Suicide prevention day is every day

Suicide Prevention

Someone with depression is 20 times more likely to die from suicide than someone without it. Depression has been found to play a role in more than one-half of all suicide attempts.

Suicide Prevention

This year, World Suicide Prevention Day took place on 10 September. It was a day for all of us to think about those that had lost their lives to suicide, share our stories, and provide our on-going support to families of suicide victims still trying to cope with the tragedy. Moreover, the occasion warranted careful consideration of the ways in which supporters of mental health sufferers can assist in suicide prevention by educating themselves about mental illness, developing an understanding of the risk factors and identifying warning signs.

The global outlook for mental illness and suicide

In 2017, there were 972 million people around the world (or 10.7 per cent of the population) suffering from mental illness (including depression, anxiety, bipolar, drug, alcohol, eating and various other mental disorders).[2] The suicide rate among those collectively suffering from these mental disorders in the same period was 12.5 per cent[3].

Required skills

While supportive questions and actions are essential, often it is the careful listening and observation skills that become vital to the overall effectiveness of supporting someone with a mental illness and preventing suicide. A depressed person, for instance, may not respond to the question ‘Are you OK?’ by saying ‘Actually, I’m not’. Watching for signs that things might escalate can, therefore, be equally as important as learning what to say, and the things to avoid saying, to someone with depression.

The fact is that if you care for, or provide support to, someone with depression, there is a high risk that they will at some point think about suicide, particularly if they are suffering from severe depression.[4] The words and actions of someone contemplating suicide can provide clues that they are at risk of hurting themselves. Asking someone if they have suicidal thoughts will not give them the idea of suicide. This is a myth.[5] You should ask questions and gather facts to help someone who is depressed because the more people are willing to talk with a friend or family member about suicidal thoughts, the more likely they can help them take positive steps towards healing.[6]

It can be challenging to understand why someone has reached the point where they are considering ending their life. Sufferers may view suicide as a means of ending the intense emotional pain they experience. Depression steals hope. When that is lost, everything in your life can feel overwhelming. To some people, suicide seems like it is the only option because they lack any hope for the future. The focus of recovery pathways, therefore, must always be the restoration of hope.[7]

Knowing the suicide risk factors

Knowing the risk factors (conditions associated with increased risk of suicide)[8] and warning signs of suicide is the best way to help prevent it.[9] Suicide is a complex topic requiring detailed consideration. Educating yourself about the various risk factors and warning signs is imperative to maximising the effectiveness of your support in this area. To get you started, I will now provide a brief overview of these. It is not exhaustive.

Risk factors are categorised in a variety of ways.[10] Broadly, the most common risk areas relate to a person’s health, environment, and history. Warning signs stem from the things someone says, their mood and behaviour.[11] Though it may be easier to recognise situations and times when suicide is more common, understanding how someone is feeling can be more difficult.[12]

Someone with depression is 20 times more likely to die from suicide than someone without it.[13] Further, depression has been found to play a role in more than one-half of all suicide attempts.[14] Consequently, the risk of suicide is higher if you have depression, but it does not necessarily correlate that someone with it will attempt or commit suicide. Just because there is a higher chance of something happening does not necessarily mean that it will. Nonetheless, the risks are well-documented in research and should never be ignored.

Depression is not the only health risk factor for suicide. Other factors associated with an increased risk of suicide include other mental health conditions and disorders such as anxiety, substance abuse problems and personality traits of aggression, mood changes and poor relationships, and severe physical health conditions, including pain.[15]

A person’s environment can also influence the risk of suicide. Some examples are prolonged stress, exposure to harassment, bullying, death or terminal illness of a relative or friend, another person’s suicide, divorce, separation, or the breakup of a relationship, loss of a job, home, money, status, self-esteem, or personal security, access to firearms and drugs.[16]

Similarly, historical factors are also relevant. Prior suicide attempts, a family history of suicide, childhood abuse, neglect or trauma are associated indicators.[17]

The timing of certain life events can also make people more prone to suicidal feelings. Events such as anniversaries and holidays, the commencement of treatment with antidepressant medication, the diagnosis of a significant illness,[18] significant life changes (such as retirement) that lead to a loss of independence,[19] and court or disciplinary proceedings.[20] While not everyone who suffers from one or more of the above conditions or situations will become suicidal, there is an elevated risk that people who do so will go on to experience changes in personality and behaviour that may increase the risk of suicide.[21]

Warning signs

Some of the emotional and behavioural changes that may increase the chance that a person may try to take their life include:

  • talking about killing themselves, feeling hopeless, having no reason to live, being a burden to others, feeling trapped or experiencing unbearable pain;[22]
  • increased use of alcohol or drugs, social withdrawal (or perhaps joining a group with different standards to those of the person’s family), isolating from friends and family, looking for ways to end their lives (such as searching online for methods), changes in sleeping or eating habits (in either direction: suddenly sleeping or overeating, or sleeping or eating poorly), fatigue, giving away prized possessions, declining performance in school or work, feeling rage or uncontrollable anger or seeking revenge, inappropriate goodbyes or unexpected visits to friends and family members, especially combined with saying goodbye as if they won’t be seen again;[23] and
  • signs relating to moods such as depression, anxiety, loss of interest, irritability, humiliation and shame, agitation and anger, relief, or sudden improvement.[24]

Once again, not all people who experience these changes will become suicidal, but the risk for it is higher.[25] Some who experience such changes will go on to exhibit suicidal behaviours, marking the final step in the journey to suicide.

A note about warning signs

While most people who attempt suicide do show some sort of warning signs, there are also those people who, because of social stigma or a desire to not appear weak, will successfully hide what they are feeling[26] and may hide the effects of any associated changes. If the person exhibits even a few of the above features in any of the categories, they need to be taken seriously.[27] However, failing to recognise the warning signs in these situations is not a source of blame. Doing the most you can do with the information you have is invariably the only option you have to lend support.

Suicide prevention tips

There are things you can do to support someone with the urge to suicide. Encourage them to seek help from a mental health professional. If they refuse, be persistent. If they appear to be in immediate danger of hurting themselves, do not leave them alone, remove any possible means that they can use to hurt themselves, and get them to an emergency room as soon as possible.[28] In the longer term, support will hinge on your ongoing presence in their life, encouraging them towards actions that keep them in life.[29]

The Australian Institute of Professional Counsellors has developed some useful tips to help, including some practical questions for supporters to ask in assessing the risk posed to the supported person and statements to make that provide confirmation of your support in these circumstances.[30] Without seeking to diminish the intrinsic value of the publication, the essential guidelines may be summarised in point form as follows:

  • Take the situation—and the person—seriously.
  • Be pro-active: start ‘The Conversation’ about suicide.
  • Assess their risk level.
  • Be prepared to act quickly in a crisis.
  • No secrets—do not agree to keep suicidal plans a secret!
  • Urge professional help.
  • Make a safety plan.[31]
  • Plan to follow up on their treatment.
  • Assure the person of your support over the long haul; offer it proactively.
  • Encourage a healthy lifestyle.

Encouraging and even facilitating the use of suicide prevention apps[32] is a powerful mechanism specifically designed to assist in the practical prevention of suicide. The sharing of safety plans with supporters is an invaluable feature of these apps.

Every day is a suicide prevention day.

Notation

© 2020. Robert Nicholls. All Rights Reserved. Selected parts of this post are extracted, and modified as appropriate, from my published book, Surviving the Darkness: Lessons learned from a battle with depression and anxiety, released on 5 August 2020. ISBN: 978-0-6488865-0-1.

Featured image: Shutterstock


Subscribe for FREE

If you enjoyed reading this article, why not subscribe to my website for free to gain advance member access to blogs, free eBooks and books, feature articles, newsletters, and information about upcoming publications and events?

SIGN UP FOR FREE

[1] Ritchie, H. and Roser, M. (2020). Mental health. Published online at OurWorldInData.org. Retrieved on 16 April 2020 from https://ourworldindata.org/mental-health [online resource].

[2] Ibid.

[3] Gotlib, I. and Hammen, C. (2002). Handbook of depression. New York: Guilford Press; Preventing Suicide, Centers for Disease Control and Prevention, reviewed on 5 September 2019; 10 leading causes of death and injury, Centers for Disease Control and Prevention. Updated 10 April 2019.

[4] Smith, K. PhD. (2019). Suicide warning signs. Retrieved on 13 May 2020 from https://www.psycom.net/suicide-warning-signs.

[5] Ibid.

[6] Preventing suicide, Centers for Disease Control and Prevention, Reviewed 5 September 2019; 10 leading causes of death and injury, Centers for Disease Control and Prevention. Updated 10 April 2019.

[7] Nicholls, R. (2020). Surviving the Darkness: Lessons learned from a battle with depression and anxiety, released on 5 August 2020. ISBN: 978-0-6488865-0-1  

[8] Suicide Prevention Resource Center. A comprehensive approach to suicide prevention. Education Development Centre Inc. Retrieved on 13 May 2020 from https://www.sprc.org/effective-prevention/comprehensive-approach.

[9] For example, see Smith, K. PhD. (2019). Suicide warning signs. Retrieved on 13 May 2020 from https://www.psycom.net/suicide-warning-signs; American Foundation of Suicide Prevention, Risk factors and warning signs. Retrieved on 13 May 2020 from https://afsp.org/risk-factors-and-warning-signs.

[10] Australian Institute of Professional Counsellors (2015). Suicide: Warning signs and prevention tips, 20 February. Retrieved on 8 May 2020 from https://www.aipc.net.au/articles/suicide-warning-signs-and-prevention-tips/; Smith, K. PhD. (2019). Suicide warning signs, 9 September 2019. Retrieved on 13 May 2020 from https://www.psycom.net/suicide-warning-signs; American Foundation of Suicide Prevention, Risk factors and warning signs. Retrieved on 13 May 2020 from https://afsp.org/risk-factors-and-warning-signs.

[11] Schimelpfening, N. (2020). The worst things to say to someone who is depressed, 25 March. Retrieved on 6 May 2020 from https://www.verywellmind.com/worst-things-to-say-to-someone-who-is-depressed-1066982.

[12] Ferrari, A.J. et al. (2014). The burden attributable to mental and substance use disorders as risk factors for suicide: Findings from the Global Burden of Disease Study 2010. PLoS ONE, vol. 9, no. 4, p. e91936. https://doi.org/10.1371/journal.pone.0091936.

[13] Gotlib, I. and Hammen, C. (2002). Handbook of depression. New York: Guilford Press; CDC (2020). Preventing suicide. Centers for Disease Control and Prevention. Updated 21 April 2020. Retrieved on 11 May 2020 from https://www.cdc.gov/violenceprevention/suicide/fastfact.html; CDC (2020). 10 Leading Causes of Death and Injury, Centers for Disease Control and Prevention. Updated 30 March 2020. Retrieved on 11 May 2020 from https://www.cdc.gov/injury/wisqars/LeadingCauses.html.

[14] American Foundation of Suicide Prevention, Risk factors and warning signs. Retrieved on 13 May 2020 from https://afsp.org/risk-factors-and-warning-signs.

[15] Australian Institute of Professional Counsellors (2015). Suicide: Warning signs and prevention tips, 20 February. Retrieved on 8 May 2020 from https://www.aipc.net.au/articles/suicide-warning-signs-and-prevention-tips/; Smith, K. PhD. (2019). Suicide warning signs, 9 September. Retrieved on 13 May 2020 from https://www.psycom.net/suicide-warning-signs; American Foundation of Suicide Prevention, Risk factors and warning signs. Retrieved on 13 May 2020 from https://afsp.org/risk-factors-and-warning-signs.

[16] American Foundation of Suicide Prevention. Risk factors and warning signs. Retrieved on 13 May 2020 from https://afsp.org/risk-factors-and-warning-signs.

[17] Saad, A.M., Gad, M.M. and Al-Husseini, M.J. et al. (2019). Suicidal death within a year of a cancer diagnosis: A population-based study. Cancer, vol. 125, no. 6, pp. 972-979. doi:10.1002/cncr.31876.

[18] Ainsworth, M. (2011). What can I do to help someone who may be suicidal? Metanoia.org. Retrieved on 8 May 2020 from https://metanoia.org/suicide/whattodo.htm; Smith, M., Segal, J. and Robinson, L. (2012). Suicide prevention: Spotting the signs and helping a suicidal person. Helpguide.org. Retrieved on 8 May 2020 from https://www.helpguide.org/articles/suicide-prevention/suicide-prevention.htm.

[19] For others see, for example, Florida Office of Drug Control. (2009). Understanding & preventing suicide: A customizable Powerpoint training. Florida Office of Drug Control. Statewide Office of Suicide Prevention and Suicide Prevention Coordinating Council. Retrieved on 8 May 2020 from http://www.helppromotehope.com/documents/Understanding&PreventingSuicide.ppt cited by Australian Institute of Professional Counsellors (2015). Suicide: Warning signs and prevention tips, 20 February. Retrieved on 8 May 2020 from https://www.aipc.net.au/articles/suicide-warning-signs-and-prevention-tips/.

[20] Australian Institute of Professional Counsellors (2015). Suicide: Warning signs and prevention tips, 20 February. Retrieved on 8 May 2020 from https://www.aipc.net.au/articles/suicide-warning-signs-and-prevention-tips/.

[21] Ainsworth, M. (2011). What can I do to help someone who may be suicidal? Metanoia.org. Retrieved on 8 May 2020 from https://metanoia.org/suicide/whattodo.htm; Smith, M., Segal, J. and Robinson, L. (2012). Suicide prevention: Spotting the signs and helping a suicidal person. Helpguide.org. Retrieved on 8 May 2020 from https://www.helpguide.org/articles/suicide-prevention/suicide-prevention.htm; Australian Institute of Professional Counsellors (2015). Suicide: Warning signs and prevention tips, 20 February. Retrieved on 8 May 2020 from https://www.aipc.net.au/articles/suicide-warning-signs-and-prevention-tips/; Smith, K. PhD. (2019). Suicide warning signs, 9 September. Retrieved on 13 May 2020 from https://www.psycom.net/suicide-warning-signs; American Foundation of Suicide Prevention, Risk factors and warning signs. Retrieved on 13 May 2020 from https://afsp.org/risk-factors-and-warning-signs.

[22] Ainsworth, M. (2011). What can I do to help someone who may be suicidal? Metanoia.org. Retrieved on 8 May 2020 from https://metanoia.org/suicide/whattodo.htm; Smith, M., Segal, J. and Robinson, L. (2012). Suicide prevention: Spotting the signs and helping a suicidal person. Helpguide.org. Retrieved on 8 May 2020 from https://www.helpguide.org/articles/suicide-prevention/suicide-prevention.htm; Australian Institute of Professional Counsellors (2015). Suicide: Warning signs and prevention tips, 20 February. Retrieved on 8 May 2020 from https://www.aipc.net.au/articles/suicide-warning-signs-and-prevention-tips/; Smith, K. PhD. (2019). Suicide warning signs, 9 September. Retrieved on 13 May 2020 from https://www.psycom.net/suicide-warning-signs; American Foundation of Suicide Prevention, Risk factors and warning signs. Retrieved on 13 May 2020 from https://afsp.org/risk-factors-and-warning-signs.

[23] American Foundation of Suicide Prevention, Risk factors and warning signs. Retrieved on 13 May 2020 from https://afsp.org/risk-factors-and-warning-signs.

[24] Australian Institute of Professional Counsellors (2015). Suicide: Warning signs and prevention tips, 20 February. Retrieved on 8 May 2020 from https://www.aipc.net.au/articles/suicide-warning-signs-and-prevention-tips/.

[25] Schimelpfening, N. (2020). The worst things to say to someone who is depressed, 25 March. Retrieved on 6 May 2020 from https://www.verywellmind.com/worst-things-to-say-to-someone-who-is-depressed-1066982.

[26]Australian Institute of Professional Counsellors (2015). Suicide: Warning signs and prevention tips, 20 February. Retrieved on 8 May 2020 from https://www.aipc.net.au/articles/suicide-warning-signs-and-prevention-tips/; Schimelpfening, N. (2020). The worst things to say to someone who is depressed, 25 March. Retrieved on 6 May 2020 from https://www.verywellmind.com/worst-things-to-say-to-someone-who-is-depressed-1066982.

[27] Schimelpfening, N. (2020). The worst things to say to someone who is depressed, 25 March. Retrieved on 6 May 2020 from https://www.verywellmind.com/worst-things-to-say-to-someone-who-is-depressed-1066982.

[28] Australian Institute of Professional Counsellors (2015). Suicide: Warning signs and prevention tips, 20 February. Retrieved on 8 May 2020 from https://www.aipc.net.au/articles/suicide-warning-signs-and-prevention-tips/.

[29] Ibid.

[30] Once the person is out of immediate danger, work with them to develop a safety plan. According to the Australian Institute of Professional Counsellors this is ‘a set of steps that they commit to following if they have another suicidal crisis. Jointly list triggers that are more likely to bring on a crisis for the person; these could include anniversaries of losses, stress from relationships, employment issues, and abuse of alcohol or drugs. Make sure to list contact numbers of all relevant health professionals: doctors, psychiatrists, counsellors, etc. Put down the names of family members and friends who have agreed to help out in an emergency.’ Australian Institute of Professional Counsellors (2015). Suicide: Warning signs and prevention tips, 20 February. Retrieved on 8 May 2020 from https://www.aipc.net.au/articles/suicide-warning-signs-and-prevention-tips/.

[31] Examples of apps include BeyondNow by Australian Monash University and Beyond Blue Ltd), iBobbly by the Black Dog Institute in Australia, Stay Alive by Grassroots Suicide Prevention (UK) and the Suicide Prevention App by ISD Innovations, Inc. (US).

%d bloggers like this: