Behaviours Related to Mental Disorders: (Suicide and Self-Harm)

Behaviours Related to Mental Disorders: (Suicide and Self-Harm)

What is suicide?

Suicide the act of ending one’s life. Suicide is the outcome of a behavior, is not a mental disorder. But one of the most important causes of suicide is mental illness – most often Depression, Bipolar Disorder (Manic Depression), Schizophrenia, and Substance Use Disorder.

Suicide is found in every culture and is the result of complex social, cultural, religious and socio-economic factors in addition to mental disorders.

The reasons for suicide may vary from region to region. Because of these, it is therefore important to know what the most common reasons for suicide are in the region in which you are working. This may be difficult to determine accurately because of the “taboos” and stigma around suicide.The preferred methods of completing suicide may vary from location to location – ranging from firearms to fertilizer poisoning to self-burning to overdosing on pills. Therefore, it is also important to know the most common methods of suicide in the region in which you are working.

What does suicide look like?

Not all self-harm behaviours are attempts to die. Indeed, most are not. There may be many reasons for selfharm behaviours besides suicide. These include a person attempting to access help. For example, from a person who is stuck in a harmful situation that they cannot escape such as ongoing sexual abuse. A suicide attempt is distinguished from a self-harm behavior by the person’s intent to die. Suicidal behavior has three components: ideation, intent, and plans.

1. Suicidal ideation includes ideas about death or dying, wishing that they were dead, or ideas about committing suicide. These ideas are not persistent for some youth but for some they can become so. These ideas can be fairly common in people with mental disorders or in people who are in difficult life circumstances. Most people with suicidal ideation do not go on to attempt suicide but the suicidal ideation is a risk factor for suicide.

2. The second component is suicidal intent. With suicidal intent, the idea of suicide is better formed and more consistently held than in suicidal ideation. A person with suicidal intent may think about suicide most of the time, imaging what life would be like for friends and family without them, etc.

 3. The third component is the suicide plan. This is a clear plan of how the act of suicide will occur. Vague plans (such as “someday I will jump off a bridge”) are considered as part of intent. In a suicide plan the means of suicide will be identified and obtained (such a gun, poison, etc.) and the place and time will be chosen. The presence of a suicide plan constitutes a psychiatric emergency.

What can I do if it is Suicide?

The first thing is to identify the presence of suicide ideation, intent and plans. Young people who have thoughts of suicide ideation or have intents may benefit from supportive or cognitive based counseling. The presence of a suicide plan should lead to placement of the person in a situation in which they can be safe and secure. That situation should be therapeutic and not punitive and should be accompanied by supportive and cognitive counseling. Any mental disorder should be treated. If a suicide has happened, the family or loved ones may benefit from non-judgmental supportive bereavement counseling. Educators may be faced with situations in which they encounter students self-harming. Do not panic. Calmly bring the student to the most appropriate “in school” support.

When discussing self-harm, it is useful to explain the behavior as an attempt to solve and problem and to note that better solutions exist. Encourage the student to work towards using those. Do not get involved in discussions about self-harm.

If a teacher is faced with a student who is talking about or writing about suicide then it is important to include the most appropriate student services provider to assess the situation. Supportively accompany them to the most responsible student health provider in the school so that an assessment of risk can be conducted.

Generally it is better to err on the side of caution and take the young person to a location in which they can be safe. Schools should have policies about how to deal with a suicidal youth – know your school’s policy. If there is no policy, bring this issue to the attention of the principal. If a young person dies by suicide, there can be negative repercussions amongst peers, classmates and teachers. It is important not to force students or others into reliving or analyzing the event. Traditional Critical Incident Stress Debriefing interventions have not been shown to be helpful and may even cause harm.

Bringing grief counselors into a school is not usually helpful.

A supportive space for those students who wish to use it should be provided after school hours and a teacher or guidance counselor known to the students should ideally be available for those who wish to talk.

Each community will have its own traditions for dealing with this kind of event and it is not necessary to create highly effective responses to a suicide in the school setting.

Self-harm can become a preferred (but unhelpful) approach to problem-solving. Certain mental illnesses (such as Bipolar Disorder) may lead to self-harm because of unstable mood. Sometimes self-harm behaviors can become part of a group identity. Contagion effects can occur in both self-harm and suicide attempts.

What are risk factors for suicide?

The following are the most common (and strongest) risk factors for suicide in young people. Remember that a risk factor does not mean something that causes an event to happen. Rather, it is something that increases the probability of an event.

• Depression or other mental disorder

• Previous suicide attempt

• Family history of suicide

• Excessive alcohol or drug use

Suicide risk is higher in people with mental disorders, in particular those with: Depression, Bipolar Disorder (Manic Depression), Schizophrenia, and Substance Use Disorder. If a young person talks to you about suicide, take them seriously and take them to the person in the school best able to help. Do not keep suicide or self-harm confidential. It is not helpful to engage in persistent public discourse about suicide or self-harm. Youth need to know that the presence of suicidal thoughts is a signal that they need help and that they shouldapproach a trusted adult for assistance. Youth who self-harm can be counseled to seek alternative and better methods to solve problems.

For more information, check out this link: intent to die.