(Source: www.med.umich.edu/depression/suicide_assessment)

Many people will experience the suicide ideation at some points in their life, although people who are diagnosed with depression (and bipolar disorder, too) are more likely to commit suicide than individuals with any other diagnosable psychological disorder. The rate of death from suicide within the population diagnosed with depression ranges from 9 to 60% (WHO Collaborating Centre for Mental Health and Substance Abuse, 2000).

The role of the community mental health workers in suicide management is twofold. Firstly, they need to be able to handle actual suicide attempt and secondly they need to be able to recognise and act on suicide ideation. It is important for the professional to be non-threatening, non-judgmental and empathetic when talking to the suicidal client.

Listed below are some useful questions to ask the client who has suicidal thoughts:

1. Have you been feeling depressed for several days at a time?
2. When you feel this way, have you ever had thoughts of killing yourself?
3. What did you think you might do to yourself?
4. Did you act on these thoughts in any way?
5. When was the last time you had these thoughts?
6. Have your thoughts ever included harming someone else?
7. Have you taken any steps towards doing this? Have you thought when and where you would do this?
8. Have you made a note?
9. What has stopped you from acting on your thoughts so far?
10. What are your thoughts about staying alive?
11. How does talking about suicide make you feel?

(Adapted from: Fremouw, W.J., de Perczel, M., Ellis, T.E. (1990). Suicide risk: Assessment and response guidelines. New York: Pergamon Press)

When working with a client who is contemplating suicide or recovering from the attempt, it is important to develop a management plan to help an individual safely move out from distressed state. The suggestions for this management plan are outlined below:

1. Ensure appropriate supervision and/or hospitalisation for the client
2. Ensure that the client has immediate 24 hour access to a mental health service
3. Remove all means of committing suicide
4. Build a therapeutic relationship with the client
5. Try to delay the client’s suicidal impulses (e.g. make a contract)
6. Neutralise the precipitating problem
7. Involve family members or supportive family network

(Adapted from: WHO Collaborating Centre for Mental Health and Substance Abuse, 2000)

Predictors of Suicide Risk

Sex – women attempt suicide more often, but men complete suicide more often. Significant others – meaning of intimate relationships. Stressful life events – such as loss of a loved one, financial strains
 
Unsuccessful attempts – make it more likely that a future attempt will be successful. Unemployment – or being retired increase a risk of suicide. Unexplained improvement – in clinical sense may indicate a resolution
 
Identification – with others who have committed suicide
 
Chronic Illness – depression is also associated with higher risk
 
Depression – hopelessness, frustration and hostility are associated with greater risk. Decision – that suicide in future is an option
 
Age – generally, the older the individual, the greater the risk. Alcohol – or other substance abuse is often associated with completed suicide. Availability – of weapons, especially guns represent higher risk
 
Lethality – of previous attempts. 

(Adapted from WHO Collaborating Centre for Mental Health and Substance Abuse, 2000)

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