Mental Health Experts Seek To Block the Paths To Suicide

HughPickens.com writes: Experts and laymen have long assumed that people who died by suicide will ultimately do it even if temporarily deterred. Now Celia Watson Seupel reports at the NY Times that a growing body of evidence challenges this view, with many experts calling for a reconsideration of suicide-prevention strategies to stress "means restriction." Instead of treating individual risk, means restriction entails modifying the environment by removing the means by which people usually die by suicide. The world cannot be made suicide-proof, of course. But, these researchers argue, if the walkway over a bridge is fenced off, a struggling college freshman cannot throw herself over the side. If parents leave guns in a locked safe, a teenage son cannot shoot himself if he suddenly decides life is hopeless.

Reducing the availability of highly lethal and commonly used suicide methods has been associated with declines in suicide rates of as much as 30%–50% in other countries (PDF). According to Cathy Barber, people trying to die by suicide tend to choose not the most effective method, but the one most at hand. Some methods have a case fatality rate as low as 1 or 2 percent," says Barber. "With a gun, it's closer to 85 or 90 percent. So it makes a difference what you're reaching for in these low-planned or unplanned suicide attempts." Ken Baldwin, who jumped from the Golden Gate Bridge in 1985 and lived, told reporters that he knew as soon as he had jumped that he had made a terrible mistake. "From the instant I saw my hand leave the railing, I knew I wanted to live. I was terrified out of my skull." Baldwin was lucky to survive the 220 foot plunge into frigid waters. Ms. Barber tells another story: On a friend's very first day as an emergency room physician, a patient was wheeled in, a young man who had shot himself in a suicide attempt. "He was begging the doctors to save him," she says. But they could not.

Comments

Maybe in a different country

[damn_registrars]

If parents leave guns in a locked safe, a teenage son cannot shoot himself if he suddenly decides life is hopeless.

People have been proudly campaigning for irresponsible gun ownership in the US for a very, very, long time. Suggesting things like locking up guns - even in the gun owner's home - will be quickly shot down by people claiming you are impeding on their constitutional right to overthrow the government.

I really, really, wish I was exaggerating or kidding on this one.

Re:Maybe in a different country

[JaredOfEuropa]

There's a big difference between promoting gun safety at home, and putting it into law. The latter comes with regular, mandatory police inspections of gun owners' homes, to ensure guns are kept according to the rules. This is what we have in the Netherlands, where it's hard to get a gun license in the first place. Now I am not against such rules and inspections personally, but I can see how "freedom loving" gun owners in the US would object to that. However, the few of such gun owners that I know do voluntarily practise and advocate safe gun ownership, especially around kids.

Re:Maybe in a different country

[dwillden]

Great points, and as demonstrated in Australia after their firearm ban and confiscation, removing firearms does not remove suicides. After the ban yes firearm suicides nearly vanished. But the overall suicide rate did not drop. In fact it spiked significantly the two years immediately following but then returned to the exact same level and gradual downward trend it had been running at in the years prior to the ban. But now suicide by firearm was a fraction of the occurrence that it had been before the ban and confiscation of most handguns and many rifles.

Guns do not cause suicide. They are a convenient method when available, but if not available those determined to exit this sphere of existence will find a way to do so.

Re:Maybe in a different country

[tibit]

As someone who has attempted suicide and just barely made it, I think that the so-called mental health experts are a bit stuck up in seeing things from nobody's perspective but theirs. The freedom to lead your way the way you choose to must include ending your own life at any time of your choosing. It is true that quite often people who attempted suicide are happy with making it out alive, and being able to live their lives. I certainly am!! On the other hand, the thought that some "expert" who is not in my frame of mind would have the ability to, essentially, take over my ability to take my life - is downright scary. Just because I'm happy with the life I have now doesn't mean that I'd be happy about someone preventing me from attempting to take my life when I did so. Two decades later, I'd consider it a gross invasion of privacy, and a horrific, slippery slope takeover of basic human liberty.

