SEEKING HELP: A GUIDE TO MENTAL HEALTH RESOURCES FOR SUICIDE AND SELF HARM PREVENTION

Definition of Suicide

Suicide is the act of intentionally causing one’s own death. It is often the result of a complex interplay of various factors including mental health disorders, such as depression, anxiety, and bipolar disorder, as well as life stressors like financial problems, relationship issues, or chronic illness. The intent behind suicide is to end one’s life due to overwhelming emotional pain or a perceived lack of alternatives.

Definition of Self-Harm

Self-harm, also known as self-injurious behavior (SIB), self-mutilation, non-suicidal self-injury (NSSI), parasuicide, deliberate self-harm (DSH), self-abuse, and self-inflicted violence, refers to the act of deliberately hurting oneself without the conscious intent to die. This behavior often results in damage to body tissue and can include actions such as cutting, burning, or hitting oneself. The primary purpose of self-harm is typically to cope with emotional distress or psychological pain rather than an attempt to end one’s life.

Global Statistics

• Annual Deaths: More than 700,000 people die due to suicide every year globally.
• Attempted Suicides: For every suicide, there are many more people who attempt suicide. A prior suicide attempt is a significant risk factor for future suicides.
• Age Group Impact: Suicide is the fourth leading cause of death among 15–29-year-olds worldwide.
• Geographical Distribution: Approximately 77% of global suicides occur in low- and middle-income countries.

Methods of Suicide

• Common Methods Globally: The ingestion of pesticides, hanging, and firearms are among the most common methods of suicide globally.
• Pesticide Self-Poisoning: Around 20% of global suicides are due to pesticide self-poisoning, predominantly in rural agricultural areas in low- and middle-income countries.

Demographic Variations

Certain groups have higher rates of suicide:

• Age Groups: Young people (ages 10 to 34) have particularly high rates.
• Vulnerable Populations: Refugees, migrants, indigenous peoples, LGBTI persons, and prisoners are at increased risk due to factors like discrimination and isolation.

Differences Between Suicide and Self-Harm

While both suicide and self-harm involve inflicting harm on oneself, they differ significantly in terms of intent and outcome:

• Intent: The primary distinction lies in the intent behind the actions. Suicide is driven by a desire to end one’s life permanently. In contrast, self-harm is generally a coping mechanism aimed at managing intense emotions or psychological pain without an intention to die.
• Outcome: Suicide results in death if completed successfully. Self-harm usually does not aim for death but rather seeks temporary relief from emotional suffering.

Overlap Between Suicide and Self-Harm

Although distinct in their definitions and intents, there can be overlap between suicide and self-harm:

• Escalation: Self-harming behaviors can sometimes escalate into suicidal behaviors over time. For instance, individuals who initially engage in self-harm may develop suicidal thoughts if their coping mechanism ceases to provide relief.
• Desensitization: Repeated episodes of self-harm can desensitize individuals to pain, making the idea of a suicide attempt less frightening during a crisis situation.

Risk Factors for Self-Harm

Several risk factors may predispose individuals to engage in self-harming behaviors:

• Loss of a parent
• Childhood illness or surgery
• Childhood sexual or physical abuse
• Family substance abuse
• Negative body image perceptions
• Lack of impulse control
• Childhood trauma
• Neglect
• Lack of strong family attachments

These factors may lead individuals to adopt self-harming behaviors as a learned coping mechanism to satisfy unmet emotional needs.

Reasons for Self-Harming

People may engage in self-harming behaviors for various reasons:

1. To Feel Better: Some individuals use self-harm as a way to release pent-up feelings such as anger and anxiety or to feel “something” when they are emotionally numb.
2. To Communicate Emotional Pain: Others may use self-harm as a means to express their internal suffering when they find it difficult to communicate their emotions verbally.

Triggers of Suicide

Suicide is a complex phenomenon that often results from a convergence of multiple factors. These factors can be broadly categorized into health-related, environmental, and historical triggers. Understanding these triggers can help in identifying individuals at risk and providing timely intervention.

Health-Related Triggers

1. Mental Health Conditions
   • Depression: The most common condition associated with suicide, often undiagnosed or untreated.
   • Substance Use Problems: Increases the risk of impulsive behavior.
   • Bipolar Disorder: Characterized by extreme mood swings.
   • Schizophrenia: Can involve hallucinations and delusions that may lead to suicidal thoughts.
   • Personality Traits: Aggression, mood changes, and poor relationships can contribute to suicidal ideation.
   • Conduct Disorder: Particularly in younger individuals.
   • Anxiety Disorders: Persistent anxiety can lead to feelings of hopelessness.
   • Serious Physical Health Conditions: Chronic pain or terminal illness can increase the risk.
   • Traumatic Brain Injury (TBI): Can affect cognitive function and emotional regulation.

Environmental Triggers

1. Access to Lethal Means
   • Availability of firearms, drugs, or other means can facilitate suicide attempts.
2. Prolonged Stress
   • Situations such as harassment, bullying, relationship problems, or unemployment create ongoing stress that can lead to suicidal thoughts.
3. Stressful Life Events
   • Events like rejection, divorce, financial crisis, or other significant life transitions or losses can act as immediate triggers.
4. Exposure to Suicide
   • Knowing someone who has committed suicide or being exposed to graphic accounts of suicide can increase the risk.

Historical Triggers

1. Previous Suicide Attempts
   • A history of previous attempts significantly increases the likelihood of future attempts.
2. Family History of Suicide
   • Genetic predisposition and learned behaviors from family members who have committed suicide.
3. Childhood Abuse, Neglect, or Trauma
   • Early life trauma can have long-lasting effects on mental health and increase the risk of suicidal behavior.

