Suicide attempts, completed or not, are most often caused by serious mental conditions like depression or bipolar disorder that have not been diagnosed or have not been effectively treated. But mental illness alone typically won't do it. There's a complicating factor, like a romantic breakup, attention deficit hyperactivity disorder or substance abuse. Recent stresses can be a trigger, particularly among impulsive youths. AFSP data says 80-90 percent of those who killed themselves were not in counseling or treatment programs at the time of their deaths.
The first step to suicide prevention is to recognize signs, including suicidal talk, obsession with death, loss of interest in formerly loved activities, mood swings, not eating, sleeping too much or too little, taking excessive risks, withdrawing, increased drug use, agitation or anxiety, buying a gun or putting affairs in order.
Underlying mental illness is typically treatable with medications and with cognitive therapy.
Baum's other relative had many of the signs, but Baum and her family were blindsided by the suicide attempt. "She withdrew, she quit going out, she quit talking to friends. I don't know if I was in denial or not being aware. Now, it seems apparent how depressed she was." If she had seen it, Baum wonders whether she'd have addressed it. The suicide attempt removed the reluctance. They had to act fast.
"I think suicide needs to be talked about," says clinical psychologist John Malouf of Valley Mental Health in Salt Lake City. "If somebody is concerned about a family member or friend, it is okay to say, 'Are you thinking about hurting yourself' and bring it out." Not everyone set on killing himself will tell you. The point is someone might and it could "open the door to exploring alternatives."
Suicide is a permanent solution to a temporary problem, Malouf said. If lethal means are available, someone who is impulsive may act. He warned that communication needs to be open, but it's also important to make sure there are no tools of self-destruction available. There's a tendency -- perhaps a yearning -- to think that threats of self harm are empty. Experts say you can't count on it. They require expert assessment and perhaps intervention.
Generation to generation
It is probably not suicide that runs in families, he said, but rather the mental health diagnosis that causes it. But there are factors that increase the risk, including earlier attempts, a close relative who committed suicide, recent losses such as a breakup or death, social isolation, substance abuse and availability of handguns and ammunition, among others.
In a youthful population, ideally parents and schools would pick up on signals and direct the individual to professional help, said Dr. Mark Schwei, medical director for Primary Children's inpatient psychiatry unit. But again, you have to discuss what's going on and what's available. If children and adults don't know about services, they don't do any good.
Schools tackle trouble
Bullying puts both the victim and the bully at higher risk of suicide. Someone who has been both the picked-on and the aggressor is at the highest risk.
The strategies to prevent bullying have a lot in common with suicide prevention, including the type of school environment, outreach to families and identification of students in need of mental and behavioral health services, according to the Utah school suicide prevention manual that Gregory A. Hudnall, Provo School District's associate superintendent, and others have written. Hudnall became an expert in suicide prevention after he was called upon as a school principal years ago to identify the body of a young man who killed himself. He became an anti-suicide activist and policymaker.
The manual discusses factors and strategies, including how to talk to kids about suicide using an age-appropriate approach.
Schwei said 77 percent of all public schools have some kind of intervention program. Some of them target enhancing "protective factors," like making sure students don't feel alone, have connections, can talk to someone.
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