Talking about suicide in many cultures is frowned upon. In many countries, it is taboo, a sin or still illegal, even counsellors and helping professionals struggle to talk about it. Many people have fears and anxieties around this unspoken topic. Many people, including counsellors, believe that if they talk about suicide, they will somehow put the ideas inside the other person’s head. That is not true!
“There is no evidence that asking clients whether they have suicidal
thoughts will put the thought into their mind if it was not there before.
There is, however, a great deal of evidence to suggest that being able to
talk to clients about suicide is extremely important in providing a safe
space for them to explore their feelings. Clients often describe a sense
of relief at being able to talk about their suicidal feelings. However, some
clients will not feel able to express their suicidal feelings at all, either
implicitly or explicitly. Clients may also feel suicidal but have no intention
of acting on those feelings. Some clients say that knowing suicide is
an option for them is sufficient to help them cope with distressing or
overwhelming feelings. It is therefore, important to ask clients about
suicide if you suspect that they may be feeling suicidal, even if, at that
point, they do not feel able to explore it further.”
Reeves (2023) BACP Gia 042 page 11
I decided to write this article to help counsellors feel more comfortable talking about suicide with their clients, but also for everyone else who may know someone having suicidal thoughts. Perhaps it is you who is feeling suicidal and that’s why you stopped here to read this article. Remember you do not need to go through this alone and yes you can feel okay again. According, to the World Health Organization WHO “more than 700 000 people die due to suicide every year. Suicide is the fourth leading cause of death among 15-29-year-olds.”
To illustrate what suicidal feelings are like I am using a song by Californian rock band Papa Roach called Last Resort. In an interview with Songfacts band member Tobin Esperance said the song was about a friend of the band’s who was going through a rough patch:
“Cut my life into pieces This is my last resort
Suffocation, no breathing
Don't give a fuck if I cut my arm bleeding
This is my last resort
Cut my life into pieces I've reached my last resort Suffocation, no breathing
Don't give a fuck if I cut my arm bleeding
Do you even care if I die bleeding?
Would it be wrong, would it be right
If I took my life tonight? Chances are that I might
Mutilation out of sight. And I'm contemplating suicide”
This song talks about someone self-harming and quickly starting to contemplate suicide, you can guess by the verses that this person is under enormous emotional pain and distress. They mention feeling suffocated and not being able to breathe, and this is their last resort. I wonder how many coping mechanisms this person has tried previously. A last resort is what it says – the last thing you will do after trying different solutions and we can see that the coping strategy of self-harming is not working anymore so they are contemplating suicide as the last resort.
I want to bring to your attention the neurobiology of suicide – Carolyn Spring mentions in her training “Dealing with distress: working with suicide and self-harm” – that suicidologists have suggested there is a pre-suicide state called the suicide mode. This is a brain state where thoughts of suicide are remembered and laid down in memory, therefore suicide behaviour builds risk over time as someone who thought about suicide in the past is more likely to go into it again as the mind will go back to that memory. That is why is important to have conversations around suicide prevention to help people not to return to negative thought patterns or to avoid developing these thoughts in the first place.
Spring also states the three characteristics of suicide mode:
1. Psychological distress and pain
2. Inability to think clearly
3. Relational disconnections (cannot ask for help)
I believe no one wants to die, it’s one of the most difficult things a human can do to themselves as our brain is programmed to survive. For someone to overpass their biological survival mode; they must be under such a constant overwhelming amount of pain physical or emotional that the thought of dying is the only viable solution to make the pain stop, but the goal is to stop the pain, not to die. Here we have the first 2 characteristics of suicide mode that Spring mentioned in her training - psychological distress and not thinking clearly. The same can be seen in my illustration above.
Staying safe
When thoughts of suicide are overwhelming, staying safe for just a few minutes takes a great deal of strength. You can draft a safety plan for yourself or help someone you are supporting to draft one. The suicide prevention charity Papyrus has templates on their: https://www.papyrus-uk.org/resource-suicide-safety-plan/ .
The idea behind the plan is to find things that you can do and people you can speak to when the thoughts and feelings start think about things that you can do right now to keep yourself safe. For example, you might want to think- what strengths do I have that can keep me safe? Who can I contact for help? What makes it harder for me to keep safe and what can I do about it? What makes me want to stay safe? Is there anything that I want to change? Do I have someone: animals or people that make me want to stay safe?
