Each year almost 800,000 people die by suicide, according to the World Health Organization. Suicide accounts for 1.4% of all deaths worldwide, and it’s the second leading cause of death among those aged 15–29 years old. The American Foundation for Suicide Prevention reports that there were 1.4 million suicide attempts in that country in 2017, and over 47,000 deaths by suicide.
Probably the most visible suicide prevention strategy is promoting the use o f suicide crisis lines. These support services aim to be low-barrier and easily accessible, and now there are often text or online chat alternatives available besides talking on the phone. Suicide prevention campaigns often focus heavily on the importance of reaching out to these types of resources for help in getting through a crisis. These are crucial services to have, and for some people, the support of a crisis line is enough, whether that’s repeated support across multiple contacts or getting pointed in the direction of mental health services.
When suicidal thinking is a symptom of serious mental illness, though, a chat with a crisis line volunteer may help in the moment, but it’s not going to change the underlying problem. Over-emphasis and over-reliance on crisis lines to play a starring role in suicide prevention doesn’t serve those people whose suicidality isn’t going to abate without effective treatment of severe mental illness.
Hospitalization may be the most effective option for people who are highly mentally unwell and suicidal, but what are the chances that someone will make a choice to go in to hospital voluntarily? Far too many people have very negative experiences in emergency departments and/or inpatient psychiatric units, and those memories can serve as a strong deterrent to seeking hospital-based care. Personally I’ve had multiple traumatizing hospital encounters, and the chances of me voluntarily going to hospital are somewhere in the vicinity of 0%. That’s not to say that I’m discouraging people from taking themselves to hospital. Rather, this points to the need for a respectful, non-stigmatizing, trauma-informed approach on the part of mental health care providers in hospital. As a mental health nurse myself, I’ve seen an unacceptably high number of colleagues approach patient care without any of those characteristics.
There is also the question of timely access to appropriate care in the community. As just one example, people with borderline personality disorder often struggle with suicidal ideation, but there are lengthy waitlists to access dialectical behaviour therapy (DBT), the gold standard for treatment.
Not only must there be access to treatment, there must be effective treatments available. The treatments that are currently available are effective for some people some of the time, but there are also many people who either do not respond or only partially respond to the best treatment currently available. I have treatment-resistant depression; I’m on a combination of treatments that help, but they don’t make the illness go away, and suicidal thinking continues to flare up sometimes.
To effectively prevent suicide, it’s not enough to intervene when suicidal thinking is already occurring. The underlying systemic factors also need to be identified and addressed. A Government of Canada report entitled Breaking Point: The Suicide Crisis in Indigenous Communities described the elevated suicide rates in Indigenous communities, and identified the effects of colonization and intergenerational trauma as key contributing factors. Such systemic problems require community-based interventions long before a given individual ever becomes suicidal.
To effectively prevent suicide, all of these elements need to be addressed. Suicide is a multi-faceted problem, and that requires a multi-faceted solution. Let’s not get so distracted by one part of the solution that we neglect the rest.
If you are feeling suicidal, please reach out to your local mental health services, or you can contact the following supports:
United States: National Suicide Prevention Lifeline at 1–800–273-TALK (8255)
Canada: Crisis Services Canada at 1–833–456–4566
U.K.: Samaritans at 116–123