Most frequent mistakes made when approaching a person in suicidal crisis

  • Jul 26, 2021
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Most frequent mistakes made when approaching a person in suicidal crisis

The author exposes the errors that frequently occur when dealing with people in situations of suicidal crisis. Suicide, as a cause of death, has some peculiarities that are not observed in other causes of death, since neither natural deaths, nor those caused by Accidents, nor homicides, are the reason for the interpretations, speculations and even professional interference that are observed in deaths due to suicide

In this PsychologyOnline article, we will expose the Most frequent mistakes made when approaching a person in a suicidal crisis.

You may also like: Managing the Suicidal Crisis in Adolescents

Index

  1. Discussion
  2. Mistake No. 1
  3. Mistake No. 2
  4. Errors 3, 4 and 5
  5. Errors 6, 7 and 8
  6. Error 9, 10, 11, 12
  7. Errors 13, 14, 15, 16
  8. Errors 17 to 25
  9. Errors 26 to 35
  10. Errors 36 to 45
  11. Errors 46 to 55
  12. Other errors
  13. Other errors II

Discussion.

And it is that the subject of suicide is similar to football and politics: Everyone considers themselves entitled to an opinion and everyone considers themselves experts on the subject. But

good intentions are not enough for a good performance, so it is not uncommon that when a suicidal crisis is approached by a person who does not have the required skills Don't even have the experience in handling this particular type of crisis. Various strategic mistakes can be made, such as the ones mentioned below. Not all the slips that can be committed are included, but some of the most frequent that are can observe when approaching a subject in suicidal crisis without having professional competence to it.

Mistake No. 1.

Confusing a crisis with a suicidal crisis it is a frequent mistake.

According to the sociologist W. L. Thomas in 1909 defined a crisis as a threat, a challenge, a wake-up call, a demand for new behaviors. Although it does not always have to be acute or extreme, in personal and social development the crisis is a cataclysm, it disturbs old habits, evokes new responses, and becomes the greatest generator of innovations. In other words, these are new situations that cannot be solved with old solutions, which includes the positive aspect of them. There are different types of crisis those that, although they cause varying degrees of emotional distress in the subject, cannot be considered as a suicidal crisis. A person may have a schizophrenic outbreak and be having multiple, unsystematized delusions about damage, prejudice, referral and persecution which indicates serious mental disturbance, and not having suicidal risk any.

An individual may be drunk, wandering the streets aimlessly, ragged, dirty, smelly, hungry, and never commit suicide despite being immersed in a permanent critical situation, but not in a suicidal crisis, which, as we have already mentioned, is that crisis in which once the mechanisms are exhausted adaptive, creative or compensatory of the subject, suicidal intentions emerge, existing the possibility that the subject solves the problematic situation through intentional self-harm, this type of crisis requiring proper time management, being directive, and trying to keep the person alive as main objective. Its duration is variable, it can last minutes, hours, days, rarely weeks and all available resources must be used to keep individual alive until the crisis stops.

If the individual with schizophrenia cited in the previous example begins to think that he must kill himself in order not to continue supporting the harassment of his persecutors, he is already in a suicidal crisis.

If the subject with alcoholism cited in the previous example, considers that he must commit suicide in order not to continue living in such a deplorable way, the diagnosis of suicidal crisis is imposed.

Mistake No. 2.

Not knowing the common characteristics to any suicidal crisis, regardless of the condition that causes it and among those common characteristics the most relevant are the following:

  • Presence of suicidal ideation with a greater or lesser degree of planning
  • The possibility of the occurrence of an intentional self-harm, regardless of the meanings that said act could have.

Errors 3, 4 and 5.

ERROR # 3

Consider that if there is no desire to die, the suicidal crisis is not dangerous, without taking into account that the meanings of a suicidal act are multiple and many people, mainly adolescents and young people, commit the so-called accidental suicides, because although they did not want to die with the suicide attempt, they used a method of which they did not know its lethality, such as fire, whose prognosis is conditioned by the damaged body surface, following the principle that governs the prognosis of burns: “the greater the affected body surface, the greater the chances of To die".

These adolescents did not want to die, but they die for ignoring this principle of burns. Other times the body surface is not very damaged but the burns have affected very dangerous areas such as the genitals, or the abdomen. Finally, in this type of suicide attempt by fire, the subject can become infected by pseudomonas or other microorganisms and This caused his death and the suicidal act could have been carried out to punish the partner, instill fear, manipulate him, etc. and the outcome is death even though he had not made the suicide attempt to die.

ERROR # 4

Do not explore systematically the presence of suicidal ideation in people who come to the clinic in a critical situation, for whatever reason thinking, mistakenly, that they do not necessarily have to be thinking about committing suicide. And this the professional can only know if he asks, but many times it is considered, by what the subject in crisis is saying that he should not be thinking about suicide. And you shouldn't make that mistake of thinking through someone else's head. You always explore the presence of suicidal ideation. For this reason, the question is recognized: Are you thinking of committing suicide? as the "Saving Question", since its realization can initiate the prevention of this cause of death and save the subject from being a suicide victim.

ERROR # 5

Not considering the various forms of ideation suicide that can help make a more accurate prognosis. People in a suicidal crisis when asked how they have thought about killing themselves can answer that they do not know how but that they plan to do it.

In that case the subject still has not thought of any method and the possibilities that the therapist has to avoid a suicidal act are wide. But he can answer that he plans to commit suicide, hanging himself, taking pills, throwing himself off the roof of the building, shooting himself, and even if he does not have the means available to carry it out immediately, the therapist has less time to carry out the pertinent actions that can prevent the occurrence of an act suicide, because unlike the previous response, in this one the subject handles various ways of ending his life, although he has not yet decided on any of the they. In this case the danger has increased.

