Inpatient Psychiatric Care Resources

by Band Back Together | Aug 19, 2018

What Is Psychiatry?

Psychiatry is a sub-specialty of medicine that is devoted to both the study and treatment of mental illnesses. Mental illnesses are medical conditions that disrupt a person’s thinking, feelings, mood, ability to relate to others and daily functioning. Just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a diminished capacity for coping with the ordinary demands of life. Mental illnesses are serious medical illnesses. They cannot be overcome through “will power” and are not related to a person’s “character” or intelligence.

Read more about mental illnesses.

Psychiatric assessment for a person with a mental illness may be performed by a psychologist or psychiatrist. This assessment usually begins with a check of current mental status and collection of a complete case history about the mental illness and other stressors in the personal life. This information is used to diagnose mental illnesses.

Mental illnesses are diagnosed using the criteria in such diagnostic manuals as The Diagnostic and Statistical Manual of Mental Disorders (DSM-V), put out by the American Psychiatric Association as well as the International Classification of Diseases (ICD) put out by the World Health Organization (WHO).

How Are Mental Illnesses Treated?

Treatment for psychiatric disorders uses a variety of methods including, psychotherapy, medications, psychoactive meditation, as well as other techniques. Treatment for mental illnesses may be given on an inpatient or outpatient basis, depending upon the severity of symptoms, aspects of the mental illnesses, and other factors.

Innovations in the range of evidence based medications, therapy services such as psychiatric rehabilitation, housing, employment and peer supports have made wellness and recovery a reality for people living with mental health conditions.

Choosing the right mix of treatments and supports that work for you is an important step in the recovery process. Treatment choices for mental health conditions will vary from person to person. Even people with the same diagnosis will have different experiences, needs, goals and objectives for treatment. There is no “one size fits all” treatment.

When people are directly involved in designing their own treatment plan, including defining recovery and wellness goals, choosing services that support them and evaluating treatment decisions and progress, the experience of care and outcomes are improved.

There are many tools that can improve the experience on the road to wellness: medication, counseling (therapy), social support and education. Therapy can take many forms, from learning relaxation skills to intensively reworking your thinking patterns. Social support, acceptance and encouragement from friends, family and others can also make a difference. Education about how to manage a mental health condition along with other medical conditions can provide the skills and supports to enrich the unique journey toward overall recovery and wellness.

Together with a treatment team you can develop a well-rounded and integrated recovery plan that may include counseling, medications, support groups, education programs and other strategies that work for you.

When Does Inpatient Hospitalization Occur?

If you have severe symptoms of an illness like depression or bipolar disorder, a brief stay in the hospital can help you stabilize.

You might need to go to the hospital if you:

• are seeing or hearing things (hallucinations).
• have bizarre or paranoid ideas (delusions).
• have thoughts of hurting yourself or others.
• are thinking or talking too fast, or jumping from topic to topic and not making sense.
• feel too exhausted or depressed to get out of bed or take care of yourself or your family.
• have problems with alcohol or substances.
• have not eaten or slept for several days.
• have tried outpatient treatment (therapy, medication and support) and still have symptoms that interfere with your life.
• need to make a major change in your treatment or medication under the close supervision of your doctor.

How can hospitalization help?

• The hospital is a safe place where you can begin to get well. It is a place to get away from the stresses that may be worsening your mood disorder symptoms. No one outside the family needs to be told about your hospitalization.
• You can work with professionals to stabilize your severe symptoms, keep yourself safe, and learn new ways to cope with your illness.
• You can talk about traumatic experiences and explore your thoughts, ideas, and feelings.
• You can learn more about events, people, or situations that may trigger your manic or depressive episodes and how to cope with or avoid them.
• You may find a new treatment or combination of treatments that helps you.

What do I need to know about the hospital?

• Hospitalization is intended to create a safe place to allow severe symptoms to pass and medication to be adjusted and stabilized. It is not punishment and it is nothing to be ashamed of.
• You may be on a locked ward. At first, you may not be able to leave the ward. Later, you may be able to go to other parts of the hospital, or get a pass to leave the hospital for a short time.
• You may have jewelry, personal care items, belts, shoelaces, or other personal belongings locked away during your stay. You may not be allowed to have items with glass or sharp edges, such as picture frames, CD cases, or spiral notebooks.
• You may have to follow a schedule. There may be set times for meals, groups, treatments, medications, activities, and bedtime.
• You may have physical or mental health tests. You may have blood tests to find out your medication levels or look for other physical problems that may be worsening your illness.
• You may share a room with someone else.
• Hospital staff may check on you or interview you periodically.
• Your prescribing doctor may not be able to see you right away. You will probably talk to several different doctors, nurses, and staff members while you’re on the ward. You might have to ask for things you need more than once.

If a person is very ill and refuses to go to the hospital or accept treatment, involuntary hospitalization is an option. The legal standard for an involuntary hospitalization requires that a person be considered a “danger to self or others.” This type of hospitalization usually results in a short stay of up to 3 days but can occasionally last a week or so longer. For an involuntary hospitalization to be extended, a court hearing needs to be convened, and a judge and two doctors must agree that there is still a need for hospitalization. The rules for involuntary hospitalization are done at the state level. The initial criteria are typically based on whether or not there is an immediate safety risk to his or herself or others. In other states, other criteria, such as being severely disabled, may be used as criteria for involuntary hospitalization.

What Is Inpatient Psychiatric Treatment?

There may be times when a person is admitted to the hospital for intensive treatment. Private psychiatric hospitals, general hospitals with a psychiatric floor or state psychiatric hospitals are designed to be safe settings for intensive mental health treatment. This can involve observation, diagnosis, changing or adjusting medications, ECT treatments, stabilization, correcting a harmful living situation.

If a person and their doctor agree that inpatient treatment is a good idea, they will be admitted on a voluntary basis, meaning that they choose to go. Some private hospitals will only take voluntary patients.

Before a person is discharged from the hospital, it is important to develop a discharge plan with a social worker or case manager. Family members should be involved in discharge planning if the person is returning home or if they will need significant support. A good discharge plan ensures continuous, coordinated treatment and a smooth return to the community.

Treatment for mental illnesses have changed dramatically over the past few decades. While in the past, those with mental illnesses were confined to a psychiatric hospital for periods greater than six months (sometimes for several years), most people today are treated for their mental illnesses on an outpatient basis.

Once in the care of a hospital psychiatric unit, people with mental illnesses are continually assessed by a group of doctors and nurses who specialize in the treatment of mental illnesses. Medication and treatment plans are developed with a team of doctors, psychologists, psychiatric social workers, therapists, occupational therapists, psychiatric nurses, and pharmacists. Those who are admitted to an inpatient psychiatric hospital may be admitted voluntarily or involuntarily.

What Are The Goals of Inpatient Psychiatric Care?

While the first goal of inpatient psychiatric care is to stabilize the person so that he or she is no longer a danger to his or herself or others, there are a number of other goals that can be met through inpatient psychiatric care.

• Titration and experimentation with medications to treat the mental illness.
• Group therapy to connect with other people experiencing similar mental illnesses.
• Supportive structure aimed at establishing normal, stabilizing routines for the day and night.
• Individualized goals for each person.
• Development of proper self-care habits – from resting to hygiene, to medication compliance.
• Learning to take responsibility for one’s actions.
• Boosts self-esteem by being part of a community.
• Forming relationships and supporting people going through the same things.
• One-on-one therapy to work through problems, past and present.
• Additional types of therapies, like occupational, art, animal, and music therapy.

What Is Involuntary Admission To A Psychiatric Unit?

Involuntary Commitment (or Civil Commitment) is a legal process in which a person who has severe mental illness is ordered by the court into treatment at an inpatient psychiatric hospital.

While seeking help voluntarily is always preferable, a family member may have to make the decision to hospitalize someone with a mental illness involuntarily. This act, while difficult, can be more caring than it seems if that is the only way to get someone the care they need, especially if there is a risk of suicide or harm to others. A family member should consider working with their relative who is at risk of a mental health crisis if they would like to create a Psychiatric Advance Directive during a time when they are well.

If a person is very ill and refuses to go to the hospital or accept treatment, involuntary hospitalization is an option. The legal standard for an involuntary hospitalization requires that a person be considered a “danger to self or others.” This type of hospitalization usually results in a short stay of up to 3 days but can occasionally last a week or so longer.

For an involuntary hospitalization to be extended, a court hearing needs to be convened, and a judge and two doctors must agree that there is still a need for hospitalization. The rules for involuntary hospitalization are done at the state level. The initial criteria are typically based on whether or not there is an immediate safety risk to his or herself or others. In other states, other criteria, such as being severely disabled, may be used as criteria for involuntary hospitalization.

The criteria for an involuntary psychiatric commitment are established by law and vary tremendously from nation to nation and (in the US) state-to-state.

Commitment proceedings usually follow a period of emergency psychiatric hospitalization during which the mentally ill individual with acute psychiatric conditions is held for 72 hours (also known as the 72-hour hold). During those 72 hours, an individual is:

• Evaluated by a team of mental health professionals
• Stabilized

At the civil commitment hearing, it’s determined whether or not the person should continue to be involuntarily held for further treatment.

Why Are People Involuntarily Committed To Psychiatric Hospitals?

Most areas of the world confine those who are mentally ill to such an extent that it impairs abilities to reason, or “found incompetent.”

