“Only two things are certain in this world — change and death.”

A relative told us this as we gathered in the balcony one summer evening many years ago. For a young boy, those words sounded strange and profound.

As a physician, I’ve realized that change and death are more than just facts of life. On one hand, change triggers excitement, anxiety, or discomfort. On the other hand, death elicits not just anxiety and concern but also fear; a simple reality that most people dread.

Strange as it may seem, some people choose self-induced death as a convenient escape from life’s drudgery—a seemingly quick path to freedom.

Why would some people kill themselves?

Recent studies have shown the correlation between suicide and serotonin deficiency in the brain. Significant stress has dangerous consequences especially if the stressor, such as legal entanglement or divorce, results in hopelessness and depression. When there is no immediate solution to the problem, suicide becomes an attractive option.

Obviously, suicide is not only a medical impairment but also a psychosocial issue. It is more than just an expression of emotional distress. It is also a complication of an unresolved state of affairs.

No question, suicide is devastating to everyone. I have seen loved ones grapple with the pain of the loss and shame associated with the manner of death. Emotional pain and grief persist for months despite efforts to feel better through counseling and medication.

Can suicide be prevented?

Suicide prevention is as much a science as it is an art. Although applying psychotherapeutic techniques can be effective, the gentle art of dealing with the suicidal person makes all the difference.

Having stated these, if clues of suicidal behavior can be recognized early and sources of stress addressed immediately, then the risk of suicide can be reduced. The issue of early recognition and remedy therefore becomes crucial. The CARE approach can help anyone cope.

What is the CARE Approach?

The CARE Approach refers to a four-step process that any person can use as a mental health first aid for conditions such as suicidal behavior and depression. This approach highlights early recognition and intervention. CARE is an acronym for: 1. Check for signs of emotional illness; 2. Anticipate complications; 3. Remedy with early intervention; and 4. Educate yourself about the illness.

Check for signs of emotional illness

Suicide, like some medical signs, does not happen instantly. Usually, it is preceded by significant emotional turmoil such as depression, fear, agitation, anxiety, impulsivity, and feelings of hopelessness and helplessness.

Does the person feel depressed, anxious, or fearful? Is the person less motivated to work? Does the person prefer to stay in bed and withdraw from friends and family members? Is the person distressed? Does the person have inappropriate beliefs and impaired thinking? Does the person hear or see things that others can’t perceive?

Look for outward signs that show deviation from the person’s usual self. Observe any changes in mood, behavior, belief, and functioning. Also, check for any physical changes such as poor hygiene, weight loss, and impaired sleep, appetite, and concentration.

Anticipate complications

Watch out for complications once you know that the person shows signs of emotional illness. Be aware of any changes such as aggression or suicidal and homicidal tendencies. If not showing any destructive behavior, ask for any thoughts of death including ideas of killing oneself or others.

Asking about the presence of suicidal or homicidal thoughts will not push the person to act destructively. In fact, he or she might be encouraged to disclose more information and to reveal unexpressed emotions.

Remedy with Early Intervention

Early intervention requires you to first acknowledge that a problem exists and that there’s a need to urgently address it. Being in denial can only make matters worse.

Assist in addressing pressing issues. Help with household chores or if applicable, contact appropriate government agencies. For those in legal trouble, suggest obtaining the advice of a good lawyer.

Be available and supportive. Provide reassurance about your willingness to help. Let the person talk about worries and travails. Give a listening ear. Avoid arguments and criticisms. Show empathy.

Be alert for signs of destructive behavior such as wrist slashing, overdosing, agitated behavior, writing or changing a will, giving away properties, or verbalizing death. If the person is in distress, clarify if one has entertained destructive thoughts.

Call for help. Suicidal and homicidal behavior requires immediate help. Further delay is not an option. Call mental health hotline, mental health services, or emergency room to seek guidance and to ask for the next step. Take the person to the doctor or hospital. Do not hesitate to call law enforcement agencies or mental health crisis team if the person refuses to get help.

Educate Yourself

Knowing about the illness —its do’s and don’ts and how to best cope— is a powerful way of dealing with suicide or other destructive behavior. Furthermore, educating yourself helps get rid of misconception, self-blame, guilt, and shame.

In summary, suicide has only one goal — death. It has caused agony, sleepless nights, and oceans of tears for those who are left behind. However, despite its deadly intentions, suicidality is also a cry for help. Fortunately, the CARE approach makes suicide surmountable.


The CARE Approach comes from Dr. Rayel’s book First Aid to Mental Illness.

Author's Bio: 

Copyright © 2007. Dr. Michael G. Rayel – author (A 31-Day Series and First Aid to Mental Illness) psychiatrist, and inventor of emotional intelligence games -- The Oikos Game Series and The CEO. Since 2005, he has published Oikos’ Insights! www.oikosinsights.com as an online resource for personal development. For more information, visit http://www.oikosglobal.com .