“You can go with us, or you can go with them…”

Assisting a patient committing suicide is a crime in Georgia, but actually committing suicide is not. Sometimes, in an effort to resolve the situation, the police might be tempted to give the patient an ultimatum, “Go with them or come with us.” There is no legal standing for such statements. Furthermore, the police might order the ambulance crew to transport the patient from the scene. There are only 2 people that can make the choice about ambulance transport, the patient or medical control. If the patient does not want to be transported to the hospital, the medics need to contact medical control and explain the situation and ask for orders to restrain the patient and transport against their will. If the doctor gives the order, then the medics should restrain the patient and transport.

Suicide

Suicide is a leading cause of death in the United States and a major public health concern. When a person dies by suicide, the effects are felt by family, friends, and communities. Suicide is when people harm themselves with the goal of ending their life, and they die as a result. A suicide attempt is when people harm themselves with the goal of ending their life, but they do not die.

Avoid using terms such as “committing suicide,” “successful suicide,” or “failed suicide” when referring to suicide and suicide attempts, as these terms often carry negative meanings.

Who is at risk for suicide?

People of all genders, ages, and ethnicities can be at risk for suicide.

The main risk factors for suicide are:

• A history of suicide attempts
• Depression, other mental disorders, or substance use disorder
• Chronic pain
• Family history of a mental disorder or substance use
• Family history of suicide
• Exposure to family violence, including physical or sexual abuse
• Presence of guns or other firearms in the home
• Having recently been released from prison or jail
• Exposure, either directly or indirectly, to others’ suicidal behavior, such as that of family members, peers, or celebrities

Most people who have risk factors for suicide will not attempt suicide, and it is difficult to tell who will act on suicidal thoughts. Although risk factors for suicide are important to keep in mind, someone who is showing warning signs of suicide may be at higher risk for danger and need immediate attention.

Stressful life events (such as the loss of a loved one, legal troubles, or financial difficulties) and interpersonal stressors (such as shame, harassment, bullying, discrimination, or relationship troubles) may contribute to suicide risk, especially when they occur along with suicide risk factors.

What are the warning signs of suicide?

Warning signs that someone may be at immediate risk for attempting suicide include:

• Talking about wanting to die or wanting to kill themselves
• Talking about feeling empty or hopeless or having no reason to live
• Talking about feeling trapped or feeling that there are no solutions
• Feeling unbearable emotional or physical pain
• Talking about being a burden to others
• Withdrawing from family and friends
• Giving away important possessions
• Saying goodbye to friends and family
• Putting affairs in order, such as making a will
• Taking great risks that could lead to death, such as driving extremely fast
• Talking or thinking about death often

Other serious warning signs that someone may be at risk for attempting suicide include:

• Displaying extreme mood swings, suddenly changing from very sad to very calm or happy
• Making a plan or looking for ways to kill themselves, such as searching for lethal methods online, stockpiling pills, or buying a gun
• Talking about feeling great guilt or shame
• Using alcohol or drugs more often
• Acting anxious or agitated
• Changing eating or sleeping habits
• Showing rage or talking about seeking revenge

Does asking someone about suicide put the idea in their head?

No. Studies have shown that asking people about suicidal thoughts and behaviors does not cause or increase such thoughts. Asking someone directly, “Are you thinking of killing yourself?” can be the best way to identify someone at risk for suicide.

Do certain groups of people have higher rates of suicide?

According to the Centers for Disease Control and Prevention (CDC), women are more likely to attempt suicide than men, but men are more likely to die by suicide than women. This may be because men are more likely to attempt suicide using very lethal methods, such as firearm or suffocation (e.g., hanging), and women are more likely to attempt suicide by poisoning, including overdosing on prescribed or unprescribed prescription drugs. However, recent CDC data suggest that the leading means of suicide for women may be shifting toward more lethal methods.

CDC data also show that suicide rates vary by race, ethnicity, age, and gender. American Indian and Alaska Native men have the highest rates of suicide, followed by non-Hispanic White males.

Although the rate of suicide death among preteens and younger teens is lower than that of older adolescents and adults, it has increased over time. Suicide now ranks as the second leading cause of death for youth ages 10 to 14. For children under age 12, research indicates that Black children have a higher rate of suicide death than White children.

Do people ‘threaten’ suicide to get attention?

Suicidal thoughts or actions are a sign of extreme distress and an indicator that someone needs help. Talking about wanting to die by suicide is not a typical response to stress. All talk of suicide should be taken seriously and requires immediate attention.

What treatment options and therapies are available?

Effective, evidence-based interventions are available to help people who are at risk for suicide:

• Cognitive Behavioral Therapy (CBT): CBT is a type of psychotherapy that can help people learn new ways of dealing with stressful experiences. CBT helps people learn to recognize their thought patterns and consider alternative actions when thoughts of suicide arise.
• Dialectical Behavior Therapy (DBT): DBT is a type of psychotherapy that has been shown to reduce suicidal behavior in adolescents. DBT also has been shown to reduce the rate of suicide attempts in adults with borderline personality disorder, a mental illness characterized by an ongoing pattern of varying moods, self-image, and behavior that often results in impulsive actions and problems in relationships. A therapist trained in DBT can help a person recognize when their feelings or actions are disruptive or unhealthy and teach the person skills that can help them cope more effectively with upsetting situations.
• Brief Intervention Strategies: Research has shown that creating a safety plan or crisis response plan—with specific instructions for what to do and how to get help when having thoughts about suicide—can help reduce a person’s risk of acting on suicidal thoughts. Staying connected and following up with people who are at risk for suicide also has been shown to help lower the risk of future suicide attempts. Research also has shown that increasing safe storage of lethal means can help reduce suicide attempts and deaths by suicide. In addition, collaborative assessment and management of suicidality can help to reduce suicidal thoughts.
• Collaborative Care: Collaborative care is a team-based approach to mental health care. A behavioral health care manager will work with the person, their primary health care provider, and mental health specialists to develop a treatment plan. Collaborative care has been shown to be an effective way to treat depression and reduce suicidal thoughts.

Actions On The Scene

Nobody in the police department or EMS really wants to leave the patient alone at their house, only for the patient to be found dead the next morning. Medics do not have the legal authority to apprehend patients and take them to the hospital against their will. In order to accomplish this task, they would need to contact medical control and speak to the doctor. Medical doctors in Georgia have the legal authority to restrain a patient for observation purposes. By obtaining orders, the medics are only following the doctor’s orders, which is much better than kidnapping (and if a paramedic gets involved, poisoning with Versed).

Once the order has been given, the medics should restrain the patient. Chances are the patient will not resist. The patient needs to be restrained with soft medical restraints. Many medics have been convinced to skip the restraints by a patient who is now charming and cooperative, only to be surprised when the watch the patient jump out of the back of a moving ambulance.