In 1992 the late Dr. Jock Cleghorn advised that only 2% of those with schizophrenia who commit suicide did so in response to their voices. Young men and those with chronic illness are more at risk. A good educational background and high performance expectations are also risk factors. Some people are more aware of their illness than others and fear for the future and possible deterioration. Suicide is more likely to happen in an upswing of the disorder, when the symptoms have abated a little and the person sees reality more clearly. Feelings of hopelessness may run high at this time. People often keep their thoughts of suicide very private. Rarely do professionals know how they feel. People are more likely to confide in family members, most naturally their mothers or close siblings. Talking about suicide should be taken seriously as it is often a plea for help. Most people who commit suicide have a history of depression or depressive features. They have taken a bleak view of the future.

The death of a loved relative may precipitate suicide. In the general population indicators for suicide are: loss of employment; loss of a girlfriend/boyfriend; inability to work; feelings of worthlessness. In the schizophrenic population any or all of these are often present. Suicide may be precipitated by easy access to a means of killing ones' self: living high up in an apartment building; access to a weapon. People often jump from bridges, throw themselves under a train or drown themselves. An overdose of medications saved up by the patient is often a method to be aware of. When a loved-one is in hospital, be sure that staff issue day, evening, or weekend passes judiciously, especially to young patients with chronic relapsing illness. Immediately following discharge from hospital people are very vulnerable. Quite often they are not yet stable. The incidence of suicide is high among people with mental illness at this time. Careful discharge plans should be made by the hospital team and the family. Sometimes families are not aware that the patient is to be discharged. Divorce of family member or self may be too much to bear.

 
"Copycat" effect

Hearing about a suicide may prompt the action in the person. (Some family organizations do not openly publicize suicides of members for fear other members will suffer the same fate.) Feelings of being alone, not having family or other support may influence a person who is already troubled. Suicide is more likely to happen when the family is away from home leaving the ill person behind. If the person lives in the family home, try not to leave him/her alone at home all day, every day if he seems more withdrawn or disturbed than usual. Persons living alone with few friends and very few visitors have a high incidence of suicide. If this is your situation, visit, phone or mail postcards or greetings cards regularly to keep in contact. Give your relative hope by speaking of the many advances in research and the new medications that will soon be available. Tell him/her that you want him/her to be around to benefit from a cure when one is found. Be particularly suspicious when someone's previously gloomy mood suddenly changes to cheerfulness without sufficient reason", says Health News of the University of Toronto. (This may apply, but would probably be difficult to separate from manic depressive or schizo-affective behaviour in some people).

People sometimes write poems, notes or other material dwelling on death or suicide when they are contemplating these. An informal study of local suicides prompts one group to suggest being especially vigilant and considerate of your relative in the Spring. This may be because Spring marks the beginning of new life and those who find life difficult may not see a new beginning for themselves. Set realistic house rules if the person lives at home. You are not dealing with a wayward child but a person coping with incredibly difficult symptoms. Issues of suicide should be addressed directly. Acknowledge with empathy the patient's view that death is one solution to the problem of the unbearable psychological pain.

Reproduced , with thanks, from the World Schizophrenia Fellowship pamphlet of the same name, January, 1996.

124 Merton Street, Suite 507, Toronto, Ontario, M4S 2Z2, Canada

http://www.world-schizophrenia.org/publications/23-suicide.html

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