Suicide mitigation: a compassionate approach to suicide prevention†

Suicide r isk assessment and management are of significant importance in reducing the likelihood of a completed suicide. Psychiatrists have a responsibility to all patients experiencing suicidal thoughts, regardless of the presence of mental illness. A patient contemplating suicide, or one who has tried to take their life, will at the very least be experiencing personal distress that needs respectful consideration. Failure to treat these patients with understanding and com­ passion is likely to have a detrimental impact on their mental state (Hawton 2009). Therefore, clinicians should routinely ask patients with depression or emotional distress about thoughts of suicide and self­harm and suicidal behaviour (Cole­King 2011). The prediction of suicide is fraught with difficulty, and the level of accuracy is likely to be very low – a situation that leaves some clinicians feeling resigned to the futility of any actions taken to help keep a person safe (National Confidential Inquiry into Suicide and Homicide by People with Mental Illness 2010; Cole­King 2013, this issue). Consequently, it is prudent to take all suicidal thoughts with complete seriousness. Evidence also tells us that increasing hopeful­ ness, resilience and reasons for living reduces the suicide risk (McLean 2008). It is therefore proposed that the only safe response is to adopt a suicide mitigation approach (Cole­King 2010). Suicide mitigation is an active process to try to prevent suicide. It starts from the assumption that suicidal thoughts need to be taken seriously and met with compassion and understanding on every occasion in order to engage positively with the person. For the many suicidal individuals ambivalent about their wish to die, compassionate engagement can be the tipping point back to safety.