A Reconceptualization of Suicide and Social Workers’ Duty to Report

Theoretical Framework

In order to strengthen my analysis I will draw from several different theorists and theories including Joseph (2015), Ahmed (2007, 2010), Critical Suicidology, and Mad Studies. Joseph (2015) introduces the idea of confluence, which identifies how systems of oppression are inseparable and connected. He writes, “…a confluence is never static, no part is completely distinct from another, and there are multiple perspectives from which one can examine or trace the same idea, system, factor, or influence” (Joseph, 2015, p. 17). Within a confluent frame of analysis, identity categories of difference are understood as the result of historically produced violence (Joseph, 2015). Equity-seeking groups are not oppressed in isolation; thus, instead of focusing on the ways that different groups are oppressed in different ways, confluence calls us to examine how oppressions are part of a cohesive system of power (Joseph, 2015). Confluence “focuses on the common practices and technologies within these systems across temporal periods to reveal relations and operations of power and their common projects” (Joseph, 2015, p. 16). Common projects such as assimilation, colonization, and subordination are achieved through a diversity of tactics including micro-aggressions, social conditioning, and resource distribution.

Sara Ahmed also provides useful theories in analysing duty to report policies through her paper A Phenomenology of Whiteness (2002) and book The Promise of Happiness (2010). Ahmed (2007) describes whiteness as, “…the very ‘what’ that coheres as a world” (p. 150). Whiteness has become the backdrop to all experiences (Ahmed, 2007). While Ahmed’s (2007) work focuses primarily on race, her descriptions of whiteness are not race specific. As race cannot exist in isolation (Joseph, 2015), I interpret whiteness broadly as the perpetuation of white, colonial values. Thus, the subordination of the mad community through asylums, eugenics, and other means are also examples of whiteness. Ahmed (2010) later argues that happiness is tied to the values and characteristics of whiteness. Society expects happiness, forcing othered groups to perform positivity (Ahmed, 2010). This performance reinforces the validity of existing structures that uphold whiteness (Ahmed, 2010). Happiness is further approached from a utilitarian perspective (Ahmed, 2010). When one performs happiness adequately, it in turn makes others happy as well (Ahmed, 2010). So, one’s ability to perform happiness is correlated with their ability to maximize the positive experiences of those around them and improve society as a whole. Accordingly, marginalized groups that fail or refuse to perform happiness are often villainized (Ahmed, 2010). Examples of this include the “feminist kill joy”, the “angry black woman”, and of course, suicidal individuals. When scrutinized, the demand for happiness can be seen as another form of silencing and forced assimilation.

Habit is another key concept outlined in Ahmed’s (2007) work. Habits are described as the ways that bodies are conditioned to operate and how these conditioned behaviours uphold whiteness (Ahmed, 2007). Our responses to madness and suicide have become habits that support whiteness. Physical spaces further reinforce habits as they are often designed for white bodies and bodies that perform whiteness. Ahmed (2007) writes that, “Colonialism makes the world ‘white’, which is of course a world ‘ready’ for certain kinds of bodies, as a world that puts certain objects within their reach” (p. 154). The world we live in and the spaces constructed within it, including social services, are ‘ready’ for happy, non-suicidal bodies. Happy bodies are oriented in ways that put rights, freedoms, and respect within their reach while unhappy bodies are restricted in their ability to make decisions. Visible unhappiness challenges the idea that society is at its ‘best’ and draws attention to the flaws within our system. Happiness therefore becomes a common project, historically enforced through othering and habits, that is necessary to uphold the order of things and maintain whiteness.