There is a very fine line between truly helping someone, and "helping" someone by - as you unashamedly admit - putting someone else's feelings over your own. Yes, as a society we have an obligation to give as much help as we can, but that help IMHO should not extend to overriding the decision of someone who wishes to take their life away. I find it, actually, completely incomprehensible that people think that preservation of human life over all else should be forced down everyone's throat. I also find it not all that clear that suicidal thoughts should be treated like a malaise in all cases. My attempt at my own life made me into a person that I am now, and who are you, or anyone else for that matter, to say that I'd be better off not having tried it? It's quite possible the worst case of "what if" imaginable, because you're not merely hypothesizing, you intend to take action.

The implication that all people with suicidal thoughts have a "very real chance" of taking down someone else is just an icing on the cake. You're nuts. I'm not a murderer, and can't imagine how attempting to take my own life would have ever made me take the life of someone else while doing so - other than indirectly, say by someone close to me dying of a stress-induced heart attack. I can't imagine that any sort of a majority, or even a significant minority of people who attempt a suicide are murderers and would take down others with them - not unless they were murderers to begin with, and suicial thoughts were just an enabler, like alcohol or drugs would be for others.

TL;DR: You're nuts, you really are.

Re:Maybe in a different country

[jjn1056]

Its a lot harder to kill yourself (or another person that is actively resisting) with a knife than with a gun. Having been in barroom brawls where knifes came out I can tell you that with certainty.

People that kill themselves by cutting themselves typically have to do a lot to make it work (for example preparing a hot bath to prevent clotting, etc.). And they need to cut deep, and cut correctly (slashing up and down the wrist, not across for example, as typically shown in movies) to achieve the goal, which is rather painful unless again one takes the time to acquire pain medication and consume it. This increased preparation time increases the mental barrier one needs to overcome to order to actually complete the suicide attempt and the increased time required to perform the act makes it more likely that someone might catch you in the act and save you.

People also tend to kill themselves in private, in their home, where they can't be interrupted and have had a lengthy time of isolation to deepen their depression. A handgun in the bedroom drawer "just in case" is a very easy way to attempt suicide and is in the ideal, private and quiet location that most people seek when trying to kill themselves. Other means that people choose in private, such as hanging themselves, typically have large mental barriers to overcome. Its not easy to correctly form the type of noose one needs, for example and also the death itself (by a possible lengthy suffocation) is a scary barrier to overcome. One must be very depressed to overcome that, and often when someone is that depressed they are not capable of the work involved to make it happen (and also there is a bigger chance for another person to notice how depressed they are, and offer help).

Although it is easy to crash a car as you mention, typically this is not what people want to do to kill themselves (typically, but yes there are always going to be outliers). As pointed out most people seek privacy and a period of isolation. Driving on the highway at speeds enough to cause death is not private nor isolated. And bridges can be better secured such as to make it harder (using fencing for example) and we can place emergency help phones on the bridge as well, which have been known to save people by giving them a person to speak with when they need it most.

The study is suggesting that people when deprived of an easy, private death in the convenience of their own home act on suicide impulses a lot less simple because its harder to do in the conditions one typically seeks.

Re: Maybe in a different country

[ultranova]

Not trying to be mean, just thinking clinically.

No you aren't, you're simply trying to appear tough by spouting sociopathic garbage. Such emotionally motivated behaviour is the very antithesis of "clinical", and not the least bit impressive. Please grow up.

We've redefined success!

[fuzzyfuzzyfungus]

Since we've made remarkably limited advances in the treatment of patients who think that the world is worth escaping; we've decided to just start blocking the exits. On the plus side, we have some emotionally salient anecdotes, of the sort that will probably cheer you right up unless you are one of those pesky people we can't really treat!

Re:We've redefined success!

[javilon]

So it is forbidden to make a decision about your life. WTF?

I am allowed to marry the wrong person and ruin my life at the drop of a hat. I am allowed to have kids where I may not be qualified to provide a decent life. I am allowed to sign a mortgage that I know I can't pay. I am allowed to try to climb the K7 if I am 70 years old, wich is very close to suicide.

But I am not allowed to take my own life.

Bollocks.

Treating symptoms

[Anonymous Coward]

Suicide is a symptom of mental illness. Taking away the possibility to commit suicide doesn't solve the underlying cause.

