Suicide: Risk Factors, Warning Signs And How To Talk To A Person With Suicide Ideation

Today is World Suicide Prevention Day and as so many talk of ‘raising awareness’ as the saying goes nowadays, I’d like to talk a little about communicating with a person experiencing suicidal thoughts. Perhaps a good place to start is in understanding risk factors for suicide and recognising the sometimes subtle warning signs.

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Each and every suicide is a tragedy, and one which leaves unanswered questions. Most often, suicidal thoughts develop from deep feelings of hopelessness and an inability to cope with certain challenges in our lives. From this, a belief that taking our own life is the only possible or most simple solution to our problems can grow. A great pity of course is that those very challenges are often temporary in nature. A permanent solution – suicide – is applied to what in essence is a temporary problem. Indeed, it can be seen that most people who survive suicide attempts go on afterwards to live full and most rewarding lives.

Risk Factors

Arguably, the most prevalent risk factor for suicide is that of depression but there are many others. These diverse factors include experiencing chronic pain, post-traumatic stress disorder (PTSD), psychiatric disorders, suicide in the family, substance abuse and not least, a previous suicide attempt. Impulsive thoughts, particularly in the young, can play a role too.

Warning Signs

If a person is felt to be at risk due to any of the above they may exhibit behaviour such as mood changes – even to the extent of a sudden and unexpected upbeat mood. They may alternatively display completely new behaviours. These behaviours can indicate a person who is actively suicidal.

A common myth about suicide is that those who ‘talk about it are not the ones who do it’. This is a fallacy. Whether people talk about it or not has no true bearing on the likelihood of them completing a suicide.

People with suicide ideation will commonly talk of not wanting to be a burden to others in their lives, of having nothing to live for or not seeing the light at the end of the tunnel. They may talk of feeling trapped in some way or of their unbearable pain, whether physical or emotional pain. These types of words can indicate a person who is contemplating taking their own life.

Talking To A Suicidal Person

Here we encounter another great myth about suicide, the notion that talking to someone about their suicidal thoughts is somehow encouraging them to carry out the act. In these situations, it is important to begin a dialogue, to initiate a conversation about the subject. The conversation can include discussion about sources of help and assistance such as attending the GP or a therapist. It is wise to identify a help line such as The Samaritans and to keep that number in their phone or wallet/purse. An agreement can be made to follow up these actions with a future chat in which progress can be reported and reviewed.

I feel it’s better to be fairly direct with a person by asking similar to the following questions:

  • How are you coping with your problems?
  • Are you thinking about dying or hurting yourself?
  • Have you made any plans to take your own life?

The latter – making the distinction between a person experiencing suicidal thoughts and one who is actually making the plans to do it is of high importance. This is not only for the helper/listener but also for the person themselves in understanding and clarifying their own situation a little better.

Samaritans: Freecall. 116 123 (24 hours)   E. jo@samaritans.org.uk (response: 24 hours)

 

 

9 Replies to “Suicide: Risk Factors, Warning Signs And How To Talk To A Person With Suicide Ideation”

  1. and then what? so you ask the questions and get the answers. Coping – not at all. Thinking about dying – every minute of every day. Made plans – yes, researched and detailed. What comes next? Having been in this situation more times than can be counted …. what comes next? Just because its been spoken about doesn’t mean the situation is any different. Samaritans do a good job but the question has to be asked – what comes next?

  2. Hello Lisa, thanks for your comments. The article is aimed at family and friends and how they might best deal with this difficult situation and offer first help to a person with suicidal feelings. The first part of dealing with any such problem is to recognise it and then have a dialogue about it – to give the person a ‘safe place’ and opportunity to talk about their feelings rather being feeling alone and unable to express those thoughts. This in itself has therapeutic value for some. For someone with the severe suicide ideation you describe – feeling like dying ‘every minute of every day’ – what is required is to access mental health services. Here in the UK that is generally via a referral from your General Practitioner but you can do this directly by consulting the NHS website and searching for ‘Find a psychological therapies service’ or similar. The service will offer an assessment and recommend a therapy for the person. For those in immediate danger the Samaritans can give a number to access local mental health crisis teams one can walk into any accident and emergency department at a local hospital.

    As in many essential services it can be acknowledged that provision is far from ideal or perfect but these are general guidelines as to how to obtain help. I realise that this blog doesn’t cover the actual work that can be carried out with an individual and acknowledge that’s what you might be seeking information about but that would be down to each individual case assessment and the person’s needs. The scope of this article is only to discuss how close ones can help in the situation, not professional services. The latter will decide upon the best course of action, be it psychological support such as counselling needed, medication or both. I hope this helps in some small way.

