Montgomery County has a serious problem with suicide, losing over one-hundred residents yearly. It is probably less well-known that the county has a much bigger problem with non-fatal suicide attempts, all of which raise the individual’s life time suicide risk, and many of which subsequently become fatal attempts.
There is little data on the incidence of suicide attempts, an act in which a person with intent to die acts on a plan using potentially lethal means. Many attempts occur without coming to anyone’s attention. Those that do usually are as a result of a need for medical treatment, self-reporting by the individual in seeking help, or when there has been an intervention.
Depending on age and gender, the ratio of suicide attempts to fatalities varies widely. Youths make more attempts than adults, men make considerably fewer attempts then women, elders tend to die on their first attempt. Lethality of means, particularly firearms, accounts for these disparities.
Individuals with serious mental illness, especially schizophrenia, bipolar disorder, and major depression, attempt suicide more frequently than those without these conditions. Alcohol abuse and dependence figure highly in suicide attempts. Imminent and actual suicide attempts account for a significant number of voluntary and involuntary psychiatric hospitalizations.
We could go on, but suffice it to say that focusing suicide prevention on individuals who have made a suicide attempt would likely save a lot of lives, enhance the recovery prospects and duration of those who may re-traumatize themselves when beset by even passing suicidal thoughts, and free up ERs and psychiatric hospitals to address other needs.
In 2012, the Action Alliance, a national suicide prevention coalition, identified support for attempt survivors as a priority for focus in the revised National Strategy for Suicide Prevention (NSSP). This led to a national Suicide Attempt Survivors Task Force to help forge a path for stopping suicide attempts and deaths by engaging and supporting people with lived experience of a suicidal crisis.
In 2014, the Pennsylvania Adult Suicide Prevention Plan included an objective (9.1) to “identify all suicide strategies and services that respond to and care for individuals affected in the aftermath of a suicide attempt…and promote awareness of these resources.” This state plan will presumably motivate the implementation of aftercare resources for suicide attempt survivors at the county level.
There are few suicide attempt support groups anywhere. A 12-step based “Suicide Anonymous” group met for several years in Norristown, but ceased when its leader moved out-of-state. At present, the only such support resource that we know of anywhere near Montgomery County is a “Suicide Anonymous” group in Burlington County, NJ:
Rise Above/R.I.T.E. Center
Twin Oaks Community Services
693 Main Street Building C
Lumberton, NJ 08048
1st Floor, Center Door
Group and Skype: 7:00pm 2nd and 4th Thursdays
Skype Only: 1st, 3rd, and 5th Thursdays
So why such a paucity of support groups in a major metropolitan area that probably has support groups for every other malady known to humanity? Liability for self-injury or fatalities among group participants is often cited. This probably would not apply to a peer-led group and has not proved insurmountable in the few provider-based groups around the country. Bigger problems are stigma and finding peer facilitators. (It is likely that there are a number of Certified Peer Specialists who have “lived experienced” of a suicide attempt as well as group facilitation skills.[i]) Indifference toward the needs of attempt survivors is an issue. Perhaps those affected by recurrent episodes of acute suicidality will at some point step up.
Repeatedly hospitalizing those who make or almost make suicide attempts may be more part of the problem than part of the solution. Clearly inpatient care may be indicated for stabilization and safety but there is no evidence of any long-term preventive value. Moreover, the first 30 days after discharge from a psychiatric facility are a very high risk period for suicide. Many readmissions within 30 days of discharge involve suicidal behavior.
Here are some on-line information resources on this topic:
- “With Help comes Hope” http://www.suicidepreventionlifeline.org/
- Didi Hirsch Mental Health Services Suicide Attempter Support Group Manual http://www.sprc.org/bpr/section-III/manual-support-groups-suicide-attempt-survivors
- American Association of Suicidology Attempt Survivors/Lived Experience Division http://www.suicidology.org/members/divisions/attempt-survivor
- Suicide Anonymous http://www.suicideanonymous.net/
[i] See “Peer Specialists can Prevent Suicide” Behavioral Healthcare, September 30, 2010 at http://www.behavioral.net/article/peer-specialists-can-prevent-suicides