Suicide intervention

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Suicide intervention is a direct effort to prevent a person or persons from attempting to take their own life or lives intentionally.

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Asking direct questions is a recommended first step in intervention. [1] [2] These questions may include asking about whether a person is having thoughts of suicide, if they have thought about how they would do it, if they have access to the means to carry out their plan, and if they have a timeframe in mind. Asking these questions builds connection, a key protective factor in preventing suicide. [3] These questions also enable all parties to establish a better understanding of risk. Research shows that asking direct questions about suicide does not increase suicidal ideation, and may decrease it. [4]

Most countries have some form of mental health legislation which allows people expressing suicidal thoughts or intent to be detained involuntarily for psychiatric treatment when their judgment is deemed to be impaired. These laws may grant the courts, police, or a medical doctor the power to order an individual to be apprehended to hospital for treatment. This is sometimes referred to as being committed . The review of ongoing involuntary treatment may be conducted by the hospital, the courts, or a quasi-judicial body, depending on the jurisdiction. Legislation normally requires police or court authorities to bring the individual to a hospital for treatment as soon as possible, and not to hold them in locations such as a police station.

Mental health professionals and some other health professionals receive training in assessment and treatment of suicidality. Suicide hotlines are widely available for people seeking help. However, some people may be reluctant to discuss their suicidal thoughts, due to stigma, previous negative experiences, fear of detainment, or other reasons.

First aid for suicidal ideation

Crisis hotlines, such as the National Suicide Prevention Lifeline, enable people to get immediate emergency telephone counselling Lifelinelogo.svg
Crisis hotlines, such as the National Suicide Prevention Lifeline, enable people to get immediate emergency telephone counselling

There are a number of myths about suicide, for instance that it is usually unpredictable. In 7580% of cases, the suicidal person has given some sort of warning sign. [5]

A key myth to dispel is that talking to someone about suicide increases the risk of suicide. This is simply not true. [6] :8 Someone expressing suicidal thoughts should be encouraged to seek mental health treatment. Friends and family can provide supportive listening, empathy, and encouragement to develop a safety plan. Serious warning signs of imminent suicidal risk include an expressed intent to commit suicide and a specific plan with access to lethal means. [6] :30 If a person expresses these warning signs, emergency services should be contacted immediately.

Another myth is if someone is speaking of committing suicide, that they are merely seeking attention. It is important that the person feel they are taken seriously.

Safety plans can include sources of support, self-soothing activities, reasons for living (such as commitment to family or pets), safe people to call and safe places to go. [6] :38–39 When a person is feeling acutely distressed and overwhelmed by suicidal thoughts, it can be helpful to refer back to the safety plan or call a suicide helpline if the safety plan can not be done at that moment.

Mental health treatment

Comprehensive approaches to suicidality include stabilization and safety, assessment of risk factors, and ongoing management and problem-solving around minimizing risk factors and bolstering protective factors. [6] :4 During the acute phase, admission to a psychiatric ward or involuntary commitment may be used in an attempt to ensure client safety, but the least restrictive means possible should be used. [7] Treatment focuses on reducing suffering and enhancing coping skills, and involves treatment of any underlying illness.

DSM-5 axis I disorders, particularly major depressive disorder, and axis II disorders, particularly borderline personality disorder, increase the risk of suicide. [6] :45 Individuals with co-occurring mental illness and substance use disorders are at increased risk compared to individuals with just one of the two disorders. [7] While antidepressants may not directly decrease suicide risk in adults, they are in many cases effective at treating major depressive disorder, and as such are recommended for patients with depression. [7] There is evidence that long-term lithium therapy reduces suicide in individuals with bipolar disorder or major depressive disorder. [7] Electroconvulsive therapy (ECT), or shock therapy, rapidly decreases suicidal thinking. [7] The choice of treatment approach is based on the patient's presenting symptoms and history. In cases where a patient is actively attempting suicide even while in a hospital ward, a fast-acting treatment such as ECT may be first-line.

Ideally, families are involved in the ongoing support of the suicidal individual, and they can help to strengthen protective factors and problem-solve around risk factors. Both families and the suicidal person should be supported by health care providers to cope with the societal stigma surrounding mental illness and suicide.

