Suicide is a growing public health issue in the United States. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), clinicians answered approximately 2.2 million calls via the National Suicide Prevention Lifeline (NSPL) and over 100K online chats in 2018 alone. It’s safe to say the demand and need for mental health care is dire and tangible.
As counselors, it’s critical to note some of the clinical risk factors associated with suicide:
- More than 90% of those who commit suicide have a diagnosable psychiatric illness at the time of death, usually depression, alcohol abuse, or both;
- Of those living with major depressive disorder, close to 50% report feelings of wanting to die, 33% consider suicide, and 8.8% report a suicide attempt;
- The adverse childhood experience (ACE) questionnaire accounts for 10 different types of ACEs including abuse and neglect, and ACEs in any category increase the risk of attempted suicide by two- to fivefold throughout a person’s lifespan;
- A history of a suicide attempt is the strongest predictor of future suicide attempts, as well as death by suicide.
Thankfully, we’ve made headway in the suicide arena as a society-at-large. Starting in 2022, a three-digit number (“988”) will be used to direct people to the NSPL, signifying a public awakening to the threat suicide poses to Americans every day. Although suicide is complicated and tragic, the silver lining is that it’s PREVENTABLE! And with the right education, skills and communal support, we can change the trajectories of at-risk individuals’ lives.
First, there are a few myths work debunking…
- Asking someone about suicide plants the idea in their head. Asking how someone feels doesn’t create suicidal thoughts any more than asking how their chest feels would cause angina.
- There are talkers and then there are doers. Most people who die by suicide have communicated some intent. Someone who talks about suicide gives you an opportunity to intervene before suicidal behaviors occur.
- They wouldn’t kill themselves since they just made plans for vacation; have young children; signed a no-harm contract; know how much their family loves them, etc. The intent to die can override any rational thinking. In the presence of intent or ideation, the clinician shouldn’t be dissuaded from thinking that the client is capable of acting on these thoughts and feelings.
Next, we have to jump into risk assessment mode. A simple screening tool to keep in your clinical toolbox is the Suicide Assessment Five-step Evaluation and Triage resource, conceived by Dr. Douglas Jacobs and commonly referred to as the SAFE-T. The steps include:
- Identify Risk Factors
- Identify Protective Factors
- Conduct Suicide Inquiry (thoughts, plans, behavior, intent)
- Determine Risk Level/Intervention
- Document (assessment of risk, rationale, intervention, follow-up)
*See the end of the blog post for a detailed breakdown of the above steps!
You may not be in a position to screen for suicide from a clinical judgment standpoint. I have a client who recently asked how to 1) identify suicidal warning signs and risk factors in others, and 2) carry out the crucial conversation calmly and productively. What a powerful, intentional question! And yet another alert to the need for psychoeducation at the societal level.
What are some ways to help someone threatening suicide or engaging in suicidal behaviors in the moment?
- Speak directly – talk openly & matter-of-factly about suicide, what you have observed, and what your concerns are regarding their well-being;
- Be willing to listen – allow for their expression of feelings, accept them and be patient;
- Practice non-judgment – don’t debate over whether suicide is right or wrong or whether the person’s feelings are good or bad. Don’t give a lecture on the value of life;
- Be available – show interest, understanding and support;
- Don’t dare them to engage in suicidal behaviors;
- Don’t act shocked;
- Don’t ask why;
- Don’t be sworn to secrecy;
- Offer hope that alternatives are available – but don’t offer reassurance that any one alternative will turn things around in the near future;
- Take action – remove lethal means of self-harm such as pills, ropes, firearms, and alcohol or drugs;
- Get help from others with more experience and expertise;
- Be actively involved in encouraging the person to see a mental health professional as soon as possible and ensure than an appointment is made.
The bottom line is, we can disrupt the pandemic that is suicide. May we be a people with open eyes and hearts so that we may attend to the cries of others. Should you be looking for continued education, SIGN UP for a FREE webinar on 9/10 at 2pm CST hosted by three mental health experts on how to take action for suicide prevention. You may also check out Sip of Hope on Instagram or Facebook for free suicide prevention and mental health resources, events and activities as well.
Cheers to being a collective force for change!