Understanding Suicide Can Help Prevent It

EAP Ask the Expert: Mark Schechter MD, Chair of the Department of Psychiatry – Salem Hospital

Did you know that most people who struggle with suicidal thoughts get better and do not go on to kill themselves? Many are never suicidal again. They need care, compassion, treatment, and the belief that they can move past the despair. Recovery is possible.

However, suicide continues to be a significant public health issue and causes pain and grief to those impacted. The American Foundation for Suicide Prevention, (AFSP) referencing CDC data, reports that, in 2022 in the US:

• There were nearly 50,000 reported suicides
• An estimated 1.6 million attempts
• Males make up 80% of suicides
• Suicide is the 11th leading cause of death overall and the 2nd leading cause of death for young men

We don’t fully have an accurate understanding of what drives people to have suicidal thoughts or attempt suicide. Perhaps the biggest barrier to decreasing suicide is stigma and shame, which prevent those who are struggling from seeking help, and those who care, from offering assistance and compassion.

As a healthcare organization, we want to be in the best position to help our patients, but also, our family, friends, and colleagues.

Healthcare workers are under significant stress and at higher risk for suicide. A 2023 JAMA article showed that the risk of suicide was higher for health care workers, compared with the general population. This research was unique in that it included workers, beyond just nurses and doctors. The risk percentages compared to non-health care workers are as follows:

• Support workers – 81%
• Nurses – 64%
• Technicians – 39%
• Social & behavioral health workers – 14%
• Physicians – 11%

To better understand suicide and how to prevent it, we turned to Dr. Mark Schechter, psychiatrist from Salem Hospital, who is regarded as an expert across MGB and in the field.

Why is there a Stigma Associated with Suicide?

Dr. Schechter explains that stigma related to mental health and substance use disorders (SUDs), both common with suicide, is intertwined with, and exacerbated by perceptions about suicide.
When we don’t fully understand something, we often perceive it as different or bad, and in the case of suicide, even repulsive, selfish, and weak.

Those with mental health issues and/or SUDs, may face disparate treatment in and outside of the medical system. For example, some mistakenly believe that SUDs stem from personal choice, rather than from an illness with biological and psychosocial components.

When you add suicide to the mix, there are even more significant stigma-related hurdles.
It’s natural to respond to discomfort with avoidance or judgment, but how can we combat these tendencies as individuals or healthcare delivery systems and help those who are struggling? In short, through increasing knowledge and access to avenues for help.

Separate Myth from Fact 

Dr. Schechter was the expert on this MGB video about Suicide Facts. Below we elaborate on the facts about suicide and address some common misconceptions.

Why do people attempt suicide?

For most people, attempted or completed suicide is not about death or wanting to die but rather about feeling unbearably bad. Experts refer to “entrapment,” which involves a sense of total desperation and the perception that there’s no way out and no end in sight, even though these feelings are in fact transient.

Is suicide only about depression or mental health?

No, although depression or other mental illness may predispose some to suicide, these are not the only precipitants.

Some individuals experience a sudden or unexpected life event (relationship, legal or job issue), that is perceived as so catastrophic that it triggers an extreme loss of hope, shame, and feeling stuck. The usual self-esteem supports are compromised, and it feels like the structure beneath this person is caving in or non-existent.

Are suicidal feelings chronic or permanent?

Not typically. Despite an intense belief of no solution when they experience suicidal thoughts, these feelings are usually temporary. If we can help someone stay safe and feel supported, they can usually get through the period of feeling suicidal.

Is it true that if you stop someone from killing themselves with one method, they will probably just choose another.

This is FALSE!  Making the environment safer, such as by removing a gun from the home, limiting access to toxic medications, or putting up suicide barriers on bridges, does help to save lives. Studies have found that approximately 90% of people who have survived even the most near lethal suicide attempt do not go on to kill themselves

Are all suicides preventable?

Suicide is often preventable, but not always. There are many steps that can and do save lives, but they don’t work 100% of the time. This is the case with many conditions, such as cancer or heart disease. Sometimes there is not a cure. Even the most highly trained therapist or psychiatrist cannot predict every suicide, and what cannot be predicted cannot be prevented. Even the most caring family or friends cannot heal all illness.

When suicide happens, it’s a is a tragedy, but usually a blameless event. It’s important for loved ones, friends, and professionals to understand this, so we don’t avoid a person in need for fear of failure.  We should not hold back on reaching out to people who are struggling because of discomfort, fear of doing something “wrong,” or somehow making things worse.

How to Help or Get Help

Many people avoid offering help, even when they suspect that someone may be struggling or presents a safety risk. This is understandable, especially if they are not familiar with how to intervene or approach someone. You don’t need to be an expert to offer support. Dr. Schechter stresses that with knowledge and practice, you will achieve greater comfort and feel less awkward. Below is some guidance:

Learn about common risk factors

• Mental Health – depression, anxiety, bi-polar disorder, personality disorders
• Substance use disorders
• A devastating health diagnosis
• Sudden life change -marriage, job, financial
• Previous suicide attempt
• Family history of suicide

Understand the Warning Signs

AFSP offers a full list of warning signs. Here are some to be aware of:

Feelings:

• Hopeless
• Believing there is no reason to live
• The perception of being a burden to others
• Trapped
• Unbearable pain
• Fatigue

Mood:

• Depression
• Anxiety
• Loss of interest
• Irritability
• Humiliation/shame
• Agitation/anger
• Relief/sudden Improvement without a legitimate explanation

Behavior:

• Increased use of alcohol or drugs
• Withdrawing from activities
• Isolating from family and friends
• Sleeping too much or too little
• Aggression

Does asking about suicide make people more likely to hurt themselves?

No. It makes a suicide LESS LIKELY because it is often experienced as a relief and can represent a pathway to getting help.

• What people need when they are struggling is human connection
• When people feel suicidal, they feel alone
• When someone reaches out, they feel less alone and it less likely they will feel that the only choice is suicide
• In general, reaching out is interpreted as caring rather than being intrusive
• The standard for caring is not perfection

What can you say when you are concerned about someone?

Anything that starts and keeps the lines of communication open

As a family member or friend

Move from general to specific

• As your friend, I can’t help but notice that you have been struggling lately. How have you been feeling?
• I have been concerned about you
• I have just been wondering because you seem so hopeless
• Has it ever gotten to the point where life is not worth living?

As a clinician

• Ask about thoughts:
  – Did it ever get specific?
  – When was the last time that happened?
  – Have you ever come close or done anything to hurt yourself?
  – Taken meds or contemplated it?
• Do you have access to a way to do this?
  – Guns or pills?

Identify the right kind of help

• If it gets to intent and plan, then seek immediate help from a professional or the Emergency Department
• If thoughts are less specific or immediate, then find a therapist

If you are struggling with thoughts of suicide

• You are not alone
• There is help at work, home or in the community
• Don’t judge yourself
• People who care about you want to know that you need help
  – They will feel honored that you would trust them enough to reach out
  – They are likely to feel relieved, rather than burdened
  – They prefer to help, instead of coping with guilt or regret if you harm yourself
• People who love us don’t care about what society thinks
• You will find new ways to fill the void you feel right now
• It won’t always feel this way. It’s temporary

If someone has lost a loved one to suicide 

• When people have lost someone, they need compassion
• Don’t be afraid to approach them or say something
• What you say will not make it all better or worse; you don’t have that much power
• Human connection is usually helpful and appreciated
• Be willing to overcome your own discomfort and reach out

Resources

• EAP Suicide Resources
• The Center for Suicide Research and Prevention (Harvard & MGB)

Suicide Prevention Hotlines & Assistance

• 988 – Suicide & Crisis Lifeline
  – Dial or Chat
• Samaritans – Suicide Prevention
  – 877-870-4673 or Text
• The Trevor Project – Suicide & LGBTQ+ Youth
  1-866-488-7386 & Chat
  Text “START” to 678-678
• 988 Lifeline for Veterans
• 988 Lifeline – Suicide Support on Social Media

Resources for at-risk Populations 

• Teens & Young Adults
• LGBTQ+
• Veterans

Healthcare Workers

• Reaching out to a colleague to ask, “RU OK?
• Understanding Burnout in Healthcare
• Preventing Nurse Suicide
• AFSP – Suicide Prevention for Healthcare Professionals

Help from the EAP

If you find that you or a loved one is struggling, you are not alone.  The EAP is here to help. The EAP offers free and confidential services for Mass General Brigham employees and their immediate household family members. EAP records are separate from medical and HR records. Contact the EAP at 866-724-4327 or request an appointment via our online form for confidential assistance. In-person appointments are available at the following locations. Phone or Video (Zoom) appointments are available from all locations