Suicide

Often contemplation of suicide is a result of someone being overwhelmed by a variety of life circumstances. If you know what to look for there are generally signs and symptoms pointing to the fact an individual is contemplating suicide. What are the signs and symptoms? And how should we react once we spot the signs or symptoms in our loved ones or ourselves?

Symptoms that an individual is contemplating suicide often coincide with those of depression. Symptoms often vary and depressive symptoms are treatable. Usually the onset of symptoms is gradual and therefore can go unnoticed. Even the person himself or herself may assume that he or she is just transitioning into a “normal stage of life” where relationships and experiences are no long as interesting or exciting as they once were. This is not true.

Depression and thoughts of suicide can be brought on by a variety of causes, including setbacks or disappointments in life, loss, divorce or breakup, financial stress, medical illness, family history and genetics, trauma and stress (ranging from being unemployed to getting married), pessimism, low self-esteem, physical conditions, medical conditions, etc. Any one of these causes or a combination of several can contribute to depression because they bring on physical weakness and stress.

Depression or thoughts of suicide can affect anybody. The encouraging news is that depression is very treatable and thoughts of suicide can be turned into thoughts of hope. To find out your diagnosis and potential treatment options, speak with your health care provider immediately.

There is help and hope available. Many people living with depression or thoughts of suicide try to harm themselves because they believe that they’re “stuck this way forever.” This isn’t true. Situations and circumstances can change. Things will get better. Taking the first step by deciding to seek treatment and support will make a big difference.

Signs to Look For

What are the warning signs?

Saving the life of someone from suicide depends on our ability to recognize those people who are in distress and may be at risk. The American Association of Suicidology developed a simple tool that is available for everyone to use to remember the warning signs of suicide. This tool is called “IS PATH WARM” and outlines the key points to remember.

• I – Ideation (suicidal thoughts)
• S – Substance Abuse
• P – Purposelessness
• A – Anxiety
• T – Trapped
• H – Hopelessness/Helplessness
• W – Withdrawal
• A – Anger
• R – Recklessness
• M – Mood changes

Other signs and behaviours to be aware of and that might suggest someone being at risk of suicide include, but are not limited to:

• Direct and indirect verbal expressions: “I don’t want to live anymore”, “there is nothing to live for anymore”, “people will be better off without me”
• Dramatic changes in mood
• Loss of interest in previously enjoyed activities
• Agitation
• Increase in drug and alcohol use
• Risk taking behavior
• Aggressive, impulsive and/or violent acts
• Expressions of hopelessness and purposelessness
• Lack of self care or outright neglect of self
• Sleeping too much or too little
• Feeling tired most of the time
• Gaining or losing a significant amount of weight
• Changes in eating and sleeping pattern
• Withdrawal from family, friends, and interests
• Giving away prize possessions and/or making a will; tidying up personal affairs; writing notes; making notes on belongings
• Reconnecting with old friends and extended family as if to say goodbye
• Previous unresolved or recent suicide attempt(s)
• Unusual happiness and peace after an intense period of turmoil and displaying the above characteristics

What to Do: Suicide First Aid

The following guidelines are based on the expert opinions of a panel of mental health consumers, carers and clinicians from Australia, New Zealand, the UK, the USA and Canada about how to help someone who may be at risk of suicide.

How to Use these Guidelines

These guidelines are a general set of recommendations about how you can help someone who may be at risk of suicide. Each individual is unique and it is important to tailor your support to that person’s needs. These recommendations therefore may not be appropriate for every person who may be at risk of suicide. Also, the guidelines are designed to be suitable for providing first aid in developed English-speaking countries. They may not be suitable for other cultural groups or for countries with different health systems.

Self-injury

Self-injury can indicate a number of different things. Someone who is hurting themselves may be at risk of suicide. Others engage in a pattern of self-injury over weeks, months or years and are not necessarily suicidal. These guidelines can assist you only if the person you are helping is suicidal. If the person you are assisting is injuring themselves, but is not suicidal, please refer to an excellent web resource hosted jointly by the University of Guelph and McGill University.

Asking Someone If they are Suicidal

How can I tell if someone is feeling suicidal? It is important that you know the warning signs of suicide. People may show one or many of these signs, and some may show signs not on the above list.

If you suspect someone may be at risk of suicide, it is important to ask them directly about suicidal thoughts. Do not avoid using the word ‘suicide’. It is important to ask the question without dread, and without expressing a negative judgment. The question must be direct and to the point. For example, you could ask:

• “Are you having thoughts of suicide?” or
• “Are you thinking about killing yourself?”

If you appear confident in the face of the suicide crisis, this can be reassuring for the suicidal person.

Although some people think that talking about suicide can put the idea in the person’s mind, this is not true. Another myth is that someone who talks about suicide isn’t really serious. Remember that talking about suicide may be a way for the person to indicate just how badly they are feeling.

How Should I Talk to Someone Who is Suicidal?

It is important to:

• Tell the suicidal person that you care and that you want to help them.
• Express empathy for the person and what they are going through.
• Clearly state that thoughts of suicide are often associated with a treatable mental disorder, as this may instill a sense of hope for the person.
• Tell the person that thoughts of suicide are common and do not have to be acted on.

Suicidal thoughts are often a plea for help and a desperate attempt to escape from problems and distressing feelings. You should encourage the suicidal person to do most of the talking, if they are able to. They need the opportunity to talk about their feelings and their reasons for wanting to die and may feel great relief at being able to do this. It may be helpful to talk about some of the specific problems the person is experiencing. Discuss ways to deal with problems which seem impossible to cope with, but do not attempt to ‘solve’ the problems yourself.

How Can I Tell if the Situation is Serious?

First, you need to determine whether the person has definite intentions to take their life, or whether they have been having more vague suicidal thoughts such as ‘what’s the point of going on?’. To do this, you need to ask the person if they have a plan for suicide. The three questions you need to ask are:

1. Have you decided how you would kill yourself?
2. Have you decided when you would do it?
3. Have you taken any steps to secure the things you would need to carry out your plan?

A higher level of planning indicates a more serious risk. However, you must remember that the absence of a plan is not enough to ensure the person’s safety. All thoughts of suicide must be taken seriously.

Next, you need to know about the following extra risk factors:

• Has the person been using alcohol or other drugs? The use of alcohol and other drugs can make a person more susceptible to acting on impulse.
• Has the person made a suicide attempt in the past? A previous suicide attempt makes a person more likely to make a future suicide attempt or to kill themselves.

From the Article “Suicidal Thoughts & Behaviours, First Aid Guidelines:” The Department of Psychiatry The University of Melbourne AUSTRALIA

Once you have established that the risk of suicide is present, you need to take action to keep the person safe.

How Can I Keep the Person Safe?

A person who is actively suicidal should not be left on their own. If you can’t stay with them, you need to arrange for someone else to do so. In addition give the person a safety contact which is available at all times (such as a telephone help line, a friend or family member who has agreed to help, or a professional help giver).

It is important to help the suicidal person to think about people or things that have supported them in the past and find out if these supports are still available. These might include a doctor, psychologist or other mental health worker, family member or friend, or a community group such as a club or church.

Do not use guilt and threats to prevent suicide. For example, do not tell the person they will go to hell if they die by suicide, or that they will ruin people’s lives by killing themselves.

What About Professional Help?

During the crisis

Mental health professionals advocate always asking for professional help, especially if the person is psychotic. If the suicidal person has a weapon or is behaving aggressively towards you, you must seek assistance from the police in order to protect yourself.

However, the person you are helping may be very reluctant to involve a professional and, if the person is close to you, you may be concerned about alienating them. In fact, some people who have experienced suicidal thoughts or who have made plans for suicide feel that professional help is not always necessary.

After the crisis is over

After the suicide crisis is over, ensure the person gets whatever psychological and medical help they need. Other guides in this series may be useful for you in achieving this.

What if the Person Makes Me Promise Not to Tell Anyone Else?

You should never agree to keep a plan for suicide a secret. Even if you do, this is a promise you should not keep.

Do Your Best

Do your best for the person you are trying to help. Remember, though, that despite our best efforts, some people will still die by suicide.

Signs that an individual is contemplating suicide often coincide with those of depression and can often vary, but such symptoms are treatable. Often, the onset of symptoms is slow and therefore goes unnoticed. Even the person himself or herself may assume that he or she is just transitioning into a “normal stage of life” where relationships and experiences are no long as interesting or exciting as they once were. Time to be careful.

Is There Help?

Depression or thoughts of suicide can affect absolutely anybody – you’d be surprised at just who. You are not alone or ‘weird’ or ‘a loser’. Be encouraged. Depression is very treatable and thoughts of suicide can be turned into positive hope. To find out your diagnosis and potential treatment options, speak with your health care provider/doctor immediately.

There is help and hope available. Many people living with depression or thoughts of suicide try to harm themselves because they believe that they’re “stuck this way forever.” This isn’t true. Situations and circumstances do change. Things will get better. Take the first step by deciding to seek treatment and support. It will make a vital difference.

If you are seriously considering suicide, there are a few things that you need to truly know.

You are important. You are valuable. You have a place in this world. The feelings you are going through will not last forever. Suicide is a permanent solution to a temporary problem. You can work through this. There is hope. There is help.

It is important that you talk to someone you trust about how you are feeling and seek attention from your health care provider or other authority. You can get through this. You are not alone. You do not need to hurt yourself of anyone else.

Where Can I Turn for Help?

If you are in a serious emergency situation, call your local emergency service:

• In North America, call 911
• In the United Kingdom, call 999
• In New Zealand, call 000.

If you can, talk to a loved one about how you are feeling and let them know you want to find help. Or, you can talk to someone at your school, like a teacher or a guidance counsellor.

Your Life Counts is also here for you. If you ever need to talk, you can visit www.yourlifecounts.org and a trained facilitator will respond within 24 hours. We can even connect you with local resources in your area to find you the support you need.

What if My Loved Ones Don’t Take Me Seriously?

Sometimes people don’t know how to react when they hear that someone they know is considering suicide. Their immediate emotional reaction may appear to be anything from laughter to anger. This does not mean that they don’t care about you! They need to come to terms with your thoughts as well. Let them know that the feelings you have are real and serious and that you are asking for their support in finding help.

Remember that you are important. Your life counts, and you can make a difference in this world. If you ever need to talk about this or anything else, feel free to get in touch with us. We’re here for you.

If a loved one or friend is feeling suicidal, take them seriously. Step in and let them know you care, that there is hope, and that you are there for them. Encourage them to seek help or call a crisis line for direction. Don’t make the promise that you will keep their feelings a secret. You may need to let someone know so you can find help for them.

Depression or thoughts of suicide can affect absolutely anybody. Reassure your friend or loved one that they are not alone. Be encouraging. Depression is very treatable and thoughts of suicide can be turned into positive hope. Encourage them to seek diagnosis and potential treatment options, to speak with their health care provider/doctor immediately.

There is help and hope available. Many people living with depression or thoughts of suicide try to harm themselves because they believe that they’re “stuck this way forever.” This isn’t true. Situations and circumstances do change. Things will get better. Encourage your friend or loved one to take the first step by deciding to seek treatment and support. It will make a vital difference.

Remember that you are important. Your life counts, and you can make a difference in this world. If you ever need to talk about this or anything else, feel free to get in touch with us. We’re here for you.

“Committed suicide”, “completed suicide” or “successful suicide” have historically been used to describe a death by suicide. The suicide prevention community is now realizing that this language is not accurate nor is it helpful.

“Committed suicide,” with its implications of criminality, is a carryover from the Middle Ages, when civil authorities, finding the deceased beyond their reach, punished the survivors by confiscating their property. Those who died by suicide were forbidden traditional funerals and burials, and suicide was considered both illegal and sinful by the laws and religions of the time.

Today, the word “commit” presents a particular problem since it is also used for criminal offences such as homicide and assault. Suicide is no longer a criminal act in Canada. The term “successful” used to describe a suicide death does not reflect the reality. Every suicide death is a tragedy, not a success.

Initiated by the Compassionate Friends, in 2002 the CASP Board recommended using death by suicide, died by suicide, suicide or suicide death. These terms are non-judgemental and consistent with how we describe other types of death – died from cancer, died in a car accident, and thus died by suicide.

Likewise, to describe a suicide attempt that does not result in death as a “failure,” “unsuccessful,” or “incomplete” is not helpful, nor is it accurate. Each of these terms imply that the person who attempted suicide is a failure, when, in fact, a suicide attempt that does not result in death gives the person the opportunity to find help and hope.

The terms “non-fatal suicide attempt” or just “suicide attempt” more accurately and appropriately reflects that event.

Changing the language used to describe suicide is not easy – old habits die hard. But as we in the suicide prevention community work to change our language in our own work, the new language becomes more familiar. Most others (even media) usually understand the rationale when we take the time to explain – though they do take reminding!

Change DOES come, if slowly.

Thank you for your support

P. Bonny Ball is past board member and Survivor Chair CASP;member of 2011 Vancouver CASP conference committee. This article is adapted from AMHB “What’s in a Word: The Language of Suicide” Alberta Mental Health Board