It is important to note that involuntary commitment to a psychiatric hospital for a personality disorder, social deviance, or substance abuse is not allowed.

The most common reason for involuntary commitment to a psychiatric hospital is because the person is considered to have a mental illness, severe dementia or other intellectual disability that means the person is a:

1. A danger to him or herself – such as in the case of people who have attempted suicide or confessed to plans of a suicide.
2. A danger to others – such as people who are in psychosis, driven by delusions or hallucinations to harm themselves or other people.

Who Can Get Someone Involuntarily Committed To An Inpatient Psychiatric Facility?  

How Long Does Involuntary Hospitalization Last?

What Is Voluntary Commitment to Inpatient Psychiatric Care?

The large majority of people (88%) who receive inpatient psychiatric care do so voluntarily – or, who decide freely to enter the inpatient psychiatric hospital for treatment. It’s important to note that voluntary psychiatric patients aren’t entirely free to leave the unit without the permission of the staff. Should a person who has been voluntarily committed prove to be a danger to him or herself or others, he or she may be detained via involuntary commitment for up to 24 hours.

Voluntary admission to a psychiatric facility happens very similarly to the way that one is admitted to a hospital. Your GP or psychiatrist may write you a referral and you may check-in for treatment at an agreed-upon time.

What Sorts Of Freedom Are Available At Inpatient Psychiatric Hospitals?

One of the major benefits to staying as an inpatient at a psychiatric hospital is the reduction of every day stresses. This comes at a cost of personal freedom.

Most inpatient facilities limit the amounts and types of belongings brought inside. Activities are scheduled. Usage of television and internet may only occur at certain times of the day. Most facilities have a strict bedtime as well.

Finding An Inpatient Psychiatric Hospital:

Once you have decided to undergo inpatient psychiatric treatment, you’ll have to choose a hospital. This will, in part, depend on the level of care you need to receive. Who administers that care depends on where you go to seek treatment.

• In-patient, 24-hour care is provided by the psychiatric units within general hospitals, and also at private psychiatric hospitals. Care is supervised by psychiatrists, and provided by psychiatric nurses and group therapists.
• Each state has public psychiatric hospitals that provide acute (short-term) and long-term care to people without means to pay, those requiring long-term care, and forensic patients.
• Partial hospitalization provides therapeutic services during the day, but not on a 24-hour basis. It can be an intermediate step between in-patient care and discharge.
• Residential care is 24-hour psychiatric care provided in a residential setting for children or adolescents, or residential programs for the treatment of addictions.

What Happens After Checking Into The Psychiatric Hospital?

Generally speaking, after arriving at the psychiatric hospital, a nurse will meet with you to discuss your mental illness and problems.

You might want to ask a loved one to help you go through hospital check-in procedures and fill out forms. Ask your loved one to help you communicate with hospital staff if needed.

You or a loved one may also want to call the hospital in advance to find out about check-in procedures and items you can bring. Ask if you can bring music, soap, lotion, pillows, stuffed animals, books, or other things that comfort you. Find out about visiting hours and telephone access. Be sure your family and friends are aware of hospital procedures. Tell them what they can do to help you.

Ask these questions upon check-in at the facility:

• Does your facility treat patients with my specific diagnosis only?
• If I have other health or emotional problems will I receive treatment for these problems also?
• Does your facility require tests when admitted? If so, what are they?
• When will the initial evaluation take place?
• Who will evaluate me when I am admitted?
• What are the person’s qualifications? Title?
• Will this person continue to treat me?
• Will I be seen by this professional on a regular basis?

You will be searched to make sure that you’re not carrying anything dangerous on you and your belongings will also be inspected. Anything considered contraband (something as innocuous as mouthwash may not be allowed) will be removed and given back to you when you leave.

Your first hours will likely be spent settling into the hospital as your treatment team learns more about you so a treatment plan can be developed. Within 24 hours of admittance, you will speak to a doctor for a complete psychiatric evaluation.

Goals for treatment at a psychiatric hospital center around discharge planning, developing healthy coping mechanisms, working through mental illnesses, obtaining proper medications, as well as learning basic self-care.

During Your Stay:

Before your treatment can begin, you will undergo a complete physical examination to determine the overall state of your health. The information collected during this examination, and the information collected during the initial evaluation will be considered when making your treatment plan.

You have the right to have your treatment explained to you in order to be informed of the benefits and risks, and you have the right to refuse treatment if you feel uncomfortable or if you feel it is unsafe. You also have the right to have your health information protected and kept private through confidentiality. The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule gives you rights over your health information and sets rules on who can look at and receive your health information.

Below are some questions you can ask during your stay:

• When can family members visit? For how long?
• Will I be allowed to make and receive phone calls?
• What clothes should I bring?
• Can I walk around the hospital? Are there restrictions on where I can and cannot go?
• Will I be able to leave the treatment facility grounds?
• How long will I be at the facility? Who makes this decision?
• Will I have to share a room with someone else? Can I request a single room?
• Will I have a daily schedule or set times for activities, treatments, and medication?
• What types of activities will I be involved in?
• Is there a set bedtime or curfew? When will this be?
• When can I (or another family member) talk to the therapist or doctor?
• Will we be able to discuss treatment with the doctor or therapist? When? How often?
• Will I (or my family) be advised of changes in my treatment?
• Is therapy in a group setting or one-on-one? Is it part of my treatment plan?
• Will I have to undergo tests while I am treated? Can I refuse these tests?
• Will I be able to continue schoolwork while receiving in-patient care?
• If classes are offered to patients, what are they and who teaches them?

If you sign yourself into the hospital, you can also sign yourself out, unless the staff believes you are a danger to yourself or others. If you are not a danger, the hospital must release you within two to seven days, depending on your state’s laws. If you have problems getting the hospital to release you, contact your state’s protection and advocacy agency.

You have the right to have your treatment explained to you. You have the right to be informed of the benefits and risks of your treatment and to refuse treatment you feel is unsafe. You also have the right to be informed about any tests or exams you are given and to refuse any procedures you feel are unnecessary, such as a gynecological exam or other invasive procedures. In addition, you have the right to refuse to be part of experimental treatments or training sessions that involve students or observers. Make sure the people treating you know your needs and preferences.

It may take time to get used to the routine in the hospital. If your symptoms are severe, some things may not make sense to you. Try to get what you can out of the activities. Concentrate on your own mental health. Listen to what others have to say in groups. Keep a journal of your own thoughts and feelings.

You will meet other people who are working to overcome their own problems. Treat them with courtesy and respect, regardless of what they may say or do. If someone is making you feel uncomfortable or unsafe, tell a staff member. Make the most of your time with your doctor. Make a list of questions you have. Ask your family or other hospital staff to help you with the list. Let your doctor and staff know about any other illnesses you have or medications you take. Be sure you receive your medications for other illnesses along with the medications for your depression or bipolar disorder.

Self-Care and Wellness after Hospitalization

If you were admitted voluntarily, you may have the option of checking out against medical advice; which, in other words means, if you feel you are ready to leave the hospital on your own without a “green light” from your doctor, you maybe be allowed to go. However, if your hospitalization was court ordered, or if a family member admitted you involuntarily, you will need to complete an evaluation process to determine if you are in a condition to care for yourself outside of 24-hour inpatient care. Every facility has different policies and procedures, so check with the facility in which you are seeking or receiving care.

Below are some questions you can ask regarding your discharge:

• Who will make the evaluation for my discharge? When will this happen?
• What can my family and I expect when I am discharged?
• Will someone advise me and my family about adjustment concerns such as the need for further counseling or a medication schedule?
• Will I be on medications? Which ones? What is the dosage?
• How will these medications help? Are they habit-forming? What are the side effects?
• How long will I have to take this medication?
• If I leave the hospital without permission how will the hospital handle this? If this occurs, what is my family’s responsibility?
• How soon after I have been discharged can I continue with my schoolwork?
• What follow-up treatment or support group options should I consider?

Know your treatment. Before you leave the hospital, make sure you have a written list of what medications to take, what dosage, and when to take them. Find out if there are any foods, medications (prescription, over-the-counter, or herbal), or activities you need to avoid while taking your medication, and write these things down. Track your medications and moods.

Learn all you can about your illness. Talk to your doctor about new treatments you might want to try. Find out what to expect from treatments and how you know if your treatment is working. If you think you could be doing better, ask another doctor for a second opinion.

Take one step at a time. You might not feel better immediately. Allow yourself to slowly, gradually get back to your routine. Give yourself credit for doing small things like getting out of bed, dressing, or having a meal.

Prioritize the things you need to do. Concentrate on one thing at a time. Write things down or ask friends and family to help you to keep from becoming overwhelmed.

Set limits. Take time to relax. If you feel stressed or exhausted, you can say no or cancel plans. Schedule time to care for yourself and relax, meditate, take a long bath, listen to music, or do something else that is just for you.

Have faith in yourself. Know that you can get well. If you were manic, you may not feel as productive as you felt before. But you will have a more stable and safe mood, which will help you be more productive over the long term.

Stick with your treatment. Go to your health care appointments, therapy, and support groups. Be patient as you wait for medication to take effect. You may have some side effects at first. If they continue for more than two weeks, talk to your doctor about changing your medication, your dosage, or the time you take your medication. Never change or stop your medication without first talking with your doctor.

