Suicide medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Medical Therapy

Management includes identification of people who are at high risk of attempting to commit suicide and implementing behavioral and other psychiatric evaluation.

• Identification of the triggers which cannot predict but help in getting aware of the individual
  • Mental disorders, particularly mood disorders, schizophrenia, anxiety disorders, and certain personality disorders
  • Alcohol and other substance use disorders
  • Hopelessness
  • Impulsive and/or aggressive tendencies
  • History of trauma or abuse
  • Major physical illnesses
  • Previous suicide attempt(s)
  • Family history of suicide
  • Job or financial loss
  • Loss of relationship(s)
  • Easy access to lethal means
  • Local clusters of suicide
  • Lack of social support and sense of isolation
  • Stigma associated with asking for help
  • Lack of healthcare, especially mental health and substance abuse treatment
  • Cultural and religious beliefs, such as the belief that suicide is a noble resolution of a personal dilemma
  • Exposure to others who have died by suicide (in real life or via the media and Internet)

• The next step is to admit all the patients who are at high risk for committing suicide
  • Medical professionals advise that people who have expressed plans to kill themselves be encouraged to seek medical attention immediately.
  • This is especially relevant if the means (weapons, drugs, or other methods) are available, or if the patient has crafted a detailed plan for executing the suicide.
  • Mental health professionals suggest that people who know a person whom they suspect to be suicidal can assist him or her by asking directly if the person has contemplated committing suicide and made specific arrangements, has set a date, etc.
  • Posing such a question does not render a previously non-suicidal person suicidal.
  • According to this advice, the person questioning should seek to be understanding and sympathetic above all else since a suicidal person will often already feel ashamed or guilty about contemplating suicide so care should be taken not to exacerbate that guilt.
  • Mental health professionals suggest that an affirmative response to these questions should motivate the immediate seeking of medical attention, either from that person's doctor, or, if unavailable, the emergency room of the nearest hospital.
  • If the prior interventions fail, mental health professionals suggest involving law enforcement officers. While the police do not always have the authority to stop the suicide attempt itself, in some countries including some jurisdictions in the US, killing oneself is illegal.
  • In most cases law enforcement does have the authority to have people involuntarily committed to mental health wards. Usually a court order is required, but if an officer feels the person is in immediate danger he/she can order an involuntary commitment without waiting for a court order.
  • Such commitments are for a limited period, such as 72 hours – which is intended to be enough time for a doctor to see the person and make an evaluation. After this initial period, a hearing is held in which a judge can decide to order the person released or can extend the treatment time.
  • Afterwards, the court is kept informed of the person's condition and can release the person when they feel the time is right to do so. Legal punishment for suicide attempts is extremely.

Mental health treatment

• Treatment, often including medication, counseling and psychotherapy, is directed at the underlying causes of suicidal thinking.
• Clinical depression is the most common treatable cause, with alcohol or drug abuse being the next major categories.
• Other psychiatric disorders associated with suicidal thinking include bipolar disorder, schizophrenia, Borderline personality disorder, Gender identity disorder and eating disorders.
• Suicidal thoughts provoked by crises will generally settle with time and counseling. Severe depression can continue throughout life even with treatment and repetitive suicide attempts or suicidal ideation can be the result.
• Methods for disrupting suicidal thinking include having family members or friends tell the person contemplating suicide about who else would be hurt by the loss, citing valuable and productive aspects of the patient's life, and provoking simple curiosity about the victim's own future.
• During the acute phase, the safety of the person is one of the prime factors considered by doctors, and this can lead to admission to a psychiatric ward or even involuntary commitment.
• According to a 2005 randomized controlled trial by Gregory Brown, Aaron Beck and others, cognitive therapy can reduce repeat suicide attempts by 50%.