Let’s Talk About Suicide

How to engage in a conversation to create hope 

No matter how you look at it, suicide does not make for great dinner party conversations. Annually, 10th September’s World Suicide Prevention Day presents a global opportunity to broach this knotty issue. The 2021-2023 triennial theme, ‘Creating Hope through Action’, calls out to each of us as individuals to engage in those conversations with the distressed and struggling, who are potential suicide victims.

Suicide is a devastating event. Each of us has a role to play in supporting those experiencing a suicidal crisis or those bereaved by suicide. Preventing suicide is often possible. Annually, over 6,000 lives are lost in the UK – an average of 16 deaths daily. Globally, men are twice as likely as women to die by suicide. In the UK, men are even more affected, accounting for three out of every four suicides, and a person suffering from depression is 20 times more likely to die by suicide.

Warning Signs 
Hopeful action starts with knowing which warning signs to look out for that someone is not OK. Suicide results from a complex interplay of often multiple factors, but we know that life events, social stresses, and mental disorders – along with a family history of suicide and a personal history of self-harm or past attempts – are all risk factors. The warning signs that someone may be struggling, include a change in behaviour, such as becoming tearful, aggressive, irritable, restless, withdrawn, or distant. The suicidal often feel trapped and think they are a burden to their friends, family, and community. This results in believing they are alone, and have no other options aside from suicide.

The COVID-19 pandemic has further compounded these feelings of isolation and vulnerability. It is not uncommon to hear these feelings verbalised as expressions of being hopeless, worthless or helpless.

A change in routine – such as excessive or diminished eating and sleeping patterns, and also harmful coping strategies, such as excessive alcohol, use of street drugs, or engaging in gambling or violence – are additional alarm bells.

What can you do? 
Each one of us can become skilled at starting potentially life-saving conversations if we spot mental distress. The Samaritans (www.samaritans.org) have devised a simple plan to engage in this hope to engender conversations. It is an acronym for active listening: SHUSH.

S: Show you care 
This is about expressing care for the distressed by giving undivided attention. Ensuring there is privacy is a key point here. This is not about offering advice or trying to fix their problems, but being a non-judgemental listening ear. It is also about creating a safe space to reflect on difficult emotions. The other ways to show care will be making eye contact and putting anyway all distractions, such as your phone. Resolving not to talk about self; aiming to learn at least one thing about the other person; keeping a listening diary to record and reflect on your strengths and challenges with listening are additional handy tips. The Samaritans also say: “Getting into this habit takes practice, so don’t be too hard on yourself.”

H: Have Patience 
It is important to bear in mind that you may need to ask the opening questions about whether they are OK more than once, because it may take several attempts before someone is ready to open up. Trust can take time to build, and it is crucial for the distressed not to feel rushed. Articulation of difficult emotions can be challenging. Be comfortable with pauses, and don’t feel obliged to fill the silence. Using encouraging body language in form of nods, hums and open posture can help to move the conversation along. R U OK – an Australian Suicide Prevention Charity (www.ruok.au.org) – has an excellent interactive and simple-to-follow role play on their website to give guidance on persisting with the enquiry in an empathetic way.

U: Use Open Questions 
Avoid using questions that lead to a simple Yes or No response, and also aim to use conversation facilitators, such as “Tell me more” or “What does that feel like?” 

S: Say It Back 
Summarising back what you think you heard – and checking to confirm accuracy – is a profound way to communicate with and connect with the distressed. It is important to avoid putting your own interpretation to the conversation.

H: Have Courage 
It takes courage to ask upfront if you suspect someone is suicidal. The common worry that this may actually sow the idea is unfounded. In fact, research shows that asking gives permission to the distressed to talk, so it is best to follow your gut feeling and ask if you are in doubt. You could be saving a life.

Next time, I will be sharing on how to support the struggling by creating a safety plan. 

I am keen to hear from you, so please email me at tripartcare@gmail.com 

Written by: Dr. T. Ayodele Ajayo

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