What is the Problem?

Every 40 seconds around the world a person dies by suicide. Over 800,000 people die by suicide every year and there are many more who attempt suicide. For all ages, suicide is one of the leading causes of death in Australia. In 2016, 2,866 people died from intentional self-harm in Australia, which equates to around eight deaths every day. Deaths from intentional self-harm occur among males at a rate three times greater than that for females. The statistics are similar across many Western countries and throughout much of the globe. Yet suicide is preventable. Quite simply, as professionals and as members of the community, we need to do more to prevent suicide.

Suicide is a complex issue. This article conveys some important but basic information for identifying factors related to suicide. However, it is not intended to be, and should not be, relied on as a substitute for specific medical or health advice, nor does it replace training or professional consultation. To ensure a safe response to potential suicide risk, seek professional support and/or formal training in suicide prevention. 

What is Suicide?

The language, terms, and concepts used around the world in relation to suicide are inconsistent and variable. However, there is clear international agreement on some of the terms that should not be used when discussing suicide. For example, in place of the more emotive and / or stigmatising terms including “successful suicide”, “failed suicide attempt” and “commit suicide”, it is important to utilise appropriate terms such as “completed suicide”, “non-fatal suicide attempt”, and “death by suicide”.

The most precise terms used in Western Australia are as follows:

  • Suicide is an act of deliberately killing oneself.
  • Suicidal ideation is consideration of killing oneself.
  • A suicide attempt is an act with the underlying intent of killing oneself.
  • Non-suicidal self-injury is deliberate self-injury that does not have the underlying intent of killing oneself.
  • Self-harm is an overarching category that encompasses all suicidal and non-suicidal self-injury.

Why do People Suicide?

It is important to acknowledge that external appearances are irrelevant. Individuals who may appear to have everything going for them in life – a seemingly positive family unit, supportive peers, gainful employment, abundant assets, etc. – can, and do, kill themselves. To the individual suffering, none of this matters. Most people with suicidal thoughts do not actually want to die, yet they may be unable to see a way out of the problems they are facing and consequently view suicide as their only option. Their perception is their reality.

Appropriate intervention can support suicidal individuals to resolve their problems and instil a sense of hope for the future.

Factors that Influence Suicide

Suicide is rarely the result of a single event or factor. It is usually a result of a person feeling hopeless, alone, and viewing themselves as a burden to others.

In contrast, non-suicidal self-injury often results from a desire to replace unbearable psychological pain, to release psychological tension, and to break through psychological numbness.

In instances of both suicidal and non-suicidal self-injury, a combination of biological, psychological and environmental factors are likely to contribute. While we can never accurately predict who will suicide, or be truly certain why someone will attempt to end their own life, knowing the prominent risk factors and warning signs can assist us to identify and intervene with the individuals who are most vulnerable to suicide.

Risk factors, protective factors, warning signs and tipping points play an integral role in understanding suicide. These are defined below. For clinicians, identifying such factors provides critical information to inform assessment and intervention strategies to ameliorate suicide risk. Simply stated, decreasing risk factors and / or increasing protective factors decreases suicide risk.

Risk factors are characteristics that increase the likelihood that individuals will consider, attempt or die by suicide.

Protective factors are characteristics that decrease the likelihood that individuals will consider, attempt, or die by suicide.

Risk and protective factors are found at various levels:

  • individual (e.g., genetic predispositions, mental disorders, personality traits),
  • social / family (e.g., cohesion, dysfunction, availability of supports), and
  • community / contextual (e.g., availability of mental health services).

They may be fixed and unchanging (e.g., family history of suicide) or modifiable and amenable to intervention (e.g., depressive episode).

Warning signs are an early indication, or signpost that gives early warning of the potential for suicidal behaviour. Warning signs indicate an immediate risk of suicide, whereas risk factors indicate that an individual is at heightened risk for suicide, but suggest little or nothing about immediate risk.

Tipping points are the point at which a person’s risk of taking their own life increases due to the occurrence of some precipitating event; immediate stressors that provide the final impetus for suicidal behaviour.

For individuals, families, and communities, it is important to be aware of these factors to ensure that any individuals at increased risk of suicide are referred to an appropriately qualified health professional for formal assessment. It is important to acknowledge the complex interplay of risk factors, protective factors, warning signs, and tipping points: having many risk factors does not mean that an individual will suicide or attempt suicide; similarly if an individual has a range of protective factors they may still suicide or attempt suicide. Elevated risk for suicide is usually found in a combination of multiple risk factors.

Below is a (non-exhaustive) summary of some of the more prominent factors.

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What Can You Do to Help?

