Suicide is not inevitable. Most people experiencing suicidal thoughts are ambivalent about dying but may be unable to imagine other potential solutions. With the right support people can find their way through a suicidal crisis and recover.
Many people have been touched in some way by suicide. It is an emotive subject. Suicide is a significant public health concern. Everyone can potentially help someone with suicidal thoughts. The majority of people who end their lives by suicide almost always have had contact with someone in the health services. Every contact a suicidal individual has represents an opportunity to intervene and prevent them from going on to die by suicide.
Suicidal thoughts and feelings are far more common than most people realise and are often not related to the presence of a mental illness. Suicide is a behavior and not a diagnosis. Suicide cannot be predicted accurately in any given individual at a single point in time. Suicide usually occurs as a result of a multifactorial process, where vulnerability to suicide may be generated over several weeks, months, or years.
Self-harm and suicidal thoughts should be taken seriously, and met with empathy, compassion, and understanding given that they are risk factors for suicide, particularly when associated with a history of a mental illness (most commonly major depressive disorder and substance misuse).
Clinicians, patients, and their caregivers (supporters) are calling for a paradigm shift in suicide risk assessment that moves away from "characterizing, predicting, and managing risk" towards "compassion, safeguarding, and safety planning".
Originally called suicide risk management, suicide risk mitigation aims to be a more realistic and compassionate approach. It refers to the identification, assessment, intervention, and treatment of a person at risk of suicide. It is an ongoing process whether due to a mental illness or a life crisis. Traditionally the term "suicidal behavior" refers to a suicide attempt, an episode of nonfatal self-harm, a suicide plan, and suicidal ideation. The literature sometimes includes nonsuicidal self-harm as a component of suicidal behavior. The authors of this topic suggest avoiding the term "suicidal behavior" and being more specific about what you observe. There are several key components to suicide: ideation, intent, plan, access to lethal means, and history of past suicide attempts.
History and exam
Key diagnostic factors
- previous suicide attempt or self-harm episodes
- current suicide plan
- access to lethal means
- history of psychiatric disease, including substance misuse
- family history of suicide or mental illness
Other diagnostic factors
- chronic medical illness, disability, or disfigurement
- significant psychosocial factors
- unhelpful traits
- current suicidal plan
- history of mental illness, including substance misuse
- availability of lethal means
- history of childhood abuse or neglect
- family history of death by suicide
- male sex
- prison inmate
- family history of psychiatric illness
- physical illness
- marital status (divorced, single, widowed)
- professions/occupations (unemployed, self-employed, agricultural workers, medical and dental professionals)
- psychosocial stressors
1st investigations to order
- clinical diagnosis
patients who may be vulnerable to self-harm and suicide
those left behind after a death by suicide
- VA/DoD clinical practice guideline for assessment and management of patients at risk for suicide
- WHO mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings
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