Helpful Hints: Suicidal Behavior
Establishing a relationship with the possible suicide attempter, identification and clarification of this person’s focal problem, evaluation of suicide potential, assessment of the strengths and resources available to the individual, implementation of rescue operations if necessary, and referral to appropriate agencies are the critical aspects of suicide prevention that may occur in this or any other sequence or at the same time. Law enforcement officers who come in contact with a potential suicide attempter should have a basic knowledge of these important aspects of suicide prevention.
When officers come in contact with suicidal ideation, they should be patient, interested, self-assured, optimistic, and knowledgeable. By assuming this attitude and behavior, they communicate to potential suicide attempters that they have done the right thing by letting officers know they are contemplating suicide. Potential attempters should be accepted without challenge or criticism and allowed to tell their story in their own way while officers listen.
If potential attempters make contact through a telephone call, certain clear approaches should be followed. First, the officer answering the call should clearly identify the agency and give his or her name. As soon as it is known that callers are suicidal, the officer should request a name and telephone number. If callers refuse to give a name, the officer should calmly accept this refusal for the moment and proceed with the conversation. However, at some later appropriate time, the names and phone numbers of interested persons, such as family members, physicians, or close friends who might be possible resources, should be obtained. Since the immediate goal is to gather information to be used in evaluating suicide potential, getting into a discussion or argument about whether callers are going to reveal their name will be counterproductive.
Identification and Clarification of the Problem
In conversations with officers, suicide attempters often may display a profound sense of confusion, chaos, and disorganization. Because they are often unclear about their main problems and get lost in details, one of the most important services officers can perform is to help them recognize what their principal problems are and to place them in proper perspective.
For example, a woman called the police department and voiced many complaints, including feelings of worthlessness, despair, and inadequacy. She said that she was not a good mother because she could not manage her housework and that her family would be better off without her. Careful initial listening by the officer, followed by some specific questioning, helped him learn that her main problem was her relationship with her husband. When the officer reflected this back to her with authority, she was able to organize herself better and to address this specific problem more effectively.
Evaluation of Suicide Potential
“Suicide potential” refers to the probability that a person might kill him- or herself in the immediate or relatively near future. As soon as officers begin talking with someone who is contemplating suicide, it is extremely important that they start to evaluate the suicide potential in order to make an accurate assessment of the immediate lethal risk. Officers’ plans of action will depend upon this evaluation.
Statistics indicate that the suicide rate rises with increasing age and that men are more likely to kill themselves than women. Other things being equal, a communication from an older male indicates more danger than one from a young female. However, young people do kill themselves, even though their original aim may have been to manipulate others rather than to die. Therefore, age and sex offer only a general framework for evaluating suicide potential. Each case must be further appraised according to other criteria.
One of them is the suicide plan. Three main elements should be considered in appraising the plan: lethality of the proposed method, availability of the means, and specificity of the plan’s details. Methods involving a gun, jumping, or hanging are more lethal than pills or wrist cutting. Further, if the gun is at hand, the threat must be taken more seriously than when people talk about shooting themselves but do not have a gun. If people describe specific details, indicating that they have spent time making preparations, such as changing a will, writing suicide notes, collecting pills, buying a gun, and setting a time, seriousness increases markedly. In addition, if the plan is bizarre and the details are apparently irrational, it is quite possible that officers are dealing with a psychotic person; this also increases potential lethality.
Information about precipitating stressors also is useful in evaluating potential. Typical precipitating stresses include losses, such as a loved one by death, divorce, or separation; loss of a job, money, prestige, or status; loss of health through sickness, surgery, or an accident; or threat of prosecution for criminal involvement or exposure for some misdeed. Occasionally, increased anxiety and tension may be associated with success, such as a job promotion with increased responsibilities.
Officers must evaluate stress from the callers’ point of view and not from their own or society’s. What officers might consider minimal stress may be felt as especially severe by callers.
The specific clues to suicidal behavior described in the previous section also serve as criteria in evaluating suicide potential. Officers should keep in mind how these symptoms compare to the stress that they have found out about. For example, if the symptoms are severe but the stress precipitating them appears to be minor, then either the story may be incomplete or the individual may be chronically unstable, with a history of prior crises similar to this one.
Stress and symptoms also must be evaluated in relation to the individual’s life-style. For example, officers should evaluate whether the suicidal behavior is acute or chronic. If officers discover that serious attempts have been made in the past, the current situation must be rated as potentially more dangerous. On the other hand, if undergoing severe stress, a person with no prior history of suicide attempts also may be at high risk.
In forming a plan of action, officers should assess the available relationships of potential suicide attempters. If they discover that the suicidal person has severed all communications with others, then potential danger is increased.
Finally, it is also useful for officers to inquire tactfully into the medical status of potential suicide attempters. For example, if the person is suffering from a chronic illness that has changed his or her self-image, suicide potential may be greater.
In summary, no single suicide criterion need be alarming by itself, with the possible exception of the person who has a very lethal and specific plan. Rather, the evaluation of suicide potential should be based on the general pattern that develops after an examination of all the criteria in the context of a specific person. For example, feelings of exhaustion and loss of resources will have different implications in two persons of different ages. A twenty-five-year-old married man stated that he was tired, depressed, and was having vague ideas of committing suicide by driving into a freeway abutment. There was no history of prior suicidal behavior. He reported difficulty in his marriage and talked of separation but was still in contact with his wife and working at his job, which he had had for many years. This case was considered a low suicide risk.
In contrast, at high risk was a sixty-four-year-old man with a history of alcoholism who reported that he had made a serious suicide attempt one year ago and was saved when someone unexpectedly walked in and found him unconscious. He had a history of three failed marriages and many job changes. Further, he said that his physical health had been failing, that he had no family left, and that he was thinking of killing himself with the gun he had in the house.
This article is an excerpt from Psychological Aspects of Police Work: An Officer’s Guide to Street Psychology by former police officer and federal agent, Bruce A. Rodgers, PhD.