Thoughts / suicide

Showing up after suicide

This week the latest Australian Bureau of Statistics (ABS) figures were released about reported causes of death in 2016. And for the first time in some years, we saw a decrease in the number of deaths by suicide. It’s possible that the suicide prevention efforts are making some headway.

There is still a long way to go. Suicide still remains the leading cause of death for Australians aged 15-44 years and we are still looking at a figure of nearly 8 Australians per day, dying by suicide.

This tragedy means that suicide, in some way, is going to continue affecting our lives.

And if it directly affects the life of someone close to us, let’s make sure we know how to show up.

Supporting someone who is bereaved by suicide is possibly one of the most challenging things we can go as humans. But, if we can, being present and being supporting, can be invaluable to someone going through the grief process after suicide.

There are so many reactions a loved one may experience following a suicide. Grief, in general, is a pretty complex and chaotic and terrifying emotional experience. While a wide range of reactions can be anticipated, our response to grief will be as unique an expression as our personality is. The experience of grief can be impacted by other things like pre-existing mental and physical health conditions, our gender, and most importantly, the relationship with the person who has died. Experiences may include, but are not limited to:

  • Anger – towards the person who has died, towards themselves, or towards others
  • Despair – feeling unable to live without the person who has died
  • Guilt – that they couldn’t save/help the person who died
  • Questioning – ‘why’ and ‘what if?’
  • Sadness
  • Shame – feeling that they have done something wrong or because of the stigma attached to suicide
  • Defensiveness – due to the uncertainty of how people will react, fearing judgment
  • Disbelief
  • Numbness
  • Rejection – from the person who died and/or the community
  • Searching – wanting to go to the places the deceased person went or believing they have seen the person
  • Depression and anxiety
  • Fear
  • Physical reactions
  • Relief – if the person has been in pain for an extended period of time
  • Sense of acceptance – they may feel they can accept the person’s wish to due
  • Shock
  • Suicidal thoughts

Considering that someone bereaved by suicide could feel any or all of these things, we might feel unable to provide adequate support. Or we might struggle to understand the depth of the distress. We might find it difficult to know what to say and feel awkward, uncomfortable and concerned about saying the wrong thing. Let’s stop worrying about ourselves and just show up for them.

What has been learned from people bereaved by suicide is they really need compassion, empathy, acknowledgment of what has happened and validation of how they are feeling.

To do this, we really only need to do three things:

  1. Show up
  2. Ask
  3. Listen

It really is this simple. Firstly, let’s ignore all of those thoughts and feelings which might stop us from being present with the person – ‘I don’t want to make it worse for them’, ‘They don’t need me’, ‘There is nothing I can do anyway’. All BS. Ignore these thoughts and do what you know will be tough and challenging but the most important – show up.

And then we ask them to talk. If they want. We might ask how they are feeling today. Or if they’d like to chat. Or if they’d just like to hang out. Whatever. An open question would be good here. Don’t avoid the subject of suicide.

And then we shut up. And we listen. Listen to understand the experience. With patience and compassion and no judgment. By allowing a loved one to express their grief, we are helping. We can’t take away the pain, but we’re enabling part of the process. This is probably the most important bit of the process. For those of us who are more prone to talking than listening, reverse this impulse – try and listen 80% of the time and talk only 20% of the time. Because we are listening, rather than talking it will also mean that we might be less-inclined to do some of the less helpful things (e.g., provide advice, try and compare this to the time our dog nearly died, fill moments with clichés and simplistic explanations for one of the most complex issues).

And once we’ve done that, we’ll do it again. And again. And again …

If we do these three things – repeatedly – we have the opportunity to provide the person who is bereaved the following:

  • To be really listened to, heard and understood
  • To receive non-judgmental support
  • An opportunity to tell their story over and over again
  • A safe and supportive environment
  • The capacity to express their grief in their own way

People bereaved by suicide can feel really alone and isolated. The silence that surrounds the issue of suicide can complicate the experience. Because of the social stigma surrounding suicide, it is common for people feel the pain of the loss, yet may not believe they are allowed to express it. By being present, asking the questions, listening and learning, we can provide the comfort of companionship on the most tragic path of sorrow.

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Bullying and Suicide: Are they really related?

This topic is really hard to write about. Or even think about. I don’t really know why I have chosen to do either.

Bullying and suicide, as all of us know, can be tremendously painful experiences for young people. And both issues – independently - are causes for public concern. But with the extensive media coverage of the deaths by suicide of young people who were victims of bullying, we could almost assume a causal relationship.

The link between the two might be a little more complex than that.

