An Accessible Guide for Understanding and Managing Suicidality

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Suicide is a pressing public health concern affecting individuals across the globe. The pathways leading to suicidal thoughts and actions are complex, involving a myriad of factors ranging from biological and psychological to social and environmental.

The Integrated Motivational-Volitional (IMV) Model offers a comprehensive framework to help us understand and manage suicidality. This model breaks down the process into three phases: the pre-motivational phase, the motivational phase, and the voluntary phase. Let’s delve into each of these phases and discuss practical strategies for managing suicidality.

The Integrated Motivational-Volitional Model: A Roadmap to Understanding Suicidality

Imagine the journey to suicidal behaviour as a river with three distinct segments:

  1. The Source (Pre-Motivational Phase): This is where the river begins, fed by various streams representing different background factors such as genetic predispositions, early life experiences, and socio-economic conditions. Just as streams merge to form a river, these factors create a backdrop that can increase vulnerability to suicidal thoughts.
  2. The Rapids (Motivational Phase): As the river flows, it encounters rapids caused by intense psychological experiences. Here, feelings of defeat and entrapment churn like turbulent waters, leading to the formation of suicidal thoughts. This phase highlights how overwhelming life events and internal struggles can make individuals feel trapped and hopeless.
  3. The Waterfall (Volitional Phase): Finally, the river reaches a waterfall, representing the transition from suicidal thoughts to actions. Various factors, known as volitional moderators, such as access to means, exposure to suicide, and impulsivity, determine whether an individual goes over the edge and attempts suicide.

Breaking Down the Phases

Pre-Motivational Phase: This phase involves the underlying factors that set the stage for suicidal thoughts. These include:

  • Genetic and Biological Factors: Just as some rivers are naturally prone to flooding, some individuals have a genetic predisposition to mental health issues. For example, a family history of depression or anxiety can increase one’s susceptibility.
  • Early Life Experiences: Traumatic events in childhood can create emotional scars, much like pollution entering the river upstream. Experiences such as abuse, neglect, or loss can significantly impact one’s mental health.
  • Socio-Economic Conditions: Poverty, unemployment, and social isolation can erode mental health, similar to how deforestation can destabilise riverbanks. Economic hardship and lack of social support can lead to feelings of despair and hopelessness.

Motivational Phase: Here, the focus is on the psychological processes that lead to suicidal ideation:

  • Defeat and Humiliation: When individuals feel they have failed or been humiliated, it can create powerful currents of negative emotions. These feelings can stem from personal, professional, or social failures, leading to intense emotional pain.
  • Entrapment: The sense of being trapped with no way out acts as the force driving these currents towards dangerous rapids. This could be due to ongoing stressful situations, such as an abusive relationship or a toxic work environment, where the person feels there is no escape.

Volitional Phase: This phase determines whether suicidal thoughts translate into actions:

  • Access to Means: The availability of tools or substances for self-harm increases the risk, much like a clear path to the waterfall’s edge. Ensuring that harmful means are not easily accessible can significantly reduce the likelihood of an attempt.
  • Exposure to Suicidal Behaviour: Knowing others who have attempted or died by suicide can make the idea of suicide more conceivable. This is similar to how seeing others navigate the rapids might make one believe it is a viable path.
  • Impulsivity and Planning: Impulsive tendencies or detailed planning can push individuals closer to the brink. Those who are more impulsive might act on suicidal thoughts without fully considering the consequences, while those who meticulously plan might feel more committed to their decision.

Applying the IMV Model: A Case Study

Meet Jane is an imaginary character. She is a 35-year-old woman who has been struggling with depression and anxiety. Jane’s journey can be mapped onto the IMV model to understand her suicidal behaviour:

Pre-Motivational Phase:

  • Jane grew up in a household where she faced emotional neglect, leading to deep-seated feelings of worthlessness. Her parents were often critical, and she lacked a sense of security and support.
  • She has a genetic predisposition to depression, as her mother also struggled with mental health issues. This genetic background makes her more vulnerable to developing depression.
  • Jane recently lost her job, which exacerbated her financial stress and social isolation. The loss also impacts her financial stability, self-esteem, and sense of purpose.

Motivational Phase:

  • Jane feels defeated by her inability to maintain stable employment and experiences intense humiliation from what she perceives as repeated failures. Every job application rejection deepens her sense of inadequacy.
  • She feels trapped in her situation, believing there is no way to improve her circumstances. Jane’s mounting debts, including from gambling and lacks of a support network, making her feel like there is no escape from her predicament.

