Well folks, when I started writing this blog, I made a promise that there would be more to it than posts about Bayley. I have decided to incorporate into my posts a discussion series about various topics which are of a more serious nature and are of importance to me. The first topic in the series (as the title describes) is suicide. Given my line of work, I have a lot to say about the topic of suicide including risk factors for suicide, how to talk to someone who might be considering suicide, and what to do after a suicide occurs.
With medical illnesses, we commonly look for "signs and symptoms". With suicide, we look for "risk factors". Risk factors are things that might put someone at a higher risk for suicide. There are several different risk factors for suicide, including acute risk factors (things happening right this moment), chronic risk factors (things that happened in the past that increase the likelihood of suicide), and general risk factors (this is sort of the miscellaneous category). To help people remember the acute risk factors for suicide, some creative men and women came up with a mnemonic: IS PATH WARM. Here is what it stands for:
IS PATH WARM (Acute risk factors)
Ideation: does the individual have ideations of suicide (put simply: Does the person want to die? Does the person want to kill him/herself?)
S: substance use/ abuse: (Is the person using substances excessively? How about more than usual?)
P: purposelessness (Does the person feel like there is a sense of purpose in life?)
A: anxiety/ insomnia (Is the person having difficulty sleeping? Are they feeling anxious?)
T: Trapped (Does the person feel trapped in life or situation?)
H: hopeless (Does the person have any hope that things will get better?)
W:withdrawn (is the person withdrawing from friends or family?
A: Anger (Is the person experiencing more anger than usual? Maybe becoming irritable?)
R: reckless behavior (Is the person engaging in behaviors that would be considered reckless? Like driving too fast, drinking and driving, self injury, etc?)
M: mood swings (Is the person experiencing sudden or drastic mood swings?)
Next, we can look at chronic risk factors for suicide. These include:
1) previous suicide attempts: the likelihood of attempting suicide again increases with each subsequent suicide attempt. Also, the lethality of suicide attempts increases with each attempt.
2) chronic isolation: the less support someone has in life, the more likely he or she is to attempt suicide
3) past abuse: this includes any kind of past abuse, including physical, sexual, and verbal/ emotional as well as neglect. It also includes rape and domestic violence.
4) significant medical illness: chronic pain increases the risk of suicide as does any terminal illness or medical condition that decreases quality of life.
5) poor coping skills
6) low self esteem
7) diagnosable mental illness: this includes depression, anxiety, PTSD, schizophrenia, or any other mental illness. Most frequently, I come across individuals with depression, anxiety, and PTSD from past trauma.
8) family history of mental illness or suicide: people who have had someone close to them commit suicide are more likely to commit suicide.
Some other general risk factors to consider when thinking about suicide include:
1) age: older individuals and teenagers are most likely to attempt suicide
2) sex: men are 3x more likely to complete suicide than women and women are more likely to attempt suicide than men. Men usually use more lethal means to attempt suicide.
3) Bullying: this is significant for children and adolescents. It would appear that bullying significantly increases the risk of suicide in the younger population (just look at the recent news stories of teen suicides...).
4) Change in sleep patterns (sleeping more than usual or less than usual).
5) change in eating patterns (eating more or less than usual)
6) giving away important possessions
7) going from feeling unusually sad to very happy without any significant life changes occurring (sometimes people feel happy once they have resolved to kill themselves).
It is also important to know that people are at greatest risk for suicide when a deep depression begins to lift because they don't want to go back to that dark place. Also, recent losses (including jobs, houses, family members, pets, or the death of a loved one) increases risk of suicide. Middle aged white males are at a higher risk than any other individuals to complete suicide (especially if they have recently had a job loss).
Now that you know the risk factors for suicide, you are ready to have a discussion about suicide with someone. In our society, there are a few topics that are taboo and frightening to discuss. Suicide is one of those topics. We have a hard time talking about death and we have an even more difficult time asking people if they want to die. We think that we might put ideas in people's minds or push them over the edge. I can assure you, this will never happen. Here are some basic guidelines for talking with someone about suicide.
First, start a conversation. Try to understand the person and build some sense of trust. Ask what's bothering them. Comment on the fact that they seem different lately or they seem down or you want to help. Ask if they are okay. As you talk to the person, look for clues that can help you engage in a discussion about suicide. These can include things like, "I just can't go on like this"; "I'm tired"; "I'm done"; "I don't think I can take it"; "I just want to go to sleep"; "I wish this were over"; "I don't know how long I can do this".
As you talk with the person about the pain he or she is feeling, you can gently ask about suicide. It is important to use the words, "suicide", "death", and "kill yourself". You can say something like, "With everything going on, I am wondering if you've been thinking of killing yourself?" or "Are you considering suicide?" If the person says no, help them brainstorm ways to solve the problems they are facing and continue to listen to them. If the person says yes, ask them what is causing them to want to kill themselves. You can also clarify if they want to kill themselves or if they just want to die. Sometimes people think death would be easier and would like to fall prey to a random act of death but they are not thinking of actively taking their own life.
When people are thinking of suicide, they will feel ambivalent. They will be torn between the desire to live and the desire to die. Talking to them about this ambivalence will help the person move from wanting to die to wanting to live. Most of the time, people don't want to die. They just want the pain to stop. It is important to listen to a person express reasons for wanting to die before moving on. People cannot think about safety planning or reasons for wanting to live until they feel heard in their desires to die. I promise you that having them talk about this will decrease their risk rather than increasing it. People just want to be heard and understood!!!! Don't be afraid to have this discussion.
After you've listened to the reasons for wanting to die, ask the person what reasons they have for wanting to live. They might mention family, pets, morality, hope for the future, or fear of going to hell. I personally do not believe that if you kill yourself, you will go to hell, but I never take this reason away from people. Anything that will keep the person alive is acceptable at this point! We've had people stay alive for their goldfish before!
Next, engage the person in a discussion about lethality. Ask them if they have thought about how they would kill themselves? When? Where? With what? (you know, the 5 W's and H from English class). Ask for as many details as they can give you. Much of the time, the first method a person gives you will not be the intended method. It is important to ask, "Have you thought about how you will kill yourself?" and if the person says, "Yes" and tell you a method, follow up with, "Have you thought of any other ways?" until the person says no. The most lethal ways to commit suicide include firearms, hanging, and jumping. Once you have assessed the lethality of the suicidal ideations, you can begin to safety plan with the person. Begin asking him or her to tell someone close to him or her about it, to stay with you so that you can keep them safe until they can get professional help, ask them to give you the item they are considering using to kill themselves (pills, guns, knives, rope, etc). If you do not think you can keep this person safe, talk to them about the need for treatment. You can call 911 and they will respond quickly. You can also go to your nearest ER. There are also a number of crisis hotlines to call. Here is one: 1-800-273-TALK. It is important to get someone who is considering suicide some professional help. The best time to do that is as soon as you begin to feel lost or overwhelmed by what the person is experiencing. Last, once you have helped the individual, help yourself. Talk to someone about your feelings and take some time to debrief from a stressful situation. Then, congratulate yourself for saving a life.
If someone you know or love does commit suicide, there are two very important things for you to do:
1) DO NOT BLAME YOURSELF.
2) Get help for you and your family members (if applicable). There are many support groups for survivors of suicide as well as professionals of all types willing to help you walk through this difficult, confusing, and trying time. It's worth it to seek out someone who can help you walk through the grief and pain. Even those of us that deal with suicide every day need help when a client completes suicide. Needing help to heal is not shameful.
**I realize that I have changed tense many times in this entry (from person to they, etc.) Please excuse this. I find it tedious to write him/her every time!**
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