The means matter in suicide

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depression lib INDEPENDENT MEDIA The writers say a complex strategy needs to be developed as many factors that lead to suicide are not psychiatric or medical. File photo: Thys Dullaart

Efforts to prevent suicide generally focus on the why. We provide support and care to those who are suicidal - trying to help resolve the problems that led to their hopelessness. This is a valuable and humane response.

But as we understand more about who attempts suicide and when and where and why, it becomes increasingly clear that how people attempt - the means they use - plays a crucial role in whether they live or die.

According to a pamplet released by Gun Free South Africa firearms are used in 14 percent of suicides in South Africa

Hangings account for 46 percent of suicides, followed by poisonings (17 percent) and firearms (14 percent).

Nearly 70 percent of all suicide victims are aged between 15-44 years. Deaths due to suicide are highest among youth aged 15-29 years (36 percent) followed by adults aged 30-44 (33 percent). There are four male suicides for every female suicide. The major external causes of suicide among males are hanging (50 percent) and firearms (15 percent); while among females it is poisoning (38 percent) and hanging (30 percent).

The pamphlet, developed by Gun Free South Africa (see: www.gfsa.org.za, email: [email protected]) from information developed by the Harvard Injury Control Research Centre, Harvard School of Public Health (http://www.hsph.harvard.edu/means-matter/downloads/ ) has the following information:

When do people take their lives?

Many suicide attempts occur impulsively during a crisis.

A study of people in the United States (US) who nearly died in a suicide attempt, were asked: “How much time passed between the time you decided to complete suicide and when you actually attempted suicide?”

* 24 percent said less than five minutes.

* Another 47 percent said an hour or less.

Although some people who die by suicide plan their act carefully, many don't. In fact, many take their lives within 24 hours of a crisis - like an argument with a family member or a relationship break-up. One third of youths who died by suicide in the US had faced a crisis within 24 hours .

Why do people take their lives?

Many factors lead individuals to try to end their lives. Drug and alcohol dependence and abuse, depression and certain other mental illnesses, impulsiveness and aggressiveness, family history of suicide, parental psychopathology, previous attempts, and recent losses or setbacks (like a relationship break-up, arrest, or job problem) are risk factors for suicide deaths and attempts.

The why of suicide is important, but a growing body of research indicates that how people attempt suicide is also important. Reducing access to lethal means is an effective way to increase the odds that a suicide attempt will end in care, not in death.

About 85 percent of attempts with a firearm are fatal: that's a much higher case fatality rate than for nearly every other method. Many of the most widely used suicide attempt methods have case fatality rates below five percent .

Reducing access to lethal means saves lives.

How do guns differ from other means?

Guns are more lethal. They're quick. And they're irreversible. Once the trigger is pulled, death usually follows within minutes. Attempters who take pills or inhale car exhaust or use razors have some time to reconsider mid-attempt and summon help or be rescued. The method itself often fails, even in the absence of a rescue. Even suicide attempters who use hanging can stop mid-way as about half of hanging suicides are partial-suspension (meaning the person can release the pressure if they change their mind) . With a firearm, once the trigger is pulled, there's no turning back.

Won't an attempter just substitute another method if no gun is available?

Often yes. But any method substituted will be less likely to kill - in some cases a lot less likely. Some attempters will die - particularly if they are very purposeful and determined, but more will live than if a gun was used.

Will an attempter go on to die by suicide later?

In the US, 90 percent of those who attempt suicide and survive - even when making very serious attempts like jumping in front of a train - do not go on to die by suicide later. Some 20-25 percent make another nonfatal attempt, but very few die by suicide, even 10-20 years later.

Putting time and distance between a suicidal person and a gun may save a life. So, what can you do?

1. Remove guns from the home

If you have firearms at home and a household member is suicidal or at risk (e.g. an impulsive teen, a person struggling with depression or drug or alcohol problems, or someone going through difficulties like divorce or arrest), seriously consider removing the guns from the home.

Procedure: Handing in a legal firearm

If you have a firearm that you want to get rid of you can either sell it or have it destroyed - you are not allowed to destroy it yourself. The only way you can legally sell a gun is to either sell it to a gun dealer or sell it privately, but you may not hand it to a new owner until that person has a licence for the weapon in question.

In order to have your firearm destroyed, you should undertake the following steps:

1. Make photocopies of the licence of the firearm you wish to have destroyed for your own records.

2. Go to your nearest police station during normal office hours taking your firearm and original licence with you.

3. Complete the SAPS 522(a) and 522(b) forms. Both forms can be downloaded from the www.saps.gov.za website.

4. State that you wish the firearm to be destroyed.

5. Obtain the following from the police officer assisting you:

* A copy of the SAPS forms for your records.

* The police officer's rank, name and force number.

* A contact number to follow up on the removal of the firearm from your/ licence holder's name.

* The SAPS 13 reference number for the firearm you have handed in. This number is the reference number for every piece of property/ evidence handed in to the police station. It consists of the name of the police station/ then SAPS 522/ then a sequential number/ year. Once a gun is officially registered as being in the custody of a police store, it will not easily disappear out of the back door, which is the anxiety of many people handing a firearm in for destruction.

* A receipt for the firearm.

6. Wait for one month and then confirm with the National Head Office, Statutory Administration that the firearm has been removed from your name in the Central Firearms Register. The telephone number is: (012) 353 6111, postal address: Private Bag X811, Pretoria, 0001.

7. If the gun has not yet been removed from your name, contact the police officer that helped you in the first place. Please note that the destruction of an individual firearm may take some time because it has to be sent to Logistics in Pretoria for melting or cutting into pieces.

8. If, after two months, your firearm has still not been removed from your name, you should inform the Station Commissioner of the police station you handed your firearm in at. You could also contact Gun Free South Africa for help, email: [email protected], call: 072 544 0573.

2. Store guns securely

Not having guns at home is safest. But if this isn't an option:

* Store guns locked and unloaded. South Africa's Firearms Control Act requires that a gun owner, “lock the firearm away in a prescribed safe, strong-room or device for the safekeeping of a firearm”.

* Store ammunition locked separately.

* Keep the key or combination secure.

Remember, most teenagers know their parents' hiding places.

There are different ways to help prevent suicides, but one step is clear. Reducing a suicidal person's access to lethal means helps save lives, particularly among impulsive attempters. Firearms are the most lethal suicide method. Suicide attempts with a firearm are almost always fatal, while those with other methods are less likely to kill. And nine out of ten people who survive an attempt do not go on to die by suicide later.

HOW TO HELP A LOVED ONE

A person who is suicidal needs to know you care. Listen to them. Ask questions. Help them discuss their feelings.

Learn all you can about depression.

You might be your loved one’s only source of information. Let them know you care. Remind them that they shouldn't feel ashamed or guilty. Avoid telling them things like “Snap out of it”. Let them know their feelings are caused by an illness that can be treated.

Invite them out. Realise they might not want to go at first. If they say no, ask them again later or offer to stay in and spend time with them.

If you are worried they might be suicidal, ask them about it and help them get help. A straightforward, caring question about suicide will not cause someone to start having suicidal thoughts. If they are thinking of suicide, don't promise secrecy. Tell someone you trust immediately.

Talk to the person about attending a support group meeting if there is one in their area. It can help them to learn that they’re not alone.

Make sure they do not have access to things that can cause injury, like knives, guns, alcohol or drugs.

DO NOT take responsibility for making your friend or family member well. You are not a therapist.

If the person is in immediate danger, take the person to a hospital, casualty or to a clinic.

Source: The South African Depression And Anxiety Group

Tel: 011 262 6396

http://www.sadag.org/

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