No objective test exists for suicidal thoughts – no X-ray to detect broken hope, no CAT scan to reveal intolerable emotional pain, no blood test to expose toxic intentions.
This reality is disappointing, even devastating. People understandably want professionals to predict and prevent suicide. For example, in the aftermath of the pilot Andreas Lubitz intentionally slamming a Germanwings plane into a mountain in the Alps, some people have called for airlines to screen pilots for suicidal thoughts.
There seems to be a hope that screening pilots for suicidal thoughts would automatically reveal which pilots secretly long to die. Unfortunately, it is not that simple.
The Benefits of Screening for Suicide Risk
Screening people for mental illness and suicidal thoughts undoubtedly identifies many people whose suicidal thoughts would otherwise remain hidden. And it appears that screening can save lives.
As Time Magazine reports, “When the U.S. Air Force began requiring annual suicide prevention and awareness training in 1995, including screening for mental illness, the suicide rate plummeted from about 16 suicides per 100,000 members to about 9.”
Suicide screening tools are used in primary care physicians’ offices, schools, the military, and more. Often, we simply cannot know if someone is considering suicide if we do not ask.
The Limits of Screening for Suicide Risk
Yet suicide risk screening is no panacea, for several reasons.
First, millions of adolescents and adults in the U.S. seriously consider suicide in any given year, and the vast majority – all but 40,000 – do not die by suicide. This means that suicidal thoughts alone do not convey whether the person is at high risk for suicide.
As Dr. Seena Fazel, professor of forensic psychiatry at University of Oxford, explained to NBC News:
“…If you apply a reasonably good [suicide] screen to 100,000 persons, for whom you expect 10 to die from suicide (based on population averages), this suicide screening tool would lead to eight correct screens, two missed suicides, but importantly nearly 30,000 persons who would be identified at high risk but would not die from suicide.”
And those are the people who reveal suicidal thoughts. Even when asked directly if they are thinking of suicide, many others keep such thoughts secret.
Screening people for suicidal thoughts is as effective as each person lets it be. It depends on the person’s honesty.
Why Do People Hide Suicidal Thoughts?
Many forces conspire against the honest disclosure of suicidal thoughts:
There is embarrassment, as if suicidal thoughts signify a weakness of character or will.
There is fear, a fear that others will judge, and perhaps, too, a fear of loss – loss of one’s job, loss of one’s identity, and loss of one’s freedom, too, if hospitalized.
There is hopelessness, a conviction that telling others of suicidal thoughts will do no good.
And then, most dangerous of all, there is on occasion determination – that is, determination to not be stopped from dying by suicide.
What Can We Do, Then?
With these realities in mind, we must recognize that there is only one way to learn about suicidal thoughts in people who do not volunteer or otherwise reveal their intentions: coax them out.
To coax the suicidal thoughts out, professionals need to skillfully ask questions, often posing the same question in different ways. As I explain in a different post, there are techniques for drawing out this kind of sensitive information.
Professionals can also look at situational crises, recent developments, risk factors and warning signs to form an opinion about whether a person is at high risk for suicide. Again, obtaining this information depends on skillfully asking questions, as well as looking at medical records and talking to people who know the person well.
If we want the suicidal person to open up, we also must provide an environment where it is safe to get help, safe to share what is terrifying to share, safe to make oneself vulnerable in a world with too much stigma, judgment, and hate.
What We Should Not Do
The reaction to the crash of the Germanwings flight, in particular the reaction to reports of the pilot’s apparent history of depression, creates the opposite environment of one that would help suicidal people feel safe to disclose their thoughts.
Some people question why pilots with depression would be allowed to fly. Yet a ban on flying would assure that pilots who have depression and who want to keep their jobs would not disclose their depression to others. Such pilots almost certainly would be less willing to seek professional help if a doctor or therapist had to report the results to the pilots’ employer.
And then what would we have? We would have pilots with depression flying planes carrying hundreds of passengers while feeling even more desperate and trapped than ever, unable to get help without tremendous loss to their career, professional identity, and income. This is a recipe that certainly will not improve passenger safety.
A Plan Beyond Magical Thinking
To help people from endangering others with their suicidal plans, we as a society must make it OK to ask for help.
We must be careful not to brand people with depression and suicidal thoughts as potential murderers, as if one suicidal pilot’s mass murder speaks for all people with depression. (In reality, many millions of people in the U.S. alone experience major depression every year. Among people who receive mental health services for depression, only 2% ultimately die by suicide, and roughly the same amount do physical harm to others.)
We must remain vigilant for suffering souls, and ask with compassion and concern about the welfare, feelings, and thoughts of those who are hurting.
We must stop stigmatizing mental illness and mental health treatment.
Coaxing out suicidal thoughts, by skillfully asking questions and creating an environment in which it is safe to answer honestly, is hardly an objective test to detect suicidal thoughts. But presently, in the absence of magic or medical advances, it is the best we can do.
© Copyright 2015 Stacey Freedenthal, PhD, LCSW, All Rights Reserved. Written for www.speakingofsuicide.com