September is National Suicide Prevention Awareness Month

By Brian Justice

Suicide has “been declared an epidemic, and the numbers have gone up over the past several years, especially for young adults,” said Frederick Miller, MD, PhD.  “A lot of prevention has to do with having access to psychiatric care and educating the public on the importance of asking somebody in distress if they need help.”

To strengthen support to patients, Dr. Miller and several NorthShore clinicians traveled to New York to meet with Igor Galynker, MD, PhD, who heads an internationally acclaimed clinical research program on suicide.

Upon their return, Dr. Miller and his team established initiatives, processes and best practices to help patients suffering from imminent suicidal behavior, which included identifying indicators of “suicide crisis syndrome.”

“Suicide crisis syndrome is an intolerable state of despair that is more predictive of imminent risk for suicide,” Dr. Miller said. “The two key attributes are feeling that one’s problems are intolerable and unsolvable and being flooded with ruminations about one’s predicament.”

Patients who present a risk of suicide are assessed for the presence of those overwhelming, and dangerous, thought patterns.

Other initiatives implemented within the Department of Psychiatry, are:

SafeSide risk model. “SafeSide is a comprehensive set of questions that create an engaging ambience for conducting an interview and drives more thorough assessment,” explained Dr. Miller. “The key elements are ‘connection,’ to encourage direct conversations about suicidal thoughts and behaviors; ‘assessment,’ a deep dive into risk and protective factors; ‘respond,’ which includes critical safety planning and suicide specific therapies; and finally, ‘extend,’ which includes follow-ups and family involvement.”

Zero Suicide Initiative. The Zero Suicide initiative is a national, organized approach to help health systems and communities work toward the aspirational goal of preventing all suicides. This has been implemented in many hospital systems in the country.

The Collaborative Assessment and Management of Suicidality (CAMS). “The most important point of CAMS is that one does not solve the suicide problem simply by treating depression,” said Dr. Miller. “Suicidality is a state of mind. A set of thoughts, feelings and actions.”

Stanley-Brown Safety Intervention. This is a brief, collaborative intervention between clinician and patient designed to mitigate risk and increase safety, addressing suicide in cognitive behavior therapy, and short-term intensive therapy for suicidal adolescents.

“Suicide prevention is not just the job of psychiatry alone,” Dr. Miller said. “After all, many people who commit suicide have been in the health system, often recently. So, the idea is that everybody must be educated about this risk and what to do.”

Warning Signs of Suicide

• Risk-taking behavior. Those who are contemplating suicide might “tempt fate” by taking risks that could lead to death, such as driving at dangerous speeds. 
• Losing interest in previously important activities and friends. Unexplained loss of interest in things like sports, work and volunteer activities might also be combined with a withdrawal from interactions with friends and self-imposed isolation.
• Researching methods of suicide. Searching suicide online or buying anything that could be used to commit suicide is an important sign to watch for.
• Talking about death and hopelessness. Conversations and discussions might center on death and wanting to die or on feelings of hopelessness and lacking reasons to live. Potentially suicidal people might also talk about being a burden to family and friends or experiencing unendurable pain.
• Extreme shifts in mood. Periods of deep depression could be punctuated by feelings of elation, happiness or rage.
• Increased substance abuse. A history of substance abuse is a risk factor for suicide but increased use could be a warning sign of suicidal thoughts.
• Noticeable changes in sleep patterns. This could either be exhibited as sleeping too much or suffering from insomnia. 
• Giving away possessions. Suddenly giving away multiple items that seemed important to the person in the past.

If you or a loved one feel like you need emotional support, please reference this list of local and regional mental health resources or contact NorthShore’s Department of Psychiatry & Behavioral Services.