Suicide is defined as the process involving one ending his/her own life. There are various types of suicide which can make it rather difficult to help define the term. Traditional suicide is referred to those individuals who plan or act upon self-destructive thoughts and feelings whilst under immense stress. Assisted suicide is another term where a physician may help a terminally ill person to die, avoiding an imminent, inevitable and potentially painful decline.
The World Health Organisation (WHO) defines mental health as a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her own community (Organization, http://www.who.int/mediacentre/factsheets/fs220/en/, 2010).
The rate of suicide in the UK is continuing to fall where figures reached their lowest in 2007 for both men and women. Suicide rates in 2008 were slightly higher than those seen in 2007 where 5,706 suicides were recorded however in 2009 there was a slight decrease were 5,675 suicides were recorded in the UK (Statistics O. f., Suicide rates in the United Kingdom, 2011).
Although suicide rates are seen as rather low when compared to the early years such as the period between 1990- 2000, there is still a major concern in the number of suicides committed each year.
The prevalence of suicide in the UK is still rather high and remains a major concern due to the number of people going to hospital after having attempted suicide.
The rate of men committing suicide is estimated to be about three quarters of the men in the UK, where men aged 25-34 are at highest risk of suicide, followed by men aged 35-44. Suicide is considered as the second most frequent cause of death within men aged between 15-44, after accidental death (NHS Choices , 2009).
Suicide and young people is also common within people aged 15-24, where accidental death is generally the cause of death followed by suicide. Figures state about 7-14% of young people will self-harm at one point in their life (NHS Choices , 2009).
Suicide is major problem when it comes to the elderly because figures in 2006 showed that 217 people aged 80 or over took their own lives which equated to 5.2% of overall deaths from suicides (NHS Choices , 2009).
Comparing the suicide rates in 2008 between men and women, there were 17.7 suicides per 100,000 population in men and 5.4 per 100,000 in women, thus showing men were three times more likely to commit suicide than women (Statistics O. f., Suicide rates in the United Kingdom, 2010).
Statistics are currently as they stand where women are less likely to commit suicide than men, as women are more likely to report symptoms of common mental health problems instead of men therefore they receive appropriate treatment be it drugs and/or therapy (Statistics N. , 2003).
Possible risk factors for suicide:
A previous attempt at suicide
Possible exposure to suicidal behaviour of others (friends, family or media figures)
Family history of suicide
Family history of substance abuse
Violence within the household (physical or sexual)
Family history of mental disorder
Depression or other mental disorders
When dealing with suicide many individuals who have lost a loved one sometimes wonder if they could have possibly prevented it or some individuals may even blame themselves for the main cause of suicide in others. Therefore this self blaming may lead to behavioural changes which could represent itself as a decrease in the person’s ability to express emotions. Those who experience grieving go through a series of emotions which could render them rather emotionally unstable, those who do experience these emotions sometimes become fixated upon the fact that they may be involved in the death in some manner thus feeling suicide may be the only option to make up for what they believe is all their fault.
Observing suicide rates and the possible risk factors behind suicide, research has shown that majority of people who do commit suicide or attempt to commit suicide actually do have a mental illness where the common cause is depression. Following depression, 10-15% of people affected by bipolar disorder will commit suicide followed by 4% of people with schizophrenia committing suicide soon after their illness begins (NHS Choices , 2009).
The most common types of mental health problems currently in the UK are: (Organization, mhGAP Intervention Guide, 2010)
Impulse control and addiction disorders
Mental illness has shown to play a crucial role and is possibly the main precipitating factor in preventing suicides. Research studies (stated earlier) have shown to form a relationship between suicide rates and mental disorders which leads to suggest that if the appropriate help and support is provided to those with mental illnesses then possible there could be a decline or prevention in the number of suicides seen each year.
Depression is the leading cause of suicide in people with mental health problems thus people in this mind of frame are usually of low mood and may occasionally have thoughts of suicide.
Therefore if we treat the mental disorder then it can stand to reason that thoughts of suicide may also disappear.
