Suicide is often a taboo and avoided subject, even in the mental health field. A lot of counselors are uncomfortable with talking about and assessing for suicide. There can be multiple reasons that lead to counselors feeling uncomfortable discussing suicide or working with clients who have suicidal ideation. Some reasons can be fear of liability, anxiety around the topic of suicide, or lack of training on suicide. Even in counseling programs, conversation and education around suicide are often limited. My main education on suicide came from on-the-job experience as a crisis counselor. I was fortunate enough to have very knowledgeable supervisors who had a lot of crisis experience and were able to provide me with training. Suicide became something I talked about everyday with clients. I would see clients for crisis calls in person and over the phone and was constantly assessing for suicidality. After assessing for suicidality, we would work on creating safety plans or figuring out the next level of care.
I would have to talk about suicide with people of all ages. I would have to assess children as young as 6 years old for suicidality. There is even stigma around whether or not children can have true suicidal ideation. In my experience, children of all ages would have suicidal ideation. It is important to take all reports of suicidality seriously and not minimize suicidal thoughts because of age. In my opinion, the more comfortable we are talking about suicidality the higher chance we have of helping somebody who suffers from suicidality.
Because suicidality is a taboo subject, people can have a lot of shame around the topic. If counselors feel more confident and educated on the topic of suicidality, it can help lessen the shame or fear around the topic. If people feel more comfortable talking to mental health providers about their suicidality interventions like safety plans can be done to provide support and lessen the chance of a suicide attempt. According to the CDC, over 49,000 people died by suicide in 2023. Per the CDC, that means there was 1 death every 11 minutes. Thinking about suicide is also very common. Per the CDC, 12.8 million adults seriously thought about suicide, 3.7 million adults made a plan for suicide, and 1.5 million adults attempted suicide. Suicide rates decreased by 5% in 2018-2020, but returned to their peak in 2022. According to the CDC firearms are the most common method for suicide, firearms were used in 55% of suicides in 2023. As the statistics show, suicide is unfortunately common and even thought about frequently.
In my work experience I frequently encounter people who have passive suicidal thoughts. Passive suicidality is when somebody has thoughts of suicide or dying, but does not have any plan or intention. Passive suicidality is something that can occur in both adults and children. When talking about suicidality and assessing for it, safety planning is also very important. Safety planning is a skill that is often not talked about in depth. Safety planning involves creating a plan for the person in case suicidality worsens or to help prevent any suicide attempts. There are many safety planning templates available to counselors, and most involve using social supports, providing crisis lines, and identifying coping skills. Some involve how to make the environment safer, and limit access to lethal means. Limiting access to lethal means does not always just involve restricting access to firearms. This can involve restricting access to medications, sharp objects, and other weapons. An important part of safety planning that is also left out is seeing if somebody can stay with a person who is part of the support system. This would normally be an identified social support, who would stay with this person for the next day or two and keep an eye on them or provide supervision. How in-depth a safety plan is can also depend on the severity of suicidality and whether there is plan or intention. ROIs (Realeases of Information) can also be an option for safety planning. An ROI can be done for someone who is a social support or lives with this person. The counselor can then collaborate with that person to ensure there is a good safety plan in place. Informing people of resources like crisis lines can be a valuable aspect of safety planning. There are often local crisis lines that people can access and national crisis lines like 988. People can call these crisis lines when suicidal ideation arises. These lines can provide emotional support, and call for a wellness check if there is a safety concern. If suicidality and safety planning are talked about more, counselors, families, and friends can provide more support to individuals suffering from suicidality. If a loved one is reporting suicidality, crisis lines like 988 are available to provide support. If a loved one is reporting suicidality but does not need higher levels of care, encourage them to see a counselor whom they would feel comfortable discussing the topic with.