Attention should also be given to the suicidal person's cultural background, as this can aid in understanding protective factors and problem-solving approaches. Risk factors may also arise related to membership in an oppressed minority group. For instance, Aboriginal people may benefit from traditional Aboriginal healing techniques that facilitate a change in thinking, connection with tradition, and emotional expression. [6] :21–22

Psychotherapy, particularly cognitive behavioural therapy, is an important component in the management of suicide risk. [7] According to a 2005 randomized controlled trial by Gregory Brown, Aaron Beck and others, cognitive therapy can reduce repeat suicide attempts by 50%. [8] [ non-primary source needed ]

Suicide prevention

Various suicide prevention strategies have been suggested by mental-health professionals:

Research

Research into suicide is published across a wide spectrum of journals dedicated to the biological, economic, psychological, medical, and social sciences. In addition to those, a few journals are exclusively devoted to the study of suicide (suicidology), most notably, Crisis , Suicide and Life Threatening Behavior , and the Archives of Suicide Research .[ citation needed ]

Related Research Articles

<span class="mw-page-title-main">Cognitive behavioral therapy</span> Type of therapy to improve mental health

Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. Cognitive behavioral therapy is one of the most effective means of treatment for substance abuse and co-occurring mental health disorders. CBT focuses on challenging and changing cognitive distortions and their associated behaviors to improve emotional regulation and develop personal coping strategies that target solving current problems. Though it was originally designed to treat depression, its uses have been expanded to include many issues and the treatment of many mental health conditions, including anxiety, substance use disorders, marital problems, ADHD, and eating disorders. CBT includes a number of cognitive or behavioral psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.

<span class="mw-page-title-main">Major depressive disorder</span> Mental disorder involving persistent low mood, low self-esteem, and loss of interest

Major depressive disorder (MDD), also known as clinical depression, is a mental disorder characterized by at least two weeks of pervasive low mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities. Introduced by a group of US clinicians in the mid-1970s, the term was adopted by the American Psychiatric Association for this symptom cluster under mood disorders in the 1980 version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), and has become widely used since.

Suicide is the second leading cause of death for people in the United States from the ages of 9 to 56.

Psychological trauma is an emotional response caused by severe distressing events that are outside the normal range of human experiences. It must be understood by the affected person as directly threatening the affected person or their loved ones with death, severe bodily injury, or sexual violence; indirect exposure, such as from watching television news, may be extremely distressing and can produce an involuntary and possibly overwhelming physiological stress response, but does not produce trauma per se. Examples include violence, rape, or a terrorist attack.

<span class="mw-page-title-main">Mental health</span> Level of human psychological well-being

Mental health encompasses emotional, psychological, and social well-being, influencing cognition, perception, and behavior. According to World Health Organization (WHO), it is a "state of well-being in which the individual realizes his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully, and can contribute to his or her community". It likewise determines how an individual handles stress, interpersonal relationships, and decision-making. Mental health includes subjective well-being, perceived self-efficacy, autonomy, competence, intergenerational dependence, and self-actualization of one's intellectual and emotional potential, among others. From the perspectives of positive psychology or holism, mental health may include an individual's ability to enjoy life and to create a balance between life activities and efforts to achieve psychological resilience. Cultural differences, personal philosophy, subjective assessments, and competing professional theories all affect how one defines "mental health". Some early signs related to mental health difficulties are sleep irritation, lack of energy, lack of appetite, thinking of harming oneself or others, self-isolating, and frequently zoning out.

<span class="mw-page-title-main">Suicide prevention</span> Collective efforts to reduce the incidence of suicide

Suicide prevention is a collection of efforts to reduce the risk of suicide. Suicide is often preventable, and the efforts to prevent it may occur at the individual, relationship, community, and society level. Suicide is a serious public health problem that can have long-lasting effects on individuals, families, and communities. Preventing suicide requires strategies at all levels of society. This includes prevention and protective strategies for individuals, families, and communities. Suicide can be prevented by learning the warning signs, promoting prevention and resilience, and committing to social change.

<span class="mw-page-title-main">Emergency psychiatry</span> Clinical application of psychiatry in emergency settings

Emergency psychiatry is the clinical application of psychiatry in emergency settings. Conditions requiring psychiatric interventions may include attempted suicide, substance abuse, depression, psychosis, violence or other rapid changes in behavior.

<span class="mw-page-title-main">Suicidal ideation</span> Thoughts, ideas, or ruminations about the possibility of ending ones life

Suicidal ideation, or suicidal thoughts, is the thought process of having ideas, or ruminations about the possibility of committing suicide. It is not a diagnosis but is a symptom of some mental disorders, use of certain psychoactive drugs, and can also occur in response to adverse life events without the presence of a mental disorder.