After making an initial safety plan it is important to think about a long-term safety plan and about the services you can contact such as your GP, therapist or counsellor, a crisis team. When you visit them take your safety plan with you.
Signs to look for
People are different and feel and behave in different ways, however, when someone is feeling suicidal there may be signs. If you are worried that someone is having suicidal thoughts, you can look out for the following indicators:
· Changes in behaviour (withdrawal, loss of interest)
· Physical changes (weight loss, lack of interest in appearance)
· Experiencing negative thoughts or feelings (hopeless, sad, guilty, worthless, loneliness, shame)
· Language such as (“I can’t take it anymore” “My family would be better off without me” “I can’t go on like this” “No one would notice if I was not here”
· Unusual preoccupation with death and or jokes about being dead” o
· Self-destruct behaviour – increased in taking drugs, alcohol, risk behaviour
· Self-loathing, self-hatred
· Saying goodbye to family and friends in a way that sounds like they won’t be seeing each other anymore
· Self-harming – people self-harming are under great distress and while most people who self-harm don’t go and take their own life, it is a risk factor for future suicide. The two can be related but self-harm is often intended to help the person to feel better. If someone is self-harming it may not necessarily mean they are feeling suicidal.
How to start a conversation?
I know it can be distressing to learn that a loved one is feeling suicidal, but feelings of suicide are common. The suicide prevention charity Papyrus says on its website that 1 in 4 young people in the UK experience thoughts of suicide at some point.
To start a conversation, you just need to gently ask them questions about how they are doing, and how they are coping. If you suspect they are feeling suicidal just ask! And remember it’s really brave for someone to open up and talk about feeling suicidal.
When we don’t talk about suicide for all the reasons above and others, we end up socially isolating people in distress. Most people feeling suicidal will not talk about it due to stigma and feelings of shame at not being able to cope but many will drop hints to family and friends.
“Evidence shows asking someone if they're suicidal can protect them. They feel listened to, and hopefully less trapped. Their feelings are validated, and they know that somebody cares about them. Reaching out can save a life.”
Rory O'Connor, Professor of Health Psychology at Glasgow University – Samaritans website.
Similarly in the song Last Resort, we can see clearly that the person in distress wants to speak with someone and be comforted “Cause I'm losing my sight, losing my mind Wish somebody would tell me I'm fine
Losing my sight, losing my mind
Wish somebody would tell me I'm fine”
Finally, “recent research has indicated that asking a young person if they are experiencing thoughts of suicide can actually reduce the risk of them ending their life.” Papyrus
Given the above, let’s reduce the stigma around suicide and have healthy conversations about it. You can save a life.
Where to find more help:
https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/behaviours/help-for-suicidal-thoughts/
I don't offer a crisis helpline but feel free to contact me if you wish to book a session with me https://www.dalvestherapeuticounselling.com/contact
References
Papa Roach Wikipedia 02/04/24. https://en.wikipedia.org/wiki/Papa_Roach
BACP 02/04/24 – Reeves, A Good Practice in Action 042 Fact Sheet: Working with suicidal clients in the counselling professions is published by the British Association for
Counselling and Psychotherapy, BACP House, 15 St John’s Business Park,
Lutterworth, Leicestershire LE17 4HB. Updated November 2023.
https://www.bacp.co.uk/events-and-resources/ethics-and-standards/good-practice-in-action/publications/gpia042-working-with-suicidal-clients-fs/
Papyrus 07/04/24. https://www.papyrus-uk.org/resource-suicide-safety-plan/
Carolyn Spring 07/04/24 -Spring C, CPD Training - Dealing with Distress: Working with Suicide and Self-Harm. https://www.carolynspring.com/course/dwd/
WHO 07/04/24. https://www.who.int/news-room/fact-sheets/detail/suicide
Samaritans 07/04/24 - https://www.samaritans.org/how-we-can-help/if-youre-worried-about-someone-else/myths-about-suicide/
Samaritans 08/04/24 https://www.samaritans.org/about-samaritans/media-guidelines/suicide-facts-journalists/
