Counseling & Wellness Center

Suicide

If you suspect a student is suicidal, it is quite helpful to ask the student if he/she is feeling suicidal, and if so, how the wished-for suicide is planned. The more detailed and immediate the plan, the more imminent the danger.

Tell the student you would like for him/her to call the Counseling and Wellness Center that day to talk with a counselor; if the student is reluctant to do so, do it for them and accompany them to our office, if necessary.

If you talk to the student on the phone, suggest he/she call a counselor, and call our office yourself, informing us of your contact and concern with that student. In either case, ask the student to promise not to hurt him/herself and to follow through on the contact, and emphasize you will check with the Counseling and Wellness Center to be sure that a connection has been made, though you are not interested in whatever the student may choose to confide to the counselor.

In the event this is a suicide attempt, call the AU Rescue Squad (2911 on a campus phone or 607-871-2300 from a cell phone) or other medical personnel if necessary, and contact the Counseling and Wellness Center during business hours. During the evenings and on weekends, contact any member of the counseling center staff at their home.

The Behaviors Chart and Referral Guide may assist you in assessing a potential crisis, and help determine an appropriate course of action.

The "typical" suicidal person.
Is there such a thing as a typical suicidal person? In one sense there isn't because suicide is so widely dispersed throughout the population that it affects virtually all groups of people. However, in another sense, so much has been learned about attempters and completers that certain general observations about suicidal people have been made.

Most suicidal people do not want to die. They are generally seeking relief from an intolerable situation. Suicidal people have fallen out of love with life, but they are not usually ready to embrace death. However, if you are dealing with someone who has an extremely strong desire to die, you will not be able to stop him/her even if you institutionalize the individual. Suicidal people typically view themselves in their intolerable situations as helpless and hopeless. The suicidal person usually wants to be helped but has difficulty asking for help, isn't sure who to ask, and doesn't know what it is he/she wants done for himself/herself. The suicidal person is seeking an authoritarian figure who will tell him/her what to do. It is imperative that you quickly assure the suicidal person you are going to render the necessary assistance.

Progression of suicide.
Suicide is hardly ever a spontaneous activity. No one wakes up in the morning, yawns, stretches, looks out the window and concludes: "What a wonderful day to kill myself." Suicide is usually the result of a long-term, gradual wearing-away process of the ability to cope with stress, loss, frustration, and disappointment. Although the breaking up of a romance or a marriage may be the precipitating factor, it is not usually the cause of the suicide. Suicide may be directly traceable to childhood experiences.

For example, if someone close to a child, such as a parent, commits suicide while the child is quite young, the odds are nine times greater that the child will grow up to commit suicide. Suicide is often the final outcome of a 10- or 20-year process. Suicide victims are people who have been nickeled and dimed to death in a psychological sense.

Ambivalence.
Ambivalence is present when a person has opposite feelings at the same time. Most people seem to be ambivalent about almost everything in life, but overwhelmingly ambivalent feelings are especially prominent during suicidal states. Suicidal people feel as though they want to live and they want to die at the same time. The suicidal state includes a balancing of the life versus death forces within the individual. A minor event may cause the person to act out his/her suicidal feelings. The suicidal person is much more negative about life than positive about death.

The dyadic nature of suicide.
A suicidal crisis usually concerns two people. The first is the suicidal person, and the second is referred to as the significant other. Usually that is a spouse or friend; but it could be a parent, sibling, child, etc. To determine who the significant other is, you could ask one of two questions: "If you did kill yourself, who would be most affected by your death?" or "If you were going to write a suicide note, to whom would you address it?" The relationship between the suicidal person and the significant other is often one of neurotic dependency. A crisis may be triggered by an argument that leads to a complete breakdown of communication between them. The best way to resolve the crisis is to talk together. In about half of the cases, you probably won't be able to even locate the significant other. In a quarter of the cases, the significant other may be located but is so hostile the person would not make a good resource. In the remaining quarter of the cases, the significant other is usually willing to provide the answers to several of the questions you have. That in itself may prove to be quite helpful. The suicidal person may believe the only alternative is either to murder the significant other or kill himself/herself. In either case, the potential suicide victim removes himself/herself from what he/she perceives to be an intolerable situation. There is another alternative--he/she can murder the significant other and then murder himself. However, in the United States, murder-suicides account for less than 4 percent of all suicides.

