Suicidality

The Suicidality Scale

People often get scared the first time they experience suicidal thoughts. It can be particularly stressful too for your loved ones and those around. Unfortunately it is all too common an experience for those patients I see. 

A concept I have used in practice is the suicidality scale. The first thing to remember is that any of these experiences or thoughts are a cause for concern and should prompt a visit to your treating professionals or GP for further evaluation and/or treatment. 

The scale is as follows in order of increasing severity and seriousness.  

This step involves wishes that one's death would occur, but without thoughts to actively make it occur. For example one might think "I wish I just wouldn't wake up tomorrow" or "I wish I could be hit by a car". 

This step involves thoughts of or picturing killing oneself or ending your own life. These thoughts can be outside of one's control and inconsistent with your values or beliefs. They can be fleeting or last longer. 

As they get worse the duration and intensity can increase, as well as the effort it takes to resist the thoughts. 

Suicidal ideation may range from a brief thought when seeing a knife that one should stab themselves to more prolonged contemplation about how to end one's life. 

This step may include researching methods to end one's life, developing a plan of what you will do to commit suicide or preparing for suicide. This is really the beginning of the very serious and dangerous zone. It is of utmost importance to seek assistance at this stage (please do, see tips and tricks section). If it's urgent please seek urgent assistance by presenting to your local emergency department. 

Examples of this stage might include researching how to end one's life, preparing a will or suicide note and/or making plans for when and where one will commit suicide. 

Seek help immediately by presenting to your local emergency department. At this stage one has decided and has intent to commit suicide. The most important step here is to seek urgent help. 

There is much that can be done to help with suicidality, but the first step is seeking help. From there depending on the assessment treatment can be instituted that should improve the level of suicidality. 

It is important to recognise that some people live with a constant level of suicidality. For these patient's I would recommend seeking assistance from their treating team should the suicidal ideation worsen compared to their baseline level of suicidality. I would still recommend seeking assistance if they develop a suicidal plan and urgent assistance if they develop suicidal intention. 

Suicide Helplines

Consider contacting the following suicide helplines for assistance particularly if it's after hours, could benefit from having someone to talk to or would like advice. 

See Contact Numbers for a list of contact numbers that may be useful. 

For Carers

For carers suicidality can be a very unknown and therefore scary concept. They may feel out of their depth and like they do not know what to do. I think the above information can be useful to carers. Additionally see the bottom of the page for a website explaining how carers can help when someone is suicidal. You may also want to speak to someone over the phone by calling the number below. 

Sane Support Line- 1800 187 263

https://www.sane.org/counselling-support 

My Experience

From my perspective, I lived with a mild level of suicidal ideation for many years in my teen years. I honestly didn't recognise that there was anything wrong with this and never told anyone. This improved on moving out of my family home. Since then I have had periods of suicidal ideation when acutely depressed or in crisis. I have never acted on these thoughts. I have sought help from my treating professionals and the suicidal ideation has consistently improved over time.