Mental Health Research For Suicide Prevention
From Your Mental Health
Content warning: This blog discusses suicide and other subjects that can be upsetting. Reader discretion is advised.
Researchers and clinicians often describe the devastating impact of suicide as a set of ripples, because of the number of lives touched. Suicide is the second most common cause of death in young people worldwide and it has been estimated that for every death by suicide around 135 people will be affected (Cerel et al, 2019).
Suicide is still a taboo subject, one that we don’t want to think about or talk about, and that we fear. But it is by bringing suicide into our discussions and conversations that we can support those considering suicide and make a change. Research can help unveil the subject, dispelling myths that surround it and contributing to the development of new approaches to help reduce the number of people who die by suicide.
Although the risk of suicide is closely linked to mental health conditions, in the UK only a third of those who die by suicide are in contact with mental health services in the year before they die. This compares to 80 per cent who are in contact with primary healthcare services (Stene-Larsen & Reneflot, 2019). This demonstrates the importance of self-destructive behaviour in building awareness around suicide in all services, with particular consideration of the most common points of contact for people considering suicide. People who die by suicide may not present to services with suicidal thinking or ideation, but rather with a range of other behaviours, such as depression, long-term health conditions and substance use.
Samaritans Talk To Us
This July is the Samaritans Talk To Us campaign, a chance to raise awareness that support is available for any who are struggling to cope. The Samaritans have a key focus on suicide prevention and are always available to talk in times of crisis.
When life is difficult, Samaritans are there – day or night, 365 days a year.
You can call them for free on 116 123, email them at jo@samaritans.org, or visit www.samaritans.org to find your nearest branch.
Risk Factors
There has been considerable research into possible risk factors for suicide as a means to help support those who are vulnerable. According to Your Mental Health, no single factor is responsible for suicide and a number have been found to be influential, including genetic vulnerability and psychiatric, psychological, familial, social and cultural factors. These must all be considered in any preventative approach.
According to the Integrated Motivational-Volitional (IVM) model developed by O’Connor (2011), suicidal thinking emerges from a sense of entrapment, caused by feelings of defeat and humiliation, which are further driven by feelings of loss, shame and rejection, often linked to stress. Feelings of powerlessness and of not being able to escape from mental pain are key to suicidal behaviour.
Researchers have developed an entrapment scale, used to identify these feelings, which can be used in research and clinical practice. High levels of entrapment combined with high levels of loneliness have been found to increase someone’s risk of suicide considerably.
The 4-Term Entrapment Scale (short-form)
I often have the feeling that I would just like to run away.
I feel powerless to change things.
I feel trapped inside myself.
I feel I’m in a deep hole that I can’t get out of.
With a sense of entrapment, rejection and isolation that can often form the basis of suicidal thoughts and action, there are certain groups of people that may be at higher risk according to Your Mental Health:
- LGBT+ young people - suicide can be understood as a response to stigma, discrimination and harassment.
- Autism - Societal issues, such as social exclusion and isolation, poverty, unemployment, trauma and abuse, are significantly more common among autistic people than non-autistic people, and these issues further increase their risk of attempting suicide.
- Loneliness - Research shows that loneliness predicts both suicidal thinking and death by suicide and that depression could be the factor that mediates the relationship.
- Trauma - Given that research has also shown that people who have experienced trauma have a lower cortisol response, it adds to our understanding of the possible pathway to suicide. This highlights the importance of early intervention and protecting those children and young people who have experienced or are vulnerable to trauma.
Myths Around Suicide
Research is improving our understanding of the complex journey that brings people to suicide and how we might be able to change the nature and direction of that path. Despite this increase in awareness and understanding, there still exist a number of myths around the subject, and these can hinder progress towards suicide prevention.
Some of these myths are more harmful and rigid than others. One that is proving particularly hard to dispel is the belief that if you talk to, or ask, someone about suicide it may plant the idea of suicide in their head or encourage them to have suicidal thoughts or to act on them. There is no evidence behind this. There is, however, evidence that if you ask someone if they are suicidal it may start a conversation that could help them get the support they need, or even save their life.
