Parkinson’s: Suicide awareness and your role

Parkinson's Academy webinar

In this webinar you will be given a global and national update on suicide. Our speaker Emma Edwards will then delve into suicide and neurological issues with an emphasis on Parkinson’s. You will then be talked through when and how to ask the right questions and what to do with the answers you receive.

The session will finish with signposting to resources to support you in protecting your mental health.

Summary

Parkinson’s: Suicide awareness and your role

Worldwide, an estimated 703,000 people die from suicide every year, and, in 2019, it accounted for one in every 100 deaths. Risk factors are wide ranging, from relationship problems to exposure to bulling, and include many crossovers with the realities of living with Parkinson’s.

It is something that Emma Edwards, a former mental health nurse and current Parkinson specialist nurse in Plymouth, has first-hand experience of. When one of her patients took their own life, it prompted her to start studying “suicidology”, and led to a secondment as a suicide awareness trainer.

“There are various warning signs, and it is important that we know them,” she said, adding that they include people feeling isolated or like a burden, unhealthy coping strategies, and having a very negative self-view.

According to leading suicidologist, Thomas Joiners, four factors tend to be present when someone has suicidal thoughts or is about to embark on a suicidal act. These are “thwarted belonginess”, or feeling alone or rejected, perceived burdensomeness, the desire for suicide, and the physical capability to carry out the act.

Suicide and neurological conditions

While there is a lack of evidence on the association between suicide and neurological conditions in the UK, data from other countries do shed some light on the issue.

A 2020 Danish study found that people with neurological health conditions were more at risk from suicide than the general population. The conditions that featured highly included Huntington’s, motor neuron disease, and multiple sclerosis, with Parkinson’s ranking further down the list. A Taiwanese population study from the same year suggested people with Parkinson’s were twice as likely to take their own life than those in the general population.

In terms of risk-factors for suicide among people with Parkinsons, there appears to be a large degree of crossover with those for the general population. A 2019 literature review found those who took their own lives or had suicidal ideation were more likely to be male, experience mental health issues such as depressive disorder, bipolar disorder, psychosis, or have a history of self-harm or previous suicide attempts, for example.

One important difference was that while being single or widowed was a risk factor in the general population, being married increased the risk of suicide among those with Parkinson’s.6 “That really stood out to me, because I think it relates back to the perceived burdensomeness identified by Joiner,” said Emma.

Interestingly, motor fluctuations, or a perceived lack of medication inefficacy, played a greater role in inducing suicidal thoughts that the severity or duration of Parkinson’s.6

Asking the question

Healthcare professionals (HCPs) do not always ask about depression and suicidal thoughts for a number of reasons, from not having the time to not knowing what to do with the answer. But doing so, said Emma, “could be life saving”.

“Mental health should he held in the same esteem as physical health. We would always act on crippling chest pain, so why not emotional pain?” she went on, adding that patients rarely offer information on non-motor symptoms voluntarily. “We need to ask them, because if we don’t, who else is going to?”

Prompts that should trigger a question about suicide include:

• People presenting with risk signs such as depression, bipolar disorder, or previous self-harm or suicide attempts

• People talking about suicide, no matter how vaguely

• People talking about “feeling trapped”

• When a family member raises concerns about the patient’s mental health

• People who exhibit a sudden change in their mental state

• People dealing with impulse control disorders

• People talking about assisted dying or travelling to Dignitas

• If the HCP has a gut instinct that something is wrong

Knowing how to pose the question can be challenging for HCPs. Emma’s advice was to only bring the topic up after establishing a rapport, and to do so with compassion and authenticity. “Ask clearly and with confidence, so they know what you have asked,” she added.

In terms of wording, Emma explained she found it useful to say: “It’s is quite normal for us, when we are depressed or feeling in emotional pain, to have thoughts of taking our own life. Is this happening to you?”

“Some people may say ‘absolutely not’, some may say ‘yes, when I was first diagnosed, but I’m okay now’. But some they may say ‘I am waking up feeling like this every day’,” said Emma.

She went on to reassure delegates that asking the question would not “put the idea” of suicide into people’s heads. “That is a myth and there is no evidence to support it,” she said.

Mounting a response

The first thing to remember if someone says they are having suicidal thoughts is not to panic. Emma said: “Don’t make them feel guilty, don’t tell them to think of their family. That’s not helpful.” Instead, HCPs should continue to be compassionate and empathetic.

Ask questions such as how long they have felt that way and why, if they have told anyone how they are feeling, and what, if anything helps elevates the feelings. This will help inform next steps.

If the patient says they are planning on taking their own life imminently, or admit to havingalready hurt themselves, it is time to stop the consultation and get help. Depending on the situation, that might be from the emergency department, or the local mental health crisis team.

If the situation does not require immediate action, teams can signpost the patient to support. This might include the Samaritans, other voluntary groups, or, from April, NHS 111, which will triage the call and connect the patient to their local mental health crisis line.

Teams should also document the conversation, and notify the relevant members of the wider multi-disciplinary team.

Summing up, Emma said HCP should never be afraid to ask the difficult questions.

“If we don't do it, we're potentially going to miss something. We know from the research that suicide in Parkinson's is low, but every year families are bereaved in this way – the chances of someone having a cardiac event in your clinic or at home is low, but we still go on yearly training for basic life support,” said Emma.