Know the warning signs
What are warning signs and why are they important?
There are a number of known suicide risk factors. Nevertheless, these risk factors are not necessarily closely related in time to the onset of suicidal behaviors – nor does the presence of any single risk factor necessarily indicate that the individual is at elevated risk. Population based research suggests that the risk for suicide increases with the number of risk factors, such that individuals with a greater number of risk factors are at a greater risk for suicide than individuals with fewer risk factors.
A recent review of the literature has identified a number of acute warning signs that precede the onset of suicidal behaviors (e.g., within hours to a few days). These signs should warn the clinician of ACUTE risk for the expression of suicidal behaviors, especially in those individuals with other risk factors . Three of these warning signs (bolded on the VA SUICIDE RISK ASSESSMENT Pocket Card) carry the highest likelihood of short–term onset of suicidal behaviors and require immediate attention, evaluation, referral, or consideration of hospitalization.
THE FIRST THREE WARNING SIGNS ARE:
Threatening to hurt or kill self
Looking for ways to kill self; seeking access to pills, weapons or other means
Talking or writing about death, dying or suicide
The remaining list of warning signs should alert the clinician that a mental health evaluation needs to be conducted in the VERY near future and that precautions need to be put into place IMMEDIATELY to ensure the safety, stability and security of the individual.
Rage, anger, seeking revenge
Acting reckless or engaging in risky activities, seemingly without thinking Feeling trapped – like there’s no way out
Increasing alcohol or drug abuse
Withdrawing from friends, family or society
Anxiety, agitation, unable to sleep or sleeping all the time
Dramatic changes in mood
No reason for living, no sense of purpose in life
Gives away valued possessions
Other behaviors that may be associated with increased short–term risk for suicide are when the patient makes arrangements to divest responsibility for dependent others (children, pets, elders), or making other preparations such as updating wills, making financial arrangements for paying bills, saying goodbye to loved ones, etc.
Factors that may increase a person’s risk for suicide include:
Current ideation, intent, plan, access to means
Previous suicide attempt or attempts
Alcohol / Substance abuse
Current or previous history of psychiatric diagnosis
Impulsivity and poor self control
Hopelessness – presence, duration, severity
Recent losses – physical, financial, personal
Recent discharge from an inpatient psychiatric unit
Family history of suicide
History of abuse (physical, sexual or emotional)
Co–morbid health problems, especially a newly diagnosed problem or worsening symptoms
Age, gender, race (elderly or young adult, unmarried, white, male, living alone)
Same– sex sexual orientation
The VA now has its own Crisis Hotline, staffed by VA professionals 24/7. Veterans in distress should be encouraged to call the Hotline at any time if they are unable to access their own support system for any reason. The veteran calls 1–800–273 TALK (8255), the number of the National Suicide Lifeline, and will be asked to “press 1” if they are a veteran. This automatically routes their call to the special Veterans Suicide Hotline Call Center in Canandaigua New York. There, trained professional mental health clinicians will help the caller, even arranging for police or emergency medical technicians to be called to the scene. The Hotline staff are able to make immediate direct referrals to the Suicide Prevention Coordinators at any VA treatment center across the country, who will contact the veteran in a matter of hours. This comprehensive service should be made known to all veterans on your caseload whom you think may benefit.
1. Rudd M.D., Berman, A.L., Joiner, T.E., Nock, M.K., Silverman, M.M., Mandrusiak, M., Van Orden, K.,& Witte, T. (2006) Warning signs for suicide: Theory, research and clinical applications. Suicide and Life Threatening Behavior; 36, 255–62.