If you are feeling suicidal
PLEASE DON'T.
There's not much I can say here without being clichéd or patronising, but I truly do not want you to die. Although I probably don't know who you are, you are a human being and that makes you of great worth. Please read on, and stay with us.
IF YOU'RE AT IMMEDIATE RISK, GET IMMEDIATE HELP.
You might consider attending the emergency clinic at your nearest psychiatric hospital (look in the phone book, or try NHSDirect or Saneline), going to A&E, phoning 999 or the police. If you've actually already taken some kind of suicidal action, call an ambulance. Yes, part of you doesn't want to; let the part that does want to, win.
TELL SOMEONE.
Someone may be able to help you, and it would be tragic not to offer them the chance. Choose carefully who and how.
- A helpline or similar organisation
Good idea. You may feel better having unburdened yourself to someone who will simply listen. Also, it will help you to sort through your feelings, and give you practice before you perhaps tell someone you know.
Organisation Number Opening hours Notes Samaritans 0800 909090 (or see phone book for local branch). jo@samaritans.org 24 hours. Emails answered within 24 hours. Suicide prevention organisation offering befriending by phone, email, letter or face-to-face. Saneline 0845 767 8000 12noon - 11pm Mon-Fri, 12noon - 6pm Sat/Sun. Mental health helpline offering support and information. Bristol Crisis Service for Women 01179 251119 Fri & Sat 9pm - 12:30am, Sun 6pm - 9pm. Helpline for women, with a focus on self-harm. - The internet
Internet support groups can be a good place to find support and understanding, but I would suggest that if you are acutely at risk, then internet friends are not the people to ask for help. The reason is that people on the Net who don't know who or where you are can get very worried and yet be powerless to do anything, and (unlike helpline volunteers) are not trained to handle that kind of situation. Think carefully.
- A friend or family member
An excellent idea. Someone who knows you well has at least some chance of understanding your situation, and someone geographically close to you can help in practical ways too. These people can, however, be the most difficult to talk to about suicidal thoughts. Some issues to think about:
- How are you going to tell them? In person? By phone? In a letter? On a piece of paper that you just hand to them to read? Do whatever you can manage.
- What do you want them to do or not do? Just listen? Help to remove some of the stresses in your life? Accompany you to see a doctor? Stay with you? Have a look at the friends' section below.
- May they tell anyone else? It's very hard to be the only one in the world who knows that someone might take their own life. If possible, allow them to talk it over with at least one other person, such as their spouse, so that they don't feel solely responsible. This also makes them less likely to panic and take action you don't want.
- A health professional, such as your GP, or psychiatrist or
counsellor if you have one
This is also an excellent idea: these people have the training and the practical means to help you, so let them.
- A common fear is that any talk of suicide will have you immediately sectioned. It won't: doctors have met many suicidal patients before and will not over-react. They will however want you to talk honestly about your thoughts, plans etc. If hospital admission seems necessary, they will try to get your agreement; in many cases it is not necessary and you will be offered other forms of support. If you can give an honest assurance that you will be safe until your next appointment, this helps, but don't make any promises you can't keep.
- Another fear is of the opposite problem: not being taken seriously. Unfortunately that can happen—it depends a lot on how well you and your doctor know each other, and of course being taken seriously and feeling taken seriously are not the same thing. All I can say here is, TRY and keep trying, be as honest as you can, neither exaggerating nor minimising. And if one doctor lets you down, don't take it personally—it's the system not you—and try someone else.
- Anyone else
There are many other possibilities. Does your work have an occupational health service? If you're a student, is there a Nightline service? Or a tutor you can trust? What about a religious person? Even if you don't have an active faith, you may find talking to a priest in confidence helps, and you may benefit from prayer. There are many different possibilities. Find a person you are comfortable with and tell them.
MAKE IT HARDER TO CARRY OUT.
Of course, part of you won't want to make it harder, but in your better moments, listen to the part that does.
- Dispose of the means
You probably have a pretty good idea of what you might do and how. The person you have told may help you with this step.
