# MHApps BPD – Manage Suicidality Specifically – BPD EUPD GP Health Professional

7 Suicide
GP

- 7. Manage suicidality specifically The suicide rate for people with BPD / EUPD is significantly higher than the general population, however it is difficult to predict who will kill themselves, as the act may be impulsive and without warning. It can be useful to think of people with BPD / EUPD as chronically suicidal, as it has become a mode for adapting to life.
  The onus is on the GP to decide what to do when someone presents as suicidal. You have a duty of care to determine the risk on the basis of their history, what they are saying and what they are doing. Do they have a plan? Have they written a note? Have they given away prized possessions? Are they experiencing symptoms of psychotic depression such as hallucinations or nihilistic delusions?
  Try not to automatically over-react when someone expresses suicidal ideation. If you can work out with the patient what has been happening and why they are feeling like they are, you are in a better position to work out what step to take next.
- The following anti-suicide interventions can help:
  - Fostering and encouraging realistic hope.
  - Looking for alternatives to suicide such as focusing on specific problems and generating solutions. This might include referral to an agency which deals specifically with the problem identified.
  - Making a connection and tending to the patient’s feelings of alienation.
  - Looking for internal contradictions and ambivalence regarding the desire to die.
  - Decreasing impulsivity by making an internal agreement to wait until the next appointment to discuss the situation.
  - Creating distance, if possible, from the patient’s access to lethal weapons and drugs.
  - Organising a follow-up appointment as soon as feasible with back up contact, e.g. a brief phone call in the interim by yourself or others.
  - Teaching them breathing exercises and how to focus attention - anything that changes the physical sensations changes emotions and helps to focus on the real problem.
  - Don’t promise what you can’t deliver and don’t blur the boundaries of your professional relationship with them.
- Over time you can establish what their chronic pattern of suicidal ideation is, to help you in your decision making in the future and help you identify interventions which work to change the pattern of emotional response for that patient. Remember, how you respond the first time will set the pattern of expectations for the future - if you are calm, inquisitive, validating and operating in a problem solving mode you will provide the foundations for them learning from the crisis and taking responsibility.

7 Suicide
GP