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Suicidal ideation presents significant risks for those struggling with mental health issues. Through this lesson, you will learn how to define suicidal ideation and gain insight into the most effective ways for assessing risk.

What Is Suicidal Ideation?

Although it is one of the more unpleasant aspects of working in mental health, clinicians are often called on to assess whether or not a person is a threat to him- or herself or someone else. To make this determination, doctors and therapists consider whether or not a person is demonstrating suicidal ideation, which is defined as the actions and thoughts a person has about taking his or her own life.

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People demonstrating suicidal ideation may already have a plan for how they intend to kill themselves, may have already made an attempt at self-harm, or might just be seriously considering it. In many cases, suicidal ideation is grounds for having someone hospitalized involuntarily in order to keep that person from inflicting self-harm, which makes an accurate assessment of considerable importance. There are some cases in which a quick assessment of state of mind can be the difference between life and death.

Who Experiences Suicidal Ideation?

Mental illness is a major contributor to suicidal ideation. In a clinical context, suicidal ideation is most common among those experiencing profound depression or suffering from a psychotic disorder, like schizophrenia. Very often, suicidal ideation is preceded by feelings of extreme sadness, helplessness, loss of hope, and anhedonia, which is a loss of interest in things that a person once found enjoyable.In recent years, clinicians have discovered that suicidal ideation affects a disproportionate number of people living with borderline personality disorder. Though there are many symptoms of borderline personality, it is broadly an impairment that makes interpersonal relations incredibly difficult and causes seriously unstable moods, which can cause periods of profound depression.There are also certain cases where psychosis might be a motivating factor behind suicidal ideation; specifically, a person might be experiencing command hallucinations.

A command hallucination is a type of auditory or visual hallucination that prompts a person to say or do something. For example, a schizophrenic person might hear the voice of a deceased relative repeatedly telling the person suffering from schizophrenia to kill himself/herself.Other factors that may drive a person to consider taking his or her life include health problems, financial issues, relationship struggles and workplace problems. Whether they have made an attempt to end their life or are only considering it, most people who demonstrate suicidal ideation do not successfully follow through with their plan.

Nevertheless, it clearly poses a serious risk and should never be dismissed.

Assessing Suicidality

There is no universal approach to assessing suicidal ideation in a clinical setting; rather, it generally involves a series of interview questions. Prior to a mental health professional asking a person about suicidal feelings, it is important to establish a feeling of trust and sympathy. After all, in most cases the only measure of suicidal ideation will be a person’s self-reports, which means that he or she is the only one who can say whether or not there is a risk of self-harm.

An interview or a conversation is often the most effective way to assess suicidal ideation and provide support.

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Imagine that you’re working in an emergency department and your patient Jane tells you that she’s having suicidal thoughts. In order to assess Jane’s suicidal ideation you would begin by expressing sympathy and compassion, gently exploring what has led her to have such thoughts. This period is critical in establishing trust, which means that you don’t want to push Jane to tell you exactly what she’s thinking; rather, you want to ask broad questions about her employment, her relationships with friends and family, and so on.In your discussion with Jane, it becomes clear that she is experiencing chronic depression and has formulated a plan to end her life by overdosing on her medication, which she has been saving for the last month. At this point you need to gauge how serious she is, which you do by asking a series of questions about whether or not she has picked a location, written a note, or whether or not she has access to other instruments of self-harm, like a gun.Based on the information that you get through your seemingly casual conversation with Jane, you are able to better assess whether or not she is a threat to herself.

Given that she is experiencing profound depression, has already formulated a plan for how to end her life, and has the means with which to do it, you know this is a serious case that requires immediate attention.Keep in mind that asking questions in this manner is the best and often only way to measure a person’s suicidal ideation, which makes this a fragile and profoundly important interaction between the clinician and the patient.

Methods of Treatment

Regardless of whether or not a person actually plans to take his or her life, suicidal ideation is a fairly strong indication that an individual is experiencing a problem that requires some form of treatment. Given that, the form of the treatment will depend largely on what is motivating the feelings of suicidality and may involve an involuntary hospitalization.For example, if an individual is experiencing symptoms that align with depression or a mood disorder, that person may be treated using a combination of medication and psychotherapy to explore the causes of the depression. Coping skills can also be developed.If the symptoms are caused by a psychotic disorder, this, too, can be treated with therapy, but there will likely be a need for an adjustment or addition of medications to treat the hallucinations.

Lesson Summary

In the field of mental health, suicidal ideation is a term that refers to the actions and thoughts a person has about taking his or her life. More often than not, suicidal ideation can be preceded by a number of symptoms of depression or mood instability, including anhedonia, defined as a loss of interest in things that a person once found enjoyable. It is important to remember that this is not exclusive to those with depressive or psychotic symptoms and is common among those diagnosed with borderline personality disorder.Assessments of suicidal ideation often take place in a clinical environment and involve an interview in which the individual self-reports on his or her emotions and state of mind. In some cases, the cause can also be related to symptoms of psychosis, like command hallucinations, or auditory or visual hallucinations that prompt a person to say or do something. Regardless of the cause, suicidal ideation should always be taken seriously and be treated immediately.

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