Suicide risk assessment protocol and warning signs.

A series of key ideas for assessing and detecting warning signs of suicidal thinking.

In recent years, the suicide rate has increased significantly in several countries around the world; however, for many people it remains a taboo subject and they are uninformed.However, for many people it is still a taboo subject and they are not informed and do not know how to identify warning signs, thus complicating the possibility of preventing it.

This is related to the lack of sensitivity that exists in many countries about mental health, since suicide is often one of the consequences of suffering from a mental disorder that was not adequately treated, or was never treated at all.

Suicidal ideation is something that anyone can experience, and that is why it is important that we know about it, know what is true about suicide and what are myths, and how to help a person we know who is going through a difficult time and has suicidal ideation or has had suicidal attempts.

Characteristics of suicide

The main common characteristics of suicide are the following.

1. Stimulus

What drives a person to commit suicide is usually unbearable psychological pain.

2. Purpose

The purpose is to seek a solution to the Pain he/she feels.

3. Emotion

The person may experience may experience various emotions such as shame, guilt and hopelessness..

4. Internal attitude

In many cases, the individual presents a feeling of ambivalence about the fact that, on the one hand, he/she wants to die to end this pain, but on the other hand, he/she hopes to be rescued; a struggle between our life drive and our death drive.

5. Goal

Similar to the purpose, the goal is to put an end to the self-consciousness that carries all the psychological pain..

6. Cognitive state

The person is in a state of constriction in which he/she sees suicide as the only option and can hardly see other alternatives to achieve the goal.

Suicide prevention: signs of risk

Each person may express or communicate suicidal ideation in his or her own way, either verbally or nonverbally. It may be easy to recognize it when he or she openly says phrases such as "I am good for nothing", "I don't want to live anymore", "everyone would be better off if I died", "my life has no meaning", among others; however, there are signs that are not as easy to identify and may go unnoticed such as the fact that the person becomes more apathetic, starts making specific arrangements to "tidy up" his or her things, has irregular sleeping patterns, gets rid of cherished belongings, or presents depressive moods.

When a psychological intervention is performed with a patient who has suicidal ideation and/or who has had attempts to end his or her life, it will be important to begin to inquire using words or terms that have been said by the patient himself or herself, to avoid the patient feeling judged or incorrect interpretations of the situation being made.

In these cases, psychologists will ask neutral questions avoiding critical or judgmental questions.. With this, a relationship of trust can be established between patient and therapist, since the patient will not feel judged and will know that the therapist is really interested in helping him/her.

Protocol for assessing suicidal ideation

For the evaluation of dangerousness, it will be important to take into account 3 variables:

1. Plan

How far have you gone with the idea? It is evaluated whether you have the means to carry it out or how difficult or easy it is to get them.

2. History of previous attempts

The aim is to know how many there have been, how they have happened and how they have turned out; each attempt increases the likelihood of success..

3. Willingness to make use of external aids

Lonely patients are usually at greater riskIf the patient is reluctant to ask for help, a contingency plan should be devised.

The objective is to gain time to ensure the patient's well-being and that an agreement can be reached with the patient.

Myths about this topic

Despite the fact that some ideas about suicide have already been changed, there are still some myths that can make it difficult to reach an agreement with the patient, there are still some myths that may hinder or impede the prevention of suicide.. These are the following misconceptions.

• Suicide attempts are attention-seeking.
• People who really want to end their lives don't tell, they just do it.
• Those who commit suicide are selfish or brave (it can change people's perspective).
• If information is given in the media, it causes more people to do it.
• Suicide cannot be prevented.

Suicide attempts are a manifestation of despair, frustration and psychological pain.The fact that someone commits suicide does not mean that he/she is selfish or brave, but it reflects a person with a very high level of suffering. Normally people "warn" or transmit in a certain way their desire to die, although unfortunately we do not always perceive it and we do not know how to read the signals they give us.

The publication of responsible and accurate information in the media is a very useful prevention tool, because yes, yes suicide is preventable.

Bibliographic references:

• Suicide and Psychiatry. Preventive recommendations and management of suicidal behavior. Bobes García J, Giner Ubago J, Saiz Ruiz J, editors. Madrid: Triacastela; 2011