SUICIDE PREVENTION

SUICIDES ARE PREVENTABLE AND EVERY SUICIDAL ATTEMPT SHOULD BE TREATED BY A TRAINED MENTAL HEALTH PROFESSIONAL.
According to the latest medical research, only 4 things help in reducing the number of suicides and preventing suicides. If one has suicidal thoughts they should:

  • Visit to Hospital - casualty or emergency department
  • Psychiatric Consultation
  • Diagnozing Depression
  • Taking Happy Pills or Anti-Depressants

WHY HELPLINES DON"T WORK?

Either the person calling these helplines is suffering from mild depression and is actually at no risk of ending the Life in Suicide, and crank calls.The person taking the call maynot have the right knowledge or training.
A person who is actually at risk wants not just to talk to someone but also need to be in a safer environment under medical supervision and this place is a hospital manned by Psychiatrists - 24/7. Only then the person can be effectively treated.
It is necessary to educate and spread awareness regarding some truths behind this disturbing phenomenon called suicide.
Suicidal thoughts/attempts are troublesome and extremely distressing to the person suffering from it, especially when they are accompanied by depressive disorder and other psychiatric illnesses. This situation demands immediate evaluation. These thoughts/attempts indicate serious underlying illness.
Research has shown that 90% of people who ended their lives suffered from depressive and other psychiatric illnesses.
About 1.5 lakh people die by suicide in India and around 40,000 in the USA every year according to official and WHO statistics. Unofficially many more go unreported. These numbers are about direct and active suicides. Indirect and passive suicides maybe double this number or more.
Active suicides mean - losing the wish to live and attempting by direct means like consuming poison, pesticides, hanging, self-immolation, accidents etc.
Passive suicides mean losing the wish to live and not taking life saving medication for common medical illnesses like heart disease, diabetes, cancer, etc and dying at home or in the hospitals with medical complications. This is seen more commonly in elderly population and people with chronic diseases.
Each and every completed suicide affects atleast 6 people around them for a lifetime.

Why does one have Suicidal Thoughts/attempts?

There is no single cause or factor causing suicide.
Remember if the cause of suicide is exam failure then millions of students should be committing suicide every year. If it is crop loss, then millions of farmers (and all the farmers in the same village) should be committing suicide every year. If it is financial problems, then everyone including the rich and famous people on earth should be committing suicide every year. If it is relationship problems, then every married and unmarried couples should be committing suicide every year.
As per the latest research, one has the suicidal thoughts/attempt if one has less neurotransmitters or neurochemicals in particular part of the brain which is secondary to depressive and other psychiatric illnesses. One has less of these chemicals because of several factors combined together over a period of time.
The levels of the neurotransmitters can be affected by a number of factors like heredity, personality traits, medical illnesses, medications, alcohol and other drugs, unhealthy eating habits and stressful life events.

Who are more likely to think about harming self or suicide?

There is no single factor to identify suicidal behavior and each persons situation is unique. Suicide is a complex phenomenon. However, research has revealed a number of common risk factors in people, which may increase the likelihood of someone thinking about harming self or suicide. They are:
People suffering from depressive disease, bipolar disorders and other psychiatric disorders are more likely to have suicidal thoughts
Individual factors: people experiencing physical health problems and stressful life events such as bereavement or relationship breakdown.
Family-related factors: people with family breakdown, family conflicts, child custody issues, abuse or family history of suicide.
Social factors: people with socio-economic disadvantage, financial stress, job stress and loss, unemployment, educational stress, social and geographical isolation.
Environmental factors: people with easy access to methods of suicide and those who are exposed to suicide methods via the media or peers.
The equation that best describes the factors leading to this complex suicidal phenomenon is:
1. Triggering or precipitating factor/event like, marriage, breakup, divorce, loss of job, failure in an exam, deadlines for debt payments, crop failure, media reporting.
PLUS
2. Current history of persistent and ongoing stressors like in stressful job, educational difficulties, difficult financial situations, difficult marriage, relationship issues, current medical illnesses.
PLUS
3. Genetic Vulnerability (i.e. history of suicide/depressive illness in the family).
All the above factors combined bring about biochemical changes in the brain nerves and abnormalities in the levels of certain chemicals in the brain lead to changes in the thoughts, mood and behavior leading to depressive and other psychiatric diseases.

