No Longer a Taboo: Suicide in Dentistry

With recent events during the past couple of weeks, I've forced myself to write this blog post - a blog post that has been sitting in my drafts for about 3 years now...

I began writing this blog post over 3 years ago after a series of encounters working in an acute dental setting (which I touched on in this blog post). Back then, talking about suicide felt like a taboo for me and was probably the main reason why I never got round to finishing this post. But with recent events and the sad loss of a very kind, genuine and caring dentist, I've decided to revisit my drafts folder, dig out the rough plan of what I was going to write and finally TALK about suicide. 

Suicide affects all of us in some way. The charity Samaritans has excellent information on the facts and figures around suicide in the UK; 

  • There were 6,589 suicides in the UK and ROI in 2018
  • Deaths by suicide have risen by 10.9% 
  • Men are three times more likely to die by suicide than women
  • The highest suicide rates are among men aged 44-49
  • Deaths by suicides in the under 25 category rose last year by 23.7%
Suicide has not only affected my life personally, but in my life as a dentist. The encounters in the acute dental clinic I was working in involved managing patients who were threatening suicide. These patients often had complex needs, whether that was medical or social problems, chronic pain which was difficult to manage such as facial pain, or were suffering from severe acute dental pain. Until I had to manage these patients, I had no idea of how to approach this situation, and at the time I was lucky to be part of a large hospital trust where there was lots of support, not only from other dental colleagues, but from other medical specialities. These experiences lead to me completing a project about mental health in the department, audit staff confidence in managing these patients and ultimately deliver departmental training. 

As part of the training that was implemented in the department, was the circulation of our Trust's Guidelines for dealing with potentially suicidal adults. If you work in a trust, find your local guidance, but here is a summary of guidance you can adapt to your practice. 

Guidance for Managing Potentially Suicidal Patients

This has been adapted from Guy's and St Thomas' Clinical Guidance for Staff Caring for Potentially Suicidal Adolescent and Adult Patients.

The Samaritans challenge the myth that talking about suicide may give people ideas and that there is nothing that can be done:

“Suicide can be a taboo topic in society. Often, people feeling suicidal don’t want to worry or burden anyone with how they feel and so they don’t discuss it. By asking directly about suicide you give them permission to tell you how they feel. People who have felt suicidal will often say what a huge relief it is to be able to talk about what they’re experiencing. Once someone starts talking they’ve got a better chance of discovering other options to suicide. Often, feeling actively suicidal is temporary, even if someone has been feeling low, anxious or struggling to cope for a long period of time. This is why getting the right kind of support at the right time is so important”

Behaviours which might be indicators of suicide risk:

  • Recent suicide attempt (further attempts are more likely)
  • Research/planning: suicide notes, changes to will, accessing suicide internet sites
  • Self-neglect (e.g. not eating)
  • Hostile rejection of help
  • Change in sleep pattern (this may occur as a feature of depression)
  • Alcohol and/or drug misuse
  • Crying, emotional outbursts 

Identifying Suicide Risk and Taking Action

Flowchart for Managing Suicidal Patients, click to enlarge

What if the patient doesn't want to wait for liaison psychology or to go to A&E?

  • Inform the patient that their GP will be contacted to convey concerns 
  • Suggest they can contact their GP, their local A&E department or The Samaritans, or give leaflets or links to further help
  • If you have concerns that the patient will harm themselves or others on leaving the hospital, dial 999 and ask for advice, contact their GP immediately and record in the patient medical notes

What if you are speaking to a patient on the phone?

If the patient is at home/elsewhere, follow the same questioning as above, but also:

  • Obtain their phone number & address they are calling from 
  • Ask if they are alone? (Consider children/dependants) 
  • Have they told anyone how they are feeling? Remind patient of support available: – Direct them to their GP, local A&E department or The Samaritans
  • After the call: Contact GP immediately and document in patient notes & alert team clinicians e.g. safeguarding 
  • If immediate action or risk is apparent: (i.e. “I’ve taken an overdose”) – Call 999 if immediate risk of death or caller is threatening to harm someone – Use another phone to keep line open to caller 

Suicide Prevention

Suicide is preventable. Everyone needs to be more willing to talk about it... and actually say the word SUICIDE. 

The above algorithm is useful when managing patients, but what about loved ones, colleagues, strangers even? In these situations, remember the 3 S's:

SEE - recognise when things are not right

SAY - ask if someone is thinking about suicide or harming themselves

SIGNPOST - know where you can signpost people in your area e.g. GP, Samaritans, other charities or even A&E

Resources, Training & Further Information

The Samaritans - online resources, helpline, letterline, email help and face to face

Zero Suicide Alliance - online training which takes 20 minutes

Public Health England Psychological First Aid - 4 week online course focusing on COVID-19 Crisis

Confidental - dental-volunteer lead helpline

Other resources from Confidental - list available here.

Please reach out if you need help. The links above are amazing contacts, but I am always here with my door open!

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