September is Suicide Awareness Month and 10 September is International Suicide Awareness Day. This year’s campaign slogan is ‘connect, communicate, care’. In this spirit, I would like to share some of my experiences of working with suicidal individuals, in order to educate you on the risk factors and warning signs so that you can connect, communicate and care if needed.
In my practice I work with people experiencing suicidal thoughts almost every day. These individuals range on a continuum from low risk for suicide, to very high risk for suicide and the way I approach them differs greatly depending on their degree of risk. Some individuals are at low risk. They have thoughts of dying, but they have never considered how they would go about doing this and have no intention of following through with their suicidal thoughts. These individuals are not overwhelmed by hopelessness and despair and are able to find other means of solving their problems or dealing with their difficult emotions. Significantly, they are able to appreciate that life can get better and that whatever is causing the suicidal thoughts will pass. Importantly, these individuals are not abusing any substances and are not impulsive in their behaviour. They have stable and supportive relationships with significant others. A person in this situation does not require emergency intervention but it would be useful to help them gain professional help to assist them with the underlying feelings that are causing the suicidal thoughts.
On the other side of the spectrum are individuals who are at high risk for suicide. These individuals have a very high degree of hopelessness and significant despair about their current circumstances and their future. They feel that life will always be emotionally painful and they long for the peace that death can offer. These individuals have thought in detail about how they will kill themselves and may even have researched various options. They might have started making preparations for their death such as writing letters to loved one’s and sorting out their affairs or giving away special belongings. These individuals may or may not have attempted suicide in the past. Also at high risk, are individuals who may not be as determined and organised as the above individual, but who are abusing substances and/or are impulsive in their behaviour. These individuals may attempt suicide ‘in the heat of the moment’. Especially concerning are individuals who feel socially isolated or whose relationships are characterised by a high degree of conflict.
Unfortunately, people who are at high risk do not always tell anyone how they are feeling and they take action in private. Still, you might notice certain behaviour changes that could alert you to the fact that someone is suicidal. These include:
Social withdrawal. An individual starts spending much time alone or isolated. In the case of teenagers, parents might notice that where their child was once spending time engaged in family life, their child is now isolating himself permanently in his room. To be clear, this alone does not suggest suicide, but can can be an indicator that there is a problem and it might be worth connecting and communicating with the individual in order to understand how they are feeling and why they are withdrawing.
Giving away special belongings. Taken out of context, this might appear that the individual is being generous or sentimental and this very well might be the case. However, it is worth probing and finding out what is motivating this behaviour.
Change in mood. A person who is suicidal is more often than not depressed. You may notice that an individual who used to be well put together and functional suddenly appears lethargic, sad, irritable or angry. They may loose interest in previously enjoyed activities and their performance in work or school might decline. They may appear slightly dishevelled and you may notice a change in their sleeping patterns….sleeping a lot more than usual or being unable to sleep. They may lose weight or alternatively gain weight.
Expressions of hopelessness. Hopelessness is one of the strongest risk factors for suicide. Some people may be direct in their expression of hopelessness saying things such as ‘what is the point’. They may talk about death and dying. Or they may be more subtle. You might start noticing that they have stopped making plans for the future or that their attitude towards themselves has become very negative ‘I’m worthless’.
Substance abuse. Substance abuse alone does not make an individual at risk for suicide. But, if they are experiencing thoughts of suicide or have an unstable mood, substance abuse can often lower an individuals inhibitions enough that they act on their emotions whilst in an inebriated state. If an individual is experiencing suicidal thoughts and using substances, they are at greater risk for suicide.
Planning their suicide. Obviously if you find direct expressions of suicide you should take these very seriously. Letters, notes, evidence of research into suicide methods, stockpiling medication, accessing knives, rope, guns, or poison, should be taken very seriously and professional help should be sought immediately.
What should you do if you have noticed these warning signs and are concerned that a loved one might be suicidal? As this year’s slogan suggests, connect, communicate and care. Do not be afraid to talk about your concerns directly to the person involved. I often hear loved one’s saying that they are scared to talk about it, in case they put idea’s into the individuals head or in case they are wrong and they cause offence. This is not the case at all. Talking about it can help the individual feel less isolated and more understood. This alone can make a significant difference but it can also enable you to assess the level of risk so that you can get the individual the help that they need.
Questions to ask include: Do you have suicidal thoughts? Have you thought about how you would do it? Do you have access to the things required to carry out your plan? Have you decided on when and where you would do it? How hopeless do you feel about the future? If there are positive answers to these questions, the person is at high risk. Practically, it is important to remove any means of suicide – weapons, poison, medication, knives, rope to name a few. Most importantly, do not leave a highly suicidal person on their own and seek professional help.
Many people do not know that a highly suicidal person can simply arrive in the emergency room of any hospital. Arrive at casualty and explain the problem. The doctors will then be able to take over to ensure the safety of the individual and to start accessing the treatment that they require. There are also professional organisations such as Lifeline and SADAG who have helplines that you can phone. SADAG can be accessed on 0800 567 567 or SMS 31393. Lifeline numbers vary depending on your area but Johannesburg is 011 728 1331.
If you are feeling suicidal yourself and you identify with the risk factors that I have mentioned, consider taking the steps mentioned above, or opening up to a loved one. Very few problems are untreatable, most problems have many different solutions and you are almost certainly more loved than you are currently able to realise.
Lastly, do not dismiss suicidal behaviour as attention seeking or selfish. Individuals who are highly suicidal do not believe that they are of any value to their loved one’s and more often than not, believe that their loved one’s would be better off without them. Do not judge… connect, communicate, care.