Of course, it would be irresponsible to discuss the topic of suicide without including the foundational voices of Mad Studies and Critical Suicidology. Both of these bodies of knowledge have identified the harm caused by psychiatry (Lefrancois et al., 2013; Starkman, 2013). Psychiatry is supported by science, which is generally understood to be a means of producing objective information (Starkman, 2013). However, science is often far from objective, especially in the mental health field. In recent history scientifically backed practices such as electroshock therapy were widely used (Starkman, 2013). The validity and success of these methods has since been disproven (Starkman, 2013), demonstrating that scientific theories still require continued scrutiny from those with modern knowledge and values. Mad Studies identifies the psychiatrization of suicide as a tactic of oppression to decenter the voices of the mad community (Lefrancois et al., 2013). To make psychiatric judgements one requires a specific set of qualifications, which bars the mad community from participating in the co-production of mad-related knowledge (Lefrancois et al., 2013). Critical Suicidology takes many of the principles of Mad Studies and applies them directly to the concept of suicide. Critical Suicidology calls for a broader understanding of suicide than the acontextual view that psychiatry can provide (White et al., 2016). Suicide cannot be separated from the ethical, political, social, and historical context within which it occurs.

Epistemology and Personal Connection

Epistemologically, I believe that it is impossible to produce “objective” data when working with human subjects. Each researcher enters the field with frameworks of understanding and intended outcomes for their work, which are likely to shape their data collection and guaranteed to shape their analysis of said data. This further indicates the importance of reflexivity in research and analysis. As true objectivity is unattainable, I have determined it is most ethical for me to disclose my personal connection to the topic. I will attempt to practice competent reflexivity and use my personal experience as an advantage in my analysis rather than a detriment. Through this transparency I encourage readers to form their own informed opinions about the strengths and weaknesses of this paper.

As someone who has been reported for suicide disclosure and has reported others, I am bound in inescapable self-reflection. From my time as a front-line social worker, I know how difficult it is to oppose policy as the lowest person in the organizational hierarchy. As a service-user, I also know what it feels like to be the only person with even less authority than the front-line worker. I understand, to an extent, the feeling of betrayal that comes from being reported and the trauma that can result. I am in a unique position to experience genuine accountability because more so than other workers, I truly know the damage I have caused. Yet, as a practicing social worker, I am still mandated to report service-users should the situation arise again. Thus, the first step in practicing full accountability is to work on deconstructing the policies that require social workers to report service-users in order to inspire top-down change.

Suicide as Mental Illness

Currently, suicide is popularly conceptualized as the result of mental illnesses that compromise the suicidal individual’s ability to think rationally (Mishna et al., 2002). Strategies for intervention are based off this assumption and correspondingly, do not consider the self-efficacy of the suicidal individual. Suicide has become so inextricably linked to mental illness that it is difficult to conceptualize treatments not related to mental illness (Marsh, 2016). White et al. (2016) argue that, “…the field of suicidology has become too narrowly focused on questions of individual pathology and deficit, as well as too wedded to positivist research methodologies, and thus has come to actively exclude from consideration approaches to understanding and preventing suicide that do not fit well within these orthodoxies” (pp. 1–2). The existing understanding of suicide as the result of uncontrolled mental illness is generally taken as fact, as it is supported by scientific evidence (White et al., 2016). Intervention methods that strip suicidal individuals of their rights are similarly unquestioned as they are seen as the natural course of action. However, as previously mentioned, science has not always been as unbiased as it appears on its surface.

Today suicide remains highly stigmatized and is still considered the result of mental illness. Social workers operate with the goal of preventing suicide at all costs, but do not take the time to trouble the origins of this desire. Foucault’s book Madness and Civilization provides a look at the history of mental health care which is useful in understanding modern practice. Madness was first viewed as the manifestation of sin and laziness (Foucault, 1961). Mental health ‘care’ was correspondingly theocratic and neoliberal in its approach; prisoners at asylums were made to pray constantly and repent for their sins as well as perform physical labour (Foucault, 1961). Notable is the individualism in these perceived causes for madness. They are personal shortcomings and place the responsibility for madness with the individual. Already the influence of social inequality was being obscured and these ideas remain salient in modern ideas of suicide. Many with religious beliefs continue to believe that suicide is a sin that will send you to hell. Others deny that depression is real and consider it to be the result of hypersensitivity; they insist that conditions such as depression can be overcome with a little hard work and resilience.

