R. Murali Krishna, M.D., president and COO, INTEGRIS Mental Health and the James L. Hall Jr. Center for Mind, Body and Spirit

Every minute, someone in the United States attempts suicide. Every 15 minutes, someone succeeds in that attempt and a life is lost, a family is shattered, and a shadow of pain and questioning falls upon friends and acquaintances.

When someone attempts or commits suicide, people close to that person usually have one immediate question: Why? At the deepest levels, the reasons for suicide are varying mixes of biology, genetics and brain chemistry. We know tendency toward suicide can run in families. And medical research has found that the brains of people who commit suicide have lower levels of serotonin activity than the brains of other people.

Whatever the causes are at deeper levels, they generally find expression in one of several ways. Overwhelmingly, people attempt suicide out of a sense of hopelessness. Many times the hopelessness is part of depression. But sometimes the hopelessness is circumstantial, such as crises in important relationships or personal finances. Whatever the cause, people who attempt suicide see the future as overwhelmingly bleak, and believe that leaving the world altogether is the only solution to problems that seem unbearable.

People also commit suicide out of a sense of desperation – a feeling that life is impossible without changes that seem beyond the realm of possibility. People with this sense of desperation feel they must do something, and sometimes that something is suicide.

Guilt may also be at the root of suicide. People who have survived a traumatic incident where others were killed or seriously injured sometimes develop what is known as survivor guilt. As part of that response, some people begin to hate or punish themselves. At its extreme, these feelings can lead to suicide.

Aggression and violence, which are natural biological drives, may drive a person to suicide if not handled in a healthy way. In a stress-filled professional world of escalating time conflicts, economic pressure and competition, these drives can be destructive. Studies demonstrate that people live longer and experience fewer ailments when they have lower levels of hostility and aggression. It's not much of a leap to deduce that they are less likely to commit suicide, too.

How can you know if someone is thinking of committing suicide? About 70 percent of people who commit suicide give clues as to what they are thinking. Some will make direct statements that they feel like killing themselves or that they don't know how much longer they can deal with the situation that is disturbing them. Others may even hint that they have acquired the means for suicide, such as saving up pills with which to take an overdose. Warning signs of suicide include:

• Deepening depression
• Talking about suicide
• Statements about hopelessness, helplessness or worthlessness
• Preoccupation with death
• Sudden happiness or calm
• Loss of interest in things one cares about
• Not visiting or calling people one cares about
• Setting one's affairs in order
• Giving things away
• Risk taking or self-destructive behavior, including increased alcohol or drug use or abuse
• Rage, uncontrolled anger or revenge seeking.

If you know someone who exhibits some of these warning signs, there are a number of steps you should take.

Listen. Empathize with their feelings and let them know you care. Be available and understanding.

Help them find other options. People in emotional crisis don't think clearly and may believe suicide is their only option. Help redirect thoughts into positive action and looking for solutions.

Buy time. Suicide is often an impulsive decision. Encourage the person to not make irreversible decisions while in crisis.

Call in others. Enlist the aid of someone else close to the person, such as a spouse, a friend or a caring employer. All can be important allies in the process. If the crisis seems acute, call 911, a suicide hot line, a hospital emergency room or a mental health center. In an acute situation, do not leave the person alone.

Offer to arrange for professional help. Let the person considering suicide know you are so concerned that you are willing to arrange for help beyond the immediate conversation you are having. Offer to call their psychiatrist or family physician or arrange for an evaluation of their emotional or mental health.

Overall, the sense you want to give to people considering suicide is that the suicidal crisis is temporary, they are not alone, help is available and they will survive the pain. By no means can you be certain that offering these assurances will prevent suicide. When people are suicidal, there are simply no guarantees. In the time it took you to read this article, five or six people in the United States attempted suicide. Perhaps someone even died from that attempt. By educating yourself, you're now better able to help someone who is considering suicide.

To Learn More
For more information on INTEGRIS mental health services, call the INTEGRIS Mental HealthLine at (405) 951-2273.

R. Murali Krishna, M.D., is president and COO of INTEGRIS Mental Health Inc., one of the state's largest providers of mental health services. He is also president of the James L. Hall Jr. Center for Mind, Body and Spirit. He has practiced psychiatry for more than 30 years and is a clinical professor of psychiatry at the University of Oklahoma Health Sciences Center.

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