Category: Breaking the stigma

Suicide is still considered a taboo subject to discuss, some people think that by not talking openly about it people are less likely to take their own life by suicide.  However, there is little evidence to prove this and research has found that talking openly about suicide allows people who are vulnerable to feel heard and supported within their community [1, 2].

The statistics associated with suicide are particularly difficult to read, worldwide over 800,000 people die by suicide each year equating to 1 person every 40 seconds [3] and even though there has been a reduction of 3.6% seen in the UK between 2015 and 2016 with 5,965 recorded deaths due to suicide [4] there is still more that we as a society can do

Which, leads me to my question – how should we talk about suicide?

When I was at my lowest point all I wanted was for someone to ask me how I was, not in that polite kind of way, but how I was REALLY feeling. I wanted someone to hear me and I wanted someone to empathise with what I was going through. But no one did. Other than Laurence and Becky no one really saw the chaos that was me. They were scared of me, the volatility of my moods and trying to reduce my angry outbursts was their priority. So, having any kind of open conversation would not have worked out too well for anyone involved.

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So, therefore I think the question should be broken down even further:

1. How do you talk generally about suicide?
2. How do you talk to someone who you think might be having suicidal thoughts?

1. How do you talk generally about suicide?

Preconceived ideas about suicide

This is important because if you feel that people who attempt suicide or have died by suicide are weak, selfish, cowardly, attention seeking, and a whole host of other negative opinions then you need to look more into the research and the why’s. Myths surrounding suicide are rampant and are unfounded. In my opinion, if you feel this way don’t approach someone who is having suicidal thoughts – it is not fair on them. If you have these opinions, please put them aside to help the person who is suffering.

Suicide is not weakness and never will be. Try thinking about suicide and dying by suicide as a result of a person being in so much pain that they see no other way of dealing with life. 

We as a community have the responsibility of supporting that person – and not putting them down. They are entitled to their thoughts, feelings and emotions and we should be guiding and encouraging them to seek help rather than adding to the situation they find themselves in

Be compassionate, be responsible and think about the language you are using about suicide.

For a general discussion, it may help you to find some kind of prompt that leads you into a discussion on suicide. Or you could just start talking about emotions and feelings – for me when I am talking generally about suicide I use my own past experiences but if you haven’t ever felt suicidal, then please don’t make it up you could do more harm than good. I personally would feel like you were mocking me making the situation worse.

Language

The words that we use have power and certain words that are often used in association with suicide apply their own stigmas [5]. So, when speaking about suicide please avoid the following words:

• Committed suicide
• Successful suicide
• Completed suicide
• Failed attempt at suicide
• Unsuccessful suicide

Use instead:

• Died by suicide
• Suicided
• Ended his/her life
• Took his/her life
• Attempt to end his/her life

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Remember that we are all human and will more often than not make mistakes, if you do, apologise and use a different term, learn from the experience and move on. Your guilt and shame about using the wrong language will not help the situation.

Don’t Judge

Whatever the reason is for suicide or a suicide attempt don’t criticise it or make a judgment about it. For example, someone said to me recently something that made me start. Whilst talking about another person in crisis they said, “something as silly as £10,000 debt made a person feel suicidal.” At this point, I spoke up and suggested that the use of language suggested they were judging that person’s situation and if it had come to this point it probably wasn’t silly to them. We have no right to place our own judgments about another person’s emotions.

2. Approaching someone who may be feeling suicidal

Signs

People who are feeling suicidal may exhibit warning signs about their thoughts and you may notice that there is a change in their behaviour.

Rethink Mental Illness provides the following list [6]:

• becoming anxious, irritable or confrontational.
• having mood swings.
• acting recklessly.
• sleeping too much or too little.
• preferring not to be around other people.
• having more problems with work or studies.
• saying negative things about themselves.

There are some signs that suggest someone is more likely to try suicide. These include:

• threatening to hurt or kill themselves,
• talking or writing about death, dying or suicide, or
• actively looking for ways to end their life, such as stockpiling medication.

But remember you know this person and may see changes in behaviour that are not on this list so trust your judgment.

Starting the conversation

Whilst researching for this post I came across this very helpful information page written by the Samaritans about starting difficult conversations and think that it is very useful. They suggest the following [7]:

1. Find a good time and place
2. Ask gentle questions and listen with care
3. Use open questions e.g. when, where, what, how
4. Find out how someone is feeling
5. Check they know where to get help
6. Respect what they are telling you and don’t pressure them – all of us want to fix things, offer advice but it is better for them to make their own decision
7. Don’t panic if you say something wrong
8. Show you understand
9. Look after yourself – it is important to remember that when you approach someone about suicide it may bring up a range of emotions in yourself

Assessing the risk

There are several questions you can ask to assess the person’s risk of attempting suicide but remember that if someone doesn’t want to answer you or they do not tell you their real thoughts then it may be difficult to prevent the individual from taking their own life. Even trained clinicians including The Secret Psychiatrist have not been aware of a person’s intention and she is a highly trained psychiatrist.

Questions you could ask to assess the risk [8, 9, 10, 11, 12]

1. Have you made a suicide plan? How specific is the plan? Do you know how and when you will attempt suicide? (PLAN)
2. Do you have what you need to carry out your plan? (do they have access to pills, insecticide, firearms…)? (MEANS)
3. Do you know when you would do it? (TIME SET)
4. Do you intend to attempt suicide (INTENT) e.g. Have they carried out any acts in anticipation of death (e.g. putting their affairs in order).
5. Have you been using drugs or alcohol? (can increase impulsivity)
6. Is there anyone available to support you? (family, friends, carers…)

If the attempt seems imminent then you need to address the situation by calling emergency services, going to hospital and not leaving that person on their own.

Suicide is preventable and by talking openly about it in general or by specifically approaching someone you are worried about will help in reducing the number of deaths each year from suicide. We shouldn’t be afraid – it is common to have suicidal thoughts and we as caring human beings have the ability to help. By reaching out and speaking to someone about how they are truly feeling you are showing that person that they are not alone. Whilst I can’t say with any certainty that if someone had asked me if I was feeling suicidal that I would not have made attempts it certainly would have gone a long way in making me feel less alone.

References

1. Dazzi T., Gribble R., Wessely S. and Fear N. T. (2014) Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychological Medicine, 44(16):3361-3
2. S. Office of the Surgeon General, National Action Alliance for Suicide Prevention. 2012 National strategy for suicide prevention: goals and objectives for action. Washington, D.C.: HHS; 2012. https://www.ncbi.nlm.nih.gov/books/NBK109906/#introduction.s5
3. WHO (2014) Preventing suicide: A global imperative http://www.who.int/mental_health/suicide-prevention/world_report_2014/en/
4. Office for National Statistics Suicides in the UK: 2016 registrations https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/suicidesintheunitedkingdom/2016registrations
5. Beyond Blue Suicide Prevention https://www.beyondblue.org.au/the-facts/suicide-prevention/worried-about-suicide/having-a-conversation-with-someone-you’re-worried-about/language-when-talking-about-suicide
6. Rethink Mental Illness: How to support someone with suicidal thoughts https://www.rethink.org/carers-family-friends/what-you-need-to-know/suicidal-thoughts-how-to-support-someone/signs
7. Samaritans: Difficult Conversations https://www.samaritans.org/difficultconversations
8. Assessment of suicide risk in people with depression
9. http://cebmh.warne.ox.ac.uk/csr/clinicalguide/docs/Assessment-of-suicide-risk–clinical-guide.pdf
10. Suicidal Thoughts & Behaviours Mental Health First Aid Guidelines https://mhfa.com.au/sites/default/files/MHFA_suicide_guidelinesA4%202014%20Revised.pdf 
11. Reducing the risk of suicide: a toolkit for employers https://wellbeing.bitc.org.uk/sites/default/files/business_in_the_community_suicide_prevention_toolkit_0.pdf
    MHFA England (2016) Adult MHFA Manual, Two Day Course