Suicide Prevention
Learn about common suicide prevention techniques ...
Prevention is a buzzword in health care today, a word that translates into significant economic savings for individuals, communities, and private insurers when measures taken by individuals decrease their risk for serious diseases and illnesses – while also improving the quality and longevity of their lives.
But when talking about mental health, prevention presents a special challenge, especially when referring to suicide, one of the greatest public health crises plaguing the U.S. population today.
If not the toughest, suicide is one of the hardest and most tragic situations for any family or community to manage. What makes it especially tragic is that mental health professionals know that it’s preventable, that certain risks are identifiable, and that psychotherapy and medications are effective interventions.
But unlike watching someone light up a cigarette, eat three donuts a day, or sit for hours staring at a television instead of exercising, identifying an individual’s suicidal thoughts and patterns can be a much more discerning and discriminating process.
The reason stems from the fact that 90% of individuals who die by suicide – one every 16 minutes in America today – have a mental illness or substance abuse disorder. Yet the vast majority of these victims did not seek treatment or get help for their extreme distress. Truth be told, many are shocked when someone they know commits suicide.
Despite the fact that the U.S. Centers for Disease Control (CDC) identify depression (see Depression) and bipolar disorder (see Bipolar Disorder) as the two most common disorders associated with acts of suicide, followed by substance abuse disorders, many who are suicidal have never been questioned about their destructive thoughts.
Prevention programs work
Yet suicide prevention research provides hope in the midst of these grim statistics. This research is aimed at identifying those at the highest risk for suicide, either by demographics, observable behaviors, personality characteristics, life events, physical illnesses, or cultural characteristics, and increasing awareness through a variety of methods and processes. (see “Risk Factors for Suicide and Suicidal Behaviors”)
For example, one of main reasons individuals refuse to seek treatment for depression is the stigma attached to getting help from mental health professionals. And perhaps nowhere is this stigma more prevalent than in the military.
However, suicide rates among service members is climbing. Two ongoing wars and the number of warriors returning home from multiple deployments with traumatic brain injuries and post traumatic stress disorder are directly linked to these rising suicide rates.
And those in command are noticing. One prevention technique the military has begun instituting revolves around training commanders and officers on identifying signs of depression and distress among their troops. This, in combination with campaigns aimed at reducing the stigma associated with getting help, remain the key strategies for halting or reducing the troubling suicidal trend. (See article on the Real Warriors Campaign)
According to the Research!America website, the U.S. Air Force successfully decreased its suicide rate by reducing stigma. It encouraged and promoted seeking help early when the first signs of depression and other mental health issues surface. Based on its prevention program, it reduced its suicide rate by one-third.
Like other “train-the-trainer” programs, the Air Force Suicide Prevention Program (AFSPP) specifically trains Air Force leaders on how to identify suicidal individuals, and also on how to get the identified individual into counseling.
Some of the key suicidal risk factors among service members parallel those found among troubled civilians, but there are also several military-specific risk factors. These include the constant pressure of “kill or be killed” in intense combat situations, witnessing gruesome combat scenes and death, and marital, family, or financial problems resulting from numerous deployments and extended separations.
SOS for teens
Programs like AFSPP are being developed to work across a number of private and public institutions, including fire and police departments, corporations and schools.
The CDC, for instance, reports that suicide is the third leading cause of death for Americans ages 15 to 24. Stigma keeps many teens from seeking help, but another factor also plays a major role with this age group: adolescents don’t understand or know to recognize depressive symptoms. (see Adolescence Developmental Psychology).
The SOS or Signs of Suicide prevention program for middle and high school students was designed to teach students how to identify depression and suicidality in themselves or their friends.
In a randomized control study, SOS was proven to reduce self-reported suicide attempts by 40%, according to the Screening for Mental Health website.
Because research shows that teens turn to their peers rather than adults when considering suicide, SOS gives teens the information they need to spot depression and suicidal tendencies among each other. It educates students on the treatability of depression and other mental health disorders, and teaches that suicide is not an answer.
The program encourages and empowers teens to intervene when a friend or acquaintance shows behaviors or attitudes that appear depressive and/or suicidal. The model employed is called ACT – which stands for Acknowledge-Care-Tell.
Help for older adults
The tragedy of a young person taking his or her life affects most Americans viscerally, especially when that death is a family member or a friend. A life lost before it has lived the majority of its years creates a void in society that can never be filled.
However, most Americans don’t realize the toll of suicide among older adults, lives rich with experience and wisdom - hardly less valuable or meaningful to society.
One of the most startling statistics reported by the CDC is that the highest suicide rate in the U.S. population is among those 75 and older. (see article on Suicide in Older Adults.) And major depression is the most significant suicide predictor for this age group.
The National Institute of Mental Health (NIMH) reports that a key preventive measure for addressing this unusually high suicide rate centers on training primary care physicians on detecting depression among the elderly.
The organization bases this belief on the history of those who have committed suicide and their visits to primary care doctors close to the time of suicide: 20% on the same day of the suicide; 40% within one week of the suicide; and 70% within one month of the suicide.
But doctors and older patients have difficulty identifying depressive symptoms, which, contrary to what many believe, are not normal at this age, or at any age.
