Discussing suicide as a public health issue can help reduce the stigma and increase awareness. It’s important to talk about risk factors, but it’s also helpful to know what steps you can take to prevent suicide.
Reducing suicide risk involves work at the individual, system and community levels. This includes limiting access to lethal means of self-harm, educating people about how to safely store medications, changing the way medication is packaged and encouraging the use of crisis hotlines and text lines.
1. Identify people at risk.
Whether someone is just thinking about suicide or has already made a plan, it’s important to know what warning signs to look for and how to help them get the support they need. This includes teaching about the warning signs of suicide, training gatekeepers (people who interact with people at risk) to recognize them, and providing screening and assessment tools.
Research has shown that a range of protective factors at the individual, relationship, community, and societal levels can reduce the risk of suicide. These include:
One of the most effective ways to reduce suicide risk is to prevent people from accessing lethal means of self-harm, such as by removing guns, pills, razors and other potential weapons. Reducing the availability of suicide methods also decreases method substitution, a common phenomenon where people try to kill themselves with something other than what they originally intended. Moreover, helping someone develop the skills to manage their thoughts and emotions with psychotherapy can be life-saving.
2. Start a conversation.
Talking about suicide can be uncomfortable, but it could save someone’s life. When someone shares their suicidal thoughts, it’s important to listen and offer support without judgment. It’s also important to avoid blaming or lecturing, which can be extremely distressing for the person. Remember, people who have thoughts of suicide are often very ambivalent and do not want to be judged.
Providing a safe space to discuss suicidal thoughts can help reduce the stigma associated with mental illness. Listening for warning signs and reducing access to lethal items can also be helpful. It’s also important to connect them with professionals and other resources, even if they are resistant. Research has shown that ongoing contact with high risk individuals who are receiving professional help is a powerful form of intervention. It has been found to decrease death by suicide.
3. Make a safety plan.
A safety plan is a tool to help people manage suicidal thoughts and feelings when they are at risk. It can include steps like identifying warning signs, distraction techniques, removing lethal items from the environment, emergency contact details, and reasons to live.
A person who is experiencing suicidal thoughts or feelings should develop a suicide safety plan with a friend, family member, health professional, or support service. It is best done when they are not in a crisis and can think clearly.
In addition to a suicide safety plan, it is important to work with families to reduce access to lethal means of self-harm. It can be difficult for families to talk about this and feel they are being judged. However, using trauma-informed care principles to discuss this with the family may help them to accept it and make changes. This strategy has been shown to improve outcomes for youth at risk of suicide. It has also been linked to reduced access to lethal means and improved attendance at treatment.
4. Follow up.
Follow up calls or messages can be used to check in on someone, share ongoing support, and remind them that there are people who care. Studies have shown that this type of contact can reduce the risk of suicide reattempts and save treatment costs.
We reviewed randomized controlled trials of ED-initiated interventions involving active contact and follow-up (intensive care plus outreach, brief interventions and contact, letter/postcard, telephone, and composites of these). Four trials reported results on repeat suicide attempts within 6 months, and we performed a meta-analysis to determine pooled relative risks and 95% confidence intervals.
The main finding was that all of the trials showed that interventions reducing access to lethal means significantly reduced the rate of suicide attempts. However, there is still no evidence that it is possible to predict fatality or prevent suicide by psychotherapy alone. Other forms of prevention are needed, including restricting access to means and strengthening support systems. It is important to create a culture that supports Zero Suicide and provide training on the implementation of recommended practices.