As someone who suffers from medical depression I feel pretty strongly about this subject, at least as strongly as I can allow myself to feel.
It may sound paradoxical but having the option to commit suicide was one of the things that helped me to finally seek treatment. Before I approached counseling I decided on method and location for a possible suicide. Had that option not been available to me I might not have been able to push through.
Had there been a policy in place to put people with depression on a 24/7 watch-list to prevent suicide the I would have probably gone for the suicide option first.

When the subject of suicide comes up I often see people claiming that suicide is the "easy" way out. What they don't seem to realize is that more importantly it is a way out.
Some people support assisted suicide for non-treatable painful diseases. Typically autoimmune disorders or certain forms of cancer where the body attacks itself. They have seen how much victims of those diseases have to suffer.
It is much harder to see how much you suffer when the mind attacks itself. People think that therapy cures those problems. It doesn't. Bipolar disorder, schizophrenia and depression are permanent. You can only learn how to endure it or acquire the discipline to keep it back.
To me the depression is much like one would expect from alcoholism. I function, but I can not allow myself to think freely. I have to keep my mind busy in complex projects and not let it wander off. Some relatives seem to have a hard time understanding that I will never want to talk nostalgia with them, ever.
Preventing suicide kind of lacks relevance since the person my mind was before died with the depression anyway.

Taking away to option of suicide doesn't solve anything of that. It only removes the inconvenience of having to deal with a body.

Barking up the wrong tree?

[jandersen]

Trying to address the issue of suicide by taking away the means of killing yourself is probably entirely the wrong way to go about it. People who are serious about suicide will always find a way, for starters, and unless something substantial is done to address the mental suffering that drives a person to suicide, all you achieve is to prolong the suffering. It is the kind of boneheaded, incompetent idiocy that you get from politicians, when their only goal is to get re-elected.

I think a much better approach would be

1) Give people the right to suicide and the help to do so safely, if that is the right word. This will show people who are suicidal, that you respect them, something is all too often not the case. I think respect is crucial, because if you see suicide as the only way out, you don't want to seek help if you fear that this way out will be taken away; so you have to know that you can go ahead, if you really want to.

2) Make that right dependent on them having been through good quality advice and assessment. Many people only want kill themselves because they can see no other way - they can often be helped to find a better way out.

There is still too much religiously motivated prudishness towards death - life does not belong to some 'God', it belongs to the individual and it is ultimately the responsibility of the individual what they want to do. It is IMO deeply unethical to force life on somebody who really doesn't want it.

Cost of making the entire world 'safe'?

[burtosis]

I can only imagine the costs of changing every last bridge, high area, train track, city sidewalk, etc. into hampster style fenced off tunnels to be, at a minimum, in the hundreds of billions of US dollars (world costs in the tens of trillions) while leaving hundreds of millions of homes in the US alone still chock full of methods to commit suicide anyway. Not to mention natural areas - are we going to fence off every cliff within a few miles of a homestead too?
Here's a thought that's way out there; let's spend those billions on research and development of new medication and treatments instead - that would likely have a far bigger impact. Sadly it's just poorly thought through emotional click bait instead of a sane approach to solving a serious problem. It's as if the rationality of humans is as well evolved as our lower spines.

Not true

[aepervius]

"People who are serious about suicide will always find a way"

No You don't. At some point in my teenage life I came to that dark place. But since the easy method was removed from my reach, I did not go for other method. the moment *passed*. In fact suicide is not always associated with a mental illness. I see many poster here pretend that, but it is not. Suicide is a symptom that somebody feels is in a situation where living further is more painful than dying. It CAN be a symptom of mental illness but also simply a symptom of intense physical pain or a symptom of plain stupid teenage angst. And for the last group, removing the easy means can simply make the person force to have more time to think.And thus prevent suicide. And then post about it on slashdot 25 years later.

Re:Suicide: the planners and the spontaneous

[StikyPad]

Just one point: Talking or "joking" about committing suicide are high risk factors. It may be "attention seeking" as well, but in many cases, suicidal people feel socially isolated and genuinely need attention.