It is important to understand that there are known characteristics that improve outcomes for suicidal people. When engaging with individuals potentially at risk of suicide, we all need to take responsibility to ensure that we acknowledge suicide as:

  • understandable: the suicidal person is in acute distress and sees no other option but to kill themselves;
  • interpersonal: the suicidal person needs social connection and engagement to be supported to move from their acute suicidality;
  • transient: acute suicidality is generally linked to negative environmental events;
  • ambivalent: suicidal individuals often want the pain of living to stop but see suicide as the only option; and
  • preventable: we all need to work towards a goal of having zero suicides in our community holding the underlying belief that suicide is preventable.

Communities need to ensure that appropriate suicide prevention initiatives are supported by local and State government.

It is integral that suicide prevention is systematic and evidence-based and encompasses primary prevention, early intervention, and postvention.

Primary prevention involves addressing the likelihood of individuals becoming suicidal by reducing environmental stressors, improving coping strategies, and building resilience.

Early intervention involves identifying, engaging, and supporting individuals who have become suicidal by linking these individuals with supports and referring for professional assessment and intervention.

Postvention involves evaluating and addressing the systemic gaps that did not prevent an individual attempting or completing suicide, including via broad-based community engagement, education, and intervention.

For Professionals

Suicide Risk Assessment Australia (SRAA) is a great resource for training around suicide assessment, prevention, and intervention. By engaging in training with SRAA, you can ensure that you are equipped to appropriately manage any clients experiencing a suicidal crisis. (Disclaimer: the author contracts to SRAA as a Consultant Clinical Psychologist and Workshop Facilitator).

Mario Andolfi, a world-famous Master Family Therapist and Master Teacher is presenting a workshop in May 2018 that aims to provide an understanding of how best to intervene with at-risk youth.

For Carers and Family Members

Alternatives to Suicide is an innovative peer-led suicide prevention approach from the Western Massachusetts Recovery Learning Community in the USA. A number of workshops are being presented in Perth throughout 2018.

For Community Members

By providing a safe, respectful, non-judgmental and supportive space for members to share experiences, resources, and events that promote mental health, resilience, and social and emotional wellbeing, the FreoMind Facebook group is one resource for the community that addresses some of the contributing factors to suicidality. Please join the FreoMind community and encourage others that may benefit from being in the group to do the same.

Lifeline Australia is one of Australia’s most well-known providers of crisis support and suicide prevention services. By volunteering your time and skills to Lifeline you can help people experiencing a suicidal crisis.

A newly funded four-hour Mental Health First Aid for the Suicidal Person course teaches people how to see subtle signs, approach someone they are worried about, and support them throughout their crisis.

If you are concerned that someone you know might be having suicidal thoughts or is planning to kill themselves, it is important to take what they say seriously and act immediately. Ask them directly about whether they are having thoughts of suicide and if they have a plan for how they will do it. This will not “put thoughts into their head” and is vitally important in assessing their risk of suicide and ensuring that they get the help that they need. If we don’t ask, we won’t know, and if we don’t know, we can’t help.

If you believe that an individual person is at immediate or high risk of attempting suicide, you should:

  • stay with them (or arrange for supervision) until they can be assessed by a mental health professional;
  • remove access to methods of suicide or self-injury (such as sharp objects, medications, alcohol or other drugs); and
  • contact a local mental health service, call Life Line on 13 11 14, call 000, or take them to the local emergency department for further assessment.

For Individuals in Crisis

All Australians experiencing a personal crisis have access to 24 hour crisis support and suicide prevention services via Lifeline Australia on 13 11 14.

References

Australian Bureau of Statistics (2016). 3303.0 – Causes of Death, Australia, 2016. Retrieved from: http://www.abs.gov.au/ausstats/abs@.nsf/mf/3303.0

Harris, E. C., & Barraclough, B. (1997). Suicide as an outcome for mental disorders. A meta-analysis. British Journal of Psychiatry, 170(3), 205-228. doi: 10.1192/bjp.170.3.205

World Health Organisation (2014). Preventing suicide: A global imperative. Retrieved from: http://apps.who.int/iris/bitstream/10665/131056/1/9789241564779_eng.pdf

The FreoMind team will be contributing a regular column to this publication. If you have any requests for our column to address a topic related to mental health, resilience, or social and emotional well-being that you believe would benefit the Fremantle community, FreoMind are open to suggestions. Get in touch via kaine.grigg@gmail.com and join the FreoMind community.

These columns are for general information only. They are not intended to be, and should not be, relied on as a substitute for professional medical or health advice.

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Kaine Grigg

Dr Kaine Grigg is co-founder of, and consultant clinical psychologist for, FreoMind. He is also the Principal Consultant Psychologist for the Australian Clinical and Forensic Psychology Services, a Consultant Clinical Psychologist with Suicide Risk Assessment Australia and a clinical psychologist within the WA Departments of Justice and Health. Kaine has a wealth of clinical knowledge and experience from working with children and adolescents, individuals impacted by substance use/dependence, trauma and those with offending histories. Kaine will be contributing a regular column to Freo Pages on behalf of Freo Mind. Articles will address all topics related to mental health, resilience and social and emotional wellbeing relevant to the Fremantle community.