World Suicide Prevention Day – Sept 10, 2016

September is a month full of activity that includes not only seasonal changes and a new school year, but also many different days of recognition and awareness campaigns. Being a psychologist I may be biased, but I believe that mental health awareness efforts are among the most important!

Even if not directly identified, mental health plays a large factor in many of the other awareness campaigns; whether they are focused on improving physical health or eating habits, combating disease, reducing illiteracy, or addressing bullying.

Without good mental health, other life concerns become more difficult to address or manage. When mental health goes unchecked, people can find themselves becoming overwhelmed and overstressed. If left unchecked long enough, a sense of hopelessness can begin to set in; leading some people to feel trapped in their circumstances and sometimes believing that the only way out of their pain is suicide.

Therefore, even though there is incredible value and importance with other awareness campaigns, I believe one of the most important ones is World Suicide Prevention Day. If we do not ensure that we are able to effectively address suicide, then other important issues can become almost unattainable.

Suicide is preventable, but to be effective in prevention, we need to increase awareness about what leads to suicide and how people can effectively help those who are experiencing suicidal thoughts.

The alternative is to not prepare and then find ourselves in the unexpected position of either:

• Being suicidal ourselves and not knowing how to address these thoughts or how to reach out for help, or
• Supporting someone who is suicidal and feeling overwhelmed at the “responsibility” and frightened that we will say the wrong things.

Please know, the chance that you will either experience suicidal thoughts or know someone who feels suicidal is not farfetched or improbable.

According to the most current statistics available from Statistics Canada (2009), suicide is the 9th leading cause of death in Canada, and the 3rd leading cause of death among adults aged 35-44 years and the 2nd leading cause of death among youth aged 15-24 years (Statistics Canada, Canadian Vital Statistics, Death Database (CANSIM table 102-0561).

In fact, in Canada, approximately 11 people will end their lives by suicide today (Canadian Association for Suicide Prevention, CASP).

Therefore, I encourage you to spend time this month to learn more about suicide prevention, the risk factors and warning signs, how to assess for level of risk, how you can effectively support someone, and how you can reach out for help if you are feeling suicidal.

Please Note: If you are feeling suicidal yourself or worried that you are heading in that direction, then please keep reading. Although this article is written primarily for supporters, you will still be able to gleam insights and apply what is discussed below, thus increasing your own awareness and self-knowledge. You can also print out or forward this article to one of your supporters so they have access to this information. Together, you can collaboratively build a safety plan that meets both your needs and your supporter’s needs. If you have not disclosed the fact that you are feeling suicidal, then you could use this article as a way to bring up this concern with a loved one and begin the process of planning your next steps to ensure safety and a return to mental health.

Risk Factors

There are many risk factors that lead to suicide making it a complex issue to understand. Suicide is often caused by someone experiencing unbearable pain, pain that is not believed to have an ending…outside of suicide. This pain can be caused by significant or cumulative loss, unexpected life changes, financial hardship, physical injuries or illness, trauma, substance abuse, or any combination of multiple life stressors. More than three times as many males will die by suicide, while more than three times as many women will attempt. Depression is the most common mental illness associated with suicide.

Those most at risk are:

• males,
• seniors,
• youth and young adults between the ages of 15-34 years,
• individuals who identify themselves as LGBTQ,
• individuals from a First Nations, Métis, or Inuit background, and
• people living in the lower socio-economic levels.

Most people who contemplate about or attempt suicide do not want to actually be dead, but rather want to escape the pain they are feeling. They have gotten to a point where they can no longer see another way out of the pain they are in. They feel overwhelmed. They feel hopeless. They feel as though there will be no end to their pain.

Knowing all this gives us valuable clues as to what we can do to help.

But first, what are the clues that someone is suicidal?

Warning Signs

Here is a quick list of the most common signs:

• Depression mixed with a sense of feeling hopeless and helpless.
• Significant anxiety and agitation
• Increased substance abuse
• Decreased or lack of self-care or hygiene
• Withdrawal from family and friends (or reconnecting with loved ones as attempt to say goodbye)A sense of having no purpose or feeling worthless
• Increased aggression or risk-taking behaviors
• Giving away belongings or tying up loose ends (i.e., preparing a will)Sudden improvement in mood (as this could indicate a decision has been made).
• Talking about death or suicide

Important: Not all suicidal people will openly disclose or talk about their suicidal thoughts directly, so listen to their language! Rather than saying, “I want to kill myself” or “I wish I were dead,” they may say things like:

• “I hate my life,
• “I can’t take it anymore,
• “What’s the point,” or
• “Why do I bother?”