Volitional Phase:

  • Jane has access to medication that she is considering using for an overdose. She keeps her prescribed antidepressants in an easily accessible location.
  • She recalls a friend’s recent suicide, which has made the idea of ending her own life more tangible. This friend’s suicide has left a profound impact on her, making suicide seem like a potential solution.
  • On particularly bad days, Jane experiences impulsive urges to harm herself, which she struggles to control. These urges often come suddenly, leaving her feeling overwhelmed and vulnerable.

Managing Suicidality: Practical Strategies

Understanding the IMV model provides a foundation for addressing suicidality at different stages. Here are some strategies for managing suicidal thoughts and behaviours on your own, with the help of friends, and with professional support.

Self-Management

  1. Recognise Triggers: Identify situations, thoughts, or feelings that increase your distress. Keep a journal to track these patterns. For instance, Jane might notice that her suicidal thoughts are more intense after job rejections or arguments with her family.
  2. Develop Coping Skills: Engage in activities that help you manage stress, such as exercise, mindfulness, and hobbies you enjoy. Regular physical activity can boost mood, while mindfulness practices can help you stay grounded.
  3. Safety Planning: Create a safety plan that includes emergency contacts, coping strategies, and steps to take when you feel overwhelmed. Write down who you can call, what you can do to distract yourself, and places where you feel safe.
  4. Limit Access to Means: Remove or secure items that you might use to harm yourself. For Jane, this could mean giving her medication to a trusted friend or locking it away in a safe place.

Leveraging Support from Friends

  1. Open Communication: Share your struggles with trusted friends who can provide emotional support and understanding. Jane could tell a close friend about her feelings and ask for regular check-ins.
  2. Buddy System: Arrange regular check-ins with a friend to ensure you have consistent support. This could be daily text messages or weekly meet-ups to talk and provide mutual support.
  3. Encouragement: Friends can help motivate you to engage in healthy activities and remind you of your strengths and achievements. They can encourage Jane to pursue her hobbies, join social groups, or take small steps towards her goals.

Professional Help

  1. Therapy: Cognitive-behavioural therapy (CBT) and other therapeutic approaches can help address negative thought patterns and build resilience. Therapists can provide tools and strategies to manage distressing thoughts and emotions.
  2. Medication: In some cases, medication prescribed by a psychiatrist can help manage symptoms of depression and anxiety. Jane might benefit from adjusting her current medication or exploring new treatment options.
  3. Crisis Intervention: If you are in immediate danger, seek help from crisis intervention services or hotlines (see the end of this document). They provide immediate support and can guide you to further resources. Knowing these resources are available can give a sense of safety and reassurance.
  4. Long-Term Support: Consider joining a support group for ongoing community and understanding from those who share similar experiences. These groups offer a space to share and listen, reducing feelings of isolation.

Expanding Understanding: Beyond the Basics

To further enhance our understanding of suicidality, it’s important to consider additional elements that influence the journey from suicidal thoughts to actions.

The Role of Social Media

In today’s digital age, social media plays a significant role in shaping our thoughts and behaviours. For some, social media can be a source of support and community, while for others, it can exacerbate feelings of loneliness and inadequacy. It’s crucial to curate your social media experience by following supportive and positive accounts and limiting exposure to triggering content.

Addressing Stigma

The stigma around mental health and suicidality can prevent individuals from seeking help. It’s essential to foster an environment where talking about mental health is normalised and encouraged. This can be done through education, open conversations, and promoting mental health awareness campaigns.

Building Resilience

Resilience is the ability to bounce back from adversity. Building resilience involves developing a positive mindset, fostering supportive relationships, and learning effective coping strategies. Practicing gratitude, setting realistic goals, and maintaining a hopeful outlook can strengthen resilience over time.

The Importance of Self-Compassion

Self-compassion involves treating yourself with the same kindness and understanding that you would offer to a friend. When facing difficult times, it’s important to acknowledge your struggles without judgment and remind yourself that seeking help is okay.

