Topic Expert Roundup: What Can Be Done to Address Suicide?

The latest figures from the Centers for Disease Control and Prevention, from 2010, show that suicide is responsible for more deaths (38,364) than motor vehicle accidents (33,687) in the United States. But if suicides are vastly underreported, as many scholars and researchers insist, the official statistics don’t account for the true scope of their tragedy.

Consider, also, that for every completed suicide, there are between eight and 25 attempts. Add it all up and you’re left with immeasurable hurt and despair among not only those with suicidal thoughts, but their loved ones as well.

Suicide rates have been rising steadily since 2000, when—at 10.4 deaths per 100,000 people—they’d fallen to a 10-year low. That number had climbed to 12.1 by 2010. The CDC hasn’t yet arrived at figures for the past two-plus years, but the upward trend was expected to continue.

But why? For a person teetering on the edge of life, what ultimately tips the scale from hope to hopelessness? The reasons people take their lives vary greatly, of course, but research shows that socioeconomic status, sexual orientation, and gender identity are common issues that people considering suicide wrestle with. Depression and substance abuse are considered among the strongest risk factors.

While, proportionally, suicide affects more younger and elderly people, the suicide rate among middle-aged Americans—the so-called “baby boomer” generation—is cause for alarm. In the 35-64 age bracket, the rate rose by nearly 30% from 1999 to 2010, from 13.7 deaths per 100,000 people to 17.6. Far more men (27.3 per 100,000) than women (8.1) in this group committed suicide; among all age groups, the numbers were 19.9 and 5.2, respectively, despite females attempting suicide three times as often as males.

Sadly, most who attempt suicide never seek professional care. With September marking Suicide Prevention Awareness Month, GoodTherapy.org turned to its panel of Topic Experts for insight.

In an increasingly demanding and complex world, can the rates of suicide and suicidal ideation realistically be reduced? How? What steps can people take to help loved ones who may be feeling suicidal? What makes suicidal ideation so challenging from a therapeutic standpoint?

Here’s what they had to say:

• Tina Gilbertson (self-esteem): “Emotional literacy is key. There will probably always be people to whom nonexistence will seem a better option than staying alive. However, too many people who would rather live don’t know how to ride waves of strong negative emotions all the way back to shore. They’re not even sure there is a shore anymore; they feel lost at sea. And so they give up hope. … If children learned that painful feelings are normal and tolerable rather than strange and overwhelming, that emotions are temporary, and that even a good and worthwhile life is emotionally difficult sometimes, a layer of suffering would be removed in challenging times. Feelings (like despair) and actions (like suicide) might not be quite so enmeshed.”
• Margie Nichols (LGBT issues): “We all need to be concerned about the rates of suicide for LGBT young people—those in their teens and early twenties. The suicide rate for young Americans has risen dramatically over the past few decades, and LGBT kids attempt suicide two to five times more frequently than their peers. This is a serious problem, but we know the reasons for this and we have the means to prevent it. … The two major factors that lead to LGBT youth suicide are lack of family support and bullying and harassment at school. LGBT children and teens are more likely to end up homeless because they have been kicked out of their homes or run away from hostile families; they are abused by parents more frequently than other kids. And 85% to 90% of LGBT young people report being bullied—20% have been physically attacked at school! … It is imperative that we get the word out to parents that their disapproval will not only NOT change their child—it is likely to lead to depression, hopelessness, suicide, or self-harm. Don’t stand by silently if you have a friend, neighbor, or family member with an LGBT child—educate them! And it is essential that we address school bullying, not only through anti-bullying legislation and actions, but also by getting to the problem of LGBT harassment at its root. Schools need to go beyond teaching ‘tolerance’ for homosexuality; they need to educate students that being gay is a fully legitimate and equal lifestyle, and that discrimination against gay people is not only illegal, it’s immoral as well.”
• Betsy Sansby (depression): “ ‘How could he be so selfish?’ ‘How could he do that to his children/parents/wife/partner?’ These questions speak to the understandable anguish of those left behind in the wake of suicide. What they don’t speak to is the depth of despair that causes someone to end their own life. Imagine waking up each day with a dread so deep, so terrifying, so relentless that you want to rip your skin off, just to get rid of the pain. Only you know it won’t get rid of the pain. Nor have the drugs, nor the well-meaning therapists and doctors who reassure you that you’ll ‘likely feel better at some point’—and then explain that depressions like yours tend to recur. People who kill themselves aren’t ‘doing’ anything to their families. They are simply ending the unbearable torture that has become their lives.”
• Lynn Somerstein (object relations): “More people in the United States die from suicide than from car accidents—and some of those accidents might be suicides, too. … Suicide rates are increasing especially for men in their fifties and for women in their sixties. The boomers have always had higher-than-usual suicide rates. Their expectations for themselves and for society seem not to have come true, and they are caught in the middle, trying to provide for their parents and for their children, too. … Most people who commit suicide use guns; one way to prevent some of these deaths is to tighten gun laws with better background checks. The next-biggest cause of death is poison; people use prescription drugs—let’s control their availability, too. … Finally, people are scared to talk about suicide, another instance of ‘silence = death.’ Open discussion is a powerful preventive force. Suicides leave survivors in terrible pain and make it easier for the next generation to consider suicide as a choice.”
• Stuart Kaplowitz (anxiety): “I think when we hear that someone may be seriously depressed and wonder if they may considering taking their own life, we get scared. What can I do or say to best help? What if I say something and make it worse? We’re confused. So, instead of trying to help, we may think saying nothing is the better option and hope that someone or something else will help. … We need to be there, even if we do not say much—just be there. Let them know you want to support them and that you may not know what to do. One of the most important things that any of us can do is to help build their support system. They may even have such positive people in their life and yet these resources have no idea that this person is struggling. Help them make the connection; they need the support.”
• Diann Wingert (biofeedback/neurofeedback and adjusting to change/life transitions): “I have encountered many individuals who have shared that they were intermittently or even persistently suicidal while seeing a therapist and yet the subject of suicide was given only superficial attention. Standard questions such as, ‘Are you feeling like hurting yourself?’ or ‘Do you even think of killing yourself?’ really miss the point for many hurting people who don’t want to hurt themselves—they simply want to end their pain. For some, suicidal ideation takes the form of wishing they could go to sleep and not wake up, what I think of as passive suicidality. They may be seen as low risk as compared to the individual who is aggressively self-loathing and has a plan and the means to carry it out, but they require just as much attention, albeit perhaps of a different kind. As helping professionals, we need to do a better job of not being afraid of the other ‘S word’ and ask more insightful questions. When our instinct or intuition tells us the individual in front of us may be experiencing suicidal ideation, we need to be bold enough to ask a series of questions, if necessary, and do so in a manner that reflects our ability and willingness to hear the true answers.”