A major depressive episode (MDE) is a period characterized by symptoms of major depressive disorder. Those affected primarily exhibit a depressive mood for at least two weeks or more, and a loss of interest or pleasure in everyday activities. Other symptoms can include feelings of emptiness, hopelessness, anxiety, worthlessness, guilt, irritability, changes in appetite, difficulties in concentration, difficulties remembering details, making decisions, and thoughts of suicide. Insomnia or hypersomnia and aches, pains, or digestive problems that are resistant to treatment may also be present.

Suicide risk assessment is a process of estimating the likelihood for a person to attempt or die by suicide. The goal of a thorough risk assessment is to learn about the circumstances of an individual person with regard to suicide, including warning signs, risk factors, and protective factors. Risk for suicide is re-evaluated throughout the course of care to assess the patient's response to personal situational changes and clinical interventions. Accurate and defensible risk assessment requires a clinician to integrate a clinical judgment with the latest evidence-based practice, although accurate prediction of low base rate events, such as suicide, is inherently difficult and prone to false positives.

A suicide crisis, suicidal crisis or potential suicide is a situation in which a person is attempting to kill themselves or is seriously contemplating or planning to do so. It is considered by public safety authorities, medical practice, and emergency services to be a medical emergency, requiring immediate suicide intervention and emergency medical treatment. Suicidal presentations occur when an individual faces an emotional, physical, or social problem they feel they cannot overcome and considers suicide to be a solution. Clinicians usually attempt to re-frame suicidal crises, point out that suicide is not a solution and help the individual identify and solve or tolerate the problems.

Bipolar II disorder (BP-II) is a mood disorder on the bipolar spectrum, characterized by at least one episode of hypomania and at least one episode of major depression. Diagnosis for BP-II requires that the individual must never have experienced a full manic episode. Otherwise, one manic episode meets the criteria for bipolar I disorder (BP-I).

Youth suicide is when a young person, generally categorized as someone below the legal age of majority, deliberately ends their own life. Rates of youth suicide and attempted youth suicide in Western societies and other countries are high. Youth suicide attempts are more common among girls, but adolescent males are the ones who usually carry out suicide. Suicide rates in youths have nearly tripled between the 1960s and 1980s. For example, in Australia suicide is second only to motor vehicle accidents as its leading cause of death for people aged 15 to 25.

<span class="mw-page-title-main">Suicide</span> Intentional act of causing ones own death

Suicide is the act of intentionally causing one's own death. Mental disorders, physical disorders, and substance abuse are risk factors. Some suicides are impulsive acts due to stress, relationship problems, or harassment and bullying. Those who have previously attempted suicide are at a higher risk for future attempts. Effective suicide prevention efforts include limiting access to methods of suicide such as firearms, drugs, and poisons; treating mental disorders and substance abuse; careful media reporting about suicide; improving economic conditions; and dialectical behaviour therapy (DBT). Although crisis hotlines are common resources, their effectiveness has not been well studied.

<span class="mw-page-title-main">Depression in childhood and adolescence</span> Pediatric depressive disorders

Major depressive disorder, often simply referred to as depression, is a mental disorder characterized by prolonged unhappiness or irritability. It is accompanied by a constellation of somatic and cognitive signs and symptoms such as fatigue, apathy, sleep problems, loss of appetite, loss of engagement, low self-regard/worthlessness, difficulty concentrating or indecisiveness, or recurrent thoughts of death or suicide.

<span class="mw-page-title-main">Persecutory delusion</span> Delusion involving perception of persecution

A persecutory delusion is a type of delusional condition in which the affected person believes that harm is going to occur to oneself by a persecutor, despite a clear lack of evidence. The person may believe that they are being targeted by an individual or a group of people. Persecution delusions are very diverse in terms of content and vary from the possible, although improbable, to the completely bizarre. The delusion can be found in various disorders, being more usual in psychotic disorders.

<span class="mw-page-title-main">Igor Galynker</span> American psychiatrist

Igor Galynker is an American psychiatrist, clinician and researcher. His research interests include bipolar disorder, suicide prevention, and the role of family dynamics in psychiatric illness. He has published on these topics both in professional journals and in the lay press. His recent research has been devoted to describing Suicide Crisis Syndrome (SCS), an acute suicidal cognitive-affective state predictive of imminent suicidal behavior.

