I think it's very important to differentiate between suicide as response to fatal illness versus suicide as response to acute stress. I think someone who is dying of a neurodegenerative disease, for example, should be offered the choice to go early, before their quality of life has become so terrible that they are living in misery. This should be an informed choice made by someone with a clear head, full understanding and appreciation of the facts, and with enough time for consideration. Someone who is experiencing acute stress, such as an episode of depression, cannot do this. Unfortunately, we can't possibly know if a person suffering from mental illness is experiencing an episode when they mention wanting to die by suicide. Is this what they truly want, or is it what their disease has convinced them they want right now? We can't know, so healthcare providers assume that they would want to be safe, even when the disease causes their words and actions to suggest otherwise. This is why we stop people with severe autism from hitting their heads on the wall during meltdowns, why we restrain patients who are having psychotic episodes and are scratching their skin to the muscle to get at perceived bugs, and is why we put people at immediate risk of dying by suicide on watch. Someone with schizophrenia is more likely to die by suicide during periods of acute stress (during a psychotic episode, during a severe depressive episode, and in the first few months after beginning medication when they begin thinking more clearly and realise they have schizophrenia) suggesting that once they clear these acute periods they no longer engage in these behaviors. I think we are on the right track to try and ensure that people with severe mental illness have the resources and support to withstand the acute stress and make it to the other side, where recovery is possible.