Will suicide ever be 100% preventable?

American Foundation for Suicide Prevention, from Pinterest

Have you seen some of the claims out there that suicide is 100% preventable? There are a variety of organizations that promote a zero suicide goal. One example is the Zero Suicide Alliance, which is based in the UK and offers free suicide prevention training in order to help get suicidal people connected to appropriate resources and put an end to suicide. There’s a suicide is preventable website, https://www.suicideispreventable.org, which belongs to Know The Signs, an organization based in California in the United States. Preventable, preventable, preventable. But is it reality or just a pipe dream?

While it would certainly be nice if suicide could be fully preventable, I have strong doubts as to whether this is actually realistic. I’m also concerned that saying suicide is 100% preventable suggests that when there is a completed suicide, or even a suicide attempt, somebody has dropped the ball and failed to prevent it. And I just don’t think it’s that simple.

For suicide to ever be 100% preventable, the stars in a number of different areas would need to align 100% of the time. Here’s some of the pieces that I can come up with:

Individual factors

One factors is the stigma regarding help-seeking. This is one area where suicide prevention campaigns can potentially have a significant positive effect, in encouraging people to reach out for help. The more help-seeking for mental health is normalized, the better. Still, even normalization isn’t necessarily going to help if, for example, someone is feeling utterly worthless and undeserving of help of any kind.

Hopelessness is often a part of suicidal thinking, and this may be accompanied by feelings of helplessness. If someone is feeling that there’s no possible way that anyone would be able to help them, they may not see any point in reaching out to ask for help. Addressing this is partly about making people aware of the treatment options that are available, but it’s also about making sure there are highly effective treatment options to offer people.

System factors

Calling a crisis line is seldom going to be enough to deal with thoughts of suicide. The majority of people who experience acute suicidality are experiencing some form of mental illness, and that requires effective mental health treatment.

In a world where scarcity of resources is the norm in healthcare, there are always going to be limitations on what treatment is available and how soon it will be available. As long as people are being discharged from emergency departments because they’re not suicidal enough, suicide will never be fully preventable.

There are often financial costs associated with mental health treatment, and these can stand in the way of people accessing the treatment that would be most appropriate for them. If people can afford effective treatment, all that’s left is stopgap bandaid solutions.

There’s also the matter of how palatable treatment options are. I doubt I’m alone in wanting to avoid hospitalization at almost any cost. For people who are extremely ill, crisis lines are likely not going to do all that much; really sick people people need inpatient treatment. If inpatient treatment is a hellish experience, people are unlikely to seek it out voluntarily. And unfortunately, there are all too many horror stories of inpatient experiences from hell.

Treatment factors

I think the biggest barrier to achieving zero suicide any time soon is the lack of effective treatments. Not everyone responds well to currently available treatment. There are a lot of people out there with treatment resistant depression, and calling a crisis line may get someone through a difficult moment but it’s not going to change the big picture at all. We need more treatments available so that everyone, or at least the vast majority, has access to something that will work for them.

Also, treatments also take time. Antidepressants take weeks to start to work. For people with borderline personality disorder, dialectical behavior therapy (DBT) is the treatment of choice. Even once someone has made it through the often lengthy waiting period and gotten into treatment, there’s no quick fix; DBT programs can take six months to a year to work through.

Now what?

I’ve personally had multiple suicide attempts. The first two came before I got my depression diagnosis, and I thought I should be able to handle things myself. Since then, though, I think the only thing that would have really made a difference was if better treatment available. Not as in access, but the treatment itself. My illness has always been difficult to treat, and all the suicide prevention campaigns in the world aren’t going to change that.

So, do I think suicide will ever be entirely preventable? Sadly, no. What I think is important, though, is that suicide prevention campaigns target the multiple factors that play a role in suicide rather than focusing solely on awareness.

Do you think suicide is preventable?

If you’re struggling with thoughts of suicide right now, I’ve made up a list of crisis resources available around the world that can offer support and help to point you in the right direction for treatment.

Originally published at mentalhealthathome.org on February 25, 2019.