Suicidal Attack

A thought to kill oneself due to depressive illness or other psychiatric illness followed by distress, sadness, depressed mood, self harming behavior and wish to die triggered or precipitated by a distressing event in some people is said to be a suicide attack.
Suicide attack is equivalent to heart attack(angina/chest pain) in a patient with heart disease.
Depressive Illness => Heart disease
Suicidal thoughts => Chest Pain
Suicidal plan/intent => Angina/Heart attack
Suicidal Attempt => Myocardial Infaction
Completed Suicide => Cardiac Arrest and Death
Hence it can be confidently assumed that act of Suicide is the end pathway for severe depressive illness like cardiac Death is to heart disease. Hence it would be appropriate to call it a suicidal attack or having a suicide rather than committing suicide. This is similar to heart disease: one does not commit heart attack but has a heart attack.
When the depressive or any psychiatric illness becomes severe, then the thoughts of suicide take three pathways.
Suicide attack precedes 3 common pathways of thought process:

  • Fear of embarrassment or social abandonment.
  • Thoughts of helplessness or 'no solution' to the current problem.
  • Thoughts of hopelessness or 'no further purpose is served by living'.
  • Pathway of hopelessness :When these diseases and factors are persistant and severe, then the person suffers and has thoughts about Hopelessness- pathway of suicide - 'pessimistic views, no purpose in life, philosophical. Some neurochemicals are slowly and gradually worsening in their levels.
  • Pathway of helplessness: During depressive illness and other psychiatric illness, When there is another triggering factor( like a deadline to pay debts, exam results day, qualrrel, separation etc) then there is second worsening of the neurochemical imbalance leading the person to go on the helplessness ( no solution to that single triggering problem) pathway.
  • Pathway of social embarrassment: when a person (of societal standing in the neighbourhood, locality, city, state or nation in their respective fields) suffers from depressive or psychiatric illness for sometime now and on top of this they have encountered an incident or a triggering factor (there is second worsening of the neurochemical imbalance) which the person perceives will affect their societal standing, then they have suicidal thoughts of social embarrassment pathway.

Suicidal process or pathway involves wish to die, self harming, suicidal ideas, thoughts, plans, intent, suicidal attempt and finally completed suicide. This process is extremely distressing and painful to the person suffering from it. This process takes hours, days, weeks, months or sometimes years to progress. Suicidal process can be prevented at any stage and any time and hence the emphasis on prevention.

Common Misconceptions

1."People who talk about suicide won't really do it."
False
Its like telling others that they have chest pain when one has an heart attack. Its a cry for help and fear of dying. Almost everyone who commits or attempts suicide has given some clue or warning. Do not ignore suicide threats. Statements like "you'll be sorry when I'm dead," "I can't see any way out," -- no matter how casually or jokingly said may indicate serious suicidal feelings.
2. "Anyone who tries to kill him/herself must be crazy."
False
Most suicidal people are not psychotic or insane. They have severe emotional distress and pain and are upset, grief-stricken, depressed or despairing.
3. "If a person is determined to kill him/herself, nothing is going to stop him/her."
False
Even the most severely depressed person has mixed feelings about death. The person does not want to die but the illness makes him have the thoughts about suicide. They are wavering until the very last moment between wanting to live and wishing to die. Its like telling others that they have chest pain when one has an heart attack. Its a cry for help and fear of dying. Most suicidal people do not want death; they want the pain to stop. The impulse to end it all, however overpowering, does not last forever.
4. "People who commit suicide are people who were unwilling to seek help."
False
Studies of suicide victims have shown that more than 80% had sought medical help within six month before their deaths with either headaches or sleep problems being the common complaints.
5. "Talking about suicide may give someone the idea."
False
Its like talking about cancer one gets cancer or talking about heart disease one gets heart attack. You don't give a suicidal person morbid ideas by talking about suicide. The opposite is true --bringing up the subject of suicide and discussing it openly is one of the most helpful things you can do.

WARNING SIGNS OF SUICIDE

What a person would say or how would he/she behave

  • Talking, reading, or writing about suicide or death.
  • Talking about feeling worthless or helpless.
  • Saying things like, Im going to kill myself, I wish I were dead, or I shouldnt have been born.
  • Visiting or calling people to say goodbye.
  • Preoccupation with death.
  • Suddenly happier, calmer.
  • Loss of interest in things one cares about
  • Making arrangements; setting one's affairs in order.
  • Giving things away.
  • Giving things away or returning borrowed items.
  • Organizing or cleaning bedroom for the last time.
  • Self-destructive behavior like self-cutting, or other risk-taking behaviors.
  • Obsessed with death, violence and guns or knives.
  • Previous suicidal thoughts or suicide attempts.

He or She may also say things like:

  • I shouldn't be here.
  • I wish I were dead.
  • I'm going to kill myself.
  • I wish I could disappear forever.
  • If a person did this or that..would he/she die?
  • The voices tell me to kill myself.
  • Maybe if I died, people would love me more.
  • I want to see what it feels like to die.

WHAT TO DO - HOW CAN YOU HELP

Aim is to get assessed by a Psychiatrist. Whatever one does, convince the person to take to a trained psychiatrist.
People with depressive illnesses or suicidal thoughts delay or avoid seeking help because of stigma, family or social nuances and lots of misconceptions about their illness. As a friend or a family member, your willingness to talk about depressive disease and suicide with the sufferer, can be the first step in getting help and preventing suicide.

