Suicide is a serious problem in our country. Most people are uncomfortable discussing it and are particularly uncomfortable talking to somebody about it if they are concerned that individual may be having thoughts of suicide. Nevertheless, it is important to talk about it because it is the eighth leading cause of death among adults and the second leading cause of death among adolescents. Thirty thousand people kill themselves in the United States every year.
Suicide Prevention Week occurs once a year with the goal of increasing public awareness about suicide and suicidal behavior. This year National Suicide Prevention Week ran from Sept. 7 through today. Increased awareness of suicidal thoughts and behavior and of the resources available to treat people who are having such thoughts and behavior, can lead to preventing suicides. Ninety percent of suicide victims are suffering from a major psychiatric illness and about half are clinically depressed. Drug and alcohol abuse are risk factors as well. People who are under the influence of substances are more likely to act impulsively on suicidal thoughts than they would were they not under the influence. About half of all suicide victims are coping with chronic alcoholism.
Both men and women commit suicide, though men do so at a much higher rate. Women are about three times more likely to attempt suicide than men, but men are at least twice as likely to die as a result of their attempts. Men generally use more lethal means. Suicide rates in men continue to increase over the life span, generally peaking around age 75, whereas the rate for women tends to peak in the late 40s or early 50s.
While mental illness and substance abuse problems are extremely significant risk factors when assessing suicidality, there are others which should be considered. Such other factors might be a personal history including physical, emotional or sexual abuse; a history of family violence; a family history of suicide; or exposure to suicide behaviors of friends or acquaintances. Separation or divorce are also risk factors as is declining health, particularly in the elderly.
Suicide is very difficult to predict, however, there are some warning signs of which people should be aware. Individuals who are depressed or having difficulty sleeping, not eating, lack of energy, express no interest in previously enjoyed activities and have become socially withdrawn should be evaluated for depression and possible suicidal ideation. Suicide is of particular concern among such people if they express feelings of hopelessness and helplessness relative to their future. Individuals who are depressed and have made previous suicide attempts are at a particularly high risk. Some additional indicators would be giving away prized possessions, or a severe depression following a stressful situation such as a serious health problem or the loss of a spouse or parent.
Many times individuals will state they believe that if someone is intent on killing themselves, they will do so and there is not much that can be done about that. This, unfortunately, is a common belief. However, it is an erroneous one. Suicidal thinking is not a permanent condition. Most individuals who have had suicidal thoughts are not sure if they really want to die or not. They are however feeling they have very few options. Getting help to such a person in a timely manner can frequently trip the balance in the favor or life. Most people in treatment improve or recover and are no longer suicidal.
If you have a friend or family member you are concerned about and think they may be having suicidal thoughts, it is important to talk to them about it. Sometimes people express the concern that they will be increasing the likelihood of their friend of family member committing suicide if they bring the subject up. Actually, if you are suspicious they may be thinking about suicide, it is almost a certainty they have already thought about that. It is important you let them know that you are concerned, that you care about them and that you are willing to talk about their suicidal thoughts and feelings in detail.
When talking to someone about suicide, never promise to keep it a secret. Let them know you may need to contact another responsible individual to get them the help they need. This is a common mistake adolescents make when friends express suicidal ideation to them after extracting a promise not to tell anyone. It is far better, if you make such a promise, to break it and have someone live than to keep the promise and have them die.
When talking to someone about suicidal thinking, it is helpful to have an idea how specific their plans are. Have they thought through how they would do it and do they have the means? For example, if they thought about shooting themselves, do they have a gun or have access to one - the more specific the plan, the more dangerous the situation. Nevertheless, regardless of how specific or general the plan is, if a person shares with you they are thinking about suicide, it is important that you get them help and be willing to accompany them to that help.
While it is very important that you express concern and caring, and you are willing to listen to them talk in detail about their plans, it is equally important that you do not try to be a counselor or try to handle the situation on your own. You will be the most helpful to your friend if you refer them to a professional with the skills and experience in dealing with these kinds of situations. It is important that you continue to offer ongoing support, particularly while they are getting started with treatment.
There are resources available for individuals who might be suicidal. If the situation is urgent and you don't believe you can get them to help, you should call 911 and have your friend or family member taken to the emergency room at the nearest hospital. Other sources would include a minister or family physician or, in the case of an adolescent, a school counselor. The Berryhill Center for Mental Health has a phone which is answered 24 hours a day, seven days a week. That number is (800) 482-8305 or (locally) 955-7171. If a person calls the Berryhill Center during business hours, one of the staff will make arrangements to see them.
Suicide is a very difficult and scary subject, particularly when confronting the reality of a friend or family member who may be thinking about it. You may be the person who initiates them getting the help they need, but you will not be alone in that effort. By being willing to bring up the topic and discuss it with your friend or family member, by being willing to help them get into treatment and by being willing to work with the treatment staff, you can save a life.
Jim Burr is executive director of the Berryhill Center for Mental Health, part of Trinity Health Systems.