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Clinicians’ Language Choice Can Impact Care of Patients With Suicidal Ideation

March 01, 2021
Jill Harkavy-Friedman, PhD
Jill Harkavy-Friedman, PhD

Jill Harkavy-Friedman, PhD, Vice President of Research at the American Foundation for Suicide Prevention, New York, New York, discussed a critical shift in language and how clinicians frame their discussions with patients with suicidal ideation at a Psych Congress Regionals session on suicide prevention.

“Suicide is a complex act. There’s never one single cause,” Dr. Harkavy-Friedman told virtual attendees. “It’s a constellation of risk factors”.

“We can’t really decide what we should do until we hear their full story, until we understand where they are at that moment and the recent moments in relation to their life, and to their suicidal ideations.”

Suicide is often thought of as being caused by one factor, such as job loss, but it is more complex and involves early life experiences, trauma, health condition history, current stressors, and access to lethal means.

“You’re not going to make someone kill themselves by using the word suicide,” she told attendees, and offered ways to extrapolate helpful information from the patient.

Everyone has a different definition of what “suicide” or “suicide ideation” means, so Dr. Harkavy-Friedman suggests asking patients if they have ever thought about or attempted taking their own life and when that happened. This language will keep things clear and get to their personal story.

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The language surrounding suicide attempts has also shifted to better represent the condition, she said. Suicide is not a crime, but it is the result of health status. Thus, using phrases like “successful suicide attempt” or “unsuccessful suicide attempt” can make it seem like “success” is attained when the patient dies. Dr. Harkavy-Friedman recommends using phrases such as “died by suicide” and “took their life” when discussing suicide with patients or the public.

Clinicians should retrieve informed consent and an emergency contact during the first session with a patient to be immediately prepared in case there is ever a crisis, she said. To prevent the patient from taking any impulsive action to harm themselves, clinicians should also properly frame the way in which they discuss access to lethal means.

“Make sure they understand that you understand the reason they have those guns so that they feel you understand. You are not trying to take away their guns, you are trying to help them feel safe,” Dr. Harkavy-Friedman said.

Clinicians can suggest another way for them to have access to that weapon but making it not immediate, such as removing the magazine or putting it in another room, she told attendees. Other lethal means, such as pills or other medication, can be handled similarly.

If a gun needs to be temporarily entirely removed from the patient’s possession, Dr. Harkavy-Friedman suggests utilizing the Lock for Life program to arrange a safe place where they can store the weapon.

In the latter portion of the Q&A session, Dr. Harkavy-Friedman discussed social media and gaming being potentially positive and supportive environments for people who have had thoughts of suicide. These platforms can offer community, a sense of connection, and in the case of social media, provide helpful resources on where to seek help if necessary, she said.

—Meagan Thistle


“Ask the Expert: Suicide Prevention.” Presented at Psych Congress Regionals: Virtual; February 26, 2020.

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