Next, madness became medicalized and the idea of madness as mental illness came into effect (Foucault, 1961). Doctors assumed power within asylums and acted as moral authority and judge. Through this history there is a common thread of judgment and observation (Foucault, 1961). Asylum workers were given the power to observe the “insane” and determine which behaviours were bad and good (Foucault, 1961). Characteristics like “sin” and “laziness” hold inherent negative connotations that asylum workers were able to place on their clients. In many ways, social workers and other health professionals still operate in the role of asylum keepers through these same technologies of judgment and observation. Doctors are still revered as all-knowing experts on mental health and continue to hold the power to imprison the mad, an act in which social workers are deeply complicit. While medicalized understandings of suicide take away from the theocratic, sin-based conceptualizations they still fail to consider the systemic forces involved (Button, 2016).

At different points in history the label of ‘mentally ill’ was also used to control specific identity groups, such as women. In fact, ‘insanity’ and ‘hysteria’ were considered innate characteristics of women at the time (St-Amand & LeBlanc, 2013). Women who failed to adhere to patriarchal expectations of womanhood were also imprisoned in asylums (St-Amand & LeBlanc, 2013). Now somewhat famous for her written accounts of her experience, Elizabeth Packard was confined in a psychiatric institution for 3 years for disagreeing with her husband’s views on raising children, slavery, and the family’s finances (St-Amand & LeBlanc, 2013). As women were considered to be the property of their husbands, no hearing was needed in order to commit Elizabeth (St-Amand & LeBlanc, 2013). Elizabeth’s case illustrates that asylums were not truly intended to care for those experiencing madness. Instead, they functioned as a threat and punishment to subjugate and control those with less power. The label of mentally ill was similarly employed to discipline anyone who failed to adequately perform whiteness. In keeping with Ahmed’s (2007) theories on the operation of whiteness, Elizabeth’s defiance resulted in society restricting her access to objects that had previously been within reach through the label of mental illness. The confluence of this history demonstrates that the label of mental illness and treatments for mental illness are not always based purely on science, but on a sociopolitical agenda.

Social work has attempted to position itself alongside the doctors and husbands as authority and expert. Chambon (2013) identifies that social work is built on a foundation of disparity between privileged and marginalized groups. The field was conceived from the observations of ‘slum travellers’, who were wealthy people that visited slums to learn about the lives of the poor (Chambon, 2013). The services developed by these upper-class slum travellers were developed on the basis of observable difference between themselves and the poor. These attitudes were also the basis of the mental health system in which dominant groups would use their power to label subordinate groups as mentally ill and deviant. Violences imposed by social workers upon subjugated groups cannot be neatly separated, as Elizabeth Packard’s story cannot be severed from either sexism or psychiatry. Oppressions often occur in tandem and within social structures built on complex, shared histories. As mentioned, confluence encourages us to instead search for common projects throughout history to identify how power works to marginalize groups in similar ways (Joseph, 2015). Social workers continue to use the learned technology of observable difference in practice, inadvertently supporting systems of whiteness in the common project of assimilation.

Social Worker as “Expert”

The next assumption underpinning suicide intervention is that social workers hold superior knowledge about suicide and have insights that assist them in analyzing and making decisions when working with suicidal clients. Interestingly, though all can agree that life has unmatched value, scientists still disagree about what constitutes life. The month of pregnancy at which life comes into existence and the brain function required to be considered “alive” are all highly contested topics within biomedicine (Jones & Kessel, 2001). In Western culture, life was originally defined by Christianity (Jones & Kessel, 2001). Over time, science has risen to replace religion as the entity with answers, but life continues to elude definition (Jones & Kessel, 2001). How can professionals claim superior knowledge about the desire to end one’s life when they cannot even agree on a definition?

Social workers also find themselves in disagreements about knowledge production. Chambon (2013) describes social work as being divided into “two tightly woven strands” (p. 122), the first promoting inclusion and freedom from otherness. The assumption that social workers have superior knowledge promotes the second strand, which Chambon (2013) describes as being, “…a distance between the knower and the known, the professional (Self) and the client (Other), on the basis of professional and academic knowledge” (p. 122). Social work claims to be backed by research in its addressing of suicide, but often these approaches take the form of hollow statements. Promises like “it gets better” are just as provable as their opposite, yet one is considered rational and the other mad. Social work’s claims of elevated understanding become even more difficult to justify when considering the confluence (Joseph, 2015) of social work, mental health incarcerations, and its history of being developed by upperclassmen. Social workers use the presumption of their knowledge and professional skillset to justify their continued participation in the technologies (Joseph, 2015) of observation and judgment, as they were used in asylums (Foucault, 1961).

Throughout my bachelor’s degree in social work I received no direction on how to address suicide in direct practice. In fact, in my core courses we barely discussed the topic of suicide at all; according to Feldman and Freedenthal’s 2006 study, nearly 80% of social workers reported having no formal training about how to address suicide. In keeping with the historical hubris of social workers, 80% also reported feeling competent and confident in their ability to work with suicidal clients (Feldman & Freedenthal, 2006). This demonstrates a clear disparity between social workers’ self-perceived skills and the skills intended to be garnered from training. This, I would suggest is a display of the whiteness inherent in social work practice

Having taken on a position of superiority from the start (Chambon, 2013) social work is comfortable in its beliefs. Social workers remain confident in their ability because they practice in spaces that were designed for them (Ahmed, 2007). The physical spaces of social service agencies operate as extensions of the social workers themselves, reinforcing their authority (Ahmed, 2007). In these spaces, social workers feel comfortable and confident as there is nothing there to challenge their position. This is not to say that no social workers have insight into suicide, only that this insight is not guaranteed. From my limited experience working at different social service agencies, knowledge levels about suicide are varied. Addressing suicide often requires subjective assessment using the worker’s best judgment of the situation and these judgments can be wrong. Social workers are only human beings operating under their own personal ethical frameworks. Given the history of the mad community with abusive professionals and the power that is awarded to these professionals in the modern day, the label of mental health ‘expert’ must be given only with immense care. I have found no literature detailing the mental health-related knowledge that social workers graduate with and therefore feel uncomfortable allowing the field as a whole to claim the title of mental health ‘expert’. Until we know more about the knowledge and skills of Bachelor Social Work graduates it would be unfair to service-users to purport their expertise. With this information in mind, the restricting of suicidal individuals’ rights becomes less about social workers having an elevated understanding of the situation and more about suicidal individuals having a diminished understanding of the situation.

Suicide as Irrational

The idea that suicidal individuals are irrational and unable to act in their best interest is the core assumption that underpins social works’ ability to restrict and even remove people’s rights and freedoms. The CASWSSW names confidentiality and the right to self-determination as two of the ethical principles foundational to the profession (Ontario College of Social Workers and Social Service Workers, 2018). However, these ethics are discarded in cases of beneficence (Mishna et al., 2002). Research depicting suicidal individuals as incapable is primarily based on positivist research and historical conceptions of mental illness as dangerous. Liegghio (2013) writes, “Under psy discourses, a dangerous person is someone who is unpredictable, who cannot be trusted, who threatens the public order, and who, consequently, needs to be controlled.” In order to be labelled dangerous, mad individuals do not need to actually inflict harm, only inspire the belief that they pose potential for harm (Liegghio, 2013). This makes silencing the mad community even easier. Those who express suicide ideation often do not get the chance to explain the reasons behind their desire to die and are immediately labelled as incapable.