    Kind regards
    Stuart

  3. Thanks Stuart. I was speaking from personal experience, and whilst services such as the samaritans offer a valuable service it does leave the situation of “what now”. Looking at it from both perspectives – the person trying to helo and the person who is suicidal, once you have discussed it all, the not coping, the potential strategies to cope, the planning, the method etc etc etc you are left with “what now”. When Mental Health Services continually discharge people on the basis of not having a mental illness but the suicidal tendancy is due to the situation they are in, and all the talking for England has been done it leaves both those trying to support and those who are suicidal just hanging in the balance. For the supporter its a case of well all the agencies have said there is nothing they can do because its due to a traumatic situation that the person is living in so what can I do, and for the suicidal person it leaves them thinking well nothing has worked so its time to stop whining about it and get on with it.
    I got the impression you worked for samaritans, and so I was just wondering where do you go when all other avenues have been exhausted?
    But I understand where you’re coming from and do think that for those who have manic episodes the services of Samaritans and the other support agencies is an extremely important one. Hence I shared your post. 🙂

  4. Hi Lisa, I understood you were talking from experience, you made that clear. For the record, I have nothing to do with Samaritans. I am a professional practitioner working in the area of addiction and trained in psychology.

    I also understand what you say by ‘what now’. Clearly, this should be the support of appropriate mental health services but as we know they are inadequate for various reasons. That is unfortunately where we are with things.

    I can comment quite well on the subject of services discharging people inappropriately. My late partner was discharged over the telephone by a local mental health crisis team and the very next day threw herself from a tall building to her death, making me a suicide survivor with all the great difficulties that entails. One might speculate that their uncaring and deficient attitude contributed towards her death and subsequently cast a huge calamity on my and other people’s lives. You might imagine how angry I was – and still remain to a degree.

    There is no question of you (or anyone) ‘whining’ here. Having continual suicidal thoughts can be a desperately difficult life and very hard to bear so you are in my thoughts. To be clear, I see Samaritans as a service for people in crisis, not to offer therapy and so it is not so much a question of comparing them with services that are therapeutic in the sense that they can bring you into recovery. I actually share your cynicism regarding the provision of adequate MH services as you will see. Nevertheless, I believe it important not to give up on the possibility of recovery and to pursue every avenue possible. I also believe that due to the inadequacy of services it is important to practice whatever self-help one can to the extent of learning and gaining information and doing one’s best to act upon it. Current thinking often revolves around becoming as active as possible as an example.

  5. Hi Stuart,

    Yes I had seen your story and I am sorry for your loss. My personal opinion is that I struggle to understand why people would commit suicide when they have someone who loves them and cares about them. I know that its not always easy to see but the people I have spoken to have all been able to realise they have someone who does care. They have all been able to look at that picture of being in the hospital when the attempt fails and someone they care about being there, in desperation, not knowing how to help etc. In this instance that is not the case. In this instance there is just no one who does care and it has been proven time and time again.

    In this instance MH services have discharged 3 times, on the basis that its not a mental health illness. It is depression and anxiety in its most extreme form with strong suicide ideation, recorded suicide attempts, and extreme high risk factor but they can’t afford support as its psychosocial and reactional causation. The GP refers back to them time and time again and has now reported the MH services to the clinical commissioning group as he is concerned of the adverse outcome and also how that will affect him – after all the question will be asked as to why he didn’t do anything.

    MH services seem to be rolling the dice, and one report even states that the number of times that suicide has been threatened in relation to the number of times it has been attempted is significant in their support. Its something like for every 3rd threat an attempt is carried out so the threats are now seen as frustration at the service not meeting the need rather than out of desperation for help. As I said – they are rolling the dice as to what comes first, death or resolution of the stressors. I know the answer to this, and I think in honesty so do they but as I said – they claim its not a MH situation.

    I definitely see that Samaritans have their place, and they are a useful service in certain situations. However I think they are limited and when it is a complex issue and you have to repeat the story to a new person every time they lose their appeal.

    It just brings it all back to that same question – “What now”. When there is no reason to recover, when those who are supposed to love you and care about you are not there to support you to recover or give you a reason to recover, and when the people that are paid to help you recover don’t give you that support its just little old you on your own fighting yourself with no chance of winning.

    And I suppose that answers the question.

  6. Hi Lisa

    I don’t have the same struggle that you do in understanding why people take their own lives despite the great pain it brings to their loved ones. Perhaps that’s part of the learning process one goes through as a suicide survivor when attempting to reconcile and have an understanding of what has happened. Quite simply, for some people the pain they are feeling in their lives becomes unbearable for them and they have to make the pain stop – no matter what. If we went down the line of believing that no one who takes their life cares or loves the people they leave behind it would be completely inaccurate. Sometimes there are protective factors that work well such as feeling the need to look after children, for example, that stops them from completing a suicide but of course, by no means is this always the case as we see.

