From the Guidelines
Thinking about pretending to fall in front of a bus to make it look like an accident, starting at age 12, is considered suicidal ideation with a method and elements of a plan. This type of thinking indicates serious suicidal thoughts that require immediate professional attention. The thought contains both a specific method (being hit by a bus) and planning elements (making it appear accidental), which makes it particularly concerning. Anyone experiencing these thoughts, especially a child or adolescent, should seek help from a mental health professional immediately through a local emergency department, crisis hotline (such as 988 Suicide and Crisis Lifeline in the US), or their primary care provider. Parents or guardians should be informed so they can provide support and ensure safety. These thoughts often stem from overwhelming emotional pain, and with proper treatment including therapy and possibly medication, healthier coping mechanisms can be developed. The persistence of these thoughts from a young age suggests they may have become an ingrained response to distress, making professional intervention even more important, as suggested by recent guidelines 1. Key aspects of management include assessing the degree of acute risk, ensuring the patient's safety, and providing appropriate treatment for underlying psychiatric disorders, as outlined in recent clinical practice guidelines 1. It is also crucial to restrict access to potentially lethal means, such as firearms and medications, as part of a comprehensive safety plan, as recommended by studies on suicide prevention 1. Given the complexity and severity of suicidal ideation, a collaborative approach to care, including close follow-up and timely mental health evaluations, is essential for reducing the risk of suicide attempts, as emphasized by recent research 1. Ultimately, the goal is to provide supportive and effective care that addresses the individual's specific needs and reduces the risk of suicidal behavior, prioritizing their safety and well-being above all, in line with the most recent and highest quality evidence available 1.
From the Research
Suicidal Ideation Classification
The patient's thoughts about pretending to fall in front of a bus to make it look like an accident, starting at age 12, can be classified under suicidal ideation.
- Suicidal ideation refers to thinking about, considering, or planning suicide 2.
- The presence of a specific method, in this case, pretending to fall in front of a bus, indicates a level of planning.
- However, the fact that the patient thought about it often but did not have the courage to do it suggests that it may not have progressed to a full-fledged plan.
Distinction between Suicidal Ideation with a Method and with a Plan
- Suicidal ideation with a method refers to thinking about a specific way to end one's life, such as using a firearm or overdosing on medication 2.
- Suicidal ideation with a plan involves not only thinking about a method but also taking steps to prepare for the act, such as acquiring the means or making arrangements 2.
- In this case, the patient's thoughts about pretending to fall in front of a bus may be considered suicidal ideation with a method, as they have thought about a specific way to end their life, but there is no indication that they took steps to prepare for the act.
Importance of Addressing Suicidal Ideation
- Suicidal ideation is a significant predictor of suicide attempts and completed suicides 2.
- Addressing suicidal ideation is crucial in preventing suicide attempts and completed suicides 3, 4.
- Effective treatments, such as cognitive behavioral therapy and dialectical behavioral therapy, are available to help individuals with suicidal ideation 3, 5.