The most confounding aspect of suicide is its taboo nature. It is a subject not to be mentioned, and surely not to be openly discussed. Therefore, the key to successful intervention is open and full-disclosure. Suicidal feelings or attempts must be thoroughly talked about. Family, mental health professionals and friends all need be part of ongoing discussions. There can be no secrets.
Next, a collective decision should be made about whether only inpatient treatment can truly insure a patient’s safety. If this is the consensus decision and the patient refuses, then involuntary hospitalization is the,“least bad” alternative. Even though inpatient can be extremely unpleasant, patients’ will be kept alive and given the message that their loved ones recognize how serious their suicidality really is. If drug and/or alcohol addiction is involved, then the patient may need to be transferred for detox before further psychiatric treatment.
Most suicidal patients suffer from a mood disorder. Also, alcohol and or other drugs are involved in most suicides. People with a mood disorder, in addition to experiencing highs and lows, are moody, irritable, impulsive, abuse alcohol and drugs and show decreases in judgment and insight. Unfortunately, such patients are at high-risk for suicide. Untreated, over the course of their lifetime, their risk of suicide is increased 20-fold. Nearly all these patients are depressed but have “treatment resistant depression” that does not respond to monotherapy with anti-depressants.
With regards to the most effective form of treatment, lithium is an incredible drug. It is the only psychiatric drug that is specifically anti-suicidal. Patients on lithium are 5-10 times less likely to attempt suicide compared to treatment with any other psychiatric drug. (See this psychiatric journal article that documents these assertions on “The suicide prevention effect of lithium”). It is extremely unfortunate that lithium is the most under-utilized drug in American psychiatry. As an unpatentable and naturally occurring, it is very inexpensive. Therefore, drug companies want psychiatrist to remain ignorant of the incredible efficacy of lithium and to instead use much more expensive drugs. They have gotten American psychiatrists to believe that lithium is an unsafe and out-dated drug. However, for the rest of the world, where drug companies do not control medicine, lithium remains by far the most utilized mood stabilizer.