- If you have acquired something solely for the purpose of suicide, get rid of it as soon as you can. (Be careful how: old drugs—pharmacy. Firearms—police for safekeeping or disposal. Etc.)
- If there are things you might use that you do need for ordinary purposes (such as prescribed medication, kitchen knives etc) give them to someone else for safekeeping. In the case of drugs, some pharmacists are willing to hand out small amounts and keep the rest safe for you. Or, being honest with your doctor, ask for smaller prescriptions.
- Make the venue difficult
If there is a particular place you have in mind, don't go there, or at least don't be there alone. If that means having someone over to stay with you, do it. Or perhaps give someone your car keys or out-of-hours work pass to prevent your using them.
- Make sure you'll be missed
To commit suicide you generally need a fair amount of time undisturbed and in private. Prevent any such window from occurring, by keeping your diary full of events where you'll be missed, promising to phone people at certain times, etc. You can take these measures even without telling people why.
CREATE REASONS TO POSTPONE IT.
These can be anything. Eg waiting until legal and financial things are in order, until an aged loved one dies to spare them the distress, until an academic course is completed or a sporting challenge achieved... Once, my "target" was to wait until a friend's baby had arrived and that I had finished knitting him/her a cardigan. Like I said—it can be anything.
AVOID ALCOHOL.
It's a depressant, which is something you really don't need right now. And it makes you more likely to make rash decisions. The same goes for illicit drugs. If you have booze at home, give it away to friends or throw it out.
BE CAREFUL WHAT YOU FEED YOUR MIND.
If you've been gathering literature on suicide methods, or other unhealthy stuff, get rid of it. If it's pro-suicide websites, delete the bookmarks and ban them from your computer. On the other hand, some other books and sites on suicide and depression may be helpful for you: read my reviews and links page and visit your library.
There can also be a tendency to seek out depressing books, films and music, or to obsess over newspaper articles dealing with suicides. Recognise and fight this tendency, and counter it by surrounding yourself with things that will lighten your mood.
DON'T GIVE UP.
The dark times you are in will pass, and although it's painful, it's worth getting through this time and out the other side. So try all of the above, and keep trying. Desperate times call for desperate measures: if you're considering choosing death, then you haven't much to lose by trying everything else first. Including all those things you normally wouldn't dream of doing—no point in dying of embarrassment, is there? Remember, suicide is permanent. You owe it to yourself and to those around you to make it only a final, very last, resort. And I hope and pray that you and I will never reach that end.
If someone you know may be suicidal
KEEP LINES OF COMMUNICATION OPEN.
If a person has told you that they are thinking of taking their own life, then they trust you a great deal. It is very important that you continue to be a safe person to talk to, and a few Dos and Don'ts will be listed below, but above all make it clear that the subject of suicidal feelings is OK to talk about and that you are willing to listen.
If the person has not told you directly, but you suspect they may be having suicidal thoughts, ask them. Asking will not "put ideas into their head", and even if the answer is "No", they will likely be relieved that you have realised the seriousness of their situation. Be careful not to phrase the question in a way that seems judgmental: "But, you're not thinking of... are you?". Just ask, gently and calmly, "Are you having thoughts of suicide?".
MAKE IT CLEAR THAT YOU DO NOT WANT THEM TO DIE.
To many people, this seems to go without saying, but in fact a severely depressed person can easily believe that they are a burden, are evil, that everyone hates them and would much prefer they were gone. So be sure to say quite explicitly that you do not want them to die. It's good to say things like "I care about you. I would miss you dreadfully." etc, but be careful not to slip from this into making the person feel guilty for wanting to die, with all the heartbreak that it would cause.
DON'T PANIC AND TAKE ACTION THAT IS UNWANTED.
Your first feelings might be terror and your first impulse to tell someone else or try to get the person admitted to hospital. Resist this. Those things, if necessary at all, can wait until you have listened to the person and assessed the situation and their wishes. A hasty reaction could so easily break trust and mean that the person will not ask you for help again.
DON'T JUDGE.
