Preventing Suicide

A Handbook for Pastors, Chaplains and Pastoral Counselors

Karen Mason

• Publisher: IVP
• Year: 2014
• ISBN:
  9780830896479
• Topic: Theology & Religion
• Subtopic: Christian Ministry

v12th Annual Outreach Resource of the YearWhat is the church's role in suicide prevention?While we tend to view the work of suicide prevention as the task of professional therapists and doctors, the church can also play a vital role. Studies show that religious faith is an important factor reducing the risk of suicide. Yet many pastors, chaplains and pastoral counselors feel overwhelmed and unprepared to prevent suicides.In this practical handbook, psychologist Karen Mason equips ministry professionals to work with suicidal individuals. Integrating theology and psychology, she shows how pastoral caregivers can be agents of hope, teaching the significance of life, monitoring those at risk and intervening when they need help. Because church leaders are often present in people's lives in seasons of trouble and times of crisis, they can provide comfort in the midst of suffering and offer guidance for the future.When our church members struggle in the darkness, the darkness need not overcome them. Discover how you and your church can be proactive in caring for those at risk of self-harm.

1

WHO DIES BY SUICIDE?

The phone rings at your home at 10:30 p.m. Jim is sobbing. Bit by bit he tells you that he plans to kill himself tonight because his wife has discovered his ongoing affair. He says he has disappointed God, his family and himself in an unforgivable way.

Jim is the last person in your congregation you would have expected to experience suicidal thinking. He’s an involved member of your church, a committed Christian. He has never discussed any concerns about his marriage. And even if he had, he is upbeat and positive, and people describe him as “dependable” with “a winning personality.” You wonder: If Jim is suicidal, are there others in your faith community who might be as well? Suicidal thinking and suicide are a lot more common than we often believe.

Is Suicide That Widespread?

The World Health Organization has found that for every death due to war in the world, there are three deaths due to homicide and five due to suicide.1 Closer to home in the United States, suicide was the tenth leading cause of death across all ages in 2010 (affecting 38,364 people), ahead of homicide (16,259 people) and HIV (8,352 people).2 Even as you read this chapter, there will be one US suicide every sixteen minutes.3 Suicide is a serious threat and must be taken seriously, especially because these numbers are underreported. Take this example from 1899 cited by Kushner: A 34-year-old woman inhaled gas but revived. She then swallowed morphine and lost consciousness, but again she recovered and showed improvement. She died five days later of pneumonia, which is listed as the cause of death on both the coroner’s report and her death certificate in 1899.4

Those who actually die by suicide are just the tip of the iceberg. Based on large national surveys, it is estimated that for every fourteen suicides per hundred thousand people each year, approximately five hundred people attempt suicide and three thousand think about it.5 Therefore, there’s a significant chance suicidal thinking occurs in your faith community. Individuals in your pews, those who request counseling and even members of your governing board may at some point have thought about suicide or even attempted it. And you may experience a suicide death in your faith community.

Jim’s story ended well. He called his pastor who talked about God’s forgiveness (Rom 5:20-21) and prevented his suicide. But what happens when the Jim in your church doesn’t call you? Is there a way to identify him and help him anyway?

We can try to answer that question using the same approach that helps doctors understand what causes high blood pressure. A public health approach involves (1) surveillance, or tracking who gets high blood pressure—which ages, sex and races are affected?—and (2) research on what factors tend to co-occur with high blood pressure—being overweight, eating a high-salt diet, smoking. Let’s apply these same methods to suicide to see if we can identify the Jim in your faith community.

Which Groups Die by Suicide?

Let’s start with surveillance to discover which groups experience more suicide and attempts.

Age. On the evening news we hear about teens like Phoebe Prince, who was bullied and took her own life, and we know that suicide is a serious problem for teens.6 In 2010 in the United States, suicide was the third-leading cause of death among 10- to 14-year-olds, the third-leading cause of death among 15- to 24-year-olds, and the second-leading cause of death among 25- to 34-year-olds.7 Suicide is a problem for teens because psychiatric illnesses and suicidal behavior start to emerge as a serious concern in the 10- to 14-year-old age group, and suicide attempts are highest in adolescence and young adulthood.8

But when we look at the number of people who actually die, people in the middle years of life are at higher risk. In 2010, 4,600 young people in the 15- to 24-year-old age group died by suicide, while 6,571 35- to 44-year-olds, 8,799 45- to 54-year-olds, and 6,384 55- to 64-year olds took their own lives.9

Even young children think about suicide and, though rare, die by suicide. In 2010, seven US children in the five- to nine-year-old age range died by suicide.10 Researchers have found that preschool children aged two-and-a-half to five years old think about and attempt suicide.11 Jane told me that her earliest memory of a suicidal thought was of holding a knife to her stomach around age three.

We can talk about these numbers in a different way if we look at the rates for these different groups. The suicide rate is simply the number of people in a group who die by suicide divided by the larger number of people in that group, and standardized by multiplying by 100,000 to permit meaningful comparisons between groups. When we look at suicide rates, we discover that 45- to 54-year-olds had the highest rate of suicide in 2010: There were 19.55 suicide deaths per 100,000 compared to 12.43 suicide deaths per 100,000 Americans of all ages.12 The second-highest rate occurred in the 85-plus age range (17.62 per 100,000), with the 55- to 64-year-old age range a close third (17.50 per 100,000).13 The rate for the oldest Americans is especially unexpected because older adults made up 13 percent of the 2010 population but represented 15.6 percent of suicide deaths.14

So how does this information help us identify Jim or Joan in our faith community? By reminding us not to exclude anyone. Every age group thinks about and dies by suicide. If we pay particular attention to middle-aged congregants and do not remain alert to warning signs among other age groups, we might miss people who need our help.

Sex. Almost four times more men than women die by suicide each year. In 2010 in the United States, 30,277 males died by suicide compared to 8,087 females; the suicide rate for males was 19.95 per 100,000 compared to 5.15 per 100,000 for females.15 But more women than men attempt suicide. Women made up 57 percent of all people treated for nonfatal self-harm in a US hospital emergency department in 2010. Of the 464,995 people with nonfatal self-harm injuries treated, 199,204 were men with a rate of 131.67 per 100,000, and 265,727 were women with a rate of 180.59 per 100,000.16

Males. Many theories exist about why more men die by suicide than women. One is that men use firearms. In 2010, 56 percent of men who died by suicide used firearms as opposed to 30 percent of women.17 In that same year, 88 percent of suicide deaths involving firearms were men,18 perhaps related to the fact that three times more men than women own a gun.19 A striking characteristic of most people contemplating suicide is their ambivalence: a part of them wants to die and often another part wants to find reasons to live. William Cowper, a Christian hymnodist, planned to overdose on the narcotic laudanum but experienced this ambivalence when he brought a vial of laudanum to his mouth twenty times and each time set it back down, “distracted between the desire for death, and the dread of it.”20 Kevin Hines, who suffers from bipolar disorder and who started hearing voices in high school, jumped from the Golden Gate Bridge in 2000. As soon as he jumped he realized he did not want to die. Miraculously, he survived.21 Another example of someone who survived is Ken Baldwin, who jumped from the Golden Gate and then realized his ambivalence: “I instantly realized that everything in my life that I’d thought was unfixable was totally fixable—except for having just jumped.”22 A woman may swallow pills and then suddenly realize she wants to live. She can pick up the phone and dial 911 for help. But a man using a firearm has little opportunity for a second thought. I am not suggesting that women are more ambivalent, but I am highlighting a gender difference in method. If a woman uses a method that allows the desire to live to emerge, she may be more likely to survive an attempt than a man who uses a firearm.

Other theories attempting to explain why more men die by suicide include the cultural script theory, which suggests that masculinity is associated with killing oneself and femininity with nonfatal attempts.23 Another theory is that men have higher substance abuse rates, which are related to greater impulsivity and impaired judgment as well as problems in relationships.24 Men fall in love earlier in a relationship, t...