Suicide Prevention (Part 2)

Treatments and Therapies

Brief Interventions

• Safety planning—Personalized safety planning has been shown to help reduce suicidal thoughts and actions. Patients work with a caregiver to develop a plan that describes ways to limit access to lethal means such as firearms, pills, or poisons. The plan also lists coping strategies and people and resources that can help in a crisis.¹
• Follow-up phone calls—Research has shown that when at-risk patients receive further screening, a safety plan intervention, and a series of supportive phone calls, their risk of suicide goes down.²

Psychotherapies

Multiple types of psychosocial interventions have been found to help individuals who have attempted suicide (see below). These types of interventions may prevent someone from making another attempt:

• Cognitive behavioral therapy (CBT) can help people learn new ways of dealing with stressful experiences through training. CBT helps individuals recognize their thought patterns and consider alternative actions when thoughts of suicide arise.
• Dialectical behavior therapy (DBT) has been shown to reduce suicidal behavior in adolescents. DBT has also been shown to reduce the rate of suicide in adults with borderline personality disorder, a mental illness characterized by an ongoing pattern of varying moods, self-image, and behavior that often results in impulsive actions and problems in relationships. A therapist trained in DBT helps a person recognize when his or her feelings or actions are disruptive or unhealthy, and teaches the skills needed to deal better with upsetting situations.

Medication

Some individuals at risk for suicide might benefit from medication. Doctors and patients can work together to find the best medication or medication combination, as well as the right dose. Because many individuals at risk for suicide often have a mental illness and substance use problems, individuals might benefit from medication along with psychosocial intervention.

Clozapine is an antipsychotic medication used primarily to treat individuals with schizophrenia. To date, it is the only medication with a specific U.S. Food and Drug Administration (FDA) indication for reducing the risk of recurrent suicidal behavior in patients with schizophrenia or schizoaffective disorder.

If you are prescribed a medication, be sure you follow these precautions:

• Talk with your doctor or a pharmacist to make sure you understand the risks and benefits of the medications you're taking.
• Do not stop taking a medication without talking to your doctor first. Suddenly stopping a medication may lead to "rebound" or worsening of symptoms. Other uncomfortable or potentially dangerous withdrawal effects also are possible.
• Report any concerns about side effects to your doctor right away. You may need a change in the dose or a different medication.
• Report serious side effects to the Link opens in a new windowFDA MedWatch Adverse Event Reporting program online or by phone at 1-800-332-1088. You or your doctor may send a report.

Other medications have been used to treat suicidal thoughts and behaviors, but more research is needed to show the benefit for these options.

Collaborative Care

Collaborative care has been shown to be an effective way to treat depression and reduce suicidal thoughts.³ A team-based collaborative care program adds two new types of services to usual primary care: behavioural health care management and consultations with a mental health specialist.

The behavioral health care manager becomes part of the patient's treatment team and helps the primary care provider evaluate the patient's mental health. If the patient receives a diagnosis of a mental health disorder and wants treatment, the care manager, primary care provider, and patient work together to develop a treatment plan. This plan may include medication, psychotherapy, or other appropriate options.

Later, the care manager reaches out to see if the patient likes the plan, is following the plan, and if the plan is working or if changes are needed to improve management of the patient's disorders. The care manager and the primary care provider also regularly review the patient's status and care plan with a mental health specialist, like a psychiatrist or psychiatric nurse, to be sure the patient is getting the best treatment options and improving.

Ongoing Research

To know who is most at risk and to prevent suicide, scientists need to understand the role of long-term factors (such as childhood experiences) as well as more immediate factors like mental health and recent life events. Researchers also are looking at how genes can either increase risk or make someone more resilient to loss and hardships. Link opens in a new windowNIMH is funding a number of ongoing studies related to suicide.

References

1. Stanley, B., Brown, G.K., Brenner, L.A., Galfalvy, H.C., Currier, G.W., Knox, K.L., et al. (2018, September 1). Comparison of the safety planning intervention with follow-up vs usual care of suicidal patients treated in the emergency department. Journal of the American Medical Association (JAMA) Psychiatry, 75(9), 894–900. doi: 10.1001/jamapsychiatry.2018.1776
2. Miller, I.W., Camargo, C.A., Jr., Arias, S.A., Sullivan, A.F., Allen, M.H., Goldstein, A.B., et al. (2017, June). Suicide prevention in an emergency department population: The ED-SAFE Study. JAMA Psychiatry, 74(6), 563–570. doi:10.1001/jamapsychiatry.2017.0678
3. U.S. National Institutes of Health (NIH), National Institute of Mental Health (NIMH). (2016, December 30). Adding better mental health care to primary care. Retrieved September 17, 2019, from https://www.nimh.nih.gov