Additional Considerations

• Changes in behavior or new behaviors related to painful events are critical warning signs.
• Expressions of hopelessness, feeling trapped, being a burden to others, or experiencing unbearable pain are verbal indicators that someone might be considering suicide.

Understanding these triggers helps in recognizing when someone might be at risk and taking appropriate action to provide support and intervention.

Common Predictors of Suicide

Suicide is a complex issue influenced by various factors, and there are common predictors that can indicate an increased risk of suicidal behavior. These predictors can help identify individuals who may be at higher risk for suicide. Some of the common predictors of suicide include:

1. Mental Health Conditions: Mental health conditions such as depression, anxiety disorders, bipolar disorder, schizophrenia, and substance use problems are significant predictors of suicide. Individuals with untreated or poorly managed mental health issues are at a higher risk of suicidal behavior.
2. Previous Suicide Attempts: A history of previous suicide attempts is a strong predictor of future suicide attempts. Individuals who have attempted suicide in the past are at a heightened risk of trying again.
3. Family History of Suicide: Having a family history of suicide can also be a predictor of suicidal behavior. Genetic and environmental factors may contribute to an increased risk within families.
4. Access to Lethal Means: Easy access to lethal means like firearms or drugs increases the likelihood of impulsive suicidal acts. Restricting access to these means can help prevent suicides.
5. Prolonged Stressful Situations: Persistent stressors such as harassment, bullying, relationship problems, unemployment, financial crises, and other life transitions can contribute to feelings of hopelessness and despair, increasing the risk of suicide.
6. Traumatic Experiences: Traumatic events like childhood abuse, neglect, trauma, or exposure to another person’s suicide can also serve as predictors for suicidal behavior.
7. Changes in Behavior: Sudden changes in behavior such as increased alcohol or drug use, social withdrawal, giving away prized possessions, expressing feelings of hopelessness or being a burden to others can be warning signs that someone is at risk for suicide.
8. Mood Changes: Persistent feelings of depression, anxiety, irritability, agitation, or sudden improvements in mood (which may indicate a decision to attempt suicide) are important mood-related predictors to watch out for.
9. Isolation and Withdrawal: Social isolation and withdrawing from activities or relationships can be indicators that an individual is struggling with suicidal thoughts.
10. Verbal Cues: Direct verbal cues such as talking about wanting to die, feeling trapped or hopeless, or being a burden on others should be taken seriously as potential predictors of suicidal behavior.

Identifying these common predictors and warning signs early on can help in intervening and providing support to individuals at risk for suicide.

Management Plan for Suicide Pathologies

1. Establish a Therapeutic Relationship

Building a trusting and supportive relationship with the patient is essential. The nurse should demonstrate empathy, active listening, and a non-judgmental attitude to create a safe environment for the patient to express their feelings and concerns. This involves:

• Empathy: Understanding and sharing the feelings of the patient.
• Active Listening: Fully concentrating, understanding, responding, and remembering what the patient says.
• Non-Judgmental Attitude: Avoiding judgments based on personal beliefs or biases.

2. Conduct a Comprehensive Assessment

Performing a thorough assessment of the patient’s mental health status is crucial. This includes evaluating suicidal ideation, intent, and plan. Key components are:

• Mental Health Status Examination: Assess mood, thought processes, cognition, and behavior.
• Suicidal Ideation Assessment: Determine if there are specific thoughts about suicide.
• Intent and Plan Evaluation: Assess if there is an intention to act on suicidal thoughts and if there is a specific plan in place.
• Underlying Conditions: Identify any psychiatric disorders (e.g., depression, schizophrenia), substance abuse issues, or psychosocial stressors contributing to suicide risk.

3. Implement Safety Measures

Immediate steps must be taken to ensure the patient’s safety:

• Remove Harmful Objects/Substances: Eliminate access to items that could be used for self-harm.
• Close Observation: Monitor the patient closely according to facility policies.
• Suicide Precautions: Follow healthcare facility protocols for high-risk patients.

4. Collaborate on a Safety Plan

Work collaboratively with the patient to develop a personalized safety plan that includes strategies to manage suicidal thoughts or urges:

• Identify Support Systems: List family members, friends, or professionals who can provide support.
• Establish Coping Mechanisms: Develop strategies that have previously helped manage distress.
• Crisis Response Plan: Create a plan with emergency contact information for immediate help during crises.

5. Provide Education and Support

Educate patients about their condition and available resources:

• Condition Education: Inform patients about their mental health condition and its management.
• Resource Information: Provide details about support groups, hotlines, and community resources.

6. Facilitate Collaborative Care

Coordinate care with other healthcare providers:

• Interdisciplinary Team Meetings: Regularly discuss patient progress with psychiatrists, psychologists, social workers, etc.
• Referral Services: Refer patients to specialized services as needed (e.g., substance abuse treatment).

7. Promote Self-Esteem and Resilience

Encourage activities that build self-esteem and resilience:

• Positive Reinforcement: Acknowledge small achievements to boost confidence.
• Skill Development Workshops: Offer workshops on stress management, problem-solving skills.

Brief Interventions for Managing Suicidal Crises

Several brief interventions provide tools for managing suicidal crises effectively:

Safety Planning Intervention (SPI): Developed by Drs. Barbara Stanley and Gregory Brown, SPI involves collaboration between an individual and a mental health care provider to create a personalized safety plan. The plan includes identifying warning signs of an impending crisis and listing effective coping strategies.

Lethal Means Counseling: This intervention focuses on reducing access to means of suicide (e.g., firearms) through counseling sessions aimed at making environments safer.

Crisis Response Planning: A structured approach where individuals identify steps they will take during a crisis situation. It includes listing personal coping strategies and emergency contacts.

These interventions aim to provide immediate options other than suicidal behavior during high-risk periods when cognitive flexibility is reduced.