FNQ Suicide Prevention Taskforce - Suicide prevention and early intervention

Suicide Prevention and Early Intervention

Intervention - Three Crucial Elements in Helping the Suicidal Person

Activity

The suicidal person must not be left alone. The suicidal person needs to feel assured that something is being done for them. This will relieve some of their stress.

Taking Charge

The helper must be prepared to set him/herself as the support person who will be taking charge at this time. The suicidal person’s life is often at a point of despair so the helper needs to be in control and directive.

Involvement of Others

When the suicidal person realises that others are involved and caring, they may be more inclined to feel that they are being cared for and willing to accept further assistance.

It must be noted that, even with your best effort, prevention of suicide cannot always be assured.

Stages of Suicidal Behaviour

1. People who attempt suicide

There are those who wish to take their lives but do not complete. Their attempt may lead to a further attempt unless their circumstances change.

Whilst little research has been done in this area, and many attempts go unreported and unrecorded, it is difficult to estimate the number of attempted suicides which occur each year.

The fact remains though that attempted suicide is much more common in adolescents than completed suicide.

Researchers differ in their view as to the ratio of attempts compared to completed suicides. Research has identified that for every one completed suicide, there are between 20 and 50 attempts.

2. Suicidal Gestures

A suicidal gesture is when people do not want to die, but try to alert others to get help for them.

The method, timing and place of their attempt will typically be such that they will not die and will be found by others. We must, however, see that these people may have an unintended lethal consequence if help does not arrive.

3. Suicidal Ideation

Many people think of suicide as an option. If it doesn’t go past thoughts of suicide, then we call this suicidal ideation. Suicidal ideation is very common in adolescents at some stage of their development. It is also very common with depression.

4. Completed Suicide

There is a general agreement amongst researchers and practitioners that the real incidence of suicide is higher than actual figures would indicate.

It is generally recognised that this under-counting is due to sociological reasons (eg. shame) and because of the burden-of-proof issue which requires coroners to be very sure before they decide on a verdict of death by suicide.

5. Survivors of Suicide (eg. family and friends)

This term is often commonly confused with one who has not completed suicide. Survivors are those left behind following a death by suicide (eg. a loved one, family member, friend or relative). Much support needs to be given to survivors of suicide within the first 24 hours following the suicide.

Community Strategies help address issues to reduce risk factors

• Strengthening communities, increasing connections within communities. (eg. sports clubs, arts groups, service clubs, church groups, support groups, focused school programs.
• Health promotion
- Increasing community knowledge through booklets, media.
- School based programs
• Strengthening families
- Having a sense of responsibility for the children is a major protective factor
- Improving family communication patterns (Smith J, Mercy J, Conn J. (1988) Marital Status and the risk of Suicide American J Pub Health, 78: 78 – 80.)
- Increasing the number of positive touches children receive in childhood and reducing the number of negative touches (Beautrais A. (2004) Risk and Protective Factors for Suicide for Men in the Middle Years. Cantrbury Suicide Project. NZ.)
- Improve connections and support for elderly (De Leo D, Hickey P, Neulinger K, Cantor K. (1999) Ageing and suicide: A Report to the Commonwealth Department of Health and Aged Care. Australian Institute for Suicide Research and Prevention, Griffith University.)

Individual Strategies

• Reduce time spent unoccupied
• Increase connection with community and family
• Increase sense of responsibility for impact of their suicide on others
• Organise the presence of a significant other adult for a young person, or a spouse or partner
• Increase personal resilience
• Enhance problem solving skills - acknowledge suicide is never the best option
• Strengthen the belief that suicidal thoughts are a risk to life
• Improve physical and mental health
• Strong spiritual or religious faith or a sense of meaning and purpose to life is protective (De Leo D, Hickey P, Neulinger K, Cantor K. (1999) Ageing and suicide: A Report to the Commonwealth Department of Health and Aged Care. Australian Institute for Suicide Research and Prevention, Griffith University.)

Reducing the Means

• Maintain strict regulation of firearm licensing, storage and accessibility of guns.
• Promote change to car exhausts systems that cannot be used to suicide.
• Erect barriers at suicide sites where appropriate.
• Decrease the number of tablets of dangerous medication sold per packet and improve practitioner education on the dangers of certain medications.
• Policies to minimize substance abuse risks.

Target high risk groups

• Youth
• Men aged between 25 – 45
• Families dealing with family court issues
• Recent admission to and/or discharge from mental health unit
• Depression or other mental health issues
• Previous suicide attempts
• Alcohol and drug dependency
• Elderly
• Isolation in rural and remote areas
• Minority groups

Signs of Suicidal Intent

Recent Crisis
Many suicides have been in response to some immediate or specific stress (eg. relationship breakdown and job loss). Each person evaluates stress differently

Suicidal Symptoms
. long illness (eg. terminal cancer)
. sudden mood changes (eg. unusual elated mood)
. depression
. isolation

Suicidal Activity
. making sure bills are paid up
. making out a will
. making arrangements as if they were going on a long trip
. giving away treasured possessions to loved ones

The Hint
Someone who expresses a keener than usual interest in suicide may be hinting that they may attempt suicide.

The Threat
Any kind of threat should be taken seriously. The majority of those who talk about suicide may attempt it.

The Attempt
This is the most clear and dramatic cry for help. A person who has attempted suicide needs immediate help and support.

Warning signs

Warning signs are the clues that alert us that an individual may be contemplating suicide. These clues can be divided into 2 categories.

1. Verbal warning signs
2. Non-verbal warning signs/behaviour

Picking up early warning signs

Those who talk about self harm or suicide are at risk. If they say their death would benefit others, the risk may be higher.

1. Verbal Warning Signs

With these statements the suicidal intention is made clear and occurs in the context of other clues that indicate an individual may be contemplating self-harm or suicide. Statements such as:-

"I've had enough. I don't want to live anymore."
"I've had it. I give up. Life's beaten me."
"Life sux (sucks). I'm getting out."
"You won't have to do anything for me anymore. I won't be around."
"Nobody will kick me around anymore. I won't be here."

2. Non Verbal Warning Signs

Observing behaviour tells about an individual's affective and cognitive (emotional and mental) state. Some non verbal warning signs to be aware of are:

1. Depression. Indicators of depression are, sadness, tearyness, lethargy, loss of focus, poor sleeping and eating. Other indicators may be aggressive outbursts, frenetic and oppositional behaviour.
2. Hopelessness. Feelings of hopelessness and loss of control have been found to be predictors of suicidal intention.(Drake et al, 1986; Fawcett et al, 1987: Beck, 1986)
3. Isolating self and withdrawing from others.
4. Sudden changes in behaviour. (eg. increased risktaking)
5. Preparing for death. Such as preparing wills, giving away possessions and preparing notes.
6. Collecting means to attempt suicide. Such as obtaining a gun or gathering medication.
7. Over-use of alcohol and/or drugs.
8. Previous attempts. One of the most important indicators are attempts that have been previously made by the individual themselves or someone they consider close to them.

Unclear Statements

Some statements give no clear signal of the intent to engage in self destructive behaviour. However, in the context of additional risk factors and other warning signs the hidden intention can be obvious.
Statements may be:

"I'm not the man I used to be."

"I never feel good any more and I bring everybody else down."

"No one cares about me any more, I don’t even care about myself."

"How much does life insurance cost."

In themselves these statements may be harmless, but in conjunction with other risk factors and warning signs, and if checked out directly, we may find these benign statements are lethal in nature.

Men particularly are often ashamed of having suicidal thoughts and feel guilty for having them. They are often reluctant to express the thoughts directly.