Signs of Self-harm and Suicidal Ideation


Suicide is not a mental problem in itself, but a serious potential consequence of treatable mental disorder.

Suicide is the act of taking one’s life.

Suicide terminologies

  • Suicidal behaviour includes completed suicide and attempted suicide
  • Thinking about, considering or planning suicide is referred to as suicidal ideation
  • Completed suicide: a suicidal act that results in death
  • Attempted suicide: a non-fatal, self-directed potentially harmful act intended to result in death but may or may not result in injury
  • Non-suicidal self-injury: A self-inflicted act that cause pain or superficial damage but is not intended to cause death

Burden of suicide/epidemiology

  • Every year, about 800,000 human beings die from suicide.
  • The global annual mortality rate has been estimated by the World Health Organization (W.H.O.) to be 10.7 per 100,000 individuals
  • Suicide is the one of the leading cause of premature death among individuals.
  • 78% of completed suicide in LMIC’s
  • Completed suicide are 3ce more common in males than female
  • Suicidal attempt is commoner in females than males

Risk factors for suicide

  • The primary remediable risk factor is DEPRESSION
  • Mental disorders
  • Use of alcohol, drugs and prescription analgesics
  • Previous suicide attempts, family hx
  • Serious physical disorder, especially in the elderly
  • Personality disorder

Other risk factors

  • Traumatic childhood experiences
  • Family hx of suicide and/or mental disorders
  • Also lesbian, gay and transgender individuals have a higher risk of committing suicide
  • Certain professionals like the police, health care workers, fire-fighters, first responders and individuals in the army have elevated suicidal risk
  • Certain socioeconomic factors like bullying or harassment, arrest, legal problems, unemployment and economic downturns

Methods of committing suicide

  • Self-poisoning with pesticides
  • Drowning
  • Hanging
  • Use of firearms
  • Jumping from heights
  • Carbon monoxide poisoning
  • Stabbing self or slitting the throat

Signs of suicide

  • Talking about suicide and death
  • Talking about feeling empty, hopeless, worthless
  • Feeling of guilt, shame.
  • Talking about being a burden to others
  • Social withdrawal or isolation
  • Giving away possessions, making a will or saying goodbye
  • Increase use of alcohol or drugs
  • Engaging in high risk behavior
  • Any unusual change in mood or behavior
  • Changes in sleep pattern
  • Accessing means to commit suicide
  • Emotional distance

How do I help?

  • Do not leave the person alone (ask for help from friends and family)
  • Ask about thoughts of suicide.
  • Ask the person to give you any weapons they have. Keep the person calm, stay calm and reassure.
  • Keep the person calm, stay calm and reassure.
  • Acknowledge that feeling are legitimate.
  • Offer support and encouragement.
  • Refer to the MH worker
  • If possible, follow them to see the healthcare provider.

Suicide prevention

  • Blocking access to respective means e.g. poisons, barriers around bridges, tall buildings, firearms.
  • Community awareness Crisis intervention
  • Referring them to an appropriate place for follow-up care as soon as possible
  • Don’t try to minimise their problems
  • Do not attempt to shame them into changing their minds

Effect of suicide

Any suicidal act has a marked emotional effect on all involved. The physician, family members, and friends may feel guilt, shame, and remorse at not having prevented a suicide, as well as anger toward the deceased or others. The physician can provide valuable assistance to the deceased’s family members and friends in dealing with their feelings of guilt and sorrow.


  • Globally, suicide rates have increased in the population with chronic medical, mental illness including alcohol and other drug user including previous suicide attempters.
  • Quality of data is poor
  • Prevention is possible, therefore interventions should be put in place
  • The need for the wellness center cannot be overemphasized.


Other names: deliberate self-harm Non suicidal self-injury parasuicide. Self-harm is said to happen when the person intentionally causes physical injury to oneself, without wanting to die

How common is self-harm

Difficult to give an accurate measurement

  • 1 in 10 young people will self-harm at some point but can happen at any age.
  • Rates higherin young people, especially females
  • Also occurs in prisoners, asylum seekers and war veterans
  • Young people in groups
  • Gays, bisexual individuals
  • Childhood history of physical, emotional or sexual abuse


The most common methods of self-harm include

  • Cutting or stabbing the skin with a sharp object (e.g., knife, razorblade, needle)
  • Burning the skin (typically with a cigarette)
  • Jumping from high places
  • Embedded objects like staples and tacks that are not for fashion
  • Ingestion of strange chemicals or meds
  • Hair pulling

What makes them do it?

  • Feeling depressed
  • Feeling bad about self
  • Relationship problems with partners, friends and family
  • Unemployment or having difficulty at work
  • Physical or sexual abuse
  • Feeling they are not listened to
  • Hopeless, helpless, powerless
  • Alcohol and other substance use
  • To show they are in distress

How does it make them feel?

The motivations for non-suicidal self-injury are unclear, but self-injury may be

  • A way to reduce tension or negative feelings
  • A way to resolve interpersonal difficulties
  • Self-punishment for perceived faults
  • A quick-fix for feeling bad
  • Gives them a sense of control

What to look out for

  • Extensive patterns of scarring. Patients are often
  • Preoccupied with thoughts about the injurious acts.
  • Look out for scars, bruises, broken bones
  • Wearing long sleeves and slacks
  • Interference with wound healing
  • Wanting to be alone
  • Ask questions about their self-worth or identity

Does it mean I am mentally ill?

Possibly not. You may be depressed, or have personality difficulties

Danger signs

  • Use of dangerous or violent methods
  • Self-harm regularly
  • Social withdrawal
  • Have mental illness

What can I do for them?

Some patients view the self-injury as a positive activity and thus tend not to seek or accept counselling.

  • Remember the person is in crisis
  • Validate the person’s experience
  • Remain calm, show care and compassion
  • Learn more about self-harm
  • Do not panic, overreact, show revulsion
  • Find out about getting help

What shouldn’t I do?

  • Trying to be their therapist
  • Expect them to stop overnight
  • Struggle with them when trying to self-harm
  • Making them promise not to do it
  • Feel responsible for their behaviour

Take home

  • Early detection and timely intervention is key
  • Self-harm should be taken seriously
  • It may serve one or many different functions
  • Non-judgmental emphatic response is important
  • Education about self-harm
  • Refer for specialist care


Cara main slot