suicide prevention (nimh)

https://www.nimh.nih.gov/health/topics/suicide-prevention/index.shtml

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 and/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.

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https://www.nimh.nih.gov/health/publications/5-action-steps-for-helping-someone-in-emotional-pain/index.shtml



Here are 5 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 number (1-800-273-TALK) and the Crisis Text Line (741741) in your phone so they’re there if you need them. 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.

For more information on suicide prevention: www.nimh.nih.gov/health/topics/suicide-prevention.

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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. But people most at risk tend to share specific 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. See the resources on NIMH’s Find Help for Mental Illnesses page if you're not sure where to start.

Suicide is complex. Treatments and therapies for people with suicidal thoughts or actions will vary with age, gender, physical and mental well-being, and with individual experiences. NIMH has focused research on identifying people at risk for suicide and identifying effective interventions.

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https://www.nimh.nih.gov/health/topics/suicide-prevention/index.shtml#part_153178

TREATMENT  & THERAPIES

A. Brief Intervention

1. Safety Planning

a. (-) Limit access to lethal means, e.g. firearm, pills, or poisons

b. (+) Teach coping strategies & resources when in crisis

2. Follow-up Phone Calls

NB: Research shows that when at-risk patients receive further SCREENING, a SAFETY PLAN intervention, and a series of SUPPORTIVE PHONE CALLS, the risk of suicide is decreased.

B. Psychotherapies (Psychosocial Intervention)

1. CBT (Cognitive Behavioral Therapy)

a. [T] Recognize thinking pattern

b. [A] Consider alternative actions

2. DBT (Dialectic Behavioral Therapy)

a. [T] Recognize disruptive or unhealthy feelings & actions

b. [A] Teach SKILLS needed to deal with upsetting situations

NB: Research has found that DBT reduces suicide risk among adolescents and adults with borderline personality disorders (= ongoing patterns of varying moods, self-image, & behaviors that often lead to impulsive actions and problems in relationships)

C. Medication

CLOZAPINE is the only antipsychotic medicine with US FDA indication for reducing risk of recurrent suicidal behavior in patients with schizophrenia or schizoaffective disorders.

D. Collaborative Care

A team-based approach composed of (1) a care manager, (2) the primary care provider, (c) the patient, and consulting with a (d) mental health specialist, e.g., psychiatrist or psychiatric nurse.

NB: Many individuals at risk for suicide often have a mental illness and substance use problem.