The Suicide Severity Hierarchy

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On the Suicide Hierarchy: Serious Attempts Versus Non-Serious Attempts

(This post was originally published on the Live Through This blog on September 5, 2020.)

So, let’s talk about this weird hierarchy around “serious” or “medically serious” suicide attempts versus “non-serious” ones. In short, it’s harmful to all of us with lived experience of suicidal intensity of any kind.

Based on what we know about suicide attempts, there are over 1.2 million each year — and those are the ones we’re able to count. Many folks attempt suicide and don’t seek care — because they’re afraid to tell anyone, because they’re afraid they will be hospitalized against their will (and such disruptions could end up with results like job and income loss, which could put a person already in distress in further distress), because they don’t think it was serious enough. I’d wager that “serious” or “medically serious” attempts are in the minority. This isn’t a judgment or a statement with any kind of unstated-but-implied meaning; I just assume that most folks who use “serious” methods don’t live, and get counted in a different statistic: over 48,000 Americans died by suicide in 2018 (the last year for which we have data).

I think minimizing any suicide attempt is harmful; all are valid and indicate that a person is in distress, and thus, needs help of some kind (which is not always therapy and/or meds). We often hear people say that an attempt was a cry for help, that the person was looking for attention. If someone is in so much distress that attempting suicide is the only way to get attention then, to me, that means they need attention. Further, more violent means do not equate to more serious intent. Separating people out into groups in this way runs counter to our goals for the folks we serve.

Folks with “less serious” suicide attempts are hospitalized all the time, and sent through the same processes that can help or harm folks who used methods that were potentially more lethal. It’s possible they are held for 72+ hours (and maybe more), have traumatic experiences with police (QTBIPOC folks are at high risk for this), have traumatic experiences in the emergency department and potentially traumatic experiences in behavioral health units, where physical and chemical restraints may be used on them involuntarily. The seriousness of an attempt is irrelevant throughout that process.

There is a lot of harm done by this hierarchy, wherein people who have made “less serious” attempts don’t feel their pain is validated by folks they encounter, from their support systems, to law enforcement, to medical professionals. I cannot tell you the number of people who have said to me, “I don’t know if you want to hear my story. My attempt wasn’t particularly violent/serious.” The fact that anyone feels or thinks that breaks my heart.

The pain or hopelessness or whatever-it-is that makes someone want to die isn’t any less because a person reached for whatever was around them when they wanted to die and it wasn’t a gun or a ligature. I’m not sure that folks who make more “serious“ attempts are any more likely to die by suicide than others. 90% of attempt survivors go on to die of other causes. If there is literature on this, I’m not familiar with it (but open to reading), and I’m positive folks with lived experience weren’t involved in asking those research questions — because they miss the point.

At its core, suicide is about pain. All attempt survivors can identify with that. No one is more special than anyone else, and I don’t think violence/severity of method indicates that one person “means it” more than another. In the end, the needs of attempt survivors, regardless of method used/severity of attempt, are unmet, are underserved and mis-served, and ultimately misunderstood.

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