Though, suicide may not always be the irrational result of diminished mental capacity. In fact, suicide can even be viewed as the natural result of systemic oppression and/or trauma. Social workers often struggle to address suicide because they are unable to see beyond the privilege of the ‘self’ position, while the reality of suicide can be the inability to see beyond the violence of the ‘other’ position. A useful framework is that of Reynolds (2016), a critical suicidology scholar who argues that the language used to describe suicide places responsibility on the suicidal individual and masks the influence of stigma and exclusion. Reynolds (2016) goes as far as to state that suicidal individuals have not ended their own lives but have had their lives “stolen by hate” (p. 170). While the idea of lives being “stolen by hate” is powerful, the phrasing conjures examples of overt discrimination. Reynold’s (2016) writes about social inequality in a broad sense, using extreme examples. Though, the works of Chambon (2013) and Joseph (2015) can further this analysis. Chambon’s (2013) description of the Other presents a more nuanced picture of the realities of living with oppression. Suicide can be the result of blatant hate speech and violence, but it may also be the result of exhaustion from living in constant exclusion. Confluence (Joseph, 2015) can also provide context to Reynolds’ framework by incorporating history. Lives are not only ended by hate and othering, but by a history of hate and othering as generational trauma and ingrained systems of oppression can be similarly taxing to overt discrimination. Communities that have been historically oppressed continue to feel the effects of this history; sadness and suicide ideation can be inherited.

This framework aligns more closely with my own experience of suicide ideation. While I do identify as experiencing depression, my illness does not alter my ability to use logic and reason, only my mood. I am still able to assess the benefits of life as well as the reality that I may never find ways to alleviate my pain. Further, my own ideations have not wholly been produced by my depression, but by the confluence of my identity. I am shaped by generational trauma from colonialism, and the struggles both of my parents faced through immigration, settling in Canada during the 1980s, a time when Self/Other differences were mostly viewed through a racial lens (Chambon, 2013). I was also raised in a white-dominant neighbourhood and felt the effects of othering very tangibly in my everyday life. My skin colour was a clear indicator to myself and my peers that I did not belong. I developed the skills to capably perform whiteness, but this performance was exhausting and took a toll on my wellbeing. I further felt the weight of patriarchy in my home life and have faced several instances of gender-based sexual violence. These instances of trauma catapulted my depression into suicidality. The confluence (Joseph, 2015) of my identity has played a large role in my construction of self and my overall level of happiness and satisfaction.

A broader example of how confluence (Joseph, 2015) constructs suicidal intent is demonstrated by Kral (2016) through an analysis of suicide in Canadian Inuit communities. Canadian Inuit have one of the highest suicide rates in the world (Kral, 2016). As with my own experiences of othering, suicide in Indigenous communities cannot be attributed solely to mental illness. “Instead, suicide in Indigenous communities is often conceived as the terminal outcome of historic oppression, current injustice, and ongoing social suffering” (Morris & Crooks, 2015, p. 59). Correspondingly, they also have low rates of employment and education and are provided with few social supports (Kral, 2016), leaving them to grapple with generational trauma alone. Canada’s psychiatrization of suicide draws focus away from trends that demonstrate the influence of shared experience and trauma. This coupled with the othering of Indigenous peoples that allows us to dismiss their knowledge and insight obscures the social factors that lead to suicide. The heightened rates of suicide in socially marginalized group are unexplainable through a biomedical lens. Clearly, there are more factors at play that mental illness alone.

Confluence (Joseph, 2015) can also help us understand how analysis of suicide in a Canadian context can also support us in understanding suicide globally. European domination through colonialism led to a homogenizing of practices and values across the West. Thus, the oppression of the mad community through the assumptions outlined in this paper is an issue in all areas of the West. Privilege, power, and saneism are all continually perpetuated and reinforced through existing political and sociocultural structures such as government, policy, media, and health facilities. All citizens of the West can benefit from reflecting on their role in the maintenance of these structures and the perpetuation of assumptions about the mad community.

