Prevention of suicide in mental health care
In mental health care, suicide prevention largely appears to concern identifying and treating a presumed underlying mental disorder (2, 3). A well-established 'truth' is that at least 90 % of those who take their own lives have one or more mental disorders (4). Even though it has been documented that the evidence base for this ʻtruth' is weak (5), constant reference is made to it (6, 7). This helps to maintain the assumption that suicide is primarily linked to an underlying mental disorder. However, suicide is a complex relational phenomenon that cannot be understood independently of contextual factors (8).
We do not deny that a number of those who take their own lives may have one or several mental disorders. Nevertheless, suicide probably always involves something more than or something other than a mental disorder (9). Only a very small proportion of those with serious mental disorders take their own lives (10). A recent study shows that many of those who take their own lives have been in contact with the mental health service and/or interdisciplinary addiction treatment teams during the previous year (46.2 %) or in the course of their lives (66.6 %) (7). However, this gives an incomplete picture of what suicide entails.
But what underlies mental difficulties and/or addiction problems? What problems or living conditions contribute to the pain, despair, hopelessness and desperation that cause someone to see death as the best and perhaps the only solution? Moreover, clinical practice and research devote little attention to whether the treatment the person in question received – or did not receive – may have played a role in the suicide (11).
In keeping with the National guidelines for suicide prevention in mental health care (12), considerable focus has also been put on assessments of suicide risk and various safety measures, for example, intermittent observation or continuous observation of the patient.