Suicide and self-harm (attempted suicide) are actions taken to inflict death upon oneself. U.S. governmental findings in 2016 list suicide as the 10th leading cause of death and even higher for specific groups (e.g., the second leading cause of death for those 25–34 years of age). The understanding and prevention of suicide and self-harm, as well as intervention with those who are contemplating, actively threatening, or attempting suicide are of special concern to law enforcement, correctional personnel, mental health professionals, and the community at large because of the frequency with which these professionals must address this growing societal problem. It is important for those who intervene in these situations to understand common reasons for suicide, the characteristics of those who kill themselves, suicide assessment, skills for suicide intervention, therapeutic interventions for the prevention of future suicide attempts, and suicide by cop. A case example is provided to illustrate some of the interventions.
Common Reasons for Suicide
Common reasons for suicide are situational stressors (e.g., loss of a job, financial problems), relational motivations (e.g., ending of a relationship), existential or spiritual motivations (e.g., life having no meaning; going to be with God/a better place), somatic motivations (e.g., poor health, being in physical pain), and psychological motivations (e.g., inability to cope, feeling like a failure). A common cognitive factor for many who commit suicide is the inability to see another solution or perspective.
Assessment
The most important factor in predicting suicide is previous suicide attempts. Other factors that help assess the likelihood of suicide are (a) a detailed and imminent suicide plan (e.g., I will lay down in my bathtub and use the gun I just bought), (b) lack of resources (e.g., social support or finances), (c) being a veteran, (d) life stressors (e.g., death of a spouse, sexual assault, someone the individual knows committed suicide, impending court appearance, recent discharge from a psychiatric facility), (e) psychiatric conditions (e.g., mood disorder, bipolar disorder, substance/alcohol abuse), and (f) being symptomatic (e.g., crying, angry, abnormally withdrawn, sullen).
Assessment should be conducted relative to a person’s baseline (e.g., how is the person on a good day as compared with today?). Assessment questions consider the information outlined herein and may also include questions such as What are your thoughts about hurting yourself? What is something that could happen that would push you to hurt yourself or keep you from hurting yourself? Are you on any medications and have you been taking them as prescribed? Have you written a note or given things away? How will hurting yourself affect others? What are your religious beliefs about suicide? Is there anything else you can tell me about your thoughts about hurting yourself?
Interventions
Generally speaking, the first step in intervening with someone who is contemplating or threatening suicide is a calm (speak low and slow), trustworthy, and empathetic presence. Empathy denotes viewing a situation, cognitively and emotionally, from the perspective of another and allowing this perspective to inform one’s interaction with that person. Empathy also denotes a caring demeanor that seeks the welfare of another person. The goal is to understand what the other person is going through and allow that person to vent their thoughts and emotions. A common mistake made by those who intervene in these situations is to move to problem-solving too quickly. Patience is required to allow another individual to speak about his or her emotions and perspectives until the individual believes he or she has adequately expressed himself or herself.
During this phase, the listener may hear irrational or faulty cognitions (e.g., It is all my fault, I deserve to die). To paraphrase these cognitions, and the emotions that go with them, is an effective intervention skill. To dispute these irrational cognitions, especially early on in the intervention, is another common mistake. Once the foundation of empathy, understanding, patience, and reaching the point where the other individual feels heard and validated is reached, then the person listening may offer alternative cognitions, beliefs, and perspectives. If the individual in crisis begins to adopt alternative cognitions, beliefs, and perspectives about himself or herself and his or her circumstance, the likelihood of future suicide attempts can be reduced. Long-term care of these individuals is often focused on this cognitive behavioral therapeutic approach to assisting those who have contemplated or attempted suicide. Other therapeutic interventions that can reduce future suicide attempts include brief solution-focused therapy, mindfulness training, and for suicide ideation due to traumatic experiences, eye movement desensitization and reprocessing.
