Suicide Prevention

02 August, 2020
According to recent estimates from the World Health Organization, approximately a million people around the world commit suicide every year, which makes it the leading cause of violent death. When faced with those numbers, it's important to remember that prevention is possible if we identify and control the risk factors.
 

Can you predict suicide? Is there a way to stop it from happening? Although this behavior, like all human behavior, is complex and depends on a lot of variables, some indicators can help with detection and suicide prevention.

There are some higher-risk groups and some risk factors, or possible triggers, of future suicidal behavior. Among those, we have mental illness, especially depression and schizophrenia. Personality disorders, especially borderline personality disorder and antisocial personality disorder, as well as chronic and debilitating physical illnesses, cause biological and/or psychological vulnerability.

Suicide has always been a concern, which is why, in Spain, nearly every sector of the National Health System has developed different action protocols. In fact, the WHO calculates that a million people commit suicide every year. It’s one of the three main causes of death in adolescents and young adults, and the 10th in the general population. In the past 50 years, that figure has increased by 60%.

“The bravest thing I ever did was continuing my life when I wanted to die.”

-Juliette Lewis-

A sad person sitting on the floor.
 

How can we approach suicide prevention?

There are two main approaches to suicide prevention:

1) Strategies for high-risk populations, such as psychiatric cases with a history of suicidal behavior, emotional disorders, and alcoholism. In those cases, experts propose the following:

  • Optimize the treatment for their mental disorders, and ensure the patient’s personal integrity.
  • Improve the continuity of care and social-healthcare for high-risk patients after they leave the psychiatric hospital. Uninterrupted therapy is especially important.
  • Improve the psychiatric training of primary care doctors in order to facilitate early detection and effective treatment for patients affected by mental disorders that often lead to suicidal behavior.

2) Strategies geared towards the general population, such as:

  • Educate the public about the prevalence, risk factors, and behavioral changes associated with suicidal behavior.
  • Recommendations for the media in order to prevent the imitation effect, especially among young people.
  • Mental health education in community centers, schools, and workplaces, among others, with a focus on improving quality of life and good health and providing strategies to cope with stress and improve social skills.
  • Rethinking the availability of drugs that people use to commit suicide and security measures in places where people often commit suicide.
  • Taking steps to prevent alcohol and drug abuse.

“Sometimes even to live is an act of courage.”

-Lucius Annaeus Seneca-

Incorrect beliefs

 

Next, we’re going to look at the incorrect beliefs that many people have about suicide.

Incorrect belief

Scientific belief

People who want to kill themselves don’t talk about it. Nine out of every ten people who commit suicide clearly state their intentions and the tenth person insinuates what they’re going to do.
The ones who do talk about it, don’t actually do it. Every individual who commits suicide expressed it beforehand, either with words, threats, gestures, or behavioral changes.
People who attempt suicide don’t actually want to die, they’re just doing it for show. While it’s true that not everyone who commits suicide wants to die, it’s a mistake to say that they’re doing it for attention. They do it because their mechanisms of adaptation and survival have failed, and they feel that taking their own life is the only option.
If they’d really wanted to kill themselves, they would’ve thrown themselves in front of a train. Every person who’s at risk for suicide is in an ambivalent situation. That is, they want to die, but they also want to live. The method they choose is not an indicator of how strong their desires are to die. Suggesting a more lethal method, in fact, is a crime (suicide assistance) penalized by the current penal code.
An individual who recovers from a suicidal crisis won’t be in danger of it happening again. Between 1 and 2% of people who attempt suicide kill themselves within the first year after the attempt. Between 10 and 20% will end up doing it successfully at some point in their lives. A suicidal crisis lasts hours, days, or weeks (rarely). That’s why recognizing it is crucial for prevention.
Everyone who commits suicide is depressed. While anyone with depression is at risk for suicide, not everyone who commits suicide has depression. They might suffer from schizophrenia, alcoholism, personality disorders, etc.
Every individual who commits suicide has a mental illness. People with mental illness commit suicide more frequently than the general population, but it’s not a requirement. What isn’t up for discussion is that everyone who’s at risk is suffering in some way.
Suicide is an inherited trait. There’s no evidence that suicide is an inherited trait, though there are examples of several people in the same family taking their own lives. In those cases, the trait that gets passed down is the predisposition to suffer from a particular mental illness in which suicide is the main symptom, such as emotional disorders and schizophrenia.
You can’t prevent suicide because it’s an impulsive act Anyone who commits suicide or attempts to commit suicide displays a series of symptoms that experts define as “pre-suicide syndrome.” It consists of the construction (of the intellect and feelings), inhibited aggression toward the self, and suicidal fantasies. If these symptoms are detected in time, you can prevent suicide.
Talking about suicide with someone who’s at risk can trigger them to carry out their plans. Research shows that the opposite is true. If you talk about suicide with someone at risk, instead of inciting, provoking, or introducing the idea of suicide, you’ll actually reduce the possibility that they’ll do it. Talking about it might be the only opportunity that the person has to analyze their own self-destructive plans.
Trying to help a person in a suicidal crisis without the proper training, armed with only your common sense, is harmful and takes time away from an appropriate approach. If common sense tells you to be an attentive and patient listener who has a genuine interest in helping the person in crisis to find alternatives to suicide, you’ve already started suicide prevention.
Only psychiatrists can take measures to prevent suicide. While it’s true that psychiatrists are experienced professionals trained to detect and manage suicide risk, they aren’t the only ones who can prevent it. Anyone who is interested in helping people in this situation can also be a valuable part of suicide prevention.
 
A sad and worried man.

Where to get help

If an individual starts to have suicidal thoughts, many organizations in Spain offer resources and help. Here are some:

  • CEIFEM. Spanish Center of Information and Training about Mental Illness.
  • Health centers. Primary Care and Community Mental Health Teams. Website: http://www.sas.junta-andalucia.es/principal/default.asp 36| Guide for suicide prevention for people with suicidal thoughts and their families.
  • Member associations of FEAFES. Spanish Confederation of Groups of Families and Individuals with Mental Illness.
  • Salud Responde.
  • Teléfono de la Esperanza (Telephone of Hope). A 24-hour phone service that offers help for overcoming emotional problems.
  • Health professionals.

In conclusion, although these resources are valuable, they don’t do any good if the at-risk person never uses them. That’s where society has an important responsibility to help people who are suffering find the support that they need.

 
  • Mingote, Adán, José Carlos, et al. Suicidio: asistencia clínica, Ediciones Díaz de Santos, 2004.
  • Pérez, Barrero, Sergio, and Plaza, Jesús Guerra. Prevención del suicidio: consideraciones para la sociedad y técnicas para emergencias, Servicio Editorial de la Universidad del País Vasco, 2016.