Preventing Suicide

If you know someone who is suicidal, help them get treatment. Psychotherapy, like cognitive behavioral therapy and dialectical behavior therapy, can help people recognize ineffective thinking patterns, improve mental wellness and learn coping skills.

Dramatic changes such as withdrawing from friends and family, displaying mood swings, dramatic weight loss or gain, avoiding sleep or becoming tired all the time can be warning signs of suicide. Removing guns, pills or other lethal materials and keeping them locked up can also reduce risk.

Identifying Individuals at Risk

Suicide is a complicated issue. It affects people from all walks of life. Everyone can help prevent suicide by building connections and seeking professional mental health help. People who have had a history of mental health problems are at higher risk, and the aftermath of any trauma or loss is often a “tipping point” toward suicide.

Individuals who have a plan for suicide (for example, giving away prized possessions or making preparations like writing a will) are more at risk and should be sought out for professional help immediately. Also, those who have access to lethal means should be encouraged to seek professional help and to safely store or temporarily remove guns from the home.

Suicide rates are much higher in areas that lack a cohesive social fabric and when people are left out of mainstream society. Research has shown that community-wide initiatives to reduce the stigma around suicide and make it easier for people to access mental healthcare, can significantly decrease suicide rates.

Providing a Full Continuum of Care

Many people who commit suicide have had contact with a general practitioner in the month prior to their death10,11. This presents an opportunity for intervention. Providing effective psychotherapy and pharmacotherapy, including treatments that specifically target suicidal thinking and behavior, may help reduce these risks.

Schools can also play a key role in preventing suicide. Students often exhibit warning signs, such as dramatic changes in personality or social withdrawal. Parents, teachers and school counselors can help by educating themselves about warning signs of suicide and encouraging students to seek help.

In addition, reducing access to lethal means can significantly reduce suicides. This includes limiting access to firearms and other potentially lethal methods, such as hanging, and regulating the sale of medications that can lead to overdoses. Lastly, avoiding media coverage of the location or method of suicide has been shown to decrease community vulnerability to suicide.71,72. Personalized safety planning can further reduce suicide risk by helping individuals to identify ways to limit access to lethal means and list coping strategies and resources.

Postvention Planning

Schools should include postvention planning when preventing suicide to prepare the school community to respond effectively in the event of a suicide. This step can help normalise and encourage help-seeking behaviours and assist the community with longer term recovery.

Survivors may struggle with unanswered questions like “Why?” and intense emotions such as guilt, shame, rejection, relief and anger. They need to be able to seek support in an environment where they feel safe and supported. This can be challenging in higher education, where students are often living away from home or in a residential college setting for the first time.

When a student is bereaved by suicide, schools should be prepared to provide immediate and ongoing support through a process known as ‘talk-throughs’ or psychological debriefings. This can be done by a trained member of staff or through an outside organisation such as telehealth provider TimelyCare. Communication templates to inform the team should be drafted in advance (Appendix A). This will help ensure that messages are delivered sensitively and without adding further trauma for the survivors.

Increasing Suicide Screening and Risk Detection

A suicide death has repercussions far beyond the person who died; their loved ones experience grief, shock, fear and guilt. And those who survive a suicide attempt may develop serious injuries that require long-term medical care, and may be at high risk for developing depression or other mental health concerns.

NIMH has developed tools to help clinicians identify warning signs and connect people with treatment. In addition, a number of clinically validated screening tools are available, including the Ask Suicide Screening Questions (ASQ) toolkit, which is designed for use with medical patients ages 10 and older.

It is recommended that providers implement universal screening by asking every patient if they have experienced recent suicidal thoughts or a history of suicidal attempts. However, some settings choose to selectively screen people with characteristics that put them at a greater risk of suicide, such as being Veterans or having homelessness or substance use disorders. This is called targeted screening.