Suicide
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Introduction
Suicidality reveals the extent of desparation.
affects more males than females (3:1 for completed suicide).
Rates increase after age 14; suicide is the second-most common cause of death for ages 15-24. However, rates are highest in people over 65 years old.
In Nova Scotia, about 11/100,000
Annually, over one million people die by suicide around the world (WHO, 1999).
There is a lot of varation among countries.
There is a lot of overlap between deliberate self-harm and suicide
There are 100-120 suicide attempts for every successful suicide.
For each completed suicide, 5 suicide attempts occur.
The ASIST training program utilizes the PAL model - Pathway for Assisting Life. It includes three phases: connect with suicide, understand with choices, and assist with life.
These can occur linearly, and it can be helpful to work through the steps in order. However, often times it is helpful to cycle through the steps if they need to be revisited.
Risk Factors and Warning Signs
Major risk factors that should prompt risk assessment include:
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Other demographic factors associated with increased risk of suicide include:
- male
- older age
- white
- aboriginals
- widowed or divorced, or other recent losses
- alone, with no children under 18 in the house
- access to firearms
Symptoms associated with suicide can include:
- hopelessness
- anhedonia (loss of pleasurable activities)
- preoccupation with death
- insomnia
- guilt
- decreased self-esteem
- decreased energy
- poor concentration
- changes in appetite
- severe anxiety or panic attacks
- impaired concentration
- psychomotor agitation
- psychotic features
Suicide Assessment
Assessing suicide risk should be carried out if there are identified signs or concerning risk factors.
It is important to demonstrate care and compassion while identifying and exploring suicidality. Some questions that you can ask include:
- do you ever think about doing yourself in?
- have you ever thought about how you might do this?
- have you imagined your funeral, and how people might react to your death?
- have you changed your will or life insurance policy, or given away possessions?
Explore risk factors, described above, especially:
- alcohol and drug use
- a concrete plan
Understanding the Situation and Choices
Once the topic of suicide has been raised, listen to the person's story, using effective listening techniques. Avoid interrupting to correct or solve problems as the person talks through their issues.
Look for uncertainty and hope.
Help the person move towards hope by finding positive aspects in their life and their future. Oftentimes people will provide cues that you can build on. Some questions that can be used to elicit a way forward include:
- What would it take to resolve this situation for you?
- What could you do that could bring meaning to your life? to the lives of those around you?
Others to inquire into include family that depend on the person, pets, responsibilities, and events in the future they could look forward to.
Look for supportive factors, including:
- caregivers
- medical and mental health professionals
- hobbies
Safety Planning
Developing a safety plan is very important in resolving the conversation.
Help to establish hope.
You can consider the following phrases:
During the conversation, ensure linkage with caring supports, and participate in the connection, as needed.
Work to disable the suicide plan, if it exists. Take away the gun, medications, or rope, within the parameters of safety. Often you will benefit from family or friends, or the authorities, if you will need to go into the home to disable the safety plan.
Ensure there is an effective handover to another caregiver.
Make a plan to connect with a medical or mental health professional, as identified.
An emergency access card, with local crisis lines, is important.
- problem-solving therapy
- cognitive behaviour therapy
Prevention
There are a number of means that societies have used to prevent suicide. A number of these follow.
Education
School based educational programs have been used (equivocal success)
General community education programs can be offered to people more broadly. Some examples include SafeTalk.
Peer counselling
Publishing and marketing the number for crisis lines can provide support if people are struggling.
Decreased Access to Means
Put barriers in front of lethal means can reduce access. Examples include:
- car catalytic converters decrease carbon monoxide production, reducing the ability for poisoning
- firearm control laws and licensing requirements
- safety engineering of buildings and bridges, to reduce ability to jump
- packaging over the counter analgesics, such as acetaminophen, with sublethal doses
Media Guidelines
There is a
reduce sensationalist guidelines
- details of method/location
- interviews with the bereaved
include a bit about getting help
Resources and References
Stovall J, Domino FJ. 2003. Approaching the Suicidal Patient. Am Fam Physician. 68:1814-8.
WHO. 1999. Figures and facts about suicide.
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