Q: The theme for World Suicide Prevention Day in 2013 is “Stigma: A major barrier to suicide prevention.” How does the stigma associated with suicide impede suicide prevention?
A: Unfortunately, many people are uncomfortable discussing or directly considering issues surrounding suicide. This limits awareness of risk factors or “red flags” that someone may be suicidal, and can make people who are suicidal less likely to seek help. Feeling rejected and isolated can increase the risk that a person who has previously attempted suicide will make another suicide attempt. Social stigma can also isolate those who have lost a loved one to suicide.
Q: So how can we respond to this?
A: Key steps to reducing stigma include understanding why people attempt or commit suicide; being able to identify risk factors and warning signs and knowing how to respond; knowing how to respond to someone who has attempted suicide and knowing how to support those who have lost loved ones to suicide.
Q: Why do people attempt or commit suicide?
A: Suicide is sometimes seen as the “only way out” of unbearable psychological or physical pain. This can include people experiencing severe mental illness, such as clinical depression or schizophrenia, or intense mental anguish, for example loss, shame or guilt, people facing extremely difficult life events, as well as those undergoing chronic or terminal physical illnesses. Some other reasons for suicide include attempting to benefit others, expressing ambivalence about continuing to live, attempting to “send a message” or achieve an outcome by one’s death, or exercising control over the timing or manner of one’s death.
Q: What are risk factors and warning signs we should be aware of?
A: While some suicides are impulsive actions with no warning, others are planned carefully. People feeling suicidal may or may not express their feelings to other people. Factors which put a person at greater risk of considering suicide include having mental health difficulties, alcohol and substance abuse, being male, being isolated geographically or socially, experiencing financial stress or family violence or bereavement, and having attempted suicide previously or having a family history of suicide. Warning signs that a person may be contemplating suicide include expressing the intention to harm or kill themself or saying goodbye to family and friends; preoccupation with death or dying; expressing strong feelings of hopelessness, of the pointlessness of living, of feeling trapped or of anger and revenge; withdrawal from other people; increased alcohol or substance use; undertaking reckless, risky or self-harming behaviours; dramatic mood changes, including suddenly changing from long-term depression to happiness; and extreme anxiety or agitation. It is also important to be aware of the kinds of events which may “trigger” a person to commit suicide. These include traumatic life events, relationship breakdown, job loss, diagnosis or recurrence of severe physical or mental illness, major change in life circumstances, financial or legal stress, and the death or suicide of a loved one or public figure.
Q: What can we do if we suspect someone is suicidal?
A: If you observe warning signs in someone you know, it is important to remain calm but act immediately. Ask the person if they are feeling suicidal, whether they have made a plan to kill themselves and whether they have the means to carry out that plan. Contrary to popular belief, talking calmly with someone in this way will not increase the chance of them carrying through with a suicide plan. If the person has a clear plan and intends to carry it out imminently, call 000 or a health professional who can see the person immediately, or take the person to hospital. Do not leave the person alone. If the person is at lower risk of suicide, talk with them about their suicidal thoughts and help them to plan how they will stay safe, including assisting them to find appropriate support services. Acknowledge their feelings but express your hope that, with help, they will be able to cope.
Q: How do we respond to someone who has attempted suicide?
A: While it is normal to feel a range of emotions including shock, guilt and anger when a loved one has attempted suicide, providing acceptance, care and support can help them to recover and reduce the risk they will attempt suicide again. Practical support includes encouragement to attend appropriate medical and psychological help, making sure the person cannot access means to attempt suicide again, if possible, preventing access to alcohol or drugs and assisting the person to manage re-building their lives, for example returning to work or school. Providing such support can be psychologically tiring, so access help wherever possible.
Q: How does suicide affect loved ones, and how do we help those bereaved by suicide?
A: Bereavement following suicide is usually intense and complex, including feelings of shock, disbelief, anger, guilt, sadness and shame. Loved ones may have many “unanswered questions” and may also be experiencing trauma from discovering the deceased. The most important thing we can all do to help is to express support and demonstrate our care. We may feel awkward but it essential to say (or write) something to show our love and concern. Let the bereaved person talk – when they are ready – and listen supportively. Try to understand how they are feeling and allow them to grieve in their own way. Be patient – understand that it may take years for the person to work out how to live with their loss. Don’t avoid talking about the person who has died, but don’t press for details or make judgments – it is important to honour and accept both the person who has died and those left bereaved. Offer practical support. With children and teenagers, answer questions honestly and take their concerns seriously. And remember – it is never too late to approach someone bereaved by suicide in the past and say “I didn’t know what to say to show you that I cared, and I’m sorry. How are you going now?”
Q: What part can psychologists play?
A: Psychologists can assist people who are feeling suicidal, and those who have attempted suicide, to address the causes of their pain and distress and to build their coping skills. This includes providing treatment for mental illness, often in consultation with GPs or other doctors; providing coping strategies to manage life stressors or psychological or physical pain; and helping people to build relationships and social support networks. Psychologists can also help those who have been bereaved by suicide to cope with grief and other emotional reactions, to build social support networks and to rebuild their lives.
Q: What should a reader do if they are feeling suicidal?
A: Please don’t suffer alone – help is available to you. Tell someone you trust how you feel, or call one of the free, confidential counseling lines listed below. If possible, stay with someone supportive. Seek help from your doctor, a psychologist or another health professional. Avoid drugs and alcohol, try to exercise and eat healthily. You may find it helpful to write down your thoughts and feelings. And if you need immediate, urgent help, call 000 or ask someone to take you to a hospital emergency department.
Q: Where can people get more information?
A: Confidential, 24/7 support is available at Lifeline: 13 11 14; Kids Helpline: 1800 55 1800; Mensline Australia: 1300 78 99 78 and the Suicide Call Back Service: 1300 659 467.