Suicide, What to Know and What to do. Q and A
A brief introduction into understanding mental health risk factors and its possible prevention.
Any introductory comments?
This is just a brief discussion to get one thinking about three basic things the mental health problems and risk factors that are involved with suicide in a general way and to stress the importance of adequate treatment based on an understanding of these factors, and the equal importance of exploration of thinking about death and suicide.
What problems or disturbances are most associated with suicide ideas, intent and plan?
Disturbances in mood, thinking, anxiety, substance use, impulse control, and sensorium meaning problems with level of awareness, alertness and orientation , and certain medical-neurological problems and medications, are the usual risk factors for suicide. They need to be evaluated, immediately and on a regular basis if suicidal thinking is suspected. The more of these individual factors that are present at the same time and the more intense they are , the more likely a suicide.
What are the specifics about these problems that increase suicide risk?
The more there the following specifics are present the more likely that suicidal ideas, intent or planning will occur:
1) hopelessness associated with a depressed mood,
2) disturbed illogical, bizarre, disconnected thinking,
3) anxiety with panic approaching terror,
4) inability to control impulses without thinking about the consequences ,
5) factors interfering with awareness, alertness, orientation, like use of substances like alcohol, drugs, many medications prescribed and OTC,
6) medical and especially neurological illnesses like fragile diabetes, dementia, a seizure disorder
Will one get more suicidal by asking about these things?
No , it is less likely to happen. Ask about these factors over and over. The asking is not only diagnostic but therapeutic.
What should be specifically asked?
Representative questions would be as follows or any that would cover these six areas of concern and risk:
1) How depressed are you? Are you thinking about hurting yourself or taking your own life, that is committing suicide?
2) Is or has your thinking been mixed up, confused, not making sense, too slow or too fast, thoughts getting to loud like voices, beginning to believe people are referring to you, talking about you, out to get you ?
3) Do you find yourself doing things without thinking about the consequences?
4) Have you had periods of confusion , memory lapses, changes in alertness and awareness , like dream like states, forgetting or not sure where you are, what you are doing, not sure of who you are, feeling like another person?
5) Have you been using any drugs, alcohol, mind/mood altering substances or energy or health foods that may affect your thinking , concentration, alertness mood, sleep or appetite?
6) Do you have any medical illness or neurological problem, or are you taking any medicines, OTC or prescribed?
What are the specific disorders and problems that might be diagnosed and be present?
The major disorders that need to be screened for are any depression, thinking disorders like Schizophrenia, severe anxiety states with panic and terror, drug and alcohol use, medical, neurological disorders and any medications, and anything that would increase impulsivity, decrease concentration, change level of awareness and alertness, and lower frustration tolerance, including external stresses, especially perceived losses, in the family, at home, at work at school, in relationships.
Can you tell me more about suicide ideas in depression?
Every mood disordered person no matter how mild , needs to be screened for suicide. Every depression as it gets worse makes one feel more and more worthless, negative and thoughts of being better off dead, enter one’s mind. This is an expected symptom of severe depression, and lower grade depression that are chronic, that is they have lasted a long time.
What can be done to help prevent this from happening?
Many suicides and attempts could be prevented if the person suffering from depression knew there was help or more help for them, and if those who knew them openly discussed the thinking process involved in suicide often and in detail.
Are there exceptions to this rule?
There are many exceptions, especially those so hopeless, and or psychotic, they tell no one, and those who complete suicide impulsively out of extreme excruciating despair , confusion, panic and terror, especially those with rapidly cycling mixed bipolar, with or without psychotic symptoms.
Why is comprehensive, adequate and complete evaluation and treatment of a depression so important?
Besides helping the depression it is the best hope of preventing suicide. This is the most important reason to treat any mood disorder especially bipolar disorder adequately, and all of its symptoms, and I mean all symptoms, and to adequately and completely treat all , and again I mean all of its associated disorders.
Are there screening tools that can help and are they adequate?
Though there are some excellent screening tools, they are no substitute for adequate treatment and adequate exploration with the mood disordered person, and their family, and those who know them, their thoughts about dying and suicide. These two things offer best hope for preventing suicide, adequate exploration of ideas of death and suicide, and adequate treatment.
Is there a usual progression of suicide ideas?
There is a progression from, feeling better off dead, to thinking maybe one should die, to having actually suicide ideas, that is one will do something to bring about one death. Then there is more thinking and thought about, actually contemplating how one may do it, what means, and actual suicide plan. Then there is more thinking and worsening of the depression until one develops suicide intent, the actual motivation, the wish to carry out the plan.
What usually happens next?
Then there must be means, what you need to do it, and opportunity to do it, and actually preparing first in one’s mind, and then in reality to carry ,or to be ready to carry out the plan. In most cases all of this thinking occurs, and may be more complex than is portrayed here, because in a prolong depression, there is much over thinking to the point of obsession, and doubt along the way.
Is there a best point to intervene to help the person?
Anywhere along this way the successful suicide could have been prevented if someone intervened with, support, education, therapy, and medication to offer symptom relief and hope. In many suicides the person including a child or teen has been thinking about it for weeks, months if not years, often giving many hints along the way, for people to pick up and offer help.
Are there some general guidelines about suicide prevention?
Two basic things must be done well and completely as possible use as much time as is needed 1. Adequate treatment, and 2. Explore ideas about living, dying and suicide.
Can you be more specific?
The more time one spends in being sure treatment is adequate and complete based on the right diagnosis and in the exploration and understanding in microscopic detail and with surgical precision the persons thinking and motivations about death, dying, depression, hopelessness, specifics of suicide ideas, intent and plans the more likely suicide can be prevented.
Can you summarize these important concepts, starting with exploration of the persons thinking about death and suicide?
To summarize many suicides and suicide attempts can be prevented by adequate historical exploration often and in detail, of the victims thoughts as they progress, from thoughts about death and dying, to suicide thoughts, suicide intent, and suicide plan, with means and opportunity, all must be present at a minimum for the suicide to be successful. Other factors and some may beyond our control may also be operative, also need exploration. This is too big, complex, important and serious job for the professionals alone, but also friends, family, anyone who knows the individual, and suspects suicide must question and explore this topic. This can be life saving. We must be like homicide detectives, trying to prevent another homicide, but in reverse, actually suicide detectives trying to prevent suicide, by meticulous, detailed, investigating and exploration, questioning all involved, not just the potential victim. Questioning thoughts about death, dying, and suicide ideation, intent, and plan, and the means, planning, and opportunity , to hopefully intervene in time, and halting the progression, from feeling, to thought , to intent, to action.
What the importance of treatment?
The second and equally important thrust must be adequate treatment, and here again the professional should not be alone, but needs the help of the individual, their family, anyone who knows them and can be helpful, like teachers, co workers, neighbors, friends, to assess the adequacy of treatment response, in its totality, not just distress, but how this distress shows itself, in impairment at home, school, work, socially and in leisure time. Adequate treatment should offer the hope, and the profession needs and often to tell the mood disordered person there is hope, for more and more symptom relief, and hope for preventing relapses, and re occurrences, and hope of treating painful and impairing symptoms of associated disorders, and the professional will keep trying over and over again, and not give up until there adequate treatment is in place, and it is working, and will continue to work. All this needs to be conveyed over and over again to the mood disordered person and their support system, this information sharing and the hope it instills is as necessary and essential , as is the adequate treatment if a suicide is to be prevented.