Alternatives to Suicide

Beyond Risk and Toward a Life Worth Living

Andrew Page, Werner Stritzke

• Publisher: Academic Press
• Year: 2020
• Print ISBN: 9780128142974
• eBook ISBN: 9780128142981
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Alternatives to Suicide: Beyond Risk and Toward a Life Worth Living demonstrates how fostering resilience and a desire for life can broaden and advance an understanding of suicide. The book summarizes the existing literature and outlines a new focus on the dynamic interplay of risk and resilience that leads to a life-focus approach to suicide prevention. It calls for a treatment approach that enhances the opportunity to collaboratively engage clients in discussion about their lives. Providing a new perspective on how to approach suicide prevention, the book also lays out key theories on resilience and the interplay of risk and protective factors.Finally, the book outlines how emerging technologies and advances in data-analytic sophistication using real-time monitoring of suicide dynamics are ushering the field of suicide research and prevention into a new and exciting era.- Focuses on what attenuates the transition from thinking about suicide to attempting it- Calls for a life-focus treatment approach as opposed to risk-aversion intervention techniques- Demonstrates how fostering resilience can advance our understanding of pathways to suicide- Discusses emerging technologies being used in current suicide research and prevention- Outlines the differences between risk factors and risk correlates- Covers real-time assessment of dynamic suicide risk

Part 1

Time for a paradigm shift

Outline

Chapter 1. Suicide is about life

Chapter 2. The implicit suicidal mind clings to life

Chapter 3. Zest for life: an antidote to suicide?

Chapter 1

Suicide is about life

Werner G.K. Stritzke, and Andrew C. Page School of Psychological Science, University of Western Australia, Perth, WA, Australia

Abstract

“Alternatives to Suicide: Beyond Risk and Toward a Life Worth Living” the authors call for a new approach to suicide. This chapter provides a review and critique of the current risk-centric approach to understanding suicide. It highlights the stark mismatch between conventional risk-centric approaches to suicide and what suicidal people tell us they actually need. It discusses the ethics of balancing risk-centric with life-oriented approaches to suicide. This volume brings together contributions from international experts in suicide research and practice, and importantly, also features prominently the viewpoints of those with lived experience, as well as the unique perspectives from within Indigenous cultures and refugee populations where suicide rates are disproportionately high. Authors provide a shared vision of how a safe path away from suicide must go beyond risk mitigation and include charting a course toward a life worth living that is characterised by respect for autonomy and firmly aligned with the needs of the suicidal person.

Keywords

Ethics; Lived experience; Suicide; Suicide risk mitigation

San Francisco's Golden Gate Bridge is an iconic landmark. It is an engineering feat that speaks to the triumph of human ingenuity to overcome the obstacle to travel presented by the Bay. However, it has iconic status in a more tragic manner, as it has been a common location for attempted suicide. Each death is tragic, but there has been a study of the survivors of a suicide attempt on the Golden Gate Bridge and this study is revealing.

Seiden (1978) followed up the 515 individuals who, in the period up until 1978, had come to the bridge with the intention of killing themselves, but had been dissuaded by the highway patrol officers. Of this group, 35 individuals had proceeded to die by suicide. Despite the tragedy of each subsequent death, the overwhelming pattern was that 90% of people who had come to the bridge with the express purpose to die by suicide went on to live a life without future attempts. In fact, one of the few survivors of jumping, Kevin Hines, described that the very second he let go of the bridge, he knew that he had made a big mistake. These results are revealing, because the vast majority of those who had been at the brink of following through with a suicide attempt using a highly lethal method, nonetheless re-engaged with a life worth living without attempting to end their life again.

A more recent large study used the Swedish national registers to follow-up over 34,000 people admitted to hospital after deliberate self-harm (Runeson, Haglund, Lichtenstein, & Tidemalm, 2016). Although not all the self-harm events may have been a suicide attempt, less than 3.5% (i.e., 1182) went on to die by suicide during the follow-up period of up to 9 years (670 males and 512 females). Thus, death by suicide following an initial attempt is the rare exception rather than the rule. Yet, evidence also informs us that a history of prior attempts (especially multiple attempts) raises the risk level for a future attempt. But rather than seeking to understand what helps the vast majority of attempters (despite their increased risk level) to continue living and not die by suicide, which might hold the key to preventing future attempts, the conventional approach has been to focus instead on identifying risk status and those factors that may lead to a future attempt. The problem with the latter approach is that there is now compelling evidence that it has not been effective (Franklin et al., 2017). First, the accuracy of a suicide ‘expert’ to predict a patient's future suicidal thoughts and behaviors based on a thorough assessment of risk factors is no better than the accuracy of a lay person flipping a coin. That is, after decades of trying, research has produced no meaningful advances in suicide prediction. Second, the World Health Organisation declared suicide prevention a “global imperative”, because suicide rates in many countries have been increasing in recent years (WHO, 2014). For example in Australia, suicide is the leading cause of death for people aged 15 to 44 (AIHW, 2018). Third, our conventional approach to interventions with ‘high risk’ individuals by hospitalization (voluntary or not) has kept many a suicidal person alive, but does not appear to extend to making an individual's life worth living following discharge. In the first three months after discharge, the suicide rates of patients admitted with suicidal thoughts or behaviors are nearly 200 times the global suicide rate (Chung et al., 2017). If we are unable to predict suicide attempts at better than chance, if suicide rates are increasing rather than decreasing, and if the rates of death by suicide following discharge from conventional risk-centric inpatient interventions are so high that some have them described as a “nightmare and disgrace” (Nordentoft, Erlangsen, & Madsen, 2016), then is it not time for a paradigm shift?

Suicide...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• Contributors
• Acknowledgment
• Part 1. Time for a paradigm shift
• Part 2. To be or not to be
• Part 3. Through the lens of the suicidal person
• Part 4. Suicide and a life worth living from indigenous and refugee perspectives
• Part 5. Epigenetics of suicidal behaviors
• Index