held a conjoint lecturer position at the University of New South Wales from 2009 to 2011, lecturing on the treatment of anxiety and depression. He is currently completing a PhD on internet-based interventions for post-traumatic stress disorder (PTSD). He is developing these treatments as part of the Centre for Emotional Health at Macquarie University because PTSD is the most prevalent anxiety disorder in Australia. However, many people do not have access to effective treatments. He sees patients in private practice in Darlinghurst, Sydney.
Phil Owens – Leading Australian Hypnotherapist and NLP Practitioner
In any given person, suicide risk is not fixed but changeable. Under periods of increased personal stress, the potential for suicidal crisis increases. Although there is no way to predict who will die of suicide, recognising and responding to the clear warning signs is critical.
Data suggests that less than 3.5 percent of the population will have suicidal thoughts, with only 0.01% actually dying of suicide. While suicide has a low prevalence in the community, it is important to note that its outcomes on surviving family, friends and communities can be devastating.
Warning signs are specific symptoms or behaviors that a person demonstrates or expresses that may indicate an increased risk to suicide. In particular, anxiety, physical agitation, sleep problems and poor concentration, as well as hopelessness, social isolation, and excessive or increasing use of alcohol or drugs. These are all factors that could indicate greater risk of suicide. Key static risk factors regarding suicide include reported previous suicide attempt by themselves or a family member, and history of mental illness.
On the other hand, a series of potential protective factors have been identified. These can include stress-management skills, religious beliefs that increase the stigma of suicide, and frustration tolerance, along with a sense of responsibility to family or friends, a healthy network of social supports, and positive therapeutic relationships. Protective factors diminish in importance when a potentially suicidal person is placed under increased stress, which can simply overwhelm them. This is especially true when the person is in an intoxicated, impulsive or in a uninhibited state.
The difference between suicidal thought and death by suicide is large. Individuals are usually assessed by being observed and interviewed. In particular, specific questions (safe-t model) are used to determine the level of potential risk. The aim of any assessment is to identify the following:
- Does the person have suicidal intent?
- Do they have a specific plan?
- Do they have the means to carry it out (the pills, weapons, which is relative to their plan)?
- Have there been previous attempts or rehearsals?
- What outcome are they after, death or rescue?
- Identification of risk factors and warning signs.
- Identification of coping potential.
Identifying a person that may be at risk of suicide can be complex, as often the person will not engage in full or truthful disclosure about their plans. Connection of the person to a properly trained resource — medical, counselling or psychological — is critical to ensure they are properly evaluated and supported.
Often individuals at higher risk of suicide during their treatment will be encouraged to negotiate ‘safety plans’ with their clinicians. This will only occur in more chronic scenarios, as individuals at acute risk will be managed much more directly, with hospitalisation, for example. A safe-plan is a pre-arranged strategy that the individual can follow when they determine a higher level of stressors or behaviours that could lead to them being at greater risk. Many of the items in such a plan are pre-emptive, including ensuring all potential weapons or support items are not available, without supervision. Stress-management processes are taught, abstinence or reduction of alcohol or drugs is encouraged and identification and deployment of supportive resources including regular ‘check-in’ buddies and scheduling me