SOCIAL AWARENESS PROGRAM (S.A.P.

Suicide is the act of intentionally causing one's

own death. Mental disorders, including depression, bipolar
disorder, schizophrenia, personality disorders, and substance
abuse—including alcoholism and the use
of benzodiazepines—are risk factors. Some suicides
are impulsive acts due to stress, such as from financial
difficulties, troubles with relationships, or bullying. Those
who have previously attempted suicide are at a higher risk for
future attempts Effective suicide prevention efforts include
limiting access to methods of suicide—such as firearms,
drugs, and poisons; treating mental disorders and substance
misuse; proper media reporting of suicide; and improving
economic conditions. Even though crisis hotlines are
common, there is little evidence for their effectiveness
Approximately 0.5-1.4% of people die by suicide, roughly 12
per 100,000 individuals per year. Three quarters of suicides
globally occur in the low and middle income countries. Rates
of completed suicides are generally higher among men than
among women, ranging from 1.5 times as much in the
developing world to 3.5 times in the developed world.
Views on suicide have been influenced by
broad existential themes such as religion, honor, and
the meaning of life. The Abrahamic religionstraditionally
consider suicide as an offense towards God, due to the belief
in the sanctity of life.

Risk Factors
The most cited risk factors for suicide include psychiatric
disorders, genetics, substance abuse, and family and social
situations. Oftentimes, psychiatric factors and substance abuse
co-exist. Access to weapons and other methods of suicide also
increase risk. For example, rates of suicide in homes with
guns are greater than in homes without them.

Mental disorders play an overwhelming role in the increased

risk of suicide – with estimates suggesting up to 90% of
individuals who take their own life suffer from some type of
psychiatric disorder. Risk of suicide for individuals suffering
from mental disorders drastically decreases once admitted to
treatment.

Heroin and cocaine use is also a common risk factor for

suicide, with heroin users having a 14-fold greater risk of
suicide and cocaine users having a higher risk of suicide
during withdrawal drug use. Cannabis use has not been found
to increase suicide risk among users.

Genetics is thought to play a role in risk of suicide – such that

a family history of suicide tends to indicate an increased risk
of suicide among other family members – accounting for up to
55% of suicidal behaviors. Family history of mental disorders
and substance abuse is also a risk factor for suicide. In a
similar respect, exposure to suicide (e.g., watching a family
member commit suicide or finding their body) is also
indicative of an increased risk of suicidal behavior.

Family and socio-economic problems are also contributing

factors to suicide risk. Unemployment, homelessness, poverty,
childhood sexual abuse, social isolation, loss of a loved one,
and other life stresses can all increase the likelihood of
suicide. Sexual abuse alone is thought to contribute to 20% of
the overall risk of suicide.

PREVENTION

A suicidal person may not ask for help, but that doesn’t mean
that help isn’t wanted. People who take their lives don’t want
to die—they just want to stop hurting. Suicide prevention
starts with recognizing the warning signs and taking them
seriously. If you think a friend or family member is
considering suicide, you might be afraid to bring up the
subject. But talking openly about suicidal thoughts and
feelings can save a life.
Suicide prevention methods and treatment are based on
patient risk factors. Treatments are prescribed in light of
underlying conditions in addition to prevention of suicidal
thoughts and acts. If you are suffering from a mental disorder,
a treatment plan to treat this condition is implemented first.
One of the most common suicide prevention techniques is
psychotherapy – also known as talk therapy – in the form of
Cognitive Behavioral Therapy (CBT) or Dialectical Behavior
Therapy (DBT).

Cognitive Behavioral Therapy is a common treatment option

for individuals suffering from a variety of mental disorders. In
this method of psychotherapy, you are taught new ways of
dealing with stress and stressful life experiences. In this
manner, when thoughts of suicide arise, you can redirect those
thoughts and cope with them in a different way than
attempting to take your own life.

Dialectical Behavior Therapy is used to help an individual

recognize disruptive or unhealthy feelings or actions. In
relation, this therapy method then introduces techniques on
how to deal with difficult or troubling situations. More
research is needed on psychotherapy related to suicide
prevention though, as DBT, in particular, has been shown to
decrease the prevalence of attempted suicide but has shown
no effect on completed suicides.

Medications can also be prescribed as a prevention method to

suicide; however, controversy exists in this method, as many
medications used in the treatment of mental disorders include
increased risk of suicide as a side effect. Antidepressants
especially carry a risk of potential increase in suicidal
thoughts and behavior – but this risk might be dependent on
age. Clinical research has shown that young adults increase
their risk of suicide and suicidal thoughts when taking
antidepressants, but in older individuals, this side effect
diminishes.

Increased awareness among doctors is also a prevention

technique. Research indicates that many individuals who have
completed suicide or attempted suicide did seek medical
attention in the year prior; however, warning signs may have
been missed. Increased education and awareness among
medical professionals might decrease suicide rates in the
future.

Popular “crisis hotlines” have not received solid data

indications in the research that suggest their use is effective or
not. Though, one positive side effect of these hotlines is that
they are generally well-known and common – increasing the
general population’s awareness of suicide. In an additional
effort to bring awareness to suicide and risk factors associated
with suicide, September 10 has been observed as World
Suicide Prevention Day in partnership with the International
Association for Suicide Prevention and the World Health
Organization.