‘I don’t dispute that it’s difficult to ask about suicide and most people’s biggest fear when they ask someone if they are suicidal is that they say “yes”. If they do say yes it’s crucial to be non-judgemental, not to minimise and to try to empathise. That sense of validation, containment and connection is so important. It’s not your responsibility to solve their problems, but this is the start of a conversation that could be the chink of light for them. A sense of compassion and common humanity is key.’ - Professor Rory O’Connor, MQ-Funded Researcher who leads the Suicidal Behaviour Research Laboratory at the University of Glasgow.
Another common myth is that an improvement in emotional state equates to a lessened risk of suicide. Sadly, the reality is that people who have been depressed and suicidal often appear recovered in the days or weeks before they die. This lift in mood offers a false reassurance to others that the person is getting better, when in fact their mood has lifted because they have decided on suicide as a means to end their pain. With this lift in mood comes the capacity and motivation to plan and carry out the suicidal act.
‘If somebody gets better because their crisis has resolved or their medication or psychological therapies are working, you can understand that. It’s the unexpected increase or unexplained lift in mood that, when people have been suicidal, can be a concern. It stresses the importance of vigilance.’ - Professor Rory O’Connor
If you're worried about someone else you can contact the Samaritans here: Samaritans Support If You Are Worried About Someone Else
Approaches To Suicide Prevention
From Your Mental Health
Evidence shows that cognitive behavioural therapy (CBT) can be effective in helping to change thinking patterns that may lead to suicidal behaviour, and models such as CBT-SP have been developed specifically to this end (Stanley et al, 2009).
Dialectical behaviour therapy (DBT), which is based on CBT, has also been found to be effective. It is specially adapted for people who feel emotions very intensely, helping them to understand that two things that seem opposite can both be true. These approaches work at the motivational stage of the IVM model to reduce the sense of defeat, entrapment and humiliation.
The Attempted Suicide Short Intervention Program (ASSIP) is an innovative therapy that has been shown to be highly effective in reducing the risk of further attempts of suicide. The emphasis is on the therapeutic relationship, with four therapy sessions followed by continuing regular contact by letter.
CAMS
Another approach that has had success is the Collaborative Assessment and Management of Suicidality (CAMS), which focuses on the management of suicidal thoughts through the relationship with the clinician, who aims to understand the patient’s suffering from an empathetic, non-judgemental perspective. Common to these various psychosocial approaches to prevention is a safety planning component.
Safety planning is a tool for helping people navigate suicidal feelings and can be a way for the person and those supporting them to plan how to communicate and check in with each other. It may include a list of signs that indicate someone is in crisis, internal coping strategies, the names of friends and family who can help them navigate a crisis, lists of mental health professionals and agencies to call, and ways to make it harder for the person to harm themselves.
Samaritans provide a list of community and charity therapists who may offer free or low-cost talking therapies:
• Your local Mind branch may be able to offer you talking therapies.
• SilverCloud is an online therapy platform that helps people manage their problems. You can access SilverCloud directly without a referral from your GP.
• Anxiety UK offers talking therapies for anxiety. There is a fee, but they do offer reduced costs for people on a low income.
• Cruse Bereavement Care may offer free counselling services if you have experienced the death of someone close to you.
Visit Samaritans How We Can Help page for support resources, including their Finding Your Way booklet here below:
Thanks to research, our understanding of all aspects of suicide is improving: its prevalence, the factors that influence suicidal thoughts and behaviour, and what influences the move from thoughts to action. We are also gaining greater insight into vulnerability and fluctuation in risk. Ultimately, this knowledge will inform prevention and support.
References
Cerel, J., Brown, M.M., Maple, M., Singleton, M., van de Venne, J., Moore, M. and Flaherty, C. (2019), How Many People Are Exposed to Suicide? Not Six. Suicide Life Threat Behav, 49: 529-534. https://doi.org/10.1111/sltb.12450
Stanley et al,. (2019) Cognitive-behavioral therapy for suicide prevention (CBT-SP): treatment model, feasibility, and acceptability. Child Psychiatry.
Stene-Larsen K, Reneflot A. Contact with primary and mental health care prior to suicide: A systematic review of the literature from 2000 to 2017. Scandinavian Journal of Public Health. 2019;47(1):9-17. doi:10.1177/1403494817746274