If you notice the warning signs of suicide

Start a dialogue by talking about this illness and suicidal thoughts in a nonjudgmental way. Suicidal thoughts are common in people with depressive illness and your talk can be the push a person needs to get help. After the initial dialogue, also ask:
Do you ever feel so badly that you have thoughts of suicide?
Do you have a plan?
Do you know when you would do it (today, next week)?"
Do you have access to what you would use?
If the person hesitates or replies yes to any of the above questions, then he is in great danger. Immediately take him to a Psychiatrist, mental health worker or even Accident and Emergency department of your local hospital. A suicidal person should see a doctor or psychiatrist immediately. Calling help lines, suicide prevention organizations in your city/town are other options.
Always take thoughts of or plans for suicide seriously.
Do not keep a thought or plan for suicide a secret. Immediately inform the patient's family members and friends about it. Do not try to talk him out of the suicidal thoughts. Remember that suicidal thoughts are due to neurochemical changes and trying to talk him out will not change these chemicals immediately. Just like you cannot talk a person out from having a heart attack, one cannot talk a person out of the suicidal thoughts. Take the person to a psychiatrist/doctor immediately. Dont worry about endangering a friendship/relationship if you truly feel a life is in danger. It's better to regret something you did, than something you didn't do to help a friend/family member.
Don't try to minimize problems or shame a person into changing her mind. Your opinion of a person's situation is irrelevant. Trying to convince a person it's not that bad, or that she has everything to live for will only increase her feelings of guilt and hopelessness. Reassure her help is available, that depressive illness is treatable, and that suicidal thoughts are temporary.
If you think that the person isn't in immediate danger, acknowledge the distress as legitimate and offer to work together to get help. Make sure you follow through. This is one instance where you must be tenacious in your follow-up. Help find a doctor or a psychiatrist, participate in making the first phone call, or go along to the first appointment. If you're in a position to help, don't assume that your persistence is unwanted or intrusive. Risking your feelings to help save a life is a risk worth taking.
Educate yourself about depressive illnesses and suicide prevention. Assure the patient that he/she will get better, that suicidal thoughts are only temporary, and that there are people who can help him/her. Know that early intervention is the key to successful treatment for people who suffer from depressive illnesses. Understand that treatment should be a team-approach including a psychotherapist/psychiatrist, parents, relatives, caregivers, friends, neighbors and other significant people in the patient's life.

HOW DO YOU TREAT A PERSON WITH SUICIDAL THOUGHTS

The treatment for suicidal thoughts/attempt might range from counseling to hospital admission.
If the person is suicidal, thoughts are believed to be of a dangerous nature, immediate admission to the hospital may be necessary. Hospitalization is done with 24hour 1:1 nursing observations in an intensive care unit for at least 3-4days.
Every person who has attempted Suicide and brought to the hospital must be evaluated by a qualified psychiatrist according to international guidelines and treatment protocols.
If someone is admitted to the hospital because of suicidal attempt, he or she undergoes extensive evaluation by a psychiatrist and is often started on medication and scheduled for necessary psychotherapy or counseling.
From the doctor's perspective, suicidal thoughts/attempt are to be taken seriously and evaluated thoroughly. Predicting suicide is difficult.

Medication

Various Antidepressants suited for the individual as well as other necessary medications are the treatments of choice. People start to feel better soon and will regain their normal mood and behavior and would be able to withstand any situations or circumstances in their lives. Their coping abilities improves along with their confidence as symptoms of the underlying illness improve.

Psychotherapy or counseling

  • Cognitive Therapy teaches positive thinking, coping skills and problem solving techniques.
  • Interpersonal Therapy might teach how to make and maintain friends and relationships.
  • Group Therapy with others of similar age that have a depressive illness.
  • Family Therapy works with the entire family and discusses various family dynamics.
  • Supportive Therapy - helps to resolve stressful issues and distress.Provision of Various supports at home/college/school/work place.
  • Various forms of alternative therapy including meditation, relaxation therapy, Yoga and biofeedback.

Follow-up

  • Persons who actually attempt suicide need close psychiatric follow-up and psychotherapy/counseling.
  • This may seem obvious, but many suicidal people do not get good follow-up treatment and often end up thinking of suicide (or even attempting it) again.
  • Follow-up usually consists of psychotherapy and medication for depressive illness.

Other Useful Resources for Suicide and suicidal thoughts
Web sites

www.afsp.org
www.save.org
www.cdc.gov
www.sprc.org
www.iasp.info

Definition

Center for Disease Control and Prevention: Suicide: Additional resources http://www.cdc.gov/ViolencePrevention/suicide/resources.html

Prevention

Suicide.org - Suicide Prevention, Awareness, and Support
Befrienders Worldwide: Find a suicide helpline http://www.befrienders.org/support/helplines.asp

Risk factors
National Alliance on Mental Illness: Suicide in youth http://www.nami.org/Template.cfm?Section=By_Illness&Template=/Tag...

Symptoms
American Association of Suicidology: Suicide warning signs http://www.suicidology.org/web/guest/stats-and-tools/warning-sign...

Treatments and drugs
National Suicide Prevention Lifeline: Get help http://www.suicidepreventionlifeline.org/GetHelp/Default.aspx

Hopeline: Get help now http://hopeline.com/gethelpnow.html