Other times the subject, when asked how he has thought about killing himself, answers that by hanging himself and continuing to explore that suicidal idea he does not know how to say when he will do it, or where he will do it or why it has to do it. In this case, the danger increases because, unlike the previous examples, it no longer handles the using several methods, but have already decided on one of them, but have not planned it yet duly. This suicidal ideation carries a greater risk of death than the previous examples.

Finally, if the subject, when asked how he is going to commit suicide, he answers that by hanging himself that night while the relatives sleep, in his room because he is very in debt and that is his only exit, the suicide danger is imminent and actions to prevent suicide must be energetic, otherwise the subject has a high chance of dying by his own hand.

Most frequent mistakes made when approaching a person in a suicidal crisis - Errors 3, 4 and 5

Errors 6, 7 and 8.

ERROR # 6

Once the suicidal idea is explored and the subject says that if he has thought about suicide, he makes the mistake of continue the interview with an interest in the reason, i.e. asking why is he thinking about suicide without considering other questions, which carried out in a timely manner following the same sequence referred to elsewhere in this book, allows the realization of the diagnosis of the well-planned suicidal idea, typical of suicidal crises that carry serious danger suicide. The sequence that must be observed once the subject manifests his suicidal ideas is the following: how, when, where, why and for what wishes to commit suicide. While more questions answer more serious is the crisis suicidal, the more likely it is to die and the more preventive measures the therapist must take to keep the subject alive until the suicidal crisis ceases.

ERROR # 7

Confusing the various types of suicidal crisis, which we have classified in advance as light, moderate, severe and with imminent suicide danger, with their particularities, who can jugulate them and how to do it. Failure to do the right thing can cost the subject his life.

ERROR # 8

Failure to refer promptly to a subject in a suicidal crisis to a more experienced colleague for not being able to recognize the intensity of suicidal crisis or not wanting to lose a client, can lead to suicide, which is ethically and morally unacceptable.

Error 9, 10, 11, 12.

ERROR # 9

Not knowing how to continue the interview with the suicidal subject and start talking about topics that are not of interest to the person at risk of suicide, which denote anguish or ignorance of the therapist, who may mistakenly consider that the other does not evaluate his interlocutor. This error is derived from the previous one, when when knowing the reasons why the subject has thought to commit suicide, the therapist inexperienced begins to give their views regarding the alleged reason or attempts to perform an intervention for therapeutic purposes to counteract the reason without taking into account that the subject is not yet ready for it due to being immersed in a crisis suicide.

ERROR # 10

When the subject is immersed in a suicidal crisis, the inexperienced therapist can try to start therapy at that critical time, confusing the objectives of coping with other types of crisis, which differ in the approach to a suicidal crisis whose main objective is to keep the individual alive while the suicidal crisis lasts and not other. First thing's first.

ERROR # 11

I have already mentioned in another part of this book that it is a very frequent mistake that therapists try to find the strengths that the individual has immersed in a suicidal crisis to use as factors that can protect you from committing a suicide act. The error consists in that the individual in a suicidal crisis does not perceive, because of his adverse mood, what the therapist is perceiving, since it is like being looking through windows at different landscapes or also showing a blind man what he cannot see, with the advantage for the blind that he can imagine it, which does not happen to the subject in suicidal crisis whose imagination is colored by his adverse mood, and therefore, they would be pessimistic, negative imaginations, depressive.

ERROR # 12

Another common mistake is repeat the attitudes assumed by family members with the subject in a suicidal crisis, such as, for example, thinking that he is a manipulator, that he is a blackmailer, that what he is doing is a theater to demand attention or take sides in favor of relatives and make alliances with them against the subject in crisis suicide. Such attitudes would notably increase the difficulties in the therapeutic relationship with these people because it is not possible to establish it on the basis of feeling manipulated, blackmailed, or cheated.

Errors 13, 14, 15, 16.

ERROR # 13

The fear of dealing with people in suicidal crisis It can be another common error among those who do not have enough experience to deal with subjects in this specific type of crisis and usually magnify the risk, imposing inappropriate treatments, which instead of improving the subject, cause multiple adverse effects that can hinder the development of him in daily activities and that make an inexperienced observer notice that he is under the effects of powerful medications. Another behavior assumed as a result of the therapist's fear is to alarm family members about a possible suicidal act that due to the characteristics of the own suicidal crisis, has no possibility of occurring or referring the subject to be admitted to a hospital without the need for their hospitalization.

ERROR # 14

Another error no less frequent than the preceding one when approaching a subject in a suicidal crisis is assume the opposite behavior of fear, that is, extreme trust, at all costs, without taking into account the semiological characteristics of the suicidal crisis in which the subject is immersed. As part of these errors is not using those resources that can prevent suicide from occurring, such as hospitalization, intensive psychopharmacological treatment, application of electroshock treatment if necessary due to serious suicidal danger accompanied by serious mental disturbance that substantially increases the chances of committing suicide. Remember that electroshock can damage some brain cells, but suicide will damage all of them.

ERROR # 15

Consider the suicidal crisis caused solely and exclusively by psychiatric factors without taking into account other options as they are physical illnesses that carry suicide risk, such as certain brain tumors, pancreatic head carcinoma, etc. treatments with certain drugs such as SSRIs that were demonized as a trigger for episodes suicide in depressed patients without recognizing that they were used precisely for this contingency that can lead to suicide. In other times other antidepressants suffered the same fate. The use of modern technologies for the treatment of certain conditions can lead to the appearance of a suicidal crisis.

