Exploring suicidal risk
Depression and suicide are strongly linked, with up to 10-15% of patients with severe and recurring depression eventually dying by suicide. Between 40 and 70% of depressed patients have suicidal thoughts, and 90% of people who die by suicide had suffered from a mental disorder, most often depression. Indicators for acute suicide risk include pressing suicidal thoughts, hopelessness and feelings of guilt, a strong desire for action, and direct and indirect messages referring to suicide.
You may feel uncomfortable addressing suicidal thoughts and acts. However, if you have the feeling that a person is seriously thinking about harming him/herself, it is best to communicate about this in a direct way in order to verify if the person involved requires urgent medical assessment. If this is the case, you can call the designated emergency services in your area. Also, if you feel it is useful, and the person seems to be willing to disclose his/her thoughts, it is important that you create a warm and open atmosphere.
Try to explore whether there is an acute suicide risk in order to determine if there is an urgent need for help.
Sometimes, it is not easy to obtain a clear picture of the level of suicide risk. Many people experience a situation in their lives in which they think of the possibility of dying, regardless of their mental health. This is more common in older and religious people. Some of them even report passive death wishes and thoughts of suicide in such situations. This does not necessarily mean that there is an immediate risk that they will act upon these thoughts. However, the risk increases extensively if the idea becomes very pressing and concrete plans are made. Therefore, it is very important to try to get a more accurate idea of what the actual level of suicidal intent is.
The following questions can help you to evaluate the severity of the suicidal risk (see box):
Procedure in case of acute suicide risk
Should you be involved in a situation with acute suicide risk, the following steps may help you with the situation. They also apply if you have the feeling that after exploring suicide risk during a personal conversation, the suicidal thoughts are very concrete and that the person talking to you is in danger.
- Gain time. Acute suicide risk is usually not a permanent condition. An acute suicidal crisis can pass in a short time. If a suicidal act can be deferred, the chances are higher that the person will survive. Invoking sources of hope, including faith but also family and friends, can be invaluable;
- Listen empathically. Do not offer solutions, listen patiently and understandingly;
- Get additional help. Can relatives be involved? Is (or was) the person already in contact with a psychiatrist? Is there mutual trust with the general practitioner? Where is the closest psychiatric clinic or emergency department? If necessary, call a doctor or the ambulance.
In the situation that you feel that someone is in immediate danger of harming him or herself, and this person is so despondent that they will not consider your suggestions to get help, the question of compulsory hospitalisation might arise. If a patient has a distorted view on his or her personal situation because of depression and perceives suicide as the only escape from their unbearable situation, you should not simply accept this view and let the person go. The patient is driven by depression and desperation, not free will. You have to provide help by referring this person to urgent medical assessment and this may involve contacting the hospital emergency service in your area.
In summary, members of the clergy play an important role in the community by supporting those experiencing difficult life circumstances. They also can play a key role as a gatekeeper between those experiencing depression and suicidal behaviour and the relevant health services, and thereby enhance saving lives.