Greatest tools in prevention: eyes and ears

By JUSTIN GEORGE, Times Staff Writer
Published November 12, 2007

ADVERTISEMENT Marshall Knudson is director of the Alachua County Crisis Center in Gainesville. [Carrie Pratt | Times]

The topic of suicide doesn't hit the news except when the deaths are public or the victims well-known. That's happened more than usual here in recent weeks, with the suicides of a Brandon businessman, a prominent Tampa hostel owner and a Cuban exile artist living in Ybor City.

Tampa recently hosted the state-sponsored Florida Suicide Prevention Symposium, where the attendees included Marshall Knudson, director of the Alachua County Crisis Center in Gainesville.

In an interview with the St. Petersburg Times, Knudson talked about suicidal desire, whether there is a "suicide gene" and a new system designed to help people better analyze suicide risk.

Do people have any innate factors that push them to kill themselves?

We certainly have not found any gene that is the suicide gene (but) there probably are innate factors that make people more vulnerable. And probably at this time, that's the way to think about it. ... Certainly some mental illnesses seem to have some genetic qualities. But that doesn't mean you're going to do it. ... There's not a simple predictor.

There is a new system that distills 4,000 variables into a three- or four-part checklist to assess people who are suicidal. What makes it effective?

It probably helps us in being more consistent. I think it also can be a much more effective training model. It makes sense and instead of trying to memorize lots of variables and trying to mesh them together, desire, intent and capacity allows us to train both professionals and lay people ... Historically, it was just more difficult trying to make sense of how dangerous a situation was.

Suicidal desire and intent - or planning - are easy to understand. But what are capacity and capability?

Think about it in these terms: A person who has attempted suicide in the past has maybe desensitized themselves each time they've done it and that may make them more capable of doing it. ... Another way where you might become more capable is through mental illness, which makes it difficult to concentrate or to focus or to see options. That may be a way to increase your capacity. Or it may be through great distress. Or it may be through drugs or alcohol.

How do you assess someone for risk?

You may say that you feel like you're a burden to your family or you may show cognitive restrictions or you may not be able to see clearly in the future. I'm going to ask about history of suicide attempts. I'm going to be asking you about present plans for suicide. ... I'm certainly going to want to know your thoughts of suicide, your desire for suicide, but I'm going to want to know your intent. Do you have a method? Is your method one that's available? I'm also going to be aware of your capacity for suicide. Some of the things that will be indicative of that is your drug and alcohol history. ... I'm going to be aware of your mental health history. Are you under any medications? I'm going to be aware of how agitated you are. Is there a history of violence? ... Then on the other side of the equation, I'm going to look at those protective factors. What is keeping them alive? Why haven't they killed themselves already?

What's the good news?

The good news, especially for crisis centers, is that the vast majority of people who have suicidal desires need not be at risk because they don't have the intention or capacity at the moment. What they're wanting is assistance and support to live through a difficult time in their life. It's a very small percentage of people calling crisis centers who are in immediate, grave risk. ... But there are many, many people who are calling who could use great assistance by having someone listen to them."

Call for help

National Suicide Prevention Lifeline: 1-800-273-8255

[Last modified November 12, 2007, 00:24:26]