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A serious subject at Christmas – suicide prevention

Christmas is coming again! This time can be a time of joy for many people, but for others it can be a lonely and challenging time. Unfortunately, we especially need to think about preventing suicide around this time of year. Over 3,000 Australians complete suicide each year, and Christmas can be a time when isolation and family issues can be pronounced.

Hence this blog talks about suicide, and what we can all do to help someone who is having suicidal thoughts. At the centre of all crises is suffering. Suicidal thoughts and behaviours may be motivated by the desire to escape or relieve distressing feelings or situations, or to communicate feelings.

Having suicidal thoughts or behaviours is invariably very distressing, but please know that there is always hope and whatever the situation is, it can improve. Every individual has many strengths and resources within themselves to draw on, and help is available. If you are struggling, don’t wait – please seek help straight away.

In this blog, we are going to look at a few suicide prevention strategies. Based on the work of Mental Health First Aid Australia, if you are concerned that someone is suicidal, watch for these signals or signs:

  • Threats of suicide, searching for ways to kill themselves (e.g. online searches, looking for weapons), talking about death or suicide, expressing hopelessness, anger, revenge seeking, acting recklessly.
  • Saying they are trapped or there is ‘no way out,’ or that there is no reason for living or sense of purpose in life.
  • Increasing alcohol or drug use, withdrawal from family or friends, signs of anxiety or depression, inability to sleep, dramatic changes in mood (including a sudden improvement in mood or calmness).

And if you think someone is suicidal:

  • Tell them you are worried, and that you care.
  • Express empathy for them and in relation to what they are going through.
  • Talk in a matter of fact way – there is no need to skirt around things.
  • Ask directly whether they are suicidal (e.g. “Are you having thoughts of suicide? Are you thinking about killing yourself?”).
  • Let them know suicidal thoughts are common and can be associated with treatable mental health issues.
  • Tell them they need to get help, offer to help with this.
  • Get them to ring a crisis service or assist with this.

If you think the person might be at the point of ending their life, indicated by them saying that they have decided how or when to kill themselves, that they have access to the means to take their life, or that they are more at risk due to past behaviours or substance use, do not leave them alone and call the emergency services.

There are many risk factors for suicidal behaviours, and these encompass a range of mental and physical health factors, as well as a range of social factors. The risk factors include:

  • A previous suicide attempt.
  • Current mental health issues, or recent discharge from a psychiatric hospital.
  • Physical illness (especially if terminal, painful or debilitating).
  • Family history of suicide.
  • History of bullying, trauma or abuse.
  • Being socially isolated, or family problems.
  • A tendency to be impulsive.
  • Recent exposure to suicide of someone else.
  • Loss and grief.
  • Unemployment, poverty.
  • Rejection by a significant person; relationship breakdown and divorce.
  • A sense of hopelessness (from social issues or depression).

Professor Patrick McGorry recently wrote that “the necessary element is a descent into a particularly lethal stated of ‘mental ill-health’, which may involve varying combinations of emotional pain, hopelessness, guilt and anger, often fanned or triggered by substance use and immediate  stressors or losses”. For these reasons, when an individual is having suicidal thoughts or there have been suicidal behaviours, it is important to seek help. Depending on the issues, help may be sought from emergency services, crises or mental health services or a doctor or therapist. The most important thing is that whomever is struggling is helped to feel safe and has the opportunity to talk.

In general, increases in frequency, intensity and duration of suicidal behaviour are an indicator of how severe the issue is. There is great concern when the person is saying that they have no reason to live, are a burden to others or are in unbearable pain. Changing behaviours, such as more risk-taking behaviours, substance use, withdrawing from people and activities, sorting out personal affairs or giving away possessions can also indicate increasing risk.

Doctors and mental health professionals will assess the degree of risk and manage any risk so that help can be provided to stave off suicide attempts. The level of care that is needed will be considered. As risk increases more support is needed, from mental health services, a therapist or psychiatrist. Sometimes immediate referral to a hospital for further assessment, and possibly admission to ensure safety, may be needed.

A safety plan may be helpful for individuals. This involves writing a plan when feeling calm and writing about warning signs of a crisis, creating a safe place, people who can be contacted as well as professional help. The Australian organisation BeyondBlue has developed ‘Beyond Now,’ a suicide safety planning app for smartphones that provides a helpful way for people to develop a personalised safety plan. Information can be found at

https://www.beyondblue.org.au/get-support/beyondnow-suicide-safety-planning

When individual treatment is needed, it will focus on support and listening; problem-solving any worrying issues; dealing with unhelpful thoughts through Cognitive Behaviour Therapy; dealing with uncomfortable emotions; help with any interpersonal issues (e.g. relationship breakdown); loss and grief counselling; identifying the person’s  strengths; and dealing with substance related issues. Peer support can be especially important.

Here are some resources on suicide prevention:

Family members affected by a person’s suicidal thinking or behaviours also need support and assistance. Seeking out help from your doctor is a good place to start. They can talk with you and provide support and assistance, as well as a organise referral for specialist assistance if needed.

Remember that it can be very difficult, if not impossible at times, to predict suicidal behaviour in a loved one. Experts in the field struggle to understand all of the related factors and how they interact. Sometimes there are no or minimal signs that the person is suicidal. And so there is no place for self-blame.

If the person has been harmed or has died, there will be significant trauma for family and friends, and many distressing emotions. Assistance will most likely be needed, so please seek some support and help, maybe starting with your doctor. There is an excellent book by Dr S Clark called  ‘After Suicide Help for the Bereaved.’ The following websites may also be useful:

References:

  • Ellen, S., & Deveny, C. (2018). Mental: Everything You Never Knew You Needed to Know about Mental Health. Carlton : Black Inc. .

 

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