When we talk about bullying we’re referring to the intentional and repeated intimidating behaviour by an individual or group against another person or group, in the context of ongoing social relationships. It can take many forms and can occur in a ‘real’ or virtual environment. Bullying that occurs face-to-face can be verbal, physical, relational/social, and indirect (involving a third party). Cyber-bullying involves intimidating behaviour or degradation via technological resources such as mobile phone text messages, email, chat rooms/discussion groups and online social networking sites. Methods of bullying tend to overlap, so often if young people are cyber-bullied that also tend to be bullied face-to-face.

Bullying can be seen as a significant public health problem because it is prevalent and harmful. Australian data reveal that 1 in 8 young people have experienced verbal bullying over the past school term and half of year 8 students reported being victimised in a large-scale Victorian survey. Around 10% of Australian students have reported being cyber-bullied. In 2010, bullying was ranked the third highest issue of concern for 11 to 14 year olds. Specific subgroups are more likely to be victimized. For example, in one survey bullying victimization was found to be more prevalent upon lesbian and gay youth—60% reported victimization during the past 30 days prior to the survey compared with 28.8% of heterosexual youth.

For young people involved in bullying in any capacity—youth who bully others, who are bullied, or who both bully and are bullied - this involvement is correlated with poor mental and physical health and engagement in other risk behaviours. Youth who are bullied are more likely to be depressed or anxious, have lower academic achievement, report feeling like they do not belong at school, have poorer social and emotional adjustment, greater difficulty making friends, poorer relationships with classmates, and experience greater loneliness. Bully-victims (those who bully and are bully) are more likely than those who bully, those who are bullied, or their uninvolved peers, to report being physically hurt by a family member, to witness family violence, and exhibit suicide-related behaviours. Those who bully others are more likely to drink alcohol and use cigarettes, to have poorer academic achievement and poorer perceived school climate, but to also report greater ease of making friends.

Involvement in bullying can also have long-lasting, detrimental effects months or even years after the bullying occurs. Young people who are bullied are more likely than uninvolved youth to develop depression and anxiety and report abdominal pain and feeling tense over the course of a school year. One study examining the impact of bullying victimization of those who were between 9, 11, and 13 years of age when they were victimized found, that over a 7-year period, youth who were bullied were more likely to develop generalized anxiety and panic disorder as adults while bully-victims were more likely to subsequently suffer from depression, panic disorder, and suicidality. Another longitudinal study found that those who were perpetrators of bullying at age 14 were more likely to receive a diagnosis of antisocial personality disorder, to have low job status at age 18 years, and to use drugs at ages 27–32 years.

Many studies have examined the relationship between bullying and suicidality, which includes suicidal thoughts and behaviours. One recent meta-analysis – a study that rounds up all the studies to date on the topic – examined 47 studies on bullying and suicide among students in K-12 settings. The studies were from a number of countries including the US, China, Australia, the UK and Finland. The meta-analysis found:

  • Overall, youth involved in bullying in any capacity were more likely to think about and attempt suicide than youth who were not involved in bullying.
  • The studies showed that bullies and bully-victims (youth who bully others and are also bullied themselves) all reported more suicidal thoughts and behaviours that those who were not involved in bullying.
  • Bullying and suicidality were most strongly related for bully-victims. This suggests that bully-victims are a group at a particularly high risk for experiencing mental health issues.

So, it appears there is a link between bullying and suicidal thoughts and behaviours. But it’s not just a relationship between the person who is being bullied and feeling suicidal. It’s to do with everyone involved. And there’s also some other things that might need to be considered.

For example, one study of fifth through eighth graders found that youth with no involvement in bullying reported significantly fewer thoughts of suicide and suicidal behaviours than youth who were involved in bullying in any way. However, once depression and delinquency (engaging in illegal behaviours) were considered, there were only small differences between youth who were not involved in bullying and kids who were targets of bullying and between these uninvolved kids and bully-victims. Another study has highlighted the role of low self-esteem and depression as factors contributing to suicidal ideation for sexual minority and heterosexual youth who had been bullied.

So after all of this analysis we can’t really do not know if bullying directly causes suicide-related behaviour. We know that most youth who are involved in bullying do NOT engage in suicide-related behaviour. It is correct to say that involvement in bullying, along with other risk factors, increases the chance that a young person will engage in suicide-related behaviours.

When we focus attention on the relationship between bullying and suicide it can have some positive impacts. It can raise the awareness of the serious harm that bullying can do to all the youth involved in bullying in anyway and it can highlight the significant risk for some of our most vulnerable youth.  