Some individuals who are actively threatening suicide may not be in touch with reality (psychosis) due to a psychiatric condition such as schizophrenia or due to being under the influence of a substance. In these cases, short and concise sentences and paraphrases can be very effective. Because of the psychosis and the individual’s inability to focus attention, it may be necessary to repeat what has been said. Asking the individual to focus on the person intervening as well as his or her voice can also help the individual focus on reality instead of hallucinations. Disputing delusions (false beliefs, such as, I am the devil) is rarely effective, but placating or agreeing with said delusions is not effective either. Rather, attention is focused on reality and the situation at hand. Suggesting to the individual that he or she does not have to listen to the voices may be helpful. Even though psychotic, the individual may still be able to discern whether he or she is being lied to, bluffed, or patronized. A standard rule in these situations is to talk with someone as if you will see him or her in the same situation again in the future. Stalling for time, not backing the individual into a corner, a low tactical presence, nonthreatening body language, and even allowing the individual to ingest nicotine may all be helpful in resolving the situation peacefully. Emergency detentions (whereby a police officer commits a person to an inpatient facility) and referral to a mental health professional are common practices. Although not supported by research, no-harm contracts also remain common practice.
Progress is indicated by a shift in violent statements, disclosure of personal information, moving from the emotional to the cognitive, speaking for longer periods of time, willingness to discuss topics unrelated to the crisis at hand, lower and slower speech, and developing trust and rapport with the person intervening.
A last resort, as in the case of someone who obviously is about to kill himself or herself, is the technique “clap to stop the countdown.” In this instance, the person intervening claps loudly, abruptly yells, “Hey!” or shouts the individual’s name in an effort to shock the individual back into coherence and away from their immediate plan.
Case Example: Suicide by Cop
Suicide by cop, or victim-precipitated suicide, is an instance in which an individual provokes, through intentional action, a law enforcement response that causes his or her death. Following is part of a transcript from a real negotiation in which M represents a man with knives (Mike), O stands for any officer talking, H stands for Sgt. Hester (a crisis negotiator), and A represents Andy (a mental health professional and crisis negotiator). As documented by Young in 2016, the transcript begins with three officers, weapons drawn, trying to talk Mike out of rushing at them with a knife from a closet.
O1—Mike, put the knife down and let’s talk about this. Come on, do the right thing, Mike. Put it down.
M—Is she here?
O1—No, she’s not here. They’re not going to let your mom in here because you’re too agitated.
M—I’m agitated because she f—ing ain’t here.
O1—You’re not going to get to talk to her until you put the knife down and come on out.
M—Why are you watching from the back?
SWAT’s already here. I’m outta here, man.
O2—We’ve got negotiators here.
M—Okay, well, tell them to get out of here, man. They’re f—ing . . . They’re drilling through the f—ing walls. (hallucinating)
O1—They’re not drilling through the walls.
M—And, there’s f—ing wires along . . . You . . . go ahead and shoot me, man . . . Hello? Hello?!
O2—I don’t want to have to hurt you. Don’t come out of the closet any further, man. You got that knife. You’re dangerous. Okay?
M—Aw, man. They’re right behind that thing, man.
O2—There’s two other guys over here, okay. There’s two other guys over here.
M—(incomprehensible arguing) . . . trying to get me . . . No wires, man! What the f— is that? You’re trying to trick me, man!
O3—There’s a negotiator standing right here.
M—No f . . . ! I know, they’re probably trying to trick me to get me to . . . no b—s—, tell him to come out.
O3—Alright. This is Andy Young. He’s a negotiator with the SWAT team. Okay?
(Andy steps out so Mike can see him).
M—Why are they . . . ?
A—I’m sorry? (low, slow, calm tone)
M—Why are they trying to get me right here with these f—ing things right here, man?
A—No, there’s nothing there that’s going to get you. . . . . He’s with me. We’re both doing the same thing for you.
M—It ain’t a good day.
A—No, it’s not. Can you tell me about it?
M—Nah. I want to die.
A—Well, we don’t want that. Okay? If you want to talk to your mom, all you got to do is put the knife down.
M—Get in those handcuffs, man, and then I’ll talk to her from jail.
A—You want to talk to her later?
M—You’re lying, man.
A—You’re worried I’m lying to you?
M—I’m going to give up the knife, and I’m going to jail. No talking.
A—No talking to who?
M—To anyone. Right?
A—That’s up to you.
M—No, I’m saying that’s what’s going to happen.
A—Well, you can talk to your mom before you leave this house.
M—You’re lying.
A—I’ve got no reason to lie to you.
