Suicide, Counseling and Prevention

The term suicide encompasses both behaviors in which people intentionally cause their own deaths (complete suicide or fatal suicide) and those behaviors where the person survives the action (attempted suicide, parasuicide, or deliberate selfharm). Suicidal behavior, more than many other behaviors, often creates severe anxiety in those professionals who encounter and endeavor to help such individuals because of the fear that the smallest misstep may result in their clients' deaths.

Overview

There are six major tactics that have been employed for preventing suicide:

• 1.
  Preventing access to lethal methods of suicide. Preventing access to lethal methods of suicide includes such tactics as fencing in high bridges and buildings to prevent people jumping from them, passing and enforcing stricter gun control laws, and using less toxic and lethal medications for psychiatrically disturbed individuals. It is impossible, of course, to limit access to all methods for suicide. For example, drowning, hanging, and cutting are available to most individuals. Furthermore, it is likely than many, although not all, individuals will switch methods for suicide if their preferred method is unavailable. However, this tactic may delay the suicidal action and provide an opportunity for crisis intervention.
• 2.
  Educating people about suicide and the resources available for suicidal individuals. These programs have been primarily set up in schools where the students are given information about suicide and the community resources available, and sometimes, basic information about crisis intervention. There is research that indicates that these programs do inform students about suicide and resources, but there is no evidence yet on whether they indeed prevent suicide.
• 3.
  Educating general practitioners. In some regions of England, Hungary, and Sweden, educational programs have been established to educate general practitioners and family doctors on the identification of and appropriate medications for the depressed patients that they encounter in the course of their practice. The available evidence to date indicates that these programs may, in some cases, result in a temporary reduction in the incidence of suicide in some segments of the population (for example, women).
• 4.
  Crisis intervention hot lines and walk-in clinics. Telephone crisis intervention centers have been set up in many nations of the world, some of which have walk-in clinics with around-the-clock access so that suicidal individuals can receive crisis intervention. Some nations have now established toll-free numbers that serve the whole nation, and crisis intervention is now available online via e-mail and instant messaging.
• 5.
  Programs for survivors. Survivors are those who have had a loved one or significant other commit suicide. Research has shown that this type of loss increases the potential for suicide in the survivors, and self-help groups are available in many nations for survivors (see the websites mentioned earlier). Protocols have also been established for helping people after friends, peers, or fellow staff members have committed suicide.
• 6.
  Providing treatment for suicidal individuals. Once suicidal individuals have been identified or [Page 912]have sought help on their own initiative, they can be provided with effective treatment involving both medication and psychotherapy. These are addressed in the following sections.

Medication for Suicidal Individuals

The primary tactic for helping suicidal individuals is to identify their psychiatric disorder and prescribe the appropriate medication. If the suicidal individual has schizophrenia, then an anti-psychotic medication is needed; if they are anxious, an anxiolytic agent is needed; and if they are depressed, either an antidepressant or a mood stabilizer (for bipolar affective disorders) is needed. There is a great deal of research on the effectiveness of these medications, with clear evidence-based data.

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