Suicide intervention

Suicide intervention or suicide crisis intervention is direct effort to stop or prevent persons attempting or contemplating suicide from killing themselves. Current medical advice concerning people who are attempting or seriously considering suicide is that they should immediately go or be taken to the nearest emergency room, or emergency services should be called immediately by them or anyone aware of the problem. Modern medicine treats suicide as a mental health issue. According to medical practice, severe suicidal ideation, that is, serious contemplation or planning of suicide, is a medical emergency and that the condition requires immediate emergency medical treatment.

In the United States, individuals who express the intent to harm themselves are automatically determined to lack the present mental capacity to refuse treatment, and can be transported to an emergency department against their will. An emergency physician there will determine whether or not inpatient care at a mental health care facility is warranted. This is sometimes referred to as being "committed." If the doctor determines involuntary commitment is needed, the patient is hospitalized and kept under observation until a court hearing is held to determine the patient's competence.

Individuals suffering from depression are considered a high-risk group for suicidal behavior. When depression is a major factor, successful treatment of the depression usually leads to the disappearance of suicidal thoughts. However, medical treatment of depression is not always successful, and lifelong depression can contribute to recurring suicide attempts.

Medical personnel frequently receive special training to look for suicidal signs in patients. Suicide hotlines are widely available for people seeking help. However, the negative and often too clinical reception that many suicidal people receive after relating their feelings to health professionals (e.g. threats of institutionalization, increased dosages of medication, the social stigma) may cause patients to remain more guarded about their mental health history or suicidal urges and ideation.

First aid for suicide ideation
Medical professionals advise that people who have expressed plans to kill themselves be encouraged to seek medical attention immediately. This is especially relevant if the means (weapons, drugs, or other methods) are available, or if the patient has crafted a detailed plan for executing the suicide. Mental health practitioners (MHPs) suggest that people who know a person whom they suspect to be suicidal can assist him or her by asking directly if the person has contemplated committing suicide and made specific arrangements, has set a date, etc. Posing such a question does not render a previously non-suicidal person suicidal. According to this advice, the person questioning should seek to be understanding and sympathetic above all else since a suicidal person will often already feel ashamed or guilty about contemplating suicide so care should be taken not to exacerbate that guilt.

MHPs suggest that an affirmative response to these questions should motivate the immediate seeking of medical attention, either from that person's doctor, or, if unavailable, the emergency room of the nearest hospital.

If the prior interventions fail, MHPs suggest involving law enforcement officers. While the police do not always have the authority to stop the suicide attempt itself, in some countries including some jurisdictions in the US, killing oneself is illegal.

In most cases law enforcement does have the authority to have people involuntarily committed to mental health wards. Usually a court order is required, but if an officer feels the person is in immediate danger she can order an involuntary commitment without waiting for a court order. Such commitments are for a limited period, such as 72 hours – which is intended to be enough time for a doctor to see the person and make an evaluation. After this initial period, a hearing is held in which a judge can decide to order the person released or can extend the treatment time. Afterwards, the court is kept informed of the person's condition and can release the person when they feel the time is right to do so. Legal punishment for suicide attempts is extremely rare.

Mental health treatment
Treatment, often including medication and psychtherapy, is directed at the underlying causes of suicidal thinking. Clinical depression is the most common treatable cause, with alcohol or drug abuse being the next major categories.

Other psychiatric disorders associated with suicidal thinking include bipolar disorder, schizophrenia, Borderline personality disorder, Gender identity disorder and eating disorders. Suicidal thoughts provoked by crises will generally settle with time and counseling. Severe depression can continue throughout life even with treatment and repetitive suicide attempts or suicidal ideation can be the result.

Methods for disrupting suicidal thinking include having family members or friends tell the person contemplating suicide about who else would be hurt by the loss, citing valuable and productive aspects of the patient's life, and provoking simple curiosity about the victim's own future.

During the acute phase, the safety of the person is one of the prime factors considered by doctors, and this can lead to admission to a psychiatric ward or even involuntary commitment.

According to a 2005 randomized controlled trial by Gregory Brown, Aaron Beck and others, cognitive therapy can reduce repeat suicide attempts by 50%.

Suicide prevention
Various suicide prevention strategies are suggested by Mental Health professionals:
 * Promoting mental resilience through optimism and connectedness.
 * Education about suicide, including risk factors, warning signs, and the availability of help.
 * Increasing the proficiency of health and welfare services in responding to people in need. This includes better training for health professionals and employing crisis counseling organizations.
 * Reducing domestic violence and substance abuse are long-term strategies to reduce many mental health problems.
 * Reducing access to convenient means of suicide (e.g., toxic substances, handguns).
 * Reducing the quantity of dosages supplied in packages of non-prescription medicines e.g., aspirin.
 * Interventions targeted at high-risk groups.

Research on suicide prevention
Research into suicide is published across a wide spectrum of journals dedicated to the biological, economic, psychological, medical and social sciences. In addition to those, a few journals are exclusively devoted to the study of suicide (suicidology), most notably, Crisis, Suicide and Life Threatening Behavior, and the Archives of Suicide Research.

The American Foundation for Suicide Prevention is dedicated to funding research on suicide and its prevention.