Suicide Prevention Is Every Social Worker’s Business

Over the past couple of years, the need for psychiatric social work services in the Eastern Cape and specifically Port Elizabeth, has continuously increased.

In her professional capacity offering Psychiatric Social Work Services, Cora Bekker has put together a practice that provides an all-encompassing service to fulfill this need.

One of the areas that she and her team are dedicated to providing support in, is that of suicide.  There is a desperate need for social workers who are trained and educated in this arena, and who can provide much needed support to the patient – helping them to navigate this minefield and achieve a positive outcome.  Here is some food for thought when addressing this alarming issue.

REFERENCE:

Excerpts taken from the article: “Suicide Prevention Is Every Social Worker’s Business” – By Kate Jackson – Social Work Today – Vol. 19 No. 1 P. 10

Reject the Myths

A first step in educating yourself to work with at risk individuals may be to correct inaccurate perceptions. Even social workers, experts say, are vulnerable to myths about suicide. “Perhaps the biggest myth is that asking someone about suicide will cause them to have suicidal thoughts,” Marson (Kesha Marson, MSW, LCSW, an adjunct professor at Augsburg University’s masters of social work program in Minneapolis) says. “That’s absolutely not true, as we know that individuals thinking about suicide were thinking about suicide before the question was even asked,” she says. “The reality is having an open dialogue with clients about suicide opens the door for clients to share their personal thoughts and feelings about whether they’re actively thinking of suicide. This creates a safe, nonjudgmental place for clients to share in the future as well.”

As human beings, Marson says, “we tend to avoid things that make us uncomfortable or are unfamiliar to us, so I think there’s a level of fear when it comes to asking clients about suicide. There can be this feeling of responsibility and helplessness that comes with not being trained in how to work with individuals at risk for suicide. There’s the fear of saying the wrong thing or not knowing what to say or do that may prevent someone from asking about suicide in the first place.”

But it’s imperative for social workers to move out of their comfort zones and ask the hard questions: First, “Have you been thinking about suicide?” And, if the answer is affirmative, “Have you developed a plan for how to end your life?” And finally, “Do you have access to lethal means?”

Equally misguided is the belief that depression is always behind suicide. “Some of the symptoms associated with depression are probably associated with almost all suicides,” Singer (Jonathan Singer, PhD, LCSW, an associate professor of social work at Loyola University Chicago and secretary of the American Association of Suicidology) says. Hopelessness, for example, is a symptom of depression. “But being hopeless doesn’t mean you’re depressed.” He points to a Centers for Disease Control and Prevention (CDC) report that came out in which Anthony Bourdain and Kate Spade took their lives that, he says, noted that “half the people who took their lives did not have a diagnosable mental illness, which is different than the story that’s been told for decades, that 90% have a psychiatric disorder.” Social workers, he adds, may miss opportunities to help if they don’t feel they need to be concerned about patients who are not depressed.

Risk Factors and Warning Signs

At minimum, social workers must be aware of risk factors and recognize warning signs. Risk factors, according to the CDC, include a history of suicide in the family, prior suicide attempts, child maltreatment, mental disorders, alcohol and other substance use disorders, isolation, physical illness, feelings of hopelessness, and access to lethal means. Standard risk factors, Singer says, include being a white male over the age of 55, divorced, and unemployed, and having access to a firearm. “But you can have a 50-year-old white male sitting in his apartment, unemployed, with a gun, and he has no interest in killing himself. Risk factors are useful, but they’re kind of limited in terms of identifying a person who might be in front of you who might be suicidal, so we distinguish warning signs.” As an analogy, he says, “risk factors for heart attacks are high cholesterol and a sedentary lifestyle, but the warning signs are tightness in the chest, pain down the arm. When you see those warning signs, then you know it’s happening.”

Warning signs, unlike risk factors, are individual and signal an immediate risk. The first and most obvious warning sign, Singer says, is when people talk about killing themselves. If individuals say, “‘I don’t feel like this world is for me; I think people would be better off if I weren’t around,’ that’s a statement you should take seriously and follow up on, because it could be a statement that they are actively thinking about killing themselves.” Other signs include expressing a significant change in mood or significantly disrupted sleep. More subtle signs, Singer says, include a change in interests—a shift in what they find pleasurable.

In addition to being alert to risk factors and warning signs, it’s also necessary to be able to help clients build and expand protective factors such as social connectivity, therapeutic alliances, coping and problem-solving skills, and appropriate clinical care for physical and mental health issues and substance use disorders.

You Already Know More Than You Think

It’s not enough for social workers to be prepared to recognize warning signs and refer clients to others they think can be more helpful because, sometimes they are the resource that receives the referral. And while it’s crucial to become educated, it also may be helpful for those starting on their learning journeys to be reminded that they already have skills that can make a difference.

Social workers are in diverse fields, but at the bottom line we’re dealing with people. The desperation that leads to suicidal feelings is something everyone feels at one point or another, and it’s important to be able to respond effectively rather than feel it’s somebody else’s job if you’re not adequately trained. Get trained so you can at least ask the basic questions, diffuse the intensity, and be able to say to someone genuinely, ‘Let’s see what I can do. I may not be the person that can help you, but we’ll work together to find someone who can.’

Social workers all learn to rely on joining words: together, we, us, let’s. People who are suicidal feel isolated and alone, believing no one wants or understands them, no one wants to talk to them. Using these joining words is one of the simple techniques that begins to alleviate some of the stress. It doesn’t fix the whole thing, but there’s an opening of a door, and if you feel like that’s the best you can do, that’s okay.

What social workers need most is an understanding that suicide is not usually about wanting to die, but it’s rather a solution to a problem they can’t solve in any other way. It’s a crisis, and social workers are trained to work with crises. Caregivers need to be more open to the hints that people are dropping and talk to them about it, ask them to tell you more. And you don’t need advanced clinical skills to do this. You just have to be willing to walk with them, to sit with them in their pain, and help them out of the hard place they’re in.

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