When we consider those who have died by suicide, it’s common to look back and scour our memories for clues that could have foreshadowed the tragedy. We think about all of the things that person said or did. We ask ourselves whether there was something we could have done, or whether there were certain moments that alluded to their despair and hopelessness that we just hadn’t noticed; or worse, taken seriously.
Part of saving the lives of our loved ones certainly means recognizing the warning signs of immediate suicide risk, and reaching out with support and resources. But what if we could identify those who are at-risk even earlier, not only in the minutes, hours, or days leading up to a suicide? Though there won’t always be something we could have done any better or differently - despite our best efforts - by learning what to look for and and actively working towards supporting wellbeing, we can increase our ability to prevent suicide when possible.
The first step in identifying those at-risk for suicide is understanding that there is no single cause or stressor that prompts someone to want to take his/her life. The American Foundation for Suicide Prevention states that “suicide most often occurs when stressors exceed current coping abilities of someone suffering from a mental health condition.” Warning signs indicate that a person is in imminent danger for attempting suicide and requires immediate intervention and action. These at-risk individuals are feeling hopeless and have reached a point where they have determined that there is no other option. Effective and successful suicide prevention efforts require that we intervene if or when a person displays these warning signs. More importantly though, when applied properly, effective and successful prevention efforts help us identify those at risk before they even reach this tragic moment.
Learning to identify risk factors enables friends, family members, and medical professionals to intervene and provide support early enough to prevent suicide attempts and deaths, and focus on providing treatment and care. Unlike warning signs which signal immediate risk, risk factors are “characteristics that make it more likely that someone will consider, attempt, or die by suicide,” though “they can’t cause or predict a suicide attempt.” Risk factors can be identified through demographics, and past history or behavior - information that is often readily available not only to the people who know and love these individuals, but to medical professionals who might already have this information on file.
- Family history of suicide
- History of depression or other mental health conditions
- History of substance abuse
- History of trauma or abuse
- History of violence
- Previous suicide attempts
- Stressful life event or loss (job, financial, relationship)
- Easy access to lethal means/methods
- Stigma associated with mental/behavioral health and/or asking for help
Friends and family members might already be able to identify these risk factors in someone they know, even if the individual hasn’t expressed suicidal thoughts or doesn’t appear to have a behavioral health condition. Being cognizant of these risk factors early on means that we can lay the groundwork for better supporting our loved ones and promote protective factors that can actively reduce the risk of suicide.
Protective factors reduce the risk of suicide and play a complementary role in prevention efforts. Most risk factors we cannot control, but we can act upon many protective factors. In contrast to risk factors which identify unchangeable demographics and behaviors, protective factors consist of methods that promote positive healthcare, life skills, and support, such as:
- Effective and more comprehensive mental and behavioral healthcare
- Cultural and societal emphasis on developing skills in problem-solving, coping, adaptability, and conflict resolution
- Connectedness to or support from individuals, families, communities, and institutions
- Cultural or religious beliefs that emphasize seeking help and discourage suicide
- Reducing cultural stigma associated with mental and/or behavioral health conditions, and asking for help
Incorporating protective factors into the fabric of our communities and institutions can help us proactively take steps to prevent suicide. However, to ensure that every person (regardless of their resources and access to those resources) is given the same opportunity to live a healthy life, we must look towards improving and changing the ways in which we support and interact with those who are at risk.
On an individual level, we can be more of a lifeline for our loved ones and help direct them toward resources that promote wellbeing and incorporate protective factors. Specifically, this can include things like helping them find treatment, reaching out to them often and providing support, and being cognizant of the way we personally speak about behavioral health - to ensure we’re not adding to the stigma.
On a community level, we must also consider how we can reach out to community members who need our help. We must emphasize understanding, compassion, and connectedness - building strong and healthy relationships with each other - to create a safe environment in which people who might be at-risk feel comfortable asking for help. We should encourage healthy problem-solving, conflict resolution, and coping skills as we interact with each other, cultivating a community that values respect and empathy.
Finally, on an institutional level, the Pain of the Nation Report, produced by the Trust for America’s Health, Robert Wood Johnson Foundation, and Well Being Trust calls for “A National Resilience Strategy” to “create a more comprehensive, focused and effective approach that prioritizes putting prevention first, promoting positive mental health, and that develops systems of support to identify issues early and ensures Americans receive the support and care they need to thrive.” This strategy would put protective factors at the forefront of cultural priorities, as opposed to pursuing reactionary care, that waits until a diagnosis or worse, a death, to address and rectify a serious mental or behavioral health issue. As the report suggests, we must implement evidence-based policies, expand the services we offer and ensure that those services are extensive. Electing and supporting leaders who understand, support and pursue this strategy ensures that people who need our help have easy and readily available access to the resources and support they need.
With suicide rates at a 30-year high, we need to focus on reducing risk factors and increasing protective factors to improve suicide prevention. The Pain of the Nation Report underscores this point in saying “without better strategies that focus on preventing problems and providing effective support, services and treatment, the trends are likely to be perpetuated and get worse.” We cannot be reactionary; we must be proactive in ensuring all people have access to the care, resources, and skills they need to prevent suicide.