Suicide is a world wide issue, nevertheless and multi-disciplinary – polemic issue in any community. As a mental health professional, enthusiast or simply as a human being, it is vital to understand the extent of this phenomenon, and to take preventive action when it is possible. In Australia, there are various suicide prevention programs, both publicly and privately funded, which provide help to those in need, undertake research, or inform the public about the risks of suicide in our society.
According to a report published by the World Health Organisation (www.who.int), it was estimated that in 2001, approximately 815,000 people committed suicide worldwide. This number represents 49.1% of the deaths cause by violence – which vastly outnumbers other causes such as homicides or wars. In Australia, in 2003, there were over 2,100 registered cases of suicide (according to the Australian Bureau of Statistics). Recent reports show that this trend has been reduced, however, still remains a serious public health issue.
Suicide prevention begins with the awareness of the problem, and understanding common warning signs can play a big role in helping others dealing with the situation. In most cases, these signs are quite clear and recognisable – as they represent a noticeable change in one’s behaviour and social responses:
– Threat/talk about self-harm and suicide;
– Seeking access/looking for ways to kill oneself;
– An ordinary person excessively talking about death or self-harm;
– Hopelessness, excessive rage, impulsive behaviours;
– Increased alcohol and/or drug consumption;
– Withdrawal from social circles (friends, family, other);
– Dramatic mood change;
– Anxiety, depression, sleeping problems, agitation.
There are various types of risk factors associated with increased suicide incidence or behaviour. Some of these factors include:
Generally suicide risk is directly related with age.
Male suicide rates are almost twice as high; however self-harm (including attempted suicide) is higher among women.
Unemployment, separation, widowing, retirement and/or loss of socio-economic status.
Both mental health and physical illnesses are closely related with suicide rates. Chronic and severe physical illnesses, particularly resulting in impairment, are the common causes for suicidal thoughts. Depression, bipolar disorder, schizophrenia, borderline and anti-social personality disorder and alcohol and drug abuse are among the major mental health-related causes.
Access to means
Having access to weaponry, chemical substances, and other harming materials is also a predominant risk factor.
Assessment of Suicidality
A Manual of Mental Health Care in General Practice, by John Davies and published by the Commonwealth Department of summarises the following stages for assessing suicidality:
1. Consider the person’s risk factor;
2. Ask about the felling of hopelessness;
3. Ask about any plans for suicide;
4. Evaluate the context of any suicidal act and its meaning to the individual;
5. Assess the means used, and the lethality and intent of the act;
6. Ask about access to firearms and other means;
7. Clarify the problem that the suicidal act attempts to
8. Diagnose physical disorder;
9. Document past suicidal behaviour;
10. Assess the extent of social support.
Davies, J. (November 2005) A Manual of Mental Health Care in General Practice, Commonwealth Department of Health and Ageing, page 29, Canberra.
Due to it’s mythical nature (at least from a common perspective), suicide has produced several misconceptions which, if applied to certain situations, could cause further harm (or disable preventive actions). Some of these are listed below, along with the ‘real’ facts behind each one of them:
1) You should not talk about suicide or death with suicides (with someone that has attempted or is thinking about it).
In fact, talking about suicide is recommended by specialists. In most cases, the person who has attempted, or is thinking of committing suicide, needs to analyse the situation from a different perspective. The best approach is to openly talk about the topic, but avoid confrontation, aggressive behaviour or questioning about the reasons for it.
2) Suicidees are fond with death, or with being dead.
The suicidal action is perceived as a way out of the situation, or an opportunity to enter a better one. Killing (or attempting to kill) oneself per se is not a common attribute of suicides.
3) Suicide is not a social problem, but an individual issue.
Suicide rates are near to a million deaths a year. However, not only the suicidees are affected by the action. According to a publication in the American Association of Suicidology (www.suicidology.com), in a very conservative estimate, at least 6 other people are emotionally affected by the death of a friend, relative, or loved one. If we do that maths, it would mean that, each year, over 5 million people could possibly deal with mental health issues associated with suicide.
Did You Know?
1) In the Crusades period, Medieval Europe, the Catholic Church was the source of most ethical codes – and nonetheless an extremely powerful institution. In that context, the self-harming (resulting in death) action was considered a heresy, and therefore threaded as such: dead bodies of suicidees used to be buried in crossroads as a sign that their souls would be lost forever, and a clear note that these bodies were not accepted into holy grounds.
2) The Hindus consider suicide equally condemning as homicide. However, the ‘Sallekhama’ – or hunger strike – is seen as an acceptable practice. The justification is based on the fact that, in order to actually die of hunger, one must plan their actions; apply self-control and discipline, as opposed to an impulsive action. Mahatma Gandhi, famous for his political views towards violence, went on a hunger strike himself to protest over the conflict between Muslims and Hindus: fortunately, his cause was resolved before he achieved the final outcome.
3) In the feudal Japan, period of the Samurai warriors, suicide was viewed as a noble action in order to preserve honour and accept defeat. The practice, called ‘Seppuku’ (or belly/stomach-slicing) was not only common between trained warriors – but also promoted within the society.
4) In Vietnam, during the 1960s, communist monks practised self-immolation (burning their own bodies) in order to gain Western attention towards their protests.
Verifying, analysing and examining these various cultural/religious influences helps us in recognizing the mystery nowadays.