I can handle psychotic patients just fine because of a low bar expectation that they're going to act sane. But what tests me the most are non-psychotic cases where people are still within their normal executive functions but are distressed.
The nugget of wisdom I learned over the months about handling suicidal patients:
A psychotic patient that's suicidal versus a patient that uses suicide for secondary gain can be separated from their motivations for doing it versus how they did it. It's not a text book knowledge but something you just observe after noticing some trend. If a psychotic patient intends to kill themselves because the voices told them to, they will carry it out and pain wouldn't stop them, they'll bury that blunt knife into the heart or jump over a building without any second thoughts. But for cases where they use suicide to be noticed, they'll have some way of safety measure to come out alive, like ingesting several pills then informing their loved ones they did it than be quiet about it, or attempting to cut themselves but somehow just missing the vital points causing superficial wounds. It's not true for all cases but I get to notice the same patterns in more than half the time.
It's frustrating especially when they already have some degree of good insight that their behaviors (referring to non-psychotic ones) do not show a good exercise of judgment and yet they can't seem to remove these tools as a first option whenever they don't get what they want.
BF/GF left them? try to die.
Parent's gift them an iphone? try to die.
Wife/Husband wants to leave the relationship? try to die.
I say try because they use the attempts as a means to emotionally manipulate the people around them. I don't see this motivation from psychotic patients because once the psychosis has been treated, the behavior goes away. But for non-psychotic ones with a mix of personality disorder, it can be a nightmare to deal with because of how much draining over the long term.
I got inspired after my recent run in with someone that expressed they intended to die with some plans already in mind. Even if the back of my head says they're unlikely to follow through on impression, the thought that they expressed some intent warrants me to take it seriously but they refused because of the conditions being admitted to a psychiatric facility and being with other patients that aren't mentally well.
There were some obstacles present which I won't go into detail but it required me to ask for permission from several departments just to accommodate them and after all the phone calls and laborious explanation of the situation to different people, they just decide to leave and signed a waiver despite how much I tried to explain the risks of going home at their current state.
That one patient made me waste 4 hours of my time. Time I could've used to tend to others and or do my reports. It's these situations that make me a little more numb about suicidal behaviors due to how much it became a fashion taken lightly.
Ever had that friend or habit when at the slightest inconvenience they make a joke about wanting to die, or how much saying stuff like killing themselves was treated as a usual joke? it's these behaviors normalized that makes it difficulty to take people seriously when they do really need help.
Thanks for your time.