If tragedy offers us anything, it's a chance to learn and take action to prevent another similar incident from occurring. While news is still coming out regarding the Germanwings plane crash, we do know that it was an apparent murder-suicide carried out by a young pilot reportedly suffering with mental illness. According to research, 94 percent of murder-suicides are carried out by males. The aftermath of this event provides an opportunity to address the larger ongoing tragedy of suicide and engage in a global conversation about suicide prevention.
Suicides happen all the time, but when mass casualties are involved we pay more attention, says Dr. Paul Quinnett, the president and CEO of the QPR Institute, an educational organization dedicated to suicide prevention by basic recognition and referral intervention.
And he's right. Mental illness is treatable, and suicide is preventable. If those things are true (and they are), then logic says: Prevent suicide, and you can also decrease the risk of a rare event such as mass violence like that of the Germanwings crash.
How can we get through to mentally-ill men, living in quiet desperation, who are unlikely to self-report desire and intent to kill themselves? How can we prevent suicide?
Quinnett advocates for what he calls "gatekeeper training," a prevention program that teaches anyone the warning signs of suicide, how to ask an at-risk person about suicide, and how to refer an at-risk person for help before an adverse event occurs. This is based on the idea that people who live and work together are in the best position to recognize early changes in behavior and to assist each other getting life-saving help. Often suicidal people give off "weak signals" as to their plans, either by discussing a rhetorical suicide ("If someone took all of this medicine at once would it kill him?") or saying something like, "Everything will be better when I'm gone," or by drastically changing their appearance and upkeep. When it comes to suicidal men, it's important to note that men present symptoms more commonly in mood shifts -- they're often more irritable and agitated. How to recognize the warning signs of suicidal behavior and ways to take action should be taught the way life-saving CPR is taught.
Clinicians are the obvious next source of assistance. In the cases of attempted suicides, when a clinician evaluates patients for increased support in the cases of attempted suicide, it's important to ask questions that encourage patients to be more transparent about how they are feeling. Oftentimes, non-completers downplay the incident out of embarrassment or denial, or from a desire to protect family secrets. Clinicians can override this by focusing on the behavior itself and reframing interview questions accordingly. For example, instead of asking, "How close did you come to killing yourself?" a clinician could say, "How many pills did you take?"
Suicide is still very much stigmatized, however, and patients may be ashamed of their behavior or suicidal thoughts. Psychiatrist Shawn Christopher Shea advocates for normalizing, in which the clinician implies that others have experienced the behavior in question. He also recommends gentle assumption, which he likens to asking a group if they masturbate (people will usually say no) and then rephrasing the question by asking how often they masturbate. This subtle shift infers that the behavior is common, accepted, and already present. In suicide, gentle assumption assumes, in a non-accusatory way, that certain behaviors are already happening, e.g., "How many times have you tried to kill yourself?"
Finally, clinicians can be first in line to build powerful, preventative alliances with their patients that could circumvent potential suicides and suicide-murders. Law mandates a clinician contact the authorities if a patient reveals intent to commit harm others. If a patient is talking about self-harm, the clinician is focused on getting help for the patient. You might ask why a patient would ever tell a clinician his or her plans, and that's because the patient is expressing ambivalence if they are talking with a clinician. It's a cry for help, a plea for an intervention. Clinicians can capitalize on this ambivalence and implement immediate measures to avoid catastrophe.
A recent New York Times article reported that out of 2,758 aviation accidents between 2003 and 2012, only eight were suicides. The pilots were all male, and researchers "found that five of the pilots had given hints of their intentions to others before their final flight."
A woman reported as the ex-girlfriend of Germanwings co-pilot Andreas Lubitz told the press that Lubitz had once made vague threats about "doing something" that would gain him notoriety someday. This statement, coupled with Lubitz's reported depression, was a missed warning sign, which if heeded might have led to the prevention of this horrendous act.
The Germanwings tragedy can further stigmatize those with mental illness and make people with suicidal thoughts frightened that they'll be linked to a horrific crime. Yet this is also an opportunity to educate the world about the warning signs of suicide. Armed with critical information, everyone can easily train to be a gatekeeper, and this, coupled with the treatment of at-risk populations, can prevent not only suicide, but, in those rare instances, murder-suicides as well.
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