The risk though, is that if the discussion of the issue is of bullying being a single, direct cause of suicide it can be unhelpful and potentially more harmful. There’s the risk that that the increased attention could perpetuate the false notion that suicide is a natural response to being bullied which has the dangerous potential to normalise the response and thus create copycat behaviour among youth and it may encourage further sensationalized reporting. Furthermore, the focus of the response on blame and punishment can become misdirected from getting the required support and treatment to those who are bullied as well as those who bully others.

While a young person’s death by suicide is a tragedy and both bullying and suicide-related behaviour are serious public health problems, our response to such situations must reflect a balanced understanding of the issues informed by the best available research.

So, if bullying doesn’t directly cause suicide, what do we know about how bullying and suicide are related?

Circumstances that can affect a person’s vulnerability to either or both of these behaviors exist at a variety of levels of influence—individual, family, community, and society. These include:

  • emotional distress
  • exposure to violence
  • family conflict
  • relationship problems
  • lack of connectedness to school/sense of supportive school environment
  • alcohol and drug use
  • physical disabilities/learning differences
  • lack of access to resources/support.

If, however, young people experience the opposite of some of the circumstances listed above (e.g. family support rather than family conflict; strong school connectedness rather than lack of connectedness), their risk for suicide-related behaviuor and/or bullying others—even if they experience bullying behaviour—might be reduced. These types of circumstances/situations or behaviours are what we sometimes call “protective factors.”

In reality, most people will have a combination of risk and protective factors for both bullying behaviour and suicide-related behaviour.

And this is one of the reasons why we need to remember that the relationship between the two behaviours and their health outcomes is not simple. The ultimate goal of any prevention efforts is to reduce risk factors and increase protective factors as much as possible.

BUT, I suppose if I did have to sum it up as simply as possible it’d be this - The bottom-line of the most current research findings is that being involved in bullying in any way—as a person who bullies, a person who is bullied, or a person who both bullies and is bullied (bully-victim)—is ONE of several important risk factors that appears to increase the risk of suicide among youth.

I knew that would be hard.

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Self-Harm and Suicide: Are they related?

Please note - Some may find the content in this article distressting or triggering. For support or information please make contact with the support phone numbers listed below. 

On the surface, deliberate self-harm and suicidal behaviours can seem pretty similar. But mostly they’re not. And unless we’re clear on both the differences between the two, and the relationship they can possibly share, things can get even more confusing.

Self-harm is also commonly known as self-injurious behaviour (SIB), self-mutilation, non-suicidal self-injury (NSSI), para-suicide, deliberate self-harm (DSH), self-abuse, and self-inflicted violence. As one would expect, having multiple terms of self-harm begins the multitude of misunderstanding and confusion in the academic research and clinical settings – let alone in the community.

Self-harm (and all the other terms) refer to a range of behaviours, but not a stand-alone mental illness or disorder. People who engage in self-harm behaviour deliberately hurt their bodies. Most commonly this is done by cutting, burning, hitting, picking at skin, pulling hair, or biting.

The majority of those who self-harm do not have suicidal thoughts when they are self-injuring. And here lies the difference between self-harming and suicidal behaviours. It is one of intent. Whilst this may seem counter-intuitive, the person who is self-harming, does not intend for this harmful behaviour to be fatal. Instead, there are a number of reasons why a person may self-harm (Klonsky, 2007):

  • To alleviate intense emotional pain or distress, or overwhelming negative feelings, thoughts or memories
  • As a form of self-punishment (some people damage their bodies to punish themselves for what is going on in their lives. They may lack the appropriate coping skills and suffer from low self-esteem so feel they are deserving of what they are doing to themselves).
  • To feel euphoria (When we experience pain, endorphins are released into the blood stream, resulting in a ‘natural high’ or a feeling of euphoria. Sometimes self-harming behaviours can become addictive and habit-forming.)
  • To experience dissociation or numbness from overwhelming negative experiences.

So although self-harm is not the same as suicide, self-harm does have the potential to escalate into suicidal behaviours. The intent to die can change over time. One study found that almost half of people who self-harm reported at least one suicide attempt.

Self-harm has also been found to lead to suicide when:

  • Self-harm is no longer an effective coping method. It ceases to assist in helping the person deal with the feelings cause by stress or trauma.
  • In a crisis situation, people who engage in self-harm and have become desensitized and habituated to pain through repeat harming episodes may view a suicide attempt as less threatening.

For some of us, when we engage in things for a while and these behaviours have a positive effect on our mood (i.e., release our anger, alleviate boredom, ease stress, reduce pain) such behaviours can eventually take on a repetitive and almost compulsive and habitual quality when used in response to regulating our mood. Something similar to how we might conceptualise substance-use disorders. And this can come with an increasing tolerance – having to engage in the behaviour more often and with more intensity to get the same effect – and withdrawal – difficulty ceasing the behaviour.

So whilst not initially intended to be fatal, the potential for harm with deliberate self-harm is great and should be taken seriously. Many people may try and hide their self-harming behaviour and only around 50% of people who engage in self-harm seek help – other through informal sources such as friends and family, rather than professionals.

While all the people are different, there are some warning signs that someone may be self-harming. Aside from the obvious signs such as exposed cuts or bruising, some less obvious signs might include:

  • Appearing withdrawn, or more quiet or reserved than usual
  • Social withdrawal - Stop participating in their regular activities
  • Rapid mood changes
  • Get angry or upset easily
  • Have experienced a significant event in their lives (e.g., a relationship break up)
  • Suffer poor school/work performance when they usually do very well
  • Wearing clothes that are inappropriate for the weather (e.g., wearing long sleeves on a hot day)
  • Strange excuses provided for injuries
  • Hiding objects such as razor blades or lighters in unusual places

If you think that someone you know or love is engage in self-harm, the very best thing you can do is talk to them about it. I’ve worked with a number of people who have overcome self-harming behaviour. There are heaps of excellent services and supports to help. Here are some ideas for how you might be able to get the conversation started:

  • Ask them how they are feeling
  • Try not to be judgmental
  • Be supportive without reinforcing their behaviour
  • Educate yourself about self-harm
  • Acknowledge their pain
  • Try not to avoid the subject
  • Do not focus on the behaviour itself
  • Encourage the person to seek professional help (a good place to start is with the person’s GP).

As always, talking and learning about self-harm and suicide is so important but it can bring up some really tough emotions. Please take care of yourself and reach out to a trusted family member, friend or one of the suggested crisis lines below if you need to talk about how you’re feeling.

Lifeline 13 11 14 www.lifeline.org.au/gethelp
Suicide Call Back Service 1300 659 467 www.suicidecallbackservice.org.au
Kids Helpline 1800 55 1800 www.kidshelp.com.au
MensLine 1300 78 99 78 www.mensline.org.au

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The C-word

Please stop using the ‘c-word’

No, not that c-word. The word ‘commit’. In relation to suicide.

Consider the phrase “commit suicide”. Does this seem unusual? Acceptable? Familiar?

We could argue that there is nothing all that alarming about the words themselves. They are a pretty standard and common description of a tragic act. In any case, it’s such a common and widely accepted descriptor that we could almost expect to see a hyphen (one of these ‘-‘ things) between the words, if it were grammatically correct to do so. We could be wondering if it’s even worth considering question the phrase, and instead just dismissing the question. Shouldn’t we be more concerned with the act of suicide itself, not the triviality of a particular verb or adjective?

Over time, the phrase has become so entrenched in our collective vocabulary that is has an apparent naturalness, implying harmlessness. This harmlessness is pretty deceptive though. Like so much of the language we use, there are underlying negative connotations to this phrase. This one is particularly repugnant.

The word ‘commit’ has a number of significant implications when associated with the word ‘suicide’:

  1. The word ‘commit’ is commonly used in connection with religious offences. Indeed suicide is considered wrong in many religions. Over time suicide has been regarded as a cardinal sin in some religions and is still often considered a moral sin.
  2. In the past, suicide was a criminal act in many countries. For example, there was a legal prohibition against suicide in England and Wales until the Suicide Act 1961 was introduced. As well as decriminalising suicide, this Act made it an offence to assist in a suicide, which had the unique effect of criminalising an accessory when the principal has not committed a crime. The law relating to suicide in Australia varies between States and Territories, but it is no longer a crime in any jurisdiction. In the State of Victoria for example, the Crimes Act 1958, Section 6A, states “The rule of law whereby it is a crime for a person to commit or to attempt to commit suicide is hereby abrogated” (Crimes Act, 1958).
  3. The word 'commit' has been applied to the incarceration of people against their will in a mental institution. In many countries care for those with mental illness can be sought involuntarily (usually when the person is so unwell that they are unable to admit themselves to care). This is often the only occurrence, outside of committing a crime and being held, where an individual can be detained without his or her consent.

As a result, to “commit” suicide has criminal overtones which refer to a past time when it was illegal to kill oneself. Committing suicide was akin to committing murder or rape; linguistically, therefore, they are still linked. The original notoriety of the word may have dulled over time but the underlying residue remains.

Suicide is a cause of death. Of interesting note, I’ve never noticed or heard of someone “committing” another form of legal death. Do we ever say that someone ‘committed cancer’ or ‘committed heart failure’, even when they may have lived lifestyles that contributed to such diseases (for example, smoking or having a high fat diet)? Even suggesting this sounds ludicrous, and yet every day we see such examples in relation to suicide.

Making some small changes to how we speak about suicide, is not my own original thought. The impetus to alter the language of suicide began ostensibly in the bereavement community. In addition to the insensitive language used to describe suicide, silence and denial - the absence of suicide language and conversation - was targeted as a major contributor to the stigma around the subject.

“When a tragedy is not spoken of openly there can be no true sympathy, sharing or healing,” “Suicide leaves the bereaved with especially acute feelings of self-denigration and self-recrimination” (Sommer - Rottenburg, p.240).

Those who are left behind feel the full burden of suicide’s stigma, and others often steer clear of suicide survivors to avoid the “contamination” of suicide association. The bereaved can feel abandoned and ashamed, and adding to this injury is the mention of suicide in euphemistic, obituary-type language that goes to great lengths to whitewash any moral stain there might be to a particular death. Because this silence can be debilitating, the need for language that addresses the act of suicide in a direct but respectful way was identified and has, in recent years, gathered momentum.

I know I bang a lot about language and words. I am aware that policing language is not the most popular sport and rarely an easy activity. But I do it because language is powerful. Making small adjustments to our language alone, will only deal with stigma on a superficial level, however if we consider our context, intention and audience when we’re conversing with others the level of responsibility shifts. Sometimes, political correctness can be good, especially when it helps, in whatever ways possible, vulnerable people and those who love them.

Suicide is a massive public health issue throughout the community and those affected (either personally, or due to the death of a loved one) are vulnerable and often stigmatised. To overcome this health issue we need to talk more about the issue. However, such talk is often steeped in concepts and language from the past that perpetuate stigma, constrain thinking and reduce help-seeking behaviour. With this knowledge, am I still going to use language that stigmatises and increases feelings of shame in people who might be experiencing excruciating psychological distress? No. Can I still be frank and polite? I reckon.  And am I going to ask others to do the same? I think I just did.

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Suicide Myth Busting - #7 Most suicides happen unexpectedly.

This is a hard one. Let’s start with what we've learnt over the last week and what we now know.

At a glance:

  • The factors associated with suicide are varied and complex.
  • Predicting who will take their life is extremely difficult, even for experienced professionals.
  • There are several common characteristics of suicide, including a sense of unbearable psychological pain, a sense of isolation from others, lack of belonging, feeling trapped and hopeless and a burden on others and the perception that death is the only solution when the individual is temporarily not able to think clearly due to being blinded by overwhelming pain and suffering.
  • Excruciating negative emotions – including shame, guilt, anger, fear and sadness – frequently serve as the foundation for self-destructive behaviour. These emotions may arise from any number of sources.

So the question 'Why did they take their life?' is complex and unfortunately we may never be able to be completely resolved. The most honest answer is that we don't fully understand it.

A number of years ago, we lost one of our clients to suicide. It was a tragic loss. It was devastating. And shocking. And it was overwhelmingly unexpected. Even to the individual’s treating team.

There are indeed some suicides that occur without warning. They may be impulsive behaviours. Or the level of distress may have been very well hidden by the individual. To the point that may appear completely unexpected to those around them. We'll never know why they happened. But this is not the norm.

The majority of suicides have indeed been preceded by warning signs, whether verbal or behavioural. Most people experiencing suicidality — including those who are more ambivalent about suicide — consciously or unconsciously drop those around them some hints.

Some of the warning signs that a loved one might be considering suicide include:

Physical Changes

  • Major changes in sleep patterns – too little or too much
  • Losing energy
  • No interest in personal hygiene or appearance
  • Losing interest in sex
  • Sudden and extreme changes in eating habits
  • More minor illnesses

Behaviours

  • Alcohol or drug misuse
  • Fighting or illegal activities
  • Withdrawing from family and friends
  • Stopping activities they used to enjoy
  • Past suicidal behaviour
  • Self-harming
  • Putting affairs in order – giving possessions away, making funeral arrangements.
  • Writing a suicide note or goodbye letters
  • Risk-taking or recklessness
  • Unexplained crying
  • Possessing lethal means – medication, weapons.
  • Emotional outbursts

Conversational Sins:

  • A sense of hopelessness or no hope for the future – “what’s the point? Things are never going to get better?
  • Isolation or feeling alone – “No one understands me”.
  • Aggressiveness and irritability – “Leave me alone”.
  • Negative view of self – “I am worthless”.
  • Guilt – “It’s all my fault, I’m to blame”.
  • Frequently talking about death – “If I died would you miss me?”.
  • Feeling like a burden to others – “You would be better off without me”.
  • Making suicide threats – “Sometimes I feel like I just want to die”.

It’s so important that we all know and respond to these warning signs. The very best thing we can do if we notice any of the above is to raise the issue with the person we love. They won’t take their own life just because we’ve had a conversation with them about it. We know the opposite is true. Instead, we’ll have the opportunity to reassure them that we care, we’re here to help and that they’re not alone.

Every suicide, like every person, is different. We can’t prevent every person in excruciating psychological distress from taking their own life. But if we can reach out to those who are sending us the signals, maybe with the right help and support, they can go on to live a more enjoyable life.

 

If you’re concerned about a loved one’s risk of suicide or this post has raised concerns for you, please contact one of the below organisations who can provide 24/7 support, information and referral:

Lifeline 13 11 14 www.lifeline.org.au/gethelp
Suicide Call Back Service 1300 659 467 www.suicidecallbackservice.org.au
Kids Helpline 1800 55 1800 www.kidshelp.com.au
MensLine 1300 78 99 78 www.mensline.org.au

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Suicide Myth Busting - #6 Once someone is suicidal, they will remain suicidal.

We’re nearing the end of our suicide myth busting. To recap, we’ve covered some pretty important stuff. We’re now fully aware that most individuals who are experiencing suicidality desperately want to live; they just don’t know how to live with their pain and distress. Talking about suicide will never cause someone to suicide. Suicide is a complex behaviour, not a response to one problem. It can occurs across all age, economic, social, racial and ethnic boundaries and whilst it is more common in people experiencing a mental health disorder, this is not always the case. And, the people who do die by suicide usually tell those around them about it first.

Excellent sleuthing. We are getting through some of the complexity of the facts.

Today’s myth-busting comes with much hope. There is absolutely no truth behind the statement – once someone is suicidal, they will remain suicidal. Thank the baby cheeses!

People who want to kill themselves will not always feel suicidal or constantly be at a high risk for suicide. They feel that way until the crisis period passes.

We can think about suicidal thoughts, feelings and behaviours occurring on a spectrum from low to high risk. Heightened suicide risk is often short-term and situation-specific. Someone may experience a period where they are of high risk of suicide. After receiving help to overcome this pain, the pain and distress may reduce and they could go on to live rewarding and meaningful lives, never again seriously contemplating suicide. For others, a current suicidal crisis may be overcome and the risk of suicide significantly lowered or eradicated for a period of time. This period of time can range from minutes, hours or days, to possibly months, or even several years.

Whilst different for everyone, suicidal thoughts or behaviours are not a life sentence.

Like all thoughts, suicidal thoughts are not permanent.

Similarly, the feelings of distress and pain associated with suicide, whilst overwhelming, debilitating and isolating, are still just feelings. Which are also not permanent.

Our bodies and brains are resilient vessels for survival, with incredible capacity for change. This is where the hope lies. I’ve worked with many remarkable individuals who have at points, desperately wanted not to be alive; only to transform into people expressing sincere gratitude for still being here. That’s magical.

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Suicide Myth Busting - #5 Only certain people can become suicidal.

Suicidal behaviour indicates deep unhappiness but not necessarily mental disorder. It is true that the rate of suicide is much higher in people experiencing a mental illness. Suicide is three and half times higher in those with a mental illness than the general population. And some conditions are more strongly linked to suicide than others. The two most related are depression and bipolar disorder, followed by substance use disorder and then anxiety disorders.

But it is also true that around 180 000 Australians who either think about suicide, plan or attempt suicide or do take their own life each year do not have a diagnosed mental health condition. It may be a bit more complicated and unique than that. There may be an illness of some description that has not been identified or discussed with those of us left behind. Or they may have, for example, experienced issues with their sexuality, felt they were a failure for not performing to their own or their parents’ expectations. Or sometimes we just won’t know.

Whilst anyone can be affected by the threats of suicidal thoughts, some of us are more at risk than others, just because of who we are. This includes the men and the young people and the Aboriginal and Torres Strait Islander people and the lesbian, gay, bisexual and transgender people. Those of us who live in rural and remote communities and who are from culturally and linguistically diverse backgrounds. If we have attempted suicide or self-harm before or have been bereaved by suicide our risk increases. Suicide is also five times higher in people who are divorces, separated or widowed, and higher in those who have never married. And not surprisingly, suicide rates are also higher when we are not working.

Many of us can be at risk for suicidal thoughts and behaviour. We may or may not be experiencing a mental health condition. The point is, it doesn’t really matter. Assessing a person’s risk for suicide is not an exact science. We can’t just base it on where an individual fits based on certain categories because there is not one single category that a person affected by suicide fits into. There’s way too many. So instead, let’s just ask them. Maybe start with – are you okay? I’ve had that question in my head all day for some reason.

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Suicide Myth Busting - #4 People who talk about killing themselves rarely suicide.

Apparently a fair few of us Australians actually believe this (reasonably silly) myth. According to the survey undertaken by Suicide Prevention Australia in the lead up to World Suicide Prevention Day this year, a third of the people surveyed agreed with the statement – people who talk about killing themselves rarely suicide.

Existing evidence shows us that most people communicate with a health professional directly about their suicidality, or convey indirectly their desire or intent to die, in the three months prior to death. Some research has indicated that as many as 60-80% of those who suicide had communicated their intentions before they died. Very few people who attempt to take their own life have not communicated in some way with those around them or exhibited some warning signs.

Talking about suicide is always a warning sign. All warning signs should be taken seriously and listened to. Anyone who is talking about suicide is in pain and they may be reaching out for help and support.

In addition, a previous suicide attempt is one of the strongest predictors that a person will die by suicide. Talking about thoughts of suicide, and a history of suicide attempts, are two of the most important factors that clinicians will take into account when assessing a person’s risk.

We can all do our part to prevent the tragedy of suicide by remembering that the above statement is complete bollocks. And if in fact, someone close to us is talking of suicide, we don’t ignore this warning sign. We can start conversations. We can reassure them that we care. We can do what we can to help. It might just make a bit of difference.

 

As always, talking and learning about suicide is so important but it can bring up some really tough emotions. Please take care of yourself and reach out to a trusted family member, friend or one of the suggested crisis lines below if you need to talk about how you’re feeling.

Lifeline 13 11 14 www.lifeline.org.au/gethelp
Suicide Call Back Service 1300 659 467 www.suicidecallbackservice.org.au
Kids Helpline 1800 55 1800 www.kidshelp.com.au
MensLine 1300 78 99 78 www.mensline.org.au

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Suicide Myth Busting - #3 People who die by suicide, want to die.

The fact is that most people who are suicidal are pretty ambivalent about whether they want to live or die.

As someone who has experienced suicidal thoughts and has had the opportunity to work with a number of people who are experiencing suicidality, I can tell you with some authority that the biggest misconception is that people who are contemplating suicide want to die. It’s a bit more complicated than that.

Like all things, suicide means different things to different people. Always, a loss by suicide is a tragic loss. Suicidal thoughts come on a large spectrum though. It can be an annoying thought at the back of the brain. For some it might be a warm, dark cavern. For me, the thoughts were like an unwanted visitor who came to stay in my brain on occasion and I couldn’t seem to figure out if the visitor was sprouting fact or fiction to me. And the thoughts may be triggered by many number of things.

It might be pain, loneliness, and hopelessness. With duration and intensity these feelings might make us feel desperate and, in those desperate moments, our thoughts become distorted. It becomes easy to believe that the feelings of those moments will never improve, and suicide may seem like a possible answer.

It might be that isolation builds and builds and depression begins to completely overwhelm everything. Even happy memories. Everything that went before, and everything that is has become tainted. While the reality is that feelings and depression can and will pass, terrified minds become clouded and heavy with one thought and one thought only: the pain felt in this moment will never end.

Regardless of what is going on for someone, wanting to die is almost never normal. Most people never contemplate suicide.

The reasons people think about suicide are really, really varied. And I totally understand how they could be misunderstood. Because, to the average person, it makes no sense. Our bodies instinctively protect themselves from danger. We immediately pull our hands back from something hot. It’s without thought; our bodies do it automatically.

Furthermore, how could anyone give up the chance to get better? The answer is very straightforward: people who are contemplating ending their life do not believe it will ever get better.

The reality is that for a lot of the people who are contemplating suicide they probably aren’t looking for reasons to die. Instead, they are looking for a way to make the pain stop.

Most of the time, people who die by suicide don't want to actually die. They just don't want to be alive, and there is a huge difference.

The problem, of course, is that the assumption is wrong. The rational mind is not working very well here. If we are in a place where we believe that the only option is to do the opposite to what we were put here to do – survive – than something is not working properly in our mind.  

 

As always, talking and learning about suicide is so important but it can bring up some really tough emotions. Please take care of yourself and reach out to a trusted family member, friend or one of the suggested crisis lines below if you need to talk about how you’re feeling.

