A presentation by Dr Ann Luce made clear one of the reasons we struggle to talk about suicide - we haven't really unravelled our thoughts. While suicide is considered "a tragedy", she finds that someone suicidal can be considered "attention seeking" and while people seek to avoid them may feel irritated, or dismisses the problem, at the point of suicide people report feeling bad and wishing they'd seen the signs.
Mental Health Awareness Day, 10th Oct 2021 is focused on Mental Health in an unequal world...and recently research by the Thai Mental Health department revealed that death by suicide is more common where there are:
- relationship issues
- misuse of substances
- unaddressed mental health issues
- financial strains
I will now hand you to Guest writer Amy Collett with her reflections:
600 percent. That’s how much more likely those who suffer from substance abuse problems are to end their own lives. This often occurs while they are in recovery and facing troubling emotions that they had been self-medicating with drugs or alcohol. For others, morbid thoughts are the result of a co-occuring mental illness such as anxiety or depression that underlies their addiction and exacerbates the symptoms. Whatever the case, they’re in an extremely vulnerable position and need your help as a friend, relative or partner. Here’s what you can do:
Recognize the Signs
Knowing what to look out for could mean the difference between life and death, so pay attention - notably to preparation and discussion. Some of the signs are rather obvious, such as talking about wanting to die, buying a gun or hoarding medication, while others are more subtle. The latter includes having trouble sleeping and withdrawing from their social life and their interests, according to a writer with USA Today. You can learn more by talking to an addiction counselor and describing your friend’s behavior specifically. If someone has been exposed to other members of the family taking their lives, the risk of death by suicide is increased.
Stop Enabling Behavior
This needs to be done regardless of whether your loved one enters treatment or not. Enabling refers to doing things for the addict that they would normally do for themselves if they did not give in to their addiction. It includes helping them pay rent or providing them food. As long as you continue this behavior, your loved one will be unable to stand up on their own two feet and suffer from anxiety as a result of low self-esteem, which can trigger suicidal thoughts. Freedenthal (2018) reminds us "Fear can be healthy. The challenge (for the person feeling fearful) is not to be immobilised by fear, or on the other hand, to overreact".
Encourage Treatment
Those in need of help often reject it out of a need to feel independent and self-reliant. That means that getting your loved one into treatment — whether it’s a rehabilitation center, a 12-step program or an appointment with a therapist — can be an uphill battle. Start by having a simple conversation at an appropriate place when they haven’t been drinking or using drugs, and approach them with empathy. Let them know that you are worried by their behavior and want to help. That may just be enough to get the ball rolling.
Stay Close to Them
Literally. Make sure they’re not left alone for extended periods of time. If you do not live with your loved one, be sure to check in regularly or try to get them out and doing things. That could be anything from having dinner together at a restaurant to taking a hike out in the woods. In fact, the latter could be just what they need as spending time outdoors and exercising have been shown to reduce stress, and that’s often the underlying problem linking their addiction with anxiety and depression. And if you do stay indoors, do what you can to give their home as positive a vibe as possible. You may also work out a "Safety Plan" with them, with numbers they, and you can call. The Stay Alive App may give you support.
Set Up a Network
Related to the above, your loved one has other family and friends who have the patient’s well-being in mind. Get in contact with them so that you can share the responsibility of looking after the patient while sharing any observations about their condition. If necessary, you can work together on an intervention, which is a meeting where you gather together with your loved one and explain how much you care about them in an effort to get them into treatment. That may be the best option if the patient refuses to see a counselor.
Prepare
In the event of a suicide attempt, it’s unlikely that the patient will willingly go the hospital, so it’s better to call 911 (999 in the UK). The emergency services in most communities usually send the police as well as an EMT ambulance in the event of a mental health crisis such as an attempted suicide. Both elements will decide together whether or not the patient needs to be hospitalized. Later, your loved one will meet with a psychiatrist and attend psychotherapy sessions.
As you can see, when you’re the friend, relative or partner of an addict who is at risk of dying by suicide, your role is crucial as the stakes are high. Don’t let the pressure get to you, and pay attention to your own well-being as you need to be strong.
Amy Collet is the creator of Bizwell.org, a website that helps professionals and entrepreneurs build and strengthen their personal brand.
USEFUL SUPPORT LINKS:
Samaritans www.samaritans.org
ASSISTline: 08006895652
Saneline www.sane.org.uk
CALM www.thecalmzone.net – elevate small talk – LISTEN (active and deep…and active or passive positive)
Papyrus: www.papyrus-uk.org
The mix under 25 www.themix.org.uk
Shout: www.giveusashout.org
Supportline: email: info@supportline.org.uk
Angela Samata #seesaysignpost Big Questions: Angela Samata On Getting The World To Take Suicide Prevention Training | EachOther
A note from Dr Audrey Tang:
If you are going to have a conversation with someone about suicide it is important to be prepared to take action – for example – do you KNOW the nearest A&E if you need to drive them there? Do you KNOW how to get hold of the Samaritans, or the NHS or the Community Mental Health Team…?
First of all, as my guest writer suggests, it is ever more so important just to reach out – so simply check in on your friends, especially if you notice changes in their behaviour -perhaps they are a regular poster on social media and have been absent for a while…but make checking in a regular thing anyway.
Second while it isn’t up to you to solve any issues, certainly talking to people feeling down or overwhelmed has been shown to help because often people can spiral into a sea of negativity and through talking and asking them questions you can help them find a little space to clear their head and even see that they do have a way out…but it’s not for you to suggest ideas – just talk and listen.
And of course, avoid judgment.
The importance of language
But if you are going to have a conversation directly with someone, asking them:
- Are you thinking about suicide?
- Are you thinking about ending your life?
does NOT introduce the idea – it does however get you both on the same page. Be direct rather than skirt the issue with phrases such as “Are you thinking about doing something silly”.
They may refute you strongly, or they may say they have thought about it, and also may even have prepared.
- You may also need to ask “Have you done anything to harm yourself?”
You may then need to
- Remove sharps, drugs, cords, cleaning products
- Stay with them until you can get help/take them to somewhere who can help/call someone who can help with them
Phrases such as “I am worried that you are going to harm yourself so is there someone we can call”…it is possible that people may have a “crisis pack” that they have worked out with their therapist which may have numbers of people they can call when they are feeling this low.
You may need to tell them to get someone to sit with them until you arrive (while you are on the phone) if you are at a distance.
When you are with them you may be able to talk with them, maybe walk with them, or do something that could distract them from their negative thought spiral – watch a film, go for a walk, express creatively, sing…although you may need to judge the moment, as they may need more intervention than a distraction.
Removing stigma
In a 2013 study by Beaton et al, changes to terminology surrounding suicide proposed the following:
Stigmatising terminology
Committed suicide (It is neither a sin nor a crime)
Completed suicide
Failed attempt at suicide
Unsuccessful suicide
Appropriate terminology
Died by suicide
Ended his/her life or Took his/her own life
Non-fatal attempt at suicide
Attempt(ed) to end his/her life