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Understanding and Treating Suicidal Patients in 2021

Understanding and Treating Suicidal Patients in 2021

By Hannah Thompson, MSW Intern

In the United States, according to the CDC, there is one death every 11 minutes. In 2019 there were 47,500 deaths due to suicide, roughly one death every 40 seconds. Females attempt suicide three times more likely than men do. At present, findings suggest about 800,000 people die in the world annually. Warning signs include but are not limited to the following: Isolation, Loss of Interest, Self-Blame, Burdensome Expression, Risk-Taking Behaviors, and Hopelessness. The issue is that therapists miss signs of suicide ideation and then are unable to support their client/individuals at present and before they know it is too late. Suicide and Suicide ideation are much more prominent than many are aware of. In the age group of 10 to 14 years, suicide is the third most common cause of death, representing the second most common cause up to 34 years after that. Out of these deaths, half of all completed suicides are related to depressive and other mood disorders (Bachmann, 2018). Therefore, the importance of advocacy for this population cannot be stressed enough. Education regarding best practices, support, warning signs, and knowing about myths is more than necessary for every social worker and therapist.

Some myths include and are not limited to the following:
Suicide is caused by one particular trigger, most occur with little or no warning;
It is best to avoid talking about suicide in case it plants the idea into a clinician’s client’s
head,
A suicidal patient truly wants to die,
If depression is not present, then suicide is not present.

Believing in these myths will increase the number of those who take their life because they are misunderstood. People who take their life are not always depressed, but something horrible continues to happen, and they can’t take it. Those that believe that one trigger is the cause are unaware that it usually takes a good number of instances or “triggers” to take place before suicide is even thought as an option. Those that believe talking about it is not okay or inappropriate is the same as ignoring it. When suicide is ignored, suicide happens. Talking about it is not an easy topic, but it is necessary if people want to save their loved ones. Many people who do commit suicide do it as a last resort instead of wanting to truly die. Typically, people continue life, and as time goes on of hardship, they try and try more options that do not work for them, and so they believe their only option left is death because they cannot keep living like they are, it is too much for them. There are ways that peers and therapists can best support/treat those struggling with suicide and help others know about the myths and the best way to provide support.

The implementation of Collaborative Assessment and Management of Suicidality (CAMS) is very efficient in therapy working with suicidal patients in 2021 to best support a client. Through using CAMS, clients themselves can help support their peers. CAMS, in therapeutic and peer support, looks like the person who is not struggling suicidally to engage in a highly interactive process. The individual struggling with suicide/suicidal ideation is actively involved in developing their own treatment plan. Through CAMS implementation, a key component is that the individual who is not suicidal must be sincere and forthright. Many think that this is the last thing someone struggling with suicide needs; however, it is precisely what they need. They need honest and forthright involvement and support instead of tiptoeing around the subject. By not addressing the topic head-on, there is much more likely a case that they will follow through with a suicidal plan. There can be no more critical component of care than direct and respectful candor when suicidal risk is present, which is found with a therapist by practicing/implementing CAMS for any patient teetering between life and death. CAMS includes having both parties create an environment with the following actions: Engage, Identify, Inquire, Assess, and Develop an Action Plan as part of the therapeutic/peer intervention. For peers helping others or therapists working with their clients, it looks like the following. For Engage, the therapist/peer should sit forward, lean toward the person, and not get distracted. For example, convey empathy, try to see and feel things from the person’s perspective. This allows them to feel seen and heard and not alone at that moment but supported. Next, for Identify, this looks like digging deeper by the confidant. Whether the person is thinking about suicide or not. The confidant must be direct but aware of the heaviness and be sensitive. Tiptoeing around suicide keeps it from being discussed and addressed, which is the opposite of what needs to happen. Asking only once in an intake assessment is not enough or asking a friend that is not okay if they are okay and go along with their answer of “Yeah, I’m fine” is not helpful—creating this space as a therapist or as a peer gives the person permission again to share. For Inquire- If the person is considering suicide, it is a good idea to ask about their reasons. This creates an environment of safety and that they are being heard, and someone is taking the time to know and help the person feel that they are understood. After doing this, the peer or therapist must work with the suicidal individual to find other ways to cope. Though this is a way of therapy, it is just as much a way of peers to relate and support one another in times of heaviness and darkness. That is why the following method to keep a peer of a client is assessing. This looks like asking blunt questions and may come across as inappropriate/too forward or not caring but being intentional is better than not being. This looks like asking about where, when, and how they are/may be planning on doing it. It is often found that peers share with one another about suicide than their therapist. Develop an Action Plan if a friend comes to another or a client shares; this way, they also feel supported and have another plan besides taking their own life. Treating suicide in 2021 is not easy as so much has happened in the last couple of years related to COVID-19, and suicide rates have increased drastically. If you or someone you know is struggling with suicide or post-suicide actions, speaking to a trained therapist is very important to help the process. So are the following: National Suicide Prevention Line (800-273-8255), NIMH- Suicide Prevention, American Foundation For Suicide Prevention has many resources and hotlines. SAVE- is a grief support group for those that have lost loved ones to suicide, and HEARTBEAT is a non-profit organization with organized peer groups.

 

Jobes DA. The Collaborative Assessment and Management of Suicidality (CAMS): an evolving evidence-based clinical approach to suicidal risk. Suicide Life Threat Behav. 2016 Dec;42(6):640-53. doi: 10.1111/j.1943-278X.2012.00119.x. Epub 2012 Sep 12. PMID: 22971238.

Ellis, T.E., Rufino, K.A., & Schwartz, J.A.J. Negative Reactions of Therapists Working with Suicidal Patients: a CBT/Mindfulness Perspective on “Countertransference”. J Cogn Ther11, 80–99 (2018). https://doi.org/10.1007/s41811-018-0005-1

Bachmann S. Epidemiology of Suicide and the Psychiatric Perspective. Int J Environ Res Public Health. 2018;15(7):1425. Published 2018 Jul 6. doi:10.3390/ijerph15071425