    I think that my education in understanding was in seeing the great pain my late partner was going through, how confused bewildered and lost she became. I could absolutely understand her wanting to end that pain and after thinking about it carefully after the event I didn’t feel that she didn’t care for me or didn’t love me, she was quite ill and was hardly ‘herself’ any longer. I use my own example only to illustrate a point.

    I have at times spoken with people in my own work who report similar to you on their engagement with MH services. For instance that they ‘can’t be treated’ because the provision of sessions the service can offer is too small in number. I have suggested to them after hearing their frustration at being unable to obtain help that. like you, they go back to their GP and with similar results as you. I don’t pretend to have an answer to this situation. For me, it is partly down to people not doing their jobs properly. In addition, there is far too much passing of patients on to other services to simply get them off their own caseload. I see this at times with the like of psychiatrists who in dealing with patients with complex MH issues in a person, once they hear, say, of a gambling addiction being reported to them will pass them to an addiction service, ignoring the perhaps numerous other areas in which they much more urgently need help and support. There is far too much of this and it is quite wrong.

    I can see that in fairness to you, you have persevered and worked hard to gain the support you need and I am genuinely sorry for the fact that people have chosen to ignore your needs. For services to claim that the likes of depression and anxiety do not fall under the category of mental health illness – no matter what the causation – is deplorable. They could perhaps take a look at their own bible, the Diagnostic and statistical manual of mental disorders (DSM-5) and browse through it to those very subjects. The way you report this it feels as though the service is attempting to find any loophole they can use to not treat you.

    Again, I don’t pretend to have all the answers Lisa but from what you say regarding ‘not having a reason to recover’ that’s where I would begin. Certain people who should be there for you are not, you don’t feel that there’s any much point in recovering and therefore you don’t have that motivation. I would look at attempting to bring that back into my life in whatever way, even by tiny steps. There is no reason why other people cannot come to care for you I would like to suggest. No reason why you cannot develop your own support group in life. I hope that doesn’t sound presumptuous or dismissive. The first time that I talk to people with addiction problems I generally find there are several factors that can lead to suicide ideation and many report this. They also have some work to do in resolving their addiction which is by no means easy and so I’m interested to know WHY they want to take on this tough job and stop whatever it i they’re doing. I think it’s really important to recognise that and simply just acknowledge it. There is a need for a central focus that whilst won’t immediately take the addiction cravings away (or in your case, suicidality) but steers you into understanding time over why you want things to change. There IS a hunger for you to change I would respectfully say, evidenced by your willingness to talk about it and to persevere in gaining support. It may help to understand why you want this change and to be able to hold those reasons close to you, helping you maintain the motivation to find your path. I respect all people’s right to take their own life. I certainly felt very much the same way when becoming a survivor myself as is common. However, I always remain optimistic that things can be better, with a brighter future.

  7. Hi,

    You start to sound like the professionals that I have seen when you say ‘no reason why other people cannot come to care for you’ and ‘no reason why you cannot develop your own support group’, and perhaps thats where the problem is. I am fully aware of these facts, I am fully aware that I could go on to have a life that most people would be happy in but thats not the life for me. I hate it and would rather not live it.

    The professionals all seem to be trained along one route – lets not deal with the problem here, lets forget the problem that can deal with itself, and lets focus on going to social groups, going to events, working, building the business, etc etc etc all of which are totally meaningless. I don’t need someone to teach me how to live – I know how to live, I’ve done it all my life. I need someone to give me the reason to want to live, and thats the question no one can answer.

    Why must I do these things? Why must I agree with everything they say? Why must I go for coffee with someone? Why must I do anything?What is all this rubbish about you must do it for yourself? do it for you? love yourself? enjoy being with yourself? I have never heard so much rubbish in my life. Coming from someone that has no history of mental health, that has had a good stable upbringing and been in a good environment, and seen as a pillar of society I really don’t think its my self esteem that is a problem here.

    Yes there is a problem, and a major one at that. Some of the professionals say it is coercive control, some say domestic violence, some say its on the part of my daughter that has caused this and her psychological issues. No one has come to the conclusion that it stems from me. I am just the recepticle and I am the one reacting.

    But then that brings me to, ok, I understand that. How does that help me – well there we go, it doesn’t and they can’t. Its not a mental health problem – discharge. What I want is someone to help me change the situation with my daughters. What other people want is for me to forget them.

    Whatever way I look at it I have no support, no help, and no reason to keep fighting if I even knew how.

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