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Statistics about suicide are alarming, and yet they remain largely unknown. In the world today, more people die by suicide than from all homicides and wars combined. Seventy-one percent of psychotherapists report having at least one client who has attempted suicide, while 28 percent report having had at least one client die by suicide. For those of us in the mental health professions, suicide is a deeply disturbing occupational hazard and the most common psychiatric emergency we face. In an uncertain economic climate and with countless lives affected by the tragedy of suicide, now is the time for us to take the initiative to better understand, assess, and treat suicidal individuals.
A recent report released by the CDC showed that in 2008, 13.4 percent of people who committed suicide had experienced job and financial problems.With National Suicide Prevention Week having begun on Sep. 4th and closing out on World Suicide Prevention Day on Sep. 10, the time may finally come for a wide audience to unmask this quiet killer and learn what each of us can do to save a life.
Recent headlines have described suicide as an "epidemic." The difficulties associated with the current financial crisis have shown us that a need clearly exists for more extensive training for psychotherapists in the management and treatment of suicidal clients. In my 25 years of research into the causes of and treatment for suicide, I have learned invaluable techniques and approaches that can help people emerge from the dark trance in which they hear "Critical Inner Voices" instructing them to end their lives. On Sep. 8, I will conduct a 90-minute CE Webinar on "Suicide: What Every Therapist Needs to Know," which will attempt to educate professionals about the warning signs and risk factors for suicide as well as identify the treatments that have proven effective in saving lives.
There are many misconceptions about suicide, one of them being that suicidal people want to die and cannot be helped. However, the suicidal state is almost always transient and treatable. When someone decides to end their life, they are acting out the will of an internal enemy or "anti-self." By understanding the division between their true self, which is on their side and wants to live, and the anti-self, which attempts to destroy them, suicidal individuals can challenge the distorted filter through which they view the world when in a suicidal state. Therapists can help clients understand this division, challenge the anti-self, reconnect with and strengthen the real self and rediscover the natural desire to survive.
Acclaimed psychology professor and suicidologist, the late Israel Orbach, stated "It is not enough to love the suicidal patient, it's not enough to give him hope, it's not enough to change the external environment. You must deal with changing the self-destructive processes, these inner patterns that erode the self and mental well-being."
With so many individuals suffering losses of jobs, homes, or retirement security, the potential for the anti-self to gain strength is increased. The most common mental health outcome of these difficult conditions is depression, which increases suicide risk. A recent study of 26 European Union countries showed that for every 1 percent rise in unemployment, there was a .79 percent increase in suicides among individuals younger than 65 years old. This same report showed that a 3 percent or greater rise in unemployment was associated with a 4.45 percent rise in suicide.
In the U.S., a study by economist Christopher J. Ruhm similarly showed that for every 1 percent increase in a state's unemployment rate, the number of suicides increases by 1.3 percent. Other research tracking suicide rates from 1960 to 1995 has demonstrated that each $1.00 cut in state per capita public welfare expenditures was associated with an increase of .004 per 100,000 population in state suicide rates.
These stressors and losses can trigger feelings of shame, humiliation or despair, which may lead to suicide attempts in vulnerable individuals or those with limited support and resources. However, the situation is far from hopeless. Like depression, suicidality is almost always both preventable and treatable.
In a recent article I wrote for APA, I listed the results from a survey of people who had once been suicidal but had been successfully treated in psychotherapy. When the people were asked, "What were the most helpful aspects in therapy?" these three answers were given:
- Validating relationships: Clients described the existence of an affirming and validating relationship as a catalyst for reconnecting with others and themselves.
- Working with emotions: Dealing with the intense emotions underlying suicidal behavior. Clients who did not receive acknowledgement of such powerful and overwhelming feelings as despair and helplessness, reported being unable to move beyond them.
- Developing autonomy and identity: Understanding suicidal behaviors, developing self-awareness and constructing personal identity. Clients identified the therapeutic process as discarding negative patterns while establishing new, more positive ones.
In order to help ourselves be more prepared for this epidemic, it is important to enhance our knowledge of advances in risk assessment, crisis intervention, case management, and treatment of suicidal people. It is essential to learn to identify the warning signs for suicide (see below chart) as well as the steps we can take to lead an individual out of suicidal crisis.
There are prevention resources and tools we can equip ourselves with as professionals that can help us when it comes to treating suicidal individuals. Taking the time to pay attention, ask questions, explore resources, and learn more can mean the difference of knowing and not knowing what to do and say when the time comes to save a life. By educating ourselves, we learn how to be there for someone suffering with thoughts of suicide, reinforcing that their life matters, and proving that together, we can get through even the toughest of economies and the darkest of times.
Warning Signs for Suicide
- Extreme self-hatred - "You don't deserve to live."
- Personalized hopelessness - "Nothing matters anymore. You should just kill yourself."
- Pushing away friends and family - "What's wrong with you? Look at all this trouble you're causing the people who love you."
- Isolation - "Just be by yourself. You are better off alone."
- Thoughts of not belonging - "You don't fit in anywhere."
- Thoughts of being a burden to others - "You're just dragging everyone down. You are such a burden; they would be better off without you."
The following are common behaviors that indicate suicide risk:
- Past attempts
- Disrupted sleep patterns
- Increased anxiety and agitation
- Outbursts of rage or low frustration tolerance
- Risk-taking behavior
- Increased alcohol or drug use
- Sudden mood change for the better
- Any talk or indication of suicidal ideation or intent, planning or actual actions taken to procure a means
Remember, if you or someone you know is in crisis or in need of immediate help call 1-800-273-TALK (8255). This is the National Suicide Prevention Lifeline, a free hotline available 24 hours a day.
Learn more from Dr. Lisa Firestone on suicide prevention at PsychAlive.org
Learn about upcoming free and CE Webinars on suicide prevention at PsychAlive.org
