Suicide risk mitigation

Suicide is not inevitable. Most people experiencing suicidal thoughts are ambivalent about dying but may be unable to imagine other potential solutions. With the right support people can find their way through a suicidal crisis and recover.

Many people have been touched in some way by suicide. It is an emotive subject. Suicide is a significant public health concern. Everyone can potentially help someone with suicidal thoughts. The majority of people who end their lives by suicide almost always have had contact with someone in the health services. Every contact a suicidal individual has represents an opportunity to intervene and prevent them from going on to die by suicide.

Suicidal thoughts and feelings are far more common than most people realise and are often not related to the presence of a mental illness. Suicide is a behaviour and not a diagnosis. Suicide cannot be predicted accurately in any given individual at a single point in time. Suicide usually occurs as a result of a multifactorial process, where vulnerability to suicide may be generated over several weeks, months, or years.

Self-harm and suicidal thoughts should be taken seriously, and met with empathy, compassion, and understanding given that they are risk factors for suicide, particularly when associated with a history of a mental illness (most commonly major depressive disorder and substance misuse).

Clinicians, patients, and their carers (supporters) are calling for a paradigm shift in suicide risk assessment that moves away from ‘characterising, predicting, and managing risk’ towards ‘compassion, safeguarding, and safety planning’.

Originally called suicide risk management, suicide risk mitigation aims to be a more realistic and compassionate approach.[1]Cole-King A, Green G, Gask L, et al. Suicide mitigation: a compassionate approach to suicide prevention. Adv Psychiatr Treat. 2013;19(4):276-83. https://www.cambridge.org/core/services/aop-cambridge-core/content/view/2DDBBD70C18FC4C6ADBE93B9251E5A60/S1355514600017491a.pdf [2]Cole-King A, Leppina P. Will the new UK government change our approach to risk? BMJ. 2010 Jul 21;341:c3890. http://www.ncbi.nlm.nih.gov/pubmed/20659980?tool=bestpractice.com [3]Cole-King A, Lepping P. Suicide mitigation: time for a more realistic approach. Br J Gen Pract. 2010 Jan;60(570):e1-3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2801800 http://www.ncbi.nlm.nih.gov/pubmed/20040159?tool=bestpractice.com It refers to the identification, assessment, intervention, and treatment of a person at risk of suicide. It is an ongoing process whether due to a mental illness or a life crisis. Traditionally the term ‘suicidal behaviour’ refers to a suicide attempt, an episode of non-fatal self-harm, a suicide plan, and suicidal ideation. The literature sometimes includes non-suicidal self-harm as a component of suicidal behaviour. The authors of this topic suggest avoiding the term ‘suicidal behaviour’ and being more specific about what you observe. There are several key components to suicide: ideation, intent, plan, access to lethal means, and history of past suicide attempts.