Recognize your symptoms and triggers. Feeling very discouraged, hopeless, or irritable can be a symptom of your illness. If you feel very angry, your mind starts to race, or you start to think about hurting yourself, stop, think, and call someone who can help. Keep a list of your triggers and warning signs, along with a list of people you can call for help.

Give relationships time to heal. Your family and friends may be unsure of how to act around you at first. There may also be hurt feelings or apologies that need to be made because of things you may have done while in mania or depression. Show that you want to get well by sticking with your treatment. Encourage your loved ones to get support from a DBSA support group if they need it.

Help your loved ones help you. Ask for what you need. Tell them specific things they can do to help you. If you need help such as housework, rides, or wake-up calls, ask.

Take it easy at work. Explain to your supervisor and co-workers that you have been ill and you need to take things slowly. You don’t have to talk about your depression or bipolar disorder. If someone asks questions, politely but firmly tell them you don’t want to talk about it. Do your best at work. Try not to take on too much. On breaks, call a friend or family member to check in.

Get support from people who have had similar experiences and are feeling better.

How Long Will I Stay At An Inpatient Psychiatric Hospital?

The average length of stay for an adult in a psychiatric facility is 12 days. Discharge planning is begun on the first day of admission to the unit. Medical research and new, highly effective treatments mean that those who suffer from mental illness can recover more quickly than people have in the past.

Children In Inpatient Psychiatric Facilities:

Both teens and children can suffer from mental illness. Certain mental illnesses often emerge during the early years. When a child’s mental illness symptoms become very severe, it may be suggested to hospitalize the child. The following things will be taken into consideration:

• Is the child an actual danger to him or herself or others?
• Is the child’s behavior bizarre and destructive?
• Does the child need medication that must be carefully monitored?
• Does the child need 24 hour care to stabilize?
• Has the child failed to improve in less restrictive environment?

While a child is hospitalized in a psychiatric facility, a treatment plan – including goals for discharge – will be created. The child may have group therapy, individual therapy, family therapy, and occupational therapy. Treatment will also focus upon academics. To increase social skills, children are often involved in activity therapy.

The family of the child is a major part of recovery from childhood mental illness, so the child’s treatment team works closely with parents and siblings to ensure proper communication, teach the family about the mental illness, recovery prognosis and treatment options.

Families will learn how to work with their mentally ill family member and cope with the stresses that accompany those mental illnesses.

Self-Injury & Self-Harm Resources

by Band Back Together | Aug 19, 2018

What is Self-Injury?

Self-Injury (SI) (also called self-harm, self-inflicted violence, or non-suicidal self-injury) is the act of deliberately harming one’s own body, such as by cutting or burning, that is not meant as a suicidal act. Self-injury is an unhealthy way to cope with emotional pain, anger, and frustration. Self-harm is the deliberate infliction of damage to your own body and includes cutting, burning, and other forms of injury. While cutting can look like attempted suicide, it’s often not; most people who mutilate themselves do it as a way to regulate mood. People who hurt themselves may be motivated by a need to distract themselves from inner turmoil or to quickly release anxiety that builds due to an inability to express intense emotions.

Self-harm or self-injury means hurting yourself on purpose. One common method is cutting yourself with a knife. But any time someone deliberately hurts herself is classified as self-harm. Some people feel an impulse to burn themselves, pull out hair or pick at wounds to prevent healing. Extreme injuries can result in broken bones.

Hurting yourself—or thinking about hurting yourself—is a sign of emotional distress. These uncomfortable emotions may grow more intense if a person continues to use self-harm as a coping mechanism. Learning other ways to tolerate the mental pain will make you stronger in the long term.

Self-harm also causes feelings of shame. The scars caused by frequent cutting or burning can be permanent. Drinking alcohol or doing drugs while hurting yourself increases the risk of a more severe injury than intended. And it takes time and energy away from other things you value. Skipping classes to change bandages or avoiding social occasions to prevent people from seeing your scars is a sign that your habit is negatively affecting work and relationships.

The most common type of self-injury is skin-cutting, but self-harm refers to a wide range of behaviors, including burning, scratching, trichotillomania, poisoning, and other types of injurious behaviors.

There is a complex relationship between self-injury, which is not a suicidal act, and suicide. Self-harming behavior may be potentially life-threatening. There also exists a higher risk of suicide in those who self-injure.

The DSM-IV lists self-injury as a symptom of Borderline Personality Disorder; however, people who suffer depression, stress, anxiety, self-loathing, eating disorders, substance abuse, additional personality disorders, and perfectionism may also engage in self-injurious behavior.,

Who Self-Injures?

Self-harm is most common in adolescence and teen years, usually beginning between the ages of 12 and 24; however, self-injury is not limited to the teen years. Self-injury can start at any age. It’s estimated that two million people from all races and backgrounds in the US injure themselves in some way. Young women are more likely than young men to engage in self-injurious behavior.

Why Do People Self-Injure?

Self-harm is not a mental illness, but a behavior that indicates a lack of coping skills. Several illnesses are associated with it, including borderline personality disorder, depression, eating disorders, anxiety or post-traumatic stress disorder.

Self-harm occurs most often during the teenage and young adult years, though it can also happen later in life. Those at the most risk are people who have experienced trauma, neglect or abuse. For instance, if a person grew up in an unstable family, it might have become a coping mechanism. If a person binge drinks or does drugs, he is also at greater risk of self-injury, because alcohol and drugs lower self-control.

The urge to hurt yourself may start with overwhelming anger, frustration or pain. When a person is not sure how to deal with emotions, or learned as a child to hide emotions, self-harm may feel like a release. Sometimes, injuring yourself stimulates the body’s endorphins or pain-killing hormones, thus raising their mood. Or if a person doesn’t feel many emotions, he might cause himself pain in order to feel something “real” to replace emotional numbness.

Once a person injures herself, she may experience shame and guilt. If the shame leads to intense negative feelings, that person may hurt herself again. The behavior can thus become a dangerous cycle and a long-time habit. Some people even create rituals around it.

Self-harm isn’t the same as attempting suicide. However, it is a symptom of emotional pain that should be taken seriously. If someone is hurting herself, she may be at an increased risk of feeling suicidal. It’s important to find treatment for the underlying emotions.

There’s no single cause that leads to self-injurious behavior. The mixture of emotions that trigger one to self-injure is complex. Generally, self-injury is the result of an inability to cope with deep psychological pain. Physical pain distracts the sufferer from painful emotions or helps the person who self-injures to feel a sense of control over an otherwise uncontrollable situation.

Emotional emptiness – feeling empty inside – may lead to self-harm, as it allows the sufferer to feel something – anything. It’s an external way to express inner turmoil.

Self-injury can be a way to punish the self for perceived faults.

Risk Factors for Self-Injury:

There are certain factors that may increase the risk for self-injury. These include:

• Most people who self-injure begin as teenagers. Self-injury tends to escalate over the years.
• Having friends who self-injure increases the likelihood that someone will begin to self-injure.
• Having gone through sexual, emotional, physical child abuse or neglect.
• Drug or alcohol use – many of those who self-injure do so under the influence of drugs and/or alcohol.
• Being overly self-critical, lacking impulse control, having poor problem-solving skills.
• Mental illnesses such as depression, borderline personality disorder, anxiety problems, PTSD, eating disorders, and drug or alcohol abuse.

Common Traits And Signs of Self-Injurers:

While cutting and self-harming occurs most frequently in adolescents and young adults, it can happen at any age. Because clothing can hide physical injuries, and inner turmoil can be covered up by a seemingly calm disposition, self-injury in a friend or family member can be hard to detect. In any situation, you don’t have to be sure that you know what’s going on in order to reach out to someone you’re worried about. Of course not everyone who self-injures will display all of the following characteristics. Some may identify with one or two; some may identify with none at all. Here are some common characteristics of those who self-injure, and red flags you can look for:

Blood stains on clothing, towels, or bedding; blood-soaked tissues

Childhood trauma or significant parenting deficits. Many adapt to the trauma by developing unhealthy fantasies about being being rescued from their grief.

Difficulties in impulse control, like eating disorders or drug abuse. 

Covering up. A person who self-injures may insist on wearing long sleeves or long pants, even in hot weather.

Engaging in Magical Thinking: physical wounds make you immune to other, greater harm.

Fear of changes – everyday changes or any kind of new experience – people, places, and things. This may include the fear of getting well or stopping the self-injurious behavior.

Feel undeserving of proper self-care. Many people who self-injure ignore their own needs, like a good diet, enough sleep, and exercise. They may be apathetic to their appearance or feel undeserving of such care.

Frequent “accidents.” Someone who self-harms may claim to be clumsy or have many mishaps, in order to explain away injuries.

Growing up in an environment where intense emotions weren’t allowed.

History of childhood illness or severe illness and/or disability in a close family member.

Isolation and irritability. Your loved one is experiencing a great deal of inner pain—as well as guilt at how they’re trying to cope with it. This can cause them to withdraw and isolate themselves.

Limited social support network, due to shame of self-harm or because they have poor social skills. These social skills may include being hypersensitive and an inability to tune into the needs of others.

Low self-esteem coupled with a powerful need for love and acceptance by others. They may adopt an unhealthy care-taking role or take on too much responsibility for what happens in a relationship.

Needing to be alone for long periods of time, especially in the bedroom or bathroom.

Sharp objects or cutting instruments, such as razors, knives, needles, glass shards, or bottle caps, in the person’s belongings.

