Suicide Assessment, Treatment, and Prevention

Suicide, the tragic act of taking one’s own life, impacts hundreds of thousands of people around the world every year. In fact, approximately 700,000 to one million people die by suicide globally each year—about one every 40 seconds. In the United States, suicide claims a life every 12 minutes. The impact of suicide is far-reaching, cutting across all demographic groups, and it remains one of the leading causes of death, particularly for younger individuals. Globally, suicide is the second leading cause of death for those aged 15 to 29. Despite its widespread nature, many cases are preventable. Understanding the issues surrounding mental health and suicide is essential to creating prevention strategies, providing effective treatment, and raising awareness about the importance of mental health care.

Early detection and intervention are key in preventing suicide. A significant number of individuals who die have seen a healthcare provider in the months leading up to their death, making healthcare settings a crucial point of intervention. Despite this, many healthcare facilities do not routinely screen for suicide risk. In 2016, The Joint Commission, an accrediting body for healthcare programs, urged all medical settings to screen for suicide risk. Through early assessment and effective treatment, healthcare professionals can make a profound impact on reducing the number of suicides.

Suicide Risk Assessment Tools

Several tools are available to healthcare professionals to help identify individuals at risk. One such tool is the Ask Suicide-Screening Questions (ASQ) developed by the National Institute of Mental Health (NIMH). Healthcare professionals use the ASQ for pediatric patients aged 10 to 24, but they can adapt it for patients of any age. The tool consists of four questions, and if the patient answers “yes” to any of them, a follow-up question will be asked to assess the immediacy of the risk.

For example, the ASQ includes questions such as, “In the past few weeks, have you wished you were dead?” and “In the past week, have you been having thoughts about killing yourself?” When a patient answers affirmatively to any of the screening questions, they are considered a positive screen, and further evaluation is required to determine the severity of their risk. If the patient is found to be in immediate danger, they must be evaluated immediately. All potentially harmful objects should be removed from their environment.

Healthcare providers conduct a more thorough suicide safety assessment for patients with a positive screen but without imminent risk. This involves exploring the frequency of suicidal thoughts, whether the patient has a specific plan, and their access to means of carrying out that plan. Healthcare professionals examine past suicide attempts because they are one of the strongest indicators of future risk. The assessment also delves into any symptoms of depression, anxiety, or substance use, as well as the patient’s social support system and stressors in their life.

The Columbia-Suicide Severity Rating Scale (C-SSRS)

Another widely used tool is the Columbia-Suicide Severity Rating Scale (C-SSRS), developed to assess suicide risk in adults. Unlike some other tools, the C-SSRS can be administered by individuals without formal mental health training, making it accessible to a wide range of professionals such as teachers, clergy, and peer counselors. The C-SSRS includes questions about the frequency and intensity of suicidal thoughts, whether the individual has a specific plan, and if they have begun preparing to carry out that plan. The goal is to identify those at high risk and provide the necessary intervention.

Treatment Options for Individuals at Risk of Suicide

Around 90% of people who die by suicide have a mental disorder at the time of their death. Mental health treatment can play a critical role in reducing the risk of suicide, particularly for those with conditions such as schizophrenia, major depression, bipolar disorder, and substance abuse. Different treatment approaches have shown promise in addressing both mental health disorders and the risk of suicide.

For individuals with schizophrenia, clozapine is the only medication approved by the FDA specifically for reducing suicide risk. Cognitive behavior therapy (CBT) and dialectical behavior therapy (DBT) have also been shown to help individuals with schizophrenia, as well as those with borderline personality disorder and recurrent suicidal ideation.

Some studies show that mood stabilizers, such as lithium, can reduce the risk for individuals with bipolar disorder who also suffer from major depression, though the results remain controversial. Doctors also use electroconvulsive therapy (ECT) and transmagnetic stimulation (TMS) when other treatments have failed or when depression is severe. Although TMS is less invasive than ECT, research has found ECT to be more effective in treating depression symptoms and reducing suicidal thoughts.

Individuals with alcohol and drug abuse issues often benefit from CBT and DBT as well. Therapy involving family members also shows promise in addressing the underlying mental health issues that contribute to suicidal thoughts.

Prevention Strategies

Suicide prevention requires a multi-faceted approach that addresses the underlying causes as well as providing immediate support to those at risk. A comprehensive and integrated approach that spans multiple sectors of society, including healthcare, education, and the media, is essential. Some key strategies for preventing suicide include reducing access to lethal means, such as firearms or certain medications, and implementing responsible reporting guidelines in the media to avoid sensationalizing the act, which can sometimes lead to “copycat” suicides.

Additionally, early identification and treatment of individuals with mental health and substance use disorders is critical. Non-specialized health workers, such as primary care physicians, can play a crucial role in assessing and managing suicidal behavior, particularly in areas with limited access to mental health specialists.

Healthcare providers offer follow-up care to individuals who have attempted suicide as an essential prevention strategy. These individuals are at a significantly higher risk of future suicide attempts, so it is vital that they receive continued care and support after their initial crisis has passed. This can include mental health counseling, support groups, and community-based resources.

Addressing Social Stigma and Taboos

One of the most significant barriers to effective suicide prevention is the social stigma surrounding mental health issues and suicide. Many at-risk individuals avoid seeking the help they need because they fear judgment or ostracization. In some cultures, people view it as a taboo subject, which further discourages individuals from seeking help.

Raising awareness about the importance of mental health and breaking down the stigma surrounding suicide is an important step in reducing suicide rates. Efforts to educate communities about mental health, provide resources for those in crisis, and promote open discussions about suicide can help create a more supportive environment for individuals struggling with suicidal thoughts.

Suicide Prevention in Cultural Groups

Certain cultural groups, such as American Indians and Alaskan Natives, have disproportionately high suicide rates. Tailored strategies that respect the unique cultural and spiritual practices of these groups can be more effective in reducing suicide. This includes supporting intergenerational relationships, fostering economic opportunities, and incorporating traditional healing practices into suicide prevention efforts.

Providing Support to Individuals at Risk

If you know someone who struggles with suicidal thoughts, it is important to offer support in a compassionate and non-judgmental way. Encouraging the individual to seek treatment for any underlying mental health conditions is critical. Establishing a support network of family, friends, or community resources can help the individual feel less isolated. It’s also important to remind them that suicidal feelings are often temporary and that with the right treatment and support, they can get through the crisis.

If someone is in immediate danger of harming themselves, it is important to seek help right away by calling a hotline, such as the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), or contacting emergency services.

Conclusion

Suicide, a preventable tragedy that impacts individuals, families, and communities around the world. Through early detection, effective treatment, and comprehensive prevention strategies, we can reduce the incidence of suicide and provide support to those who need it most. It is essential to continue raising awareness about mental health, breaking down the stigma, and providing resources to those in crisis. By working together, we can make a difference in the fight against suicide.

Continue Your Education

To learn more about the symptoms, forms, and treatment of depression, check out our Certificate in Depression or take the individual course on Suicide Assessment, Treatment, and Prevention.