While it’s not uncommon for depression to co-occur with other medical illnesses such as cardiovascular disease, stroke, diabetes, and cancer, it’s still a medical condition that must be treated.
“Because many older adults face such physical illnesses as well as various social and economic difficulties, individual health care professionals often mistakenly conclude that depression is a normal consequence of these problems – an attitude often shared by the patients themselves,” the NIMH report “Depression and Suicide Facts” states.
Research shows that both psychotherapy and antidepressant medications used in combination to treat depression in the elderly are effective suicide interventions. And training doctors, just as training teachers, commanders, and police officers, is essential for suicide prevention.
Men and suicide
According to the CDC, 80% of suicide deaths are men. And white men are more likely to kill themselves than are African-Americans, Asian-Americans, or Hispanics.
One explanation for this is that men are more likely than women to use firearms when attempting suicide, an almost always lethal way to end one’s life, whereas women often select less lethal options, such as poisoning by overdosing on pills, and so they are more likely to survive suicidal attempts.
Research on the high rate of suicide among men also indicates that women are more likely to have social networks that allow them to share their problems and concerns. And women are less likely to attach a stigma to getting counseling or therapy.
One explanation for the fact that white males are more than twice as likely to commit suicide than African-Americans focuses on religious affiliations. Some researchers believe that a church community, connection to God, and higher degrees of spirituality – all found more prevalent in the African American community –help prevent suicide.
Other research shows that white men who are suicidal share some common factors. They feel trapped in their lives, and are commonly substance abusers. And like others who struggle with suicidal ideation, these men suffer disproportionately with depression, bipolar disorder, and schizophrenia.
Also, romantic relationships that don’t work out, unemployment, or those suffering through legal or ethical crises are more vulnerable.
Because men are less likely to open up about their distress, any of these risk factors should become warning flags for friends, family members, doctors, and mental health care providers who come in contact with these men.
Since 50% of all suicides are committed with a firearm, according to the CDC, some experts even suggest that doctors ask their male patients if they own or have access to firearms.
A suicide detection tool
Lisa Firestone, PhD, director of research and education at the Glendon Association, developed the Firestone Assessment of Self-Destructive Thoughts (FAST). This tool is a scale for doctors and mental health professionals to use to assess suicide potential.
FAST is used for both women and men, but because of the higher suicide rate in men, it’s an especially helpful tool for professionals trying to uncover suicidal ideation in males. In an interview with psychotherapy.net, Lisa Firestone said that FAST directly asks patients about thoughts concerning suicide, something that at first seems elemental, but these are actually questions that few doctors – and therapists – ask.
And, Firestone said, patients don’t freely offer that information. But her research has found that once asked, people will freely talk about suicidal thoughts, fantasies, and plans. FAST, she said, can in fact predict suicidality through the asking of questions, and ranking answers on an established, researched, quantifiable scale.
The costs of suicide
The bottom line is that suicide prevention works, and it works because like health care prevention, it aggressively addresses problems before they get out of control. The actual cost of suicide to the U.S. economy is estimated to be $13 billion annually, according to Research!America. And suicide attempts cost another $3.8 billion annually in hospitalizations.
As everyone knows, however, the true cost of suicide cannot be measured because human lives are priceless – whatever their age, socioeconomic status, or cultural identity. Ask anyone who has lost someone to suicide.
Mental health counselors and therapists can choose to become trained to detect signs of suicide ideation, and diagnose disorders that are progressing toward this extreme.
For more information, contact schools offering degree programs in mental health counseling or psychology.
Guns and Suicide
Discussing suicide today must include the topic of guns. Although controversial politically, gun ownership, firearm availability, and access to guns must be considered when discussing and developing suicide prevention techniques. A study published in the American Journal of Psychiatry interviewed 33 people who tried committing suicide with a firearm, but failed in their attempts. Most all respondents stated that they chose the firearm over other methods because it was “available.”
However, these individuals were the fortunate ones. The Harvard School of Public Health website reports that approximately 85% of attempts with a firearm are fatal - a much higher fatality rate than for almost every other suicide method.
The website states that those who try killing themselves by taking pills, inhaling car exhaust, or by using razors, have “some time to reconsider mid-attempt and summon help or be rescued.” Many who try hanging also can release pressure if using a partial-suspension.
But when a trigger is pulled, there isn’t any time to reconsider.
The Harvard website calls one of its suicide prevention sections “Means Matter.” The website’s authors state the purpose of this prevention initiative is to provide lethal means counseling, which the site defines as the following:
- assessing whether a person at risk for suicide has access to a firearm or other lethal means
- working with them and their family and support system to limit their access until they are no longer feeling suicidal
For adolescents, the fact that a firearm is available in the home is serious. In several studies, it has been acknowledged that those teens who died by suicide were twice as likely to live in a house where a gun or guns were accessible, according to the website. And researchers have found that impulsivity also plays a major role in a suicide attempt, meaning that many suicides are the result of a short-term, immediate crisis rather than painstakingly planned.
In fact, the website states that case studies have shown that one in four individuals deliberated for less than 5 minutes, and nine out of ten deliberated less than a day.
Impulsive decisions to end your life and the accessibility of a gun are lethal conditions, and increase the probability of a completed suicide dramatically.