Generally, though not always, the suicidal process starts early in life. The self-entrapment develops as an adopted strategy of living throughout life. Even the most impulsive suicidal behaviour is an indication of intense pain that resides inside. Mental pain creates experiential aspects, such as a sense of loss of control, emotional numbness and estrangement, emotional flooding, a sense of irreversibility of pain, and a sense of being aloneness. Many clients attending their first therapy session are overwhelmed, frightened and confused about their mental state1. The best route to understanding suicide is not through the study of the structure of the brain, nor the study of mental diseases, or social statistics but directly through the study of human emotions described. The most important question to be asked to a suicidal person is “where do you hurt?” and “how can I help you?”2. Suicide is mostly a felt, rather than simply a thought response and our actions and reactions are often rooted at a very emotionally visceral level3.
Examining suicide requires knowing the differences between risk factors, warning signs, crises, attempts, and completions. Warning signs include isolation, drastic changes in mood, hopelessness, anger, acting out and increased amount of substance use. They indicate a near-term threat and require immediate intervention. Risk factors are those that have been linked to suicide such as gender, age, previous suicidal attempts, mental illness, childhood abuse4, high frequency of domestic violence, substance abuse, poor economic situation, lack of close relationships and hopeless future orientation5. Even though the relationship between self-injury and suicide is unclear, evidence suggest that people who self-injure are at high risk of suicide4. A previous suicide attempt is the strongest predictor of eventual death by suicide. Suicide rates are highest in the first 6 months after an attempt6.
Mental illness is the greatest factor that predisposes people to suicidal ideation. International Association for Suicide Prevention data suggests that almost 90% of people who die by suicide have a diagnosable mental illness7. Suicide thoughts, attempts, and completions are highly related to substance abuse, especially with co-morbid depression8. The threat of suicide among homeless mentally ill people is substantial. 30 to 39-year-old homeless people with or without the dual diagnosis of mental illness are at greatest risk of committing suicide9.
Social and family support are some of the most important factors in reducing the risk of suicide5. Evidence suggest that clients are significantly more likely to remain in therapy if they had been referred by a third party or are in contact with a health-care provider, signifying the important role for an established support network such as family, friends, and health-care professionals10. Therapy with suicidal and depressed clients should not terminate when they feel better. Therapists must prepare clients for future difficulties with greater resilience. Confronting clients with possible future difficulties especially when they think their troubles are over is instrumental. The dramatization of these possible scenarios is a very useful tool to increase resilience and better coping in the future1.
Asking people about a potential suicidal risk will not put the thought into their mind however it will instead open a door to explore the issue.
Counselling and psychotherapy can help!
1: Orbach, I. (2001). Therapeutic empathy with the suicidal wish: Principles of therapy with suicidal individuals. American Journal of Psychotherapy. 55(2), 166-184.
2: Shneidman, E.S. (1998). The suicidal mind. Oxford-UK: Oxford University Press.
3: Reeves, A. (2014). Walking a fine line. Healthcare Counselling & Psychotherapy Journal. 14(1)
4: Whisenhunt, J.L., Chang, C.Y., Brack, G.L., Orr, J., Adams, L.G., Paige, M.R., Peeper, C., McDonald, L. & O’Hara, C. (2015). Self-Injury and suicide: Practical information for College Counsellors. Journal of College Counselling. 18, 275-288.
5: Karakurt, G., Anderson, A., Banford, A., Dial, S., Korkow, H., Rable, F., & Doslovich, S.F. (2014). Strategies for managing difficult clinical situations in between sessions. The American Journal of Family Therapy. 42, 413-425.
6: Yuodelis-Flores, C., & Ries, R.K. (2015). Addiction and suicide: A review. The American Journal on Addictions. 24, 98-104.
7: McAuliffe, N., & Pery, L. (2007). Making it safer: A Health Centre’s strategy for suicide prevention. Psychiatr Q. 78, 295-307.
8: Wilke, D.J. (2004). Predicting suicide ideation for substance users: The role of self-esteem, abstinence, and attendance at 12-Step meetings. Addiction Research and Theory. 12 (3), 231-240.
9: Prigerson, H.G., Desai, R.A., Liu-Mares, W., & Rosenheck, R.A. (2003). Suicidal ideation and suicide attempts in homeless mentally ill persons. Soc Psychiatry Psychiatr Epidemiol. 38, 213-219.
10: Surgenor, P.W.G., Meehan, V., & Moore, A. (2016). Early attrition among suicidal clients. British Journal of Guidance & Counselling. 44(5), 589-597.