Suicide and mental illness
The term mental illness refers to a group of illnesses, disorders or diseases that affect a person’s thought processes, perception of reality, emotions, or judgment, and could lead to disturbed behaviour. People living with mental illness may experience the following symptoms:
- auditory and visual hallucinations
- delusions
- disordered thinking
- impaired memory
- diminished concentration
- disruptions in sleeping patterns or appetite
- irritability
- lack of motivation
- flashbacks
- mood swings
- distress
Mental illnesses differ in terms of their severity and duration. A mental illness should be diagnosed by a mental health professional.
Suicide
Suicide is the main cause of premature death amongst people with mental illness. It is estimated that 10% of people with mental illness complete suicide within the first 10 years of receiving their diagnosis. Nonetheless, most people with mental illness who have attempted suicide or seriously thought about it go on to recover and live full and productive lives. The key elements of recovery include effective treatment, social support and time.
Suicide is a more common cause of death among people with schizophrenia and mood disorders such as bipolar disorder and depression, compared to general population. People with personality disorders and disorders of addiction also have higher rates of suicide than the general population.
People with mental illnesses therefore have a higher risk of suicide compared to the general population and are vulnerable to suicidal thoughts. A person’s suicide risk increases again if the person has more than one mental illness.
People recently discharged from psychiatric care also have a higher suicide risk, especially if the person was an involuntary patient, previously suicidal, or living alone.
Nonetheless, many people who experience mental illness do not have suicidal thoughts or engage in suicidal behaviour. In addition, not everyone who completes suicide has a mental illness.
Why do people with mental illness feel suicidal?
The pain and distress associated with mental illness can be so extreme that person feels an overwhelming desire to end their life.
Although mental illness is a significant risk factor for suicide, the relationship between suicide and mental illness is complex. Mental illness alone does not cause suicidal behaviour. People with mental illness may be dealing with negative life events and other difficult life circumstances in addition to the symptoms of their illness – it is an interaction between these factors that may result in suicidal behaviour.
Mood Disorders
Most people with mental illness who die by suicide will have experienced a mood disorder such as major depression or bipolar disorder.
Depression
- Six percent of people are affected by major depression. Although not necessarily the cause, depression is often a factor in suicidal thinking and behaviour.
- Adverse social circumstances such as unemployment, economic hardship, family conflict and social isolation may contribute to the development of depression for some people.
- In one study, people with depression reported high levels of negative life events before the onset of their depression. In the same study, people who attempted suicide reported four times as many negative events compared to the general population.
- People or groups prone to depression are at higher risk of suicide compared to the general population.
- In the early phases of recovery, people with depression may be at increased risk of acting due to a delayed response to treatment. It is therefore vital that family members and carers are educated about warning signs associated with suicide, and ways to estimate and minimise the risk of suicide.
- Problematic alcohol and drug use is often linked with depression. In this case, depression could either occur as a consequence of drug and alcohol abuse, or contribute to drug and alcohol abuse in situations where the person uses substances to cope with symptoms of depression.
Bipolar disorder
- One in five people with bipolar disorder will complete suicide.
- Whilst in the manic phase of their illness, people with bipolar disorder may overspend or make reckless decisions, leading to economic stress or other stressful situations that exacerbate suicidal thoughts.
- Whilst in the depressive phase of their illness, people with bipolar experience similar challenges to those diagnosed with major depression.
Schizophrenia
- One in ten people diagnosed with schizophrenia will complete suicide.
- Some people experiencing psychotic symptoms may attempt suicide because they are confused or instructed to suicide by auditory command hallucinations (voices).
- Others attempt suicide because they want relief from the psychotic symptoms connected to their illness.
Borderline Personality Disorder
- People with personality disorders are also at high risk of suicide.
- One of the symptoms of Borderline Personality disorder may be engaging in self-harm or suicidal behaviour. Self-harm brings temporary relief from distressing feelings. However, this may lead to accidental death for some people.
- People with borderline personality disorder may act in ways that throw their relationships into turmoil, giving rise to stressful situations or negative life events which could exacerbate suicidal thoughts.
Drug and Alcohol Abuse
- There are higher rates of suicide amongst people struggling with problematic drug and alcohol use compared to the general population.
- Sometimes when people use excessive amounts of drugs and alcohol, this is indicative of deliberate self-harm or a suicide attempt.
- In addition, the psychological and social consequences of alcohol and drug abuse may contribute to feelings of hopelessness and suicidal ideation.
Treatment to Reduce Suicide Risk
- Professional treatment is very important for people living with mental illness.
- In addition, providing a sense of caring, increasing social connectedness, and creating an empathic, secure, safe environment can reduce suicidal behaviours in this group.
- The person’s treatment plan needs to take into account the whole person. That is, cover the biological, psychological, social and familial factors impacting upon the person’s life, mental illness and suicidal thinking. Modalities such as medication, counselling, psychosocial rehabilitation and social support may be helpful.
- During a crisis, an admission to hospital may also be an option. It is vital that people are properly supported and followed up post-discharge. This involves exploring the circumstances that led to the person’s admission, and how will they manage work and other life stressors. Ongoing assessment of suicide risk is also very important.
Family and friends
The fear of suicide due to mental illness is a genuine concern for family members.
As a result of this fear, family members and friends may grapple with questions such as:
- How much care should I give?
- How much independence should I encourage?
- How many risks should the person realistically take whilst he or she is recovering?
The fear of suicide could possibly lead family members to become hyper-vigilant around the person. Friends and family members might also put their own lives second in an effort to protect the person living with a mental illness from suicide.
It is important to both minimise and manage the risks associated with suicide.