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Suicide intervention is a direct effort to prevent a person or persons from attemptingsuicide.
Asking direct questions is a recommended first step in intervention.[1][2] These questions may include asking about whether a person is having thoughts of suicide, if they have thought about how they would do it, if they have access to the means to carry out their plan, and if they have a timeframe in mind. Asking these questions builds connection, a key protective factor in preventing suicide.[3] These questions also enable all parties to establish a better understanding of risk. Research shows that asking direct questions about suicide does not increase suicidal ideation, and may decrease it.[4]
Most countries have some form ofmental health legislation which allows people expressing suicidal thoughts or intent to be detainedinvoluntarily forpsychiatric treatment when their judgment is deemed to be impaired. These laws may grant thecourts,police, or amedical doctor the power to order an individual to be apprehended to hospital for treatment. This is sometimes referred to as beingcommitted. The review of ongoinginvoluntary treatment may be conducted by the hospital, the courts, or aquasi-judicial body, depending on the jurisdiction. Legislation normally requires police or court authorities to bring the individual to a hospital for treatment as soon as possible, and not to hold them in locations such as apolice station.
Mental health professionals and some other health professionals receive training inassessment and treatment of suicidality. Suicide hotlines are widely available for people seeking help. However, some people may be reluctant to discuss their suicidal thoughts, due tostigma, previous negative experiences, fear of detainment, or other reasons.
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A number of myths aboutsuicide exist, for instance that it is usually unpredictable. In 75–80% of cases, the suicidal person has given some sort of warning sign.[5]
Another myth states that talking to someone about suicide increases the risk of suicide. This is false.[6]: 8 Individuals expressing suicidal thoughts should be encouraged to seek mental health treatment. Friends and family can providesupportive listening,empathy, and encouragement to develop a safety plan. Serious warning signs of imminent suicidal risk include an expressed intent to commit suicide and a specific plan with access to lethal means.[6]: 30 If a person expresses these warning signs,emergency services should be contacted immediately.
Another myth is if someone is speaking of committing suicide, that they are merely seeking attention. It is important that the person feel they are taken seriously.
Safety plans can include sources of support,self-soothing activities,reasons for living (such as commitment to family or pets), safe people to call and safe places to go.[6]: 38–39 When a person is feeling acutely distressed and overwhelmed by suicidal thoughts, it can be helpful to refer back to the safety plan or call asuicide helpline if the safety plan can not be done at that moment.
Comprehensive approaches to suicidality include stabilization and safety, assessment ofrisk factors, and ongoing management andproblem-solving around minimizingrisk factors and bolsteringprotective factors.[6]: 4 During the acute phase, admission to apsychiatric ward orinvoluntary commitment may be used in an attempt to ensure client safety, but the least restrictive means possible should be used.[7] Treatment focuses on reducingsuffering and enhancingcoping skills, and involves treatment of any underlying illness.
DSM-5 axis I disorders, particularlymajor depressive disorder, and axis II disorders, particularlyborderline personality disorder, increase the risk ofsuicide.[6]: 45 Individuals withco-occurring mental illness and substance use disorders are at increased risk compared to individuals with just one of the two disorders.[7] Whileantidepressants may not directly decrease suicide risk in adults, they are in many cases effective at treatingmajor depressive disorder, and as such are recommended for patients with depression.[7] There is evidence that long-termlithium therapy reduces suicide in individuals withbipolar disorder ormajor depressive disorder.[7]Electroconvulsive therapy (ECT), or shock therapy, rapidly decreases suicidal thinking.[7] The choice of treatment approach is based on the patient's presenting symptoms and history. In cases where a patient is actively attempting suicide even while in a hospital ward, a fast-acting treatment such asECT may befirst-line.
Ideally, families are involved in the ongoing support of the suicidal individual, and they can help to strengthenprotective factors and problem-solve around risk factors. Both families and the suicidal person should be supported by health care providers to cope with the societal stigma surrounding mental illness and suicide.
Attention should also be given to the suicidal person'scultural background, as this can aid in understandingprotective factors and problem-solving approaches.Risk factors may also arise related to membership in an oppressed minority group. For instance,Aboriginal people may benefit from traditional Aboriginal healing techniques that facilitate a change in thinking, connection with tradition, and emotional expression.[6]: 21–22
Psychotherapy, particularlycognitive behavioural therapy, is an important component in the management of suicide risk.[7] According to a 2005randomized controlled trial by Gregory Brown,Aaron Beck and others,cognitive therapy can reduce repeat suicide attempts by 50%.[8][non-primary source needed]
Varioussuicide prevention strategies have been suggested by mental-health professionals:
Research into suicide is published across a wide spectrum of journals dedicated to thebiological,economic,psychological,medical, andsocial sciences. In addition to those, a few journals are exclusively devoted to the study of suicide (suicidology), most notably,Crisis,Suicide and Life-Threatening Behavior, and theArchives of Suicide Research.[citation needed]