Unexplained wounds or scars from cuts, bruises, or burns, usually on the wrists, arms, thighs, or chest

What Are Some Forms of Self-Injury?

While self-injury may take on many different forms, most people who self-injure stab or cut their skin with a sharp object. However, self-injury types are only limited to the individual’s inventiveness and determination to harm themselves

Self-harm is a way of expressing and dealing with deep distress and emotional pain. It includes anything you do to intentionally injure yourself. Some of the more common ways include:

• Cutting or severely scratching your skin
• Burning or scalding yourself
• Hitting yourself or banging your head
• Punching things or throwing your body against walls and hard objects
• Sticking objects into your skin
• Intentionally preventing wounds from healing
• Swallowing poisonous substances or inappropriate objects
• Carving words/symbols on skin
• Interfering with wound healing
• Biting
• Head banging
• Pulling out hair
• Piercing skin with sharp object

Self-harm can also include less obvious ways of hurting yourself or putting yourself in danger, such as driving recklessly, binge drinking, taking too many drugs, and having unsafe sex.

Regardless of how you self-harm, injuring yourself is often the only way you know how to:

• Cope with feelings like sadness, self-loathing, emptiness, guilt, and rage
• Express feelings you can’t put into words or release the pain and tension you feel inside
• Feel in control, relieve guilt, or punish yourself
• Distract yourself from overwhelming emotions or difficult life circumstances
• Make you feel alive, or simply feel something, instead of feeling numb

How Do I Know if I Self-Injure?

Cutting is not the only way that someone can self-injure. Picking scabs compulsively, pulling out hair, burning, punching, hitting your head against the wall, and many other methods are considered self-injury. Sometimes, people drink harmful substances like bleach or detergent if they are self-injuring.

If you use one of these methods or a similar method, especially when in emotional conflict, you likely self-injure.

You don’t have to require stitches or a trip to the emergency room to self-injure. Even if you think it isn’t “bad enough,” it is.

Help is out there, regardless of your situation.

 Does Self-Harm Help?

It’s important to note that those who self-injure do so for many reasons – and self-injury often helps to soothe these issues. Understanding the reasons that one self-injures can help to ascertain ways to stop the self-harming.

Emotional Reasons for Self-Injuring:

• Self-soothing to calm intense emotions
• To punish yourself or express self-loathing
• Exerting control over your own body
• Express things that cannot be put into words
• Distraction from emotional pain
• Regulate strong emotions

Okay, So If Self-Harm Helps, Why Bother Stopping?

The relief that comes from cutting or self-harming is only temporary and creates far more problems than it solves.

Relief from cutting or self-harm is short lived, and is quickly followed by other feelings like shame and guilt. Meanwhile, it keeps you from learning more effective strategies for feeling better.

Keeping the secret of self-harm is difficult and lonely. Maybe you feel ashamed or maybe you just think that no one would understand. But hiding who you are and what you feel is a heavy burden. Ultimately, the secrecy and guilt affects your relationships with friends and family members and how you feel about yourself.

Self-harm may provide a temporary relief from the turbulence inside, but it comes at a steep price. In the long run, self-injury causes more problems than it stops. It makes it almost impossible to learn healthy coping mechanisms.

You can hurt yourself badly, even if you don’t mean to. It’s easy to end up with an infected wound or misjudge the depth of a cut, especially if you’re also using drugs or alcohol.

You’re at risk for bigger problems down the line. If you don’t learn other ways to deal with emotional pain, you increase your risk of major depression, drug and alcohol addiction, and suicide.

Self-harm can become addictive. It may start off as an impulse or something you do to feel more in control, but soon it feels like the cutting or self-harming is controlling you. It often turns into a compulsive behavior that seems impossible to stop.

The bottom line is that cutting and self-harm won’t help you with the issues that made you want to hurt yourself in the first place. No matter how lonely, worthless, or trapped you may be feeling right now, there are many other, more effective ways to overcome the underlying issues that drive your self-harm.

What Self-Injury Is Not:

There exist many myths surrounding self-injury. We’re here to try and dispel some of these commonly held, but wrong, beliefs about self-injury.

• Self-Injury is not suicidal behavior. While people do occasionally die from self-injurious behavior, it is by accident. Generally, those who self-injure are not suicidal.

• Self-Harm is not a cry for attention. While many people – family, friends, even doctors – may believe that self-injury is attention-seeking behavior, those who self-harm generally try to hide what they are doing because they are ashamed.

• People who self-injure are not crazy. Those who self-injure are trying to deal with trauma, not mental illness. These people are simply trying to cope the only way they know how.

What Do I Do If I Am Self-Injuring?

Acknowledge the problem. You are probably hurting on the inside which is why you self-injure.

Talk to someone you trust. It could be anyone. A doctor, a counselor, a friend, a parent. Just confide in them.

Identify your self-injury triggers. If you know what your triggers are, you can learn to avoid or address these triggers.

Recognize that self-injury is an attempt to soothe yourself. Develop better, healthier ways to calm and self-soothe.

Figure out what function self-injury is serving. Replace self-injury by expressing your emotions in healthy ways.

Treatment for Self-Injury:

There is no golden standard of treatment for self-injury; rather, treatment is tailored to the specific reasons behind the self-injury and treating any underlying psychological conditions. Successful treatment for self-injury is possible but may take time and work to learn more appropriate coping mechanisms.

The help and support of a trained professional can help you work to overcome the cutting or self-harming habit, so consider talking to a therapist. A therapist can help you develop new coping techniques and strategies to stop self-harming, while also helping you get to the root of why you hurt yourself.

Remember, self-harm doesn’t occur in a vacuum. It exists in real life. It’s an outward expression of inner pain-pain that often has its roots in early life. There is often a connection between self-harm and childhood trauma. Self-harm may be your way of coping with feelings related to past abuse, flashbacks, negative feelings about your body, or other traumatic memories-even if you’re not consciously aware of the connection.

Treatment options include:

Therapy (also known as “talk therapy”) can help identify and manage underlying issues that trigger self-injury. Therapy can help build skills to tolerate stress, regulate emotions, boost self-image, better relationships, and improve problem solving skills.

• Finding the right therapist may take some time. It’s very important that the therapist you choose has experience treating both trauma and self-injury. But the quality of the relationship with your therapist is equally important. Trust your instincts. Your therapist should be someone who accepts self-harm without condoning it, and who is willing to help you work toward stopping it at your own pace. You should feel at ease, even while talking through your most personal issues.

Medications. While there are no medications that specifically treat self-injury, doctors often prescribe anti-depressants or other medications to treat any underlying mental illnesses. Treatment of those conditions may lessen the desire to self-injure.

Hospitalization. If injury is severe or repeated, an in-patient hospitalization may be necessary to provide a safe environment and intense treatment to get through a crisis.

What Do I Do if a Friend is Self-Injuring?

• Talk to this person privately about your suspicions about their self-injury.
• Be supportive of your friend, and don’t tell them to just “get over it” or that they’re “doing it for attention.” This is a very real and serious problem.
• If you believe that your friend is in danger, or that he or she has a plan for suicide, notify your parents, a teacher, a pastor, or any other trusted adult immediately. This is not your fault, and it is not on your shoulders to fix it.
• If you offer to listen to your friend, be prepared that their feelings might be overwhelming. You may not understand, and you might want to talk them out of it. You might want to make them stop, to threaten to withhold your friendship or caring if they don’t. Please don’t. This will only add to the shame they already feel.
• Respect the fact that a self-injurer can only stop when he or she is ready. Stopping for anyone but themselves will not work.
• Validate their feelings. “I understand how tough of a time this is for you.”
• Do not judge his or her experiences with self-injury or reasons for it.
• Offer specific forms of help, like finding a counselor.
• Make sure that your friend knows that you do not think he or she is a bad person for self-injuring. It is a coping mechanism like any other, and while it’s hard to understand, your friend is doing his or her best to stay alive

Self-Injury Hotlines:

National Suicide Prevention Hotline: 1-800-273-TALK (8255)

National Self-Injury Helpline: 1-800-DONT-CUT (366-8288)

24-hour Crisis Hotline: 1-800-273-TALK

Self-Injury Foundation: 1-800-334-HELP

Additional Resources for Self-Injury:

S.A.F.E. Alternatives: a program that offers resources, referrals for therapists, and tips on how to end self-injury.

Adolescent Self Injury Foundation: an organization that works to raise awareness about adolescent self-injury and provides education, prevention tips, and resources for self-injurious adolescents and their families.

Self-Injury Support: a charity group that provides referrals and support for patients in the UK.

Page last audited 8/2018

Coping With a Suicide

by Band Back Together | Aug 18, 2018

Coping With A Death By Suicide:

The World Health Organization (WHO) estimates that over a million people die at their own hands each year. A suicide is not only a tragic loss of a life, but it leaves the survivors gasping, prostrate with grief and unanswered questions.

Read more about suicide prevention.

Grief is a universal experience all human beings encounter. Though death inevitably touches our lives, research shows that many people grieve in varying and different ways. From the textures of emotions, to length of time in mourning, to even the kinds of rituals and remembrances that help heal the irreplaceable loss. Grieving the death of a loved one is never, ever easy.

Suicide, however, has been described as a death like no other … and it truly is. Death by suicide stuns with soul-crushing surprise, leaving family and friends not only grieving the unexpected death, but confused and lost by this haunting loss.

