Chronic suicidality

Chronic suicidality is a signature symptom of borderline personality disorder (BPD). 

• Defined as any suicidal act or threat which is repetitive in nature but does not aim to end life.
• The wish to die is often reported to be strongly felt.
• The aim is usually to convey an urgent need for help when faced with perceived unmanageable distress.

There are no medications or psychotherapeutic techniques able to acutely reduce ideations; neither does hospitalisation prevent suicide in chronically suicidal people. Treatment of BPD with evidence-based psychotherapies is the best risk management we can currently offer. 

Spectrum has helped significantly reduce suicide rates by providing individualised, specialist work to enable people to lead their own meaningful and purposeful lives.

Management of chronic suicidality is based on a different set of principles than what are used to manage acute suicidality or people in crises. Chronically suicidal people recover when their quality of life improves. Medications may have some value, primarily to reduce impulsivity. Judicious use of short term 'PRN" medication may assist.

Guidance from experts in the field who have worked with people with BPD for decades may assist in signposting key elements of clinical understanding and best practice care. 

This is helpfully summarised in Chapter 5 (Helping people with BPD when they experience crises) in the free Practical Guide for Victorian Area Mental Health and Wellbeing Services.

Staff within Spectrum are often asked to speak on working with chronic suicidality, equipping other mental health professionals with the insights and strategies needed to better support their own clients or stakeholders.

Interested to building your skills or having us attend a workshop? Email our Workforce Development Department.