Nursing interventions against suicide on public roads

Yellow September is an important month for public health in Brazil and the world, for discussion a subject of such relevance. Suicide is an act thought out, voluntary and conscious of putting an end to one’s existence. Suicide is understood as a multifactorial act, and the subject who is motivated to end his existence is in suffering, unable to deal with the demands of daily life. We know that suicide is mainly caused by people with some psychic vulnerability and/or who have a pre-existing mental illness. But suicide is also a social act. We remember that psychic suffering is generated by the person’s reaction to the environment, the event, the pressure and other issues that generate important determinants of illness.

Read also: Yellow September: depression and the link with the suicide

In this sense it is It is important to talk about the self-care of Brazilian society, since we are the 10th worldwide in the number of suicides. That’s why talking about mental health in everyday life is increasingly necessary. This is important so that the population does not understand suicide as the only possibility. Yellow September is a possibility to tell the population that there is a way out of suffering, as well as directing the path that health professionals can help in this process. Today we are going to bring an important discussion about suicide, which is related to urban traffic.

Getting to work or to school in big cities is not so easy. We left very early and came back very late, but that’s not the only problem, it’s the traffic. Traffic can be understood as the movement of people or vehicles on public roads. We know that in traffic we have some vulnerabilities that generate stress and anxiety, even depression . But today we are not going to talk specifically about traffic as a risk factor for illness, but rather recognize that it is in traffic that a large number of suicides occur. Urban transport can change people’s health status, mainly due to the conditions they face. But there is another problem that happens on public roads that is not traffic and problems with urban mobility.

O Brazil leads the number of traffic accidents in the world. There are countless problems related to traffic in Brazil. The means, whether cars or motorcycles, facilitate the process of accidents, whether in the process of physical accidents or generating psychic vulnerabilities. But a relationship that catches our attention is between suicide and traffic. Everyday people kill themselves in the context of traffic, using automobiles or motorcycles as a means of ending their own lives. In traffic we have tools for a person to commit suicide. The association takes place through the speed that automobiles and motorcycles can reach, little vigilance or assistance on public roads and the relationships already widely known between alcohol and other drugs and driving can be linked to impulsiveness to end life. It is in this context that suicide leaves homes, the place where they occur most and start to happen on public roads.

We know that numerous conditions are related to the agent’s willingness to commit suicide. And that the most used means to achieve suicide are: hangings, use of firearms and pesticides. We also know that the use of psychotropic drugs is recognized in people who committed suicide or who remained in the attempt, mainly due to psychological distress such as depression. But because the concern with traffic. Well, the literature always points out that there is underreporting of suicide cases in Brazil. It is in traffic, with its high stimuli of stress and vulnerability, that we can have triggers for the development of an impulse, where ending life becomes a solution.

Learn more: Yellow September : time to rethink life

Public roads they are spaces where the person can move away from environments, where they have affections that could discourage them to act, away from families, friends or other people they know, the person has the possibility of having the courage to commit the difficult task of commit suicide. In our imagination, due to cinema films, we have the road and the bridge, as places where one chooses to represent a place of suicide. And it is common in big cities to have episodes where people choose strategic places such as bridges, train tracks, highways, among other places, to commit suicide. Therefore, we are going to bring some interventions that can be performed in front of a person who presents suicidal behavior in these locations.

The acceptance of suicidal behavior is organized into different types of attention. For the suicide attempt that happens in traffic, generally members of society and the pre-hospital care team are the ones who act the most in these situations, in addition to the fire department and public safety professionals. To assist the person about to commit suicide on the public road, whether you are a pre-hospital care professional or a professional facing the demand, you can consider some information, use it if relevant:

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Scene Evaluation:

Understand what are the threats and risks that can occur in the emergency scenario, remember to always keep safe.

Check the vulnerabilities and potential of the site and remember to never put yourself at risk during the approach, immediately call the responsible authority, they are military firefighters, police in case of need, pre-hospital care in the municipality.
• Check if the person has instruments such as a firearm or the like, if so, stay away and call the competent authorities. Remember that your safety must come first.

Recognize and classify the person with suicidal behavior:

Evaluate if the user is hostile. Their behavior may be restless, with sharper peripheral movements, or facial movements, avoiding eye contact with the rescuer. Check the tone of voice, which may be raised or laconic. It shows irritation or psychomotor agitation or even risk of violence.

Evaluate if the user is aggressive. If you are agitated, manipulate objects, or gesticulate a lot, if you have psychomotor restlessness or threaten to jump from high places or in front of vehicles.

Assess if you present anger and if you make threats by verbalizing that you will commit the suicidal act. remember never to disregard your lines. having positive attitudes and speeches, making the person focus their attention on the conversation and offering them help.

Conducts

Make an appropriate assessment objectively.
• Actions must be taken carefully.

Set a staff person to perform the voice and command commands.

Conduct negotiations in favor of life and the protection of integrity of the person, showing solidarity and being able to help them.

It is important that the person knows that the suicide is not the only way.

Keep the person under constant observation .

The purpose of the negotiation is to offer help and welcome therefore, do not use punitive speeches that can make the person do the act.

Avoid words that may make the person feel unwelcome, such as: crazy, suicidal, depressed, etc.

Do not provoke the person or mock the action as inappropriate or the person as incapable of committing the act, thus not carrying out the judgment. the person’s.
• If you can contact the person and this is in a dangerous place, remove the person respecting them.
• Send to the reference service and ensure care to specialized care locations.

Remember that caring for a person in psychological distress at risk of suicide must be taken seriously by all of us. Empower your team and discuss the matter, the greater the discussions, the best practices we can develop in helping people who are suffering.

Author:



PhD. Health Care (UFF), Master of Science in Health Care (UFF) and Specialist in Psychosocial Care.

References:

• Alcantara VCG, Silva RMRCA, Pereira ER , Silva DM, Flores IP. Stressful factors perceived by bus drivers. Rev Nurse UERJ, Rio de Janeiro, 2020; 28:e44289. doi:
• 10.12957 /reuerj.2020.44289

Franck MC, Monteiro MG, Limberger RP. Suicide mortality in Rio Grande do Sul: a cross-sectional analysis of 2017 and 2018 cases. Epidemiol Serv Saúde. 2020 Maio; 29(2): e2019512. It hurts: 10.5123/S1679-49742020000200014

Silva SL, Kohlrausch ER. Pre-hospital care for individuals with suicidal behavior: an integrative review. SMAD.
Electronic mental health magazine, alcohol and drugs. 2016;12(2):108-115. It hurts: 10.11606/issn.1806-6976.v12i2p108-115.

Firefighters Operational Manual: pre-hospital rescue/Military Fire Department of the State of Goiás. – Goiânia: – 2016. 318 p. : il.

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