Modern medical treatments have saved many who might have died by suicide.

Drugs and medicines commonly used in self-harm are safer in overdose than ever before. When available, protective (single-dose) packaging has lowered the amounts taken.

Emergency medical services, emergency rooms and intensive care units specializing in the care and treatment of acutely ill or injured persons have appeared over the past 35 years. These treatments do not appear to have affected the overall death or injury rate.

If we are ?saving? more people who self-harm and the suicide rate is relatively stable, there must be more people trying to harm themselves or complete suicide.

-          Hall and others, Association between antidepressant prescribing and suicide in Australia, 1991-2000, British Medical Journal, 2003

Suicide keeps on happening even with improvements in mental health treatments.

The modest impact of modern drug treatments in preventing suicide does not suggest these approaches are to be ignored or abandoned.

Lithium for people with serious emotional or mood disorders and the antipsychotic drug, Clozapine, for persons with schizophrenias or other psychoses are clearly able to diminish outcomes of suicide and self-harm.

The new antidepressants, which increase activity of the brain chemical Serotonin (5-HT), may be lifesaving in persons with violent and impulsive suicide attempts. The largest problem is making sure that persons who might benefit from these drugs receive them and receive them in adequate doses for a long enough period of time.

There are also mental disorders associated with suicide where drugs are not often a first or important treatment at present: personality disorders and substance abuse.

As is true with most mental health concerns, resources and research to aid persons with these disorders are often very poorly funded. It is unrealistic to expect a single approach (mental health drug therapy) to aid all persons at risk of suicide. After all, suicide is not a disease.

-          van Heeringen, The Neurobiology of suicide and suicidality, Canadian Journal of Psychiatry, 2003

Despite our best efforts, sometimes people die by suicide.

Biomedical care has saved many persons who self-harmed with lethal means and intent. Effective help is available for many of the concerns that may progress to self-harm.

There are those who are not helped despite these efforts. There are some who never ask for or even refuse help. There are some who never get the help that could be life saving. There are some for whom effective help could not be offered in time.

-          Grunebaum, Outcomes of suicidal behaviors, Clinical Neuroscience Research, 2001

There are a few people who will never be at risk of suicide.

It is estimated that one in eight people have enough reasons for living or other protective factors that thoughts of suicide will never be a consideration for them. No one knows the source of this resiliency.

Most persons who deliberately harm themselves do not come for help or treatment.

In a study of adolescent suicidal behavior, persons receiving hospital treatment for suicidal behaviors are counted. The numbers indicates that as few as 6% of the population who will attempt suicide at some time in their lives arrive at medical treatment facilities.

They may seek help from other non-medical resources. They may resolve the issues. They may die by suicide. We do not know. We do know that many persons at risk of suicide ? and especially men ? will not approach others for help because they fear being labeled or restrained.

Hope

Most suicides could be prevented.

There should be optimism in helping a person at risk. The largest majority of persons who consider suicide never act on these thoughts. Reasons for living often prevail.

A small gesture of support can be life saving.

    Deciding for or against suicide is not just a summing or balancing of reasons for living or dying. It often appears to be a matter of which side has the momentum or flow at the particular moment when the decision is made.

Although everything may be in favor of life, people still choose to end their lives. In the same way, strong reasons for death can be counterbalanced by the smallest reason for living.

Support from another when there is nothing left inside may tip the scales towards carrying on. It need not be solutions or even other choices that are offered. Sometimes it may mean just not being alone.

Understanding this is one of the core learning points of suicide first aid.

Suicide is something that can be talked about.

Stigma and taboo surrounded suicide for centuries in an effort to remove suicide from society. As a prevention strategy, it did not work.

Suicide is part of the human condition, but it is always a choice. Accepting this as a pain-full reality frees caregivers to explore, understand and do something to help a person at risk find better choices.

Preventing suicide also involves preserving and promoting life.

Suicide first aid is not just turning away from death. It is choosing to live, if only for the moment. To reinforce this choice, communities must not only honor life itself, but also be committed to making it worthwhile and meaningful. Every community can be made suicide-safer when it helps living work.

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