Medical views of suicide

Modern medical views on suicide consider suicide to be a mental health issue.

Psychiatric emergency
Modern medicine considers severe suicidal thoughts to be a medical emergency. Mental health practitioners consistently advise suicidal people to seek help. This is especially true if the means (weapons, drugs, or other methods) are available, or if a detailed plan is in place.

Current medical advice is that people who are seriously considering suicide should go to the nearest emergency room, or call the emergency services. Severe suicidal ideation, according to this advice, is a condition that requires immediate emergency medical treatment. If depression is a major factor, then treatment usually leads to the disappearance of suicidal thoughts.

Critics of mainstream views about mental health and some advocates of the right to die argue that, far from being a sign of poor mental health, considering or intending to commit suicide can be rational, and that it is the right of the individual person to decide for themselves whether to continue living.

First aid
Anyone who knows a person whom they suspect to be suicidal can assist them by taking them aside and asking them directly if they have contemplated committing suicide. Posing such a question does not render a previously non-suicidal person suicidal. Follow-up questions can include if the person has made specific arrangements, has set a date, etc. The person questioning should seek to be understanding and sympathetic above all else. A suicidal person will often already feel ashamed or guilty about contemplating suicide so care should be taken not to exacerbate that guilt.

An affirmative response to these questions should motivate the immediate seeking of medical attention. If the doctor who normally treats the person is unavailable, contacting the emergency room at the nearest hospital is recommended.

If possible a suicidal person should go to an emergency room and ask to be admitted to the mental health ward on a voluntary basis. The advantage of voluntarily seeking treatment rather than being involuntarily committed is that involuntary commitment would require intervention by the legal system. In addition, in most jurisdictions the same process followed to be committed must be followed to be released.

Law enforcement can be involved if the person seems determined to make a suicide attempt. 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, and a disruptance of public order, which could justify their intervention. 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 he can order an involuntary commitment without waiting for a court order. Such commitments are for a certain amount of time, such as 72 hours – which is long enough 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 further. 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.

Treatment
Treatment is directed at the underlying causes of suicidal thinking. Clinical depression is the major 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 anorexia nervosa. Suicidal thoughts provoked by crises will generally settle with time and counseling. For a person with strong or at least definitive family or community ties, urgently providing information about who else would be hurt and the loss that they would feel can sometimes be effective. For a person suffering poor self-esteem, citing valuable and productive aspects of their life can be helpful. Sometimes provoking simple curiosity about the victim's own future can be helpful.

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 have been used:
 * Promoting mental resilience through optimism and connectedness. This can be through various means.
 * Education about suicide, including risk factors, warning signs and the availability of help.
 * Increasing the proficiency of health and welfare services at responding to people in need. This includes better training for health professionals and employing crisis counselling 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 into suicide is published across a wide spectrum of journals dedicated to the biological, economic, medical and social sciences. Research papers, overview articles, and other material on the incidence, prevention and treatment of suicide are regularly carried by general medical, psychiatric, and clinical and medical psychology journals. In addition to those, a few journals are exclusively devoted to the study of suicide (suicidology).