The Perceived Value of Life

Finally, the process of reporting relies on the widely accepted belief that life is better than death. As with the belief that suicide is inherently wrong, life is seen as inherently good. As such, the value of life is widely considered a fact in Western society and as with many Western values, imposed as a universal truth. Many would consider the mindset of suicide prevention at all costs to be a means of demonstrating their value and appreciation for life. However, allowing clients the freedom to kill themselves does not undervalue life, but rather, shows value for autonomy. I do not argue that life has no value, only that it does not necessarily have value over all else. The choice of reporting or not reporting a client is often presented as a choice between life and death but is much more complicated than this. There are several other choices wrapped up in the decision of reporting including deciding between freewill and restriction. It can also be the case that taking away someone’s ability to choose to die can ruin their ability to appreciate life. Removing someone’s right to die also strips them of their ability to choose to live. Life then becomes a requirement instead of a choice. The empowering feeling of knowing that you have survived not because of hospital restraints, but because of your own resilience and strength can be very healing. Instead, survivors may continue to live against their will. Thus, suicide prevention become life preserving, but not life-affirming.

Another choice that complicates the decision to report is that between alleviating and prolonging suffering. While preservation of life is a strong driver for suicide prevention, it is not the only reason that social workers intervene. Despite the recent cultural shift leading to a more empathetic understanding of suicidal ideations in those with chronic, physical illness, the view of suicide for those with chronic mental illness has remained apathetic (Mishna et al., 2006). In fact, physician assisted suicide (PAS) is now legal in Canada for those with an “irremediable medical condition” (Canada.ca). Euthanasia, distinguished from PAS only in that the patient does not play an active role in administering the lethal substance (Radbruch et al., 2016) appears to remain illegal. In order to qualify for PAS in Canada an individual must be deemed “medically competent” and you must “be at a point where your natural death has become reasonably foreseeable” (Canada.ca). The law also explicitly states that, “you do not need to have a fatal or terminal condition to be eligible for medical assistance in dying” (Canada.ca) leading me to conclude that this service is available to those with fatal or terminal conditions as well as the elderly. While an entire article could be written about the implications of this law on older Canadians I will focus on the topic at hand: that madness is excluded. In a broader Western context, PAS is legalized in many European countries, but still widely opposed by many professionals (Radbruch et al., 2016). Similar to Canada, many places, Belgium for example, that do have legalized PAS only allow it for physical conditions (Radbruch et al., 2016).

As both groups, the physically ill and the mentally distressed, would be ending their lives for the same purpose (to be free from suffering), the contrasting reception of their wishes reveals how stigma and history have shaped perceptions of mental and physical illness. In the case of those living with chronic physical disabilities, the public’s revulsion and fear toward disfigurement allows them to understand their suicidality (Mishna et al., 2002). Though chronic mental illness may be equally disabling and painful, associations of madness to laziness, weakness, and immorality prevent the public from empathizing with their desire to die (Mishna et al., 2002).

Mishna et al. (2002) write, “If a person is living with intractable depression, and his or her suffering is evident and prolonged, then the professional obligation to protect and support life competes with the obligation to alleviate suffering” (p. 270). Again, this becomes a decision not simply of life or death, but of pain or relief. For those with chronic mental illness, death may be the only way to avoid further suffering (Mishna et al., 2002). Subsequently, forcing these individuals to continue living in constant pain and distress can be seen as a form of torture (Mishna et al., 2002). For many years I volunteered for a sexual assault crisis line. During this time there was an elderly woman who called daily and would talk to the volunteers for as long as they would allow her. She spent every day in crisis without reprieve, unable to stop reliving the horrific sexual abuse she experienced at the hands of her family throughout her childhood. No stranger to dealing with crisis workers, she knew not to disclose her ideation to the volunteers but would often disappear for days and weeks at a time, telling us upon her return that she had been hospitalized for attempting to end her life. We can never truly know another’s pain as we have not lived through their exact experiences in their body. Insistence that “it gets better” and suicide is the “easy way out” become laughable in the face of a woman with over 70 years of suffering. Habitual enactment of suicide prevention strategies allows workers to avoid confronting the difficult and more ethically fraught reality that it might not get better. It may even get worse.