Lecturing on why suicide is wrong, guilt-tripping about the pain it would cause other people does not help, it merely makes the person feel worse and trust you less. Belittling their feelings, or claiming that the magnitude of their despair is out of proportion, doesn't help either.
HAVE A GENTLE BUT FRANK DISCUSSION.
Basically listen to what the person wants to tell you. If they find it hard, you can quietly ask a few questions. You will want to find out how long they have been thinking like this, what (if anything) has brought it on or made it worse, whether these are fleeting thoughts that keep returning, or whether they spend a lot of time daydreaming about suicide, or making plans to carry it out. It's good to ask specifically about how and when as well as why, but make sure that no matter the answer, you are still going to take them seriously (i.e. if you find that they haven't thought of a method to kill themselves, don't act too relieved and less concerned, just say "OK" or "I'm glad" and continue the discussion). Don't force them to tell you details of the plan if they have one—you can try asking again later, after you've shown that you're not going to take any hasty action.
TAKE PRACTICAL STEPS, WITH PERMISSION IF POSSIBLE.
- Ask the person what they would like you to do.
- Offer to do things such as removing dangerous stuff, staying with the person, taking them to a doctor, or whatever.
- Negotiate: you might want to get help straightaway; but perhaps staying with them until the morning would be better. You might want not to let them out of your sight; but perhaps promising to phone every two hours would be a compromise. It is valuable to allow the person as much trust as possible.
- Persuade in a respectful way. Rather than an angry-sounding "You're a danger to yourself. I'm phoning the Crisis Team." try "You're obviously feeling utterly dreadful right now. I'm worried about what you might do. I really think you'd be safer in hospital—you can see why I think that, can't you? Will you let me phone someone?"
- If you are sure you need to take some action and can't get their agreement, at the very least, calmly tell them what you are going to do and why. It's hard, but try not to seem like an enemy.
DON'T TRY TO COPE ALONE.
Get permission to tell at least one other person. It helps to be able to discuss the situation and get someone else's perspective, particularly in the frightening area of estimating risk.
You could also seek professional support: many helplines, including Saneline, will offer advice to friends and relatives too.
EDUCATE YOURSELF.
Reading about depression and suicide will help you to understand some of what your friend is going through, as well as helping you to recognise warning signs. Read my reviews and links page and visit your library.
DON'T GIVE UP.
Stay in touch with the person. It is easier to carry out suicide if you feel that you don't matter and nobody will care, and it's easier to believe this if you haven't heard from family or friends for a while. So the person may well try in various ways to shake you off, to get rid of this barrier to their suicide. While it's hard being treated like that, do stick by your friend. It will be remembered with gratitude later.
Also, don't let your concern end as soon as they seem better. They may only be pretending, but even if not, they are still vulnerable to relapses and need your support.
Talking about suicidality—my experiences
During several years of suffering from depression, I have experienced various "levels" of suicidal thinking, ranging from fleeting ideas that cross everyone's mind and are brushed off, through thoughts that are incessant, or thoughts I don't want to brush off, fervently wanting to be dead without the impetus to make it happen, making a plan "just in case I need it" and then waiting and hoping for something to push me over the edge, taking deliberate risks in order to die but not of suicide, right through to the most dangerous type: considered planning of method, venue, and ways to avoid discovery.
I have made two separate attempts, both by swallowing household chemicals. The first occasion I basically chose the wrong substance; I intended to die but the effects were not what I had thought, and while in hospital recovering I tried again, this time by strangulation. The second time I researched better, chose a combination of two substances, did lose consciousness and possibly would have died, had my Christian beliefs not got in the way and caused me to phone someone for help before I stopped being able to.
It is right to thank God, and those friends and doctors who helped me through those times. Although, shameful to admit, I still sometimes look back at those attempts as "missed opportunities". As Kay Jamison says in her book "Night Falls Fast", if it has ever been taken up as an option, the black knight has a tendency to remain in play.
Talking to doctors.
