DRAFT Guide for families-Detection and prevention of suicidal
conduct
The World Health Organization identifies suicide attempts as one of the most serious
health problems that can affect people and it is therefore recommended to all its
state members to treat it as a priority.
Suicide apparently presents to us as a permanent solution to intense emotional
mental and /or physical temporary pain, or to interpersonal disruptive relationships.
Believe it or not, sometimes the despair, the pain and the emptiness are temporary
states, not permanent.
Suicide may be the result of a sudden impulse or it could be planned very carefully.
The impulsivity necessary for the act does not persist indefinitely (do not despair,
because normally the person doesn’t have this idea in his head permanently).
Most people who think about suicide do not really want to die; they just want to break
free from the intolerable circumstances of their lives and the mental, emotional and
physical suffering. Therefore they almost always live between the reasons for living
versus reasons for dying, and suicidal behaviour is the only alternative they see.
The challenge that presents the desperation of people attempting suicide is to find
ways to solve those intolerable feelings. The support of family and / or friends,
psychopharmacological treatments and psychotherapy are very valuable factors for
the prevention of suicide attempts and / or completed suicide.
Suicide is a very serious problem of public health. Suicide in industrialized countries
is among the ten leading causes of death. In the age groups between 15-24 is the
second or third leading cause of death, in the age group of 35-45 years old it is the
fourth cause of death, and between 45-65 years old it ranks from the fifth to the
eighth leading cause of death. Despite these figures, suicide can be prevented in
many cases.
It is estimated that at least 90% of people who take their own life suffer some form of
mental illness. Suicide is the leading cause of premature death among people
diagnosed with depression, bipolar disorder, schizophrenia, or drug use.
People affected by depression have a greater chance suicide, the risk 20 times
higher compared to the general population. Up to 15% of them died after an attempt.
The people affected by bipolar disorder have a probability of suicide risk 15 times
higher compared to the general population. Up to 15% of them die after a tentative
and up to 56% attempt it at least once in their life.
People affected by schizophrenia have a probability of suicide risk 9 times higher
compared to the general population. Up to 10% of them died after an attempt and up
to 30% try it at least once in their life.
Those diagnosed with borderline personality disorder have probability of suicide risk
between 4 and 8 times higher compared to the general population. Up to 8% of them
die after a tentative and up to 70% try it at least once in their life.
People affected by psychoactive substances and alcohol or other drugs, especially if
they are young people who have difficulties with interpersonal relationships or with
family members, have a higher suicide risk than the general population.
From 30 to 40% of suicide deaths are preceded by suicide attempts.
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Myths and misconceptions about suicide
Myth: Talking about suicide is a bad idea as it may give someone the idea to try it.
Fact: Suicide can be a taboo topic in society. Often, people feeling suicidal don’t
want to worry or burden anyone with how they feel and so they don’t discuss it. By
asking directly about suicide you give them permission to tell you how they feel.
People who have felt suicidal will often say what a huge relief it is to be able to talk
about what their experiencing. Once someone starts talking they’ve got a better
chance of discovering other options to suicide.
Myth: People who talk about suicide aren’t serious and won’t go through with it.
Fact: People who kill themselves have often told someone that they do not feel life is
worth living or that they have no future. Some may have actually said they want to
die. While it’s possible that someone might talk about suicide as a way of getting the
attention they need, it’s vitally important to take anybody who talks about feeling
suicidal seriously.
Myth – Who talks about it, doesn’t do it.
Reality – The person could have expressed the intention with words, threats,
gestures or behavioural changes.
Myth - Suicide can’t be prevented because it is an impulse.
Reality - Every person before committing suicide displayed a number of symptoms
that have been defined as Pre-Suicidal Syndrome, consisting of a constriction of
feelings and intellect, inhibition towards aggression which is no longer directed
towards other people but directed to themselves instead and existence suicidal
fantasies. All that can be detected in due time and prevent them from carrying out
their purposes.
Myth – Only people with serious problems commit suicide.
Reality - Suicide is multi causal. Many small problems together can lead to suicide,
also what for someone is something trivial, for others it may be catastrophic.
Protective factors
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Effective clinical care for mental, physical and substance use disorders
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Easy access to a variety of clinical interventions
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Early identification and treatment of mental illness.
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Long term holistic treatment for patients with mental disorders, physical
disabilities or alcohol abuse.
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Support through ongoing medical and mental health care relationships
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Hope.
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Restricted access to highly lethal means of suicide
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Presence of a significance and supportive other.
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Positive attitudes and values, such as respect, solidarity, cooperation, justice
and friendship.
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Strong connections to family and community support
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Skills in problem solving, conflict resolution and handling problems in a nonviolent way
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Cultural and religious beliefs that discourage suicide and support selfpreservation
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Self Confidence.
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Responsibility for children (particularly for women).
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Ability to develop good personal and interpersonal relationships.
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Asking for advice and help when difficulties arise.
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Ability to cope with stress, crisis and loss.
