Suicide Intervention - Mental Health Treatment

Mental Health Treatment

According to Chiles and Strosahl's 1995 Problem-Solving Model of Suicidal Behaviour, people attempt suicide when they experience the "three I's": intolerable, interminable, and inescapable pain and suffering. Comprehensive approaches to suicidality include stabilization and safety, assessment of risk factors, and ongoing management and problem-solving around minimizing risk factors and bolstering protective factors. During the acute phase, admission to a psychiatric ward or involuntary commitment may be used in an attempt to ensure client safety, but the least restrictive means possible should be used. Treatment focuses on reducing suffering and enhancing coping skills, and involves treatment of any underlying illness.

DSM-IV axis I disorders, particularly major depressive disorder, and axis II disorders, particularly borderline personality disorder, increase the risk of suicide. Individuals with co-occurring mental illness and substance use disorders are at increased risk compared to individuals with just one of the two disorders. While antidepressants may not directly decrease suicide risk in adults, they are in many cases effective at treating major depressive disorder, and as such are recommended for patients with depression. There is evidence that long-term lithium therapy reduces suicide in individuals with bipolar disorder or major depressive disorder. Electroconvulsive therapy (ECT), or shock therapy, rapidly decreases suicidal thinking. Choice of treatment approach is made based on the patient's presenting symptoms and history. In cases where a patient is actively attempting suicide even while on a hospital ward, a fast-acting treatment such as ECT may be first-line.

Ideally, family are involved in the ongoing support of the suicidal individual, and they can help to strengthen protective factors and problem-solve around risk factors. Both families and the suicidal person should be supported by health care providers to cope with the societal stigma surrounding mental illness and suicide.

Attention should also be given to the suicidal person's cultural background, as this can aid in understanding protective factors and problem-solving approaches. Risk factors may also arise related to membership in an oppressed minority group. Aboriginal people may benefit from traditional Aboriginal healing techniques that facilitate a change in thinking, connection with tradition, and emotional expression.

Psychotherapy, particularly cognitive behavioural therapy, is in important component in the management of suicide risk. According to a 2005 randomized controlled trial by Gregory Brown, Aaron Beck and others, cognitive therapy can reduce repeat suicide attempts by 50%.