Warning: This blog posts discusses and references suicide. This subject matter can be distressing towards individuals. If you or a loved one are experiencing thoughts of suicide or experiencing a mental health emergency, please call 911 or contact one of the 24/7 helplines:
Suicide & Crisis Lifeline: Dial 988 or visit 988lifeline.org
Crisis Text Line: Text HOME to 741741
National Domestic Violence Hotline: Call 800-799-7233
Please take care of yourself. You are not alone.
What is a Suicide Risk?
Suicide is a phenomena that will impact everyone’s lives at some point. Whether you are a survivor or have lost someone to suicide, the effects are life changing. It can be difficult to speak to anyone, whether it is a friend, a loved one, a mental health professional, or a trusted religious leader on your thoughts of suicide and the feelings you are experiencing. There is fear of being misjudged, losing friends or being considered a burden to loved ones, or enduring a forced hospitalization. It is the hope of this post to help demystify what is considered a suicide risk, warnings signs of suicide, and what counts as a requirement for hospitalization.
A suicide risk, to put it simply, are factors that are likely to increase the attempt or completion of suicide. Suicide, like everything else, is not contributed to one issue or factors that an individual is experiencing. These factors can be sorted into Individual, Relationship, Community, and Societal.
Individual
Previous suicide attempts
A history of depression and other mental health issues
Substance use
Lack of resiliency skills
Impulse control issues
Sense of hopelessness
Access to lethal means (firearms, substances, knives, etc)
Adverse childhood experiences
Relationship
Social isolation
High conflict relationships
Family history of suicide
Bullying/Harassment (online or in-person)
Experiencing doxxing
Community
Lack of community/general support
Community targeted violence
Discrimination
Societal
Stigma towards seeking assistance for mental health
Chronic poverty
Sudden unemployment
Lack of access to healthcare
Suicide cluster in personal community
Displacement due to war, violence, or extreme weather (fire, hurricane, tornado, etc)
As you can see, in each category are life events where someone is likely to experience a severe increase in distress. A combination of the factors listed above generally contribute to an individual experiencing thoughts of suicide or attempting suicide. Please note, that while an individual may experience one or more adverse life events, it does not necessarily mean that they will attempt suicide.
Individual experiences towards severe and adverse life experiences and the level of support that they receive (receiving shelter after losing one’s home to a fire or flood, having community support during personal hardships, access to healthcare) are all deterrents to an individual attempting or completing suicide.
What are Protective Factors?
As the name implies, protective factors are a series of characteristics that decrease the likelihood that an individual will experience suicidal thoughts or attempt suicide. Just like risk factors, protective factors can be broken down into Individual, Relationship, Community, and Societal. Notice how many of the protective factors are the opposite of risk factors.
Individual
Resiliency skills
Healthy or neutral coping skills
Strong sense of self
Conflict resolution skills
Relationship
Non-combative or high conflict relationships
Support from friends and loved ones.
Healthy communication skills
Community
Sense of identity towards community either through academic institutions, work, hobbies, etc.
Sense of safety within community
General acceptance
Societal
Access to healthcare
Having basic needs met (shelter, food, water, weather appropriate clothing, etc)
Support systems in place to reduce likelihood of homelessness, hunger, or poverty
What are the Warning Signs of Suicide
Protective factors can be crucial in establishing a safety plan when it comes to experiencing suicidal thoughts. When experiencing warning signs of suicide, falling back on healthy coping skills, community, and friends can act like a buffer. However, it is vital to be able to recognize and understand the warning signs of suicide and when to ask for help.
Risk Taking Behavior
Starting or increase in substance use
Driving at extreme speeds/letting go of the wheel to allow the car to drift
Engaging in behaviors that would increase the likelihood of death ie
Increase in aggression/fighting
Collecting lethal means (stockpiling firearms, hoarding medication/medication that can be utilized for an overdose)
Speech
Stating “I want to die”
Making jokes of wanting to die
Stating that they have no reason to live
Emotions
Sense of hopelessness
Sense of despair
Mood swings
Experiencing heightened sense of anxiety and agitation
Daydreaming of dying
Giving away important items
Sense of joy and elation
Carefree attitude.
