October 20, 2017 –
Dear Dr. Jill:
Does every person with mental illness experience suicidal thoughts?
While most people who die by suicide have a potentially diagnosable and treatable mental health condition, most people with a mental health condition do not die by suicide. Suicide is never the result of one cause, but a combination of common risk factors coming together often in the context of stress and access to lethal means. Certain mental health conditions, such as depression, bipolar disorder and, drug and alcohol use disorders are among those risk factors.
Someone once asked me, “Doesn’t everyone who has a mental illness want to die at some point?” With a puzzled look on my face, I answered, “Life and the brain don’t work that way.” Most of us, regardless of whether we are living with a mental health condition or not, are inherently motivated to live and be productive. That includes people with mental health conditions. In fact, most people with a mental health condition are able to lead satisfying and productive lives. (We should hope so: it’s been estimated that one in five of adults in the U.S. experiences a mental illness in a given year.)
Mental health conditions are like other health conditions: if we take care of our health, we can have a fulfilling life. This isn’t to say that it can’t sometimes be a challenge. It takes lots of attention and care. We need to develop a plan for managing our health conditions so they interfere as little as possible with our lives. We must also be flexible and pace ourselves, and know that it’s okay – even necessary – to reach out to the people in our lives for support.
Even among people who have made a suicide attempt, 95 percent go on living and engaging with life. Suicide has its own set of biological, psychological, social and environmental contributors. In addition to mental health conditions, factors that can increase someone’s risk for suicide include a history of physical or sexual abuse, a family history of mental health conditions or suicide, traumatic brain injury, chronic pain and chronic health conditions. Other contributors closer to the time of suicidal ideation and behavior include stress, adverse life events and intoxication. One essential – and potentially deadly – ingredient is the person’s access to lethal means, i.e. a way of killing themselves.
We have learned through research that people who have made suicide attempts think differently, especially when in a suicidal state. Their pain and desperation affect their ability to make decisions. Their brain isn’t working flexibly, and they can’t generate alternate solutions. They are hurting, feel they are a burden, and that their pain will never end.
So what can we do to help?
If we can remove access to means, and get them through their immediate suicidal crisis and to mental health care, there are medications and therapies that have been proven to reduce suicidal ideation and behavior and change brain function in the area that controls decision-making and impulsivity. This helps to remove the tunnel vision of the suicidal moment. Finding the right health team can be a tough task, but there are people out there who will work with them to make sure they get back to feeling well.
If someone mentions suicide to you, talks about how you would be better off without them, or says you won’t have to worry about them anymore or that they are a burden, raise your alert system and check in with them. Trust your instincts, and look for differences in their usual behavior. If their mood changes and they seem to feel depressed, disinterested or irritable, tell them you’ve noticed, and let them know you are concerned. We know from research that asking someone directly if they’re thinking about suicide will not put the idea in their head or propel them into taking action. It will simply let them know someone cares enough to have an awkward conversation, and that help is available.
Similarly, if someone isn’t sleeping or they are agitated, drinking more alcohol than usual or acting differently from their usual self, try to connect and be persistent! They don’t feel well, and don’t believe things will get better. Keep in mind that people are not often at their kindest in these moments. They are hurting, and there’s a good chance it’s not fun to be with them. Helping someone through a difficult moment and supporting them with patience, encouragement and even a ride to therapy can have a huge impact. Rather than running away, run toward them and try to be there. Recovery is a process and takes time. No one chooses to have a mental health condition. Everyone fares better with respect and compassion.
We can all help to prevent suicide by learning the risk factors and warning signs, and being alert to changes in ourselves, and our family, friends and co-workers.
A pioneer in suicide research, Dr. Jill Harkavy-Friedman was the first researcher to ask high school students about suicidal ideation and behavior. As the Vice President of Research, she leads the American Foundation for Suicide Prevention’s growing research grant program, working with over 150 scientific advisors to evaluate progress in the field and chart the next areas of inquiry to yield impactful insights and strategies for suicide prevention. She has published over 100 articles, and has appeared as an expert in the Washington Post, USA Today, Newsweek, and other publications.
Do you have a question about suicide for Dr. Jill? Send your question to [email protected], with “Ask Dr. Jill Question” in the subject line.
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