Suicide prevention#Lethal means reduction

{{main|Warning signs of suicide}}

Warning signs of suicide can allow individuals to direct people who may be considering suicide to get help.{{cite web |date=19 July 2023 |title=NIMH » Suicide Prevention |url=https://www.nimh.nih.gov/health/topics/suicide-prevention#part_7681 |website=www.nimh.nih.gov |language=en |access-date=26 June 2024 |archive-date=20 September 2023 |archive-url=https://web.archive.org/web/20230920115749/https://www.nimh.nih.gov/health/topics/suicide-prevention#part_7681 |url-status=live }}

Behaviors that may be warning signs include:{{cite web |title=Suicide Prevention |url=https://www.nimh.nih.gov/health/topics/suicide-prevention/index.shtml |access-date=20 November 2019 |website=The National Institute of Mental Health |archive-date=25 April 2021 |archive-url=https://web.archive.org/web/20210425232005/https://www.nimh.nih.gov/health/topics/suicide-prevention/index.shtml |url-status=live }}

1. Talking about wanting to die or wanting to kill themselves
2. Suicidal ideation: thinking, talking, or writing about suicide, planning for suicide
3. Substance abuse
4. Feelings of purposelessness
5. Anxiety, agitation, being unable to sleep, or sleeping all the time
6. Feelings of being trapped
7. Feelings of hopelessness
8. Social withdrawal
9. Displaying extreme mood swings, suddenly changing from sad to very calm or happy
10. Recklessness or impulsiveness, taking risks that could lead to death, such as driving extremely fast
11. Mood changes, including depression
12. Feelings of uselessness
13. Settling outstanding affairs, giving away prized or valuable possessions, or making amends when they are otherwise not expected to die (as an example, this behavior would be typical in a terminal cancer patient but not a healthy young adult)
14. Strong feelings of pain, either emotional or physical
15. Considering oneself burdensome
16. Increased use of drugs, including alcohol

An effective way to assess suicidal thoughts is to talk with the person directly, to ask about depression, and assess suicide plans as to how and when it might be attempted.[https://www.who.int/mental_health/media/en/59.pdf "Preventing Suicide – A Resource for Primary Health Care Workers"] {{Webarchive|url=https://web.archive.org/web/20200830100705/https://www.who.int/mental_health/media/en/59.pdf |date=2020-08-30 }} (PDF), World Health Organization, Geneva, 2000, p. 13. Contrary to popular misconceptions, talking with people about suicide does not plant the idea in their heads. However, such discussions and questions should be asked with care, concern and compassion. The tactic is to reduce sadness and provide assurance that other people care. The WHO advises to not say everything will be all right nor make the problem seem trivial, nor give false assurances about serious issues. The discussions should be gradual and specifically executed when the person is comfortable about discussing their feelings. ICARE (Identify the thought, Connect with it, Assess evidence for it, Restructure the thought in positive light, Express or provide room for expressing feelings from the restructured thought) is a model of approach used here.

File:US_Navy_091027-N-0000X-001_A_photo_illustration_produced_by_the_Defense_Media_Agency_on_suicide_prevention.jpgAll people can be at risk of suicide. Risk factors that contribute to someone feeling suicidal or making a suicide attempt may include:

• Depression, other mental disorders, or substance abuse disorder
• Certain medical conditions
• Chronic pain{{cite journal |last1=Bohnert |first1=Amy S.B. |last2=Ilgen, Ph.D |first2=Mark A. |year=2019 |title=Understanding Links among Opioid Use, Overdose, and Suicide |journal=The New England Journal of Medicine |volume=380 |issue=1 |pages=71–79 |doi=10.1056/NEJMra1802148 |pmid=30601750 |doi-access=free}}
• A prior suicide attempt
• Childhood trauma
• Betrayal and abandonment
• Financial troubles or poverty
• Family history of a mental disorder or substance abuse
• Family history of suicide
• Family violence, including physical or sexual abuse
• Psychiatric Abuse
• Benzodiazepines
• Having guns or other firearms in the home
• Having recently been released from prison, jail or mental asylum
• Self-harm
• Being exposed to others' suicidal behavior, such as that of family members, peers, or celebrities
• Being male{{Cite web |title=GHO {{!}} By category {{!}} Suicide rate estimates, age-standardized - Estimates by country |url=https://apps.who.int/gho/data/node.main.MHSUICIDEASDR?lang=en |access-date=2021-01-05 |website=WHO |archive-date=2017-04-14 |archive-url=https://web.archive.org/web/20170414080838/http://apps.who.int/gho/data/node.main.MHSUICIDEASDR?lang=en |url-status=live }}
• Food insecurity{{Cite journal |last1=Steare |first1=Thomas |last2=Lewis |first2=Gemma |last3=Evans-Lacko |first3=Sara |last4=Pitman |first4=Alexandra |last5=Rose-Clarke |first5=Kelly |last6=Patalay |first6=Praveetha |date=2023-12-11 |title=Food Insecurity, Adolescent Suicidal Thoughts and Behaviors, and Country-Level Context: A Multi-Country Cross-Sectional Analysis |journal=Journal of Adolescent Health |language=en |volume=74 |issue=3 |pages=545–555 |doi=10.1016/j.jadohealth.2023.10.018 |pmc=11139653 |pmid=38085207}}
• There may be an association between long-term PM2.5 exposure and depression, and a possible association between short-term PM10 exposure and suicide.{{cite journal |vauthors=Braithwaite I, Zhang S, Kirkbride JB, Osborn DP, Hayes JF |date=December 2019 |title=Air Pollution (Particulate Matter) Exposure and Associations with Depression, Anxiety, Bipolar, Psychosis and Suicide Risk: A Systematic Review and Meta-Analysis |journal=Environmental Health Perspectives |volume=127 |issue=12 |page=126002 |doi=10.1289/EHP4595 |pmc=6957283 |pmid=31850801|bibcode=2019EnvHP.127l6002B }}

File:United States Army Suicide Prevention Poster.jpg

The traditional approach has been to identify the risk factors that increase suicide or self-harm, though meta-analysis studies suggest that suicide risk assessment might not be useful and recommend immediate hospitalization of the person with suicidal feelings as the healthy choice.{{cite web |last1=Murray |first1=Declan |last2=Devitt |first2=Patrick |title=Suicide Risk Assessment Doesn't Work |url=https://www.scientificamerican.com/article/suicide-risk-assessment-doesnt-work/ |access-date=5 April 2017 |website=Scientific American |language=en |archive-date=21 March 2021 |archive-url=https://web.archive.org/web/20210321231616/https://www.scientificamerican.com/article/suicide-risk-assessment-doesnt-work/ |url-status=live }} In 2001, the U.S. Department of Health and Human Services, published the National Strategy for Suicide Prevention, establishing a framework for suicide prevention in the U.S. The document, and its 2012 revision, calls for a public health approach to suicide prevention, focusing on identifying patterns of suicide and suicidal ideation throughout a group or population (as opposed to exploring the history and health conditions that could lead to suicide in a single individual).{{cite web |title=National Strategy for Suicide Prevention |url=http://www.sprc.org/library/nssp.pdf |url-status=dead |archive-url=https://web.archive.org/web/20111027113337/http://www.sprc.org/library/nssp.pdf |archive-date=2011-10-27 |access-date=2012-01-15}} The ability to recognize warning signs of suicide allows individuals who may be concerned about someone they know to direct them to help.{{cite web |date=August 2021 |title=Suicide Prevention |url=https://www.nimh.nih.gov/health/topics/suicide-prevention |work=NIMH |access-date=2018-03-04 |archive-date=2023-09-20 |archive-url=https://web.archive.org/web/20230920115749/https://www.nimh.nih.gov/health/topics/suicide-prevention |url-status=live }}

