Top 3 Suicide Intervention Models: How Different Are They?
This article provides an overview of the top three models for suicide intervention: the Medical Model, Wellness Model, and Biblical Model. We will look at each model, how they are similar or different, and the relative strengths of each for suicide intervention.
Snapshots in Time
Look at the snapshot above. Young people are smiling for the camera, enjoying each other's company on a bench on a bright sunny day. This snapshot captures a moment in time. They symbolically represent people of any age. They could be your friends and family members.
Look at them again more closely. Who is putting on a smile to mask deep feelings of sadness? Who suffers from anxiety? Can you tell who is depressed and considering suicide? Which of these "happy" people feel the joy of salvation? Who is a lukewarm Christian or agnostic? Is there an atheist in the group?
These young people may be happy, healthy, and full of life, just as they appear in the snapshot. They may each be "lights shining in the darkness," knowing where they will spend eternity--in heaven. But given the statistics and world crises, one (or more) is likely suffering anxiety and depression and possibly considering suicide to end their pain. Given research trends, we also expect more young people to move from lukewarm Christian to "nones" as their faith.
Although there are people who complete suicide without showing any signs of distress, most do. Most people tell someone they know how out-of-control their life has become. We hope that we can be the light and save a life through suicide prevention and suicide intervention. This post begins the discussion about suicide intervention. If you haven't read "Why Three Dimensions of Wellness are Critically in Suicide Prevention," I recommend you read it now. We will build on that foundation in this article.
Three Different Models of Suicide Intervention
People must be aware of these three standard models to be better informed if they, or someone they know, requires suicide intervention. I pray you'll never need to use this information; however, like CPR, it's better to know it in an emergency than not. So, let's consider each of the three models for suicide intervention now.
The Medical Model
Who Follows The Medical Model in Suicide Intervention?
The simple answer to this question is that nearly every licensed professional counselor, psychologist, social worker, psychiatrist, or mental health agency follows the Medical Model. In addition, because each receives reimbursement for services through insurance, they must justify the need for services (i.e., mental disorder diagnosis).
So, if someone receives suicide intervention through a community mental health center, for example, they will be in the Medical Model because they are part of the managed care system. Of course, some contend that they aren't following the Medical Model, but you can determine it by looking at how they "treat" their consumers/clients/patients. Look at the assumptions below.
What are the Major Assumptions of the Medical Model?
Assumption #1: "Experts" Provide Mental Health Treatment. In medical model settings, you can expect to see credentialed (i.e., licensed) professionals who have earned at least a master's degree and likely a doctoral degree in one (or more) of the "helping" professions. For example, psychiatrists are medical doctors who specialize in psychiatry. Typically, psychiatrists prescribe medication. You may also find non-credentialed para-professionals who provide skills-based training under the supervision of licensed clinicians. Only "experts" are authorized to provide medically necessary treatment if they expect insurance companies to reimburse them for services.
Assumption #2: Mental Disorder Diagnosis Required. As noted above, insurance companies require a mental disorder diagnosis before authorizing reimbursement for mental health services. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) is the most recent version used by mental health professionals. The American Psychiatric Association states, "The manual will help clinicians and researchers define and classify mental disorders, which can improve diagnosis, treatment, and research."
Assumption #3: Treatment Plan (or equivalent) Required. A treatment plan is needed in the medical model because the assumption is that the individual is sick (mentally ill) and requires treatment to get better. The treatment plan usually includes the following:
Psychotherapy or some form of Cognitive-Behavioral Therapy
Various skills-based training
When is the Medical Model Most Appropriate for Suicide Intervention? Because this series is for educational rather than psychotherapeutic purposes, it may be helpful to offer an example. Let's assume you have no (or minimal) training in suicide assessment. You come across a person who is crying uncontrollably. You ask them what is wrong, and they say, "It doesn't matter. I'm going to kill myself anyway." They tell you that they have a firearm in their car and are leaving to end their life now. This person is in immediate danger. They need immediate medical care to save their life. They require hospitalization and treatment to get them stabilized. If you think of "triage," this high-priority person needs to be seen by a medical professional. Call 911, the local police department, the community mental health agency, National Suicide Prevention Lifeline at 1-800-273-8255, or just TEXT 988. For more information about this new three-digit option, see this article.
