September 10 is "World Suicide Prevention Day. On this day, worldwide attention is drawn to suicide prevention and mental health issues. It is imperative that we continue to make every effort to reduce the number of suicides and suicide attempts. Especially by translating knowledge about effective suicide prevention into concrete plans and actions.
Suicidality and all aspects associated with it have a huge social impact. But how do you identify suicidality and how do you make it negotiable? Brian Gerrits, therapist at U-center, explains what factors play a role and what to look out for as a caregiver or as a loved one.
What is suicidality?
Suicidality is about suicide and everything that can lead to it. Suicidal thoughts, suicidal ideation, suicidal plans, suicidal attempts and self-mutilation all fall under suicidality. The latter two are not always aimed at suicide but do have the goal of wanting to change problems. Suicidality is not a state but a process with a progression.
If you are now thinking, "I'll skip this topic, I have nothing to do with this," then this would be very unfortunate. By not making suicide discussable, the taboo around suicidality only continues. Prevention and knowing how to deal with the aspects that play a role in suicidality are very important. It is also good to know that in many mental disorders, aspects of suicidality are part of the disorder according to the DSM-V (Diagnostic and Statistical Manual of Mental Disorders). Think of people with depression for example, who have suicidal thoughts or someone with borderline who does self-mutilation.
Signs of suicidal behavior
Some factors by which you can recognize suicidal behavior or thoughts of suicide in your loved ones or in clients are:
- Somberness, hopelessness, despair, statements about wanting to die (always take these seriously and engage in conversation)
- Mood swings
- Mulling
- No goals or future prospects
- Threats of doing something to oneself
- Missing or running away
- Reckless behavior (antisocial driving e.g.)
- Neglect
- Anxious
- Delusions and hallucinations
- Restless and distraught
- Poor sleep
- Isolating, withdrawing, not going out
- Masking (e.g.: being very cheerful while not appropriate to the situation (incongruity))
- Giving possessions away
- Flattened or not feeling emotions
Quote
A former client of mine, whom I asked about his death wish, was surprised that I was genuinely interested and dared to ask about this. So much information came up that made it easier to help him.
Brian Gerrits, therapist at U-center
Preventive interventions in suicide
A former client of mine, whom I asked about his death wish, was surprised that I was genuinely interested and dared to ask about this. So much information came up that made it easier to help him. I also ask clients who self-mutilate about the underlying meaning of the behavior. Clients give so much information and make themselves vulnerable. As a result, I am quicker to recognize, for example, if someone has experienced inner pain. That brings me to listing the preventive interventions that can reduce the risks of successful suicide or a progression of suicidality.
1. Be involved and show understanding
Enter into the conversation without judgment and without filling in for the other person what is right. I have sometimes experienced loved ones saying, "Don't be ridiculous!" This causes someone to go even further out of touch and reinforces the not being understood. Ask for what the other person needs at this time.
2. Refer to 113 and call the family doctor together
Do this only when you have elicited sufficient signals and there is also safety and trust to support the other person.
3. Discuss thoughts and despair in a nonjudgmental way
While doing so, ask about occasion, mood and possible plans. Discuss, motivate and refer/advise.
4. Above all, follow your gut feeling
Often this is there for a reason. If you feel something is not right, listen to it.
5. Be alert to risk factors
Pay close attention to the factors that may pose a risk for suicidal behavior around suicidality, demographic and social factors, psychological factors, health factors and care-related factors.
6. Do it together, and not alone!
I am very happy with my colleagues at U-center and especially also the psychiatrists with whom I can consult when someone shows suicidal behavior. At the same time, sociotherapists and also staff at the restaurant signal striking statements and behaviors. Together you signal and observe more. Do not carry the responsibility alone, but involve family, loved ones who feel good for the other person.
7. Involve social workers as well
Do so as soon as possible after you discuss the signs and when suicidal behavior has occurred.
Crisis interventions in suicidality
When there is a threat or attempt of suicide, we speak of a crisis situation. In such a situation there are some crisis interventions, such as:
1. Contact the crisis service, family doctor or mental health institution
Is contact no longer possible and is the threat high? Then call emergency services. They will arrange for possible transfer to the crisis service. If the person already has help from a mental health institution, call that institution's crisis service. If they have no crisis service, call your own family doctor or primary care physician.
2. Provide a safe environment
If someone lives in an apartment, close doors and windows or have someone stay with you. Be alert for (hidden) medication or belongings. Also be alert to the living environment: coat rack, balcony, meter closet, handles, bathroom, stairwell, attic, etc. Reduce the chances of attempted and successful suicide. Therefore, stay with someone even if he or she does not want to talk, wait for emergency services to arrive and transfer.
3. Does anyone have certain emergency medication?
Some people have medication or emergency medication as needed that can be taken during a crisis situation. This medication can be included in both an alert plan and a crisis card.
4. Create a small crisis map with and for the other person and/or discuss it
For many people it helps to make a small crisis card or an alert plan with an emergency plan that clearly states which contact persons can be called, which mental health practitioner or institution should be called in, which medication can and cannot be given and finally name and address details with the policy number of the health insurance company. Besides making a crisis card, you can also make an application at www.crisiskaart.nl in your region.
5. Make a non-suicide contract if necessary
In this, a caregiver or loved one makes written agreements that the person will not commit suicide. This also includes agreements that caregiver or loved one is available to support the person in crisis situations.
6. The sooner you intervene the more preventative it works
For example, I remember a situation at my previous employer where a loved one called me to ask me to come over because my client had expressed suicidal thoughts. An hour later we were at the family doctor's office voluntarily and two hours later we were at the crisis service. Because of the quick action, an admission was not necessary and this client recovered faster.
We can't always see underwater
It has now been some 13 years since a family member of mine died after a suicide attempt, just when things seemed to be going so well. Intensive counseling had already been involved for a long time, yet she ended her life. Is suicide or suicidality always preventable? No! During my career I came across suicides in which both assistance was involved and where the environment knew about the suicidality.
We can't see underwater all the time. And we can't be with someone every second. Suicidality is far too complex a topic for that. At the same time, you and the other person must be open to discussing suicidality.
So always be aware, when you have done everything possible, that the possibility of suicide always remains. So do not feel guilty, but accept that it is a complex issue that cannot always be resolved, especially if there is chronic suicidality where the emphasis is more on learning to cope.
Are you thinking about suicide?
Make it negotiable and get help. Contact 113's helpline at 0800-0113 or go to 113.co.uk.