Suicide gesture and suicidal desire (a vague wish for death without any actual intent to kill oneself) are potentially self-injurious behaviors that a person may use to attain some other ends, like to seek help, punish others, or to receive attention. This behavior has the potential to aid an individual's capability for suicide and can be considered as a suicide warning, when the person shows intent through verbal and behavioral signs.{{cite journal |last1=Shahar |first1=Golan |last2=Bareket |first2=Liad |last3=Rudd |first3=M. David |last4=Joiner |first4=Thomas E. |date=July 2006 |title=In severely suicidal young adults, hopelessness, depressive symptoms, and suicidal ideation constitute a single syndrome |journal=Psychological Medicine |volume=36 |issue=7 |pages=913–922 |doi=10.1017/S0033291706007586 |doi-broken-date=1 November 2024 |pmid=16650341 |s2cid=37342106}}

The U.S. Surgeon General has suggested that screening to detect those at risk of suicide may be one of the most effective means of preventing suicide in children and adolescents.Office of the Surgeon General:The Surgeon General's Call To Action To Prevent Suicide 1999 [http://www.surgeongeneral.gov/library/calltoaction/calltoaction.htm] {{Webarchive|url=https://web.archive.org/web/20120312184938/http://www.surgeongeneral.gov/library/calltoaction/calltoaction.htm|date=2012-03-12}} There are various screening tools in the form of self-report questionnaires to help identify those at risk such as the Beck Hopelessness Scale and Is Path Warm?. A number of these self-report questionnaires have been tested and found to be effective for use among adolescents and young adults.Rory C. O'Connor, Stephen Platt, Jacki Gordon: International Handbook of Suicide Prevention: Research, Policy and Practice, p. 510 [https://books.google.com/books?id=3fDGLWQtwFkC&dq=suicide+screening&pg=PA510] There is however a high rate of false-positive identification and those deemed to be at risk should ideally have a follow-up clinical interview.Rory C. O'Connor, Stephen Platt, Jacki Gordon, International Handbook of Suicide Prevention: Research, Policy and Practice, p.361; Wiley-Blackwell (2011), {{ISBN|0-470-68384-8}} The predictive quality of these screening questionnaires has not been conclusively validated so it is not possible to determine if those identified at risk of suicide will actually die by suicide.Alan F. Schatzberg: The American Psychiatric Publishing textbook of mood disorders, p. 503: American Psychiatric Publishing; (2005) {{ISBN|1-58562-151-X}} Asking about or screening for suicide does not create or increase the risk.{{cite journal |last=Crawford |first=MJ |author2=Thana, L |author3=Methuen, C |author4=Ghosh, P |author5=Stanley, SV |author6=Ross, J |author7=Gordon, F |author8=Blair, G |author9=Bajaj, P |date=May 2011 |title=Impact of screening for risk of suicide: randomised controlled trial. |journal=The British Journal of Psychiatry |volume=198 |issue=5 |pages=379–84 |doi=10.1192/bjp.bp.110.083592 |pmid=21525521 |doi-access=free}}

In approximately 75 percent of suicides, the individuals had seen a physician within the year before their death, including 45 to 66 percent within the prior month. Approximately 33 to 41 percent of those who died by suicide had contact with mental health services in the prior year, including 20 percent within the prior month. These studies suggest an increased need for effective screening.{{EMedicine|article|805459|Depression and Suicide}}{{cite journal |vauthors=González HM, Vega WA, Williams DR, Tarraf W, West BT, Neighbors HW |date=January 2010 |title=Depression Care in the United States: Too Little for Too Few |journal=Archives of General Psychiatry |volume=67 |issue=1 |pages=37–46 |doi=10.1001/archgenpsychiatry.2009.168 |pmc=2887749 |pmid=20048221}}{{cite journal |vauthors=Luoma JB, Martin CE, Pearson JL |date=June 2002 |title=Contact with mental health and primary care providers before suicide: a review of the evidence. |journal=The American Journal of Psychiatry |volume=159 |issue=6 |pages=909–16 |doi=10.1176/appi.ajp.159.6.909 |pmc=5072576 |pmid=12042175}}{{cite journal |vauthors=Lee HC, Lin HC, Liu TC, Lin SY |date=June 2008 |title=Contact of mental and nonmental health care providers prior to suicide in Taiwan: a population-based study. |journal=Canadian Journal of Psychiatry |volume=53 |issue=6 |pages=377–83 |doi=10.1177/070674370805300607 |pmid=18616858 |doi-access=free}}{{cite journal |vauthors=Pirkis J, Burgess P |date=December 1998 |title=Suicide and recency of health care contacts. A systematic review |journal=The British Journal of Psychiatry |volume=173 |issue=6 |pages=462–74 |doi=10.1192/bjp.173.6.462 |pmid=9926074 |s2cid=43144463}} Many suicide risk assessment measures are not sufficiently validated, and do not include all three core suicidality attributes (i.e., suicidal affect, behavior, and cognition).{{cite journal |author1=Harris K. M. |author2=Syu J.-J. |author3=Lello O. D. |author4=Chew Y. L. E. |author5=Willcox C. H. |author6=Ho R. C. M. |year=2015 |title=The ABC's of suicide risk assessment: Applying a tripartite approach to individual evaluations |journal=PLOS ONE |volume=10 |issue=6 |page=e0127442 |bibcode=2015PLoSO..1027442H |doi=10.1371/journal.pone.0127442 |pmc=4452484 |pmid=26030590 |doi-access=free}} A study published by the University of New South Wales has concluded that asking about suicidal thoughts cannot be used as a reliable predictor of suicide risk.{{cite journal |last1=McHugh |first1=Catherine M. |last2=Corderoy |first2=Amy |last3=Ryan |first3=Christopher James |last4=Hickie |first4=Ian B. |last5=Large |first5=Matthew Michael |date=March 2019 |title=Association between suicidal ideation and suicide: meta-analyses of odds ratios, sensitivity, specificity and positive predictive value |journal=BJPsych Open |volume=5 |issue=2 |pages=e18 |doi=10.1192/bjo.2018.88 |pmc=6401538 |pmid=30702058}}

The conservative estimate is that 10% of individuals with psychiatric disorders may have an undiagnosed medical condition causing their symptoms,{{cite journal |vauthors=Hall RC, Popkin MK, Devaul RA, Faillace LA, Stickney SK |date=November 1978 |title=Physical illness presenting as psychiatric disease |journal=Arch. Gen. Psychiatry |volume=35 |issue=11 |pages=1315–20 |doi=10.1001/archpsyc.1978.01770350041003 |pmid=568461}} with some estimates stating that upwards of 50% may have an undiagnosed medical condition which, if not causing, is exacerbating their psychiatric symptoms.{{citation |last=Chuang |first=L. |title=Mental Disorders Secondary to General Medical Conditions |work=Medscape |url=http://emedicine.medscape.com/article/294131-overview |access-date=1 October 2011 |archive-url=https://web.archive.org/web/20111019133328/http://emedicine.medscape.com/article/294131-overview |archive-date=October 19, 2011}}{{Update inline|date=September 2021}}{{cite journal |vauthors=Felker B, Yazel JJ, Short D |date=December 1996 |title=Mortality and medical comorbidity among psychiatric patients: a review |journal=Psychiatr Serv |volume=47 |issue=12 |pages=1356–63 |doi=10.1176/ps.47.12.1356 |pmid=9117475}} Illegal drugs and prescribed medications may also produce psychiatric symptoms.{{cite journal |vauthors=Kamboj MK, Tareen RS |date=February 2011 |title=Management of nonpsychiatric medical conditions presenting with psychiatric manifestations |journal=Pediatr. Clin. North Am. |volume=58 |issue=1 |pages=219–41, xii |doi=10.1016/j.pcl.2010.10.008 |pmid=21281858}} Effective diagnosis and, if necessary, medical testing, which may include neuroimaging{{cite book |last1=Van Heeringen |first1=Kees |title=Nuclear Medicine in Psychiatry |last2=Audenaert |first2=Kurt |last3=Bernagie |first3=Katrien |last4=Vervaet |first4=Myriam |last5=Jacobs |first5=Filip |last6=Otte |first6=Andreas |last7=Dierckx |first7=Rudi |year=2004 |isbn=978-3-642-62287-8 |pages=475–484 |chapter=Functional Brain Imaging of Suicidal Behaviour |doi=10.1007/978-3-642-18773-5_28}} to diagnose and treat any such medical conditions or medication side effects, may reduce the risk of suicidal ideation as a result of psychiatric symptoms. Most often including depression, which are present in up to 90–95% of cases.Patricia D. Barry, Suzette Farmer; Mental health & mental illness, p. 282, Lippincott Williams & Wilkins;(2002) {{ISBN|0-7817-3138-0}} The calification of a case as psychiatric frequently implies more rigid treatments.

