How do we talk to others about suicide?

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

The power of words – Should we be talking about suicide?

Trigger warning: frank discussion about suicide.

Recently some prominent figures have died by suicide and subsequently, the media have been reporting their stories. People such as, designer Kate Spade, chef Anthony Bourdain and reality TV star Sophie Graydon are some of the most recent prominent people who have ended their own lives.

There has been an outpouring of grief and compassion towards these people by most. However, there are still too many people who are extremely ignorant and negative about the pain that these people would have been going through to take such drastic action.

In the immediate aftermath discussions of suicide and suicide awareness skyrocketed but this effect is only ever temporary. Yet today only a month after the media exploded with reports of Kate Spade’s death the discussion has once again disappeared and been swept away. Only to be brought back to the public’s attention when the next famous figure makes the decision that life is just too much.

So, I have to question how do we keep the discussion going?

There is still so much stigma associated with discussing suicide people feel that merely discussing this taboo topic will result in the incidence of suicide increasing. Therefore, researching this topic is difficult, researchers are expected to not cause harm to participant’s and studies need to be approved by ethics committees, so, asking questions that may increase suicide rates are extremely problematic.

However, current research looking at people talking or asking others about suicide have yet to find that there are any significant increases in people ending their own life. In some cases, evidence has shown that asking someone if they have contemplated ending their own life has been beneficial in reducing suicidal ideation [1, 2].

Yes, there has been research that has shown that actively reporting the details and methodology used for suicides has increased the likelihood of copycat behaviour, known as modelling in the psychology world [3].

Which is why several media guidelines have been prepared as the media’s portrayal of suicide can influence copycat behaviour under particular circumstances. One set of guidelines – the Mental Health Media Charter details the best way to report mental health issues. This charter is probably one of the most accessible for media outlets and bloggers alike because it is short and to the point.

The Mental Health Book Club Podcast is actively trying to raise awareness of mental health and associated issues including suicide and its prevention.

I have been there, not only have I at times experienced suicidal ideation (which I have to admit is much less these days) and my own attempts at taking my own life, I have come to realise that regardless of people discussing the topic I would have made the same decision. Maybe if someone had raised the question, and depending on who they were, I may or may not have felt comfortable enough to discuss my feelings. Even if I hadn’t, I would have at least realised that someone had noticed my distress (although I had become extremely adept at hiding it).

So, keep talking mental health, my next post will be about ways to talk about suicide with others.

[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: 3361-3363

[2] DeCou  C.R.  Schumann M.E. (2017) On the Iatrogenic Risk of Assessing Suicidality: A Meta‐Analysis, Suicide and Life-Threatening Behav. doi:10.1111/sltb.12368

[3] Definition of modelling (2018) https://psychologydictionary.org/modeling/

[4] Perkis, J. and Blood, W. (2010) Suicide and the news and information media: A critical review http://www.mindframe-media.info/__data/assets/pdf_file/0016/5164/Pirkis-and-Blood-2010,-Suicide-and-the-news-and-information-media.pdf

The power of words – Should we be conscious of the words we use when talking about mental health?

“Words: So innocent and powerless as they are, as standing in a dictionary, how potent for good and evil they become in the hands of one who knows how to combine them.” Nathaniel Hawthorne

Words have power, you only have to think back to your time in the playground and someone used words to bully you. I don’t know about your parents but mine constantly reminded me that sticks and stones may break my bones, but names can never hurt me, was a complete lie.

Those words still hurt me today over 25 years later and pop back into my mind when I am feeling particularly low.

Applying this to everyday life I am beginning to realise that the words I am using when I talk about mental health may need some conscious thought. I don’t want to offend, I don’t want to cause other’s distress and I don’t want to feel the shame associated with causing someone else to feel bad. I equally don’t want to be adding to the stigma associated with mental health.

So here are my top tips I am going to apply when I am talking about mental health (including my own) for what I have learnt so far:

  • The way mental health is discussed is constantly changing – the words that may have been used to describe a situation in the past are not necessarily the most descriptive or accurate now, it is our responsibility to look at what words are being used and if we agree with their use.
  • Mindful discussions of mental health – we need to be conscious about what we say, think about the consequences of the words before they come out but also don’t bet yourself up if someone challenges you as it is another opportunity for us to learn
  • Tone – the way we say things is equally important to the use of words if you use a particular tone that can be observed as being insincere or dismissive means that no matter what you are saying the discussion could be harming others.
  • Word choice – now this is often extremely difficult, what words can be used? In what context are you using them? We wouldn’t say “I feel so cancer filled today” but people do say “I am so depressed today because [insert sports team] lost their game last night.” It shows flippancy and fails to understand the full extent of depression. I hold my hands up and admit that I am guilty of such things, such as making statements like “I think Laurence is on the Autistic Spectrum” or “don’t be so OCD” without fully understanding the implications.
  • Honesty – if you are not sure about something then ask, if you are talking to someone about their mental health then they will probably feel like you are respecting them by acknowledging you don’t know everything. I don’t know how many times I have tried to explain borderline personality disorder to someone – I never take offence I am often flattered that the individual feels able to ask.

I think I will add to this over time, as well as additional information on the do’s and don’ts of writing characters in fiction with mental health conditions (although I am struggling with feeling qualified enough to make such a list) but I can identify my opinions about what I prefer when reading fiction!

Starting the Mental Health Book Club Podcast

After being diagnosed with Borderline Personality Disorder in 2012 the first thing I did after getting out of the hospital and having some time to reflect on what was happening was to reach out to the world of books. My mission was to learn as much about this mental health issue as possible and I consumed endless words from fiction to non-fiction, internet articles and online support groups. Some were really helpful and others not so much! Shortly after the BPD diagnosis Is was blind-sided with the news that I had relapsing-remitting multiple sclerosis and my life fell apart. The only thing that really remained was the fact I always had my nose in a book.

For those of you who don’t know much about MS, it is a condition of the central nervous system where the immune system mistakes the cells that insulate nerve cells – the myelin as bad and attacks it. Resulting in problems with coordination, eyesight, balance, pain, fatigue, numbness, heat sensitivity to name a few. Once again, my life was turned upside down and for someone who had no clear idea of who they were and the need of changing countries (I was about to apply for citizenship in Australia) I ended up back in the UK struggling.

I meandered around for two years feeling lost and alone and trying to figure out what I wanted to do with my life. In summer 2017 after my husband introducing me to the world of podcasts I started to feel excited again. The wealth of information available was immense but yet no one was talking about books with mental health issues and so for some crazy reason I thought maybe I could do that!

So once again I turned to one of my favourite past times – books, blogs and now podcasts to find out how to start a podcast. I jumped in purchased a microphone and learnt how to use Audacity for editing and jumped straight in.

I twisted Becky’s arm and thankfully she agreed to join me as a co-host and we are now up to Episode 41 and closing in on our one-year anniversary.

Yet, I felt there was still something missing and then came up with the idea of this blog. Whilst I am not an expert on writing or mental health, I still felt that for people who want to write about those with mental illness they should do so in a way that doesn’t aid the stigma that people like me have to face as a result of their mental illness.