<span class="mw-page-title-main">United States military veteran suicide</span> Suicide among veterans of the United States armed forces

United States military veteran suicide is an ongoing phenomenon regarding the high rate of suicide among U.S. military veterans in comparison to the general civilian public. A focus on preventing veteran suicide began in 1958 with the opening of the first suicide prevention center in the United States. During the mid-1990s, a paradigm shift in addressing veteran suicide occurred with the development of a national strategy which included several Congressional Resolutions. More advancements were made in 2007, when the Joshua Omvig Veterans Suicide Prevention Act created a comprehensive program including outreach at each Veterans Affairs Office (VA) and the implementation of a 24-hour crisis hotline. PTSD, depression, and combat-related guilt in veterans are often related to suicide as it can be difficult for veterans to transition to civilian life.

In 2014, the WHO ranked Nepal as the 7th in the global suicide rate. The estimated annual suicides in Nepal are 6,840 or 24.9 suicides per 100,000 people. Data on suicide in Nepal are primarily based on police reports and therefore rely on mortality statistics. However, the burden of suicide in communities is likely to be higher, particularly among women, migrant workers, and populations affected by disasters.

In colleges and universities in the United States, suicide is one of the most common causes of death among students. Each year, approximately 24,000 college students attempt suicide while 1,100 students succeed in their attempt, making suicide the second-leading cause of death among U.S. college students. Roughly 12% of college students report the occurrence of suicide ideation during their first four years in college, with 2.6% percent reporting persistent suicide ideation. 65% of college students reported that they knew someone who has either attempted or died by suicide, showing that the majority of students on college campuses are exposed to suicide or suicidal attempts.

References

  1. "Suicide: What to do when someone is suicidal". Mayo Clinic. Retrieved 28 August 2022.
  2. "How and Why the Five Steps Can Help". National Action Alliance for Suicide Prevention and the 988 Suicide & Crisis Lifeline. Retrieved 28 August 2022.
  3. Klonsky, E David (June 2015). "The Three-Step Theory (3ST): A New Theory of Suicide Rooted in the "Ideation-to-Action" Framework". International Journal of Cognitive Therapy. 8 (2): 114–129. doi:10.1521/ijct.2015.8.2.114. S2CID   8798543 . Retrieved 30 August 2022.
  4. Dazzi, T; Gribble, R; Wessely, S; Fear, NT (December 2014). "Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence?". Psychol. Med. 44 (16): 3361–3363. doi: 10.1017/S0033291714001299 . PMID   24998511. S2CID   1881668.
  5. Rosenthal H (2003). "12 Must-Know Myths About Suicidal Clients". Counselor: The Magazine for Addiction Professionals. 4: 22–23.
  6. 1 2 3 4 5 6 Monk, Lynda; Samra, Joti (2007), Samra, Joti; White, Jennifer; Goldner, Elliot (eds.), Working With the Client Who is Suicidal: A Tool for Adult Mental Health and Addiction Services (PDF), Vancouver, British Columbia: Centre for Applied Research in Mental Health and Addiction, ISBN   978-0-7726-5746-6, OCLC   223281097, archived from the original (PDF) on 2022-04-22, retrieved 2013-03-15
  7. 1 2 3 4 5 6 Jacobs, Douglas G.; Baldessarini, Ross J.; Conwell, Yeates; Fawcett, Jan A.; Horton, Leslie; Meltzer, Herbert; Pfeffer, Cynthia R.; Simon, Robert I. (November 2003), "Practice Guideline for the Assessment and Treatment of Patients With Suicidal Behaviors", American Psychiatric Association practice guidelines, Arlington, VA: American Psychiatric Publishing, vol. 1, doi:10.1176/appi.books.9780890423363.56008, ISBN   9780890423363, OCLC   71824985, archived from the original on 2012-03-27
  8. Brown, G.K.; Have, T.T.; Henriques, G.R.; Xie, S.X.; Hollander, J.E.; Beck, A.T. (3 August 2005). "Cognitive Therapy for the Prevention of Suicide Attempts: A Randomized Controlled Trial". JAMA: The Journal of the American Medical Association. 294 (5): 563–570. doi: 10.1001/jama.294.5.563 . PMID   16077050.

Journals of suicide intervention research