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We Need to Talk About Suicide

SAMHSA and the Suicide Prevention Resource Center Will Help You Start the Conversation

by Michael Hopps
Regardless of profession, class, ethnic group, or level of achievement, no one is immune to suicide or to suicidal thoughts. Even so, many of us are afraid to talk about this subject.

But if you don’t raise the question, you may never learn that your client is suicidal.

That’s why it’s important to learn how to ask. As James Wright, LCPC, a public health advisor in the Suicide Prevention Branch of SAMHSA’s Center for Mental Health Services puts it: “The data shows that asking directly about suicide does not increase risk, and many times people are relieved that someone asks and they answer truthfully.”

Wright says that most behavioral health specialists have not been directly trained to identify and assess suicide risk. He recalls that when he was in graduate school he had only one course—abnormal psychology—that dealt with suicide, and that was for a single lecture.

“Suicide should not be a taboo subject,” Wright says. “We need to talk about suicide just like we would talk about any health condition needing treatment or support.”

Several SAMHSA–funded suicide prevention efforts provide practical resources and tools to help you start the conversation and follow through with concrete steps to keep consumers safe from suicide.
Box 1. About Suicide

More than a million Americans attempted suicide last year. Many more had suicidal thoughts.

Though the great majority of suicide attempts do not result in death, almost 45,000 Americans died by suicide in 2016. Suicide is the 2nd-leading cause of death among teens and the 10th-leading cause of death within all age groups.1
One SAMHSA Grantee Offers You a Bounty of Resources
The Suicide Prevention Resource Center (SPRC), headquartered in Waltham, Mass., provides training and technical assistance for SAMHSA suicide prevention grantees, and resources and tools for anyone else working in suicide prevention.

One such free training is SPRC’s online course Counseling on Access to Lethal Means, better known as CALM. This training lays out why restricting access to means is an important part of a comprehensive approach to effective suicide prevention. “CALM is a good way to learn how to ask suicidal clients about their access to lethal means,” says SPRC’s Bridgette Hausman, “and work with them and their families to reduce their access.”

For clinicians in the primary care setting, the Suicide Prevention Toolkit for Primary Care Practices is a good place to start. The guide contains tools, information, and resources to implement state-of-the-art suicide prevention practices. It also addresses common barriers to treating suicidal clients in the primary care setting. You’ll find assessment guidelines, safety plans, sample protocols, billing tips, and more.

You can find even more resources at sprc.org, including information on how you can play a role in effective suicide prevention in your setting or community.

SPRC also publishes the Weekly Spark, an e-newsletter with the latest national, regional, and international news on suicide prevention. The publication also summarizes new research.
Sign up to keep up to date on suicide prevention.

There’s Something Beyond That Pile of Rocks
“Hopelessness and helplessness are two of the biggest contributors to suicidal behavior,” says Wright. The person who attempts suicide is usually seeking relief. “As many survivors of suicide attempts have shared,” explains Wright, “suicide usually is about not wanting to end life but to end suffering.”

Wright quotes Dr. John Draper, who leads the National Suicide Prevention Lifeline. “Draper likes to say: ‘Being imminently suicidal isn’t like having a boulder in front of you and not being able to see around it. It’s like having a stack of stones around you and not being able to see through it.’ But if someone can help you take away one of those stones—and then another, and then another—eventually you’re able to see around it. It’s not about removing one thing. One thing didn’t get you there.”

The Lifeline (call 1.800.273.8255 for help) offers providers and behavioral health professionals guidance and resources that you can integrate into your practice. You can also find consumer resources, such as brochures and other materials.
Box 2. Components of a Good Safety Plan

  • A list of things to help you take your mind off your problems

  • A list of familiar places to go where you feel safe

  • A list of trigger events and experiences that may have led to your thoughts, so you can identify what might have made you feel this way and more easily put it aside

  • Contact information for people you trust and can ask for help

  • A list of people who care about you

  • Reminders of things that are important to you

  • Reasons for living2

Keep Safe
Wright recommends that anyone working with suicidal clients download a SAMHSA–created app called Suicide Safe.The app features conversation starters, crisis line phone numbers, case studies, and a treatment locator.

Another helpful resource is the SAMHSA publication A Journey Toward Health & Hope. This 40-page booklet will help you and your client create a safety plan—a written list of coping strategies and resources to help her or him survive a crisis.

Know the Risks, Know the Protections
No group is exempt from suicide or suicidal thoughts. Risk and protective factors can vary by age group, culture, gender, and other characteristics.

“Understanding the problem of suicide for different settings and populations can help you make a greater impact through your work. ” says SPRC’s Hausman. “Knowing the factors that contribute to your patients’ well-being can also help you have more meaningful conversations.”

It may take some time and practice to feel comfortable and confident talking about suicide. But every effort is a step toward more effective suicide prevention. “We all have a role to play,” adds Hausman. “You can make a difference.”

1All statistics courtesy of C. W. Drapeau & J. L. McIntosh (for the American Association of Suicidology). (2017). U.S.A. suicide: 2016 official final data. Washington, D.C.: American Association of Suicidology.

2This is drawn largely from Gallup, Inc., S. Sinwelski, & Didi Hirsch Suicide Prevention Center’s Suicide Attempt Survivor Support Group. (2015). A journey toward health & hope: Your handbook for recovery after a suicide attempt. Rockville, Md.: SAMHSA.