Suicide
Suicide is often a taboo subject that is rarely talked about in some cultures. It is important to recognize clients who are at risk of suicide. It is also important for service providers to acknowledge their own discomfort regarding suicide and consider how they might overcome those feelings.
Research shows that immigrants are less likely to take their own life than the Canadian-born population (Malenfant, 2004). In contrast, refugees (and asylum seekers), especially those who are survivors of torture and those who are detained, are at an increased risk of suicidal ideation, suicide attempts, self-harm and suicide as compared to both native-born and immigrant groups (Cohen, 2008; Ferrada-Noli et al., 1998a, 1998b; Hedrick, 2017).
Other stressors also contribute to an increased risk of suicide. The inability to speak an official language may contribute to difficulties finding a job, which could lead to social isolation and a sense of hopelessness. The fact that many refugees experience high levels of stress and loss following resettlement may be one reason that some refugee groups have higher rates of suicide.
Risk and Protective Factors
Factors that increase the risk that a person will attempt suicide include (in no particular order):
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Physical illness
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Exhaustion
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Feelings of hopelessness
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Mental health problems
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Inability to speak an official language
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Lack of social support
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Substance use
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History of depression or current depression
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History of suicide attempts
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Unresolved grief
It is important to keep in mind that there may also be culture-specific warning signs that someone is considering suicide. Building protective factors can help prevent suicide (Refugee Health Technical Assistance Center, 2011).
When assessing risk, protective factors need to be considered as well, including...
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Strong religious beliefs against suicide
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Support network (e.g., family, community, faith)
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Sense of purpose (e.g., children, work, important social activities)
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Absence of a plan for committing suicide
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No previous history of suicide attempts
Discussing suicide
Service providers should approach the issue of suicide with clients in a sensitive manner, starting with more general questions and progressing gently toward more specific ones. Use active listening and validate the client’s feelings, showing empathy and support and avoiding any implication of judgment. Offer hope that alternatives are available, but do not offer glib reassurance.
The service provider’s words and actions can have a significant effect on a person considering self-harm.
Do not do the following:
- Debate the person on whether suicide is morally right or wrong, or whether the person’s feelings are good or bad.
- Lecture the person on the value of life.
- Act shocked (this will put distance between the service provider and the client).
- Dare the person to do it.
- Imply or state that you will keep the person’s actions a secret.
Review questions
True or false?
A person who attempts suicide is only looking for attention
False
While it is true that, for some individuals, suicidal behaviour is an invitation to others to help them live, if help is not available to those individuals, they may feel help will never come. Ignoring suicidal thoughts or actions can be dangerous.
Talking about suicide may give someone the idea to commit it.
False
Talking about suicide does not create or increase the risk that an individual will attempt to kill themselves. The best way to identify an intention of suicide is to ask directly. Open talk and genuine concern is a source of release and one of the key elements in preventing the immediate risk of suicide.
Most people who die by suicide showed warning signs that they were thinking of killing themselves
True
Most people do not want to end their lives. Suicidal thinking or suicide attempts typically occur during a serious episode of mental illness when the person feels helpless, hopeless and in a state of despair. The warning signs that a person is considering suicide include: discussing suicide and what it would be like to have things end; being concerned with providing for children, other family members or pets; giving away possessions; expressing feelings of worthlessness (e.g., “I’m no good to anybody”); feeling hopeless about the future (reflected in comments such as, “What’s the use?”); talking about voices that tell them to do something dangerous.