DEFINITIONS OF SUICIDE AND RELATED TERMS
ASSISTED SUICIDE, also known as assisted dying, is suicide undertaken with the help of another person (often a physician) by providing the individual with the means to end their life or by providing advice on how to do it.
ATTEMPTED SUICIDE OR SUICIDE ATTEMPT is an attempt to take one’s life that does not end in death but may result in self-injury or the non-fatal attempt to inflict self-harm with the intent to die.
PARASUICIDE refers to any suicidal behaviour or self-harm where there is no result in death. It is a non-fatal act in which a person deliberately causes injury to him- or herself or ingests excess prescribed medication.
POSITIVE RISK-TAKING OR POSITIVE RISK MANAGEMENT is identifying the potential risks involved and developing plans and actions that reflect the positive potentials and stated priorities of the service user. It involves using available resources and support to achieve desired outcomes and minimise potentially harmful outcomes. It requires an agreement of goals, or a clear explanation of any differences of opinion regarding the goals or courses (Southern Health NHS Trust 2012). Its purpose is for individuals to take control of their lives and make choices - either positive or negative - and learning from the consequences of those choices - again positive or negative. In practice this requires a balance between the interests of the individual and societal pressures to control risk (Felton et al 2017).
POSTVENTION is a term that was first coined by Shneidman (1972), which he used to describe “appropriate and helpful acts that come after a dire event”. A postvention is an intervention conducted after a suicide, to support those bereaved (family, friends, professionals and peers) who may be at increased risk of suicide themselves and may develop complicated grief reactions.
REASONS FOR LIVING (RFL) and REASONS FOR DYING (RFD) are important individual reasons for staying alive (e.g. family) or wanting to die (e.g. hopelessness) and reflect the internal motivational conflict of the suicidal mind (Jobes &Mann 1999).
RISK is the likelihood, imminence and severity of a negative event occurring such as violence, self-harm or self-neglect (Department of Health, DOH 2007). It is the likelihood of an event happening with potentially harmful or beneficial outcomes for self and others. Risk behaviours include suicide, self- harm, neglect, aggression and violence (Southern Health NHS Trust 2012).
RISK ASSESSMENT: A risk assessment is a detailed clinical assessment that includes the evaluation of a wide range of biological, social and psychological factors that are relevant to the individual and future risks, including suicide and self-harm (NICE 2011). A good risk assessment will combine consideration of psychological (e.g. current mental health) and social factors (e.g. relationship problems, employment status) as part of a comprehensive client review to capture care needs and assess the client’s risk of harm to themselves or other people (NCISH 2018).
RISK FACTORS AND PROTECTIVE FACTORS: Risk factors are characteristics that make it more likely that individuals will consider, attempt or die by suicide. Protective factors are characteristics that make it less likely that individuals will consider, attempt or die by suicide.
RISK FORMULATION informs risk management and involves organising and summarising risk data and the identification of risk factors.
RISKMANAGEMENT aims to minimise the likelihood of adverse events within the context of the overall management of an individuals care plan. It is the activity of exercising a duty of care where risks (positive and negative) are identified. It may involve preventative, responsive and supportive measures to diminish the potential negative consequences of risk and to promote potential benefits of taking appropriate risks. It will occasionally involve more restrictive measures and crisis responses where the identified risks have an increased potential for harmful outcomes (Southern Health NHS Trust 2012).
SELF-HARM is an intentional act of self-poisoning or self-injury, irrespective of the motivation or apparent purpose of the act (NICE 2004). It includes suicidal acts but usually refers to non-fatal self-injury.
SUICIDAL ACT: a self-inflicted, potentially injurious behaviour with any intent to die as a result of the behaviour. It may or may not end in death, i.e. suicide (O’Connor et al 2011).
SUICIDE ATTEMPT: self-injurious behaviour that is intended to kill oneself but is not fatal.
SUICIDAL IDEATION: thinking about, considering or planning suicide. The range of suicidal ideation varies from fleeting thoughts, to extensive thoughts, to detailed planning (Klonsky et al 2016).
ACTIVE SUICIDAL IDEATION: thinking of taking action to kill oneself, e.g. “I want to kill myself” or “I want to end my life and die”.
PASSIVE SUICIDAL IDEATION: thinking about death or wanting to be dead without any plan or intent, e.g. “I would be better off dead”, “My family would be better off if I was dead”, or “I hope I go to sleep and never wake up”.
SUICIDAL INTENT: the seriousness or intensity of the person’s wish to end his or her life. Intent refers to the aim, purpose, or goal of the behaviour rather than the behaviour itself (Silverman et al 2007).
SUICIDALITY is used broadly to include suicidal ideation (serious thoughts about taking one’s own life), suicide plans and “completed” or attempted suicide or the tendency of a person to die by suicide. Meyer et al (2010) argue the term “suicidality”is not as clinically useful as more specific terminology (ideation, behaviour, attempts and suicide).
SUICIDE (OR COMPLETED SUICIDE*) is the act of deliberately killing oneself or intentionally causing ones own death. Many definitions require there to be evidence that a self-inflicted act led to the person’s death (from injury poisoning or suffocation). HQIP (2018) defines suicide as deaths that receive a conclusion of suicide or are “undetermined” (open) at coroner’s inquest, as is conventional in suicide research (HQIP 2018). The Office for National Statistics’ definition of suicide includes all deaths from intentional self-harm for persons aged 10 and over, and deaths where the intent was undetermined for those aged 15 and over (ONS 2019).
SUICIDE ATTEMPT: a non-fatal, self-inflicted, potentially injurious behaviour with any intent to die as a result of that behaviour (O’Connor et al 2011).
SUICIDE MITIGATION involves encouraging help-seeking behaviour, removing or restricting access to means, and ensuring an appropriate and early response to suicidal behaviour. Increasing hopefulness, emotional resilience and helping someone to identify their reasons for living have all been proven to lead to a reduction in suicide rates (Cole-King & Lepping 2010; Cole-King et al 2013; Zalsman et al 2016).
SUICIDE PACT: an agreement between two or more people to die by suicide together.
SUICIDE PREVENTION: a strategy or approach that reduces the likelihood of suicide. Effective suicide prevention should combine population strategies aimed at high-risk groups (Lewis et al 1997) and suicide-focused interventions for individuals at risk.This includes restricting the availability of means of suicide and targeted social programmes.
SUICIDE THREAT: thoughts of engaging in self-injurious behaviour that are verbalised and intended to lead others to think that one wants to die.
SUICIDOLOGY is the scientific study of suicidal behaviour, the causes of suicidality and suicide prevention.
*It is valuable to consider the connotation of the language used about suicide. The term “complete” is usually used for a positive achievement such as completing a course or task. It implies that attempted suicide is incomplete.