In addition to the shocking, tragic loss of a suicide, survivors of suicide face many social stigmas. Suicide survivors suffer in many, many ways: someone they loved dearly has died, usually in a shocking unexpected way, the death may be considered a taboo for others. The grief surrounding a suicide is compounded by a society that is unable to fully feel and understand the pain of their grief.

Suicide survivors suffer a unique kind of pain – here are some ways to help a suicide survivor heal from their tragic loss. It is important for relatives, friends and the larger community to support people throughout the grief process.  The following are some suggestions on how to assist survivors directly.

Respect the timing and pacing of an individual’s grief process.  It is a difficult journey.  Encourage them to make choices that are right for them.

Be courageous – approach those that have lost a loved one by suicide. Let them know you heard.  Ask them how they really are.  This is important even if it has been some time since the actual death.

What Makes Suicide Grief So Hard To Handle?

Research has long known that suicide survivors move through very distinctive grief issues. Family and friends are prone to feeling significant bewilderment about the suicide. Why did this happen? How did I not see this coming? Overwhelming guilt about what they should have done more of or less of —become daily, haunting thoughts. Survivors of suicide loss often feel self-blame as if somehow they were responsible for their loved one’s suicide. Many also experience anger and rage against their loved one for abandoning or rejecting them—or disappointment that somehow they were not powerful enough, loved enough or special enough to prevent the suicide.

The grief process is always difficult, but a loss through suicide is like no other, and the grieving can be especially complex and traumatic. People coping with this kind of loss often need more support than others, but may get less. There are various explanations for this. Suicide is a difficult subject to contemplate. Survivors may be reluctant to confide that the death was self-inflicted. And when others know the circumstances of the death, they may feel uncertain about how to offer help. Grief after suicide is different, but there are many resources for survivors, and many ways you can help the bereaved.

The death of a loved one is never easy to experience, whether it comes without warning or after a long struggle with illness. But several circumstances set death by suicide apart and make the process of bereavement more challenging.

A traumatic aftermath. Death by suicide is sudden, sometimes violent, and usually unexpected. Depending on the situation, survivors may need to deal with the police or handle press inquiries. While you are still in shock, you may be asked whether you want to visit the death scene. Sometimes officials will discourage the visit as too upsetting; at other times, you may be told you’ll be grateful that you didn’t leave it to your imagination. “Either may be the right decision for an individual. But it can add to the trauma if people feel that they don’t have a choice,” says Jack Jordan, Ph.D., clinical psychologist and co-author of After Suicide Loss: Coping with Your Grief.

You may have recurring thoughts of the death and its circumstances, replaying the final moments over and over in an effort to understand — or simply because you can’t get the thoughts out of your head. Some suicide survivors develop post-traumatic stress disorder (PTSD), an anxiety disorder that can become chronic if not treated. In PTSD, the trauma is involuntarily re-lived in intrusive images that can create anxiety and a tendency to avoid anything that might trigger the memory.

Stigma, shame, and isolation. Suicide can isolate survivors from their community and even from other family members. There’s still a powerful stigma attached to mental illness (a factor in most suicides), and many religions specifically condemn the act as a sin, so survivors may understandably be reluctant to acknowledge or disclose the circumstances of such a death. Family differences over how to publicly discuss the death can make it difficult even for survivors who want to speak openly to feel comfortable doing so. The decision to keep the suicide a secret from outsiders, children, or selected relatives can lead to isolation, confusion, and shame that may last for years or even generations. In addition, if relatives blame one another — thinking perhaps that particular actions or a failure to act may have contributed to events — that can greatly undermine a family’s ability to provide mutual support.

Mixed emotions. After a homicide, survivors can direct their anger at the perpetrator. In a suicide, the victim is the perpetrator, so there is a bewildering clash of emotions. On one hand, a person who dies by suicide may appear to be a victim of mental illness or intolerable circumstances. On the other hand, the act may seem like an assault on or rejection of those left behind. So the feelings of anger, rejection, and abandonment that occur after many deaths are especially intense and difficult to sort out after a suicide.

Need for reason. “What if” questions may arise after any death. What if we’d gone to a doctor sooner? What if we hadn’t let her drive to the basketball game? After a suicide, these questions may be extreme and self-punishing — unrealistically condemning the survivor for failing to predict the death or to intervene effectively or on time. Experts tell us that in such circumstances, survivors tend to greatly overestimate their own contributing role — and their ability to affect the outcome.

“Suicide can shatter the things you take for granted about yourself, your relationships, and your world,” says Dr. Jordan. Many survivors need to conduct a psychological “autopsy,” finding out as much as they can about the circumstances and factors leading to the suicide, in order to develop a narrative that makes sense to them. While doing this, they can benefit from the help of professionals or friends who are willing to listen — without attempting to supply answers — even if the same questions are asked again and again.

Sometimes a person with a disabling or terminal disease chooses suicide as a way of gaining control or hastening the end. When a suicide can be understood that way, survivors may feel relieved of much of their what-if guilt. “It doesn’t mean someone didn’t love their life,” says Holly Prigerson, Ph.D., associate professor of psychiatry at Harvard Medical School. Adds Dr. Prigerson, “The grieving process may be very different than after other suicides.”

A risk for survivors. People who’ve recently lost someone through suicide are at increased risk for thinking about, planning, or attempting suicide. After any loss of a loved one, it’s not unusual to wish you were dead; that doesn’t mean you’ll act on the wish. But if these feelings persist or grow more intense, confide in someone you trust, and seek help from a mental health professional.

These mistaken assumptions plague survivors of suicide loss for a very long time. Many struggle for years trying to make sense of their loved one’s death—and even longer making peace—if at all—with the unanswerable questions that linger.

Society still attaches a stigma to suicide. And as such, survivors of suicide loss may encounter blame, judgment or social exclusion – while mourners of loved ones who have died from terminal illness, accident, old age or other kinds of deaths usually receive sympathy and compassion. It’s strange how we would never blame a family member for a loved one’s cancer or Alzheimer’s, but society continues to cast a shadow on a loved one’s suicide.

What also makes grieving different is that when we lose a loved one to illness, old age or an accident, we retain happy memories. We can think back on our loved one and replay fond memories, share stories with joyful nostalgia. This is not so for the suicide survivor. They questions the memories, “Where they really good?” “Maybe he wasn’t really happy in this picture?” “Why didn’t I see her emotional pain when we were on vacation?” Sometimes it becomes agonizing to connect to a memory or to share stories from the past—so survivors often divorce themselves from their loved one’s legacy.

Survivors of suicide loss not only experience these aspects of complicated grief, they are also prone to developing symptoms of depression and post-traumatic stress disorder—a direct result from their loved one’s suicide. The unspeakable sadness about the suicide becomes a circle of never ending bewilderment, pain, flashbacks, and a need to numb the anguish.

Suicide Grief in Children and Adolescents

Children and Adolescents

Children grieve in what is called “grief spurts”, they rapidly cycle through their grief and it may be apparent for only minutes at a time. The child may feel for a moment and then quite happy a short time later. They tend to grieve physically with bursts of excess energy.

The child’s response to death is very much age dependent and individualized, previous loss can also play a role in a child’s understanding of what has occurred. Young children (5 and under) are concrete in their thought processes and will not likely understand the permanence of death until they become older.

Children will express their grief through behavior. Some will act out, some will withdraw, some will become anxious in their attachments fearing something else bad might happen. It is normal to see regression in children who are bereaved (i.e. tantrums in children who are well beyond the “terrible twos)

Children and Adolescents Bereaved as a Result of Suicide:

Trying to navigate the path of grief after a death by suicide is tremendously complex to say the least. It is like desperately trying to untangle a knotted ball of string that has woven in upon itself, as soon as one thread is pulled another tightens.

This path can be especially confusing and frightening for children and teens who do not yet have the intellectual ability, the coping skills, life experience to assist them in this process.

One of the most helpful things for a child or teen at this point is the presence of caring and compassionate adults who can listen and support without judgment. Adults who will allow them to grieve in the way that they want to, not how anyone else thinks they should. Teens will tell you there should be  “no shoulds”.

Research suggests that child and adolescent bereavement can be internalized as a traumatic event. A trauma response can be considered an even stronger  possibility if the child witnessed the suicide, found the body and/or was exposed to emergency personnel attending at the scene of the death. Until the death is ruled a suicide the police operate under the assumption that it might have been a homicide. This in and of itself is incredibly frightening for adults so one can easily understand how confusing and scary this might be when viewed through the eyes of a child or teen.

Suicide Grief in Children

One of the most difficult decisions that adults face is what to tell the children about a death that has occurred as a result of suicide. Discussing death with a child can be heart-wrenching in and of itself without the added layer of explaining suicide.

Finding an age appropriate response to the truth of the cause of death is the direction that most experts will advocate: there is no need to go into the details of the death but speaking in broad terms in child friendly language is important. There are two primary reasons why honesty, although difficult, is required.  Children thrive when they are raised in an environment where they can trust the adults they interact with. When children are not told the truth of the nature of the death it can have long lasting impacts. Most children are quite intuitive and will feel the disconnect between what they are told and what is really happening, this can further destabilize them at an already volatile time. If a child is not told of the suicide and finds out later they will “re-grieve”, they will cycle back through their grief experience and relive it all over again as they reshape their view of the deceased and those who did not tell them the truth.

What happens next?

