An Introduction to Suicide
- Predisposing elements e.g., environment that sets the stage for vulnerability e.g., family history of suicide.
- Contributing elements (worsen existing risk) e.g., substance abuse.
- Precipitating elements (trigger for predisposed person) e.g., sudden loss or failure.
- Protective elements e.g., availability of at least one adult for warmth, care, and understanding.
Suicidal feelings always occur in a context. Evaluating and understanding the context of suicide is often to first step to developing support. Context can include:
- Individual level
- Family
- Peers
- School
- Other environment
Signs of Suicide Risk
Individual risk factors
- Mental illness
- Depression/anxiety
- Poor impulse control
- Confusion/conflict with sexual identity
- Loss of significant relationships
- Compulsive, extreme perfectionism.
- Lack skills to manage decision making, anger, problem solving, or sense of low status
- Feeling a sense of powerlessness or hopelessness.
- Victim of sexual abuse.
- Pregnancy or fear of pregnancy
- Fear of humiliation
Behaviour risk factors
- Prior suicide attempt
- Alcohol drug abuse
- Aggression/rape
- Running away
- School failure, truancy
- Fascination with death, violence
- Detailed plan of how, when, where.
Family Risk Factors
- Family history of suicide
- Changes in family structure through death, divorce, re-marriage, etc.
- Family involvement in alcohol
- Lack of strong bonding attachment with family
- Unrealistic parental expectations
- Violent, destructive parent-child
- Inconsistent, unpredictable parental behaviour
- Depressed, suicidal parents
- Physical, emotional, or secual abuse
Peer Factors
- Social isolation
- Negative attitude towards help seeking
- Peer modelling
- Teasing/cruelty/bullying
- Interpersonal loss
- Rejection
- Death, especially by suicide.
- School Factors
- Longstanding history of negative school experience
- Lack of meaningful connection to school
- Failure
- Expulsion
- Bullying
School Factors
- History of negative school experience
- Lack of meaningful connection to school
- Failure
- Expulsion
- Bullying
- Inappropriate or inequitable teaching methods for individuals
Community Factors
- Community legacy of suicide e.g., in Limerick when the helicopter flies overhead everyone worries that someone’s in the river having jumped off the bridge.
- Marginalisation
- Media portrayal of suicide
- Reluctance about how to help among gatekeepers
- Inaccessible community resources
- Economic deprivation
- Conflict with the law
- Death especially by suicide.
- Local laws around suicide and inheritance
Culture/ Social Factors
- Attitudes to suicide
- Attitudes to help seeking
- Isolation
- Religious attachment
- Acceptance
Environmental Risk factors
- Access to lethal means
- Religious conflicts
- Social isolation or turmoil
- Exposure to suicide or peer
- Anniversary of someone else’s suicide
- Incarceration/ loss of freedom
- High levels of stress; pressure to succeed
- Over-exposure to violence in mass media
- Threat of STD
General risk factors
- History of suicidal behaviours
- Mental illness
- Alcohol drug abuse
- Poor problem solving skills
- Relatioponship problem solving skills
- Impulsivity (especially if out of character)
- Early school leaving
- Unemployment
- Suicide/parasuicide in family/friend. Parasuicide refers to non-fatal injury that had intent for serious self-harm or death.
- Negative approach to help seeking
- Sexuality
- Poor help seeking ability
Other Signs: F.A.C.T.s
There are a number of specific feelings, actions, changes, and thoughts (F.A.C.T.s) that can indicate someone is feeling suicidal.
Feelings
- Desperate
- Angry
- Guilty
- Worthless
- Lonely
- Sad
- Hopeless
- Helpless
Actions
- Giving away possessions
- Withdrawal (family, friends, school, work)
- Loss of interest in hobbies
- Abuse of alcohol, drugs
- Reckless behaviour
- Extreme behaviour changes
- Impulsivity
- Self-mutilation
Changes
- Lack of interest in physical appearance
- Disturbed sleep
- Change/loss of appetite, weight
- Physical health complaints
- Loss of interest in sex
- A persistent lack of interest in usual activities
- Any form of self-mutilation
- Poor body image
- Self-esteem issues
- Academic failure
- Exam stress
- Trouble with the law
Thoughts (rough examples)
- “all my problems will end”
- “no one can do anything to help me”
- “now I know what they were going through”
- “I just can’t take it anymore”
- “I wish I were dead”
- “everyone will be better off without me”
- “I won’t be needing these things anymore”
- “I can’t do anything right”
- “I just can’t keep my thoughts straight anymore”
Counterintuitively, people can sometimes act very calm, happy and carefree when they plan on engaging in suicide. The thought of not having to deal with problems in the future can provide a misleading sense of freedom. This is especially important to consider if underlying issues have not been addressed with.
Helping Strategies
Immediate help can involve: staying, listening, encouragement, and planning for the future (short, medium, and long term). Long term help can include counselling or other forms of appropriate support. Suicide must never be treated as a form of attention seeking. This can come off as insulting and increase risk. It's important not to refer to someone feeling suicidal as "stupid" or "don't be daft". This shows a lack of understanding from the listener and can come off as judgemental and insulting. A sealed note is a late sign in progression towards suicide. In this context a promise to keep a note unopened and unread should be broken if it could help save a life. It's important that people have follow up care. An estimated 10% make another suicide attempt after their first one. Talking about suicide does not someone suicidal. It's important to normalise talking about this issue.
Fictional portrayals of suicide do not usually reflect reality or pain. While it's important to be gentle, it's also important not to dance around the topic. Asking directly "are you suicidal?" can be an effective way to get someone to talk about the issue. Many people who are suicidal have mixed feelings. Talking about feelings can be the first step towards understanding and dealing with a crises. Most people who are sucidial will only feel that way for a limited time. Given proper support they will probably recover. No one is suicidal all the time.
No matter how well intentioned, alert or diligent people’s efforts may be, there is no way of preventing all suicides all the time from occurring. Look after your own mental health as well.
Prevention
Personally, I believe everyone should develop a mental support plan for themselves. If everyone had one there would be no stigma in having a plan. Instead there would be a stigma in not having one. This plan can include all the things that make you happy and people you can go to for support. Depression can inhibit mental function and the ability to think clearly or make plans. That's why I think people should develop plans BEFORE they get sad. This can include a list of things you're grateful for, pictures of things that make you smile, a list of good memories, or things to look forward to. It's a fun positive exercise that I hope will get introduced into schools one day.
Support Services (Ireland)
Please email us if you have support suggestions, or if any contact information is out of date: info@mentaldiy.com If anyone has any concerns about a group or individual in any suicide support service, you can report it anonymously to the charity regulations officer: https://www.charitiesregulator.ie/en