• Sarah Swenson (autism spectrum): “In therapy, suicidal ideation can be thought of as a slippery slope. Who among us, for example, has not had at least a moment of existential flash in which we wonder what it might be like if we simply ceased to exist? Is this suicidal ideation? Or, who has ever felt so overwhelmed by financial or personal problems that a fleeting thought of death crosses their mind as a possible solution? Is this suicidal ideation? These are quite common thoughts, actually, and seldom do they indicate an intent to commit suicide. But somewhere a line is crossed, and it is the line that separates thoughts from intentions. It can be invisible both to the individual and to a therapist. It is often seen only in hindsight, when a person comes out of a depression and realizes how close suicide seemed in the darkest moments. … The great challenge for the therapist is to listen carefully enough to hear the early whispers of intent, to sense the remote possibility that ideas have shifted, that plans for suicide are becoming possible. It can feel like identifying an underground river on the shifting sands. It is very difficult. The answer seems to lie in creating an atmosphere of trust with a client so he or she can voice early half-thoughts, or glimpses of thoughts, that can then be opened up and addressed before they blossom into suicidal plans and events. It is a profound challenge.”
• Ann Marie Sochia (hypnotherapy): “With suicide rates on the rise, it is important as family members, friends, and therapists that we all be aware of the most common signs of suicide ideation and what to do if we notice someone who is: (1) feeling sad or depressed most of time; (2) unable to enjoy and withdraws from the things previously enjoyed (for example, spending time with friends and family); (3) showing decreased self-esteem; (4) suddenly trying to tie up loose ends (e.g., giving away personal items, making a will); and (5) displaying uncharacteristic behaviors or emotions (calmness or peacefulness). … If you notice these signs in anyone you know, you should make every effort to have the person seek professional mental health care. If you believe someone has attempted suicide (such as taking too many pills), call 911 immediately. Suicidal ideation is a very serious mental health concern, one that should never be taken lightly, and it is not advisable that someone without professional training in dealing with suicide attempt to counsel a person who might be suicidal.”
• Blake Edwards (family therapy/family problems): “I work primarily with foster kids, and all too frequently a child or teen in our care has thoughts about harming or even killing themselves (the clinical terminology is ‘suicidal ideation’). We must consider such thoughts in context of their history, their development, and their most recent circumstances. We must attempt to provide such a compassionate response as to redirect and repair whatever misdirection and disruption is causing an increasing sense of isolation and lack of hope. … One of the more immediate, informal, and brief forms of assessment that I recommend anyone utilize when interacting with someone expressing a desire to die is captured in the acronym SLAP. ‘S’ is for ‘specificity.’ If one was going to harm him/herself, how would they do it? If the answer to this question is specific, risk is higher. If not, it is lower. ‘L’ is for ‘lethality.’ If a specific method is described, would such a method actually be lethal? If yes, higher risk; if no, lower risk. ‘A’ is for ‘access.’ Does the person have access to whatever tool or method they have described they would use to harm or kill themselves? If yes, higher risk; if not, lower risk. ‘P’ is for ‘proximity to help.’ If an attempt was made, will it likely happen in a situation in which someone could rescue the person and stop the attempt? If yes, the risk is lower; if not, higher. A very immediate, informal, and brief conversation can provide such risk assessment.”
• Angela Lee Skurtu (relational psychotherapy and sexuality/sex therapy): “Often, people avoid letting therapists know they are suicidal because they fear going into the hospital or losing their rights. Some have even learned how to speak in a way that keeps them from looking suspicious. Example: ‘I have had thoughts, but I would never do anything; I care too much about my family.’ As a therapist, it is important to set up a safety plan with your clients. In order to create safety for your clients to discuss suicide, take a neutral approach and explain that the plan is a precaution. First, try to set up two options: (1) they can admit themselves into the hospital, or (2) they can go under watch with a friend or relative. If they choose option No. 1, have them go immediately to their emergency room. If they choose option No. 2, make a list of all potential threats to their life in their household. Have them walk through their home with a relative or friend and give those potentially harmful items to the other person. Have the relative/friend stay for at least 24 hours, checking in periodically. Make sure to make a follow-up appointment with their psychiatrist to adjust any medications, and have them come back for counseling again as soon as possible.”
• Lillian Rozin (aging and geriatric issues): “Suicide is a frequent enough occurrence in the media alone that most people have at least a base awareness of its existence. Too few people, however, are aware of how to recognize the signs and what to do when they are observed. Add to this the prevalence of suicide threats over Facebook and other social media, and you arrive at a ‘sum’ of a nation poorly equipped to identify serious concerns and to report them in an appropriate manner. Once reported, they are also rarely handled well clinically, and so clients and concerned bystanders alike become loath to seek the help they need when the quality of our mental health crisis system is so bad. I have seen far too many people who have gone to a crisis center only to become severely drugged and/or traumatized without appropriate psychotherapy. They will rarely request treatment again if they feel suicidal. This is an issue that deserves a lot of attention and that sadly gets too little—from identification of a risk to its treatment, and to the family and friends trying to cope with all of the above.”
• Tonya Lapido (relational psychotherapy and multicultural concerns): “Suicide is a scary thought and reality for all of us. The most important thing we can do is to believe someone when they say (or even hint) that they are thinking of killing themselves. No one wants to consider that someone they care about wants to die. Often suicide is the last choice for people who are hopeless. It is an expression of despair. After the first step of believing the person, the second is to get help. Go to a professional who can offer the necessary supports. Contact your local suicide hotline; they will walk you through the steps of helping yourself, your friend, or your family member.”

If you’re in crisis, please call 911, go to the nearest emergency room, or call the National Suicide Prevention Lifeline at 1-800-273-8255.

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