{{See also|Gun control}}

{{ multiple image | direction=vertical| total_width=275

|image1= 200012 Suicide methods in order of lethality - variable-width bar chart.svg |caption1= Though substance overdose is the most common method of attempted suicide in the U.S., guns are the most lethal (most likely to result in death).{{cite journal |last1=Spicer |first1=Rebecca S. |last2=Miller |first2=Ted R. |title=Suicide Acts in 8 States: Incidence and Case Fatality Rates by Demographics and Method |journal=American Journal of Public Health |date=December 2000 |volume=90 |issue=12 |pages=1885–1891 |doi=10.2105/ajph.90.12.1885 |pmid=11111261 |pmc=1446422 |quote=Table 1}}

|image2 = 2023 Gun death rates versus state gun regulation index - US.svg

|caption2 = A 2023 study concluded that more restrictive state gun policies reduced homicide and suicide gun deaths. From 1991 to 2016—when most states implemented more restrictive gun laws—gun deaths fell sharply.{{cite journal |last1=Sharkey |first1=Patrick |last2=Kang |first2=Megan |title=The Era of Progress on Gun Mortality: State Gun Regulations and Gun Deaths from 1991 to 2016 |journal=Epidemiology |date=November 2023 |volume=34 |issue=6 |pages=786–792 |doi=10.1097/EDE.0000000000001662 |doi-access=free |pmid=37732847 }} Fig. 2. ● Sharkey et al. are cited by {{cite news |last1=Lopez |first1=German |title=A Drop in American Gun Violence |url=https://www.nytimes.com/2023/11/01/briefing/gun-violence.html |work=The New York Times |date=November 1, 2023 |archive-url=https://web.archive.org/web/20231102003423/https://www.nytimes.com/2023/11/01/briefing/gun-violence.html |archive-date=November 2, 2023 |url-status=live }} Trendline is from Times article.

}}

Restriction of dangerous means ⁠— ⁠reducing the odds that a person attempting suicide will use highly lethal means ⁠— ⁠is an important component of suicide prevention.{{cite web |url=http://www.hsph.harvard.edu/means-matter/index.html |title=Means Matter |website=Harvard School of Public Health |access-date=2012-01-15 |archive-date=2012-12-14 |archive-url=https://web.archive.org/web/20121214082817/http://www.hsph.harvard.edu/means-matter/index.html |url-status=dead }} This practice is also called "means restriction". It has been demonstrated that restricting lethal means can help reduce suicide rates, as delaying action until the desire to die has passed.{{Cite web |url=http://www.sprc.org/comprehensive-approach/reduce-means |website=Suicide Prevention Resource Center |title=Reduce Access to Means of Suicide |access-date=2019-05-08 |archive-url=https://web.archive.org/web/20190516063836/http://www.sprc.org/comprehensive-approach/reduce-means |archive-date=2019-05-16 |url-status=dead }} In general, strong evidence supports the effectiveness of means restriction in preventing suicides.{{cite journal |last1=Yip |first1=Paul SF |last2=Caine |first2=Eric |last3=Yousuf |first3=Saman |last4=Chang |first4=Shu-Sen |last5=Wu |first5=Kevin Chien-Chang |last6=Chen |first6=Ying-Yeh |title=Means restriction for suicide prevention |journal=The Lancet |date=June 2012 |volume=379 |issue=9834 |pages=2393–2399 |doi=10.1016/S0140-6736(12)60521-2 |pmid=22726520 |pmc=6191653 }}{{cite journal|last1=Reisch|first1=T|last2=Steffen|first2=T|last3=Habenstein|first3=A|last4=Tschacher |first4=W|title=Change in suicide rates in Switzerland before and after firearm restriction resulting from the 2003 "Army XXI" reform|journal=The American Journal of Psychiatry|date=September 2013|volume=170 |issue=9|pages=977–84|pmid=23897090|doi=10.1176/appi.ajp.2013.12091256}}{{cite journal |last=Rosenbaum |first=Janet |title=Gun utopias? Firearm access and ownership in Israel and Switzerland. |journal=Journal of Public Health Policy |date=2012 |volume=33 |issue=1 |pages=46–58 |doi=10.1057/jphp.2011.56|pmid=22089893 |pmc=3267868 }}{{cite journal |last=Knipe |first=Duleeka |title=Suicide prevention through means restriction: Impact of the 2008-2011 pesticide restrictions on suicide in Sri Lanka. |journal=PLOS ONE |date=2017 |volume=12 |issue=3 |pages=e0172893 |doi=10.1371/journal.pone.0172893|pmid=28264041 |pmc=5338785 |bibcode=2017PLoSO..1272893K |doi-access=free }} There is also strong evidence that restricted access at so-called suicide hotspots, such as bridges and cliffs, reduces suicides, whereas other interventions such as placing signs or increasing surveillance at these sites appears less effective.{{cite journal |last1=Cox |first1=Georgina R |last2=Owens |first2=Christabel |last3=Robinson |first3=Jo |last4=Nicholas |first4=Angela |last5=Lockley |first5=Anne |last6=Williamson |first6=Michelle |last7=Cheung |first7=Yee Tak Derek |last8=Pirkis |first8=Jane |title=Interventions to reduce suicides at suicide hotspots: a systematic review |journal=BMC Public Health |date=December 2013 |volume=13 |issue=1 |pages=214 |doi=10.1186/1471-2458-13-214 |pmid=23496989 |pmc=3606606 |doi-access=free }}

One of the most famous historical examples of means reduction is that of coal gas in the United Kingdom. Until the 1950s, the most common means of suicide in the UK was poisoning by gas inhalation. In 1958, natural gas (virtually free of carbon monoxide) was introduced, and over the next decade, comprised over 50% of gas used. As carbon monoxide in gas decreased, suicides also decreased. The decrease was driven entirely by dramatic decreases in the number of suicides by carbon monoxide poisoning.{{cite web |url=http://www.hsph.harvard.edu/means-matter/means-matter/saves-lives/index.html |title=Means Matter – Means Reduction Saves Lives |website=Harvard School of Public Health |access-date=2012-01-15 |archive-date=2012-12-14 |archive-url=https://web.archive.org/web/20121214142819/http://www.hsph.harvard.edu/means-matter/means-matter/saves-lives/index.html |url-status=dead }}{{cite journal | last1 = Kreitman | first1 = N | date = Jun 1976 | title = The Coal Gas Story: United Kingdom suicide rates, 1960–1971 | journal = Br J Prev Soc Med | volume = 30 | issue = 2| pages = 86–93 | pmid = 953381 | pmc=478945 | doi=10.1136/jech.30.2.86}} A 2020 Cochrane review on means restrictions for jumping found tentative evidence of reductions in frequency.{{cite journal |last1=Okolie |first1=Chukwudi |last2=Wood |first2=Suzanne |last3=Hawton |first3=Keith |last4=Kandalama |first4=Udai |last5=Glendenning |first5=Alexander C |last6=Dennis |first6=Michael |last7=Price |first7=Sian F |last8=Lloyd |first8=Keith |last9=John |first9=Ann |title=Means restriction for the prevention of suicide by jumping |journal=Cochrane Database of Systematic Reviews |date=25 February 2020 |volume=2020 |issue=2 |pages=CD013543 |doi=10.1002/14651858.CD013543 |pmid=32092795 |pmc=7039710 }}

In the United States, firearm access is associated with increased suicide completion.{{cite web |url=http://www.hsph.harvard.edu/means-matter/means-matter/risk/index.html |title=Means Matter – Firearm Access is a Risk Factor for Suicide |website=Harvard School of Public Health |access-date=2012-01-15 |archive-date=2012-12-13 |archive-url=https://web.archive.org/web/20121213055205/http://www.hsph.harvard.edu/means-matter/means-matter/risk/index.html |url-status=dead |quote=About 85% of attempts with a firearm are fatal: that's a much higher case fatality rate than for nearly every other method. Many of the most widely used suicide attempt methods have case fatality rates below 5%.}} About 85% of suicide attempts with a gun result in death, while most other widely used suicide attempt methods result in death less than 5% of the time.{{cite journal |last1=Vyrostek |first1=Sara B. |last2=Annest |first2=Joseph L. |last3=Ryan |first3=George W. |title=Surveillance for fatal and nonfatal injuries--United States, 2001. |journal=Morbidity and Mortality Weekly Report. Surveillance Summaries |date=3 September 2004 |volume=53 |issue=7 |pages=1–57 |pmid=15343143 |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/ss5307a1.htm |archive-date=15 September 2017 |access-date=15 September 2017 |archive-url=https://web.archive.org/web/20170915023545/https://www.cdc.gov/mmwr/preview/mmwrhtml/ss5307a1.htm |url-status=live }} Matthew Miller, M.D., Sc.D. conducted research comparing the number of suicides in states with the highest rates of gun ownership, to the number of suicides in states with the lowest rates of gun ownership. He found that men were 3.7 times more likely to die by firearm suicide and women were 7.9 times more likely to die by firearm suicide living in states with high rates of gun ownership. There was no difference in non-firearm suicides.{{Cite journal |last1=Miller |first1=M. |last2=Hemenway |first2=D. |title=Guns and Suicide in the United States |journal=New England Journal of Medicine |volume=359 |issue=10 |pages=989–91 |year=2008 |pmid=18768940 |doi=10.1056/NEJMp0805923|doi-access=free }} Although restrictions on access to firearms have reduced firearm suicide rates in other countries, such restrictions are difficult in the United States because the Second Amendment to the United States Constitution limits restrictions on weapons.{{cite journal |last1=Mann |first1=J. John |last2=Michel |first2=Christina A. |title=Prevention of Firearm Suicide in the United States: What Works and What Is Possible |journal=American Journal of Psychiatry |date=October 2016 |volume=173 |issue=10 |pages=969–979 |doi=10.1176/appi.ajp.2016.16010069 |pmid=27444796 }}

For those who decide to end their lives impulsively, a 24-hour waiting period for firearm access could substantially reduce suicide success rates.{{cite news |url=https://www.npr.org/2024/04/16/1243924108/gun-violence-suicide-united-states |title=Suicides make up majority of gun deaths, but remain overlooked in gun violence debate |date=April 16, 2024 |publisher=NPR |author1=Destinee Adams |author2=Michel Martin |author3=Ana Perez |author4=H.J. Mai}} Contrary to the popular notion that suicidal people will simply find another way to kill themselves, many people who survive suicide attempts go on to lead long lives. "In 2023, more than 42,967 people died from gun related injuries. Over half of those deaths were suicides" in the United States.

{{See also||Chaplain}}

The majority of known religions consider that suicide is a sin (or an equivalent fault). Their priests are available to guide in this problem and their circumstances.

{{See also|Psychologist|Group psychotherapy}}

There are multiple talking therapies that reduce suicidal thoughts and behaviors.

In the group therapies, suicides can participate with other people (usually other patients with whom the patient of suicidal tendence would talk without major problems). The rest of the patients can have the same psychological problem or any other. A psychologist would direct the chat.

Psychotherapies that have been shown most successful, or evidence based, are dialectical behavior therapy (DBT),{{cite journal |author1=Canadian Agency for Drugs Technologies in Health (CADTH) |date=1 March 2010 |title=Dialectical Behaviour Therapy in Adolescents for Suicide Prevention: Systematic Review of Clinical-Effectiveness |journal=CADTH Technology Overviews |volume=1 |issue=1 |pages=e0104 |pmc=3411135 |pmid=22977392}}National Institute of Mental Health: Suicide in the U.S.: Statistics and Prevention [http://www.nimh.nih.gov/health/publications/suicide-in-the-us-statistics-and-prevention/index.shtml#DB-Therapy] {{Webarchive|url=https://web.archive.org/web/20101024213742/http://www.nimh.nih.gov/health/publications/suicide-in-the-us-statistics-and-prevention/index.shtml#DB-Therapy|date=2010-10-24}} which has shown to be helpful in reducing suicide attempts and reducing hospitalizations for suicidal ideation,Linehan et al., 2006 and cognitive behavioral therapy for suicide prevention (CBT-SP), a form of DBT that is adapted for adolescents at high risk for repeated suicide attempts,{{cite journal |vauthors=Stanley B, Brown G, Brent DA, etal |date=October 2009 |title=Cognitive-behavioral therapy for suicide prevention (CBT-SP): treatment model, feasibility, and acceptability |journal=J Am Acad Child Adolesc Psychiatry |volume=48 |issue=10 |pages=1005–13 |doi=10.1097/CHI.0b013e3181b5dbfe |pmc=2888910 |pmid=19730273}}{{cite web |author=Kairi Kõlves |author2=Diego De Leo |title=Child and youth suicides: Research and Potentials for Prevention |url=https://www.griffith.edu.au/__data/assets/pdf_file/0020/511760/Child-and-youth-suicide-workshop.pdf |archive-url=https://web.archive.org/web/20161229020950/https://www.griffith.edu.au/__data/assets/pdf_file/0020/511760/Child-and-youth-suicide-workshop.pdf |archive-date=29 December 2016 |publisher=Australian Institute for Suicide Research and Prevention}} and has shown to improve problem-solving and coping abilities.Stellrecht et al., 2006

The brief intervention and contact technique developed by the World Health Organization has also shown benefit.{{cite journal |last1=Riblet |first1=NBV |last2=Shiner |first2=B |last3=Young-Xu |first3=Y |last4=Watts |first4=BV |date=June 2017 |title=Strategies to prevent death by suicide: meta-analysis of randomised controlled trials. |journal=British Journal of Psychiatry |volume=210 |issue=6 |pages=396–402 |doi=10.1192/bjp.bp.116.187799 |pmid=28428338 |doi-access=free}}

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{{See also|List of suicide crisis lines}}

Crisis hotlines connect a person in distress to either a volunteer or staff member of an association that provides comfort and help. This may occur via telephone, online chat, or in person. Even though crisis hotlines are common, they have not been well studied.{{cite journal | vauthors = Sakinofsky I | title = The current evidence base for the clinical care of suicidal patients: strengths and weaknesses | journal = Canadian Journal of Psychiatry | volume = 52 | issue = 6 Suppl 1 | pages = 7S–20S | date = June 2007 | doi = 10.1177/07067437070526S102 | pmid = 17824349 | quote = Other suicide prevention strategies that have been considered are crisis centres and hotlines, method control, and media education... There is minimal research on these strategies. Even though crisis centres and hotlines are used by suicidal youth, information about their impact on suicidal behaviour is lacking. }}{{cite journal |last1=Zalsman |first1=Gil |last2=Hawton |first2=Keith |last3=Wasserman |first3=Danuta |author-link3=Danuta Wasserman|last4=van Heeringen |first4=Kees |last5=Arensman |first5=Ella |last6=Sarchiapone |first6=Marco |last7=Carli |first7=Vladimir |last8=Höschl |first8=Cyril |last9=Barzilay |first9=Ran |last10=Balazs |first10=Judit |last11=Purebl |first11=György |last12=Kahn |first12=Jean Pierre |last13=Sáiz |first13=Pilar Alejandra |last14=Lipsicas |first14=Cendrine Bursztein |last15=Bobes |first15=Julio |last16=Cozman |first16=Doina |last17=Hegerl |first17=Ulrich |last18=Zohar |first18=Joseph |title=Suicide prevention strategies revisited: 10-year systematic review |journal=The Lancet Psychiatry |date=July 2016 |volume=3 |issue=7 |pages=646–659 |doi=10.1016/S2215-0366(16)30030-X |pmid=27289303 |quote=Other approaches that need further investigation include gatekeeper training, education of physicians, and internet and helpline support.|hdl=1854/LU-8509936 |hdl-access=free }} One study found a decrease in psychological pain, hopelessness, and desire to die from the beginning of the call through the next few weeks; however, the desire to die did not decrease long term.

{{break}}

It cannot be despised that a reliable person talks directly with the person with suicidal tendences.

Some guides about conversation with suicidal patients have been distributed between people with certain probabilities to find that situation.{{Cite web |last=World Health Organization |date=2000 |title=Preventing Suicide |url=https://who.int/mental_health/media/en/59.pdf |pages=10–11|archive-url=https://web.archive.org/web/20220120055107/https://who.int/mental_health/media/en/59.pdf |archive-date=2022-01-20 }}

{{main|Caring letters}}

The "Caring Letters" model of suicide prevention{{Cite journal |last1=Luxton |first1=David D. |last2=Thomas |first2=Elissa K. |last3=Chipps |first3=Joan |last4=Relova |first4=Rona M. |last5=Brown |first5=Daphne |last6=McLay |first6=Robert |last7=Lee |first7=Tina T. |last8=Nakama |first8=Helenna |last9=Smolenski |first9=Derek J. |date=March 2014 |title=Caring letters for suicide prevention: implementation of a multi-site randomized clinical trial in the U.S. military and Veteran Affairs healthcare systems |journal=Contemporary Clinical Trials |volume=37 |issue=2 |pages=252–260 |doi=10.1016/j.cct.2014.01.007 |issn=1559-2030 |pmid=24473106}}{{Cite book |last=Nock |first=Matthew K. |url=https://books.google.com/books?id=IYNSAwAAQBAJ&pg=PA375 |title=The Oxford Handbook of Suicide and Self-Injury |date=2014-05-08 |publisher=Oxford University Press |isbn=9780190209148 |pages=375 |language=en}} involved mailing short letters that expressed the researchers' interest in the recipients without pressuring them to take any action. The intervention reduced deaths by suicide, as proven through a randomized controlled trial.{{Cite news |last=Cherkis |first=Jason |date=15 November 2018 |title=The Best Way To Save People From Suicide |url=https://highline.huffingtonpost.com/articles/en/how-to-help-someone-who-is-suicidal/ |access-date=2018-11-29 |work=The Huffington Post |archive-date=2018-11-25 |archive-url=https://web.archive.org/web/20181125170855/https://highline.huffingtonpost.com/articles/en/how-to-help-someone-who-is-suicidal/ |url-status=live }}

The technique involves letters sent from a researcher who had spoken at length with the recipient during a suicidal crisis. The typewritten form letters were brief – sometimes as short as two sentences – personally signed by the researcher, and expressed interest in the recipient without making any demands. They were initially sent monthly, eventually decreasing in frequency to quarterly letters; if the recipient wrote back, then an additional personal letter was mailed. The approach was partly inspired by Jerome Motto's experience of receiving letters during World War II from a young woman he had met before being deployed. Motto was the psychiatrist who first devised the experiment. Although the exact mechanisms have been debated, researchers generally think that the letters communicate a genuine interest and social connection that the recipients find helpful.

Caring letters are inexpensive and either the only, or one of very few, approaches to suicide prevention that has been scientifically proven to work during the first years after a suicide attempt that resulted in hospitalization.

Coping planning is an intervention that is based in the strengths of patient for solving the problems or at least reducing and damping their impact. It aims to meet the needs of people who ask for help, including those experiencing suicidal ideation.{{cite journal |last1=Stallman |first1=H. M. |year=2018 |title=Coping Planning: A patient- and strengths-focused approach to suicide prevention training |journal=Australasian Psychiatry |volume=26 |issue=2 |pages=141–144 |doi=10.1177/1039856217732471 |pmid=28967263 |s2cid=4527243}} By addressing why someone asks for help, the risk assessment and management stays on what the person needs, and the needs assessment focuses on the individual needs of each person.{{cite journal |last1=Stallman |first1=H. M. |year=2017 |title=Meeting the needs of patients who have suicidal thoughts presenting to Emergency Departments |journal=Emergency Medicine Australasia |volume=29 |issue=6 |page=749 |doi=10.1111/1742-6723.12867 |pmid=28940744 |s2cid=206925361}}{{cite journal |last1=Franklin |first1=JC |last2=Ribeiro |first2=JD |last3=Fox |first3=KR |year=2016 |title=Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research |journal=Psychol Bull |volume=143 |issue=2 |pages=187–232 |doi=10.1037/bul0000084 |pmid=27841450 |s2cid=3941854}} The coping planning approach to suicide prevention draws on the health-focused theory of coping. Coping is normalized as a normal and universal human response to unpleasant emotions, and interventions are considered a change continuum of low intensity (e.g., self-soothing) to high intensity support (e.g. professional help). By planning for coping, it supports people who are distressed and provides a sense of belongingness and resilience in treatment of illness.{{cite journal |last1=Stallman |first1=H. M. |last2=Wilson |first2=C. J. |year=2018 |title=Can the mental health of Australians be improved by dual strategy for promotion and prevention? |journal=Australian and New Zealand Journal of Psychiatry |volume=52 |issue=6 |page=602 |doi=10.1177/0004867417752070 |pmid=29320871 |s2cid=38696679}}{{cite journal |last1=Stallman |first1=H. M. |last2=Ohan |first2=J. L. |year=2018 |title=The alignment of law, practice and need in suicide prevention |journal=BJPsych Bulletin |volume=42 |issue=2 |pages=51–53 |doi=10.1192/bjb.2017.3 |pmc=6001851 |pmid=29455707 |doi-access=free}} The proactive coping planning approach overcomes implications of ironic process theory.Wegner, Daniel M. (1989). White Bears and Other Unwanted Thoughts: Suppression, Obsession, and the Psychology of Mental Control. Viking Adult. {{ISBN|978-0670825226}} The biopsychosocial{{cite journal |last1=Engel |first1=G. L. |year=1980 |title=The clinical application of the biopsychosocial model |journal=American Journal of Psychiatry |volume=137 |issue=5 |pages=535–544 |doi=10.1176/ajp.137.5.535 |pmid=7369396}} strategy of training people in healthy coping improves emotional regulation and decreases memories of unpleasant emotions.{{cite journal |last1=Katsumi |first1=Y. |last2=Dolcos |first2=S. |year=2018 |title=Suppress to feel and remember less: Neural correlates of explicit and implicit emotional suppression on perception and memory |journal=Neuropsychologia |volume=145 |page=106683 |doi=10.1016/j.neuropsychologia.2018.02.010 |pmid=29432767 |s2cid=3628693}} A good coping planning strategically reduces the inattentional blindness for a person while developing resilience and regulation strengths.

According to researches, a proper diet, correct sleeping and physical exercise have a positive influence in the mood and the activity of the person.{{Cite journal |last1=Lopresti |first1=Adrian L. |last2=Hood |first2=Sean D. |last3=Drummond |first3=Peter D. |date=2013-05-15 |title=A review of lifestyle factors that contribute to important pathways associated with major depression: diet, sleep and exercise |url=https://pubmed.ncbi.nlm.nih.gov/23415826/ |journal=Journal of Affective Disorders |volume=148 |issue=1 |pages=12–27 |doi=10.1016/j.jad.2013.01.014 |issn=1573-2517 |pmid=23415826 |archive-date=2017-11-12 |access-date=2024-07-15 |archive-url=https://web.archive.org/web/20171112120308/https://www.ncbi.nlm.nih.gov/pubmed/23415826 |url-status=live }}

{{Expand section|small=no|find=suicide diet gov|date=August 2023}}

About 50% of people who die of suicide have a mood disorder such as major depression.{{cite book | last1=Barlow | first1=David H. | last2=Durand | first2=Vincent Mark | title=Abnormal Psychology | publisher=Wadsworth Publishing Company | date=2005 | pages=248–249 | isbn=978-0-534-63356-1 }}{{cite journal |vauthors=Bachmann S |title=Epidemiology of Suicide and the Psychiatric Perspective |journal=International Journal of Environmental Research and Public Health |date=6 July 2018 |volume=15 |issue=7 |page=1425 |doi=10.3390/ijerph15071425 |pmid=29986446|pmc=6068947 |quote=Half of all completed suicides are related to depressive and other mood disorders|doi-access=free }} Sleep and diet may play a role in depression (major depressive disorder), and interventions in these areas may be an effective add-on to conventional methods.{{cite journal | vauthors = Lopresti AL, Hood SD, Drummond PD | title = A review of lifestyle factors that contribute to important pathways associated with major depression: diet, sleep and exercise | journal = Journal of Affective Disorders | volume = 148 | issue = 1 | pages = 12–27 | date = May 2013 | pmid = 23415826 | doi = 10.1016/j.jad.2013.01.014 | s2cid = 22218602 | url = http://researchrepository.murdoch.edu.au/id/eprint/13504/1/A_review_of_lifestyle_factors_that_contribute_to_important_pathways_associated_with_major_depression-final_manuscript1.pdf | url-status = live | archive-url = https://web.archive.org/web/20170109183840/http://researchrepository.murdoch.edu.au/id/eprint/13504/1/A_review_of_lifestyle_factors_that_contribute_to_important_pathways_associated_with_major_depression-final_manuscript1.pdf | archive-date = 9 January 2017 }}

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According to Healthdirect, the national health advice service in Australia, risk of depression may be reduced with a healthy diet "high in fruits, vegetables, nuts, and legumes; moderate amounts of poultry, eggs, and dairy products; and only occasional red meat".{{cite web |title=Food, drink and mental health |url=https://www.healthdirect.gov.au/food-drink-and-mental-health |access-date=25 Aug 2023 |website=healthdirect |archive-date=25 August 2023 |archive-url=https://web.archive.org/web/20230825190834/https://www.healthdirect.gov.au/food-drink-and-mental-health |url-status=live }} Consuming oily fish (e.g., salmon, perch, tuna, mackerel, sardines and herring) may also help as they contain omega-3 fats. Consuming too much refined carbohydrates (e.g., snack foods) may increase the risk of depression symptoms. The mechanism on how diet improves or worsens mental health is still not fully understood. Blood glucose levels alterations, inflammation, or effects on the gut microbiome have been suggested. More information about food (e.g. oily fish with omega-3 fats, a class of PUFA), drink (e.g. water), healthy, balanced diet and mental health can be found on Healthdirect’s website.

Vitamin B₂, B₆ and B₁₂ deficiency may cause depression in females.{{cite journal |vauthors=Wu Y, Zhang L, Li S, Zhang D |date=29 April 2021 |title=Associations of dietary vitamin B1, vitamin B2, vitamin B6, and vitamin B12 with the risk of depression: a systematic review and meta-analysis |journal=Nutrition Reviews |publisher=Oxford University Press (OUP) |volume=80 |issue=3 |pages=351–366 |doi=10.1093/nutrit/nuab014 |issn=0029-6643 |pmid=33912967}}

Vitamin B₁₂, for humans, is the only vitamin that must be sourced from animal-derived foods or from supplements.{{cite web |author=Office of Dietary Supplements |date=6 April 2021 |title=Vitamin B12: Fact Sheet for Health Professionals |url=https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/ |url-status=live |archive-url=https://web.archive.org/web/20211008103749/https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/ |archive-date=2021-10-08 |access-date=24 December 2021 |publisher=US National Institutes of Health |language=en |publication-place=Bethesda, Maryland}}{{cite journal |vauthors=Vincenti A, Bertuzzo L, Limitone A, D'Antona G, Cena H |date=June 2021 |title=Perspective: Practical Approach to Preventing Subclinical B12 Deficiency in Elderly Population |url= |journal=Nutrients |volume=13 |issue=6 |page=1913 |doi=10.3390/nu13061913 |pmc=8226782 |pmid=34199569 |doi-access=free}} Only some archaea and bacteria can synthesize vitamin B₁₂.{{cite journal |vauthors=Watanabe F, Bito T |date=January 2018 |title=Vitamin B12 sources and microbial interaction |url= |journal=Exp Biol Med (Maywood) |volume=243 |issue=2 |pages=148–158 |doi=10.1177/1535370217746612 |pmc=5788147 |pmid=29216732}} Foods containing vitamin B₁₂ include meat, clams, liver, fish, poultry, eggs, and dairy products. Many breakfast cereals are fortified with the vitamin.

Sources of Vitamin B₂ (riboflavin):

Sources of Vitamin B₆:

Contact with health professionals is important in the fight against suicide, because it makes possible to detect suicidal intentions and attempts.

{{see also|Antidepressants and suicide risk}}

{{more medical citations needed|section|date=May 2024}}

Common treatments may include antidepressants, antianxiety, antipsychotics, stimulants, mood stabilizers, and all kinds of SSRI medications. Alongside medications, a health team often includes therapy and other beneficial resources to support good outcomes for individuals and their communities.

The medication lithium may be useful in certain situations to reduce the risk of suicide.{{cite journal |last1=Smith |first1=Katharine A |last2=Cipriani |first2=Andrea |date=November 2017 |title=Lithium and suicide in mood disorders: Updated meta-review of the scientific literature |url=https://ora.ox.ac.uk/objects/uuid:e41f3269-0bb0-40e4-8fe3-22fc598b4743 |journal=Bipolar Disorders |volume=19 |issue=7 |pages=575–586 |doi=10.1111/bdi.12543 |pmid=28895269 |s2cid=39221887 |archive-date=2022-04-26 |access-date=2020-08-30 |archive-url=https://web.archive.org/web/20220426124916/https://ora.ox.ac.uk/objects/uuid:e41f3269-0bb0-40e4-8fe3-22fc598b4743 |url-status=live |url-access=subscription }} Specifically, it is effective at lowering the risk of suicide in those with bipolar disorder and major depressive disorder.{{cite journal |author=Coppen A |year=2000 |title=Lithium in unipolar depression and the prevention of suicide |journal=J Clin Psychiatry |volume=61 |issue=Suppl 9 |pages=52–6 |pmid=10826662}} Some antidepressant medications may increase suicidal ideation in some patients under certain conditions.{{cite journal |last1=Teicher |first1=Martin H. |last2=Glod |first2=Carol A. |last3=Cole |first3=Jonathan O. |date=March 1993 |title=Antidepressant Drugs and the Emergence of Suicidal Tendencies |journal=Drug Safety |volume=8 |issue=3 |pages=186–212 |doi=10.2165/00002018-199308030-00002 |pmid=8452661 |s2cid=36366654}} Medical professionals advise supervision and communication during the usage of these medications.{{Cite web |title=Antidepressants |url=https://medlineplus.gov/antidepressants.html |access-date=2024-04-29 |website=medlineplus.gov |archive-date=2017-03-18 |archive-url=https://web.archive.org/web/20170318084114/https://medlineplus.gov/antidepressants.html |url-status=live }} In case of a psychiatrist prescribes any of the medications, the problem would be taken to the field of psychiatry, with its own contexts and plannings, that are usually more rigid than those of other fields.

It is also important that, in a proportion of cases of use of drugs to prevent suicide, a "paradoxical reaction" can happen, consisting of an increase in suicidal intention,{{Cite journal |last1=Valuck |first1=Robert J. |last2=Orton |first2=Heather D. |last3=Libby |first3=Anne M. |title=Antidepressant discontinuation and risk of suicide attempt: a retrospective, nested case-control study |url=https://pubmed.ncbi.nlm.nih.gov/19758520/ |journal=Journal of Clinical Psychiatry |date=August 2009 |volume=70 |issue=8 |pages=1069–1077 |doi=10.4088/JCP.08m04943 |pmid=19758520 |archive-date=2020-07-26 |access-date=2024-07-15 |archive-url=https://web.archive.org/web/20200726174814/https://pubmed.ncbi.nlm.nih.gov/19758520/ |url-status=live }} mainly on the following occasions: the beginning of the period of taking the medication, any change of dose to adjust it, and the end of its intake period (its abandonment or discontinuation). Therefore, a bigger caution is recommended at that times.File:Tromsøbrua suicide prevention fence 2008-06-28 (cropped).jpg]]

Physical protection systems, such as barriers and anti-suicide nets, are sometimes installed in bridges, buildings and other dangerous points, to prevent suicides in them. The decision can be influenced by the frequent use for suicide attempts of those dangerous points, and the possibility of hurting someone else in those attempts (something very feasible if jumping from skyscrapers and similar situations). Sometimes, the problem is not a possible use of those points for suicide, but a simple lack of security in them that makes people to be involuntarily exposed to the danger of accident.

Some plans try to avoid suicide by avoiding previous problems that could produce it. For example: violence in a relationship, in the family, school bullying, workplace mobbing, and any other. The World Health Organization recommends "specific skills should be available in the education system to prevent bullying and violence in and around the school".{{cite book |title=Preventing suicide: a resource for teachers and other school staff |date=2000 |publisher=World Health Organization |hdl=10665/66801 |hdl-access=free}}

Prevention of suicide also implies informing to the general public, or only to a sector, about the signs of suicide, to be able to detect them, and about the existing means of help. Informative campaigns must be correctly made to work as planned. In a review of communication campaigns against suicide, only two studies of three considered that the effect of those campaigns was positive.{{Cite web |last=Observatoire national du suicide (France) |year=2014 |title=Suicide - État des lieux des connaissances et perspectives de recherche |url=https://drees-site-v2.cegedim.cloud/sites/default/files/2021-01/rapportons2014-mel.pdf |archive-url=https://web.archive.org/web/20230403213936/https://drees-site-v2.cegedim.cloud/sites/default/files/2021-01/rapportons2014-mel.pdf |archive-date=2023-04-03 |language=fr}}

Whether or not mentions of suicide increase suicidal thoughts or thoughts of self harm is dependant on the context it is mentioned in and how it is presented.{{cite web |last1=Hammond |first1=Claudia |title=Does discussing suicide make people feel more suicidal? |url=https://www.bbc.co.uk/future/article/20140112-is-it-bad-to-talk-about-suicide |work=BBC Future |language=en}}

Recommendations around media reporting of suicide include not sensationalizing the event or attributing it to a single cause. It is also recommended that media messages include suicide prevention messages such as stories of hope and links to further resources.{{cite web |title=Recommendations |url=http://reportingonsuicide.org/recommendations/ |access-date=3 December 2019 |website=Reporting on Suicide |archive-date=8 April 2017 |archive-url=https://web.archive.org/web/20170408043809/http://reportingonsuicide.org/recommendations/ |url-status=live }} Particular care is recommended when the person who died is famous.{{cite book |last1=Organization |first1=World Health |title=Preventing suicide: a resource for media professionals |date=2017 |publisher=WHO |page=viii |hdl=10665/258814 |hdl-access=free}} Including specific details of the method or the location is not recommended.

There is little evidence, however, regarding the benefit of providing resources for those looking for help, and the evidence for media guidelines generally is mixed at best.{{cite journal |last1=Stack |first1=Steven |date=October 2020 |title=Media guidelines and suicide: A critical review |journal=Social Science & Medicine |volume=262 |pages=112690 |doi=10.1016/j.socscimed.2019.112690 |pmid=32067758 |s2cid=211159266}}

TV shows and news media may also be able to help prevent suicide by linking suicide with negative outcomes such as pain for the person who has attempted suicide and their survivors, conveying that the majority of people choose something other than suicide to solve their problems, avoiding mentioning suicide epidemics, and avoiding presenting authorities or sympathetic, ordinary people as spokespersons for the reasonableness of suicide.{{cite book |author=R. F. W. Diekstra |title=Preventive strategies on suicide}}

In the United States, the 2012 National Strategy for Suicide Prevention promotes various specific suicide prevention efforts including:{{cite book |last1=General (US) |first1=Office of the Surgeon |last2=Prevention (US) |first2=National Action Alliance for Suicide |title=Introduction |url=https://www.ncbi.nlm.nih.gov/books/NBK109906/ |publisher=US Department of Health & Human Services (US) |access-date=1 May 2020 |language=en |date=2012 |archive-date=13 February 2023 |archive-url=https://web.archive.org/web/20230213083603/https://www.ncbi.nlm.nih.gov/books/NBK109906/ |url-status=live }}

• Developing groups led by professionally trained individuals for broad-based support for suicide prevention.
• Promoting community-based suicide prevention programs.
• Screening and reducing at-risk behavior through psychological resilience programs that promotes optimism and connectedness.
• Education about suicide, including risk factors, warning signs, stigma related issues and the availability of help through social campaigns.
• Increasing the proficiency of health and welfare services at responding to people in need. e.g., sponsored training for helping professionals, increased access to community linkages, employing crisis counseling organizations.
• Reducing domestic violence and substance abuse through legal and empowerment means are long-term strategies.
• Reducing access to convenient means of suicide and methods of self-harm. e.g., toxic substances, poisons, handguns.
• Reducing the quantity of dosages supplied in packages of non-prescription medicines e.g., aspirin.
• School-based competency promoting and skill enhancing programs.
• Interventions and usage of ethical surveillance systems targeted at high-risk groups.
• Improving reporting and portrayals of negative behavior, suicidal behavior, mental illness and substance abuse in the entertainment and news media.
• Research on protective factors & development of effective clinical and professional practices.

Suicide prevention strategies focus on reducing the risk factors and intervening strategically to reduce the level of risk. Risk and protective factors unique to the individual can be assessed by a qualified mental health professional.File:SuicidePrevCDC.jpg{{cite web |date=11 September 2019 |title=Preventing Suicide {{!}} Violence Prevention {{!}} Injury Center |url=https://www.cdc.gov/violenceprevention/suicide/fastfact.html |access-date=3 December 2019 |website=www.cdc.gov |language=en-us |archive-date=26 March 2019 |archive-url=https://web.archive.org/web/20190326131411/https://www.cdc.gov/violenceprevention/suicide/fastfact.html |url-status=live }}|472x472px]]Some of the specific strategies used to address are:

• Crisis intervention.
• Structured counseling and psychotherapy.
• Hospitalization for those with low adherence to collaboration for help and those who require monitoring and secondary symptom treatment.
• Supportive therapy like substance abuse treatment, psychotropic medication, family psychoeducation and access to emergency phone call care with emergency rooms, suicide prevention hotlines, etc.
• Restricting access to lethality of suicide means through policies and laws.
• Creating and using crisis cards, an easy-to-read uncluttered card that describes a list of activities one should follow in crisis until the positive behavior responses settles in the personality.
• Person-centered life skills training. e.g., Problem solving.
• Registering with support groups like Alcoholics Anonymous, Suicide Bereavement Support Group, a religious group with flow rituals, etc.
• Therapeutic recreational therapy that improves mood.
• Motivating self-care activities like physical exercises and meditative relaxation.

Postvention is for people affected by an individual's suicide. This intervention facilitates grieving, guides to reduce guilt, guides to reduce anxiety and depression, and helps to decrease the effects of trauma. Bereavement is ruled out and promoted for catharsis and supporting their adaptive capacities before intervening depression and any psychiatric disorders. Postvention is also provided to minimize the risk of imitative or copycat suicides, but there is a lack of evidence based standard protocol. The general goal of the mental health practitioner is to decrease the likelihood of others identifying with the suicidal behavior of the deceased as a coping strategy in dealing with adversity.{{cite journal |author1=American Academy of Child and Adolescent Psychiatry |title=Summary of the Practice Parameters for the Assessment and Treatment of Children and Adolescents With Suicidal Behavior |journal=Journal of the American Academy of Child & Adolescent Psychiatry |date=April 2001 |volume=40 |issue=4 |pages=495–499 |doi=10.1097/00004583-200104000-00024 |pmid=11314578 |s2cid=1902038 |doi-access=free }}

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File:Beachy Head suicide phone.jpg, a major suicide spot in the United Kingdom]]

File:Sign of 113 suicide prevention.jpg

Many non-profit organizations exist, such as the American Foundation for Suicide Prevention in the United States, which serve as crisis hotlines; it has benefited from at least one crowd-sourced campaign.{{cite web|url=http://www.escapistmagazine.com/news/view/137409-GamerGate-Leads-to-Suicide-Prevention-Charity|title=GamerGate Leads to Suicide Prevention Charity - The Escapist|website=www.escapistmagazine.com|access-date=2014-09-12|archive-url=https://web.archive.org/web/20171014133906/http://www.escapistmagazine.com/news/view/137409-GamerGate-Leads-to-Suicide-Prevention-Charity|archive-date=2017-10-14|url-status=dead}} The first documented program aimed at preventing suicide was initiated in 1906 in both New York, the National Save-A-Life League, and in London, the Suicide Prevention Department of the Salvation Army.Bertolote, 2004

Suicide prevention interventions fall into two broad categories: prevention targeted at the level of the individual and prevention targeted at the level of the population.{{cite journal |last1=Bertolote |first1=Jose |date=October 2004 |title=Suicide Prevention: at what level does it work? |journal=World Psychiatry |volume=3 |issue=3|pages=147–151 |pmc=1414695 |pmid=16633479}} To identify, review, and disseminate information about best practices to address specific objectives of the National Strategy Best Practices Registry (BPR) was initiated. The Best Practices Registry of Suicide Prevention Resource Center is a registry of various suicide intervention programs maintained by the American Association of Suicide Prevention. The programs are divided, with those in Section I listing evidence-based programs: interventions which have been subjected to in depth review and for which evidence has demonstrated positive outcomes. Section III programs have been subjected to review.[http://www2.sprc.org/bpr/section-i-evidence-based-programs Best Practices Registry (BPR) For Suicide Prevention] {{webarchive|url=https://web.archive.org/web/20111031022002/http://www2.sprc.org/bpr/section-i-evidence-based-programs |date=2011-10-31 }}{{cite journal |vauthors=Rodgers PL, Sudak HS, Silverman MM, Litts DA |title=Evidence-based practices project for suicide prevention |journal=Suicide Life Threat Behav |volume=37 |issue=2 |pages=154–64 |date=April 2007|pmid=17521269 |doi=10.1521/suli.2007.37.2.154 }}

• American Foundation for Suicide Prevention
• Befrienders Worldwide
• Campaign Against Living Miserably
• Crisis Text Line
• International Association for Suicide Prevention
• The Jed Foundation
• National Suicide Prevention Lifeline
• Samaritans
• Suicide Prevention Action Network USA
• Trans Lifeline
• The Trevor Project

In the United States it is estimated that a suicide results in costs of about $1.3 million. The loss of productivity from the deceased individual accounts for 97 percent of these costs. The remaining 3 percent of the costs were from medical expenses. Money spent on intervention programs is estimated to result in a decrease in economic losses that are 2.5-fold greater than the amount spent.{{cite web|title=Costs of Suicide|url=https://www.sprc.org/about-suicide/costs/|website=www.sprc.org|access-date=6 March 2018|language=en|archive-date=16 April 2019|archive-url=https://web.archive.org/web/20190416084758/https://www.sprc.org/about-suicide/costs|url-status=dead}}

{{Columns-list|colwidth=30em|

• Advocacy of suicide
• Caring letters
• Coping planning
• Crisis intervention
• Euthanasia
• List of suicide crisis lines
• Mental health first aid
• Psychological first aid
• Suicide awareness
• Suicide prevention contract
• World Suicide Prevention Day

}}

{{Reflist}}

• {{cite web | last=Pappas | first=Stephanie | title=New research in suicide prevention | date=25 Aug 2021 | url=https://www.apa.org/monitor/2021/09/news-suicide-prevention}} American Psychological Association
• [https://www.camh.ca/en/hospital/health_information/a_z_mental_health_and_addiction_information/suicide/Documents/sp_handbook_final_feb_2011.pdf Suicide prevention and assessment handbook], Centre for Addiction and Mental Health, 2011.
• {{cite book|author1=Nancy Boyd-Franklin|author2=Elizabeth N. Cleek|author3=Matt Wofsy|author4=Brian Mundy|title=Therapy in the Real World: Effective Treatments for Challenging Problems|chapter-url=https://books.google.com/books?id=WibZ-LMdS2UC&pg=PT341|year=2013|publisher=Guilford Press|isbn=978-1-4625-1034-4|page=341|chapter=Risk Assessment and Suicide Prevention}}
• {{cite journal |last1=Van Orden |first1=Kimberly A. |last2=Witte |first2=Tracy K. |last3=Cukrowicz |first3=Kelly C. |last4=Braithwaite |first4=Scott R. |last5=Selby |first5=Edward A. |last6=Joiner |first6=Thomas E. |title=The interpersonal theory of suicide |journal=Psychological Review |date=2010 |volume=117 |issue=2 |pages=575–600 |doi=10.1037/a0018697 |pmid=20438238 |pmc=3130348 }}

• [https://www.cdc.gov/violenceprevention/suicide/ CDC website on Suicide Prevention]
• [http://www.sprc.org/ The Suicide Prevention Resource Center (SPRC)] provides prevention support, training, and resources to assist organizations and individuals to develop suicide prevention programs, interventions and policies, and to advance the National Strategy for Suicide Prevention.
• [http://www.suicideinfo.ca/ Centre for Suicide Prevention (CSP), Canada]
• [https://web.archive.org/web/20101225145546/http://www.sprc.org/library/prevtoolkit.pdf Suicide Prevention:Effectiveness and Evaluation] A 32-page guide from SPAN USA, the National Center for Injury Prevention and Control, and Education Development Center, Inc.
• [http://www.iasp.info/ International Association for Suicide Prevention] Organization co-sponsors World Suicide Prevention Day on September 10 every year with the World Health Organization (WHO).
• [http://www.surgeongeneral.gov/library/calltoaction/calltoaction.htm U.S. Surgeon General – Suicide Prevention]
• [http://www.mentalhealth.va.gov/docs/suicide_risk_assessment_reference_guide.pdf Suicide Risk Assessment Guide – VA Reference Manual]
• [http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/suicide.pdf Practice Guidelines for Suicide prevention, APA]

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Category:Counseling