Why Professional Advice is Vital for Overcoming Suicidal Thoughts and Behaviours

Suicidal thoughts and behaviours are serious and complex issues that require professional intervention. Professional advice is crucial because mental health professionals have the training and expertise to provide effective support and treatmentHere are some key reasons why seeking professional help is vital:

  1. Expertise and Training: Mental health professionals, such as clinical psychologists, have extensive training in understanding and treating mental health conditions. They can offer evidence-based treatments tailored to individual needs.
  2. Assessment and Diagnosis: Professionals can assess the severity of suicidal thoughts and behaviours, identify underlying mental health conditions, and provide an appropriate diagnosis. This ensures that the treatment plan addresses all relevant issues.
  3. Crisis Management: In times of acute crisis, mental health professionals can offer immediate support and intervention, helping to stabilise the individual and prevent harm. They can also develop safety plans to manage future crises.
  4. Therapeutic Techniques: Professionals use various therapeutic techniques, such as Cognitive-Behavioural Therapy (CBT) and Dialectical Behaviour Therapy (DBT), which have been proven to reduce suicidal thoughts and behaviours.
  5. Confidential and Safe Environment: Seeking professional help provides a confidential and non-judgmental space where individuals can openly discuss their thoughts and feelings. This supportive environment is essential for effective healing and recovery.

Overall, professional advice plays a critical role in providing comprehensive care, support, and guidance to individuals experiencing suicidal thoughts and behaviours.

List of Support Helplines

Here is a list of support helplines that provide immediate assistance and listening services for those in crisis. The list was last updated in May 2024.

  1. Samaritans
    • OverviewSamaritans offer a safe place for you to talk any time you like, in your own way – about whatever’s getting to you. You don’t have to be suicidal.
    • Contact: 116 123 (UK and Ireland)
  2. Mind Infoline
    • Overview: Mind provides information on various topics, including types of mental health problems, where to get help, medication and alternative treatments.
    • Contact: 0300 123 3393 or text 86463
  3. Shout
    • Overview: Shout is a 24/7 text service for anyone in crisis, anywhere. It’s a place to go if you’re struggling to cope and you need immediate help.
    • Contact: Text “SHOUT” to 85258
  4. Childline
    • Overview: Childline offers support to anyone under 19 in the UK with any issue they’re experiencing. It’s free, confidential, and available at any time.
    • Contact: 0800 1111
  5. CALM (Campaign Against Living Miserably)
    • Overview: CALM provides support to men of any age in the UK who are down or in crisis via its helpline and webchat.
    • Contact: 0800 58 58 58 or webchat via the website
  6. SANEline
    • OverviewSANEline is a national out-of-hours mental health helpline offering specialist emotional support, guidance and information to anyone affected by mental illness.
    • Contact: 0300 304 7000 (4.30 pm-10.30 pm daily)
  7. Papyrus HOPELINEUK
    • Overview: Papyrus provides confidential support and advice to young people struggling with thoughts of suicide and anyone worried about a young person.
    • Contact: 0800 068 41 41, text 07860 039967, or email [email protected]
  8. Switchboard LGBT+ Helpline
    • OverviewSwitchboard provides a one-stop listening service for LGBT+ people on the phone, by email and through instant messaging.
    • Contact: 0300 330 0630
  9. The Silver Line
    • Overview: The Silver Line is a free, confidential helpline providing information, friendship and advice to older people, available 24 hours a day.
    • Contact: 0800 4 70 80 90
  10. The Mix
    • Overview: The Mix offers support for young people under 25 with a range of issues, from mental health to relationships and drugs. They offer free, confidential help via online, social and mobile.
    • Contact: 0808 808 4994

Each of these helplines offers a unique form of support tailored to different needs and demographics, ensuring that anyone in crisis can find the help they need.

References

  1. O’Connor, R. C., & Kirtley, O. J. (2018). The integrated motivational-volitional model of suicidal behaviour. Philosophical Transactions of the Royal Society B: Biological Sciences, 373(1754). https://doi.org/10.1098/rstb.2017.0268
  2. World Health Organization. (2014). Preventing suicide: A global imperative. Geneva, Switzerland: WHO.
  3. Turecki, G., & Brent, D. A. (2016). Suicide and suicidal behaviour. The Lancet, 387(10024), 1227-1239. https://doi.org/10.1016/S0140-6736(15)00234-2
  4. Franklin, J. C., Ribeiro, J. D., Fox, K. R., Bentley, K. H., Kleiman, E. M., Huang, X., … & Nock, M. K. (2017). Risk factors for suicidal thoughts and behaviours: A meta-analysis of 50 years of research. Psychological Bulletin, 143(2), 187-232. https://doi.org/10.1037/bul0000084