If they say anything like the above, then be direct and ask:

• “Are you wishing you were dead?, or
• “Are you thinking about suicide?”

Assessing Level of Risk

At the most basic level, determining level of risk involves assessing:

• Level of Intent
• How much do they want to die by suicide? Is there any ambivalence?
• Existence of a Plan and Timeframe
• Ask them, “Have you thought about how you would do it?” When you would do it?
• Access to the Means
• Determine if they have access to the means. Do they already have the weapon, pills, tool(s), or access to place available?
• Previous Attempts
• Have they had suicidal thoughts in the past? Have they attempted suicide in the past? What was the severity? Where they hospitalized? Did anyone else know of the previous attempt?

Supporting Someone Who is Feeling Suicidal

First Things First

If you are concerned then just ask them if they are suicidal. Simply say:

“Are you feeling suicidal?”

Be that blunt!

Beating around the bush will make you appear uncomfortable about the topic and make it less likely the person will disclose to you. Suicidal people often fear being a burden or being judged, and as a result, they may not easily share their suicidal thoughts with others.

If they deny feeling suicidal, then follow up with:

“Ok, but I’m worried about you because you have been different lately. If you are feeling suicidal, then please let me know. I care about you and I want to help you if you will let me.”

Talking about your concerns and asking if someone is suicidal is not going to give them the idea or increase their risk. In fact, talking about suicide and letting someone know you have noticed they are in pain helps to reduce the risk. It helps to reduce their sense of isolation and can bring on a huge sense of relief. Asking will demonstrate you are concerned and open the topic up for conversation.

Additional Suicidal Inquiry Questions

If you really feel uncomfortable asking about suicidal risk in such as straightforward manner, then you can soften your approach and use the following questions to lead up to the direct suicide question.

• “Are you feeling like things won’t ever get better?”
• “Are you feeling like you are a burden?”
• “Are you feeling trapped?”

Follow-Up Questions

If your loved one discloses that they are feeling suicidal, simply say:

“Thank you for letting me know. I was concerned and I want to help you through this.”

You can continue the conversation and find out more about their thoughts and determine their level of risk, by asking the following follow-up questions:

• “What is leading you to think about suicide?”
• “Can you help me understand why suicide seems like an option?”
• “Have you thought about how you would do it”
• “Do you have the means?” (i.e., access to the method of choice)
• “When do you plan on doing this by?”
• “Have you tried before?” (Previous attempts increase the risk level).
• “Have you lost someone to suicide before?” “Recently?” (Loss can increase the risk)

Tips for Supporting

Listen. While conversing, try your best to listen more than talk. This will take the conversation much further and let your loved one feel like you are truly trying to understand. Listening means not mentally preparing your next response while they are talking, but instead just listening to what they are saying. Listening means letting a pause in the conversation happen when they stop talking and waiting about 15-20 seconds before you respond to make sure they are done talking. This might feel like a long time to you, but I can guarantee that it won’t to the person you are supporting. Their mind will be busy with thoughts, trying to figure out what to say next, or worrying about what has caused them to feel suicidal.

Ask, not Advise. It is not your job to talk them out of suicide or point out all the reasons for them to live. If you go this route, they will likely shut down and feel misunderstood. It may even make them feel angrier or more disconnected from others than before. As a supporter, you can validate the pain that they are in and also that you understand that suicide seems like an option for them, yet still being clear that you do not agree that suicide is an option. As you validate their pain, you can also state that you would like to help them find other ways of reducing their pain. For example,

“I hear that you feel like there is no hope and that this is too much for you to take right now.
I get that because your feel so trapped in all this that you believe that suicide is the only way out.
I get that you think suicide is the only way out.
But I think there are still other options available, and I’m willing to help you explore those.”

Once you are certain that they feel understood by you, and you have given them time to share what they need too, then you may begin to venture into what has kept them going this long and what they do have to live for? Try not to provide these yourself, but rather, ask questions that help them to identify these reasons themselves.

No False Promises. Finally, don’t make any promises you can’t keep or don’t intend to, and definitely do not promise that you will keep their suicidal thoughts a secret. Let them know that you cannot support them on your own and that you will need to talk to somebody, even if it is someone outside of their family, such as a professional. Let them know that you need to make sure you have your own supports in place so that you can make sure you are helping them in the best way.

