Suicide Threats and Attempts

1
Suicide Threats and Attempts

• Assessment of Risk
• Crisis Intervention

2
Definition

• Suicide is a fatal act that is self-inflicted,
  consciously intended, and carried out with the
  knowledge that death is irreversible.

3
Why do people choose to kill themselves?

• Relief from pain suffering
• For honor
• To avoid fate worse than death
• Restitution for wrongs committed
• Religious martyrs
• Mental illness

4
Indicators of Suicide Potential

• Suicide ideation (w/ specific plan means)
• Suicide threats attempts
• Despondency, social withdrawal
• Utter helplessness disinterest
• Giving away possessions, making wills, hints at
  being gone
• Lack of ambivalence about living/dying

5
Activating Conditions

• Recent loss
• (death, divorce, status, money)
• Social isolation
• Physical illness
• Drinking drug taking
• (e.g. alcohol barbiturits)
• Impulsive or borderline personality

6
Vulnerable Times

• Anniversaries (of deaths/marriages)
• Holidays
• Financial catastrophe job loss
• Highly symbolic occasions (final divorce, or
  remarriage of partner)
• Suicide of peers media reports
• During recovery from severe depression

7
Common Etiology of Suicide

• Mental illness (DSM Axis 1 disorder)
• Intermittent severe depression
• Bipolar affective disorder
• Displaced murderous wish
• Displaced onto self
• Strategically placed to hurt another (e.g.
  murder/homicide)

8
Crisis Intervention Strategies

• Take threats seriously
• Ask direct questions re suicide intentions
• Remove means of dying
• Check for drug/alcohol use
• Check history of depression / medication
• Find out who is intended victim

• Maintain caring concerned attitude respectful
  distance
• Keep the person talking
• Express diffuse anger
• Arrange suicide watch
• Get a non-suicide commitment
• Referral for treatment or hospitalization