Lifeline 13 11 14 www.lifeline.org.au/gethelp
Suicide Call Back Service 1300 659 467 www.suicidecallbackservice.org.au
Kids Helpline 1800 55 1800 www.kidshelp.com.au
MensLine 1300 78 99 78 www.mensline.org.au

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Suicide Myth Busting - #1 Talking about it might make people act on it

Today is World Suicide Prevention Day.

Without doubt, suicide is the most tragic consequence of mental illness. For many people with a mental illness, and their families, the fear that they will take their own life can be ever-present. For others, the suicide of a loved one comes out of nowhere and those left behind can be left with a crushing guilt that they should have done more to prevent it. Mental health professionals spend a lot of time assessing how likely it may be that their patients and clients will take their own lives, and making judgment calls about whether people need to be hospitalised in an attempt to protect them from themselves.

Over 3000 people take their own lives in Australia each year – this equates to more than eight deaths by suicide each day. By way of comparison, around 1400 people die in transport accidents each year.  Deaths by suicide in Australia occur among males at a rate three times greater than that for females. However, during the past decade, there has been an increase in suicide deaths by females. The suicide rate amongst Aboriginal and Torres Strait Islander peoples is more than double the national rate. In 2015, suicide accounted for 5.2% of all Indigenous deaths compared to 1.8% for non-Indigenous people.

Looking at deaths by suicide does not paint a full picture of the tragedy. For every death by suicide, it is estimated that as many as 30 people attempt to end their lives. That is approximately 65,300 suicide attempts each year in this country. And it is estimated that at some point in their lifetime 2.1 million Australian adults have had serious thoughts about taking their own life.

For those among us who have never contemplated suicide, a drive against something as basic as the human survival instinct is incomprehensible. Some may consider those who have taken their own life to be ‘cowards’ who have ‘taken the easy way out’. Absolutely nothing could be further from the truth. Suicide is the last resort for people who have exhausted all other avenues for relieving their pain and suffering. And in doing so have overridden their very basic and primal instinct for survival.

We can all play our part in preventing the tragic impact that suicide is having on our community. Like with mental illness, there are a bucket load of commonly held misconceptions about suicide or self-harm that can prevent us from recognising when someone is actually at risk.

Findings from a nationally representative sample released today by Suicide Prevention Australia have indicated that Australians have mixed attitudes and behaviours towards people who die by suicide and an inaccurate understanding about suicide and its prevention.

Over the next week, Hope Street Cards will be separating the fact from the fiction around suicide with you. If we can debunk the myths that surround such tragedy and change the way we think about suicide we might just be able to change the way a tragedy from suicide can unfold. If we can learn to understand the distress and suffering that is happening for those we love and care for, we might just be able to change someone’s life. And improve all our lives.

As always, talking and learning about suicide is so important but it can bring up some really tough emotions, particularly on days like today. Please take care of yourself and reach out to a trusted family member, friend or one of the suggested crisis lines below if you need to talk about how you’re feeling.

Lifeline 13 11 14 www.lifeline.org.au/gethelp
Suicide Call Back Service 1300 659 467 www.suicidecallbackservice.org.au
Kids Helpline 1800 55 1800 www.kidshelp.com.au
MensLine 1300 78 99 78 www.mensline.org.au

 

Myth 1: Talking about suicide gives people the idea to do it.

In the survey mentioned above, almost 20% of respondents thought that talking about suicide increased the risk of a suicide occurring and an additional 35% admitted that they didn't know.

Research has repeatedly shown that asking about thoughts of suicide does not increase the rates of suicide. I reckon I have asked close to nearly all of my clients questions about suicide on multiple occasions and whilst it was somewhat anxiety-provoking at first (for me), none of them have ever flinched at the question or acted as a result of the conversation. Deciding that death is the only way out of pain and suffering is a drastic step that runs counter to every survival instinct we have. It is not a step that someone decides to take just because they heard someone talking about it.

Rather than encouraging suicidal behaviour, asking someone about suicide directly opens the channels to talk openly and honestly about the problem. Given the widespread stigma around suicide, most people who are contemplating suicide may not have had this opportunity or do not know who to speak to. This can provide an opportunity for people who are suicidal to feel listened to and a forum to identify what is happening for them. Discussing suicide can save lives. It can open the door for someone to get professional help.

So, let’s take an interest in those around us. Let’s look for changes. If we notice things that are of concern or a little different, perhaps in their energy or demeanour or they’re talking of helplessness, let’s ask if they are doing okay. The very best thing we can do to prevent suicide, is to raise the issue with those we might be concerned for. No one will take their own life just because you have a conversation with them about it. They will most likely feel that someone cares. And sometimes this may be the life line they need.

For more information on having conversations around suicide check out the Beyond Blue website or the tips for asking the question over at R U OK?. 

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