Suicide Prevention Basics
Why is suicide prevention important?
Suicide was the most common cause of fatal injuries among Hawaii residents over the 5-year period 2009-2013, accounting for over one-quarter (878, or 26%) of all fatal injuries. The number of suicides for youth ages 15 to 24 fell from 36 in 2011 to 29 in 2013. It was the leading cause of injury-related death for most age groups — all but the very young and the very old — outpacing car crashes, homicide, poisoning and drowning. One person dies by suicide in Hawaii every two days.
Q: Why do people attempt suicide?
A: People usually attempt suicide to block unbearable emotional pain, which is caused by a wide variety of problems. It is often a cry for help. A person attempting suicide is often so distressed that they are unable to see that they have other options. We can help prevent a tragedy by endeavoring to understand how they feel and helping them to look for better choices. Suicidal people often feel terribly isolated. Because of their distress, they may not think of anyone they can turn to, furthering this isolation.
In the vast majority of cases someone who attempts suicide would choose differently if they were not in great distress and were able to evaluate their options objectively. Most suicidal people give warning signs in the hope that they will be rescued because they are intent on stopping their emotional pain, not on dying.
Q: Are people who attempt suicide mentally ill?
A: No. Having suicidal thoughts does not imply that you are mentally ill. People who attempt suicide are often acutely distressed and the majority are depressed to some extent. This depression may be either a reactive depression which is an entirely normal reaction to difficult circumstances or may be depression which is the result of a diagnosable mental illness with other underlying causes. Or it may also be a combination of the two.
The question of mental illness is a difficult one because both these kinds of depression may have similar symptoms and effects. So whether a person who is distressed enough to attempt suicide would be diagnosed as suffering from clinical depression may vary among individuals and cultures.
Q: Doesn’t talking about suicide encourage it?
A: It depends what aspect you talk about. Talking about the feelings surrounding suicide promotes understanding and can greatly reduce the immediate distress of a suicidal person. In particular, it is appropriate to ask someone if they are considering suicide, if you suspect that they are not coping. If they are feeling suicidal, it can come as a great relief to see that someone else has some insight into how they feel.
Q: What sort of things can contribute to someone feeling suicidal?
A: Depending on a person’s individual response, risk factors that may contribute to a person feeling suicidal are
- Significant changes in relationships, well-being of self or family member, body image, job, school, university, home, locality, financial situation, world environment
- Significant losses, like a death of a loved one, the loss of a valued relationship or of self-esteem or personal expectations, the loss of employment
- Perceived abuse – physical, emotional/psychological, sexual, social
Q: How would I know if someone I care about is thinking about suicide?
A: Typical warning signs which are often exhibited by people who are feeling suicidal are:
- Withdrawing from friends and family
- Depression, broadly speaking; not necessarily a diagnosable mental illness such as clinical depression, but indicated by signs such as
- loss of interest in usual activities, showing signs of sadness, hopelessness, irritability
- changes in appetite, weight, behavior, level of activity or sleep patterns
- loss of energy
- making negative comments about self
- recurring suicidal thoughts or fantasies
- sudden change from extreme depression to being `at peace’ . This may indicate that they have decided to attempt suicide.
- Talking, writing or hinting about suicide
- Previous attempts
- Feelings of hopelessness and helplessness
- Purposefully putting personal affairs in order – giving away possessions, sudden intense interest in personal wills or life insurance, ‘clearing the air’ over personal incidents from the past
Q: What can I do if someone I care about is thinking about suicide?
A: There usually are people a suicidal person can turn for help. If you know someone is feeling suicidal, or feel suicidal yourself, seek out people who can help, and keep seeking until you find someone who will listen. Once again, the only way to know if someone is feeling suicidal is if you ask them. Ask the question, “Are you thinking of killing yourself?”
Suicidal people, like all of us, need love, understanding and care. People usually don’t ask “are you feeling so bad that you’re thinking about suicide?” directly. Locking themselves away increases the isolation they feel and the likelihood that they may attempt suicide. Asking if they are feeling suicidal has the effect of giving them permission to feel the way they do, which reduces their isolation. If they are feeling suicidal, they may see that someone else is beginning to understand how they feel.
Q: How do telephone counseling and suicide hot line services work?
A: Different services vary in what they offer, but in general you can call and speak anonymously to a counselor or therapist about any sort of problem in a no-pressure context that’s less threatening than a face-to-face session. Talking the situation over with a caring, independent person can be of great assistance, whether you’re in a crisis yourself, or worried about someone else who is, and they usually have connections with local services to refer you to if further help is required. You don’t have to wait until the deepest point of crisis or until you have a life-threatening problem before you seek help.
If you are in crisis or someone you know is, you can call the following phone numbers and talk to someone who can help you:
ACCESS Line – Hawaii’s Suicide crisis lines
Neighbor Islands: 1-800-753-6879
National Suicide Prevention Lifeline: 1-800-273-TALK (8255)
Common Misconceptions and Myths
Myth: Suicides peak during holidays.
Fact: Most people think the winter holidays are a risky time, but suicides are lowest in December and peak in the spring.
Myth: Depression is always the cause of suicide.
Fact: Two of every three people who commit suicide are depressed at the time they take their life. However, alcoholism plays a role in 1 in 3 completed suicides.
Major depression is the psychiatric diagnosis most commonly associated with suicide, with about 20 times the risk found in the general population. With more active screening and treatment, depression carries less of a stigma now, but it remains one of the big risk factors for suicide.
Myth: Teens are at greatest risk for suicide.
Fact: Teenage suicides make headlines, but the elderly are more likely to take their own life than any other age group.
At particularly high risk are white men over the age of 85, who have a suicide rate of 49.8 deaths per 100,000, compared with about 14 per 100,000 in people over 65, and 11 per 100,000 in the general population.
Myth: Caucasians attempt suicide more often than other races.
Fact: Suicide is more common among whites in the U.S. than blacks, Asians, or Hispanics.
No one is quite sure why whites are at a higher risk. It might have to do with differences in social support.
The only group at higher risk is American Indian/Alaskan Natives, who have a suicide rate of 14.3 per 100,000 compared to 13.5 per 100,000 for whites and about 5 to 6 per 100,000 for other groups.
Myth: Your family affects risk.
Fact: A family history of depression increases the chances that a child will suffer the same by a factor of 11. But family members and friends can also play a significant role in preventing suicide. Strong social support is known to lower suicide risk.
Myth: Suicides can trigger ‘copy cat’ attempts.
Fact: Exposure to others who have committed suicide may reduce some of the barriers to people thinking of taking their own lives
This link has initiated the development of new guidelines for responsible journalistic reporting. For example, journalists now typically refrain from going into detail or sensationalizing death from suicide.
Journalists often end an article with a reference to a hotline so that distressed people reading it will reach out for help rather than being tempted to emulate.
Suicide Prevention Details
Recommendation 1: Develop and implement suicide prevention training for gatekeepers
Recommendation 2: Develop and implement a public awareness campaign
Recommendation 3: Develop and promote effective clinical and professional practices and policies
For more detail, please refer to the Suicide Prevention Recommendations in the 2012-2017 Hawaiʻi Injury Prevention Plan (HIPP) (PDF 674 KB)
2014 – The newly formed American Association of Suicide Prevention, Hawaii, in collaboration with the DOH Injury Prevention Branch, sponsored two major events: “Out of the Darkness” walks on the islands of Oahu, Maui, Kauai, and Hawaii in September and; the first ISOS (International Survivors of Suicide) mini-conferences to bring survivor families together and to provide support.
2013-2014 – In the fall of 2013, IPCS collaborated with KHON TV to produce two Safe Messaging video PSAs targeted to youth at risk for suicide. The PSAs can be viewed below and are now available to the public. If you would like copies of these PSAs, please contact Nancy Deeley at email@example.com
2012 – 2013: Implementation of ASIST and safeTalk trainings statewide to enhance the proportion of individuals statewide who have the skills to intervene with someone who may be at risk for suicide.
2012 – 2013 : Implementation of “safe messaging” for at-risk youth in Hawaii. Messages are being developed for this population based on the results of focus groups held in 2012 with youth at risk and their peers on Oahu. Dissemination of these recommended messages will occur in 2013, based on recommendations of media to be utilized to distribute messages.
2012 – 2013: The Bullying Task Force – a coalition developed from Senator Suzanne Chun Oakland’s Keiki Caucus – is preparing legislation that will be introduced in the 2013 Hawaii state legislature to ensure that all public and private schools statewide develop trainings, policies and procedures to address bullying in their schools.
Department of Health Adult Mental Health Division, Child & Adolescent Mental Health Division, Maternal & Child Health Branch
Fort Shafter Suicide Prevention Program
Honolulu Police Department
Maui Police Department
Kauai Police Department
Mental Health America of Hawaii
Department of Health ACCESS Line
Queen Liliuokalani Children’s Center
Queens Medical Center
Tripler Army Medical Center
UH John A. Burns School of Medicine, Department of Psychiatry
U.S. Department of Veterans Affairs
Prevent Suicide Hawaii Task Force
The Prevent Suicide Hawaii Taskforce (PSHTF) is a state, public and private partnership of agencies and community groups working in collaboration to provide leadership, develop strategies, coordinate activities, and monitor progress of suicide prevention efforts in Hawaii. The PSHTF collaborates with the State Department of Health Injury Prevention and Control Section (DOH/IPCS) in planning and implementing these activities.
An important component of the PSHTF are the Island Task Forces that coordinate culturally appropriate activities for each of the neighbor islands/areas: West Hawaii, East Hawaii, Maui, and Kauai. The PSHTF and Island Task Forces provide leadership for suicide prevention activities statewide, including for National Suicide Prevention Week and for the suicide prevention conference. Other PSHTF activities include the statewide Prevent Suicide Hawaii Listserv that provides information to 200 members on a regular basis and the bi-monthly meetings of the PSHTF to address suicide prevention issues statewide.
Main resource document: HIPP 2012-2017
Meeting time and location of PSHTF: Queen’s Conference Center, Room 203, corner of Punchbowl and Beretania Streets, 3rd Thursday, every other month from 2:00pm – 4:00pm. Confirm date and location of meeting, as times and location may change.
Contact: IPCS Suicide Prevention Coordinator, Nancy Deeley at 808-733-9238 or firstname.lastname@example.org
Resources and Links
ACCESS Line – Hawaii’s crisis lines
Neighbor Islands: 1-800-753-6879
Mental Health America of Hawaii 808-521-1846
National Suicide Prevention Lifeline 800-273-TALK (8255) – A free 24-hour hotline available to anyone in suicidal crisis or emotional distress
Suicide Prevention Resource Center 877-438-7772
Well Aware 920-457-4033
SAVE – Suicide Awareness Voices of Education 952-946-7998
American Association of Suicidology 202-237-2280
American Foundation for Suicide Prevention 888-333-2377
Yellow Ribbon International Suicide Prevention Program® 303-429-3530