Suicide Prevention (Part 1)

If You Know Someone in Crisis

Call the National Suicide Prevention Lifeline (Lifeline) at 1-800-273-TALK (8255), or text the Crisis Text Line (text HELLO to 741741). Both services are free and available 24 hours a day, seven days a week. The service is available to everyone. The deaf and hard of hearing can contact the Lifeline via TTY at 1-800-799-4889. All calls are confidential. Contact social media outlets directly if you are concerned about a friend's social media updates, or dial 911 in an emergency. Learn more on the Lifeline's website (Link opens in a new windowhttps://suicidepreventionlifeline.org) or the Crisis Text Line's website (Link opens in a new windowhttps://www.crisistextline.org).

The Veterans Crisis Line (Link opens in a new windowhttps://www.veteranscrisisline.net) connects service members and veterans in crisis, as well as their family members and friends, with qualified, caring Department of Veteran's Affairs (VA) responders through a confidential toll-free hotline, online chat, or text messaging service. Dial 1-800-273-8255 and Press 1 to talk to someone, or send a text message to 838255 to connect with a VA responder. You can also start a confidential online chat session at Link opens in a new windowhttps://www.veteranscrisisline.net/get-help/chat.

Introduction

Suicide is a major public health concern. Over 47,000 people died by suicide in the United States in 2017; it is the 10th leading cause of death overall.¹ Suicide is complicated and tragic, but it is often preventable. Knowing the warning signs for suicide and how to get help can help save lives.

Signs and Symptoms

The behaviors listed below may be signs that someone is thinking about suicide:

• Talking about wanting to die or wanting to kill themselves
• Talking about feeling empty, hopeless, or having no reason to live
• Making a plan or looking for a way to kill themselves, such as searching for lethal methods online, stockpiling pills, or buying a gun
• Talking about great guilt or shame
• Talking about feeling trapped or feeling that there are no solutions
• Feeling unbearable pain (emotional pain or physical pain)
• Talking about being a burden to others
• Using alcohol or drugs more often
• Acting anxious or agitated
• Withdrawing from family and friends
• Changing eating or sleeping habits
• Showing rage or talking about seeking revenge
• Taking great risks that could lead to death, such as driving extremely fast
• Talking or thinking about death often
• Displaying extreme mood swings, suddenly changing from very sad to very calm or happy
• Giving away important possessions
• Saying goodbye to friends and family
• Putting affairs in order, making a will

If these warning signs apply to you or someone you know, get help as soon as possible, particularly if the behavior is new or has increased recently. Here are five steps you can take to #BeThe1To help someone in emotional pain:

1. ASK: "Are you thinking about killing yourself?" It's not an easy question, but studies show that asking at-risk individuals if they are suicidal does not increase suicides or suicidal thoughts.
2. KEEP THEM SAFE: Reducing a suicidal person's access to highly lethal items or places is an important part of suicide prevention. While this is not always easy, asking if the at-risk person has a plan and removing or disabling the lethal means can make a difference.
3. BE THERE: Listen carefully and learn what the individual is thinking and feeling. Research suggests acknowledging and talking about suicide may in fact reduce rather than increase suicidal thoughts.
4. HELP THEM CONNECT: Save the National Suicide Prevention Lifeline's number in your phone so it's there when you need it: 1-800-273-TALK (8255). You can also help make a connection with a trusted individual like a family member, friend, spiritual advisor, or mental health professional.
5. STAY CONNECTED: Staying in touch after a crisis or after being discharged from care can make a difference. Studies have shown the number of suicide deaths goes down when someone follows up with the at-risk person.

Risk Factors

Suicide does not discriminate. People of all genders, ages, and ethnicities can be at risk. Suicidal behavior is complex, and there is no single cause. Many different factors contribute to someone making a suicide attempt. However, people most at risk tend to share certain characteristics. The main risk factors for suicide are

• Depression, other mental disorders, or substance abuse disorder
• Certain medical conditions
• Chronic pain
• A prior suicide attempt
• Family history of a mental disorder or substance abuse
• Family history of suicide
• Family violence, including physical or sexual abuse
• Having guns or other firearms in the home
• Having recently been released from prison or jail
• Being exposed to others' suicidal behavior, such as that of family members, peers, or celebrities

Many people have some of these risk factors but do not attempt suicide. It is important to note that suicide is not a normal response to stress. Suicidal thoughts or actions are a sign of extreme distress, not a harmless bid for attention, and should not be ignored.

Often, family and friends are the first to recognize the warning signs of suicide and can be the first step toward helping an at-risk individual find treatment with someone who specializes in diagnosing and treating mental health conditions.

Suicide is complex. Treatments and therapies for people with suicidal thoughts or actions will vary with age, gender, physical and mental wellbeing, and with individual experiences.

Identifying People at Risk for Suicide

• Universal screening—Research has shown that a three-question screening tool helps emergency room personnel identify adults at risk for suicide.² Researchers found that screening all patients—regardless of the reason for their emergency room visit—doubled the number of patients identified as being at risk for suicide. The researchers estimated that suicide-risk screening tools could identify more than three million additional adults at risk for suicide each year.
• Predicting suicide risk using electronic health records—Researchers from the U.S. National Institute of Mental Health (NIMH) partnered with the Department of Veteran's Affairs (VA) and others to develop computer programs that could help predict suicide risk among veterans receiving VA health care.³ Other health care systems are beginning to use data from electronic health records to help identify people with suicide risk as well.

References

1. U.S. Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control, Web-based Injury Statistics Query and Reporting System (WISQARS). (n.d.). Leading causes of death reports, 1981-2017. Retrieved September 17, 2019, from https://www.cdc.gov
2. Boudreaux, E.D., Camargo, C.A., Jr., Arias, S.A., Sullivan, A.F., Allen, M.H., Goldstein, A.B., et al. (2016, April). Improving suicide risk screening and detection in the emergency department. American Journal of Preventive Medicine, 50(4), 445–453. doi: 10.1016/j.amepre.2015.09.029
3. U.S. Department of Veteran's Affairs (VA). (2017, April 3). VA REACH VET initiative helps save veterans' lives: Program signals when more help is needed for at-risk veterans [Press Release]. Retrieved September 17, 2019, from https://www.va.gov