Rates of depression, self-harm, and suicide are disturbingly high in healthcare and first responder populations. Unfortunately, there is still a stigma associated with talking about suicide. A critical first step in nurse suicide prevention is awareness. Healthcare professionals need to get comfortable with the idea of talking to their patients and to each other about mental health, self-harm, substance use disorder, and suicide.
Related: Nurses’ Mental Health: Suicide Prevention
Incidence and frequency of suicide in the United States
In 2021, 12.3 million adults thought seriously about suicide. Of those, 1.7 million attempted suicide, and 48,183 died by suicide. Nurses are at a high risk of suicide and are four times more likely to commit suicide than people working in other professions.
Risk factors for suicide
While the statistics are concerning, there are several ways to identify individuals at risk for suicide and get them the help they need. High-risk individuals should be referred to a counselor, given peer support, and approached with empathy and concern.
Risk factors for suicide include:
- Previous suicide attempt
- Depression and other mental illnesses
- Chronic illness
- Criminal/legal problems
- Job/financial problems or loss
- Impulsive or aggressive tendencies
- Substance use
- History of child abuse
- Sense of hopelessness
- Bullying
- Family history of suicide
- Loss of relationships
- High-conflict or violent relationships
- Social isolation
- Lack of access to healthcare
- Suicide or violence in the community
- History of trauma
- The stigma associated with help-seeking
- Easy access to weapons or lethal medications
Nurses are at a particularly high risk of suicide due to the trauma they are exposed to at work. Witnessing death, disfiguration, and life-threatening diagnoses each day can take a toll on a person’s mental health. The toll on mental health and increased suicide risk is exacerbated by easy access to lethal medications, long hours and overnight shifts, constant hospital noise, and working in a stressful environment.
Substance use disorder in healthcare professionals
Like the risk of suicide, the risk of substance use disorder is higher in health professionals. Substance use disorder is particularly concerning among healthcare providers who arrive at work under the influence of drugs or alcohol. Impaired care providers not only put their own health and career at risk but also endanger the lives of the patients in their care.
Research suggests that as many as 20% of nurses struggle with substance use disorder.
Related: Nurse Suicide and Substance Use Disorder: The Shocking Truth
Policies to address substance use and suicide in nurses
Before 1980, nurses who struggled with substance use disorder were immediately terminated and had their licenses revoked by their State Board of Nursing. Now, both employers and the board of nursing are more likely to support nurses in working through their addiction and do everything they can to get them back to work safely.
The NCSBN offers many resources to both nurse employees and leadership teams who have problems with substance use disorder. Usually, a nurse struggling with addiction is placed on probation. Probationary periods vary based on the severity of the problem but typically include rules such as no passing narcotic medications, no working night shift, and required check-ins and random urine screenings for a time.
Myths about suicide and substance abuse
Healthcare providers must understand several myths about suicide and substance abuse. Some of these myths include:
- “Talking about suicide increases the risk.” The opposite is true. Talking about suicide decreases the risk of self-harm and suicide.
- “People who talk about suicide are attention-seeking.” Most people who talk about suicide have seriously considered ending their own life.
- “Talk therapy and medications won’t work.” Talk therapy and medications are extremely effective in preventing suicide and decreasing depressive symptoms.
- “Young adults and teens are at the highest risk of suicide.” In reality, older adults aged 75 and up are at the highest risk of suicide.
Related: Facts and Myths about Suicide
Therapeutic relationships and nurse suicide prevention
Nurses often talk about therapeutic relationships with patients. Having a therapeutic relationship means being there to support the patient, using active listening, responding with empathy, and establishing trust. Healthcare providers should keep in mind that therapeutic relationships can also develop between co-workers. Developing these types of relationships can decrease suicide risk among the nurses in your unit.
Suicide risk assessment
The National Mental Health Institute have created a questionnaire for healthcare providers to use when assessing a patient who may be at risk for suicide. The assessment is very straightforward. It includes questions about feeling sad or hopeless, having little energy, experiencing appetite changes, and struggling with thoughts of suicide.
Nurses should not be afraid to ask questions about whether a patient has had thoughts of self-harm or suicide. In fact, research shows that when a person is asked about whether or not they have contemplated suicide, their risk of harming themselves decreases significantly.
Nurse suicide prevention resources for at-risk healthcare professionals
- National Suicide Prevention Lifeline – The National Suicide Prevention Lifeline can be reached by calling 1-800-273-TALK (8255), assistance is available 24/7 for those facing a mental health crisis.
- Crisis Text Line – The Crisis Text Line may be easier for those who prefer text messaging over a phone call. Text TALK to 741-741 to get in touch with someone who can help. This service is also available 24/7
- Emotional PPE Project – The Emotional PPE Project is a no-cost and no-insurance program that connects healthcare workers in need with licensed mental health professionals who can help.
- Federation State Physician Health Programs COVID – This program is catered towards physicians dealing with challenges and includes virtual recovery groups.
