Suicide is a serious problem in the United States. According to the Centers for Disease Control and Prevention, suicide rates have increased by 35% since 1999.2 Many in the human services industry encounter this problem first-hand. Their clients are often dealing with life issues known to be risk factors for suicide. As a result, human services organizations could find themselves thrust into the role of developing suicide-prevention and awareness policies.
Mental health organizations are taking the opportunity to spread vital information about how to develop effective and accessible crisis-response plans for people at risk. In the same way the Heimlich maneuver and CPR can be performed by those without formal medical training, there are some basic tools and knowledge almost anyone can use that might help prevent a suicide.
Risk factors and signs
Unfortunately, suicidal thoughts are not uncommon, and they are often signs of more serious issues. Much like other mental-health conditions, suicidal thoughts can affect anyone regardless of age, gender or background. However, serious suicidal thoughts do seem to occur more often in certain demographic groups than others, such as the groups listed here8:
- 4.9% of all adults
- 11.3% of young adults aged 18 to 25
- 18.8% of high school students
- 45% of lesbian, gay, bisexual, transgender and queer youth
It’s important to note changes in a person’s pattern of behavior that may indicate a mental-health issue. Changes in behavior that can indicate a mental-health issue can include the following:
- Increased alcohol and drug use
- Aggressive behavior
- Withdrawal from friends, family or community
- Dramatic mood swings
- Impulsive or reckless behavior
- Collecting and saving pills
- Giving away possessions
- Tying up loose ends, such as organizing personal papers or paying off debts
- Saying goodbye to friends and family
It is important to note that mental health is an overall wellness of how people think, regulate emotions and behave. Mental health can be affected by a mental disorder, which are often diagnosed by medical professionals through tools such as the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and clinician interviews7. However, mental illness by itself may not indicate a danger of suicide.
There isn’t an easy distinction between mental health and mental disorders, but changes in mental health, should be noted as they could lead to suicidal tendencies.
It is critical for those working in the human services field to know and recognize the signs of suicide, in addition to knowing what steps to take next. Undergoing mental health first-aid courses, such as those offered through county mental health boards or outreach programs, can be beneficial for:
- Human services workers
- Family members of human services workers
- Members of local emergency response teams.
The pandemic’s impact
For two years, the COVID-19 pandemic has restricted social contact, and has had a negative effect on the nation’s collective mental health of the nation.
It caused millions of deaths, many of which occurred in isolation without the presence of loved ones, who then may have been denied funerals and grief-processing bereavement rituals. In addition to increasing anxiety, the pandemic also worsened economic and financial stressors for many families.
Young people were unable to participate in stress-relieving activities such as sports, extracurricular clubs and socializing with their friends. Even as Covid transitions to an endemic rather than pandemic phase, mental health experts predict its psychological damages will be felt for years to come.5
Mental health professionals reported such an influx of patients seeking care during the pandemic that they often had to be turned away. Healthcare and human services systems that were already bursting at the seams were frequently overwhelmed, leaving gaps in care or long wait times for some patients.4
One of the biggest impacts of the pandemic was a rapid shift from traditional face-to-face care to various forms of virtual care. This rapid shift was made possible by emergency pandemic waivers that cut through red tape and streamlined reimbursements, allowing healthcare providers to leverage virtual technology tools.
Telemedicine offers many advantages, such as expanding care to more patients like those located in underserved or rural areas. It is also particularly valuable to the elderly because it saves frail and/or cognitively impaired patients from having to be moved around as much to receive treatment.
However, telemedicine presents challenges as well, especially for the mental-health sector. while telemedicine services increase access to care for some, others who reside in low-income, underserved or rural areas may have limited access to the kinds of technology necessary for virtual services. As a result, these patients may actually experience greater barriers to care when face-to-face options aren’t available.
Additionally, psychological assessment relies heavily on the provider’s ability to observe patients at close proximity. Throughout the pandemic, many providers struggled with a lowered therapeutic rapport among virtual patients because they were not in the same room. Even during video encounters, many doctors noted difficulty detecting subtle facial expressions, response to internal stimuli and abnormal involuntary body movements—all of which are vital clinical clues to diagnosing suicide risk and psychotic disorders.5
Despite the potential for technology challenges, telemedicine has been a beneficial tool for mental health providers and human services organizations. Its potential to reach customers where they may be more comfortable can help reduce the potential for unhealthy behaviors including violent outbursts, self-harm, and/or suicide. It can also help identify needs in a more timely fashion as the waiting time for an in-person session may be too long to disrupt a harmful chain of thoughts.
What human services organizations can do
Employee training is key to helping address suicide within the populations human service organizations serve. Staff training might include this course on Mental Health First Aid, which instructs those without formal medical training how to identify, understand and respond to signs of mental illness and substance abuse. More than 2.5 million people in the U.S. have taken this course, and it can help staff learn how to provide initial help and support to someone who might be experiencing a crisis.
As a general rule, human services employees should know the warning signs of suicidal behavior and how to approach and talk to a client or co-worker in crisis. Here are a few guidelines:
- Talk openly and honestly. Don’t be afraid to ask questions like: “Do you have a plan for how you would kill yourself?”
- Remove means, such as guns, knives or stockpiled pills.
- Calmly ask simple and direct questions, like “Can I help you call your psychiatrist?”
- If there are multiple people involved, only one person should speak at a time
- Express support and concern
- Don’t argue, threaten or raise your voice
- Don’t debate whether suicide is right or wrong
- If you’re nervous, try not to fidget or pace
- Be patient
If someone is struggling with suicidal thoughts, let them know they can talk to you about what they’re going through. While speaking, it’s important to try to adopt an open and compassionate mindset. Instead of “arguing” or trying to disprove any negative statement the person makes—such as saying things like “Look on the bright side, count your blessings,” etc.—employ what are known as active listening techniques.6
Active listening techniques involve listening carefully to the speaker, and then occasionally restating and clarifying what has just been said. While actively listening, avoid asking questions or saying what you feel, believe or want. Respond to the personal and specific aspects of what is being said, as opposed to bringing up impersonal or abstract concepts. Above all, try to focus on the feelings reflected in the speaker’s words, not just the facts or ideas. This can help the person feel heard and validated.7
In urgent situations, employees can call a new three-digit Suicide & Crisis Hotline—988—available to every person in every community nationwide. This number from the National Suicide Prevention Lifeline will put you in touch with trained crisis counselors who can help in a mental health, substance use or suicide crisis. The previous Lifeline phone number (1-800-273-8255) will always remain available to people in emotional distress or suicidal crisis.
Human services organizations interested in bolstering their suicide prevention and awareness protocols might also benefit from some of the resources available at the National Alliance on Mental Illness (NAMI).
September is Suicide Prevention Awareness Month, a time to spread hope and share vital information about this stigmatized and often taboo topic. Throughout the month, NAMI will highlight its “Together for Mental Health” campaign, which encourages people to bring their voices together to advocate for better mental healthcare, especially an improved crisis response system, exemplified most recently by the new 988 emergency hotline.