To mark World Suicide Prevention Month, Mental Health First Aid tutor, Andy Elwood shares some ways to help people contemplating suicide.
It’s not uncommon for people to think about suicide. In the UK, 20% of the population have had these types of thoughts, and that figure is based on the people that have had the courage to put their hand up or tick a box. That figure is an average across the population as a whole, as there are certain employment sectors where the figure is higher. In my old sector, emergency services, it was 25%. So, these thoughts are common, and people are not alone in having them.
However, they are temporary and will pass. For many people, thoughts of suicide are intrusive ones that pop up out of nowhere and sit there because they’re experiencing pressure and stress. That thought could leave again quite quickly, but it can be unsettling. However, just because someone has had thoughts of suicide previously it does not mean that it is something that will continue forever.
Someone may have thoughts of suicide when they no longer feel that they can continue to live. They may feel their options have narrowed down and they may be considering suicide as one of only a few options open to them. However, having thoughts of suicide does not mean the person will act on them. They can be intrusive thoughts that are temporary and pass. The person can move on, go on a recovery journey and have a successful, happy, fulfilling life with positive mental health.
As unsettling as thoughts of suicide can be, on their own they need not necessarily mean the person is likely to take their own life. However, when someone is planning, preparing or acting on these thoughts of suicide then they are at much greater risk. This is described as suicide behaviour. And the outcome of suicide behaviour will either be life or death.
Talk of death, dying or suicide should be taken as a serious warning sign. This is a time to be curious and find out more about anyone giving the sense that they are feeling hopeless, or helpless. They may say they feel trapped, don’t feel in control of things and that there’s no escape from their current situation. If they use phrases like ‘people will be better off without me’ or ‘people wouldn’t miss me if I were gone’ these are red flags that need picking up on urgently.
Other warning signs include behaving in a way that may suggest they’re saying a series of goodbyes, or they may have written a letter and given it someone for safekeeping. A sudden recovery in someone who has been down and very low for a long time is also something to question. This recovery may be because they have decided to end their life by suicide. And often we see that the weight of pressure and stress lifts from their shoulders. They appear much lighter and happier because they know they’ve found a way to end their pain and suffering. If you see this type of unexplained recovery in someone you’ve been concerned about, that is the time to check in with them and have a conversation to find out what’s happening.
Being clear is being kind – ask the question
If you do suspect someone is having thoughts of suicide, or is displaying suicide behaviours, it’s important to talk to them about it. This conversation should be clear and non-judgemental. Don’t be afraid to use the word ‘suicide’. Being clear is being kind and showing that you care.
We can ask in a kind and compassionate way about how they’re feeling. If someone has been opening up to you, you might say, “Things sound really difficult for you right now. Are they so difficult that you’ve been having thoughts of suicide?” Or “Sometimes when people are experiencing as much stress as you are, they have thoughts of suicide. Are you having thoughts of suicide?” Those are a couple of different examples of ways to ask the question.
It may seem like a difficult question to ask. But I’ve never regretted asking it. The sense of safety and trust I had with that person all increased from asking that question. I’ve never had a bad response to it. People open up and they realise that you’ve picked up on their distress. And if they weren’t thinking about it, then their response will reassure you and allow them to talk to you about what’s really happening with them.
The next steps
If, on the other hand, they say ‘yes’, then there are three follow-up questions we need to ask. They are: do they have a plan? If so, how specific is that plan? The more detailed the person’s plan, the greater the risk to them of ending their life by suicide.
Second question to ask is, do they have the means to end their life in the plan? Often, but not always, this is the final part of the plan to be put in place. This can be a way of keeping themselves safe from the plan because, if they haven’t acquired the means, they can’t carry it out.
And thirdly, have they been taking alcohol or drugs? If they have, they’re more at risk. If they have acquired the means, then they’re at even greater risk if they’re using alcohol or drugs as well. Even a small amount reduces our inhibitions, so people under the influence of alcohol or drugs are more likely to go through with thoughts of suicide or engage in suicide behaviour if they already have a plan.
Set up a safety plan
Once these questions have been asked and answered, the next step is to create a safety plan for this person. If they don’t have a plan and aren’t engaging with suicide behaviour, but they’ve had the suicide thoughts and unburdened themselves to you about those, the first thing to do is to explain that these thoughts are very common. They’re not alone having them and they’re temporary. The thoughts will pass, and they don’t have to act on them. That can really help. I’ve had many of those conversations and the person feels much better afterwards for just having offloaded how they were feeling.
However, someone who has a plan and the means to end their life is at great risk, so we need to create a safety plan with them. A safety plan, rather than listing things to avoid doing, is about positive actions to take. It should include things such as how the person would like their family and friends to help them. What they can do to help themselves. Who can they speak to and who can they turn to if there’s an emergency?
The best, easiest structured way to create this type of plan for someone, is by using the award-winning app called Stay Alive. It’s fantastic and it can be used both by people having thoughts of suicide or by anyone supporting someone in those circumstances. It has a template safety plan for people to fill in. They can also add any photographs too. It’s about reasons to stay alive, as its name implies.
Andy is running a webinar for World Suicide Prevention Day on Tuesday 19th September between 12.30pm and 1pm. Book your place on this link.
Samaritans call 116123
Text ’shout’ to 85258
NHS 111 in Eng and Scotland; Wales 0845 46 47; N.Ireland Lifelines 0808 808 8000
More about suicide myths
Animated 5 min video from NHS Scotland to build your understanding and confidence to have a conversation about suicide.
Guide to having a conversation about suicide
Other guides/ webinars from Metal Health UK
Support for those affected by a suicide
Andy Elwood is a Mental Health First Aid instructor and an ambassador for Movember. He creates safety and trust by sharing his own vulnerability and gives a unique ‘behind the scenes’ insight into life and death situations from his 20 years’ experience working in the emergency services as a paramedic on search and rescue helicopters.