In the Exam Room or Our Own Backyards, Suicide Prevention Begins With a Conversation

As health care providers, we are accustomed to talking about suicide from a clinical perspective. Yet while suicidal ideation may be a common topic in relation to our patients, many health care professionals still feel unprepared to discuss their own suicidal thoughts or concerns about suicidality in colleagues or loved ones.

Perhaps the rational comfort of statistics can begin to help by reminding us that suicide is a widespread human issue. According to the CDC, an average of 12 million American adults seriously think about suicide each year, while 3.5 million make a suicide plan and 1.4 million actually make a suicide attempt. Suicide is the second leading cause of death in individuals under age 34, and the tenth overall leading cause of death in America each year. Women tend to attempt suicide more often, but men are four times more likely to kill themselves.

Even more sobering is that for every 100,000 people, the number of doctors who die by suicide is about twice that of the general public; residents, nurses and emergency medical technicians are also at increased risk.

It can be overwhelming and scary to face the topic of suicide in our own lives. Whether we’ve experienced these thoughts ourselves or suspect someone we love is struggling with them, the fear of doing or saying the wrong thing can keep us from seeking – or providing – needed help. Certainly, no one is responsible for another’s decision to take their own life. But knowing the risk factors and warning signs of suicidal ideation, and knowing how to respond, could save a life.

First, it’s helpful to remember that suicidal ideation, a broad term used to describe thinking about or planning suicide, is broken down into two categories: passive and active. Passive suicidal ideation is when an individual might wish they were dead, or want to die, but has no plan to complete suicide. Active suicidal ideation is when an individual not only wishes they were dead but has intention to complete suicide and has thought about a plan to do so. They may also have access to that plan or are working on ways to make it happen. While passive ideation may seem less serious, it is worth noting that it can quickly change to active ideation, so it should be addressed and treated as well.

There are many reasons that people contemplate suicide. Suicidal thoughts are part of the diagnostic criteria for many mental health diagnoses, including but not limited to major depressive disorder, borderline personality disorder and bipolar disorder. Having a mental illness is a risk factor for suicide. Other risk factors are social isolation, serious illness or chronic pain, substance use disorders, and financial, career or legal problems. Relationship issues, such as divorce, childhood abuse or neglect, and bullying can also be risk factors for suicidality. Family history of suicide or previous suicide attempts also increase one’s individual suicide risk.

Additionally, health care professionals have high levels of job-related responsibility and stress; work long and often irregular hours; belong to a culture that stigmatizes reporting mental health distress and seeking help; and have greater knowledge about and access to lethal substances, all of which are significant additional risk factors.

Signs to look out for in yourself and others as possible indicators of suicidal ideation include isolating oneself from others, feeling hopeless or trapped or that your work is futile, increased substance abuse, anxiety, financial problems and thinking about a suicide plan.

If you notice in yourself that you are having persistent thoughts of suicide, contact a mental health provider to discuss your symptoms and to be assessed for suicide risk. Counseling can help you cope with difficult emotions and situations, identify the triggers that are leading you to have suicidal thoughts, change the negative thoughts that are causing distress and create a safety plan as needed.

If you recognize some of the risk factors and warning signs in a colleague or loved one, the first step is to ask a few hard questions. The Columbia Protocol is a suicide prevention tool that uses simple language to assess suicide risk and is therefore recommended for family members, friends or colleagues, not just mental health clinicians. The first question is, “Have you wished you were dead or wished you could go to sleep and not wake up?” If they answer yes, the follow up question is, “Have you actually had any thoughts about killing yourself?” Again, if the answer is yes, the third question is, “Have you been thinking about how you might do this?” If the answer to any of these questions is yes, the individual has some suicide risk and should be assessed by a mental health provider. If the answer to all three is yes, and you are worried the individual is in immediate danger, taking them to the closest emergency room is the safest option.

Many people are afraid to ask someone else about suicide because they believe it might push the person towards this option or increase their suicidality. This is not the case. Most people who are considering suicide want to talk about it but often feel helpless, ashamed or don’t know how to bring it up. Opening the door to have this conversation can be a push in the right direction to getting someone the help they need.

If you or someone you know would benefit from counseling, please call Cascade Behavioral Health at (541) 345-2800 to schedule an appointment. If you need immediate help, please call: 

1-800-273-TALK1-800-SUICIDEText support: Text CONNECT to 741741

A version of this blog post appears as a contributed article in this month's "Medical Matters," published by the Lane County Medical Society (LCMS). LCMS has a Provider Wellness Program that gives members access to confidential counseling services through Cascade Behavioral Health. Services are quickly accessible at the member’s convenience, completely confidential, and free to providers. If you are an LCMS member and would like to take advantage of the Provider Wellness Program, please contact Cascade Behavioral Health at (541) 345-2800.