ERROR # 16

Failing to address the factor or the major triggers of the suicidal crisis, such as problems related to the ingestion of alcohol or other drugs, the poor tolerance to frustrations, poor impulse control, aggressiveness, depression, harassment or bullying, etc. insisting more on the apparent motive, such as disappointed loves, financial problems, etc. which can usually be common to many people who have not attempted suicide.

Errors 17 to 25.

ERROR # 17

Magnify suicide attemptsio made with the so-called harsh methods (hanging, firing of a firearm, etc.) and minimize or ignore those who have attempted suicide with the so-called gentle methods (ingestion of tablets, inhalation of gas) without taking into account that the lethality of the method is not synonymous with the suicidal intent or the degree of mental disturbance suffered by the subject who has used them to try against The life of her. The important thing to keep in mind is that the subject tries against his life with the method that he has available, since no person can commit suicide with a method that you do not have and in which various factors intervene such as personal and family history, culture, etc. No person can commit suicide with a method that they do not have.

ERROR # 18

Deal with diagnosis and treatment of mental illness that is causing the suicidal crisis conditioning the therapist to pay more attention to the treatment of that condition that can take weeks to achieve the reestablishment of symptoms and not the suicidal attack, which usually lasts for a short time and whose main objective is to keep the subject alive while it lasts this crisis.

ERROR # 19

Derived from the previous error, another very dangerous one is generated, consisting of the inexperienced therapist offering increased interest in symptoms of mental illness that has generated the suicidal crisis and does not question as the main objective of the interview, the evolution of suicidal ideation, if the subject continues to think about kill yourself with the same frequency and intensity as before, if you have begun to think of other formulas to deal with the situation that afflicts you other than self-harm, etc.

ERROR # 20

There are specific errors that depend on other factors unrelated to the suicidal crisis, but if they are committed, they can considerably hinder its management. One of the most frequent incurred by many therapists when dealing with a suicidal crisis of a Teen what comes accompanied by his parents or tutors is don't ask if you want them to stay in the consultation or prefer that they go out while the adolescent entrusts us with her sufferings. Some answer that they do not want their parents or guardians to withdraw, but others prefer it so that they can express their thoughts more freely. In the latter case, it is best to please the adolescent, since it is most likely that she wants to express some conflictive situation that you have not yet made your parents aware of or that you do not want them to know.

ERROR # 21

Another mistake that is frequently made when facing the suicidal crisis of children or adolescents is listen to the parent / guardian's version first instead of the child's or the teenager. Inexperienced therapists can become contaminated with that first information and predispose against the child or adolescent which is extremely dangerous because perhaps the therapist was the last lifeline of the child or adolescent before a psychopathic mother or father who tries assume the role of "good and concerned" against the child or adolescent "unbearable, disobedient, disrespectful, manipulative, and blackmailers; they don't want anyone ”.

ERROR # 22

When a child or adolescent with only one parent don't make the mistake of cread only what the adult says, Well, he may be lying. Listen to both of you and look for signs of child or adolescent abuse, such as the one marked difference between the careless clothing of the child or adolescent or the presence of skin lesions due to hygiene inadequate. This contrasts with the neatness and good dress of the parent. Therefore it is convenient look for another source of information that allows you to form a more accurate judgment, since adults are not more reliable than children or adolescents for the mere fact of being.

ERROR # 23

If a old man in crisis suicidal who is accompanied by several family members interested in saying what happens to the subject, ask if you want them to stay with you while he expresses his worries to us or if he prefers to stay alone to do it. In the case of family members who try to prevent the elderly from expressing themselves freely, the possibility in question abuse is a diagnosis to take into consideration which could be the reason for the current suicidal crisis.

ERROR # 24

Consider that the therapist is obliged to believe what the subject tells him in suicidal crisis or their relatives. The role of a therapist is not to believe, but to diagnose. If he is dedicated solely to believing without processing what he is told, then it will be the individual himself who will make his own diagnosis.

The therapist should listen carefully to what they say, but you must also confront what they tell you with his experience, with their scientific knowledge, and analyze not only what they tell you, but what they mean by what they tell you, and if there is congruence between what the subject thinks, what he says, what he feels and what he does, if there is congruence between verbal and extraverbal language, if when he says that he feels sad, at Asking him what it means to feel sad for him, contributes the symptoms of sadness that as mental health professionals we are familiar.

This positive and differential diagnostic exercise based on the symptom, will allow you to make a more accurate diagnosis of the condition that is causing the suicidal crisis, You will be able to manage it more appropriately, it will prevent you from committing iatrogenesis and you will not make the mistake of making alliances with patients against family members and vice versa.

ERROR # 25

Even if you are an expert in managing people at serious risk of suicide, do not make the gross mistake of do not use available resources that they could achieve what you, despite your vast experience, could not achieve, which is to avoid the suicide of the subject. Do not hesitate to refer him for hospitalization because it is very likely that there will be better conditions to keep him alive than to continue being treated on an outpatient basis.

Most frequent mistakes made when approaching a person in suicidal crisis - Errors 17 to 25

Errors 26 to 35.

ERROR # 26

A common mistake is consider that understanding the subject's speech in suicidal crisis is a tacit acceptance of their behavior and this is not correct. Understanding the speech of the subject in suicidal crisis is the ability that the therapist must have to follow the guiding thread of the speech that the subject makes to know what it is. what has made him reach the point where suicide is the chosen option, which does not mean agreeing with suicide as a resolution mechanism problems. His responsibility is to help the person find their own non-self-destructive mechanisms to face similar or other problems in the future to which they are exposed.

ERROR # 27

One mistake to avoid is make a non-suicidal contract which is a pact that the therapist makes with a subject at risk of suicide. The main objective of this contract is to commit the individual not to harm himself, not to attempt suicide, making him responsible for his own life. The mistake is that the non-suicidal contract is not a guarantee that the subject will not commit suicide, therefore Which should never be used with those individuals who are not in obvious conditions to comply with it.

ERROR # 28

Not making your own diagnosis when caring for a subject in a suicidal crisis referred by another colleague. Taking an uncritical stance before the diagnostic judgment of a colleague can contribute to the repetition of the mistakes made by the person who referred the individual, who will be harmed by said attitude. If there are coincidences between our diagnosis and that made by the professional who has referred the subject in a suicidal crisis, the chances of making an accurate approach are increased. If there are no diagnostic matches, which may occur, approach as deemed appropriate to do so in the face of the diagnosis that you have made and not the one that the subject brought with him when he arrived you.

ERROR # 29

Another of the most frequent errors is consider the subject who has sufficient preparation to face a crisis of this nature for having helped other people in crisis situations. It should not be forgotten that the vocation of service predisposes the subject to help others, but this is not enough to do so. rightly if this aptitude is not accompanied by the knowledge that is required for it and the maintenance of its aptitude for self help

ERROR # 30

Confusing the motives for the suicide attempt with the meanings of the act. Motives answer the question "why?" And inexperienced therapists overestimate their importance, trying to address them with priority, without taking into account that reasons are common in this type of self-destructive act, the most frequent being conflicts with a partner, opposing love, breaking up a relationship, etc.), family (conflictive parental filial relationships, physical, psychological or sexual abuse) and in the case of adolescents, school conflicts are added, mainly the harassment or bullying. The meanings of the suicidal act are multiple and can be discovered by asking the subject who has committed a suicide attempt the question "Why have you tried to commit suicide? ".

If he has thought about it, but hasn't tried his life yet, the question would be "What do you want to try against your life for?"

The answers can be "to punish others", "to show others how big the problems are", "to ask for help", "to get revenge of another ”,“ to sleep ”,“ to blame others or hold them responsible for their own death ”,“ to rest ”,“ to escape from everything ”,“ to To die".

This last meaning is the most dangerous of all. Generally, it is the last of the questions that should be asked to a subject in a situation of suicidal crisis, being preceded, as mentioned elsewhere in this book by the questions: "How?", "When?", "Where?" And by what?".

ERROR # 31

Increase the subject's real risk before family members in a situation of suicidal crisis with the malicious intention of increasing fees, developing a supposed prestige for knowing how to cope "Difficult cases" knowing the characteristics of a crisis with imminent suicide risk knowing that this is not So. The error consists of believe that he is a good professional who deceives himself and causes iatrogenesis with family members to whom he causes unnecessary worry and suffering.

ERROR # 32

Consider the crushed loves or fostering chaotic relationships a suicide motive in adolescence rather than a characteristic of vulnerable adolescents and predisposed to self-harm.

Learning to foster loving relationships is one of the characteristics of this stage of life. A love relationship can become conflictive, with various manifestations of disrespect, but when the Adolescents or adolescent girls have personal protective attributes, because they know how to make a decision weather.

The little tolerance for frustrations it is usually a characteristic of adolescents and adolescent girls with a propensity for catastrophic reactions when things do not go as expected. And not being accepted by "the love of your life" can be the trigger for self-injurious behaviors in predisposed adolescents.

Consider monetary debts as a motive for suicide instead of a personality trait of those who assume them. Not all debts are similar. There are people who temporarily go into debt in essential projects to improve their quality of life knowing that they will be able to pay the money they have asked for. Generally, they request the money from people with whom they have emotional ties, friendships or some kinship and pay off their debt on the agreed date. When this is not possible, they pay the debt in installments until it is concluded.

Others get involved in projects that are not really essential to improve their quality of life, but for futile reasons, such as forming a new social image that does not They have managed to reach up to those moments and for which they must have certain possessions that they do not have, by competing with others who have certain assets that they wish to have. also.

These projects are beyond their real possibilities of achieving them, and to carry them out they ask for money from people who have means to make the loan, but to those who do not have any emotional ties and to whom, in general, you have to pay more than what is he asked them. Other times the request is made to a financial institution that imposes certain interests and terms to pay that debt.

The project usually and for various reasons does not reach the desired end within the agreed period. Then, the lender begins to pressure the subject to receive payment from him, which generates various stressful reactions in the individual, and this puts him at a disadvantage to be able to achieve the objectives that he had set and that were the reason for that petition. The individual continues to use inefficient coping mechanisms that deepen the crisis such as the abuse of alcohol or other drugs, the request for greater amounts of money, etc. The constant pressure of the creditor or creditors prepare the conditions for the subject to then use one of the most inefficient coping mechanisms: self-harm.

ERROR # 34

Not taking the subject seriously who says he wants to kill himself, an attitude based on wrong beliefs in relation to suicide, the so-called myths among which stands out "the one who wants to kill does not say it" or "the one who is going to do it does not say it" and they forget that with respect to suicide "dog that barks Yes bite ”. Of every 10 people who committed suicide, nine clearly expressed their intentions to take their own life verbally and the other implied it with their obvious changes in behavior.

Suicidal threat by not usually taken seriously carries enormous suicidal danger.

ERROR # 35

Denying the possibility of the occurrence of a suicide, considering that due to the characteristics of the subject's family this cannot happen and not taking into account that suicide is a very democratic cause of death that can affect to any individual of any family, has good functioning or is dysfunctional although suicides occur more frequently in those in which other have occurred suicides

Errors 36 to 45.

ERROR # 36

Challenge the subject who has made a suicide attempt by proposing other methods of greater lethality, to see if he dares to use them to kill himself without taking into account that people who are immersed in a suicidal crisis are not challenged, but rather helped and should be protected from their impulses self-destructive. It is not usual to find a person who has effective adaptation mechanisms, to try against his life, so the most It is sensible to think that the one who attempts suicide does not have such mechanisms, because if he had them he would use them and would not self-assaulted.

ERROR # 37

Feeling fear of qualifying yourself as incapable to face this situation and think that the subject will perform the suicidal act despite the help that is offered, without taking into account that for individuals at risk of suicide, accompaniment and giving them the opportunity to freely express their emotions and feelings, can contribute to aborting a crisis suicide. Not all suicidal crises require specialized intervention or medications to jugulate them, but the question is to detect which suicidal crises are those that meet this characteristic. Not being able to differentiate them from those that require specialized intervention and specific medication can cost the subject his life.

ERROR # 38

Not due postpone seeking specialized help for the individual in a suicidal crisis for having other priorities and thinking that the subject can wait, because in such cases it is not taken into account that the suicidal crisis constitutes a psychiatric emergency that requires immediate attention and timely referral of the patient to mental health services, to receive care specialized. Remember that tomorrow may be too late for a potential suicide.

ERROR # 39

Wasting time seeking non-specialized help or ineffective, addressing people, institutions or organizations not competent in the management of a suicidal crisis, without taking into account that a Suicidal crisis is a disorder that usually appears in people who have a diagnosable and treatable mental illness, in more than 90% of the cases. Other studies consider that it can reach 94%. However, these percentages are questioned by various investigations that consider that adverse life events do not have the ability to cause adverse moods such as depression or alcohol and drug abuse, which, for these researchers are not morbid conditions that can lead to suicide, but rather normal people who have chosen suicide as an abnormal way of resolving such conflicts.

ERROR # 40

Failing to warn those families who belong to certain congregations religious Y make the mistake of considering suicidal thoughts as a symptom of devilish possession or satanic, which may delay or prevent the subject from accessing timely mental health services to receive treatment specialized, so it is a responsibility of pastors and priests to increase their own suicidal culture and that of their faithful, so that those who may be at risk of committing suicide receive relevant medical help and opt for the culture of life, not of the death.

ERROR # 41

Consider that when the subject expresses a wish to die, he is in suicide danger. The wish to die is common in people with unpleasant emotions such as depression, boredom, boredom, annoyance, disgust, and the like. It is a passive attitude in which the individual wishes to die for an external cause or many times without even imagining that possible cause. That is why I have considered the wish to die as "the portal" of suicidal behavior and represents the subject's dissatisfaction with his way of living in the present moment ("the here-now"). It is manifested in phrases such as the following: "life is not worth living", "what should be die ”,“ to live in this way it is preferable to disappear from the face of the earth ”and other expressions Similar. It is not the same to have a desire to die than to have a desire to kill yourself, especially when the desire to die is aggravates, it can evolve into an active way of achieving death, which is the desire to commit suicide.

ERROR # 42

Perform similar interventions in individuals who have attempted suicide and those who have attempted suicide. Suicide attempt, also called parasuicide, suicide attempt, attempted self-elimination, or self-harm Intentional, is that act without the result of death in which an individual deliberately hurts himself. The frustrated suicide, on the other hand, is that suicidal act that, if there were no fortuitous, unexpected, accidental situations, would have ended in death. Those who attempt suicide are characterized by belonging to the female sex, being adolescents or young people, attempts to Suicide takes on the meaning of a call for attention, help or help and may have an impulsive component and ambivalent. The following diagnoses predominate: personality disorders, substance dependence, anxiety disorders, and situational disorders.

People who commit a frustrated suicide have some of the following characteristics: male sex, age between 35 to 44 years, resort to deadly methods such as firearms, rushing and hanging, suffering from alcoholism, substance dependence, schizophrenic disorders and mood disorders in the form depressive

ERROR # 43

Assume that when there are several members of the family in the company of the subject in a situation of suicidal crisis, there is no danger to perform an act of suicide. On multiple occasions, various members of the family are at home carrying out dissimilar activities home while the suicide remains alone in one of the rooms executing his own death. Observation and continuous monitoring can avoid a fatal outcome.

ERROR # 44

That therapists have permissive attitudes in relation to suicide Among those that it is most frequently found to consider it as a sample of supreme freedom of the individual who performs it, that each one has the right to die as he considers he should die, or assume an attitude of solidarity by imagining that in a similar circumstance they would also have thought about suicide, which will interfere in the proper approach to this cause of death avoidable. If suicide is a manifestation of supreme freedom, the mentally ill would be among the individuals who enjoy more freedom, due to the high suicide rates in these people compared to the population in general.

ERROR # 45

Consider as true What if the subject in a suicidal crisis has enough reasons to continue living will not commit suicide. Do not leave what depends on you to others. If he has reasons to continue living, it only means that he has reasons to continue living but does not rule out that despite having them he wishes to commit suicide. It is then necessary to define in the subject the degree of planning of the suicidal idea, his state of mental disturbance, his family history of suicidal behavior and the personal history of previous suicide attempts, with emphasis on discovering, in the case of repeaters, whether the lethality of the method used in the different attempts.

Errors 46 to 55.

ERROR # 46

What do not recognize each other nor are they taken into account barriers that could hinder proper communication of the therapist with the subject in suicidal crisis among which are the following: that the therapist is in a hurry fulfill other work obligations, that is exhausted after a long working day or that feels emotionally compromised by real personal problems that worry and distract him, obstructing due attention to the subject's speech in suicidal risk.

ERROR # 47

Not being able to discard excess information that masks the essential content that you want to consider, which is frequent in the lengthy and detailed messages of the subjects in suicidal crisis who have obsessive traits or in which hypochondriacal ideas predominate whose physical complaints are exposed with detail before suicidal ideas, which can arise as a result of the interpretations of such annoyances somatic. It can also be observed in people with paranoid delusions who will make an extensive speech with great detail about injustices, persecutions and other issues related to this condition before expressing your thoughts suicidal.

ERROR # 48

That the therapist is not able to interpret the metaphorical language, symbolic or ambiguous used by individuals in suicidal crisis suffering from serious disorders of the course of thought and also in people with a high culture that use proverbs, aphorisms, biblical or literary sentences as forms of masked and indirect verbal communication of their purposes suicidal. Faced with subjects with a personal history of a long history of emotional problems who use medical jargon when making their complaints, the therapist should ask to the individual who clarifies that he wishes to express when he uses these terms, since on many occasions, popular definitions do not coincide with the professionals. If this possibility is not taken into account, the inexperienced therapist may assume that what the individual says is what he is suffering from.

ERROR # 49

Let the therapist collect deficient information on the assumption that it is sufficient to understand what the subject intends to communicate, which is common in laconic, shy individuals with difficulties in expressing their thoughts. It is part of this error when there is a prior therapeutic link between the therapist and the subject in suicidal crisis, which could make him suppose that it is able to understand you just by looking at you instead of conducting an interview following the method usually used to intervene in such situations critics.

ERROR # 50

Talking too much without allowing the subject in suicidal crisis get your message across It is frequent in inexperienced, egocentric and eager to take center stage therapists, who consider that They can help them by exposing their own problems, or by offering premature, personal, and unsolicited advice. They can suffer from mental reading, a very harmful attitude that prevents the therapist from really knowing what the subject is thinking without making sure of the veracity of what is assumed as such without having all the elements of judgment that allow them to have a vision closer to the reality.

ERROR # 51

Not considering people's gender with which the individual with suicidal risk has had major problems in relationships interpersonal and that can be repeated in the therapeutic relationship causing various cognitive, emotional and behavioral discomforts in the subject. These inconveniences can be handled in two ways: refer the individual at risk of suicide to a therapist of a similar gender of those significant figures with whom who maintained better human relationships or talk about this topic, emphasizing that people of similar gender can have behaviors totally different. The therapist must insist that generalization is a good mechanism when used for learning, but very harmful when used for suffering.

ERROR # 52

That the therapist has forgotten the “child”, “adolescent” or “young person” within him, since he would assume the role of "older person", with all the inconveniences that "older people" have to understand children, adolescents and young people and even more when they are in crisis situation suicide. Then you must master the jargon of these ages, musical preferences, fashions and other peculiarities of these stages of life so that they serve the empathic base with them.

ERROR # 53

Not taking into account the methods used by repeaters to determine if suicide risk is increasing or decreasing. If the individual made a first suicide attempt by ingesting a bottle of vitamins, the second by ingesting a bottle of tricyclic antidepressants, and the third by cutting their glasses neck blood vessels, lethality has increased markedly and a fourth suicide attempt should be expected to be with a method whose chance of achieving suicide is very high. elevated. If the subject made his first attempt by cutting the blood vessels in the neck, the second by ingesting a bottle of antidepressants tricyclics and the third suicide attempt by ingesting a bottle of vitamins the risk of dying by suicide is decreasing ostensibly.

ERROR # 54

Disregarding family history of using a specific suicidal method by which the members of that family decide to commit suicide. If the grandfather committed suicide by firearm, two maternal uncles committed suicide by firearm and the subject in a suicidal crisis says that he is going to kill himself “with a bullet in the temple ”, do not doubt the certainty of this information, so you should avoid having access to this method and any other by which you could suicide.

ERROR # 55

Not knowing the cultural aspects of the subject in suicidal crisis, because people commit suicide according to their culture. For this reason, it is recommended that subjects in suicidal crisis be treated by therapists from their own culture or tell with an advisor belonging to that culture that allows the therapist to decode the information provided by the subject in crisis suicide. Maintaining an attitude of lifelong learning in new cultural conditions can mitigate errors in this regard.

Other errors.

ERROR # 56

Not following a method for the interview that includes the following topics to be investigated:

  • personal and family history of psychiatric illness and evolution of these conditions (previous admissions, required treatments);
  • personal and family history of suicidal behavior and methods used,
  • life events that served as the motive for personal suicide attempts and possible meanings for the subject,
  • presence of current suicidal ideation,
  • variant and degree of planning thereof,
  • degree of mental disturbance of the individual

...

These topics are essential to assess the dangerousness of the suicide crisis.

ERROR # 57

Consider that highly mentally disturbed subjects in suicidal crisis are at greater suicide risk than those without disturbancen any mental. While it is true that mentally disturbed individuals with auditory verbal imperative hallucinations to suicide ("kill yourself") are at serious risk, it is also true that By coexisting with other qualitative alterations of the psychic phenomenon, said disturbance becomes much more evident and they facilitate its diagnosis, which facilitates being helped opportunely. However, when the individual in suicidal crisis is not mentally disturbed, the risk increases by their discomfort will be less evident and less likely to be helped than in the subject whose mental disturbance is indisputable.

ERROR # 58

Do not rephrase those questions that have not been explicitly answered and that the therapist can take for granted, as for example, when asked “Have you had bad thoughts?" and the therapist consider that these bad thoughts refer to committing suicide. However, if you rephrase the question as "What are those bad thoughts you are referring to?" you can get the accurate answer as per example: "That they are going to give me bad news", "that nothing is going to turn out well", "that they are going to run me off work" and many others without the desire to kill they.

ERROR # 59

Not knowing the existence of situations that can be interpreted through the prism of the adolescent as harmful, dangerous, conflictive in the extreme, without necessarily agreeing with reality, which means that trivial facts for normal adolescents, can become potentially suicidal in vulnerable adolescents, who perceive them as a direct threat to self-image or dignity and to be dealt with through self-harm intentional.

ERROR # 60

Consider that the method used to commit suicide is related to the wish to die of the subject without taking into account that sometimes the subject dies without having intended to die because of having used a highly fatal and sometimes survives after attempting suicide by a deadly method such as a firearm shot in the head. The lethality of the method is related to the lethality and not to the suicidal intention.

ERROR # 61

To consider the presence of suicidal ideation an unequivocal sign of danger of committing suicide. Practically the majority of human beings have had fleeting suicidal ideas, as a test of their self-preservation instinct. However, when these ideas achieve certain planning or when they are the expression of a underlying mental illness, should be considered seriously because of the possibility that whoever has them I executed them

ERROR # 62

Consider that you have sufficient experience to treat people with which they stay close emotional ties (close relatives, partners, close friends) by not taking into account the "affective scotoma" that will prevent accurate judgment. The most sensible thing is that, once the suicidal potentiality of the loved one has been detected and the essential measures taken to avoid the committing a suicidal act, put yourself in the hands of the chosen therapist, who you trust to take charge of the intervention therapy.

ERROR # 63

Let the inexperienced therapist sit pressed to show her efficiency in treating a subject “Recommended” or “V.I.P” and don't respect the usual method that you have used with other people in a suicidal crisis situation. The non-observance of the regulations leads to errors when trying to make subjects with such characteristics and their relatives feel “well treated ”,“ at ease ”,“ pleased ”, the therapist being more interested in these aspects than in the evaluation of the suicidal danger of the subject. In such cases, the domain of the therapeutic relationship can be lost and it is the family and the individual who determine what to do and what not to do, how and when to do it. Expert therapists discuss such attitudes and the inconveniences that this entails in making decisions for jugular the suicidal crisis and will provide confidence and security so that these characteristics do not interfere with your exercise therapeutic.

ERROR # 64

Not taking into account the particularities of the environment to properly guide the relatives of a subject with imminent suicidal danger since important aspects can be ignored to preserve the life of the subject, mainly related to accessibility to the methods suicide, such as not advising that access to firearms be avoided simply because the therapist does not possess them or because their context is not frequent. utilization. It is best to suggest that you do not have access to any method by which it can get damaged.

ERROR # 65

Do not consider women seriously suicidal in an involutive stage of life who threaten furiously with suicide and present marked self-centeredness, intense anguish and excessive concern for maintain their personal appearance, the latter aspect being the one that can confuse the inexperienced therapist by assuming that these desires to look flawless are synonymous with their desire to live and not a manifestation of the aforementioned egocentricity, for when they find the corpse they will see them beautiful until the final.

ERROR # 66

If the subject in suicidal crisis requires a second evaluation, let this be performed by another therapist who does not know the details of the case. It is considered that the reevaluation should be carried out by the person who originally received the subject in a suicidal crisis and if this cannot be done, it is appropriate that the therapist knowledgeable of the clinical history of the subject in suicidal crisis offers detailed information to the therapist who will supplant him in the evaluation.

ERROR # 67

Do not consider forced hospitalization of the subject in suicidal crisis when all other resources are exhausted. It is convenient to take into consideration that in such cases bad evolution is usual which has to do, both with the forced detention, but with those conditions that entail using this resource and not others.

ERROR # 68

Sometimes to explain the aftermath of attempted suicides (groove mark on the neck due to hanging, facial or cranial deformity resulting from the firing of a gun of fire) the patients wield various arguments that do not correspond to reality, weaving a whole history fictitious about it, an obvious sign of the brain suffering suffered. It is advisable do not attempt to destroy such mechanisms for various reasons, first because they do not depend on the will of the subject but on the underlying brain damage and second because unsuspected, catastrophic affective reactions can be triggered.

ERROR # 69

Do not investigate the critic for what happened in a subject who has made a suicide attempt or an attempted suicide, if he considers that his suicidal act was a successful act or unwise, if the reasons that led you to try against his life were modified or not with self-harm, if he necessarily had to perform the suicidal act, or if on the contrary, he had other alternatives and if he had them because he did not decide on other less destructive.

ERROR # 70

Not knowing that a fixed idea can take the form of presenting a suicidal idea. In such cases the subject suffers from the manifestations of the fixed idea, among those who stand out to recognize it as their own but intrusive, which becomes more persistent in the conscience while the individual makes greater efforts to get rid of it and that generates great anguish for fear of taking it to roads of done. The error that this ignorance entails is handling the suicidal idea as it is done in any suicidal crisis and not as trying to maneuver with the idea fixed suggesting not to try to get rid of it to lessen its persistence, to bring it voluntarily to the thought when you are not thinking of it to reduce their intrusion, not fear the suicidal idea which is what usually occurs, but critically and reasonably analyze suicide as a form of die, achieving with this attitude to carry out the "autopsy" on the suicidal idea, become familiar with its characteristics and thereby neutralize its harmful effect on the subject.

ERROR # 71

In the presence of a subject who has made a recent suicide attempt, and who manifests with discrete drowsiness, conducting the interview in a high tone of voice is a mistake that is frequently committed by those professionals who receive these people in emergencies. This way of interviewing prevents perceiving the preliminary stages of clouding, disorder of consciousness in which the subject is unable to respond to sensory stimuli of intensity half. By speaking in a raised tone, the subject can respond and the novice therapist consider that he is out of line. danger, and that the dose of drugs ingested for suicidal purposes should not have any complication for their life. If you had interviewed him with a tone of voice with an average intensity, he would have detected that the subject was unable to respond, that he could frown. frown as a sign of astonishment or perplexity or would simply present drowsiness during the interview, all signs of incipient alterations of the conscience.

ERROR # 72

It is an error that before a subject who has made a suicide attempt that requires surgical or medical care internal the psychological approach is prioritized, instead of referring the individual to those specialties to be evaluated and avoid physical complications that could endanger her life or make it impossible for her to be in optimal conditions for treatment psychotherapeutic.

ERROR # 73

Special care must be taken with subjects who make a suicide attempt in the course of a alcoholic drunkenness, because sometimes lor expressed by the subject may not coincide with what happened.

A 27-year-old young man who tried to cut his throat because his friends told him that while they were having a drink at the bar, he had put a bottle of beer in it. anus, and as he had no recollection of what happened, he took it for granted, he went to his house and tried to cut his throat, being saved by his own friends who They found. When interviewed, they denied that he had done such a thing and confessed that it was a joke considering that he never remembered what he did after having ingested several glasses of liquor. The more sources of information there are, the more likely they are to get closer to the truth and the less likely they are to deal with content expressed by the subject that is not truthful.

ERROR # 74

If the therapist is an adult psychiatrist and a child or adolescent is referred to you in suicidal crisis should assess current suicidal risk and refer you to the child and adolescent psychiatrist who has greater possibilities of approaching them correctly due to the body of knowledge of this specialty in the management of children and adolescents. In case there are no specialists in Child and Adolescent Psychiatry, the adult psychiatrist must use all her skills to achieve the The main objective of coping with any suicidal crisis, regardless of the age of the person suffering from it: to keep them alive for the duration of the crisis.

Most frequent mistakes made when approaching a person in suicidal crisis - Other mistakes

Other errors II.

ERROR # 75

All people who are at risk of committing suicide they do not have the same medical diagnosis, the same psychiatric disorder, the same mental illness and that makes them different. It also makes them different to come from different family backgrounds, to have unique and unrepeatable personal stories. It is a mistake to work with differences rather than with similarities, since the common thing in all suicidal crises is the possibility that the individual solves or tries to solve the problematic situation through self-harm. If this is not possible, the individual may be in crisis, but not in a suicidal crisis.

ERROR # 76

Failure to seek timely advice from a psychiatrist to specify the diagnosis and impose the psychopharmacological treatment correct since the suicidal crisis can be determined by a specific mental disorder and if this condition is not properly treated, the suicide risk will not decrease and may even increase. A similar evolution will entail the imposition of a correct treatment to an individual who has undergone a misdiagnosis or inadequate treatment for a subject who has been diagnosed accurate.

ERROR # 77

Consider that hospitalization prevents suicide, as there are not few patients who consume it in Psychiatric wards or in other services non-psychiatric when continuous surveillance measures are not taken for the duration of the crisis suicide. The chemical fixation for which any psychotropic drug that guarantees sedation can be used prevents suicide, since a sleeping subject cannot self-harm. Other measures will help reduce the risk of the subject committing suicide in the hospital, such as marking the patient's history in red and separating it from the rest of the medical records of other patients who are hospitalized for other conditions, place them where they can be constantly observed 24 hours a day, warn all personnel to work in the hospital ward about the suicide danger, evolve the suicide plan as a fundamental objective of the medical visit, which can be carried out several times a day if the risk Suicidality increases, when the motor improves and the suicidal ideation persists, increase vigilance since the suicidal danger increases because it is in a better position to carry it out. cape, etc.

ERROR # 78

If the subject has serious suicide danger and must be referred to a hospital, the family member should be advised never to sit in the front seat of the car next to the driver, but behind and in the middle of two alert people with the ability to reduce it to the obedience if necessary because you can try to project the car against someone who comes in the direction contrary. If it is an ambulance, paramedical personnel should be warned, if it is not possible to keep him sedated, to prevent the potential suicide attempt to access the doors and stop the vehicle if the subject becomes excited and struggles within the same. In such cases, do not hesitate to perform mechanical fixation until reaching the hospital.

ERROR # 79

When the subject is in serious suicide danger the family member should be warned that it is a serious mistake to obey their supposed intentions to be "presentable", "neat" for the consultation with the therapist, as they can use this subterfuge to cut their throats with knives or project themselves under a vehicle on the way to the place where supposedly they were going to groom themselves carried by their relatives who witness incredulous, the death of their loved one before their own eyes.

ERROR # 80

Failure to warn family members of the possibility of the occurrence of a homicide-suicide in situations in which the subject should be suspected of having made a serious suicide attempt on the grounds that her ex-partner has managed to rebuild her life, who has also threatened to kill her because "if she is not mine, she is nobody's" and she suffers unbearable suffering, she does not accept the loss of that love relationship and she suffers feelings of resentment and exclusive possessiveness towards her ex partner.

ERROR # 81

Consider that people in serious crisis suicidal withsevere motor impairments cannot commit suicide. The film "The Sea Inside" is a true story in which a tetraplegic subject convinces a friend to provide him with the means to commit suicide and achieves her goal. Individuals who require wheelchairs to get around can commit suicide by hanging once they tie a rope to any overhang that resists her weight, ties her around her neck, and lets herself fall, project herself into a motor vehicle, or fall from a height that she can to access.

ERROR # 82

Assume that these are the only mistakes that can be made when approaching a suspected suicide. You may discover others that do not appear in this list, although you should not make the mistake of ignoring them when addressing a suicidal crisis or not to spread them to all who are interested in preventing a person from dying from this cause of death avoidable.

This article is merely informative, in Psychology-Online we do not have the power to make a diagnosis or recommend a treatment. We invite you to go to a psychologist to treat your particular case.

If you want to read more articles similar to Most frequent mistakes made when approaching a person in suicidal crisis, we recommend that you enter our category of Clinical psychology.

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