I recently posted about self-harm. On the back of this, I’m taking things a step further and talking suicide. Suicide is an uncomfortable thing to sit with. We hold our own thoughts about it, such as seeing it as a sad and unnecessary act. Some see it as selfish. Others may fail to understand why the person could not see all they have.
All I can say is when you in that moment it’s hard to see the positives and logical alternatives. You really believe those close to you would be better off without you. The worthlessness, despair, and perpetual hopelessness are a considerable weight. They come with thoughts and beliefs associated with an obvious and appealing way out. Other routes (intervention and recovery) hold no hope and are not an achievable option. Protecting someone from taking their own life is a heart wrenching job. It’s emotionally wearing and a burden. The responsibility can be overwhelming.
Some Facts and Figures
According to the Samaritans, men aged 45-59 years remain the most likely to commit suicide. Suicide rates amongst men are 3 times higher than women but women of the same age bracket also pose the highest risk. Working in child and adolescent mental health for many years, it was held that young men were more likely to succeed in taking there own lives. I certainly assessed more teenage girls following a suicide attempt. Some of the risk associated with adolescent suicide is the likelihood that they are more likely to act impulsively. Those I assessed over the years usually spoke of not having a plan and didn’t necessarily want to die. They were usually reacting to a stressful life event. Lets not forget the stress that comes this time of year too for those taking their exams. Sadly, there always seems to be a young person who takes their life in the run up to exams or finding out their results.
It’s not all bad news. It’s important to point out that while someone has thoughts of taking their own life, it does not mean they will act on them or are planning to. Protective life factors against suicide include having good familial and social support, and engaging in the company of others. Having good problem solving skills is believed to temper the feeling of hopelessness. Accessing and engaging with services and interventions goes a long way too. Being a parent is also cited as a protective factor. The thought of not seeing your children grow up, and consider how they would cope without you, is enough to make some people think twice before they do anything. I think the dangerous place is when someone actively believes their children, and signifiant others, would be better off without them.
If they are factors that help protect someone, what about those that elevate their risk? I’ve already mentioned gender and age but here are others:
- Do they have a plan? Those with a plan are more likely to complete a suicide. If the person will talk to you, find out as much as you can.
- A change in presentation or mood. Sometimes those who have been contemplating suicide for a while will show an improvement in mood once they have made the decision to take their own life. There may be some days between making this decision and acting on it. The elevation in mood reflects the sense of relief that comes knowing they will no longer have to experience such turmoil.
- Traumatic life events – If someone has experienced previous trauma, they are more vulnerable to the risk of suicide. Some people are able to process trauma whereas others find it too painful to talk about and integrate into their sense of self. We talk about trauma quite readily these days so to be clear, we are talking about serious events that have the potential to change your life, like the death of a child/important loved one, abuse, neglect, etc.
- Experience of being in care – A bit like the above really. A history of some form of abuse or neglect within the context of your parenting relationship is a mental health marker. It is also a risk marker for suicide. Why? If the people who were meant to keep you safe mistreated you, abused you, and frightened you, you are less likely to have developed resilience against further adversity. Sexual abuse and domestic abuse in particular have been found to be correlated (probably because they are easier to evidence and research).
- Drug and Alcohol – People use drugs and misuse alcohol for a number of reasons. If you’re a parent, do what you can to minimise alcohol consumption and any drug use. It may be that you have to structure the person’s time and reduce how much they see their peers. Admittedly, it’s a fine line.
- Company – Sometimes we can keep unhelpful company. People may encourage us to think about a situation in a certain way or influence our behaviour. Again, if you are reading this as a parent, you may have to put in place clear boundaries about peer relationships if you feel they are unhelpful. The same applies if bullying is an issue.
- Current life stressors – You may know someone who has appeared to have a good life but is struggling right now. Life may have become stressful and demanding and it may be effecting their outlook and mood. It’s important to keep in mind what has happened to the person and how they got to this point. That will help to identify what areas need to change and what can aid improvement. People contemplate suicide for all sorts of reasons. It’s important to note in the current climate that financial problems and poverty are known triggers/risks.
- Family and Personal History of Suicide – Those with a family history of suicide and those who have previously attempted suicide are more at risk. Having a family history of suicide highlights intergenerational trends of coping with difficult life events and emotions. Previous suicide attempts indicate that a person has got to the point where they have acted on their thoughts. This makes them vulnerable to doing it again.
- Diagnosis – Having a diagnosed mental health problem, such as severe depression, psychosis ad Bipolar Disorder. Having a physical illness is also believed to be a factor, especially if life changing or life limiting.
- Hopelessness – To feel hopeless is to feel like nothing can change or improve. It comes with a sense of powerlessness and a lack of energy to initiate change. Feeling hopeless about the future, one’s self, and emotions is a risk factor.
What can you do?
Here’s how to help and protect:
- Get Help – As I said in my self-harm post, don’t hold the risk alone, it can be too much. Contact the GP, raise your concerns. As a clinician I would rather assess someone and clarify the level of risk rather than leave to chance. By getting help a safety plan can be formulated and additional services can become involved. This will make the risk more manageable.
- Structure – Reaching a person who is considering suicide is hard work. Try and help them have some structure and purpose to their day. It might be that they need you to do something with them. This is about having something in their day they can aim to do or look forward to, big or small.
- Limit Time Alone – This can be a time for rumination. If you can, regularly check on the person throughout the day, and maybe the night if necessary. It could be a mix of phone calls and actual visits if you don’t live with them. This is made easier when there are a number of people helping, including community mental health teams.
- Remove Risky Items – This is a bit easier when we are managing the risk of a young person who is at home with adults. Lock or throw away medication. Remove ties, belts, ropes, anything that could be used as a ligature. It may sound drastic but sometimes it’s necessary. It’s not forever. Obviously, this should be done in a non-blaming or shaming way. The aim is to keep someone safe not to make them feel bad or guilty about how they are feeling. The same goes for drugs and alcohol. Think about if these are part of the picture and seek help from appropriate services if needed. Naturally, limit the amount of alcohol that is at home.
- Acceptance – This is a hard one because I am suggesting there is an acceptance for the person wanting to end their life. I am not talking about encouraging them, it’s more about acknowledging what the person is struggling with at the moment. They will need this if they are to move forward.
- Safety Plan – With the person, work out what they can do when the risk is becoming insurmountable. What are the warning signs it is getting like this? Are there any triggers? Is there someone they could call? How could they distract their mind from these thoughts? Giving phone numbers for anonymous helplines is worthwhile too. The Samaritans or Childline offer a fantastic service, as do Prevention of Young Suicide.
Sometimes you can do everything possible and suicide still happens.This is simply devastating. You may find while supporting someone that you start to feel lonely, hopeless and helpless too. You may be picking up on the their feelings but this may also be an indication that it’s getting too much for you. Don’t hold the risk on your own, do involve services and ask for help, it’s what they are there for.