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CHAPTER 11 ■ Suicide Prevention
risk, what differentiates those with suicidal ideation from those who attempt, and evidence-based treat- ments and interventions. The federal government, through the Substance Abuse and Mental Health Services Administration (SAMHSA), has endorsed the “Zero Suicide” movement; a partnership of sev- eral national organizations dedicated to identifying evidence-based strategies for suicide prevention. Within the next several years, we may discover that
our understanding of and approaches to treatment will dramatically change. We are certainly begin- ning to recognize that, with the rise in suicide rates, our conventional interventions have not adequately addressed the complex needs of this population. Confusion exists over the reality of various notions regarding suicide. Some currently accepted facts and some myths relating to suicide are presented in Table 11–1.
TABLE 11–1 Facts and Myths About Suicide MYTHS FACTS
People who talk about suicide do not act on their ideas. Suicide happens without warning. You cannot stop suicidal people. They are fully intent on dying.
Eight out of 10 people who kill themselves have given definite clues and warnings about their suicidal intentions. Very subtle clues may be ignored or disregarded by others. Most suicidal people are very ambivalent about their feelings regarding living or dying. Most are “gambling with death” and see it as a cry for someone to save them. Suicidal ideation and risk fluctuate over time and may be time limited. If provided adequate support and resources, a suicidal person can go on to lead a normal life. However, multiple suicide attempts may reflect greater chronicity of suicidal ideation. Reassessment over time is important to identify current risks. Most suicides occur within about 3 months after the beginning of “improvement,” when the individual has the energy to carry out suicidal intentions. Suicide is not inherited. Many mental illnesses like depression, bipolar disorder, and substance abuse run in families and confer an increased risk, but suicidal behavior is not inevitable in these populations. However, suicide by a close family member does increase the risk of similar behav- ior in other family members. Although a majority of people who attempt suicide are extremely unhappy, or clinically depressed, they are not necessarily psychotic. They are merely unable at that point in time to see an alternative solution to what they consider an unbearable problem. All suicidal behavior must be approached with the gravity of the potential act in mind. Attention should be given to the possibility that the individual is issuing a cry for help.
Once people are suicidal, they are suicidal forever.
Improvement after severe depression means that the suicidal risk is over.
Suicide is inherited, or “runs in families.”
All suicidal individuals are mentally ill, and suicide is the act of a psychotic person.
Suicidal thoughts and attempts should be considered manipulative or attention-seeking behavior and should not be taken seriously. People usually take their own lives by taking an overdose of drugs. If individuals have attempted suicide, they will not do it again. Suicide always happens in an impulsive moment.
Gunshot wounds are the leading cause of death among suicide victims.
Between 50% and 80% of all people who ultimately kill themselves have a history of at least one previous attempt. People who are suicidal often contemplate, imagine, plan strategies, write notes, post things on the Web. The importance of in-depth exploration and assessment cannot be overstated. Each year, 30 to 35 children younger than age 12 take their own lives and not all are clinically depressed.
Young children (ages 5–12) cannot be suicidal.
Sources: Compiled from Fuller (2020); National Alliance on Mental Illness (NAMI) (2021); and The Samaritans (2021).
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