Furthermore, insistence on preserving life can deter service-users from disclosing. With policy in place at many service agencies, many service-users are aware that disclosing may lead to being reported. Consequently, like the woman who called the crisis line, service-users may choose not to disclose their ideation to avoid being reported. Importantly, this social context cannot only be limited to the present but must also account for the histories that shaped it. Chambon (2013) writes that it is important to reflexively remember the historical present, which describes how many pasts are active in each situation. This means that it is impossible to conduct suicide interventions without acknowledging the pasts of the worker, client, and the historical context within which the interaction is occurring. Social workers must reflect on how the action of reporting is reminiscent of historical practices, including detaining people in asylums.

Additionally, social workers must consider how their ability to take away the autonomy of clients stems from the classist systems of power on which social work is built. When social workers report clients in the present, they continue the perpetuation of whiteness and carry out the agenda of dominant groups. Ahmed (2007) writes that whiteness is “real, material, and lived” (p. 150) and reporting clients to authorities for suicide ideation is one example of this. Reporting then becomes a barrier to service-users getting the emotional support they require. Reporting service-users shuts down the conversation, ending the worker’s chance of learning more about the service-user and providing competent support. Even if the conversation is not interrupted by the arrival of emergency services, reporting often demolishes any rapport between the service-user and provider, irreparably damaging the therapeutic relationship. Fulginiti and Frey (2018) describe that, “…trepidation about disclosing attempt experiences can impede efforts to understand their recovery needs” (p. 1). Conversely, “…if a practitioner is able to hear the client’s unbearable suffering and death wishes empathically, this may build trust in the relationship with the therapist” (Fulginiti & Frey, 2018, p. 271). The goal of social work should be to provide support that is accessible to all without fear, even suicidal individuals.

This framework for understanding happiness is also useful in understanding suicide prevention. In many cases, suicide prevention can also be seen as a utilitarian project. Previously, suicide was viewed as a sin and therefore a crime and to a degree is still treated as such today. Social workers do not make their decisions based solely on what is best for the service-user, but also based on what is best for the family, their agency, and themselves. Suicide can negatively impact the wellbeing of the community as well as shed light on negative aspects of society such as bullying. Thus, suicide is not a crime in the traditional sense, it is a ‘social theft’ (Button, 2016). Suicide leaves communities without the contributions of the person who has ended their life. However, considering that some automatically have less social standing by virtue of their identity it is important to consider if a prior theft has taken place (Button, 2016). This would be the robbing of their chance to exercise their full capabilities (Chambon, 2013). Further, social workers’ avoidance of the ethical dilemmas associated with suicide prevention shows an unwillingness to cope with death; decisions regarding clients’ right to die are further shaped by the workers’ willingness to put themselves through emotional distress. Life is then preserved not with the clients’ best intentions in mind, but the best intentions for many.

Life Affirming Futures

These assumptions, that suicide is always the result of mental illness, suicidal individuals are irrational, social workers have superior knowledge, insight, and training on how to address suicide, and that life should be preserved at all costs lead to considerable stigma surrounding suicidal people, especially attempt survivors. In fact, in a 2018 study, 29% of attempt survivors reported never disclosing to anyone in their family out of fear of judgment (Fulginiti & Frey, 2018). This is despite 42% of the same group identifying ‘attempt survivor’ as a central part of their identity (Fulginiti & Frey, 2018). The stigma surrounding suicide is so intense that suicide attempt survivors are willing to hide what they identify as a core aspect of who they are from their loved ones. One thing critical suicidologists and mainstream suicidologists can agree on is that suicidal individuals deserve support, but providing this support is impossible if attempt survivors are too scared to disclose.