Suicide as a result of a loss.
Many suicidal people have experienced significant losses in their lives, such as self-esteem, a job, potency, power, a friend, a spouse, a lover, a child, an investment, a business, good health, a familiar neighborhood, attractiveness, a limb, a breast, etc. Among women, the loss of a romantic relationship or a marriage seems to be closely associated with suicidal feelings. Among men, suicidal feelings seem to be closely associated with a pattern of downward mobility (e.g., loss of status, loss of job, loss of income). Losses seem to have an especially devastating effect when they're related to the significant other or to the person's self-image. The unexpectedness and suddenness of the loss may also be crucial factors. Several losses occurring closely together are particularly hard and difficult to accept.

The illogic of the suicidal mind.
Someone considering suicide may not be thinking clearly or rationally when seeking a solution to his/her problems. He/she may not accept a logical response that everything will work out and be resolved. It is a good strategy to keep emphasizing the temporary nature of the crisis. Suicidal people often think, "Either my life must be perfect--which means exactly as I want it to be--or I must kill myself." Suicidal people also tend to use circular logic, such as, "I'm going to kill myself. Why is that? Because my problems can't be solved. If my problems could be solved, do you think that I'd be on the verge of killing myself?"

Assessing the degree of risk.
Once you suspect that someone is a potential suicide, the best possible approach is to confront the person directly in a warm, accepting, nonjudgmental manner and ask, "Have your problems been getting you down so much lately that you've been thinking about harming yourself?" Usually the suicidal person will answer that question honestly. Once the person has admitted that he/she has been contemplating suicide, follow this procedure: The first question that you should always ask is: "How?" Determine if the person has a plan of attack and if he/she really poses a serious threat.

Establish a relationship with the person.

  • Reinforce the person for confiding in or calling you.
  • Be accepting and nonjudgmental.
  • Try to sound confident and concerned.
  • If it's a telephone call, get as much identifying information as possible and find out specifically where the person is.

Assess the person's resources.

  • Determine who the significant other is, if that individual can be located, and if he or she will be helpful or hostile.
  • Determine if there are friends, relatives, or neighbors who might be helpful.

Mobilize the person's resources.

  • Surround the suicidal person with a wall of support by getting as many people involved as possible (especially professionals).

Take a positive approach by emphasizing the person's most desirable alternatives. Try to sound calm and understanding. Use constructive questions to help separate and define the person's problems and to remove some of his/her confusion. Help the person understand his/her situation. Mention the person's family as a source of strength; but, if he or she rejects the notion, back off quickly. Emphasize the temporary nature of the person's problems.

Risk of liability is low in suicide cases; but in order to avoid any kind of risk, helpers should take each threat very seriously. Make every effort to arrange for a psychiatric evaluation. Helpers cannot afford to ignore any serious threat of suicide, and outside support is essential for the suicidal person.

What are the signs that a person may have a high risk for suicide? Are there reliable indicators and patterns that could help the trained professional, paraprofessional, or layperson to make a judgment on the potential for suicide?

Patterson, Dohn, and Patterson (1983) have suggested a simple acronym as a training device to alert professionals to the correlates of suicide: the SAD PERSONS scale. Each of the letters in SAD PERSONS stands for a risk factor that, when present, increases the suicidal risk.

The presence of 10 of these factors would indicate the highest level of risk for self-destructive behavior; high scores in general would suggest a need for prompt professional intervention.

S = Sex. Females are three times as likely to attempt suicide as males, but three times as many males as females die from suicide.

A = Age. Teenagers and the elderly are the two major high-risk age groups.

D = Depression. Depression is involved in most suicides, and there are thirty times as many suicides in depressives as in the general population.

P = Previous Attempt. For 25 to 50 percent of those who commit suicide, at least one previous suicide attempt has been made.

E = Ethanol Abuse. An estimated 15 percent of alcoholics commit suicide.

