What is the alternative?
The risk-factor mindset is based on the biomedical illness model. Even though the notion of causality in itself is not always made explicit, this model is based on an idea of a linear cause-and-effect relationship that regards suicidal behaviour as the result of (caused by) various risk factors (6, 7). In terms of philosophy of science, however, speaking of causal explanations of human behaviour is questionable (8).
One alternative is to emphasise intentional/teleological explanations. Key questions in the assessment of suicide risk and its follow-up are consequently: What is communicated by suicidal thoughts or actions? What does this person wish to achieve through a suicidal act? What problems is this act intended to solve? (9) Thereby, the communicative aspect inherent in suicidality is included (9) – (11). Such questions will help reveal the subjective meaning(s) that the suicidality/suicidal act has for the individual.
Hereby, suicidality is linked to the context in which it appears. From the perspective of communication theory, suicidality is regarded not (only) as a matter within the individual, but as a matter between people – i.e. it is regarded in a relational and contextual perspective (11). This also includes the relationship between the client/patient and the therapist. For example, Jobes says that when suicidal persons seek help from a therapist, they are seeking for a relationship that may help them go back to wanting to live (12).
Belongingness and interaction in a given context provide a crucial background for understanding the meaning of suicidality to individuals, which in turn is important for being able to develop and provide adequate help (9). In clinical practice, understanding suicidality as communication may thus help the therapist to focus the treatment by systematically identifying the aspects that need to be reinforced, developed or changed in this person’s interaction with his or her specific environment. This has been described in several models (10, 11) and may, for example, relate to improving the patient’s self-perception, working to achieve a change in the environment or training in more appropriate communication skills.