The accepted wisdom is that a doctor's inquiry about suicidal feelings will not cause such feelings nor add to the risk of suicidal behaviour. It is certainly true that a patient (especially one who has been depressed before) does know his or her level of suicidality well, and may be willing to communicate it honestly, so such inquiries should indeed be made. But I must point out that some approaches can in fact be damaging, because they can be misinterpreted by the depressed mind in a way that increases risk. Here are some examples from my own experience:
- "Why haven't you tried again? Why are you not dead yet?" Those are the actual words my new psychologist used. At the time, I assumed it was just a tactless way of finding out how things had been since my first attempt. However, when things worsened a few days later, my mind latched onto it as some kind of signal that I ought to have another go. Even then I didn't seriously think she meant "Please try again", rather that "The System" as a whole wanted me to die and was using her as part of that. This notion seemed quite real to me. There was also an element of "We don't believe you really are depressed: if you were, you'd try again." My second attempt should not be seen as trying to provide proof, however—I really did intend to die—rather it shows how any belittling of the depressed state increases hopelessness, the dominant idea being "No-one sees, no-one understands, no-one can help."
- A more subtle example occurred with my consultant psychiatrist. Early in the conversation I had explained that although I self-injure for a variety of reasons, the more severe burns are always about stopping suicidal thoughts. He seemed to believe this, and find it interesting. Yet, at the end of our consultation he was prescribing me a drug well known to be lethal in overdose, and exhorting me to throw away what I used to burn with! Again, at the time I correctly reasoned that he had satisfied himself that ODing on antidepressants was not my chosen method, and that he simply did just want to prevent further burns and grafts. But later... I wondered what exactly he, or The System through him, was trying to tell me.
- "Like, yeah, I'm really gonna rehearse hanging myself!!" This was overheard by me when the nursing staff in the IPCU were in their morning meeting. Previously I had trusted one of them enough to talk honestly about my level of risk, and had admitted rehearsing hanging, practising tying a noose and attaching it to something suitable. Again, the belittling increased hopelessness and the sense of being hated by individuals and The System. My dominant thought at the time and whenever I recall those words is "I am so worthless that even psychiatric nurses joke about my death."
So, as I said above: inquiry about suicidal thoughts must be accompanied by a clear message that the inquirer does not want the person to die.
Other unhelpful responses:
- "You took, ahem, a small amount..." (said with a smile). Yet again, the belittling led to hopelessness, poor relationship with psychiatrist, a sense that only the physical outcome and not the degree of distress would be listened to, and, at future bad times, another memory to add to the delusion that "The System wants me to die".
- "I thought I'd seen you since then?" (said some 6 weeks after an attempt). Well he hadn't, and this gave the distinct impression that my life really wasn't important.
- Similar remarks apply to a lack of any response. My GP at the time, although I could see notification written in my notes, never once referred to the matter. And my strangulation attempt in the ward—was it ever documented in my notes, rather than just on the "Adverse Incident form"? Certainly the person who decided I was safe to discharge the following morning didn't seem to know. It's all The System...
- "But, you're not feeling suicidal are you?" I think the times I've heard it phrased like that, my "No" has been truthful. But I'm sure I could never respond with "Yes" to that anyway since the phrasing almost guarantees disbelief.
However, I have also encountered helpful approaches. These have been characterised by gentleness with directness, together with a sense of the gravity of the matter. Eye contact and a softly spoken "Are you having suicidal thoughts?" elicits an honest response from me.
Another psychiatrist preferred to beat about the bush, asking about "thoughts of death". After clarifying the question, I looked him in the eye and hesitated, which he seemed to understand was my not wanting to get myself sectioned. He reassured this by adding "Not necessarily right now, but in general?" to the question, which then made me feel able to discuss planning and methods fairly frankly.
The nurse who spoke to me as I lay in bed after trying to strangle myself in the ward that night was also gentle but direct. A soft spoken "Laura?" was followed by questions about how badly hurt I was ("not very" didn't end the conversation), then the offer of a chance to talk (declined but appreciated) and only then the firm but kindly "I understand you haven't spoken to any of our psychiatric staff yet. That now has to happen tomorrow, you know that don't you?" I took this to mean "If you try to leave you will be sectioned" but since it was said with an attitude of concern rather than anger it caused no resentment.
