What support can be given to those who “wake up”?
Professor Guillaume Vaiva. Above all, the person expects their need to break up to be taken into account. She wanted to break with an untenable psychological, emotional or material situation and this 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 is often the case after the absorption of drugs. But they more or less intended to get it over with. 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 lives.
How is the treatment going?
Pr GV Most patients are cared for in the emergency room or in a hospital care service. Then they are referred to follow-up in town (general practitioner, psychiatrist, medico-psychological centre). We receive, in the Reception and Crisis Center of our psychiatric department, the 40% of “suicidals” 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 an immense need to communicate. They want to scream but don’t know to whom, to say their torment but without having the words. We are here to listen to them and above all to help them communicate better. To get out of a very intense crisis, two or three interviews a day are usual.
Are medications needed?
Prof. GV Yes, in certain cases, to enable better sleep and to calm anxiety. But the prescription remains generally moderate, because many patients have already taken too much medicine to try to commit suicide. Antipsychotics or antidepressants will rather be delivered later, after a possible pathology has been detected. And cases of deep depression or serious delusional disorders immediately require long-term hospitalization in a psychiatric setting, with appropriate medication.
How do we help the patient afterwards?
Pr GV The classic support mechanism provides for a letter addressed to the attending physician, the psychiatrist or the medico-psychological centre. Maintaining contact is indeed essential, but these measures are generally very insufficient. Leaving the hospital, the person finds his life before and often the problems he wanted to leave. The interaction time between her and the healthcare system is generally only a few days. It’s too short to weave a reassuring 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 implemented bring?
Pr GV This monitoring system, tested since February 2015 in Nord-Pas-de-Calais and hosted at the University Hospital of Lille, allows us to show our “concern” for the patient more durably. In Belgium, we speak of “clinic of concern” to express this intention of proximity if necessary. The first 6 months after discharge from hospital, the VigilanS network multiplies the means of staying 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 an appeal number. If it is a recurrence, the person is called back within 21 days after his release. Any contact is reported to the doctor, who appreciates being kept informed. You have to find the happy medium, 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 significantly reduced 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 care actors in the field cooperated to experiment with this device. 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 of Lille. VigilanS will therefore soon be tested 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 also needs help
After the announcement of the suicide attempt, it is important to respond to the family’s need for contact. She should not be left out. It remains to spare the patient’s desire for a break with the sometimes invasive desire for closeness of relatives in the hospital room, by telephone, Skype… “It’s up to us to set limits”, estimates Professor Guillaume Vaiva . But it is normal for the family to need reassurance, which can be partly done by informing them that the person is physically out of danger, if that is the case. A suicide attempt is a disturbing drama that can reveal other personal or family suffering (incestbeginning of psychiatric pathology, difficult announcement ofhomosexuality…). 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 the slumps that can lead to attempted suicide.
Map of regional branches with local call numbers on www.sos-amitie.com.
• Christopher
This association offers discussion groups for young people and parents, interviews, referral to competent doctors…
www.christophe-lavieavanttout.com.
Such. : (0033)4 91 81 27 60.
• Well-Being and Society
To observe and prevent suicide. Relay to other associations in the regions.
• LIGHTHOUSE Children-Parents
To help parents and loved ones prevent ill-being and suicide in young people. www.phare.org. Such. : (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 bereavement following the suicide of a loved one.
www.anjpv.org. Such. : (0033)1 42 96 36 51.
Read also:
Social networks promote suicide
World Suicide Prevention Day: what is the situation in Europe?
Suicide, the second leading cause of death among teenagers