Effective Treatment for Suicidality

Treating Acute and Chronic Suicidality Across Mental Health Conditions

When it comes to addressing suicidality, the conversation often focuses on managing suicidal crises, an obviously critical topic. But there is also a broader discussion to be had involving the ongoing management of suicidal thoughts.

In this session, Nowak and White discuss how treatment can help people manage and reframe suicidal thoughts.

Watch now to learn more about:

• How suicidality is related to various mental health conditions
• The difference between acute and chronic suicidality
• What treatments are available for suicidality

Nowak and White clarify that suicide is not a diagnosis in and of itself, but rather a symptom of several different mental health diagnoses.

Suicidality is seen in many mental health conditions, including major depressive disorder, bipolar disorder, schizophrenia, substance use disorders, and post-traumatic stress disorder.

White points out that chronic suicidality is more often observed in people with borderline personality disorder and various trauma conditions.

Nowak and White also differentiate between acute suicidality, which occurs when a person experiences an isolated crisis in which they want to take their own life, and chronic suicidality, in which someone has recurring thoughts of wanting to kill themself.

“Chronic suicidality is the pervasive and ongoing recurrent status of suicidal thoughts and behavior,” Nowak says. “Often, for people who experience [suicidality] in such a protracted, ongoing way, it can come without the accompaniment of specific plans or even the intent to carry out a suicidal act.”

She adds, “But [suicide] is something that’s very much in the foreground of a person’s awareness; it doesn’t go anywhere and it has a rigidity to it.”

According to Nowak and White, both acute and chronic suicidality are highly treatable. The experts point out that, over the years, several evidence-based models for treating suicidality have been developed.

For example, for people who experience chronic suicidality, dialectical behavior therapy (DBT) is one of the most frequently used approaches. DBT’s coping skills (based on mindfulness, distress tolerance, and emotion regulation) can also effectively be used for someone who is experiencing acute suicidality.

“At its core, DBT is geared toward building a life worth living,” Nowak says. “If you are a person experiencing suicidality, then life has become unbearable to you.”

“In dealing with chronic suicidality, there are various things that we take a look at,” White says. “We may have to take a step back and address any type of [co-occurring] issues, or any other type of diagnostic issues.”

White shares how he considers specific treatments for specific disorders. For example, medications, such as clozapine for schizophrenia or lithium for bipolar disorder, are important tools in treating suicidal ideation.

He points out that for people with substance use disorders, counseling and motivational interviewing can target the suicidal ideation that is frequently seen in this population.

He states it’s important to collaborate with patients about what is going to be helpful for them.

“Chronic suicidal ideation may develop into thoughts and plans,” he says. “We want to be able to engage in safety plans they will actually utilize—not just what’s written in the book, but what they will actually utilize to move forward and get into a safer situation.”

Audience Questions

• Is suicidality a clinical diagnosis or rather a symptom of a mental health diagnosis?
• What is chronic suicidality? How common is it?
• What do we know about the prevalence of chronic suicidality?
• To what degree is suicidality considered treatable?
• Can you talk about some of the mental health conditions that commonly co-occur with chronic suicidality?
• In considering distinctions between acute and more prolonged bouts with suicidality, what should we know in terms of handling a crisis versus dealing with more chronic suicidality?
• Can you talk about some of the work being done in an emergency setting?
• How does age factor into approaches for addressing chronic suicidality?
• What are some of the main treatment protocols for addressing chronic suicidality?
• Can you walk us through some of the basics of dialectical behavior therapy (DBT) and how it applies to the treatment of suicidality?
• What are some of the specific goals of DBT with respect to suicidality?
• Can you talk about some of the ways that you’ve used DBT in your work?
• Within the clinical world, how widespread is knowledge around DBT when it comes to addressing suicidality?
• What other treatment approaches beyond DBT might be used to address chronic suicidality?
• What are some of the possible treatment roadblocks for people living with suicidality?
• In terms of access, to what degree are individuals in crisis at the emergency setting level able to find longer-term treatment for suicidality?
• What are your thoughts on virtual psychiatry and therapy support?
• Is it common for someone to think about suicide, but not intend to take their own life?
• How should clinicians navigate having conversations about suicide, suicidal ideation, and non-suicidal self-injury with patients who may have “weaponized” these topics in the past to get something that they want, like more attention or time with the clinician after hours?
• What is the role of a loved one in supporting an individual who’s dealing with chronic suicidality?
• Can you speak to how clinicians might factor in cultural considerations when working with patients?
• Any suggestions for how clinicians can address concerns from patients with chronic suicidality who report that fatigue is impacting how people in their lives can support them?

The information discussed is intended to be educational and should not be used as a substitute for guidance provided by your health care provider. Please consult with your treatment team before making any changes to your care plan.

Resources

You may also find this information useful:

• 988 Suicide and Crisis Lifeline
• Video: Managing Grief and Loss
• Video: Suicide Prevention – Learning From Someone Affected by Suicide
• Dialectical Behavior Therapy: Your Toolbox for Managing Emotions
• Video: The Power of Dialectical Behavior Therapy
• Video: Application of Dialectical Behavior Therapy to Suicidality in Adolescents
• Suicide: Know the Signs and What To Do
• Video: Management of Chronic Suicidality
• Everything You Need To Know About Grief and Loss
• Access the full Heroes for Hope: Suicide Prevention course
• McLean’s suicide prevention resource hub

About Jill Nowak

Jill Nowak, MSW, LICSW, is an independently licensed clinical social worker and the director of admissions and referral liaison for McLean’s residential DBT program that treats adolescents and young adults struggling with emotion dysregulation, depression, trauma, and self-endangering behaviors.

About DeJuan White

DeJuan White, MD, is a physician with board certifications in general psychiatry, forensic psychiatry, and internal medicine. He is an associate professor in the Department of Psychiatry and Behavioral Sciences at Emory University School of Medicine. At Grady Memorial Hospital, he treats patients with behavioral health crises in the emergency setting.