Senior Lecturer in Forensic Mental Health
The global incidence of Suicide is staggering… one completed suicide every 40 seconds. Suicide is one of the leading causes of death in the age group under 50. Risk factors for completed suicide include many variables, spanning bio-psychosocial, environmental, socio-cultural and as we have recently seen on our small island ……relational/emotional. Few politicians commit suicide, probably an indication of the type of personality attracted to politics.
Population at greatest risk include: – Young and middle-aged men; people with mental health problems …. especially depression; people with a history of self-harm; people in contact with the criminal justice system …especially when they realise the gravity and consequences of their offending behaviour; specific occupational groups, such as doctors, nurses, dentists, farmers, veterinary workers.
Men are three times at a greater risk of suicide than women. The most common methods of suicide include self-poisoning, hanging and jumping from heights/multiple injuries.
A high percentage of people who complete suicide would have indicated their motive with a friend or colleague at work.
Suicidal thoughts should be assessed by questions related to thoughts, plans and behaviour. The duration, frequency and intensity of the thoughts should be examined and the details of any suicide plan should be explored and taken seriously. Previous suicide behaviour should not be a factor in determining the present state of mind.
Suicidal thoughts may be passive or active. Questions to ask should focus on:-
Have you had any thoughts that your life is not worth living?
Have you had thoughts that things would be better if you were dead?
Are you having thoughts of wanting to harm or kill yourself right now?
When did you last have thoughts of killing yourself and what method did you intend to use?
The information gleaned from the conversation will appraise the listener of potential future actions. In the event that the person states that they will involve other people, e.g. their children or spouse, this matter needs to be treated with extreme urgency, and professional help sought straight away, not leaving the person without supervision.
Educational awareness programmes on managing moods and developing resilience:
- Promoting a balanced and positive approach to life events
- Creating strong, bonding relationships based on healthy approach to life
- Reduction of addictive and intoxicating substances
- Anger management strategies
- Developing a holistic spiritual approach in relationships
- Taking steps to reduce the feelings of hopelessness
- Community cohesion and gatekeepers for young people based on mature and respectful relationships, avoiding paternalistic approaches
- Media reporting guidelines for suicide, targeting vulnerable groups.
The dynamics of the act of suicide
The dynamic interface of the thoughts and engaging with the act can be summarised as follows:
Suicide ideation may have been harboured for some time and circumstances leading to the act may be triggered by impulsivity that then leads to hopelessness and pessimism. At this critical juncture if the person has access to lethal means, the intensity of the thoughts may be heightened, which causes loss of reasoning ability. This heightened emotional state triggers major physiological changes that further complicates their judgement and they become very focussed on the act of suicide.
The after effects of suicide on the family and community can be devastating and the ensuing trauma may be lifelong.