Unfortunately many children who lose a loved one are teased and some seriously bullied. When the death is a result of suicide children too suffer under the stigma of the cause of death. Other parents may create a distance between their own children and the bereaved child. Teachers too, who are so important in a child’s life can have negative reactions’ In this respect the child can be further marginalized and left without community supports at a time when it is most crucial.  It is important to teach the bereaved child how to respond if bullying occurs.

Typically the child will work through their feelings about the death through play and art. It can be useful to provide them with a number of outlets to work through their grief. Children are often very physical in their grief so keeping them active can be beneficial. Many care providers might find this difficult as adults tend to see a decrease in their energy while children become more energetic. In these circumstances it is worth considering having a trusted adult or teen to take the role of “playmate”.

A child may express the desire to die as well. This can be very alarming for many adults. Often what the child means is that they want to see their loved one again, to be reunited but it doesn’t mean that they truly want to die. As mentioned, young children  don’t understand fully the permanence of death. Of course if the child acts in ways that indicate something further than a passing desire to reunite with their loved one, medical intervention should be sought.

The child will come to a period where they will attempt to re-organize their life in response to the family changes, again one might see this primarily in shifts in play. Control issues will often surface in response to their lack of control over the death. It is important to provide the child with as much control over their life as is reasonable for their age.

In our experience, in order to make sense of the death children will try to understand a causal factor. This search often leads them to some distorted thinking about their own role in the suicide. Such thoughts might manifest as: if I had been a “good” boy/girl Mommy would not have died, Daddy died because I didn’t want to go the movie with him etc. Many children, like adults, feel guilt over things they did or didn’t do and what they did or didn’t say.

As the child moves through the developmental levels they will come to understand the death differently and will cycle back and appear to grieve all over as the impact of the  loss hits them at deeper and broader levels.

The impact of bereavement of death due to suicide can hit on a multiplicity of levels. Academics can be affected, behaviours can change, psychosomatic issues can manifest, social engagement can shift. It is important to remember that child development, childhood bereavement and exposure to trauma all  come together in a very complex relationship where each impacts the other.

Suicide Grief in Adolescents

Along with many of the factors listed above, grief for teens has an added complexity as a result of their stage of development. Adolescents want to fit in with their peer group, this is how they further develop their sense of self. Yet, when death directly impacts their life they are instantaneously different than their peers.  When the death is of a peer (classmate or teammate) there is the added component of teens facing their own mortality at a time when, developmentally, they still feel invincible.

The majority of bereaved teens express a sense of isolation and loneliness that seems to be even more pervasive when the death was by suicide. The longer term impact of this experience appears to be a lack of trust of relationship, an overarching sense that they will be abandoned by whomever they connect with. Asteens move through adolescence they may develop grieving patterns similar to adults (i.e decreased energy). Often, teens will keep and wear an article of clothing of the deceased. This can cause adults some concern but it is normal.

Teens appear to be exposed to potentially more triggering environments than children. Films viewed or books read at school, activities in drama class and even the use of the term“suicides” as an exercise in gym class can be very difficult for these teens to deal with. Added to that they can feel even more isolated if they publicly react and more closed off if they say nothing.

Helping teens to find a voice to express their experience can be difficult. For teens especially the ability to be surrounded by others their age who have had a similar tragedy touch their life can be very beneficial to their healing process.

Understanding The Motivations Behind Suicide:

While no single reason can account for each suicidal act, there are common characteristics associated with completed suicides. Perhaps they can help you to understand why someone you love died by suicide.

1) The common purpose of suicide is a solution. Suicide is many things, but it is neither random nor pointless. To those who choose to end their own lives, suicide is an answer to an unsolvable problem or a way out of a horrible dilemma. Suicide is somehow the preferred choice to another set of dreaded circumstances, emotional pain, or disability, which the person fears more than death.

2) The common goal of suicide is to cease consciousness. Those who die by suicide want to end the conscious experience, which, for them, has become an endless stream of distressing, preoccupying thoughts. Suicide offers oblivion.

3) The common stressor in suicide is frustrated psychological needs. People who have high standards and expectations are extra vulnerable to suicide when progress toward goals is suddenly frustrated. People who attribute failure and disappointment to their own shortcomings may come to view themselves as worthless, unlovable, and incompetent. In adults, suicide is often related to work or interpersonal problems. In teenagers, suicide is often precipitated by family turmoil.

4) The common stimulus in suicide is intolerable psychological pain. Excruciating negative emotions (i.e. sadness, shame, guilt, anger, and fear) from any circumstance frequently serve as the foundation for suicide.

5) The common internal attitude in suicide is ambivalence. Most of those who contemplate suicide – including those successful in carrying out their suicidal plans -are ambivalent. They do want to die, yet they also wish they could find another solution to their dilemma.

6) The common emotion in suicide is hopelessness and/or helplessness. A pervasive pessimistic expectation about the future is even more important than other types of negative emotions (anger, depression) in predicting suicide. A suicidal person is convinced that nothing whatsoever can improve the situation; that no one else can help.

7) The common cognitive state in suicide is constriction. Suicidal thoughts and plans are like tunnel vision. The suicidal person is unable or unwilling to engage in any effective problem-solving behaviors and may see everything in all or nothing terms.

8 ) The common interpersonal act in suicide is communication of intent. There’s a harmful myth that those who really want to die by suicide do not talk about it. However, at least 80% of those who do end up killing themselves have spoken to others about their plans or have attempted suicide before.

9) The common action in suicide is escape. Suicide provides a way to escape from intolerable circumstances.

10) The common consistency in suicide is life-long coping patterns. During crisis periods that precipitate suicidal thoughts, people tend to use the response patterns they’ve used all of their life.

How To Cope With A Loved One’s Suicide:

If you are reading this because you are trying to cope with a loved one’s suicide, let me tell you that I am so very sorry for your loss. Here are some tips for learning to survive the suicide of a loved one:

One of the biggest challenges a suicide survivor faces is the struggle to answer, “why?” Here is a guide to understand the most common motivations behind a suicide.

Deal with the facts of the suicide – the “hows” and the “whys” of a suicide can help alleviate any doubts that the death was, indeed, a suicide.

Grief is as unique as the person who experiences it – your grief will be different than anyone else’s.

Don’t compare your grieving process to someone else’s. We all grieve differently.

It’s okay to grieve – grieving the loss of a loved one from suicide means that you loved, you really loved, this person.

It’s also okay to heal. Don’t let your healing process be overshadowed by guilt for “not grieving enough.”

You may experience physical complaints (insomnia, headaches, exhaustion) that are brought about by your emotions. Talk to your general doctor about these symptoms and see what can be alleviated.

Cry if you want to cry. Don’t be afraid to let it out. And if you don’t or can’t cry? That’s okay too. Everyone grieves differently.

You will struggle with the “why” of a suicide until you’ve gotten your answer, an answer that makes sense to you, or no longer need to know why.

You might feel crazy as you run the gamut of feelings – anger, guilt, confusion, forgetfulness, those are all very common reactions. You’re not going nuts – you’re grieving a very difficult loss.

It’s okay to feel overwhelmed by your feelings.

Find at least one person who gives you the permission to grieve and lean on them.

Remember that you can postpone grief, but you can’t outrun it. If you’re living with unresolved grief, it becomes harder and harder to cope with other every day stresses. Let your grief out. Although it may be tempting, don’t throw yourself into work or other projects as a means to avoid your grief. You must deal with your grief.

Now is the time to let others know that you need help. Chances are, many people are simply unsure of how to help you. Tell them what you need, even if it’s someone to make a run to the store for you or throw in a load of laundry.

Don’t be too proud to ask for help.

Don’t withdraw from the world. Keep in touch with other people – friends, family, spiritual leaders. Use them for support, comfort, and healing.

Surround yourself with people who will listen when you need to talk and those who simply offer a shoulder if you’d rather be silent.

Prepare yourself for anniversary reactions – holidays, birthdays, anniversaries and other significant dates will be very painful reminders for you and can amplify your sense of loss.

On those special days, don’t force yourself to do or be anything. Allow yourself to do whatever it is you feel like doing – if that’s dumping an old family tradition because it’s too painful? So be it.

There will be setbacks – some days, months, and years will be better and worse than others. That’s okay. Grief and grieving doesn’t follow a straight line.

Find a support group in the area for suicide survivors. There can be a lot of strength in knowing that others have experienced a suicide as well. In a support group for suicide survivors, you can share your story, learn other coping techniques, and lean on one another for support.

Commemorate your loved one in a tangible way. Plant a tree. Dedicate a bench. Plant a garden. Create a scrapbook of memories. Put together a shadow box for the wall. These are things that can help you to feel connected to your loved one.

Write it out. Take some time to write a post for The Band about the suicide.

Keep a private journal and make writing in it a priority. Writing is one of the most effective forms of therapy.

Don’t abuse alcohol or prescription drugs as a means to cope. In the end, it will only hurt you.

Don’t concentrate all your energy on comforting others reeling from the suicide – it may be your way of avoiding the grief.

Be prepared for others to say cruel and thoughtless things to you about the suicide – they may be lashing out in grief.

It may feel like it, but not everyone is blaming you for the suicide.

The old way of thinking was that suicide should be hushed up, never discussed; but it’s come to light that this is a bad way to handle a suicide. Talk about the suicide. Talk about your feelings.

Guilt. It sucks. Talk about your feelings of guilt with someone you love and trust.