The Wellness Model
Who Uses The Wellness Model in Suicide Intervention? We are likely to find the Wellness Model among clinically-trained counselors who no longer see the Medical Model as a viable option for non-life-threatening suicide intervention. In addition, many practitioners believe psychotropic medications' side effects and addictive qualities outweigh their benefits. Instead, a more holistic/wellness approach considers the Body, Mind, and Spirit as necessary components of wellness. These practitioners typically view pharmaceuticals as the last resort rather than the first choice in suicide intervention.
What are the Major Assumptions of the Wellness Model?
Assumption #1: "Support System" Provides Encouragement and Education. In wellness settings, supportive people are engaged to encourage and educate (rather than treat) the person considering suicide. Since the wellness model is holistic, the support system may include:
Personal Trainers, Wellness Coaches, and Medical Professionals to provide encouragement and education for physical wellness (the Body);
Holistic/wellness counselors and life coaches who address psychological and emotional issues for psychical wellness (the Mind);
Pastoral counselors, pastors, and other church leaders address spiritual issues and questions about the relevance of scripture in the person's life (the Spirit).
Family and friends are also key members of the support system.
Assumption #2: Mental Disorder Diagnosis is NOT Required. Because the individual is NOT considered "sick" but instead "discouraged," the need for a psychiatric diagnosis is avoided. Members of the support system can "speak the same language" about the individual's condition without using diagnostic criteria. They also do not need a label to satisfy insurance company requirements for payment. If we want to reduce the negative stigma associated with mental illness, perhaps we should restrict the labels to those individuals who truly meet the criteria for a mental illness. Unfortunately, many people receive a lifelong psychiatric label when the conditions leading to suicide ideation have long passed. If you agree with this position, you may align with a wellness model for suicide intervention.
Assumption #3: Requires a Wellness Plan. If one of the Wellness Model assumptions in suicide intervention is the person is discouraged rather than sick and based on strengths rather than problems, then the wellness plan might include the:
Exercise and diet education, training, and coaching;
Cognitive-Behavioral approaches, including education in, for example (Rational Emotive Behavior Therapy (REBT) and Reality Therapy/Choice Theory);
Bible counseling, bible studies, discipleship classes, service to the church/community, Christian clubs/organizations, and other fellowship opportunities;
May require medication if non-medical interventions are ineffective.
When is the Wellness Model NOT the Most Appropriate for Suicide Intervention? We can think of suicide intervention on a continuum. From the person who makes a passing comment about suicide (on the low end) to the person with a specific plan, high lethality/means (exp., gun, rope), and intent (right now!). So here are some instances when immediate medical intervention is justified.
The person has a plan, the intent, and the means to complete their suicide immediately (clear and imminent danger);
The person has a history of suicide attempts while following the wellness model;
The person is unwilling to entertain non-medical options;
The person's suicide ideation intensifies or includes more specificity in a plan to complete suicide;
Anytime wellness practitioner believes their interventions are ineffective.
The Biblical Model
Who Uses The Biblical Model in Suicide Intervention? Without sounding evasive, it is God who uses the Biblical Model. This is the least likely model you will find in suicide intervention. Why? First, most mental health professionals and wellness practitioners are taught that presenting problems that lead to suicide are physiological, sociological, or both in nature. Thus, they believe the keys to solutions for these conditions are accessed through the interventions of the professionals/practitioners.
Assumption #1: "Holy Spirit" Within is the "Medicine Chest." Because God uses this model and the people He calls to implement it, it stands to reason the Holy Spirit is the "Medicine Chest" within the suffering person. Because the Holy Spirit is perfectly well, the individual Spirit of the sick/discouraged person can also be perfectly well. The goal is to align the person's body and mind with their perfectly healthy Spirit.
Note: God uses people in this Biblical Model. However, people beyond the suffering person are optional! So yes, it is radical. But consider what scripture tells us:
"I am writing these things to you about those who are trying to lead you astray. As for you, the anointing you received from Him remains in you, and you do not need anyone to teach you. But as His anointing teaches you about all things and as that anointing is real, not counterfeit - just as it has taught you, remain in Him." 1 John 2:26-27
Assumption #2: Mental Disorder Diagnosis a Free-Will Choice. The Biblical Model acknowledges the following regarding diagnoses:
The physical body can become sick. There are many examples of Jesus healing the sick during His time on earth. He said, "...It is not the healthy who need a doctor, but the sick. I have come not come to call the righteous, but sinners." Mark 2:17 Thus, if a person has asthma, they may well receive a medical diagnosis for the condition. While it is a free-will choice whether the person visits the doctor for their breathing condition, scripture is clear that physical ailments are part of the human condition.
The mind can become confused and troubled. Although contemporary society quickly labels nearly every dysfunction and poor choice as a mental illness, scripture isn't so clear about that. Anxiety, for example, is one of the most common conditions of people who consider/complete suicide. But God's word says, "Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your request to God. And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus." Philippians 4:6-7
Anxiety is also related, in many cases, to depression. The scripture above speaks to the heart (exp., depression) and mind (exp., anxiety). We also find this relationship between anxiety and depression in Proverbs: "Anxiety weighs down the heart, but a kind word cheers it up." Proverbs 12:25
We have a free-will choice whether we subscribe to the world's view of mental disorder diagnoses. Much of what the "professional" community considers psychopathology and requiring treatment is God's way of strengthening character and asking us to lean on Him. God does not give people a "pass" to engage in behaviors He calls "Sin" just because society calls such behaviors as illness.
Assumption #3: Requires Acceptance of Jesus Christ as Lord and Repentance. We know how strongly anxiety and depression are related to suicide. And we know that fear lurks in the shadows of anxious thoughts and depressed feelings. But God talks about fear in the Bible as many times as there are days in a calendar year. Nearly all are references to His removing our fears. God knows that we base many fears, anxieties, and depressive episodes on irrational beliefs about the past, present, or future.
Not all fears and anxieties are unjustified. If you want an example of "normal anxiety/fear," look to scripture in the Old Testament:
"The Lord will afflict you with madness, blindness and confusion of mind." Deuteronomy 28:28.
Could some "mental illness" result from a transcendent intervention (God) rather than physiological or sociological antecedents? The Bible says so. It's little wonder we read in Proverbs:
"The fear of the Lord is the beginning of wisdom, and knowledge of the Holy One is understanding. For through wisdom your days will be many, and years will be added to your life. If you are wise, your wisdom will reward you; if you are a mocker, you alone will suffer." Proverbs 9:10-12
Many times, wisdom leads us to simple solutions for complex problems. In this case, the simple solution to complex personal and world issues is acknowledging Jesus Christ as Lord and Savior. If we do so, we find the Holy Spirit, the perfect healer, adding clarity to irrational thoughts and joy in place of depression in our hearts.
As we awaken to our sins, we ask God for forgiveness. He is quick to offer grace and mercy. With a repentant heart and mind, our Spirit aligns with our actions. The past's disjointed thoughts, feelings, and behaviors start to change.
"Therefore, if anyone is in Christ, the new creation has come. The old has gone, the new is here!" 2 Corinthians 5:17
When is the Biblical Model NOT the Most Appropriate for Suicide Intervention? Because this is God's Model, not man's, the Biblical Model is ALWAYS the most appropriate for suicide intervention. Some, including myself until recently, would think this statement incredible. However, even if our Medical or Wellness Models are successful in suicide intervention, and the person goes on to great success, we may have saved his life but not his soul. The apostle Mark said best,
"What good is it for someone to gain the world, yet forfeit their soul?" Mark 8:36
Comparing the Three Models for Suicide Intervention: Major Assumptions
Relative Strengths for the Three Models of Suicide Intervention
This article focused on three models, the Medical Model, Wellness Model, and Biblical Model, for suicide intervention.
The predominant approach to suicide intervention in the United States is the Medical Model, which emphasizes licensed professionals, diagnosis, and treatment of mental illness, typically involving psychotropic medication and cognitive-behavioral therapies.
The Wellness Model follows a holistic approach focused on strengths rather than problems, deemphasizes psychiatric labels, and views medication as the last option in wellness planning rather than the first.
Finally, the Biblical Model emphasizes the integration of body, mind, and Spirit, similar to the Wellness Model. However, the Biblical Model requires accepting Jesus Christ as one's Lord and Savior as the prerequisite to receiving the Holy Spirit, who dwells within. The Holy Spirit becomes the "medicine chest" for healing, and the Bible becomes the guide for addressing all problems (exp., anxiety, fear, depression) that lead many to consider or complete suicide. The unique benefit of the Biblical Model is that it not only has the potential to save a life from suicide but also to ensure the person's eternal salvation.
This article has been a broad overview of three models for suicide intervention. From this point, we will look at how each model addresses the life challenges that correlate with completed suicide.