Notes from the Pastoral Counseling course by Dr. Jim Coffield at Reformed Theological Seminary, Orlando, FL

According to the World Health Association, in 2016, 1.5% of all deaths worldwide were caused by suicide.

In much of the world, suicide is stigmatized and condemned for religious or cultural reasons. In some countries, suicidal behavior is a criminal offence punishable by law. Suicide is therefore often a secretive act surrounded by taboo, and may be unrecognized, misclassified or deliberately hidden in official records of death. — World Health Organization (2002)

How to assess the potential risk of a suicide. 

1. History. 70% of those who commit suicide have had a previous attempt. Females attempt 3 time more often than males but are less successful. Men use more lethal means, guns, hanging; women use drugs, etc.

2. Definite warnings. 80% give warnings by giving away something or telling someone.

3. Age. Elderly and teenagers are more prone to suicide. Life is not what they thought it would be in the beginning or at the end of life. Many elderly people do this by not taking care of themselves.

4. Race. White male is most likely. African American woman least likely. Everyone else is in the between.

5. Gender. Male more likely than female.

6. Marital status. Divorced, separated and widowed most likely followed by single. Married is least likely. Most likely in first year after divorce. In teens after a break up of a relationship.

7. Life stress such as a failure at work or school.

8. History of mental disorders such as depression or bipolar disorder, drug and alcohol use. 

9. Physical illness especially chronic pain, terminal illness or long term illness.

10. Do they have intent, a plan and access to the plan?

• Do they have an intent?
• Do they have a plan? How specific is the plan?
• Do they have access to the plan? If they do not have a plan and access let it go.
• Speak the unspoken if you think they might be suicidal
• Ask them direct questions immediately.
• You won’t ‘give them the idea,’ they’re already thinking it.
• Listen for veiled threats such as ‘I wish I could go to sleep and not wake up;’ ‘I wish I could end it all;’ ‘If I had a gun;’ ‘Can I lose my salvation if I kill myself?’
• The goal is to buy time. Most people, given time, don’t want to die. Most want you to talk them out of it. They just want the pain to stop. Suicide is a permanent problem to a temporary situation.
• The more specific the plan and the more lethal the plan the more worried you should be.
• Get a no suicide agreement from them.
• Give them a 24 hour plan. Write down who could they call if they feel out of control again and agree to call those people.
• Make sure most common lethal methods are removed from their house. 
• Refer to it as ‘murdering yourself’ to emphasize the seriousness of the act.
• Tell them it is a selfish act – they don’t want to add this to their legacy for their children to follow.

11. As a counselor in some countries, you have a duty to warn them.

a. Inform them that you have a duty to warn, inform authorities, to break confidentiality. Try to buy time until the authorities get there.

b. Know the laws in your country. For example, the Baker Act in the U.S. allows police to hold a person in a mental institution for 48-72 hours if someone is suspicious of endangering themselves or others. A full psychiatric evaluation must be made during this time to confirm or not.

12. Coping with someone dying on your watch.

Remember that you could not have arranged the circumstances better to prevent it. Jesus let people walk away from him. Ultimately you are not responsible for the choices people make.

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Tags: Suicide