I recently had the good fortune to be invited to the Hunter Institute’s conference on suicide prevention. The guest speaker was international suicide prevention expert, Dr. Morton Silverman. I learnt so many things about suicide which I had previously not known or understood, which I have outlined below. Please understand that this was my personal experience and understanding of the conference and not a mental health professional writing this article.
What is suicidal behaviour?
Suicide is a behaviour which changes over time, varying throughout a person’s life and even between one hour and the next. Every individual has the potential for suicidal thoughts, but not everyone will act on them.
What are some of the reasons for suicidal behaviour?
There are mental illness reasons and social reasons.
Who is at risk of suicidal behaviour?
Potentially everyone is at risk of suicidal behaviour, but there must be a set of circumstances which happen to cause a suicide to complete. People who are impulsive are more at risk, with an estimated 24% of people who die by suicide acting on impulse.
What are the costs of suicide?
Suicide not only costs a human life, but it also has associated financial, social and medical costs. Suicide costs not only the person directly affected, but also their friends, family and loved ones. It affects our medical services and our emergency services, it affects neighbours and work places.
How do we know the numbers of suicide?
The monitoring of suicide and its effects on society have not been recorded for a long period of time, and as such the statistics can not be a true reflection. In 2014 the World Health Organisation released a world suicide report.
What are some ideas for suicide prevention?
Early recognition, intervention and treatment are all good ways to have a positive impact on a potential suicide. Information and education, early assessment and identification and referral to an appropriate service or practitioner can make all the difference. A referral can include an outpatient facility, an inpatient facility, a mental health professional or even after care if a person has attempted but not completed a suicide.
Suicide does not happen in a vacuum. It takes a community to prevent suicide.
We can encourage people to seek help. Teach people life skills to cope with issues and concerns which may appear overwhelming, but with perspective may become achievable. Encourage people to be a friend, to listen to what is going on around them.
In targeting people who are potentially at risk of death by suicide, you can target strategies which change themselves and we can target strategies which change their environment. To be most effective, we need to target both strategies. HOWEVER, it has to be the right time for the person to change. People have to want change before it can happen, otherwise it won’t work.
What are we trying to prevent?
We are trying to prevent the precursors of suicide, followed by the ideation (the idea) of suicide as the answer, the motives for suicide and the suicide instant where the means to carry out death by suicide are available. For example, pills are readily available in the home. The risk factors for every individual will vary according to life experiences, environment, stage of life, suicide ideation, emotional state and mental health. There is no one answer which will help everyone.
We also need to be looking at a lifespan model. We need to consider not only educating young people, but also at the risks faced by young adults, the middle aged and the elderly, all of whom through changing life circumstances may be at risk of suicidal tendencies. A program which needs to be developed needs to embrace all of society in the short, intermediate and long term.
What is an injury control model?
How can you prevent someone from hurting themselves? The issue is not always solely about the individual, sometimes it is also what is happening around them. If we can change, or help a person to change, what is around them, we can reduce the risk of self harm.
Common risk prevention can reduce suicide overall in the general population. Teaching people to ask for help, reinforcing the importance of a human connection to everyone, checking back or checking up on people who you have identified as troubled, educating parents on behaviour which may indicate self harm tendencies and supporting lifeline organisations can all contribute to an injury control model.
What is surveillance and how can we measure it?
If an individual has survived a suicide attempt, they can sometimes be at risk of repeating the behaviour. Human intervention can help to reduce the risk. Checking up on people using a phone call or a postcard once every quarter throughout the year has had significant improvement in the prevention of suicide in the United States. It can be difficult to determine who is at immediate risk and whose risk is not as urgent, but this is something we need to monitor through surveillance and need to improve our skills to keep more people safe.
What structures are in place for suicide prevention?
As a nation we are not coordinated and collaborative. Our local, state and federal governments are not coordinated in a concentrated and focussed effort to reduce death by suicide. We need to work together to achieve great things. Ultimately we must de-stigmatise suicide. As a nation, if we cannot talk about suicide we cannot act to our fullest potential and help individuals.
We need to understand the problem and develop a plan which can help all sections of our society. Remember to send a positive message, its always better than a negative message. And always remember, a smile and a how are you can put you in the right place, at the right time to save a life.