People experiencing mental health concerns or mental illness

What does the evidence tell us about suicide for people experiencing mental health concerns or mental illness?

The term ‘mental health concerns’ refers to a person’s experience of mental health issues, rather than being defined by a diagnosis or illness. A mental illness is a disorder diagnosed by a mental health professional, that significantly interferes with a person’s cognitive, emotional or social experiences. Mental illness can occur with varying degrees of duration and severity.

It is important to understand that suicide is not a mental illness. Not all people who die by suicide live with a mental illness. Nor do all people who live with a mental illness experience suicidal thoughts or behaviours, or die by suicide. However, the evidence shows that some types of mental illness are associated with higher rates of suicide. The reasons people take their own life are complex, and often there is no single reason why a person attempts or dies by suicide. By increasing our understanding of data alongside the lived experience of distress, we will increase the opportunity to save lives.

Many people who die by suicide in Australia have a prior experience of mental health concerns or a mental illness. Some mental illnesses are associated with higher rates of suicide (e.g. borderline personality disorder, anorexia nervosa, major depression, bipolar disorder and schizophrenia).¹ Other evidence suggests that living with a mental illness can greatly increase the likelihood of experiencing suicidal behaviours or dying by suicide.^2,3

The relationship between mental health concerns, mental illness and suicide is complex and has been debated within the literature. For effective suicide prevention planning, it is important to understand why people experiencing mental health concerns or mental illness are more likely to die by suicide than the general population. Many studies highlight that factors contributing to suicide are complex. For people experiencing mental health concerns or mental illness, these other factors also play a role. Suicide rates for this population are likely impacted by a combination of factors including social issues (e.g. social isolation, unemployment, access to housing, cost of living) and individual demographic and psychological characteristics (e.g. personality traits, coping mechanisms, marital status). Some studies also demonstrate that inadequate, inappropriate, or incomplete treatment for mental illness results in greater risk of suicide, rather than the mental illness itself.⁴

Factors that may increase risk of suicide

Suicide is rarely caused by a single factor. Most often there is a combination of factors that increase a person’s likelihood of experiencing suicidal distress and suicide.

For people living with mental health concerns or mental illness, some additional factors associated with higher rates of suicide include:

• Biogenetic predisposition
• Socioeconomic disadvantage
• Negative or stressful life events
• Cognitive distortions (e.g. command hallucinations in psychotic disorders, feelings of extreme hopelessness in depression)
• Social exclusion
• Stigma and discrimination
• Substance use
• Chronic health issues, pain or physical disability
• Feelings of isolation or helplessness
• Grief and loss
• Previous suicide attempt or exposure to suicidal behaviour in others.

Factors that protect against risk of suicide

For people living with mental health concerns or mental illness, some factors that may be protective and reduce the likelihood of suicide include:

• Social support and connectedness
• Effective mental health care
• A sense of purpose and belonging
• Taking medications if prescribed.

What does this mean for policy and practice?

Suicide prevention policies and practices for people with mental health concerns or mental illness are multifaceted. Understanding what factors increase and protect against the likelihood of suicide can help to shape actions that support wellbeing and prevent suicide. Interventions that attempt to mitigate factors that increase the likelihood of suicide or increase protective factors can be implemented at a national or local level. It is important for policies and practices to not assume that people living with mental health concerns or mental illness have uniform needs that relate only to that aspect of their lives. Suicide prevention policies and practices need to respond to diversity of needs within this population group.

Policies and practice related to this population group should:

• Address social and economic determinants of health that impact on a person’s mental health and wellbeing. It is important to address these factors that increase the risk of suicide earlier to prevent individuals reaching a suicidal crisis.
• Acknowledge the impact of some mental health concerns and some mental illness in suicide.
• Include a multi-faceted response that includes mental health services as a core component but is not limited only to mental health services.
• Maximise opportunities for mental health services to have a positive impact on reducing suicide, including proactive early intervention for distress, effective treatment interventions, follow-up care, and addressing the needs of families and caregivers.
• Improve strategies to encourage help-seeking behaviour by reducing stigma related to mental health concerns and mental illness.
• Be led by people with lived experience of mental health concerns or mental illness.
• Improve access to services for those who seek help and improve the quality of care provided for mental health concerns and mental illness.
• Include peer-to-peer supports as a central component.

Acknowledgements

This page was developed with the support of Beyond Blue.