Brenda L. Melton, Ph.D., LPC-S, NBCT

The University of Texas at San Antonio

“The common purpose of suicide is to seek a solution. Suicide is not a random act. It is never done pointlessly or purposelessly. It is a way out of a problem, a dilemma, a bind, a crisis, an unbearable situation. It has an inexorable logic and impetus of its own… Every suicide makes this statement: ‘This far, and no further.’”

Edwin Scheidman, Ph.D.

I find hope in the darkest of days, and focus in the brightest. I do not judge the universe.

~Dalai Lama

80 Million Reasons

To seek a solution to one or more seemingly insoluble problems

Bad gradesFailed relationshipNot getting accepted to collegeA personally humiliating exposure

No suicide is a random act; all have purpose and meaning

Solve the problem and suicide loses it appeal

Helplessness “I can’t do anything to fix what is

wrong.”

Hopelessness The utter belief that nothing will ever be

right or well or bright again forever and ever.

“Suicide is a permanent solution to a temporary problem.”

Phil Donohue

EscapeSuicide provides a way out when

none is otherwise perceived.For humans, there is always a well

lighted exit sign over the door to death.

A previous suicide Talking about being dead or wishing they

were dead Repeatedly engaging in very risky or

dangerous thrill seeking behavior. "Getting the house in order" Extreme mood swings Regular expressions of worthlessness,

helplessness, sadness and/or loneliness.

Drastic changes in habits, friends, or appearance, ie; new friends, skipping school, dropping out of favorite activities, and no longer caring about appearance or cleanliness.

Changes in weight, sleeping habits, and physical activity.

Withdrawing from friends, family, or activities that once gave the person pleasure or a sense of identity

Sex (male) Age (younger than 19 or older than 45

years of age) Depression (severe enough to be

considered clinically significant) Previous suicide attempts or received

mental health services of any kind Excessive alcohol or other drug use

Rational thinking lost Separated, divorced, or widowed (or

other ending of significant relationship) Organized suicide plan or serious attempt No or little social support Sickness or chronic medical illness

Retrieved from Medicinenet.com

Assessment is based on: How much we learn from the person The context in which suicide is being

considered Recognition of warning signs Presence of risk factors Presence of protective factors What the suicidal person is willing to do to

help us save his or her life

Have you had thoughts of killing yourself?

Are you considering suicide? Are you contemplating ending your

life? Have you had any personal

thoughts of death or suicide?

Q for Question the person about suicide

P for Persuade the person to get help

R for Referring the person to someone who can help

What is wrong?Elicits the person’s narrative

explanation or “story.”

Person’s perspective Value in story telling/emotional release Clarify and understand

Elicits the precipitating event or events

Current crisis Hopeless a long time Magnitude of change event doesn’t

matter No reserves left Hair trigger condition Final straw

“I just can’t take it anymore.”

Elicits methods of suicide under consideration

Only so many ways to dieHow (name them)Access to meansMore than one methodDegree of lethal planningBackup plan

Elicits possible location and timing of a suicide attempt

Lethal planning (less is good) Soon, Next week, Next year Anniversary date Uncontrolled contingency, e.g., “If

she leaves.” Home or work Chance of rescue

Elicits important suicide history Past attempts Past suicidal ideation Rescue sought or avoided Timing of attempt Social response to attempt What saved them New method vs. old method

Elicits protective factors Reasons for living Spiritual or religious prohibitions Duties to others/pets Tidying up or ‘to do list’ before dying Fear of death More reasons is good, none is bad Low risk does not equal no risk

Your active listening and questions may have already won the battle

Find life-affirming solutions Greater risk

Refusal to seek help Angry Unwillingness to give up means

Refuse help- reassess risk

Relationship Trust Resources ‘How to’ instructions Personalize the endorsement

Suicide risk is determined, in

large part, by the person’s

willingness to assume personal responsibility for his or her own

safety.

What do you do if it is an emergency, life or death, situation?

If possible, call the parents, inform them of what is going on

Have emergency personnel transport person to the Emergency Room. The ER will do a complete evaluation:

Physician’s EvaluationMental Health EvaluationAdmit to the hospital or refer to services in the

Community

The most authentic thing about us is our

capacity to create, to

overcome, to endure, to

transform, to love, and to be

greater than our suffering.”

Ben Okri