The suicide is not your fault. You will probably feel that you could’ve done something more to prevent it, but that’s not the case. You cannot assume responsibility for the actions of another. PERIOD.

Forgive yourself – the suicide is not your fault. You couldn’t prevent it.

Try setting up a picture of your lost loved one and talk to it. It may help to articulate all of the things you’d wished you could say to the person.

Depression is very common in suicide survivors. If you find it to be prolonged or particularly hard to deal with, seek professional help. Learn more about depression here.

Know when you can no longer manage on your own – and seek professional help. Trained grief experts are available to help you learn to cope with the grief.

Let the anger out. There’s lots of anger surrounding a suicide and it has to go somewhere. Chop wood. Scream. Hit a punching bag. Punch a pillow.

Take your grief one day, one second, one moment at a time.

You didn’t have a choice or any control over the suicide, but you DO have the choice to live through the aftermath. Choose to live.

How To Help A Suicide Survivor Heal:

When a loved one loses someone from suicide, you want so badly to help, but it’s so hard to know what to do. Here are some tips for helping to comfort a suicide survivor.

Make a special effort to go to the funeral home. The shock, denial, and shame are overwhelming for the suicide survivors. They need all the support they can get.

Suicide survivors may be a bit more paranoid due to the guilt associated with a suicide. The guilt is only increased by noting that certain people did not attend the funeral of their loved one. If you cannot attend the funeral, make an effort to send flowers, a note, a text, an email, ANYTHING, to let them know you’re thinking of them.

You may not know what to say to a suicide survivor at the funeral – simply treat the death as you would any other death, “I’m so very sorry for your loss.”

Don’t be afraid to cry openly if you were close to the person who died. Often, your tears will help the suicide survivors see that they are not alone in their grief.

The grief following a suicide is extremely complex. Survivors of suicide don’t simply “get over” their loss. Instead, they can hope to reconcile themselves to face the reality.

Don’t be surprised or alarmed by the range and intensity of their feelings – grief can sneak up on a suicide survivor and overwhelm them with their intense feelings when least expected.

Survivors of suicide may struggle with extreme explosive emotions – guilt, shame, and fear – much more so than any other type of death.

Be patient with and understanding of the feelings of your loved one as he or she grieves the suicide.

Helping a suicide survivor means that you must break down the silence surrounding the death – it begins with being an active listener.

Being physically present and willing to listen without judgment is critical for your friend. Being able and willing to listen is the best way to allow your loved one to just talk.

The feelings and thoughts a suicide survivor may feel can be very scary and hard to acknowledge. Worry less about what you say and concentrate on the words your loved one shares.

Often, suicide survivors want to share the same story again and again. Listen attentively each time. This repetition is part of the suicide survivor’s healing process.

Remember: you don’t have to have the answer to help your loved one.

Allow suicide survivors to talk, but don’t push them.

Survivors of suicide need help to come to an understanding of the reason their loved one suicided – this is extremely important for those who survive a suicide.

Give your loved one permission to express his or her feelings about the suicide without fearing criticism.

Tears are a natural and appropriate reaction to the pain associated with a suicide – don’t be afraid of the tears.

Remember that not everyone who grieves will cry – everyone expresses their feelings differently.

Grief is not restricted to a certain time-table.

Respect the need for a suicide survivor and their family to grieve. The grief of family members of someone who has suicided may be kept a secret. If the suicide cannot be openly discussed, the grief may go unhealed.

You may be the only one willing to listen and talk to the suicide survivors – you are more important than you know.

Know that the grief of a suicide is unique and that no two people will react the same way.

Anniversaries and holidays may be especially hard for a suicide survivor – these dates emphasize the absence of someone who is no longer alive.

Pain is a part of the normal grieving process – you cannot (and shouldn’t try) to take it away from a suicide survivor.

Use the name of the person who has died when talking to suicide survivors – using his or her name can be comforting and reminds the grieving survivors that you haven’t forgotten this important person.

Support groups for survivors of suicide can be one of the best ways for suicide survivors to heal. In a support group, suicide survivors can connect with others who have experienced the same type of loss and share their stories. You can help by locating a support group for suicide survivors for your loved one.

Let your loved one teach you about their feelings of faith and spirituality. They may believe that those who die by suicide are doomed to hell. Rather than contradict them, just listen and learn, non-judgmentally.

Survivors of suicide struggle to know why their loved one suicided – if they ask you, “why?” simply say, “I don’t know – maybe I’ll never know.”

Be aware that the guilt for a suicide survivor is often so painful that it’s sometimes easier to deny that it happened – be patient and understanding of this. Denial can give the suicide survivor a breather before the reality sinks back in.

Suicide survivors have the right to be extra sensitive – often others will deliberately avoid the survivor, pretend not to know the person, or ignore any type of contact made. This compounds the guilt the suicide survivor already feels.

People will often make cruel, vicious remarks to a suicide survivor – this hurts the survivor intensely. Don’t repeat the remarks and do what you can to go to the source to let them know that their words hurt the suicide survivor.

How Not To Help A Suicide Survivor:

Cliches and other trite comments are often more wounding than saying nothing at all. Cliches often diminish the loss by giving simple solutions to very hard realities. Avoid them.

“You’re holding up so well.”

“Time heals all wounds.”

“You’ll get over it in time.”

“Think of what you have to be thankful for.”

“You have to be strong for your children (or others).”

“Well, he (or she) was crazy.”

“I know just how you feel.”

“Snap out of it.”

“Stop wallowing.”

Avoid passing judgment or providing simple reasons for the suicide.

Don’t allude to the mental state of the person who suicided – you don’t know if this person was “crazy” or “mentally ill,” and it further complicates the feeling of the suicide survivor.

The grief of a suicide survivor is unique – don’t criticize what you think of as “inappropriate” behavior.

Learn more about grief and grieving here.

Don’t try to comfort the suicide survivor by saying, “it was a terrible accident.” The suicide survivor must deal with the fact that their loss was due to a suicide.

Don’t compare your grief about other deaths to your loved one – the grief of a suicide is very different than most other types of deaths.

Don’t tell stories to suicide survivors about your friend or someone else you know who tried to commit suicide, which means you totally understand how they feel. Whomever you knew who attempted suicide lived, theirs did not.

Don’t go over the signs of suicide with a suicide survivor, as the suicide has already taken place. Saying things like, “there must have been some signs of depression,” only compounds the suicide survivor’s guilt.

Page last audited 10/2018

Suicide Prevention Resources

by Band Back Together | Aug 18, 2018

If you are feeling desperate, alone or helpless, or know someone who is
call 1-800-273-TALK (8255)
to talk to a counselor at the National Suicide Prevention Lifeline.

What Is Suicide?

Suicide is one of the top 10 causes of death in the United States, accounting for around 40,000 deaths per year and an estimated 1 million deaths worldwide. It leaves behind more unanswered questions than any other cause of death. Friends and family members are left in a wake of uncertainty, most never knowing what events led to their loved one’s death.

Suicide is the act of purposely ending one’s own life. How societies view suicide varies widely according to culture and religion. For example, many Western cultures, as well as mainstream Judaism, Islam, and Christianity tend to view killing oneself as quite negative. One myth about suicide that may be the result of this view is considering suicide (suicidal ideation) to always be the result of a mental illness. Some societies also treat a suicide attempt as if it were a crime. However, suicides are sometimes seen as understandable or even honorable in certain circumstances, as in protest to persecution (for example, a hunger strike), as part of battle or resistance (for example, suicide pilots of World War II, suicide bombers), or as a way of preserving the honor of a dishonored person (for example, killing oneself to preserve the honor or safety of family members).

More than 800,000 people worldwide committed suicide in 2012, with many more suicide attempts annually. That translates into someone dying by suicide every 40 seconds somewhere in the world. More than 39,000 people reportedly kill themselves each year in the United States, making it the 10th leading cause of death.

The true number of suicides is likely higher because some deaths that were thought to be an accident, like a single-car accident, overdose, or shooting, are not recognized as being a suicide.

The higher frequency of completed suicides in males versus females is consistent across the life span, but the ratio of men to women who complete suicide decreases from 3:1 in wealthier countries to closer to 1.5:1 in less wealthy countries. In the United States, boys 10-14 years of age commit suicide twice as often as their female peers. Teenage boys 15-19 years of age complete suicide five times as often as girls their age, and men 20-24 years of age commit suicide 10 times as often as women their age.

Gay, lesbian, transgender, and other sexual minority youth are more at risk for thinking about and attempting suicide than heterosexual teens.

There are trends regarding the means of committing suicide as well. For example, the frequency of hanging, carbon monoxide poisoning, or other forms of self-suffocation increased from 1992 to 2006, while committing suicide by a gun has decreased during that period of time and has remained unchanged from 2012-2013.

Suicide is the second leading cause of death for people 15-29 years of age. Teen suicide statistics for youths 15-19 years of age indicate that from 1950-1990, the frequency of suicides increased by 300% and from 1990-2003, that rate decreased by 35%. However, from 1999 through 2006, the rate of suicide increased by about 1% per year and by about 2% per year from 2006 through 2014, both in the 10-24 years and the 25-64 years old age groups.

While the rate of murder-suicide remains low, the devastation it creates makes it a concerning public-health issue.

The rates of suicide can vary with the time of year, as wells as with the time of day. For example, the number of suicides by train tends to peak soon after sunset and about 10 hours earlier each day. Although professionals like police officers and dentists are thought to be more vulnerable to suicide than others, important flaws have been found in the research upon which those claims are based.

As opposed to suicidal behavior, self-mutilation is defined as deliberately hurting oneself without meaning to cause one’s own death. Examples of self-mutilating behaviors include cutting any part of the body, usually of the wrists. Self-tattooing is also considered self-mutilation. Other self-injurious behaviors include self-burning, head banging, pinching, and scratching.

Physician-assisted suicide is defined as ending the life of a person who is terminally ill in a way that is either painless or minimally painful for the purpose of ending suffering of the individual. It is also called euthanasia and mercy killing. In 1997, the United States Supreme Court ruled against endorsing physician-assisted suicide as a constitutional right but allowed for individual states to enact laws that permit it to be done. As of 2016, California, Oregon, Washington, and Vermont were the only states with laws in effect that authorized physician-assisted suicide, but a number of other states are in the process of considering it. Physician-assisted suicide seems to be less offensive to people compared to assisted suicide that is done by a non-physician, although the acceptability of both means to end life tends to increase as people age and with the severity of medical illness and the number of times the person who desires their own death repeatedly asks for such assistance.

Ethnically, the highest suicide rates in the United States occur in non-Hispanic whites and in Native Americans. The lowest rates are in non-Hispanic blacks, Asians, Pacific Islanders, and Hispanics. Former Eastern Bloc countries currently have the highest suicide rates worldwide, while South America has the lowest. Geographical patterns of suicides are such that individuals who live in a rural area versus urban area and the western United States versus the eastern United States are at higher risk for killing themselves. The majority of suicide completions take place during the spring.

In most countries, women continue to attempt suicide more often, but men tend to complete suicide more often. Although the frequency of suicides for young adults has been increasing in recent years, elderly Caucasian males continue to have the highest rate of suicide completion. Other risk factors for taking one’s life include poor access to mental-health care, single marital status, unemployment, low income, mental illness, a history of being physically or sexually abused, a personal history of suicidal thoughts, threats or behaviors, or a family history of attempting suicide. A lack of access to mental-health care has also been identified as increasing the likelihood of suicide. The means of attempting suicide can have particular risk factors as well. For example, individuals who attempt suicide by jumping from a height like a bridge may be more likely to be single, unemployed, and psychotic, while those who use firearms may more often have a history of legal issues, alcoholism, and certain personality disorders.

Data regarding mental illnesses as risk factors indicate that depression, manic depression, schizophrenia, substance abuse, eating disorders, and severe anxiety increase the probability of suicide attempts and completions. Nine out of 10 people who commit suicide have a diagnosable mental-health problem and up to three out of four individuals who take their own life had a physical illness when they committed suicide. Behaviors that tend to be linked with suicide attempts and completions include impulsivity, violence against others, and self-mutilation, like slitting one’s wrists or other body parts, or burning oneself.

Over 90% of those who die by suicide have a mental illness at the time of their death – the most common mental illness that leads to suicide is untreated major depression. Other mental illnesses that may lead to suicide include bipolar disorder and schizophrenia.

It’s very rare for someone to die by suicide due to a single cause. Usually, there are several reasons that someone chooses to die by suicide.

Risk factors for adults who commit murder-suicide include male gender, older caregiver, access to firearms, separation or divorce, depression, and drug abuse or addiction.

In children and adolescents, bullying and being bullied seem to be associated with an increased risk of suicidal behaviors. Specifically regarding male teens who ultimately commit murder-suicide by school shootings, being bullied may play a significant role in putting them at risk for this outcome. Another risk factor that renders children and teens more at risk for suicide compared to adults is having someone they know commit suicide, which is called contagion or cluster formation.

Generally, the absence of mental illness and substance abuse, as well as the presence of a strong social support system, decrease the likelihood that a person will kill him- or herself. Having children who are younger than 18 years of age also tends to be a protective factor against mothers committing suicide.

What Are Some Common Motivations For Suicide?

Left in the wake of a suicide, many suicide survivors try to understand why a loved one chose to end his or her life. Here are some of the common reasons for a suicide:

Suicide is a solution. Suicide is many things, but it is neither random nor pointless. To those who choose to end their lives, suicide is seen as an answer to an unsolvable problem or a way out of a horrible dilemma. Suicide is (somehow) the preferred choice to another set of dreaded circumstances, emotional pain, or disability, which the person fears more than death.

Suicide is a way to cease consciousness. Those who die by suicide want to end their conscious experience, which, for them, has become an endless stream of distressing, preoccupying thoughts. Suicide offers total oblivion.

Suicide stemming from frustrated psychological needs. People who have high standards and expectations are extra vulnerable to suicide when progress toward goals is suddenly frustrated. People who attribute failure and disappointment to their own shortcomings may view themselves as worthless, unlovable, and incompetent. In adults, suicide is often related to work or interpersonal problems. In teenagers, suicide is often precipitated by family turmoil.

Suicide may be a way to end intolerable psychological pain. Excruciating negative emotions (i.e. sadness, shame, guilt, anger, and fear) from any circumstance frequently serve as the foundation for suicide.

Suicide stems from ambivalence. Most of those who contemplate suicide – including those successful in carrying out their suicidal plans -are ambivalent. They do want to die, yet they also wish they could find another solution to their dilemma.

Suicide may be a response to hopelessness and/or helplessness. A pessimistic expectation about the future is even more important than other types of negative emotions (anger, depression) in predicting suicide. A suicidal person is convinced that nothing whatsoever can improve the situation; that no one else can help.

Suicide as a plan. Suicidal thoughts and plans are like tunnel vision. The suicidal person is unable or unwilling to engage in any effective problem-solving behaviors and may see everything in all or nothing terms.

Someone who dies by suicide has often spoken of his or her suicidal ideations. There’s a harmful myth that those who really want to die by suicide do not talk about it. However, at least 80% of those who do end up killing themselves have spoken to others about their plans or have attempted suicide before.

Suicide as an escape. Suicide provides a way to escape from intolerable circumstances.

Those who die by suicide may lack coping skills. During crisis periods that precipitate suicidal thoughts, people tend to use the response patterns they’ve used all of their life.

What Are Some of the Common Warning Signs For Suicide?

Warning signs that a person is imminently planning to kill themselves may include making a will, getting his or her affairs in order, suddenly visiting friends or family members (one last time), buying instruments of suicide like a gun, hose, rope, pills, or other forms of medications, a sudden and significant decline or improvement in mood, or writing a suicide note. Contrary to popular belief, many people who complete suicide do not tell their therapist that they plan to kill themselves in the months before they do so. If they communicate their plan to anyone, it is more likely to be someone with whom they are personally close, like a friend or family member.

While it may seem otherwise, suicide is rarely a spur of the moment idea. The strongest signs that someone is going to commit suicide are verbal, such as, “I cannot go on,” “I can’t do this anymore,” “Nothing matters,” “I’m thinking of ending it all.”

While many people do not exhibit any symptoms of suicide, approximately 75% of those who die by suicide do exhibit warning signs of suicide. Always take any warning signs of suicide very, very seriously.

Here are some warning signs that someone you love may be feeling suicidal:

• Becoming depressed and acting sad most of the time
• Losing interest in activities
• Talking or writing about death or suicide
• Sudden and dramatic change in mood
• Sudden change in personality
• Feeling hopeless/helpless without a reason to live.
• Feeling a strong rage
• Feeling trapped in a situation
• Acting impulsively
• Giving away possessions
• Getting affairs in order
• Writing a will
• Withdrawing from family and friends
• Abusing drugs and/or alcohol
• Looking for ways to kill oneself
• Feeling hopeless
• Change in sleeping and eating habits
• Performing poorly at work or school

People who take their lives tend to suffer from severe anxiety or depression, symptoms of which may include moderate alcohol abuse, insomnia, severe agitation, loss of interest in activities they used to enjoy (anhedonia), hopelessness, and persistent thoughts about the possibility of something bad happening. Since suicidal behaviors are often quite impulsive, removing guns, medications, knives, and other instruments people often use to kill themselves from the immediate environment can allow the individual time to think more clearly and perhaps choose a more rational way of coping with their pain. It can also allow the person’s caregivers or loved ones time to intervene.

Occupations That May Increase The Risk For Suicide:

Researchers reviewed more than 12,000 suicides that occurred in 17 states in 2012 using the CDC’s National Violent Death Reporting System, which provide statistics of violent deaths to help local decision-making, especially suicide prevention efforts. The dat provides a significant snapshot of how suicide rates can differ by occupation. Namely, it’s the first multistate study to look at suicide rates for all of the major occupational groups as defined by the Bureau of Labor Statistics.

Where men are about four times more likely to die from suicide than women, according to the CDC, male-dominated industries also saw higher rates of suicide. But experts note that women, too, are not immune to occupational hazards that can contribute to suicide risk.

Researchers found those who worked in farming, fishing and forestry – which together comprised one occupational group – had the highest rate of suicide: 84.5 suicides per 100,000 people working in these industries. The next highest overall suicide rates were found among individuals working in construction and extraction, at 53.3 per 100,000 people; then installation, maintenance and repair, at 47.9 per 100,000 people.

By comparison, the lowest rate of suicide overall was found among those who worked in the education, training and library occupational group, with 7.5 suicides per 100,000 people. Among women, the highest rates of suicide were found for those who worked in protective service occupations, such as police officers and firefighters: 14.1 suicides per 100,000 women working in these fields.