Risk Factors
Mental disorders, particularly mood disorders, schizophrenia, anxiety disorders
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and certain personality disorders
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Alcohol and other substance use disorders
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Hopelessness
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Impulsive and/or aggressive tendencies
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History of trauma or abuse
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Major physical illnesses
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Previous suicide attempt
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Family history of suicide
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Job or financial loss
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Loss of relationship
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Easy access to lethal means
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Local clusters of suicide
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Lack of social support and sense of isolation
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Stigma associated with asking for help
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Lack of health care, especially mental health and substance abuse treatment
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Cultural and religious beliefs, such as the belief that suicide is a noble
resolution of a personal dilemma
Exposure to others who have died by suicide (in real life or via the media and
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Internet)
http://www.suicidepreventionlifeline.org/learn/riskfactors.aspx
Warning signs of suicide
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Always talking or thinking about death
Clinical depression -- deep sadness, loss of interest, trouble sleeping and
eating -- that gets worse
Having a "death wish," tempting fate by taking risks that could lead to death,
such as driving fast or running red lights
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Losing interest in things one used to care about
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Making comments about being hopeless, helpless, or worthless
Putting affairs in order, tying up loose ends, changing a will
Saying things like "it would be better if I wasn't here" or "I want out"
Sudden, unexpected switch from being very sad to being very calm or
appearing to be happy
Talking about suicide or killing one's self
Visiting or calling people to say goodbye, giving valuable and personal objects
as presents for family and friends.
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http://www.webmd.com/depression/guide/depression-recognizing-signs-of-suicide
Physical changes
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Major changes to sleeping patterns – too much or too little
Loss of energy
Loss of interest in personal hygiene or appearance
Loss of interest in sex
Sudden and extreme changes in eating habits – either loss of appetite or increase in
appetite
Weight gain or loss
Increase in minor illnesses
Behaviours
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Alcohol or drug misuse
Fighting and/or breaking the law
Withdrawal from family and friends
Quitting activities that were previously important
Prior suicidal behaviour
Self-harming
Putting affairs in order e.g. giving away possessions, especially those that have
special significance for the person
Writing a suicide note or goodbye letters to people
Uncharacteristic risk-taking or recklessness (e.g. driving recklessly)
Unexplained crying
Emotional outbursts
Conversational signs
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No future – "What's the point? Things are never going to get any better"
Guilt – "It's all my fault, I'm to blame"
Escape – "I can't take this anymore"
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Alone – "I'm on my own … no-one cares about me"
Damaged – "I've been irreparably damaged… I'll never be the same again"
Helpless – "Nothing I do makes a bit of difference, it's beyond my control"
Talking about suicide or death
Planning for suicide
Feelings
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Sadness
Anger
Shame
Desperation
Disconnection
Hopelessness
Worthlessness
Powerlessness
Loneliness
Isolation
The identification of these warning signs could be directly related to the presence of
suicidal ideation. However the fact that these signals are not detected does not
mean that the person cannot carry out a suicide attempt.
http://suicideline.org.au/worried-about-someone/recognising-suicide-warning-signs
What Should I Do if Someone I Know Shows Warning Signs of Suicide?
First, if someone you know appears to be depressed and is contemplating
suicide, take that person seriously. Listen to what he or she is saying. Take the
initiative to ask that person what he or she is planning. But don't attempt to argue
him or her out of committing suicide. Rather, let the person know that you care and
understand and are listening. Avoid statements like: "You have so much to live for."
If someone you know appears to be depressed and talks about suicide, makes a
suicidal gesture, or attempts suicide, take it as a serious emergency. Listen to the
person, but don't try to argue with him or her. Seek immediate help from a health
care professional.
http://www.webmd.com/depression/guide/depression-recognizing-signs-ofsuicide?page=2
-Limit access to lethal means of suicide. (E.g. firearms, pills, rope…)
Always think that if the person was unsuccessful in a previous attempt, he/she will try
to use a deadlier method than the one used in the previous attempt.
Be mindful of people living in high apartments
-Never leave him/her alone, involve family and friends.
Sometimes friends can reach where families can’t, ask them to help.
Feelings such as hopelessness, impulsivity and isolation are social factors that when
combined together can multiply the risk of suicide and help synchronise the action.
- Improve your asking and listening skills
It has been proven that asking and talking to the person about the presence of
suicidal thoughts lowers the risk of acting on them. As a matter of fact it might be the
last chance we have to prevent it.
It is very important:
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Do not judge him/her. Do not criticise his/her way of thinking
Take that person seriously
Do not panic
Show you care, genuinely listen.
Understand that he/she is going through a very difficult time in his/her life.
Use pleasant and kind terms that show respect. (e.g. "I would like you to give
me an opportunity to help").
Talk about his/her idea of committing suicide openly and without fear (discard
the myth that by talking about suicide we could lead them to do it).
Try to find out the reasons which lead him/her to want to end his life and look
for options in order to find solutions, or provide emotional support if there isn’t
a solution.
Watch for warning signs.
-Taking care of the family environment or family self-care.
This strategy should be present throughout the process of helping our family
member. We cannot put aside the family or environment of the person with suicidal
ideology. Following all recommendations of this Guide takes a toll on the person
who carries them out, we must be aware that although we can overcome the
myths surrounding suicidal behaviour, identify the warning signs and implement all
the recommended preventive measures, It may not be possible for us to control or
watch our family member 24 hours a day. We must not adopt the role of health
professionals. If necessary, the family of the person with suicidal risk should also
seek specialized help for themselves.