The Truth About Suicidal Thoughts – Part 2

Suicidal thoughts are a complex and stigmatized topic, often left undiscussed due to the fear and misunderstandings surrounding it. For Suicide Prevention Month, it’s essential to break down these barriers and address why so many people hesitate to talk about their suicidal thoughts.

In part one, I recounted my personal journey with suicidal thoughts starting at age 13, leading to a near-fatal suicide attempt. The post explored how suicidal thoughts often stem from a desire to escape overwhelming emotional pain rather than a true wish to die. It highlighted how Dialectical Behavior Therapy (DBT) can help address suicidal ideation by targeting the triggers behind these thoughts and teaching coping skills like distress tolerance and mindfulness. I discussed DBT’s goal of building a “life worth living,” a concept rooted in finding meaning and purpose amidst pain. The post also provides statistics on suicide, coping strategies, and the importance of seeking support and recognizing reasons for living.

The Stigma of Suicidal Thoughts

Many people struggle with suicidal thoughts but remain silent. Society often views these thoughts as shameful, making it difficult to reach out for help. Suicidal ideation isn’t a personal failing, but stigma can make those experiencing it feel isolated. This fear can prevent them from seeking the support they need.

Why Suicidal Thoughts Aren’t Talked About

People fear being labeled or judged when they admit to having suicidal thoughts. Many avoid telling friends, family, or professionals because they don’t want to be treated differently. They fear hospitalization or being seen as a danger to others. Sadly, these fears can worsen the isolation and intensify their distress.

Fear of Hospitalization

The fear of hospitalization is one of the main reasons people are reluctant to talk to therapists about suicidal thoughts. Many believe that once they mention these thoughts, they will be immediately admitted to a psychiatric hospital, which can feel like losing control of their lives. However, mandated reporting laws require that someone be considered an imminent danger to themselves or others before hospitalization becomes necessary. Most therapists will work with clients to develop a safety plan long before this step. Hospitalization is a last resort, as the risk for suicide actually increases upon discharge.

Therapist’s Fear of Suicidal Clients

On the other side, some therapists also fear working with suicidal clients. They may feel anxious about the responsibility and risk involved, worried they won’t be able to provide adequate support or that a client may act on their ideation. This fear can affect the quality of therapy and prevent the therapist from engaging in open, honest conversations with the client. A colleague once described the expectation of working with mental health disorders and hoping no one dies by suicide as akin to being an oncologist and expecting no one to die from cancer. It’s a sobering reminder of the realities of this field.

My Experience with Suicidal Clients

Throughout my career, I’ve worked with many individuals experiencing suicidal ideation. One of the most impactful aspects of this work is helping clients find reasons to live, even in the darkest moments. Together, we create safety plans, develop coping skills, and work through their pain to build a life they find worth living. The goal is to provide a nonjudgmental space for clients to discuss their thoughts and learn to manage them, while also recognizing that suicidal thoughts can be a natural response to overwhelming distress. It also involves a lot of psychoeducation about the mental health disorder they experience.

Working with Those Who’ve Lost a Loved One to Suicide

I’ve also worked with those grieving the loss of loved ones to suicide. This is an incredibly painful experience, often filled with guilt, anger, and confusion. For survivors, it’s important to understand that they aren’t responsible for the death. Suicide is a complex process involving multiple factors. Support, understanding, and space to grieve are vital for those coping with such a loss.

Components of Suicidal Ideation and Suicide: The CAMS Approach

The CAMS (Collaborative Assessment and Management of Suicidality) Suicide Status Form (SSF) highlights essential components of suicidal ideation, including:

– Psychological Pain: Emotional suffering or deep sadness.
– Stress: Overwhelming pressure or life stressors.
– Agitation: Heightened distress or restlessness, and a desire to take action.
– Self-Hate:Internalized feelings of worthlessness.
– Hopelessness: A sense that things will never improve.

These components are critical to understanding the severity of suicidal ideation. As part of the CAMS approach, I work with clients to explore these areas and address them systematically, offering skills to manage distress and build a sense of hope.

Risk Factors for Suicide

The CAMS framework identifies key risk factors that contribute to suicidal thoughts, including:

– History of Suicide Attempts: Prior attempts significantly increase the risk of future attempts, as does suicidal preparation behaviors and rehearsal. This may include gathering pills or means to commit suicide. Rehearsal often involves practicing the steps of suicide completion.
– Impulsivity: Impulsive individuals may act on suicidal thoughts without considering the consequences.
– Substance Use: Alcohol or drug use can exacerbate mental health symptoms and lower inhibitions, increasing the likelihood of making an impulsive decision
– Significant Loss: Losing a loved one, job, or relationship can trigger intense feelings of grief and despair.
– Relationship Problems: Conflict or loneliness can worsen feelings of worthlessness and isolation. This can be especially true in those with Borderline Personality Disorder. 
– Burden to Others: Many individuals feel like they are a burden, believing their loved ones would be better off without them.
– Health/Pain Problems: Chronic pain or illness can make life feel unbearable and endless.
– Poor Sleep: Insomnia or disrupted sleep worsens mental health and can lead to feelings of hopelessness and poor judgment or impulsivity.
– Legal/Financial Issues: These can add significant stress, pushing individuals to consider suicide as a way out.
– Shame: Shame about one’s situation, actions, or identity can erode self-worth and fuel suicidal thoughts.

Suicide Prevention Efforts

Preventing suicide involves more than just crisis intervention. It requires addressing the root causes of distress, providing long-term mental health care, and fostering environments where people feel safe discussing their struggles.

Public awareness campaigns, suicide prevention hotlines, and widespread education on mental health can all play a role in reducing stigma and offering support.

My Work in Suicide Prevention

In my practice, I emphasize creating a safe space for clients to discuss their thoughts and feelings without fear of judgment or hospitalization. We work together to develop coping strategies, explore the reasons behind their ideation, and identify protective factors. A safety plan is an essential tool in this process. It outlines steps the client can take when they’re feeling overwhelmed, including who to reach out to for support.

For those at higher risk, like those with a history of attempts or impulsive tendencies, I take extra care to assess risk factors regularly. We also work on building resilience and finding meaning, even in the face of immense pain. This process typically involves the CAMS Suicide Status Form.

Reducing the Fear of Talking About Suicidal Thoughts

One of the most effective ways to reduce suicide rates is to make it easier for people to talk about suicidal thoughts. We need to create environments where these thoughts are understood and addressed without fear. Educating the public about the realities of mandated reporting can also help. Therapists aren’t required to hospitalize everyone who has suicidal thoughts. Rather, the focus is on building a plan for safety.

Conclusion

Suicidal ideation remains a taboo subject, but it’s one that needs to be discussed openly and with care. Whether you’re someone experiencing these thoughts or someone supporting a loved one, there are steps you can take toward healing. By addressing the psychological, emotional, and situational factors behind suicidal ideation, we can work toward reducing the stigma and offering life-saving support.

 

If you struggle with suicidal thoughts and need support, schedule a free 15 minute consultation to see how I can help.