Suicide intervention

Suicide intervention is a direct effort to prevent person(s) from attempting to take their own life intentionally.

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"; once in the hospital, the patient may be sedated or given some sort of treatment plan. Should they be acting in a violent manner, they may be shackled to the bed or locked inside a seclusion room for the time being. 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 invidual to a hospital for treatment as soon as practical and not 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, or other reasons.

First aid for suicide ideation

There are a number of myths about suicide. It is not usually unpredictable; in 75-80% of cases, the suicidal person has given some sort of warning sign.[1] A key myth to dispel is that talking to someone about suicide increases the risk of suicide. This is simply not true.[2]:8 If someone is expressing suicidal thoughts, he/she 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 the intent to commit suicide and a specific plan with access to lethal means.[2]:30 If a person expresses these warning signs, emergency services should be contacted immediately.

Safety plans can include sources of support, self-soothing activities, reasons for living (such as commitment to family, pets, etc.), and safe people to call and places to go.[2]: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.

Mental health treatment

According to Chiles and Strosahl's 1995 Problem-Solving Model of Suicidal Behaviour, people attempt suicide when they experience the "three I's": intolerable, interminable, and inescapable pain and suffering.[2]:3 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.[2]: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.[3] Treatment focuses on reducing suffering and enhancing coping skills, and involves treatment of any underlying illness.

DSM-IV axis I disorders, particularly major depressive disorder, and axis II disorders, particularly borderline personality disorder, increase the risk of suicide.[2]: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.[3] 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.[3] There is evidence that long-term lithium therapy reduces suicide in individuals with bipolar disorder or major depressive disorder.[3] Electroconvulsive therapy (ECT), or shock therapy, rapidly decreases suicidal thinking.[3] Choice of treatment approach is made based on the patient's presenting symptoms and history. In cases where a patient is actively attempting suicide even while on a hospital ward, a fast-acting treatment such as ECT may be first-line.

Ideally, family 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. Aboriginal people may benefit from traditional Aboriginal healing techniques that facilitate a change in thinking, connection with tradition, and emotional expression.[2]:21-22

Psychotherapy, particularly cognitive behavioural therapy, is an important component in the management of suicide risk.[3] According to a 2005 randomized controlled trial by Gregory Brown, Aaron Beck and others, cognitive therapy can reduce repeat suicide attempts by 50%.[4]

Suicide prevention

Main article: Suicide prevention

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

Research on suicide prevention

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.

References

  1. ↑ Rosenthal H (2003). "12 Must-Know Myths About Suicidal Clients". Counselor: the Magazine for Addictions Professionals 4: 22–23.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 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
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 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) 1, doi:10.1176/appi.books.9780890423363.56008, ISBN 9780890423363, OCLC 71824985 |chapter= ignored (help)
  4. ↑ 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.

External links

Journals of suicide intervention research: