Understanding the Final Loss of Self
Identifying the Vulnerable and Those Most at Risk
A well-known fashion icon takes her life, in the quiet and solitude of her New York Apartment, her young daughter safely at school and her husband in another location (Los Angeles Times, 2018). A culinary expert, known to millions of TV viewers with his exotic tours and foods, takes his life, days afterward, alone in a hotel room (Los Angeles Times, 2018).
Noted celebrities, in their midlife years, are not alone with possible indicators of frustration, loneliness, and depression.
It is probable that suicide can occur within our circle of friends, business associates, and our families (to include our children).
The American Academy of Child & Adolescent Psychiatry (AACAP, 2017), has reported that suicide is a leading cause of death for children, adolescents, and young adults, age 5 – 24 years old. Younger children suffer from sadness, confusion, and anger. Teenage suicide attempts may be accompanied by feelings of stress, self-doubt, disappointment, and loss. AACAP lists risk factors that include impulsivity, bullying, and feelings of hopelessness and rejection. Furthermore, children and adolescents may show changes in eating and sleeping, as well as sadness, withdrawal, physical problems, a decline in school work, and preoccupation with death.
The National Institute of Mental Health (2016) specifies that suicide is the 2nd cause of death in ages 10 – 34. Suicide is the 4th cause of death for ages 35 – 54.
Symptoms in adults at risk for suicide (American Foundation for Suicide Prevention, 2018), can include talk of hopelessness, increased use of alcohol/drugs, withdrawal/isolation, decreased activities, sleep changes, and fatigue. There can also be mood changes: depression, anxiety, anger, and sudden improvement (because of sudden mood changes or decision to end life/with resulting relief).
Author Bennett (2017), concerned regarding increases in elderly suicides, has indicated recent increases in suicides of adults near age 65. Adults age 85 and older have the highest rate of suicide among adults. Bennett has noted that only an approximate 3 percent of Medicare reimbursement has been for psychiatric care.
Evans & Radunovich (2018) have specified suicidal warning signs in the elderly: recent loss of person or pet, illness/pain, loss of independence, financial difficulty, depression, and isolation.
Ross (2014) has written that alcohol and drug abuse, without obvious depression, present another risk. People with substance abuse disorders are about six times more likely to commit suicide than the general population. One in three who died of suicide were under the influence of drugs, as they may have lost inhibitions and took risks.
The National Suicide Prevention Lifeline (Universal Health Services/Linkedin, 2018), indicated that 54% of suicides are actually by people without a definite mental health condition. Instead, factors include stress, health, housing, money, and employment problems.
The concept of stigma is another factor in suicide (Warrell, 2018). Fear of rejection, ridicule, and judgment often prevent people from seeking help for mental distress, mental illness, and thoughts of suicide.
Reaching, Helping, and Treating
Villano (2018) with concern for suicidal children and teenagers, has suggested giving our children tasks and taking time to express their value, monitoring social media influence, and talking with them about the subject of suicide.
The National Suicide Prevention Lifeline (2018) has indicated five steps to build a support network and make a safety plan for an individual at risk:
- Ask a person needing help about suicide intentions.
- Keep them safe, by asking about available weapons and medications. Call “911”, as necessary.
- Be there, in person—or on the phone.
- Help them connect (therapy or support groups).
- Follow up: with a call, postcard, and show you care.
The National Suicide Prevention Lifeline emphasizes the need to post its crisis call line in clinics, hospitals, schools, and all public places: 1-800-273-TALK (8255).
However, the National Suicide Prevention Lifeline warns about the concept of contagion. Contagion is the means whereby susceptible persons are influenced toward suicidal behavior by knowledge, and perhaps by sensational media coverage or other horrific suicidal acts.
The National Suicide Prevention Lifeline indicates the importance of crisis counseling, brief counseling with a focus to minimize stress, provide emotional support, and improve immediate coping strategies. Although similar to psychotherapy with assessment, planning, and specified treatment, the scope is more specific.
The San Francisco-Bay Area Institute on Aging (2018) has a 24-hour “friendship line” (instead of the suicide prevention terminology). Developed in 1973 by Dr. Patrick Arbore, goals are to provide elderly emotional support, help with grieving, and provide information about disabilities. This organization has emphasized that mental health services should be integrated into senior centers.
Occupational Therapy Treatment With Mentally Critical Clients
Many clients enter treatment settings secondary to severe depression and hopeless/helpless feelings. Activities of daily living, focus, coping, and self-awareness/ self-confidence can be diminished or absent.
This writer has helped clients in inpatient, outpatient, and community mental health settings. Therapeutic treatment in mental health settings starts with an assessment of ability to function in the areas of daily living, leisure, and work.
Formal assessments often can include the Allen Cognitive Levels-ACL (2018), which determines the ability to understand and complete tasks; the Kohlman Evaluation of Daily Living Skills-KELS (2016) helps identify safety and understanding of daily living activities; and the Canadian Occupational Performance Measure- COPM (2018) focuses on self-reported daily need areas, as explained by clients.
The Interest Checklist (1999) was developed at the University of Los Angeles Neuropsychiatric Institute to help clients identify and discuss interests in the past, present, and future.
Because the length of stay in mental health facilities can be as minimal as three days, an occupational therapist may wish to evaluate function with an informal assessment. With this format, a therapist asks questions about symptoms, living situation, stressors, description of a typical day, and will ask the client if he/she can indicate treatment goals.
In occupational therapy treatment, this writer has implemented craft activities that are chosen jointly by the client and therapist. Participation in craft activity can increase focus/concentration, ability to make decisions, help frustration tolerance and coping, provide practice in finishing a task, and promote a client’s self-esteem and sense of accomplishment.
