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Some believe that suicide is the most selfish act an individual commits, causing extreme emotional pain and distress to those left behind.
Yet those who have thoughts of suicide, attempt suicide, or actually follow through with suicide are in more pain and distress than any healthy or happy individual can imagine.
Suicide is a symptom of hopelessness that sees no way out of harsh, bleak situations, traumas, or illnesses. It’s the darkest dark of a depression that completely takes over all thoughts and emotions. Those who enter this darkness can not pull themselves out on their own; they are slaves to the depression (see Depression), or the mental illness, environmental conditions, or other distressful conditions that continuously assault their minds.
All mental health counselors and therapists must be knowledgeable about suicide counseling because every patient or client must be assessed for a possible suicide. This is especially critical when patients are seen for symptoms of depression or bipolar disorder (see Bipolar Disorder).
Yet the problem with suicide is that many individuals who are experiencing major depression to the point where they’re considering suicide refuse to seek help or they drop out of treatment. Suicidal thoughts are like snakes of the mind, curling around and choking off all rational and reasonable thinking - making the implementation of interventions and treatment extremely difficult.
Mental disorders linked to suicide
In an article for Focus, The Journal Of Lifelong Learning in Psychiatry, authors Paula Clayton, M.D., and Tracey Auster, write that more than 90% of people who die by suicide have one or more psychiatric or mental illnesses, the most common being depression and bipolar depression.
Clayton and Auster, both of the American Foundation for Suicide Prevention, base their statistics on psychological autopsy studies done in various countries for 50 years. All of the studies in all countries report strikingly similar results concerning the connection between mental health and suicide.
Following depression, substance abuse accounts for the second highest mental disorder influencing suicide. Other conditions predisposing individuals toward suicide are schizophrenia, anorexia, some anxiety disorders, and personality disorders.
However, most cases of suicide attributed to any other disorder also involve depression since depression often coexists with other mental disorders. One important example of this concerns substance abuse. Those who are depressed try to self-medicate or make themselves feel better with alcohol or drugs. Yet alcohol and drugs feed depression, sometimes causing it. This vicious cycle can become deadly, distorting depressive thoughts even further.
The counseling challenge
Clayton and Auster cite another study conducted in 2002 concerning depression and suicide, a study showing that suicide rates for those with depression, followed over the course of 40 to 44 years, was 17.7%. During the same time period, those with other mood disorders reported an 11.1% suicide rate, and those with bipolar disorder had an 11.4% rate.
Given that 20.9 million ages 18 or older have a mood disorder such as depression or bipolar disorder, according to the National Institute of Mental Health (NIMH), the potential for even higher suicide rates is unsettling.
The NIMH also states in its report “The Under-recognized Public Health Crisis of Suicide” that although evidence points to increasing rates of treatment for mental illness since the early 1990s, suicide rates are not decreasing.
So if mental health treatments are increasing, why isn’t the suicide rate dropping? The NIMH goes on to speculate that a combination of two factors might be contributing to this disturbing trend. The first involves individuals who are seriously depressed not seeking treatment; the second involves the effectiveness of treatments – a factor that directly affects the field of Mental Health Counseling.
Studies conducted by researchers across the world have demonstrated that treating mental illness with either medication or psychotherapy effectively reduces suicide rates, the NIMH states.
The key for counselors and therapists, therefore, is to provide the right type of treatment, the type of treatment that effectively targets the distorted thinking, and the reasons for that distorted thinking, that lead to suicide. The key is to uncover suicide ideation – which patients often try to hide – and help patients realize that these thoughts are not logical, reasonable, or justified. These thoughts are part of a larger problem with distorted or dysfunctional thoughts in general. However, therapists are able to help patients examine these irrational thoughts, and also provide an effective therapeutic relationship that could prevent a suicide attempt. (see article on Suicide Counselor)
Treatment combinations proven effective
For those who do consider suicide, studies have pointed out that a combination of therapies and counseling interventions are required.
Recommendations by Clayton and Auster of the American Foundation for Suicide Prevention include medication in combination with targeted therapies.
“Research has shown that treating suicidal outpatients with suicide attempt directed cognitive behavioral therapy, suicide attempts are reduced by 50% over an 18-month period,” the authors state.
Cognitive behavioral therapy (CBT) (see Cognitive Behavioral Therapy) recognizes that thoughts and the emotions associated with thoughts directly affect many types of psychopathology, and it tries to alter or change maladaptive thoughts and belief systems. CBT supports the theory that by changing cognitions or thoughts, behaviors will change as well.
Clayton and Auster also cite studies that show lithium, neuroleptics (mainly clozapine) and several antidepressants to be effective medications for severe depression and bipolar disorder – and are proven through empirical studies to reduce the rate of suicides.
Suicide counseling often involves working with doctors who prescribe these medications, and it also can involve other forms of therapeutic interventions.
For instance, dialectical behavior therapy (DBT) involves both group counseling sessions and individual sessions. Group sessions educate patients on interpersonal skills, distress tolerance, and emotional regulation techniques.
Individual sessions take the form of direct problem-solving, and supportive techniques to encourage and empower patients. DBT is also used for adolescents who often struggle with extreme family and environmental stressors. (see article on Suicide Counselor.)
All mental health counselors might have to provide suicide counseling at some point in their careers. Additionally, some counselors who work in hospitals or inpatient mental health facilities might spend a large part of their time working with suicidal patients and their families.
Additional training for suicide counseling is available through several organizations, including the American Foundation for Suicide Prevention and the American Association of Suicidology.
A career in counseling
While the work of getting suicidal individuals to seek out counseling or stay in treatment might fall within the realm of public awareness and educational campaigns, the work of helping individuals in treatment overcome suicidal thoughts resides with mental health counselors.
If you want to help individuals combat symptoms associated with severe depression or bipolar disorder, which often include suicidal ideation, consider a career as a mental health counselor. Explore schools offering mental health degree programs to learn how you can enter this career.
Substance Abuse and Suicide
Individuals with substance abuse disorders are more likely to plan and attempt suicide than others, according to a survey by the Substance Abuse and Mental Health Services Administration (SAMHSA).
SAMHSA’s National Survey on Drug Use and Health for 2004-2005 provided a look at the relationships between suicidal thoughts, suicide attempts, and substance use among individuals who are 18 or older and who have had at least one depressive episode in the year immediately preceding the survey.
During this depressive episode, 56.3% thought that it would be better if they were dead, 40.3% considered suicide, and 14.5% made a suicide plan. Of those experiencing such a depressive episode, 10.4% actually attempted suicide.
In a 2009 SAMSHA white paper, Richard McKeon, Ph.D., M.P.H., and public health adviser for suicide prevention at SAMHSA’s Center for Mental Health Services, said the following:
“The connection between substance abuse and suicide has not been sufficiently well understood. People in both the mental health and substance abuse fields have likely had experiences that would demonstrate the connection, but I think that probably few appreciate the magnitude of the relationship between substance abuse and suicide.”
Statistics place alcohol and drug abuse second only to depression and other mood disorders when it comes to risk factors for suicide. And, according to the paper, substance abuse and mental disorders often occur simultaneously, or go “hand-in-hand.”
The paper states that cultural taboos have kept the emphasis on suicide and suicide treatment from being properly investigated and researched. However, increased emphasis and rising rates of suicide over the last decade have finally led to more research and a better understanding of suicide, and this understanding is contributing to the development of more effective therapeutic interventions.