In the first decade of the 21st century, life expectancy in the U.S. increased from 76.8 to 78.6 years. An early death due to disease decreased over the course of the last decade, just as it has since the advent of modern medicine. Unfortunately, injury-related deaths are on the rise. Somewhat surprisingly, suicide is now the No. 1 cause of injury-related deaths, overtaking motor vehicle crashes and accidental poisoning (drug overdose). At a time when motor vehicle deaths are declining thanks to laws mandating airbags and other safety features, along with public awareness campaigns to reduce drinking and driving and, more recently, texting while driving, the suicide mortality rate is rising -- increasing an astonishing 15 percent in the last decade. Studies report similar findings in Europe, Canada, and China.
Unfortunately, suicide isn't an issue that can be "legislated away" like motor vehicle fatalities. Instead, reducing suicide mortality rates will happen primarily through raising awareness -- not only among potentially suicidal individuals, but among their friends and family, educators, employers, the medical community, and the public at large. What everyone needs to understand, first and foremost, about suicide is that a suicidal state of mind is temporary. There are ways to recognize when an individual may be feeling suicidal, and there are ways to effectively help such an individual pass through the darkness that makes a person want to end his or her life.
Recognize the Warning Signs
Individuals who are truly suicidal are oftentimes past the point of wanting (or being able) to ask for help. Therefore, it is up to others to recognize the various warning signs and intervene. Common suicide alerts include:
• Burden. Many suicidal people think they are dragging other people down with their needs and problems. They think that others would be better off without them.
• Disinterest. Usually people who are suicidal lose interest in activities they used to enjoy or that were important to them. Hobbies, sports, schoolwork, jobs, exercise, and self-care fall by the wayside
• Insomnia. Oftentimes people considering suicide have not slept properly for days or even weeks.
• Isolation. Suicidal individuals nearly always detach from family and friends. They feel as if they are miserable company, and others will be happier without them.
• Outcast. Oftentimes suicidal people feel as if they don't "belong" or "fit in." As a result, they also feel misunderstood, disliked, unloved, and unwanted.
• Self-loathing. Many suicidal people dislike or even hate themselves. They think that others do, too, and the world would therefore be a better place if they were dead.
• Suicidal talk. Usually people who are considering suicide will make statements about or allude to the behavior. The talk may be indirect (e.g., general chatter rather than a specific threat to kill oneself).
• Trauma. A painful ordeal such as job loss or the end of a romantic relationship can send even healthy people spinning. For those who are already depressed, it can easily trigger thoughts of suicide.
• Upswing. Sometimes after making a decision to "end it," a suicidal person appears calmer, happier, and more relaxed than normal. This "positive mood swing" often fools friends and family into thinking the suicidal individual is doing better, when in fact the opposite is true.
Intervene by Reaching Out
The easiest way to prevent suicide is to let the suffering person know that you care. Asking how he or she is feeling lets that individual know that at least one person is in his or her corner. And after you ask how that person is, do something with them. Eat lunch together, go for a walk, plant some flowers, whatever. It really doesn't matter what activity you choose, as long as you get the other person up, moving, and out of self-pity mode. There's a saying in 12-step recovery groups: When you're walking through hell, don't stop. Well, suicidal people have stopped, and they need outside help to get moving again. So the more time you spend with that person, and the more active that person becomes, the less depressed and suicidal he or she will be.
Remember, it is perfectly acceptable (and even advisable) to directly ask a person you're worried about if they're thinking of suicide. When doing this, use eye contact, give the person your full attention, encourage honesty, and empathize. And don't be afraid to trust your instincts. If someone says they're not considering suicide but your gut tells you they are, go with your gut. When someone's life is at stake it's far better to do too much than not enough. If you can, get the person to make a commitment that he or she will not engage in any self-harming behavior for a specific period of time -- so that you can work with them to lower the risk. Ask them to make the commitment out loud, rather than by nodding or some other form of nonverbal assent. Agree to discuss the situation again at the end of that time period. You want to be sure they contact their therapist or psychiatrist or if they are not in treatment to find out where emergency psychiatric services are available.
Do not try to do too much. When dealing with a suicidal person, your job is to help that individual through the immediate danger. Your intervention is not a long-term solution. For that, he or she will need long-term professional counseling and perhaps pharmaceutical intervention. Making false promises like "Everything will be better tomorrow" is not helpful, so don't do it. Instead, say something truthful like, "At some point, these feelings will pass."
Global Education and Prevention Strategies
Sadly, even though suicide is on the rise, it is not being adequately addressed by the U.S. (or any other) government. There is a tremendous lack of suicide prevention education and public awareness strategies. In some respects this may come from the mistaken belief that talking about suicide openly will encourage the behavior. This is a little bit like saying that talking about drug abuse promotes rather than prevents addiction. As we know, that is not the case. It is not the case with intentional self-harm, either.
The simple fact is we know the risk factors for suicide, and we have proven intervention strategies, but at this time the information is not reaching parents, educators, employers, medical professionals, and the general public. The time has come for public awareness to be raised through both macro and micro strategies. Governments can disseminate information through public service campaigns and by requiring educators, employers, and the medical profession to become certified in suicide awareness and prevention. Meanwhile, individuals can disseminate information through a grassroots effort focused on local events and social media. As usual, a lone voice in the wilderness is unlikely to be heard, but together, shouting as one, we can make a tremendous difference.
Need help? In the U.S., call 1-800-273-8255 for the National Suicide Prevention Lifeline.
David Sack, M.D., is board certified in addiction psychiatry and addiction medicine. As CEO of Elements Behavioral Health he oversees a network of addiction treatment centers that include Promises rehab center, The Ranch, The Recovery Place, and the Right Step drug rehabs in Texas.
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