Very often when people say "I am tired of life" or "There is no point in living", they are brushed off, or are given examples of other persons who have been in worse difficulties. Neither of these responses helps the suicidal person.

·        The first step is to find a suitable place where a quiet conversation can be held in reasonable privacy.

·        The next step is to allocate the necessary time. Suicidal persons usually need more time to unburden themselves and one must be mentally prepared to give them time.

·        The most important task is then to listen to them effectively. "To reach out and listen is itself a major step in reducing the level of suicidal despair," person the hope that things could change for the better.

Three features in particular are characteristic of the state of mind of suicidal patients:

·       Ambivalence: Most people have mixed feelings about committing suicide. The wish to live and the wish to die wage a see-saw battle in the suicidal individual. There is an urge to getaway from the pain of living and an undercurrent of the desire to live. Many suicidal persons donot really want to die - it is just that they are unhappy with life. If support is given and the wish to live is increased, the suicidal risk is decreased.

·       Impulsivity: Suicide is also an impulsive act. Like any other impulse, the impulse to commit suicide is transient and lasts for a few minutes or hours. It is usually triggered by negative day-to-day events. By defusing such crises and by playing for time, the health worker can help to reduce the suicide wish.

·       Rigidity: When people are suicidal, their thinking, feelings and actions are constricted. They constantly think about suicide and are unable to perceive other ways out of the problem. They think drastically.

A majority of suicidal people communicate their suicidal thoughts and intentions. They often send out signals and make statements about "wanting to die", "feeling useless", and so on. All those pleas for help must not be ignored.

Questions to Ask

• Do you have thoughts of suicide?
• Are they related to current stressors going on in your life, or have you had such thoughts before?
• Do you have a plan? Tell me.

Ask if they have access to the components of their plan, like a gun, pills, etc.
 

Level of Risk

1. none - no suicidal ideation
2. mild - some ideation, no plan
3. mod - ideation, vague plan, low on lethality, wouldn't do it
4. severe - ideation, plan specific and lethal, wouldn't do it
5. extreme - ideation, plan specific and lethal, will do it

Highest risk group has:

1. suicidal ideation (thoughts of killing self),
2. a plan (any plan so long as it is definite and detailed is high risk),
3. high lethality (guns and walking in front of busses are more serious than overdosing on Tylenol and slashing wrists),
4. few inhibitors (few reasons not to kill self),
5. low self-control (especially drinking or using drugs - can decide not to kill self but fail to act to reverse events and accidentally kill themselves)