Alternatives to Suicide

Domain V · Systemic, relational, group & community · 2008 · Western Massachusetts

What it is

Alternatives to Suicide (Alt2Su) is not a therapy and not something a clinician delivers. It is a peer-to-peer mutual-support practice: groups run by and for people who have themselves had thoughts of wanting to die, for voicing, sitting with, understanding and moving through those thoughts. The…

Format

• No phases or protocol. Alt2Su publishes no stages, session plan, agenda, symptom goals or discharge criteria. Groups are open-ended and organised around values, not rules. Mazel-Carlton describes the outcome as many alternatives arising between people rather than a fixed sequence.
• Standard group format (as published):

Who practises it, and how they are trained or regulated

• Facilitation: two co-facilitators who openly identify as having had suicidal thoughts or experiences. At least one should have completed the Alt2Su facilitator training. Facilitators do not have to be "past" their own suicidal thoughts.
• Training pathway:
• Alternatives to Suicide Group Facilitator Training (24 hours; earlier described as three days). Anyone may attend, but you can facilitate groups only if you have personal experience of suicidal thoughts and are willing to talk about it.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• facilitators slipping into a staff role.
• method-sharing in groups. Steer away from it.
• clinicians: your duties differ. See 4.C3 and Section 5.
• shame or withdrawal. Reach out if your group's agreements allow it.
• guilt-inducing framing; the person feeling their pain has been brushed aside.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.