Grooming groups can be offered to both men and women, with adequate staffing for safety concerns with supplies. Participation can increase awareness of a need for grooming, and within the process, improve one’s self-confidence. Community-minded cosmetic companies often are willing to donate cosmetic supplies in individual, sealed lipstick, hand, and facial creams. A creative therapist may wish to include a novel, natural egg white facial (checking first with staff and client about allergies/sensitivities).
Stress management techniques, discussions regarding coping strategies, and soft music relaxation can be a part of daily occupational therapy programming.
This writer founded a community support group for depression and anxiety. In this setting, clients are given an opportunity to share difficulties, experience group support, and receive therapist referrals, as needed, for individual therapy or hospitalization.
The occupational therapist in mental health settings must develop comfort in crisis situations. This writer, with other staff to help with a group setting, has provided individual time to talk with a select client experiencing thoughts that indicate increased depression and the possible idea of suicide.
Occupational therapists are in an ideal situation to teach resilience. Resilience training, according to the Suicide Prevention Resource Center (2018), includes helping clients develop a positive self-concept and optimism, in addition to life skills training. We can teach mindfulness (being aware of oneself, without judgment).
With the mental health occupational therapy understanding of symptoms, stress, and despair, we can promote self-forgiveness and ability to function.
Sylvia Plath, poet, novelist, and suicide victim wrote before her untimely death, “When our lives crack, is it not right to rest, to step inside, and heal?” (Hughes & McClullough,1956).
As human beings and therapists, we can actively listen to the losses, stressors, and expressions of sadness that may lead our family members, friends, associates, and clients to plan or impulsively turn to suicide.
According to Jamison (1999) a therapist, writer, teacher, and suicide survivor, we can be better informed about mental health and mental illnesses. We can be aware of the significance of alcoholism and drug abuse. We can continually seek suicide information and location of support groups, as well as medical and psychological resources for our clients.
When presented with the immense challenge of the prevention of suicide, we all have the unique opportunity and obligation to provide needed insight, comfort, and healing.
Los Angeles Times, Kate Spade. 6/5/18. www.Latimes.com/local/obituaries/la-me-kate-spade-20180605-story.html.
Los Angeles Times, Anthony Bourdain. 6/8/18. www.Latimes.com/focal/la-ct-anthony-bourdain20180608-story.html.
American Academy of Child and Adolescent Psychiatry (2107) AACAP. Org. No. 10; Updated October 2017. Suicide in Children and Teens. https://www.aacap.org/aacap/families_and_youth/Resource_Centers/Suicide_Resource_Center/Home.aspx.
The National Institute of Mental Health (2016). https://www.nimh.nih.gov/health/statistics/suicide.shtml.
American Foundation for Suicide Prevention. (2018). https://afsp.org/about-suicide.
Bennett, R. (9/06/2017). How Do We Stop the Elderly Epidemic? https://www.huffpost.com/entry/how-do-we-stop-the-elderly-suicide-epidemic.
Evans, G.D. & Radunovich, H.L. (2018). In University of Florida Extension. Warning Signs & How to Help. University of Florida, IFAS Extension eds.
Ross, C.C. (2014). Suicide: One of Addiction’s Hidden Risks. In http://www.Psychologytoday.com/us/201402/suicide-one-addictions-hidden-risks.
The National Suicide Prevention Lifeline (2018). Printed jointly with Universal Health Services on Linkedin, https://www.linkedin.com. 2018/09/25.
Warrell, M. The Rise and Rise of Suicide: We Must Remove the Stigma of Mental Illness. In https://www.forbes.com/sites/margiewarrell/2018/06/09/the-rise-and-rise-of-suicide-we-must-remove-the-stigma-of-mental-illness/.
Villano, L. (2018). The Teen Suicide Rate Has More Than Doubled. Here’s How You Can Save Your Child. In https://www.usatoday.com/story/life/allthemoms/2018/06/08/teen-suicide-how-help/685853002/.
San Francisco Area Institute on Aging. (2018). Friendship Line (elderly suicide prevention & chief services). Friendship Line, 415) 750-4111, 24 hour, established 1973, Dr. Patrick Arbore. https://www.ioaging.org.
Allen Cognitive Level Test. (2018). Allen Cognitive Group. Contact@allencognitive.com.
Kohlman Evaluation of Daily Living Skills (2016). Robnett, R.H. & Kohlman-Thompson, L. Google Books, May, 2016.
Canadian Occupational Performance Measure (2018). www.thecopm.ca.
National Suicide Prevention Lifeline (2018). https://suicidepreventionlifeline.org/.
The Interest Checklist. In American Journal of Occupational Therapy, Nov/December 1997, Vol 51, Pg. 815-823.
Sylvia Plath (Hughes & McCullough, 1956). “And , when our lives crack”, Sylvia Plath, March 6, 1956, in T. Hughes & F. McCullough, eds., The Journals of Sylvia Path. New York: Ballantine Books, 1983, pg. 125, as noted in Redfield Jamison, K. (1999). Night Falls Fast. Understanding Suicide. Pg. 399. Vintage Books, Division of Random House, Inc., N.Y.
Redfield Jamison, K. (1999). Night Falls Fast. Understanding Suicide. Pgs. 258,259. Vintage Books, Division of Random House, Inc., N.Y.
Suicide Prevention Resource Center (2018). Enhance Life Skills and Resiliency. https://www.sprc.org/comprehensive-approach%20/life-skills.