Some facts about suicide we know:

Women attempt suicide twice as many times as men, but more men commit suicide because they typically use more deadly means (e.g., guns vs. pills).

Although a single event may precipitate suicide, it typically follows long periods of depression, hopelessness, helplessness, low self-esteem, low self-worth, social isolation, feelings of abandonment, hostility toward self or others, and/or feeling overwhelmed.

Adolescent suicide has increased substantially in recent years and is currently one of the leading causes of death for this age group.

Additional signs:withdrawal from familiar supports, concentration or sleep difficulties, dramatic change in appearance or activity, preoccupation with death, self-destructive behavior, and excessive guilt. School counselors may be interested in the Signs of Suicide (SOS) program (http://guidehelpingamericasyouth.gov/programdetail.cfm? id=656).

Suicide may result from an impulsive act, but it is more often communicated to others who are not aware of the meaning of the clues.

Many times, people are undecided up to the last minute and are hoping that someone will hear their pain and will save them.

Listen for telling verbalizations: "I can't take it anymore." "No one cares if I am around." "There is nothing more that I can do." "I feel so alone and hopeless."

The risk for suicide is greater for a person coming out of a crisis or deep depression. At this time, the energy levels are high enough to carry out the plan.

Watch for sudden improvements in symptoms - the individual may feel happier now that he or she believes that a "solution" has been found.

Be alert when the individual is uncharacteristically tending to unfinished business, making amends, giving away valued possessions. This may indicate that he or she is preparing for "the end."

It is imperative to assess for suicide with a person who is depressed. Encouraging a client to talk about suicide helps him or her articulate suicidal thoughts. It also allows for a situation in which the helper can convey empathic understanding and emotional support - both of which are needed by someone in this situation.

Assessing or encouraging someone to talk about suicide does not "introduce the idea." Doing so without disparaging or judgmental reactions shows that the helper is taking the person seriously and is responsive to his or her needs, feelings, fears, and pain.

Please share your initial thoughts after reading over these facts. What are some preconceived ideas of suicide that you hold?

What comes up for you in preparing to work with suicidal clients?