Dr Heather Dyson
World Suicide Prevention Day
Suicide continues to be a significant social issue in the United Kingdom. In 2019, there were on average 18 suicides every day (ONS, 2020), with suicide being the single biggest killer of men under the age of 45, in the UK. Rates for females under 25 have also increased by 93.8% since 2012, to its highest level in 2019 (BMJ, 2020)
It can often be difficult for individuals who haven’t experienced trauma and mental health difficulties to understand why individual’s end their lives. Suicide is frequently a desperate attempt to escape from suffering that has become unbearable. Whilst the individual may desire the end of the emotional pain that they experience, the majority of these individuals feel deeply conflicted about ending their own lives and wish there was an alternative to suicide, but they can’t see one.
Common misconceptions about suicide
Myth: People who talk about suicide won’t really do it.
Fact: Almost everyone who attempts suicide has given some clue or warning. This may be direct statements of their intentions or indirect references to death or suicide e.g. “you’ll be sorry when I’m gone”.
Myth: Only individuals who have mental health problems commit suicide.
Fact: Most individuals who end their lives do not have mental health issues. They are frequently upset, depressed, or despairing, but extreme distress and emotional pain are not necessarily signs of mental illness.
Myth: If someone is determined to end their lives, nothing will stop them
Fact: Even the most depressed individual will have conflicted feelings around death. Many individuals trying to communicate that they want the pain to stop and that the only way they see it ending is through death, rather than they want to die. The impulse to end their life does not last forever
Myth: Talking about suicide may give someone the idea or push them over the edge.
Fact: You don’t give someone suicidal ideas by talking about suicide. In fact, having open, honest conversations about suicidal thoughts or feelings can help people to open up about what going on in their lives, and help to save a life. For those of us who aren’t sure how to start that conversation, here is a wonderful video from Blue Beyond: https://www.beyondblue.org.au/the-facts/suicide-prevention/feeling-suicidal/talking-to-someone-about-your-suicidal-feelings
Warning signs of suicide:
Whilst it can be hard to know the intentions of others, there are frequently warning signs that someone is contemplating taking their own life. If you believe that someone you know is at risk for taking their own life, you can play a role in suicide prevention by highlighting alternatives, getting a doctor or emergency services involved, and showing them that you care.
1. A major indicator that someone is contemplating taking their life is an increase in focus/preoccupation on death, researching suicide methods, self-harming behaviours, and seeking out things that could be used in a suicide attempt. These signs can be even more significant if the person has a mood disorder (e.g. depression), or has previously attempted suicide.
2. A sense of hopelessness can also be a significant sign of suicide. Research has shown that people who feel hopeless may talk about “unbearable” feelings and state that they have nothing to look forward to.
3. Individuals who are contemplating ending their lives may also start getting their affairs in order. You may notice a friend or loved one making out a will or giving away their prized possessions.
4. You may notice a friend/loved on making unexpected visits or calls and saying goodbye as if they won’t be seeing them again. They may start pulling away from their friends and becoming increasingly isolated.
5. Some individuals may start to engage in more “self-destructive behaviours” such as increased drug or alcohol use, or taking unnecessary risks e.g. driving extremely fast. Others may develop a sudden sense of calmness or happiness as a result of making the decision to end their life.
1. If you’re worried about someone, speak up!
Many people worry that if they talk about suicide to someone, that they’ll be more likely to attempt to end their life. In fact, research shows us that the opposite is true. Having open, honest, conversations with someone about what they’re thinking and feeling often result in individuals opening up and seeking help rather than attempting suicide. Whilst it can feel scary or uncomfortable to have those conversations, you will not be saying anything that the individual hasn’t already thought themselves. Showing that you care about their well-being provides the individual with an opportunity to express their distress and provide relief from their pent up, negative feelings.
When you have these conversations it’s important that you listen to them. It can be really painful to hear someone talking about how they want to end their life. However, by allowing them to express their negative feelings, and taking a non-judgemental and sympathetic stance, it will help them to feel heard and their experience validated.
If we think to times in our lives when we have been struggling, having someone listen to our experience, rather than trying to problem solve, or put their experience over ours, is often more helpful. Likewise, being taken seriously. Whilst we may believe that the individual isn’t really going to end their lives, or we may feel that their plans are unrealistic, to the individual talking to us those plans are perfect and they have total conviction that they are going to end their life.
2. Respond quickly
When someone informs us that they are planning on end their life, it’s important to think about the immediate danger the person is in. Asking questions about how they intend to commit suicide (Plan and Means), when they are going to do it (Time) and how strongly they believe they are going to end their life (Intention).
Individuals are more at risk of attempting suicide if they have a very specific plan, they have the physical means to carry it out, and they know exactly when they are going to do it. In situations like this, attending A&E or contacting NHS Crisis services (or the crisis services in your country) is vital. However, even when someone is expressing suicidal thoughts but without a specific plan, means, time, and low intention, we still must take this seriously. Contacting their GP or Crisis services is still very important. Occasionally, some individuals may tell you that they are planning on ending their life by want to swear you to secrecy. Whilst this may feel as though we are being putting in a difficult situation, we must always remember that there is someone’s life at stake. So, although it may feel difficult to break our promise, informing healthcare professions (e.g. GP) is essential.
3. Accessing help and support
If a friend or loved one is expressing suicidal thoughts or intentions, the best support you can offer is an empathic, non-judgemental ear. For some individuals this may be enough (although getting in touch with their GP, or supporting them to do so, is still very important), but for others, they may need further interventions.
a) Speaking with their GP. GPs will have knowledge about accessing local mental health services and are in the perfect position to offer support and advice. They may also be able to offer short-term medications to support the individual in the interim.
b) Accessing psychological therapy. This can be arranged both through the NHS or privately.
c) Following up with your friend/loved one. Asking someone who is clinical depressed to call you if their struggling may not work. Individuals in this situation may feel that they’re being a burden, or may convince themselves that you don’t really care about them. Being proactive and calling them, or dropping in on them, may be more helpful.
d) Encouraging them to go out for a walk with you. It may seem a simple thing, but research has shown time and again that low level exercise (such as walking) if the most effective treatment for low and moderate levels of depression. Exercise releases endorphins, relieves stress, and promotes wellbeing.
e) Making a safety plan with this individual around what they can do if they notice that the negative thoughts are becoming overwhelming. Things like identifying any triggers such as anniversaries, relationships, etcs. Making a list of contact numbers they can call when they feel they are in crisis.
f) Supporting someone who is actively suicidal has an impact on us as well. Although it can feel hard, taking time to look after yourself is also important.
Organisations you can contact:
These organisations operate throughout the UK and are available 24/7 to provide you with free Mental Health Support
· If you, a friend, or a loved one, are a risk of harming yourself/themselves, call 999 or your GP to make an emergency appointment.
· NHS Crisis Line (Call 111 if you don’t know your local Crisis service)
· Samaritans: Call 116 123 for free confidential support, 24/7, 365 days a year.
· Mind Allies: https://www.mindallies.co.uk/help
Other organisations that can offer support include…
· CALM (Campaign Against Living Miserably) – They provide telephone and webchat support from 5pm to midnight, 365 days a day. All conversations are free, anonymous, non-judgemental, and confidential.
· Papyrus: They provide telephone support to anyone under the age of 35 between 9am-midnight, 365 days a year.
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