R = Rational Thinking Loss. Suicide is more likely when the person has a diminished capacity to think logically.

S = Social Supports Lacking. People who are lonely and isolated from other people have a higher suicide risk than do others.

O = Organized Plan. Suicide risk is heightened when the person has thought out specific details of a suicide plan.

N = No Spouse. Divorced, widowed, and single persons have a higher risk for suicide--especially if they have no children.

S = Sickness. Illness increases the chances of suicide.

Suicidal Motivations.
Some of the major reasons people would want to kill themselves include:

  • To escape from an intolerable situation
  • To join a deceased loved one
  • To gain attention
  • To manipulate others
  • To control death
  • To avoid punishment for a crime
  • To be punished for a crime
  • To end an unresolvable conflict
  • To become a martyr
  • To punish the survivors
  • Revenge
  • Responding to a voice during a hallucination.
Because most suicidal people actually wish to be rescued, about 75 percent of them will give notice of their intentions in the form of clues. They are trying to find out if anyone around them really cares if they live or die. It is imperative that the clues be recognized and treated seriously. Look for the clustering of clues in the proper context. One clue by itself means nothing, but several clues in a negative context may be an important danger signal. Basically there are four types of clues.

Situational Clues.
The situation itself may lead to suicidal thoughts and feelings. For example, a great athlete survives a serious automobile accident but has both legs amputated.

Depressive Symptoms.

  • Insomnia.
  • Inability to concentrate.
  • Anorexia.
  • Loss of sexual drive.
  • Apathy.
  • Sloppiness.
  • Crying.
  • Poor personal hygiene.
  • Feelings of worthlessness.
  • No desire to socialize.
  • Loss of self-esteem.
  • Preoccupation with death.
  • Loss of the ability to experience pleasure and happiness.

Verbal Clues.
The following verbal clues were articulated by people shortly before they killed themselves.

  • "I'm going to kill myself."
  • "I wish I were dead."
  • "How do I donate my body to a medical school?"
  • "My family would be better off without me."
  • "The only way out is for me to die."
  • "You're going to regret how you've treated me."
  • "If (such and such) happens (or doesn't happen), I'll kill myself."

Behavioral Clues.
Something that the person does that indicates self- destructive feelings or behaviors may be present, such as:

  • A previous attempted suicide.
  • The giving away of valued possessions.
  • Buying a gun.
  • Composing a suicide note.
  • Putting personal and business affairs in order.
  • Planning his/her funeral.
  • Poor adjustment to the recent loss of one or more loved ones.
  • Preparing a will.
  • A sudden unexplained recovery from a severe depression.
  • Suddenly resigning from organizations, such as clubs, church groups, or fraternal orders.
  • Crying for no apparent reason.
  • Any unexplainable change in behavior.

In the case of serious physical injury, get medical help immediately! If there is any question about the lethality of the attempt, contact the Counseling and Wellness Center.

If the student has been seeing a counselor, call that counselor. Otherwise, call the Counseling and Wellness Center and speak to a staff member. He/she will evaluate the situation.

Try to keep yourself and your students calm. Reassure them that everything that should be done is being done. You can do a great deal to diffuse tension by suggesting that people do not congregate. Try to control rumors.

Suicide Referrals and Resources

If someone is threatening suicide, take him/her seriously.

Counseling and Wellness Center
If a student is unwilling to seek counseling regarding depression and is NOT in a life-threatening situation, contact the Counseling and Wellness Center at 607-871-2300, for further assistance. If the suicide situation is life threatening, contact the Alfred Village Police, 607-587-8877, or Alfred Village Emergency, 911.

Hotlines
Suicide Prevention 24-Hour Helpline
Telephone: 1-800-333-4444

Allegany County Crisis Hotline
Telephone: 585-593-5706

In Case of an Emergency, call:
AU Public Safety
Telephone: 607-871-2108

Alfred Police Department
Telephone: 607-587-8877 or 911

Websites
For additional information on this, and other Mental Health Topics, contact:
http://ub-counseling.buffalo.edu/selfhelp.php
http://www.dr-bob.org/mental.html
http://www.save.org

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