M—You want to see a murder?
A—Not today. But . . . I’ve seen plenty. . . . . Nobody wants to. Okay?
M—I do.
A—Why is that? Everything’s going to look different tomorrow.
M—Why’s the black one trying to get right there, man?
A—He’s with me.
O—This is Sergeant Hester. He’s a SWAT negotiator.
(Ross, then Andy takes their helmet off in an attempt to calm Mike.)
M—Gotta be the other . . . man. . . . I ain’t going to prison.
A—We’re standing here because nobody wants you to get hurt.
M—That’s it, man. I ain’t going back to no prison.
H—Why would you go to prison?
M—Why wouldn’t I not? . . . . Whacha tryin’ to do? Tase me with that f . . . ing thing?
H—No, sir.
A—What do you see?
M—Something? He keeps looking down.
A—Alright, tell me what you see. What do you see?
M—Well, I’m probably going to die. I’m probably going to die.
A—You know, nobody wants that, right? Nobody wants to hurt you.
M—It’s over. It’s gonna happen.
A—Don’t let it happen. Don’t let it happen.
M—(Pained groan) Look . . . it hurt like a m— er f—er.
A—What hurt?
M—I don’t give a f— about it hurting. I’ll be in pain for the rest of my life. Jesus, forgive me . . .
A—Are you in pain right now?
M—(Praying) Forgive me for everything . . .
A—Mike, are you hurting?
M—(Mumbles and prays.)
A—Do you have children to take care of?
M—(Mumbles and prays.)
A—Do you have children to take care of?
M—You’re trying to get me to talk. It’s over. (Pained groans.)
A—Are you hurting?
M—It’s gonna happen. It’s gonna happen.
A—Can you look at me?
M—I gotta build myself up, man. It’s gonna happen.
A—Well, we don’t want it to happen. Why do you want it to happen?
M—I don’t want to sit in no f—ing holding cell today, man.
A—You don’t want to be in a holding cell? What do you want?
M—What I want, y’all can’t give, man. I can’t go back. You can’t just let me free . . .
A—Well, we want you to go to the hospital.
M—You’re going to take me to jail, man.
A—No, we want you to go to the hospital.
M—You just tried to give him the signal to shoot me with that thing, man.
A—Nobody wants to shoot you. We got an ambulance outside; we want to take you to the hospital.
M—I’m not getting shot by no f—ing taser, man.
A—That’s fine. You’ve just got to put down the knife. We want to take you to an ambulance.
M—I’m going out in an ambulance? (sarcastic)
A—Yeah, we want to take you to an ambulance, but we don’t want you hurt.
M—I’ll be dead, I won’t be hurt. . . . Something’s going on man. There’s too much air coming in that wasn’t coming in before, man.
A—You feel air?
M—Yeah.
A—Where do you feel air coming from? This way?
M—Behind you, man.
A—From behind me?
M—You’re trying to play with my f—ing head, man.
A—Sir, I just want you to come out without the knife. (pp. 162–170)
This case study illustrates many of the intervention skills outlined and underscores the seriousness of suicide intervention. Proper care, patience, understanding, training, and intervention skills can certainly reduce the likelihood of the completion of suicide.
References:
- James, R., & Gilliland, B. (2013). Crisis intervention strategies. Belmont, CA: Brooks.
- McMains, M., & Mullins, W. (2014). Crisis negotiations: Managing critical incidents and hostage situations in law enforcement and corrections. Waltham, MA: Anderson.
- Persons, J., Davidson, J., & Tompkins, M. (2007). Essential components of cognitive-behavior therapy for depression. Washington, DC: American Psychological Association.
- Pinizzotto, A., Davis, E., & Miller, C. (2005). Suicide by cop: Defining a devastating dilemma. FBI Law Enforcement Bulletin, 74, 8–20.
- Rogers, J., Bromley, J., McNally, C., & Lester, D. (2007). Content analysis of suicide notes as a test of the motivational component of the Existential-Constructivist model of suicide. Journal of Counseling and Development, 85, 182–188. Retrieved from https://doi.org/10.1002/j.1556-6678.2007.tb00461.x
- Young, A. T. (2016). Fight or flight: Negotiating crisis on the front line. Chambersburg, PA: eGen.