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Suicide intervention is a direct effort to prevent a person or persons from attempting to take their own life or lives 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 bathroom, 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 individual 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. A key myth to dispel is that talking to someone about suicide increases the risk of suicide. This is simply not true.: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.: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.: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.: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.: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. 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.: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. 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. There is evidence that long-term lithium therapy reduces suicide in individuals with bipolar disorder or major depressive disorder. Electroconvulsive therapy (ECT), or shock therapy, rapidly decreases suicidal thinking. 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.:21–22
Psychotherapy, particularly cognitive behavioural therapy, is an important component in the management of suicide risk. According to a 2005 randomized controlled trial by Gregory Brown, Aaron Beck and others, cognitive therapy can reduce repeat suicide attempts by 50%.[non-primary source needed]
Various suicide prevention strategies have been suggested by mental-health professionals:
- Promoting mental resilience through optimism and connectedness.
- Education about suicide, including risk factors, warning signs, and the availability of help.
- Increasing the proficiency of health and welfare services in responding to people in need. This includes better training for health professionals and employing crisis-counseling organizations.
- Reducing domestic violence, substance abuse, and divorce are long-term strategies to reduce many mental health problems.
- Reducing access to convenient means of suicide (e.g., toxic substances, handguns, ropes/shoelaces).
- Reducing the quantity of dosages supplied in packages of non-prescription medicines e.g., aspirin.
- Interventions targeted at high-risk groups.
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.
- Rosenthal H (2003). "12 Must-Know Myths About Suicidal Clients". Counselor: the Magazine for Addictions Professionals 4: 22–23.
- 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
- 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
- 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.
- Debski, J., Spadafore, C., Jacob, S., Poole, D. A., & Hixson, M. D. (2007). Suicide intervention: Training, roles, and knowledge of school psychologists. Psychology in the Schools, 44(2), 157-170. doi:10.1002/pits.20213
- Granello, D. (2010). A Suicide Crisis Intervention Model with 25 Practical Strategies for Implementation. Journal of Mental Health Counseling, 32(3), 218-235. Retrieved from EBSCOhost
- Isaac, M.; Elias, B.; Katz, L.Y.; Shay-Lee, B.; Deane, F.P.; Enns, M.W.; Sareen, J. (April 2009). "Gatekeeper Training as a Preventative Intervention for Suicide: A Systematic Review". Canadian Journal of Psychiatry 54 (4): 260–268. PMID 19321032. Retrieved from EBSCOhost
- Linehan, Marsha M.; Goodstein, Judith L.; Nielsen, Stevan L.; Chiles, John A. (April 1983). "Reasons for staying alive when you are thinking of killing yourself: The Reasons for Living Inventory". Journal of Consulting and Clinical Psychology 51 (2): 276–286. doi:10.1037/0022-006X.51.2.276. PMID 6841772.
- McAuliffe, N.; Perry, L. (December 2007). "Making it Safer: A Health Centre's Strategy for Suicide Prevention". Psychiatric Quarterly 78 (4): 295–307. doi:10.1007/s11126-007-9047-x. PMID 17879162.
- Reynolds, S.K.; Lindenboim, N.; Comtois, K.A.; Murray, A.; Linehan, M.M. (February 2006). "Risky Assessments: Participant Suicidality and Distress Associated with Research Assessments in a Treatment Study of Suicidal Behavior". Suicide and Life-Threatening Behavior 36 (1): 19–33. doi:10.1521/suli.2006.36.1.19. PMID 16676622.
- Stamp Out Suicide Promoting suicide awareness and supporting suicide prevention
- Suicide Prevention Help A portal for texts, hot-lines, and other websites designed for the sufferer and care-provider of suicidal crises.
- National Suicide Prevention Lifeline
- National (U.S) Suicide Prevention Hot-lines provides telephone numbers for access to crisis intervention counselors, and brief helping texts for people in crisis situations
- It Gets Better Project The It Gets Better Project was created to show young LGBT people the levels of happiness, potential, and positivity their lives will reach – if they can just get through their teen years. The It Gets Better Project wants to remind teenagers in the LGBT community that they are not alone — and it WILL get better.
- The Trevor Project The Trevor Project is the leading national organization providing crisis intervention and suicide prevention services to lesbian, gay, bisexual, transgender, and questioning youth.
- Suicide Hotlines Directory
Journals of suicide intervention research: