No matter how you see it, suicide does not make for dinner party conversations. Annually, the 10th of September’s World Suicide Prevention Day presents a global opportunity to broach the knotty issue. The 2021-2023 triennial theme- “Creating Hope through Action” calls out to each of us. A call to individuals to engage in those conversations with the distressed and struggling who are potential suicide victims.
Suicide is a devastating event. Each of us has a role to play in supporting those experiencing a suicidal crisis or those bereaved by suicide. Preventing suicide is often possible. Annually, over 6,000 lives are lost in the UK. That is an average of 16 deaths daily. Globally, men are twice as likely as women to die by suicide. In the UK men are even more affected accounting for three out of every four suicides. A person suffering from depression is twenty times more likely to die by suicide.
Hopeful action starts with knowing what to look out for as warning signs that someone is not ok. Suicide results from a complex interplay of often multiple factors. We however know that life events, social stresses and mental disorders, along with a family history of suicide; and a personal history of self-harm or past attempts are all risk factors. The warning signs that someone may be struggling include a change in behaviour such as becoming tearful, aggressive, irritable, restless, withdrawn or distant. The suicidal often feels trapped and think they are a burden to their friends, family and community. This results in believing that they are alone and have no other options aside from suicide. The COVID-19 Pandemic has further compounded these feelings of isolation and vulnerability. It is not uncommon to hear these feelings verbalized as expressions of being hopeless, worthless or helpless.
A change in routines such as excessive or diminished eating and sleeping patterns, and also harmful coping strategies such as excessive alcohol, use of street drugs or engaging in gambling or violence are additional alarm bells.
What can you do?
Each one of us can become skilled at starting potentially life-saving conversations if we spot mental distress. The Samaritans ( www.samaritans.org) have devised a simple plan to engage in this hope engendering conversations. It is an acronym for active listening titled- SHUSH.
Show you care.
This is about expressing care for the distressed by giving undivided attention. Ensuring there is privacy is a key point here. This is not about offering advice or trying to fix their problems, but being a non-judgemental listening ear. It is also about creating a safe space to reflect on difficult emotions. The other ways to show care will be making eye contact and putting anyway all distractions- such as your phone. Resolving not to talk about self, aiming to learn at least one thing from the other person, keeping a listening diary to record and reflect on your strengths and challenges with listening are additional handy tips. The Samaritans also say “getting into this habit takes practice so don’t be too hard on yourself”.
It is important to bear in mind that you may need to ask the opening questions about whether they are ok more than once. It may take several attempts before someone is ready to open up. Trust can take time to build, and it is crucial for the distressed not to feel rushed. Articulation of difficult emotions can be challenging. Be comfortable with pauses and don’t feel obliged to fill the silence. Using encouraging body language in form of nods, hums and open posture could help to move the conversation along.
R U OK- An Australian Suicide Prevention Charity ( www.ruok.au.org) have an excellent interactive and simple to follow role play on their website to give guidance on persisting with the enquiry in an empathetic way.
Use Open Questions
Avoid using questions that lead to a yes or no response, and also aim to use conversation facilitators such as “ Tell me more” or How does that feel like?”
Say It Back
Summarizing back what you think you heard, and checking to confirm accuracy is a profound way to communicate with and connect with the distressed. It is important to avoid putting your own interpretation to the conversation.
It takes courage to ask up front if you suspect someone is suicidal. The common worry that this may sow the idea is unfounded. In fact, research shows that asking gives permission to the distressed to talk. It is best to follow your gut feeling and ask if in doubt. You could be saving a life.
Next, I will be writing on how to support the struggling to create a safety plan.
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