Preventing suicide isn’t simple and people who do experience episodes of depression or reoccurring thoughts of suicide should be dealt with efficiently and as soon as possible to prevent harm to them but also to others. It is important to emphasise that people are reminded that help is always available wherever and whenever they need it and many health care professional such as GPs or Pharmacists are there at their disposal.
Although GP’s and Pharmacists are qualified health care professionals they still may not be fully competent in providing advice in situations involving people with mental health disorders. Practitioners that are unsure whether an individual actually is mentally ill and may also be suicidal can still play a part by providing help and support and referring them to more qualified personal for diagnosis.
Suicide prevention can be carried out through many procedures such as using drugs (antidepressants) or talking therapies (counselling or cognitive behavioural therapy).
Those who are described as having a mental disorder, have the hidden burden of stigma and discrimination often faced by those with mental disorders. The term mental illness can be rather misleading as although these problems can arise from biological or medical contributions they can also result from a series of complex interactions of biological, psychological or social factors. Also many illnesses experienced by individuals may differ slightly from normal categories used to describe mental illnesses therefore sometimes a true diagnosis cannot be determined or may be misleading.
Furthermore, when diagnosing people as having a mental health problem there is no universal agreed cut off point between normal behaviour and that which is associated with mental illness. Therefore if it is hard to diagnose people with a mental illness then it does also make it rather difficult to prevent suicides from occurring aswell (foundation, 2010).
Mental illness can lead to improper thoughts such as suicide as many individuals may feel it’s not worth living if they have to go through feelings which make their quality of life rather unsatisfactory. Measures which can be taken to help fight such thoughts and help cope with feelings of sadness, loneliness or just general low self of esteem can involve:
Focusing on certain things which help shift your mind from negative thoughts such as socialising with people who you generally have fun with, spoiling yourself with new cloths/food, or doing deep breathing exercises.
Stimulating the mind and body through performing light exercises, going for a walk outside of the house to get some fresh air and to get a change of atmosphere, planning the day to ensure productivity and try to maintain your usual sleeping pattern.
Avoid depressants such as alcohol or illegal drugs which may feel beneficial at first but long term effects can cause depression and sometimes anxiety, furthermore you may make decisions that you normally would regard as dangerous/pointless.
Socialising to stay connected to the world can help prevent feelings of entrapment, also talking to people about any feelings you may be experiencing can help and spending time with friends to fight against loneliness.
Focusing on positive things in your life rather than regretting what could or should have been.
Go to support/self-help groups and share similar experiences with people in the same situation as yourself and see how they manage their day.
Comparing the likelihood of who is more likely to develop mental health problems, it was reported that women receive more treatment for mental health problems than men, however studies determined this was mainly due to women being more likely to report their symptoms rather than suffer in silence which many men tend do.
Depression is also thought to play a vital role in the development of suicide, where 1 in 4 women will require treatment for depression, whereas only 1 in 10 men will require treatment. Diagnosing depression in men and women is somewhat a difficult process and can sometimes be under diagnosed because they may present to their GP with different symptoms or possibly due to social or biological factors, thus possibly showing men more likely to become diagnosed with depression.
A common mental health problem that also occurs more in women than men is anxiety, obsessive compulsive disorder and increased chances of developing phobias. On the other hand, men are more likely to develop an alcohol or drug addiction compared to women.
It is also thought that mental health problems may be greater in minority ethnic groups than in the white population; however they are less likely to be diagnosed by the GP.
Although it is not clear to what extent mental health care and primary care providers can prevent suicide in those individuals who die due to their mental health problem(s) it is believed they can play a significant role in the prevention. Also for those who do make contact with mental health care providers, majority of these people are adults thus suggesting the youth segment may need to be targeted more to ensure everything was done to prevent their death.
When we look at prevention techniques to minimise or even deplete the frequency of suicides committed by those individuals who are not thinking clearly or those with mental health problems, we firstly think what can be done to reduce the chances of this person committing suicide, and then hopefully aiming to remove all thoughts about suicide and what he or she hopes to achieve by carrying out this act.
Mental health professionals as stated early can play a crucial role in preventing suicide through the means of providing support and help whenever the person may require it, be it day or night. The term health professional is rather a vague term which can be used to describe a broad range of qualified group of individuals each trained in their specific field to offer their unique services to ensure the can do their role in the prevention of suicide.
Many people with mental health problems who think suicide is the only way they will be free from what they may be going through, can be treated not only through the means of supplying various drugs to manage their condition but also by using techniques which provide support to those who may need it the most.
There are many mental health professionals which can provide their services to help those which are not in the correct state of mind by making sure to identify the most suitable plan of action which will be of benefit to the patient, which could entail recommending patients to other mental health professionals (such as a GP recommending a patient to see psychotherapist) to ensure their needs are fully met and overall to ensure the most beneficial therapy or treatment has been considered.
Mental health professionals: (care, 2010)
Nurses in psychiatric hospitals
Community psychiatric nurses
Occupational therapists (OTs)
Community support workers
Carrying out a history of past suicide attempts is one of the most accurate predictors of possible future risk attempts. It has been estimated that about 10-15% of people who make contact with a healthcare service due to a first suicide attempt eventually die by suicide, the risk being greatest during the first year after an attempt.
The White Paper The Health of the Nation (1992) outlined the health strategy for England, and recognised mental health as one of the five main areas in which targets were set for ensuring improvements in people’s health. The aims/targets focused on decreasing the total rate of suicide by at about 15% by 2000 and declining suicides of people with severe mental disorders by at least 33%.
Those people, who have previously attempted to commit suicide, are mainly at risk as they are more likely to repeat their actions until they are successful. Furthermore a good indicator could be those who have a history of suicide attempts within the family. Suicidal thoughts do play any important part in depression and those individuals who have symptoms of depression are therefore more likely to be at risk, in particular if they express a sense of despair about the future or see no point in life.
Research studies have shown good indication that both people with mental illnesses and some people with medical disorders, for example heart disease and cancer, are associated with an increased risk of suicide. Functional mental disorders such as depression and bipolar disorders are associated with the highest risk overall; substance misuse and organic disorders are associated with a lesser degree of risk. On average, people with reoccurring depression have a 15-20% increased risk of suicide; people living with schizophrenia have a 10-15% increased risk. These figures may be rough estimates but, as many who die by suicide may have been experiencing undiagnosed depressive illness.
The most common mental illnesses which cause suicide are depression and schizophrenia where in depression the mental health foundation estimates that about 70% of suicides are due to those in a depressive state (Foundation, 1997).
Depression is known to result in suicidal thoughts and indeed suicidal ideation is an important element in the diagnosis of depression. There is link made where the risk of committing suicide does increase with deeper the depression. However suicidal rates do increase when a individual comes out of a depressive state and energy levels and motivation become greater.
Schizophrenia was the also one of the most leading causes of death a study which was shown by the World Health Organization (WHO). Depression is generally the main factor leading to suicide in schizophrenia; however it is the hopelessness about ones future that actually leads to suicide.
Therefore certain strategies to help prevent suicides in people with mental health problems can involve: (Health D. o., 2002)
Using a Care Programme Approach for those who have severe mental illnesses and a history of self-harm
Have local arrangements for information sharing between criminal justice agencies
Carry out follow-up sessions within a week of discharge for people with severe mental illnesses or a known history of self-harm
Use of atypical antipsychotic medication to be made available for all patients with severe mental illness who are non-compliant with ‘typical’ drugs due to side effects
Promotion of access to services for people in crisis and their families
Adequate staff training in the management of risk, every three years
Prompt access to services for people in crisis and their families
Strategies for dual diagnosis entailing management of substance misuse services
Specialised care plans specifying actions to take if a patient is non-compliant or fails to attend
Assertive outreach teams to prevent loss of contact with vulnerable and high-risk patients
The prevention of suicide in patients with mental health problems is not an easy task, as we have seen there is no single route to achieving these targets for reducing deaths by suicide, since the factors associated with suicide are many and varied.