With the recent attention at AAS focused on including the voice of Suicide Attempt Survivors and the Lifeline survey circulating to find out more about what crisis workers are doing for this group of people, it is timely to discuss what an "Attempt Survivor" is. Are they people who required medical care for injuries sustained in an attempt? Are they individuals who "took the pills" or "shot the gun"? Are they people who had the means on the table in front of them – but backed away from using these means when they realized that their will to live outweighed their reasons for wanting to die? I submit that an "Attempt Survivor" is all of these things. And because of that, we can't use the imprecise term "Attempt Survivor" any more. The term, still undefined and confusing, implies that someone had to actually make an attempt—pick up the gun and shoot it—and live to tell the story.
Some well-meaning folks say an "Attempt Survivor" is anyone who identifies as one. Cool. So where does that leave the person who didn't employ the means in front of them? If a person defines an "Attempt Survivor" as someone who actually took the pills, they will not self-identify if they did not meet such a fuzzy definition of "attempt". Folks who choose to stop before acting just won't see themselves as "Attempt Survivors."
Why does this matter to Lifeline crisis centers? Well, if we want to expand services and supports to "Attempt Survivors" – and if we really mean it -- we need to be clear about to whom those services will be offered. And make sure all manner of "Attempt Survivors" identify with the group. If someone phones and a crisis worker asks them "have you ever tried to kill yourself", they will most likely say "no" if they never picked up the gun or pills. There goes the self-identification argument. They won't see themselves as an "Attempt Survivor". They will self-identify as "a something else that no one looks at or cares about". And if you're a "something else" chances are you're experiencing some shame and not talking to anyone about it.
Along the continuum of people who were acutely suicidal, these folks also have a story to tell that can be very instructive. What pulled them back from the brink? What was the" hook" that saved that life? And what can crisis workers learn about "hooks" that will help them serve people who are actively suicidal?
Another phenomenon deserves mention. Sometimes people who are acutely suicidal decide not to attempt one day, but don't rule it out for the future. The best they can do is think "not today" but keep the idea of suicide in their back pocket for future use. And, without help, it can remain in that back pocket for decades during which their thinking about suicide doesn't really change. It's still a viable option even if today isn't the right time to exercise it. This kind of thinking is dangerous.
So, if this at-risk group doesn't identify as an "Attempt Survivor", if they can't say "yes" when asked if they've tried to kill themselves, if they feel devalued because there is no term to describe them, and if they don't tell a crisis worker what's in their back pocket, we won't think of making appropriate referrals and we aren't at all helpful to them. And, even more worrisome, it's questionable they will even call a crisis center – after all, they're not actively suicidal or in crisis today. We just miss them and their lives are at risk.
So what term do we use if we want to reach out to this sub-group in light of the barriers to using the term "Attempt Survivor"? I'm not quite certain. Some indicate that "lived experience" should be included. I agree. But "lived experience" with what? Perhaps people with lived experience not actively attempting to kill themselves despite being acutely suicidal? I don't pretend to have the answer to these questions. I just want to pose them and see where the dialog progresses. But please don't forget those with "lived experience" as we undertake this emerging dialog on "Attempt Survivors". Doing so will say volumes about our commitment to everyone on the "lived experience" continuum.
-Ann Kirkwood
Board member of the Idaho Suicide Prevention Hotline
Lifeline Consumer Survivor Subcommittee Member2009 Winner of SAMHSA Voice Award for Consumer Advocacy
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