Social intervention

National Strategy for Suicide Prevention promotes and

sponsors various specific suicide prevention endeavors:
 Developing groups led by professionally trained individuals
for broad-based support for suicide prevention.
 Promoting community-based suicide prevention programs.
 Screening and reducing at-risk behavior through
psychological resilience programs that
promotes optimism and connectedness.
 Education about suicide, including risk factors, warning
signs, stigma related issues and the availability
of help through social campaigns.
 Increasing the proficiency of health and welfare services at
responding to people in need. e.g., Sponsored training for
helping professionals, Increased access to community
linkages, employing crisis counseling organizations.
 Reducing domestic violence and substance abuse through
legal and empowerment means are long-term strategies.
 Reducing access to convenient means of suicide and
methods of self-harm. e.g., toxic substances, poisons,
handguns.
 Reducing the quantity of dosages supplied in packages of
non-prescription medicines e.g., aspirin.
 School-based competency promoting and skill enhancing
programs.
 Interventions and usage of ethical surveillance systems
targeted at high-risk groups.
 Improving reporting and portrayals of negative behavior,
suicidal behavior, mental illness and substance abuse in the
entertainment and news media.
 Research on protective factors & development of effective
clinical and professional practices.

Counseling
There are multiple evidence-based psychotherapeutic talk
therapies available to reduce suicidal ideation such
as dialectical behavior therapy (DBT) for which multiple
studies have reported varying degrees of clinical effectiveness
in reducing suicidality. Benefits include a reduction in self-
harm behaviours and suicidal ideations.

Postvention
Postvention is for people affected by an individual's
suicide, this intervention facilitates grieving, guides to
reduce guilt, anxiety, and depression and to decrease
the effects of trauma. Bereavement is ruled out and
promoted for catharsis and supporting their adaptive
capacities before intervening depression and any
psychiatric disorders. Postvention is also provided to
intervene to minimize the risk of imitative or copycat
suicides, but there is a lack of evidence based standard
protocol. But the general goal of the mental health
practitioner is to decrease the likelihood of others
identifying with the suicidal behavior of the deceased as
a coping strategy in dealing with adversity.[40]

Direct talks

An effective way to assess suicidal thoughts is to talk

with the person directly, to ask about depression, and
assess suicide plans as to how and when it might be
attempted.[27] Contrary to popular misconceptions,
talking with people about suicide does not plant the idea
in their heads.[27] However, such discussions and
questions should be asked with care, concern and
compassion.[27] The tactic is to reduce sadness and
provide assurance that other people care. The WHO
advises to not say everything will be all right nor make
the problem seem trivial, nor give false assurances
about serious issues.[27] The discussions should be
gradual and specifically executed when the person is
comfortable about discussing his or her feelings. ICARE
(Identify the thought, Connect with it, Assess evidences
for it, Restructure the thought in positive light, Express
or provide room for expressing feelings from the
restructured thought) is a model of approach used here.

Coping planning
Coping planning is an innovative strengths-based intervention
that aims to meet the needs of people who ask for help,
including those experiencing suicidal ideation By
addressing why someone asks for help, the risk assessment
and management stays on what the person needs, and
the needs assessment focuses on the individual needs of each
person. The Coping Planning approach to suicide prevention
draws on the health-focused theory of coping. Coping is
normalized as a normal and universal human response to
unpleasant emotions and interventions are considered a
change continuum of low intensity (e.g. self-soothing) to high
intensity support (e.g. professional help). By planning for
coping, it supports people who are distressed and provides a
sense of belongingness and resilience in treatment of
illness The proactive coping planning approach overcomes
implications of ironic process
theory.The biopsychosocial strategy of training people in
healthy coping improves emotional regulation and decreases
memories of unpleasant emotions A good coping planning
strategically reduces the inattentional blindness for a person
while developing resilience and regulation strengths.
Lethal means reduction[edit]
Means reduction, reducing the odds that a suicide
attempter will use highly lethal means, is an important
component of suicide prevention.[29] This practice is also
called "means restriction".
Researchers and health policy planners have theorized
and demonstrated that restricting lethal means can help
reduce suicide rates, as delaying action until depression
passes.[30] In general, strong evidence supports the
effectiveness of means restriction in preventing
suicides.[31] There is also strong evidence that restricted
access at so-called suicide hotspots, such as bridges
and cliffs, reduces suicides, whereas other interventions
such as placing signs or increasing surveillance at these
sites appears less effective.[32] One of the most famous
historical examples, of means reduction, is that of coal
gas in the United Kingdom. Until the 1950s, the most
common means of suicide in the UK was poisoning by
gas inhalation. In 1958, natural gas (virtually free of
carbon monoxide) was introduced, and over the next
decade, comprised over 50% of gas used. As carbon
monoxide in gas decreased, suicides also decreased.
The decrease was driven entirely by dramatic decreases
in the number of suicides by carbon monoxide
poisoning.

The literature clearly point to the fact that there are

certain factors that protect youth or build resilience in
youth against suicide. According to Fuller, McGraw and
Goodyear (cited in Rowling, Martin & Walker, 2001, 85-
86):
‘The factors that protect young people against suicidal
behaviour include social support and their relationships
with family and peers, as well as a broad repertoire of
coping, help-seeking and problem-solving skills. Social
connectedness is the strongest antidote to suicide that
we know. Young people who are resilient have stronger
connections to school, family and peers, and young
people with those links are less likely to develop suicidal
thoughts or behaviours (Resnick, Harris & Blum 1993;
Fuller, Wilkins & Wilson 1998).’
It is interesting to note that these same resilience factors
are also positively associated with reducing the level of
problematic substance abuse in young people and
reducing the incidence of depression and delinquent
behaviours (Fuller, McGraw & Goodyear, 2001, 88). It is
vital for parents, schools and other youth groups to work
together in promoting resilience and positive healthy
relationships.
Whilst it would be too soon to yell out to the world and
say we now can prevent these problems with certainty,
this knowledge is a great step forward and can be a
source for increasing parents confidence in being able to
cope with adolescents with problem behaviours.