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nature of suicide. We need to learn a lot more. Jacobs (1999) has
edited a comprehensive book covering suicide assessment and
intervention. It is mostly by and for physicians or psychotherapists,
costs $75, and needs to be updated, but its 48 experts cover in depth
a wide variety of special topics in this complex area. For a good
discussion of assessing and intervening with adolescents see Kirk
(1993).
It is true that a quite a bit is known about the kinds of people who
kill themselves—we know many of their characteristics, particularly
what groups they belonged to (such as age group, suffered serious
losses, fought with spouses, had addictions, etc.) but these group
characteristics are not closely linked to suicide in every individual case.
Most people in these groups do not die by suicide. It is important to
recognize that accurate predictions of suicide are almost impossible if
you are trying to judge or predict if one specific person will live or die
in the next year. On the other hand, it is pretty easy to determine how
many in a town or an organization or a state have killed themselves in
the last year and then predict how many within that group will kill
themselves in the future over the same period of time. Why is it so
hard to make individual predictions? Because suicide is such a rare
event that the most statistically accurate prediction is “he will probably
be alive this time next year.”
For a specific group of 100,000 people, the yearly suicide death
rate is likely to be somewhere around 10 because that is the national
average in the US. Note: when predicting deaths in a group such as
this, we don’t have to say exactly which 10 of the 100,000 will die. But
when considering just one person, Joe Smith, the best bet almost
always is that he will be alive like 99,990 other people in the group
and not be one of the 10 that die of suicide. The best tests and the
best experts can not predict well enough to overcome those odds.
However, clinical judgment, plus a good history of the individual, the
right questions, and several psychological tests may detect significant
“warning signs” (such as thinking of suicide, drinking problems and
previous attempts) which can certainly increase the accuracy of
estimating the risk of suicide for a specific person. Thus, an
experienced clinician might judge that “the risk of suicide for Joe Smith
is very high,” meaning a constant suicide watch is advisable. Perhaps
the clinician thinks there is one chance out of three of Joe Smith dying
of suicide within a year. That is a very dangerous risk requiring many
precautions with Joe but Joe’s death can’t be predicted with any
certainty. Soon we will discuss more of the indicators or warning signs
of suicide which are, at best, crude predictors that we can use for now.
However, for a moment, it is also appropriate to view the
prediction situation from the standpoint of a professional helper who is
expected (legally required?) to do a systematic suicide risk
assessment. This overall assessment has to be thorough and accurate
enough to take reasonable steps to prevent suicide. The therapist has
to act promptly enough to care for the patient until the treatment and
medication start having a beneficial effect. This initial stage of
