of injury
exclusions or modifies them to include some form of coverage for cost associated with suicide or
attempted suicide.
Another way nurses may influence policy is to develop model policies involving suicide
prevention and addressing suicidal behaviors within educational institutions (SPRC, 2016). This
can be done on a local level by identifying challenges within the community so model policies
are directly related to populations which it will serve. APRNs can also participate and become
actively involved in research efforts to obtain data which may be used to create evidence-based
practices.
in health policy influence. The American Psychiatric Nurses Association (APNA) is a nursing
association specific to mental health. APNA collaborates with consumer groups to promote
advances based on evidence for those with mental illness and substance abuse issues. The APNA
also provides opportunity for members to be involved on committees and task forces addressing
issues related to mental health. A main resource related to taking action, is ongoing stakeholder
Nurses are in a unique position to assist in curbing suicide rates in our country, due to
their hands-on approach to patient care and the ability to create therapeutic connections with
patients. The high suicide rate in the US make it a possibility that future suicide victims will be
patients on different units and clinics in a non-psychiatric setting. Knowing the warning signs of
suicide and where to get help may decrease the incidence of suicide. Identifying key patient cues
becomes crucial. This begins with understanding that suicidal behaviors are not an illness, but a
complex set of behaviors ranging from ideas or thoughts and eventually leading to actions.
Identified cues should be recorded and included in each patient’s health care plan (Suicide
Prevention, 2008).
The APNA has put forth essential competencies for psychiatric registered nurses to
provide evidence based care. Nurses play a vital role in systems and patient level interventions.
Forming systems level interventions includes assessing and maintaining environmental safety,
developing protocol, policies, and practices consistent with zero suicide. In addition, it includes
participating in training programs. Patient level interventions include assessing suicidal risk,
patients and evaluating intervention outcomes. These essential competencies will help nurses to
provide expert care leading to reduction of suicide mortality rates (APNA, 2018).
Summary
Suicide is a major public health problem, occurring when people die by directing
violence at themselves with the intent of taking their own lives. It’s a complex phenomenon
which occurs in all demographic groups and needs to be openly discussed in communities, to
remove the stigma and taboo associated with feelings of suicide. According to the World Health
Organization (WHO), suicide is the second leading cause of death among 15-29 years old’s
CLC HEALTH ISSUE ANALYSIS: SUICIDE 21
(2017). Public awareness and methods to support social change are vital suicide prevention
strategies. Culture, religion and politics have a major influence on the community hence
religious leaders, politicians and health care providers need to educate their communities on
The focus on suicide prevention in the US has been a recent phenomenon, with the first
center for suicide being initiated only 60 years ago. Since that time, the primary focus on
prevention and treatment of suicide has rested mainly within the public health/mental health
sector. Recent initiatives show increased interest of private donors, as well as, an increase in
quality initiatives for screening by acute care givers. While there may continue to be issues
regarding access to mental health care, those within the acute setting have the advantage of
Nurses being a major work force in the health care industry, play an important role in
prevention of suicide by influencing policy making and by providing direct patient care.
justice nurses may be able to reconcile their personal objections with physician-assisted suicide.
In addressing this major public health problem, it is imperative that health care professionals
become aware of the scope of issue, risk factors, and early signs of distress which could lead to
References
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