Making sense of suicide helps clinicians increase their competency and comfort in treating suicidal ideations and related behaviors.

Part 1: Introduction

Suicide remains a national and international crisis. The World Health Organization (2018) estimated that over 800,000 people die by suicide each year. In the US in 2022, nearly 50,000 people died by suicide.  That equated to 1 death every 11 minutes. 

A great deal of resources and funding goes into researching who is dying by suicide as well as towards creating suicide prevention initiatives based on identifying risk factors and improving access to care. However, these efforts fall short in helping clinicians feel confident in working with someone struggling with suicidal ideations and related behaviors.

What gets in the way?

Additionally, there remains insufficient course work and training in graduate programs, internships, and residencies to help students become comfortable with talking in a direct and compassionate way about death and dying. Couple this with on-going social stigma towards suicide as the “cowards way out” and misconceptions that by asking about suicide you can trigger it. All told, clinicians are primed to want to avoid addressing suicide in a meaningful way.

Once in independent practice, this discomfort is then exacerbated by fear of negative outcomes and litigation, causing many providers to not be willing to take on higher-risk clients. Alternatively, practitioners will take these cases and then treat suicide indirectly by focusing on comorbid diagnoses like depression or PTSD with hopes the suicidality will resolve concurrently.  While this can work, it can also miss the mark as what is driving suicide may or may not be directly related to these other diagnoses.

Challenges

Clinicians working in larger systems are faced with mandates to complete lengthy and highly impersonal risk assessments. These check-the-box questionnaires can be experienced by the client and provider alike as yielding a detached evaluation rather than an individualized understanding. The problem is, once identified as high risk, there are often inadequate resources and support to then actually treat the person and their suicidal ideations and related behaviors. This can result in unnecessary psychiatric hospitalizations, ineffective safety contracts, poorly constructed safety plans, and again, treatment interventions that put suicide in the back seat.

What do we do?

First and foremost, we have to get comfortable talking about suicide. We have to recognize it as an “understandable solution to intolerable suffering (Jobes, 2008).” This extends to the full range of experiences that fall under suicidal ideations and related behaviors including non-suicidal self-directed violence. We do this by making sense of suicide – why it happens, why it makes sense, and how it functions.

Coming Up

I can’t capture all the nuances of suicidal ideation and related behavior in a single blog. So, I’ll be writing a series. Hopefully this introduction has piqued your interest, helped you feel seen, and established why we need to talk about suicide more.

In future posts, I’ll go over key theories, intervention options, risk assessment, safety planning, differentiating between non-suicidal self-injurious behavior and suicidal behaviors, media portrayals of suicide, and more. 

I’ll be also hosting a webinar on Making Sense of Suicide soon, so stay tuned!

For Clinicians: I hope this blog series will help you feel more confident making sense of suicide.  It is not easy work. Solid self and community care are essential. And the healing this work can provide is profound.

For those seeking healing: I hope that this series can help you too. I hope it reminds you that you are not alone; that your thoughts and feelings do make sense. AND these posts do not equate to treatment. Please, if you are having thoughts of suicide or self-harm, ask for help. If these thoughts are immediate and urgent, call 9-8-8 or go to your local emergency room.