The warning signs of suicide can be confusing, especially when we review the last two points under emotions. There is a general misconception that when an individual is considering suicide they will display emotions traditionally associated with depression, anxiety, and despair. This is partially correct. If a person has experienced severe despair and has made comments of ending their life and then suddenly displays joy and elation, one may assume it for a turning point in the right direction.
This would be a dangerous assumption to make.
If a person has a sudden shift from despair to joy, it is a strong indication that they have made the decision to end their life. This elation stems from the idea that their problems are now effectively over. Nothing matters, therefore, there’s nothing to be stressed or worried about. This is when an individual has a credible and viable plan to end their life.
What is Meant By “Viable and Credible”?
The phrase viable and credible can be confusing to new clinical practitioners and people new to suicide education. Viable and credible indicates the practicality and believability of a person’s suicide plan. When informing clients of the meaning of viable and credible in reference to suicide, I use the following example:
Not Viable and Credible
Going to the nearest active volcano to do a backflip into the magma.
Lack of easy accessibility to active volcanoes
Lack of ability to adequately perform a backflip ie leg power and core strength
Viable and Credible
Overdosing on medication
Ease of access
Ease of consuming multiple pills
What Happens if A Plan is Viable and Credible
If a person’s plan is viable and credible, meaning it is practical and believable, then a hospitalization will occur because the suicide risks and warning signs are high. Hospitalization does maintain a negative reputation and I will not attempt to downplay the level of stress that it can inspire in those who face going to the hospital for mental health concerns. However, that being said, clinical practitioners have a duty to protect their patients.
Steps to Hospitalization
The patient reports suicide ideation/intent/plan/means
The clinician explores and asses viability and credibility for suicide.
The clinician may refer patient to an established safety plan, develop a safety plan with the client, or discuss hospitalization with the patient depending on the level of suicidality that the patient is experiencing.
If the clinician believes that there is a viable and credible plan, intent, and means for the patient to attempt suicide, then a hospitalization will occur. Clinician will discuss hospitalization with patient and follow up plans for when they are discharged.
The patient is then transported to the hospital or an independent/community based in-patient facility where a secondary intake assessment is conducted, removal of life threatening personal items (belts, shoestrings, razor blades, needles, etc). The patient will go through general evaluations for their physical and mental health by either a nurse, social worker, therapist.
The patient will be placed in a structured schedule where they will go to therapy sessions either one on one or group, review medication management or start medication management if they have not started medication, take classes on developing or establishing coping skills, etc.
Once the hospitalization period is completed, the patient is discharged, provided additional resources for further care and reconnects with their therapist. An updated safety plan may be developed to reflect new resources, support systems, and coping skills. Referrals to community care may also be included to expand the care team to a social worker, case manager, etc.
Conclusion
Understanding suicide risks and warning signs can be an overwhelming learning experience, but the more knowledge that everyone possesses on this sensitive topic, the better we can all be in recognizing and providing support to our friends, family, and community. If you are interested in receiving training for suicide prevention, whether you are a brand new clinician or a community member, I would recommend QPR training (Question, Persuade, and Refer). This training can be completed online, in person, and can be done in an hour. I have personally found the training to be comprehensive with a strong community and a low cost barrier (under 30 dollars). If QPR doesn’t interest you, I would recommend reaching out to your local community mental health, hospitals, and colleges who routinely offer suicide awareness training as part of the continuing education process for staff, faculty, and clinicians.
Please remember that if you or a loved one are experiencing thoughts of suicide or experiencing a mental health emergency, please call 911 or contact one of the 24/7 helplines:
Suicide & Crisis Lifeline: Dial 988 or visit 988lifeline.org
Crisis Text Line: Text HOME to 741741
National Domestic Violence Hotline: Call 800-799-7233
Additional Resources
Please take care of yourself. You are not alone.
