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.
- 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
- 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.
- 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
- 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
- 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