Suicide Prevention Month 2023
30 September 2023
Please note, this article includes discussions around suicide and suicidal thoughts. If you’ve been affected by any of the issues raised, resources are available at the end of the article.
Topics
We all have a different relationship with suicide. Sometimes when it comes up, it feels like people are talking about something out there that happens to other people. 1 in 5 of us has had suicidal thoughts and many more of us support and love people affected by suicide. We each have a different level of intimacy with it, but the chances are that when it comes up, it’s in the room already.
I first met suicide when I was working clinically as a neuro-physiotherapist. It was my very first rotation and, as part of my induction, we had some training from the team psychotherapist about how to deal with suicide and assess risk. It seemed a bit dramatic at the time, but it was something I came across much more often than I was expecting. This really helped to take away some of the fear and taboo about talking about wanting to die.
I was pretty terrified as a new Band 5 physio that I might say something wrong and what if someone killed themselves? Something I found reassuring was to hear that talking about suicide isn’t going to make it more likely to happen — actually it can be the opposite. How grandiose to think that anything I would say would have had that much impact on someone struggling with the biggest existential question of their life — to stay living or not. But fears like this are so catastrophic they make us want to cling to our clinical comfort zone and stay protected in a professional mode. However, by staying in professional mode, I wonder if that switches off something more human that is required to be present with someone who is suicidal?
How grandiose to think that anything I would say would have had that much impact on someone struggling with the biggest existential question of their life — to stay living or not. But fears like this are so catastrophic they make us want to cling to our clinical comfort zone and stay protected in a professional mode.”
Courageous Conversations
I’m currently leading on a project called Courageous Conversations and it’s definitely struck a chord with people. There are issues that the humans in our health and care system do not feel comfortable to talk about, be that staff or patients. Suicide and mental health is one key theme.
One participant pointed out that, if you don’t have these conversations in your regular life, of course you won’t be having those conversations with your patients. A simple but striking observation. Culturally we are quite unpractised at talking about suicide and mental health. So, it’s unsurprising that we can find it tricky in health and care settings.
‘If only I’d known.’ But known what?
When working clinically, suicide was still at a respectable distance. Last year that all changed when a close friend attempted suicide. People say, ‘if only I’d known.’ But known what? And what would you do?
In this case it wasn’t out of the blue. I could see it coming. One of his main coping mechanisms was to kick it down the road, put suicide off until tomorrow, like it was on a to-do list. And it worked for quite a long time. It reduced his anxiety and struggle to know the way out was coming at some point, which actually enabled him to carry on with life.
My experience is that suicide isn’t an irrational act. It’s not that people who are suicidal don’t realise how catastrophic suicide is, it’s that whatever they are living with or dealing with is, is so much worse.
My friend survived his suicide attempt and everyone said, ‘well at least now he will get the support he needs.’ This was so infuriating. When someone survives suicide, yes they are alive, but often nothing has really changed. All the things happening in their life or in their brain that drove them to suicide are still there. Sometimes with the added sense of failure that they couldn’t even end their life successfully. There is no magic fix. Things can get better but it’s a long, slow process of surviving.
As Victor Frankl said: “To live is to suffer, to survive is to find meaning in the suffering.”
Stigma around mental health and suicide
Following my own personal experience, this time last year for Suicide Prevention month I interviewed ‘Amy’ about her experience attending hospital following a suicide attempt. In her story you will see a number of failings, but I doubt any will be a big surprise. People not talking to you directly or not introducing themselves happens. People not telling you (or not knowing!) what is going to happen to you next is not uncommon. But when someone doesn’t feel they are worthy enough to live, these misses and oversights become grotesquely dehumanising.
My experience is that suicide isn’t an irrational act. It’s not that people who are suicidal don’t realise how catastrophic suicide is, it’s that whatever they are living with or dealing with is, is so much worse.”
There’s so much stigma around mental health and suicide. When you are directly affected because someone you love is suicidal then it’s so scary and it can be easy to get angry. But I think it’s a lot harder for some people to exist in our world than others.
Suicide rates are not evenly spread. Queer youth are 5 times more likely to die by suicide. It’s the most likely thing to kill men under 50 and there is evidence that suicide rates are unequal between different ethnic groups.
Suicide isn’t the problem of only those who are suicidal — we help create the conditions that make it hard for certain people to stay alive. I don’t know what will help change these stats but if we can learn anything from Amy’s story, please just believe someone — don’t devalue what they say because they were suffering so much they wanted to die. Don’t be threatened by suicide because you can’t fix it. Even a small act of kindness could mean the world to someone. Even a simple: “this must be really hard for you, I’m so sorry.” Or if you are close to someone who is suicidal saying, “I don’t know what to say but I’m so glad you are still here” can help.
I found a real lack of any kind of support for people in my situation, supporting someone who is suicidal. There are groups for people who have lost people to suicide but not those who survive. However — speak to people — you won’t have to go far to find others who have had similar experiences. Don’t be the only person supporting someone. I read somewhere you need at least 3—4 people in your support team. I wholeheartedly agree, even if those are just people supporting you.
Resources
Here are some resources that come recommended by people I know and love who are affected by suicide. I think they can be useful for all health and care professionals, and anyone affected by suicide:
The World Is Not Better Without You