About Suicide and Mental Health

• Understanding and Recognizing Suicidal People
  • Some significant losses to look for
  • Some attitudes to look for
  • Some behaviours to watch for
• Additional indicators strongly associated with suicidality
• Responding to a Suicidal Person

Understanding and Recognizing Suicidal People

Research indicates that for most people, suicidal ideation is characterized by ambivalence – people contemplating suicide generally state that they have both a wish to live and a wish to die. When experiencing a suicidal crisis, ending their own life can seem like the only available option for getting beyond an unbearable state of anguish: were other viable options made available, most would choose to live.

Research also indicates that 70 to 80% of suicidal people signal their suicidal ideation through the expression of various recognizable warning signs, such as publicly making preparations for their death; expressing thoughts about suicide, death, and dying; and behaving in ways that are uncharacteristic and/or worrisome. It also seems clear the vast majority of people who seriously contemplate suicide are experiencing treatable mental illnesses such as depression, manic-depression, anxiety, psychosis, and drug/alcohol addiction.

What is also common to most acutely suicidal individuals is a recent experience of great loss. This loss may be an existing or pending change for the worse. The loss could also be the loss of hope that things will improve in their future. What appears to be more important than the nature of the loss is the individual’s experience of it as overwhelming or unbearable.

If the person is unable to cope with the loss, they may experience an emotional crisis. Most emotional crises are characterized by noticeable changes in behaviour, perceptions, feelings, and the physical body. When you see someone change in any significant way on the ‘outside’, it is a good idea to inquire about their wellbeing – it may be an opportunity to initiate a suicide intervention.

Discover if they are, or have been contemplating suicide. Let them know that help is available, there are supportive and skilled people to call or see in person, and professionally trained people who can help them make viable choices other than suicide. If you believe they are at risk of harming themselves and/or someone else, please do not leave them until they are with another trustworthy adult.

Some significant losses to look for

• Death of a loved one, especially by suicide
• A key relationship unraveling or ending
• Instability/turmoil at home/in one’s family
• A severe change in social status or sense of belonging
• Unemployment, loss of a highly valued ability or activity
• Fear of disciplinary action/incarceration/physical violence
• Trauma from sexual or other assault
• Trauma from serious illness or injury
• Major financial/economic loss

Some attitudes to look for

• Depression: Nothing seems important anymore. Life’s a bad joke.
• Hopelessness/helplessness: There is nothing I can do to change this.
• Purposelessness: There is nothing to live for; there is no point to anything.
• Worthlessness: I can’t do anything right. No one cares if I live or die.
• Overwhelmed: I can’t stand this anymore. This is way too much for me.
• Intense worry/anxiety: Everything is falling apart. Everyone is going to be disappointed in me.
• Recklessness/impulsiveness: I don’t care if I break my neck.
• Elation: Everything is perfect now! (suddenly, after someone has been in a lot of distress)

Some behaviours to watch for

• Increased use of drugs or alcohol
• Withdrawal/isolation from once enjoyable people/activities
• Risky impulsive activities
• Aggressive, violent behaviour; rage/revengeful acts
• Decreased or increased performance (school, work, hobbies, sports)
• Self-neglect (appearance or hygiene)
• Extreme mood swings
• Changes in energy level (up or down)
• Complaints about health
• Difficulty concentrating
• Decreased, increased or otherwise disturbed eating and/or sleeping

Additional indicators strongly associated with suicidality

1. Preparation for Death.
   • Giving away prized possessions, making a will, settling loose ends
   • Saying goodbye or talking about going away unexpectedly, or with a sense of finality
2. Talking about suicide, death or dying
   • Saying things such as ‘Life isn’t worth it…’ or ‘Things would be better if I was gone…’
   • Making jokes, poems, drawings or other references to suicide, death or dying
   • Sharing/expressing morbid fantasy or plans about dying or death
3. Previous unresolved or recent suicide attempt

Responding to a Suicidal Person

• Start the process of talking and reaching out. Find out about the person’s feelings.
• Ask direct questions such as ‘Are you considering suicide?’ ‘Do you have a plan for how you will kill yourself?’ The more realistic, specific and lethal the plan, the greater the risk. Take the answers seriously and listen and watch for potential signals.
• Be a supportive listener. Accept the person’s feelings instead of minimizing or judging them. Tell them it is okay to feel the way they do. Try to understand things from their perspective. Avoid joking around or acting shocked.
• Offer help. Let the person know you care and want to help. Be there to listen, support and encourage them to get the help they need. Keep in mind that it isn’t your job to fix their life or solve their problems.
• Help them help themselves. Suggest people they can talk to, such as a parent or relative, close friend, teacher, counsellor, doctor, or nurse. If they won’t get help for themselves, get it for them. Tell someone you can trust.
• Call a Crisis Centre. Crisis Centres give support and information to people in distress, as well as to the friends and family who care about them. Anyone who is suicidal needs the help of a professional and a Crisis Centre can provide appropriate information.
• Be firm and be focused. Never promise to keep a suicide plan secret. Never dare a person or say you don’t believe them. Never leave a high risk person alone without making sure that they have help.

We are not responsible for the decisions that someone else makes. However, we are often in the best position to recognize and initiate the first response to someone experiencing a suicidal crisis. Some suicides (20%) occur without any warning and others occur despite the very caring responses of friends, family and helping professionals. Suicide is ultimately a personal choice – it is not our job to ’save’ someone else’s life, only to offer them other options.