Additional Reading – For further ideas on what you can say or how you can revisit a conversation about suicide that didn’t go as planned, as well as how to avoid some of the common pitfalls, you can refer to an earlier article of mine titled, “What to Say to Someone Who is Feeling Suicidal,”

What Not to Say

Here is a list of some common statements that many suicidal people have determined were not helpful:

• “What? It’s not that bad. Come on.”
• “What are you talking about? Suicide is for the weak.”
• “You can’t. Suicide is a sin.”
• “It’s so selfish to attempt suicide.”
• “Just forget that other stuff, don’t think about it.”
• “That’s crazy talk; you’re not seriously thinking about suicide are you?”

These types of statements clearly show that the person making the statements does not understand the depth of pain their loved one is in. Suicide has nothing to do with being weak or selfish. Thinking about suicide does not make someone crazy. Suicidal thoughts is about wanting to escape pain and not seeing another way out. To address the risk of suicide, we need to help people who are feeling suicidal to address the concerns leading to the unbearable pain they are in. Comments like the above examples will only drive the suicidal person to bury and hide their suicidal thoughts…making the possibility of suicide a higher risk.

Help! I’m Suicidal. How to Reach Out for Help

You are not on your own! Tell those in your support system that things are getting to a point that you’re beginning to feel suicidal; that you beginning to believe there is no other way out. If they respond in an unhelpful way, please know they are likely just startled, unsure, or scared about how to help.

Remind yourself that most people are not trained in how to help in such situations, but most people actually do want to help if they had some idea of what they could do. If you have ever been to a funeral, you may have noticed that people show up to be there for the grieving family to only stumble on the right things to say. This doesn’t happen for all guests, but it happens often enough that I am sure you know what I am talking about. The point is most people want to show their support, but they do not always know how to do this in a way that is actually supportive.

When you are reaching out, try to search for supporter’s intent in helping your rather than focusing on how they are trying to help you. Let them know you see that they are trying to help, and then gently let your support person(s) know what type of support your are most needing. Whether this support is simply needing them to listen, to understand what you are going through, to just spend time with you so you are not alone, or to help you address some of the stressors you have.

Please know, I understand that if you are feeling suicidal, it may be very difficult for you to let people know what you need from them. Doing this, however, will take your farther than wishing they knew what to do and hoping they would get it right. It is still feels too difficult for you right now to explain to others what you need, let alone be able to identify what you need, please know you do not have to do this alone.

Even if have a limited support system and you have no one within your personal network to reach out too, you can connect with professionals through local distress lines, community mental health clinics, or supportive peers through support groups or online forums. Connecting with a professional often alleviates the burden of needing to know what to do, providing you the opportunity to simply receive understanding and guidance from someone who is trained to work with such situations. Do not think you have to do this alone. Fundamentally, we are pack animals and we do much better managing our life stressors when we allow ourselves to reach out and ask for support. This support can come in many forms, and due to the advancements of technology and online support, we are no longer limited to the support and resources in our immediate surroundings.

Below is a list of local Alberta resources that you can reach out too, with many of these resources offering around the clock support.

Alberta Resources

If you or someone you know is feeling suicidal, please call the suicide hotline in your area or one of the Albertan resources listed below.

• Momentum Walk-In Counselling, Suite 200, 9562-82 Ave, Edmonton, AB, 780-757-0900.
• Doctor Margaret Savage Crisis Centre Crisis 24 hours: 1-866-594-0533
• St. Paul & Distract Crisis Centre Crisis 24 hours: 1-800-263-3045
• Fort McMurray and Northeastern Alberta 24 hour Crisis Line: 780-743-HELP (4357) / 1-800-565-3801
• Salvation Army Community & Family Centres Hope Line – Mon – Friday, 9:00 am – 11:30 pm: (780) 424-9223 Greater Edmonton Area
• Distress Line of Southwestern Alberta – Canadian Mental Health Association Crisis 24 hours: 1-888-787-2880
• Distress Centre Calgary Main Crisis Line:(403) 266-4357
• Wheatland Shelter Crisis Line Crisis 24 hours: 1-877-934-6634
• Wood’s Homes Calgary Crisis 24 hours: 1-800-563-6106
• Crisis Support Centre, a Program of the Support Network Crisis 24 hours:1-800-232-7288

PsychSolutions.ca Samantha Pekh, M.A., Registered Psychologist 780.710.9567