Suicide prevention interventions include educational and social activities for the recognition of stressors, the teaching of coping strategies, the improvement of access to health services and the increase of socialization.
Alessandra Curtacci – OPEN SCHOOL, Cognitive Studies San Benedetto del Tronto
Suicide prevention and assistance to subjects at risk of suicide are relatively recent topics whose development starts from the assumption that the phenomenon of suicide is very complex to understand, prevent and treat. The aim is to develop a “culture” of suicide prevention trying to implement different approaches, from neuropsychobiological models, to the constructs of mental pain or Hopelessness, or by analyzing the phenomenon of social exclusion. Suicide prevention is primarily aimed at acquiring awareness of negative emotions, despair, anguish, sadness, anger, which in the long run lead individuals to decide to take their own life because they are unable to bear the state of deep despair in which they live.
The term suicide means the act by which a person voluntarily and knowingly procures death. It is an extreme gesture of self-harm likely in conditions of severe discomfort or mental illness. It can also be determined by strictly personal causes or motivations, particular unfavorable existential situations, adverse health conditions or non-acceptance of one’s body, serious economic and social conditions. There is no way to predict with certainty whether an individual will actually perform the gesture, but there are some factors statistically related to the execution of this act:
The intention of imminent suicide, regardless of the obvious declaration of taking one’s own life, is determined by all those situations in which the subject exposes himself to a high risk or which activates a series of behaviors by staging situations that are dangerous for his own safety: go up on roofs, window sills, handling firearms or sharp elements, presence of drugs, flammable liquid, tools connected to high voltage, gas, etc. A distinction can be made between the main suicidal behaviors:
In general, in reference to what could be considered demonstrative gestures, it is important to be aware of the fact that they should not be underestimated as those who perform them could make mistakes and really cause their own death.
The person could appear lucid or altered by any substance taken (alcoholic intoxication, use of psychoactive substances, etc.) or disturbance (anxiety crisis, psychotic crisis whether delusional or hallucinatory, etc.). Each situation should be addressed according to specific criteria according to the different causes and characteristics and, preferably, by specialized personnel (psychiatrists or psychologists). What has just been described is inherent in a situation in which the suicidal act is about to be committed; a different intervention of psychological support should instead be dedicated to the victims who survived the attempt. This has the objective of investigating and obtaining useful information on personal ability to recognize future stress conditions and in particular to develop effective strategies for managing them. The intervention should be carried out temporally, beyond the critical moment of the implementation of the suicidal action, as these manifestations are often the expression of a serious fracture that occurred in one’s personal and social sphere. Continuity of treatment therefore pursues, on the one hand, the aim of addressing the discomfort that caused the crisis, and on the other hand to teach subjects at risk alternative behavioral and cognitive strategies to cope with any other moments of discomfort. beyond the critical moment of the implementation of the suicidal action, as these manifestations are often the expression of a serious fracture that occurred in one’s personal and social sphere. Continuity of treatment therefore pursues, on the one hand, the aim of addressing the discomfort that caused the crisis, and on the other hand to teach subjects at risk alternative behavioral and cognitive strategies to cope with any other moments of discomfort. beyond the critical moment of the implementation of the suicidal action, as these manifestations are often the expression of a serious fracture that occurred in one’s personal and social sphere. Continuity of treatment therefore pursues, on the one hand, the aim of addressing the discomfort that caused the crisis, and on the other hand to teach subjects at risk alternative behavioral and cognitive strategies to cope with any other moments of discomfort.
During the historical development of man the phenomenon of suicide has always existed, and the words, associated thoughts or the expression of this will have always remained the same. Shneidman, in this regard, describes the genesis of the event:
It may therefore happen that when a subject finds himself having to face a suffering considered extreme he may begin to concretely imagine suicide which is considered with great psychological ambivalence: on the one hand the desire to die and put an end to pain and suffering on the other hand to be saved. Two fundamental aspects for a correct suicide assessment and management are:
The risk factors are those that increase the probability of it occurring, and in general these are divided into:
In fact, suicide is rarely an impulse due to a sudden decision, they can be preceded by clues, even minimal and not obvious:
a) Verbal or written signals, some examples:
b) Non-verbal or behavioral signals, some examples:
The risk assessment must be supported by as much information as possible and some areas of interest could correspond, in addition to that already described, to:
The reading of these signals can be enriched and completed by the knowledge of the previous experiences of the person who emits them (eg: family history of suicides and violence, having suffered an important bereavement, health, economic, legal problems, etc.). In light of this knowledge, the program for the prevention of dysfunctional behavior such as suicide distinguishes 3 levels of activity, each of which is characterized by specific objectives and interventions:
1) Primary prevention: aimed at prevention and work on risk factors and in this case to:
This type of intervention is aimed at the general population.
2) Secondary prevention: set of actions aimed at controlling the phenomenon in the population considered at risk. Examples of risk groups are:
People who experience certain conditions of sadness and anguish can experience the feeling of having no way out and the only way to get out of it is to make dysfunctional choices that involve severe behavioral alterations, substance abuse, suicidal and parasuicidal acts. The end of the crisis, whether constituted by psychopathological manifestations or by the development of a new adaptive equilibrium, depends on a series of factors such as personality characteristics, context and social network and the possibility of accessing specific interventions.
3) Tertiary prevention: consists of the set of interventions that are activated:
Prevention programs therefore have the ultimate goal of developing and increasing protective factors and reducing known risk factors that are susceptible to change thanks to the application of targeted interventions. To be effective, programs must have an adequate duration and the possibility of being repeated over time. The described interventions are carried out in such a way as to allow them to be addressed both to each member of the population with information that raise awareness on the subject of suicide prevention, and to individuals considered to be at high risk with specific interventions. The principles that are intended to convey with these interventions concern how to recognize or help a person in crisis,