There's No Such Thing as Suicide "Prevention"

suicide treatment with dbt

There is No Such Thing as Suicide “Prevention”

Free Will is a B*tch sometimes…

Apparently, September is “Suicide Prevention” month and since it’s the end of the month and no one has said it, it looks like I will have to be the bad guy.

As a DBT therapist for 12+ years, I have worked with multiple people with chronic suicidal urges, people who have attempted to cause their own death on several occasions, and those who have lost people to suicide. I teach licensed therapists all over the country how to use DBT to help clients who want to end their life and I supervise therapists-in-training on working with people who are suicidal. In short, I think my opinion might be worth sharing.

It is the word “prevention” that I have a problem with. Here’s why:

  1. It suggests there is a way to 100% stop people from committing suicide. There is not. People kill themselves on inpatient units while on suicide watch. Here’s the truth: If someone has the intent to kill themselves and you stop them this morning, that does not guarantee anything about this afternoon. Free will is a bitch sometimes.

  2. It suggests that stopping people from killing themselves is good enough. It is not. People who are suicidal do not have a life they feel is currently worth living….to end life is their solution. It is necessary for them to believe there are other solutions to the problem(s) and to believe that “a life worth living” is even possible. Just because you chain someone up to keep them from hurting themselves doesn’t make you a hero.

  3. It is super authoritative and implies doing away with human autonomy …like they might just lock you up to keep you from offing yourself. Oh wait, yeah, there’s that whole “involuntary commitment” thing. Wow—super helpful.

  4. No suicidal person is willing to open up to a provider who’s only goal is to “prevent” suicide unless they are ok with ending up in the hospital. So people tend to avoid therapy… or lie.

  5. The belief that with the right interventions, suicide can be prevented is why soooo many mental health providers actually Will. Not. Treat. Suicidal. People. Did you know that??? Ohhh, yes. Many, many… Why? Because they are absolutely terrified of being held responsible if a patient kills themselves. Just attend one of my trainings and listen to the therapists ask questions about “liability.” It’s heartbreaking and semi-disgusting to me that professionals refuse to help those most in need because they are afraid of getting sued.

  6. It is the perpetuation of this myth that contributes to adolescents (and adults) staying up all hours of the night worrying about how to “save” ex boyfriends, girlfriends, friends, acquaintances, and random people on the internet who post suicidal messages. You cannot “save” anyone.

  7. It is this belief that leads family members, friends, therapists, co-workers, neighbors, and anyone who might have crossed paths with a person who killed themselves to blame themselves, get depressed, and potentially even become suicidal. The thinking goes something like this, “If only I had…,” “I should have…,” “Maybe if I would have….,” If this is you, and no one has ever told you that you weren’t responsible, let me be the first: I am so sorry for your loss… you are not responsible for that person’s suicide.

  8. It suggests that suicide is BAD and “not suicide” is GOOD. Must be nice to be so certain of matters of life and death for people you don’t even know. Personally, I think global conclusions like this are insulting. Everyone has the right to decide what is GOOD and BAD for them. As a DBT clinician, it’s true that I will insist that clients “take suicide off the table as an option” for a specific period of time, but that’s not because of judgments about good and bad, it’s because, as the DBT founder, Marsha Linehan, Ph.D. says, “we can’t do treatment if you are dead.”

To sum, while it is a great thing to try to help suicidal folks, we need to remember that free will exists. We cannot fully control the actions of another person, nor in my opinion should we, because we are NOT the experts on anyone but ourselves. We can offer to help, but we cannot “save” anyone. We are just not that powerful.

— Stephanie Vaughn, PsyD