Current methods of suicide intervention focus only on the preservation of life, not on inspiring hopeful, life-affirming attitudes. As a result, social workers may succeed in preventing service-users from ending their lives, but not in ending their desire to die. Further, incarcerating the mad community does not allow them the dignity and justice that they deserve. Instead, social workers should focus on creating strong therapeutic relationships with service-users and listening to service-users empathetically. Rather than fearing disclosure of suicide ideation, workers can practice finding paradoxes in suicidal statements that promote life (White, 2017). In regards to developing more life-affirming approaches to suicide prevention, White (2017) asks the thought-provoking question, “If suicide itself were to be reconceptualized as a political issue and a “public trouble” (and not merely a matter for psychologists and mental health experts), what new collectivities and actions might emerge in response?” (480). In answering this question there are an abundance of aspects to consider including political landscape, history, culture, family, available resources, and more. Abolishing duty to report policies is the first step in creating a more trusting and productive relationship between service-user and provider.

I propose adding suicide prevention strategies at the mezzo and macro levels in addition to the existing micro-level interventions such as therapy. Using a social justice approach, social workers could identify community needs to increase culture-specific, confluence-informed resources within small areas. Within communities it is important to advocate for increasing people’s social supports to decrease sadness and isolation (Button, 2016). Culture-specific resources are incredibly important in providing competent suicide prevention and, in keeping with Mad Studies, must be developed with the guidance of community insiders (Lefrancois et al., 2013). To demonstrate this I return to the example of Inuit communities. In Canadian Inuit communities positive cultural identity was correlated with lower rates of suicide (Morris & Crooks, 2015). This has been linked to the confluence of these communities’ identities with colonization, which halted their processes and functioning (Morris & Crooks, 2015). Regaining the sense of culture and community that was stripped away by colonization is vital in fostering community satisfaction (Morris & Crooks, 2015). However, social workers have often attempted to intervene in Inuit communities using Western approaches that focused on the individual (Kral, 2016). Kral (2016) writes, “The Canadian governments spent much money in the late 1990s on training Inuit in Western suicide prevention strategies, but the rates continued to rise” (p. 690). Inuit approaches to suicide intervention focus more on preserving culture and community identity (Kral, 2016; Morris & Crooks, 2015). Services that are Inuit-specific and involve community stakeholders have been proven more successful in lowering suicide rates (Kral, 2016; Morris & Crooks, 2015).

At the same time, workers should strive toward top down change to create a more inclusive society, end othering, and dismantle whiteness. The political approach can supplement the medical approach by giving attention to the sociocultural factors at play (Button, 2016). The shift from interpersonal to intrapolitical approaches should aim to raise awareness about inclusive views on suicide and create a cultural paradigm shift in suicide prevention. Further, spaces like hospitals and social service agencies are institutions designed for dominant groups (Ahmed, 2007). Though these spaces are meant to service clients, they remain outsiders in them. Forcing clients into these spaces may foster recovery, but it may also simply encourage a performance of happiness and likeness. Moreover, it may draw attention to the elements of their identity that make them Other, leading to further deterioration of their mental wellbeing. Macro-level action should work to restructure society so that everyone is able to exercise their capabilities (Chambon, 2013).

Conclusion

Modern conceptualizations of suicide, though apparently naturally occurring, are in fact socially and historically produced. Overtime suicide has most commonly been viewed as sin, crime, and illness (Foucault, 1961). Today suicide is most often seen as the result of mental illness, though this biomedical perspective alone cannot account for the complexities surrounding suicide (Reynolds, 2016). A more accurate representation of suicide positions it within a larger context of sociopolitical oppression (Button, 2016). Suicide and social workers’ responses to it are the result of historical othering of the mad community (Lefrancois et al., 2013) and the perpetuation of whiteness (Ahmed, 2007). Suicide intervention is individualized to address the client rather than the system. Social workers attempt to address suicide within spaces and context that only reinforce the stigma and isolation felt by suicidal individuals. Further, social work’s insistence on reporting clients to EMS and police for suicide ideation recreates painful histories without accounting for the trauma this might cause. It is time social workers acknowledged that suicide occurs within a framework of systemic and historical oppression and cannot be separated from this (Joseph, 2015). By denying this, social workers contribute to a common project of subordination (Joseph, 2015).