treatment for suicide prevention

treatment for suicide prevention A number of studies are emerging which elucidate the psychology of suicide
and suicidal behaviors, particularly the hopelessness, absence of future thinking,
lack of problem-solving skills, tendency toward impulsivity, and presence
of psychological pain (Berman et al., 2006). These larger conceptual
constructs are not necessarily diagnosis specifi c (Henriques, Beck, & Brown,
2003; Jobes, 2003a; Salkovskis, 2001) and they suggest new directions in clinical
practice (Jobes, 2003b). In fact, there is a growing consensus that many
acute suicidal risk factors cut across diagnostic categories: psychic anxiety,
panic attacks, global insomnia, depressive turmoil, recent onset of alcohol
abuse, and agitation (Busch, Fawcett, & Jacobs, 2003).
At the core of virtually every suicidal struggle is an intense need for
escape and relief from psychological pain. Suicidal states also typically
involve a fundamental struggle related to the presence or absence, and
perception, of certain key relationships. Jobes believes that many suicidal
students need “asylum,” which often can be found in a well-formed and
carefully monitored outpatient therapeutic alliance rather than an inpatient
setting (Jobes, 2003a). Clearly, however, there are different kinds
of suicidal young adults; a one-size treatment does not fit all (Rogers
& Soyka, 2004). Suicidal students often need a full range of interventions—
psychotherapy, medication, engagement of peers, and spiritual
and existential experiences.
Evidence-based research consistently shows that a combination of psychotherapy
and medication is more effi cacious than either approach by itself (TADS Team, 2004). Most suicidal students can benefi t directly from
psychotherapy that helps them problem-solve, cope, and develop a thicker
and more resilient “psychological skin.”
Despite considerable disagreement as to their appropriateness, scientifi c
foundation, and clinical utility, practice guidelines continue to emerge (Rudd
et al., 1999). Recently, guidelines from the American Academy of Child and
Adolescent Psychiatry (Shaffer & Pfeffer, 2001) and the American Psychiatric
Association (2003), though disclaiming to be authoritative, have become
“must reading” for those actively engaged in working with adolescent and
young adult suicidal patients.
The following case illustrates the suicidal person’s wish to escape from psychological
pain, the pivotal role played by a disruption in key relationships,
and how therapy and medication in combination can provide relief and help
the person surmount the suicidal crisis.

Steve told his therapist that he just couldn’t shake feeling “down” following
the recent news that his parents were divorcing, and intimated that he
might have been responsible for their breaking up. Over the next week he
reported that he was feeling increased hopelessness about what would happen
to his younger sister, pessimism that he would ever be able to go home
again, and decreased motivation for studying, since his parents probably
wouldn’t be able to send him to college in the future. He reported other
depressive symptoms as well: decreased ability to follow class discussions,
crying over “stupid stuff,” and loss of interest in socializing with friends.
When he told his therapist that he just wanted to go hide somewhere and
never be seen again, the therapist thoroughly assessed his suicidal potential
and discovered that Steve was harboring strong urges to take his life
by an overdose of pills.
Fortunately, Steve had a trusting, positive relationship with his therapist
and was able to credibly agree to a safety plan, stating emphatically
that if he felt an immediate urge to commit suicide he would promptly
call either the therapist or the campus’s emergency phone number. Steve
agreed to twice-weekly therapy sessions for the next few weeks and also
to a psychiatric consultation in order to be evaluated for antidepressant
medication. Therapy focused on providing support during this diffi cult
time and gently helping Steve question his pessimistic assumptions about
his parents’ divorce. Perhaps it wasn’t true that his sister’s fate was sealed
or that he couldn’t go home again or must drop out of school. Thanks to
the combination of therapy and medication, the suicidal crisis and his
depressive symptoms subsided and he was able to resume his course of
studies.