What support can be given to those who “wake up”?
Prof. Guillaume Vaiva. The person expects above all that we take into account his need to break up. She wanted to break with an untenable psychological, emotional or material situation and it must be respected, but by showing her that this situation can be lived without going to death. The emergency department offers her this necessary airlock, this break with the outside world and with an experience that she could no longer bear. Some are ashamed of their gesture, especially when it is the result of impulsiveness, as often after the absorption of drugs. But they more or less intended to end it. They must feel that we are not judging them and that we are just going to take care of them, at this suspended moment in their life.
How does the care take place?
Prof. GV Most patients are cared for in the emergency room or in the hospital care department. Then they are directed to follow-up in town (attending physician, psychiatrist, medico-psychological center). In the Reception and Crisis Center of our psychiatric service, we receive the 40% of “suicides” who remain in a state of crisis for a longer period of time. They are welcomed for a few hours or a few days. Many have a great need to communicate. They want to shout but do not know to whom, to express their torment but without having the words. We are there to listen to them and especially to help them to better exchange. To get out of a very intense crisis, two or three interviews a day are usual.
Are drugs needed?
Prof. GV Yes, in certain cases, to allow better sleep and calm anxiety. But the prescription is generally moderate, because many patients have already taken too much medication to try to commit suicide. Antipsychotics or antidepressants will rather be delivered in a second step, after a possible pathology will have been detected. And cases of deep depression or serious delusional disorders immediately require long-term hospitalization in a psychiatric environment, with appropriate medication.
How do you help the patient afterwards?
Prof. GV The classic support system provides for a letter addressed to the attending physician, the psychiatrist or the medico-psychological center. Maintaining contact is indeed essential, but these measures are generally very insufficient. On leaving the hospital, the person finds his or her life before and often the problems that they wanted to leave. The interaction time between her and the health care system is generally of the order of only a few days. It’s too short to weave a secure care program! This certainly explains many recurrences that can be limited by better coordination between the patient and the care network.
What does the VigilanS system that you have put in place bring?
Prof. GV This monitoring system, tested since February 2015 in Nord-Pas-de-Calais and hosted at the Lille CHRU, allows us to express our “concern” for the patient more sustainably. In Belgium, we speak of “concern clinic” to express this intention of proximity if necessary. The first 6 months after discharge from hospital, the VigilanS network increases the means to stay in contact with the person. She leaves the hospital with a crisis card indicating an emergency number in case of need. And a personalized postcard is sent to him, with a contact. We send a letter to his attending physician, also with a referral number. If it is a recurrence, the person is called back within 21 days of discharge. Any contact is reported to the doctor, who appreciates being kept informed. You have to find the right balance, show that you are there without being intrusive, proactive but not intrusive.
what are the results?
Pr GV After 18 months of experimentation, we are already seeing the positive effects of this device. VigilanS has made it possible to significantly reduce the recurrence rate. While it is usually 11.6% in Nord-Pas-de-Calais, it has fallen to 7.3% currently. Another positive sign: all the healthcare professionals in the field cooperated to experiment with this system. This proves that such a tool was expected by health personnel, often disconcerted by the number of cases, which can go up to 2000 per year at the CHRU in Lille. VigilanS will therefore be tested soon in Normandy, Brittany, Languedoc-Roussillon, Jura and Martinique. Enough to provide an adequate response to the suicide rate in France, which remains one of the highest in Europe.
The family needs help too
After the announcement of the suicide attempt, it is important to respond to the family’s need for contact. It should not be sidelined. It remains to spare the patient’s wish to break with the sometimes invasive desire for proximity of relatives in the hospital room, by phone, Skype … “It is up to us to set limits”, estimates Professor Guillaume Vaiva . But it is normal for the family to need reassurance, which can partially be done by informing them that the person is physically safe, if this is the case. A suicide attempt is a disturbing drama that can reveal other personal or family suffering (incest, beginning of psychiatric pathology, difficult announcement of thehomosexuality…). It takes time to clarify the causes of this extreme gesture and provide appropriate support to the family.
Associations to prevent
• SOS Friendship
A listening and prevention network to overcome loneliness and empty periods that can lead to a suicide attempt.
Map of regional offices with local telephone numbers on www.sos-amitie.com.
• Christophe
This association offers support groups for young people and parents, interviews, referral to competent doctors …
www.christophe-lavieavanttout.com.
Phone. : (0033) 4 91 81 27 60.
• Well-Being and Society
To observe and prevent suicide. Relay to other associations in the regions.
• PHARE Children-Parents
To help parents and relatives to prevent discomfort and suicide among young people. www.phare.org. Phone. : (0033) 1 43 46 00 62
(Monday to Friday, 10 a.m. to 5 p.m.).
• Jonathan Living Stones
For support and meetings in the event of mourning following the suicide of a loved one.
www.anjpv.org. Phone. : (0033) 1 42 96 36 51.
Read also:
Social networks would promote suicide
World Suicide Prevention Day: what is the situation in Europe?
Suicide, the second leading cause of death among adolescents