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Tutorial 3

Talking about suicide

Lesson 1: What makes someone vulnerable to suicide?

By having a conversation about suicide, listening without judging, offering support and encouraging people to get further help, you can make a difference to someone considering suicide.


Suicidality is extremely complex. 3,318 Australian’s died by suicide in 2019. This is about nine Australians each day who die by suicide. (ABS, 2020)


Certain groups within our community are more vulnerable to suicide, including Aboriginal and Torres Strait Islander people, people living in remote or rural areas and people who identify as LGBTQIA+.


Other circumstances may also contribute to a person’s overall level of risk. Some factors increase risk of suicide, known as risk factors, or reduce risk of suicide, known as protective factors.

 

It is important to look out for changes in someone’s behaviour, as those experiencing suicidal thinking may not always verbalise their thoughts or feelings. As such, it is important to consider both verbal and nonverbal indicators. Signs to look out for include:

 

How people may think….

• A sense of hopelessness – “There’s no future for me, I’m a failure”; “I just can’t do this anymore”
• Belief they are a burden to others – “They’re better off without me”
• Worthlessness – “I’m not needed anymore”; “I’m useless”

How people may feel…

• Guilty – “I’m a burden to others”
• Lonely and isolated – “No one understands me, no one cares”
• Afraid – “There’s no way out for me but to die”; “I don’t know what tomorrow holds in store”

 

How people may behave…

• Mood swings and irritability – “Leave me alone!”
• Engaging in risk taking behaviours out of character – “See, I’m not afraid to die”
• Talking about suicide – “If I died you wouldn’t miss me”

• Giving away possessions – “When I’m gone I want you to have this”
• Abuse of drugs and alcohol
• Self-harm such as cutting

There may be many different reasons that someone is considering suicide. They may want relief from overwhelming emotional pain and feel their situation is hopeless, they may feel worthless and believe that other people would be better off without them. They may also believe that suicide will provide a means to relieve unmanageable emotions and thoughts. However, regardless of the reason, we need to support them in every way we can and help them to consider other options.

Lesson 2: How can I help someone at risk?

If you feel as if someone may be at risk, it is important to ask them questions to determine whether they are experiencing suicidal thinking. Be clear and direct when asking them questions to ensure unambiguity. You may feel uncomfortable starting the conversation. That’s normal. But talking is the best way you can be a good friend and support someone experiencing suicidal thoughts.

 

Remember, you don’t need to solve their problem or make them happy, you’re just helping them talk about what they’re going through and giving them some safe space to think, or simply to catch their breath – it is exhausting experiencing such strong emotions. Examples of questions you could ask include:

 

• “A couple of things you have just said have concerned me. Can I ask whether you have had any thoughts about taking your own life?”

 

• “Have you been experiencing suicidal thoughts?”

 

• “Have you been having any thoughts of suicide?”

 

• Other people who have been through similar things to you have found themselves considering suicide as an option. Have you had suicidal thoughts?

 

Expressing care means showing them you understand. That’s empathy. Be careful not to express your feelings of being ‘sorry’ for them as it may increase their feelings of guilt.

 

It is important to note that by asking the question, you are not making the person more likely to end their life. By asking the question you are demonstrating care and empathy for the person. You are letting them know that you are comfortable to have the conversation about suicide if they want to.

Many people with lived experience of suicidal thinking and/or crisis tells us that when someone actually asks directly about suicide, it is in fact a relief. They say it gives them permission to open up and talk knowing that the person is confident and comfortable to have the conversation with them

 

It is also okay if your concerns about suicide are not right – even if they are not thinking about suicide, they may be experiencing other challenges that they need support managing. You will be in a position to have a conversation regardless.

 

When they are sharing their feelings with you, ensure you’re saying things to demonstrate you are really listening to what they’ve said, such as:

 

• “I can tell this is really tough for you”

 

• “It sounds like you’re feeling really low”

 

Resist the urge to interrupt or share your own opinions or try to fix the situation. Avoid judgment, arguments or offering solutions. Be careful not to minimise their problem. This is tough. Let them talk about it and listen openly.

 

Making a safety plan

If you think a person is considering suicide, ask them. If they are, you can help them develop a plan to stay safe. This is often referred to as a safety plan, and it may include:

 

• The practical steps to be taken to help the person regain a sense of control and ways to seek support. This can include:

 

o Names and phone numbers of people (try to have at least 5) they trust and can talk to

 

o Places to go that are safe for them

 

o Techniques that they know are helpful to them to reduce the intensity of what they are feeling and thinking. (e.g. deep breathing or relaxation techniques, exercise or other activities)

 

• A list of things that make life worth living to encourage hope and more positive emotion

 

• Numbers for emergency services, helplines and health professionals to respond urgently if required

 

• Reminders of how they have managed these intense emotions and thoughts in the past

You can help a person at risk of suicide prepare their safety plan as a practical step to support them. Beyond Blue also has a suicide safety planning application that may be helpful called Beyond Now.

 

Emergency services

When you talk to someone who you think may be considering suicide it’s important to know where to go for emergency help if it’s needed. Here are some emergency services that can provide support in a crisis. Keep a list of phone numbers handy in case of emergency. Whenever possible, be transparent about what you are doing. Work with the person to determine what support they want. Remember, if a person has had a previous bad experience with one form of support, they may prefer to reach out to another support instead. Work with them. People want things to happen ‘with’ then not ‘to’ them.

 

Police 000 – for emergency situations

Lifeline 13 11 14 – 24-hour telephone service to people in crisis or those concerned about someone

 

Beyond Blue Support Line 1300 224 636 – 24-hour telephone support service for mental illness

 

Suicide Call back Service 1300 659 467 – 24-hour free phone, video or online counselling for anyone feeling suicidal or affected by suicide

 

Veterans and Veterans Families Counselling Service 1800 011 046 – to support veterans and their families exposed to military mental health

 

• State crisis numbers:

- NSW 1800 011 511 – Mental Health Line

- VIC 1300 651 251 – Suicide Help Line

- QLD 13 43 25 84 – 13 HEALTH

- SA 13 14 65 – Mental Health Assessment and Crisis Intervention Service

- WA 1800 676 822 (PEEL) ; 1300 555 788 (Metro) – Mental Health Emergency Response Line

- TAS 1800 332 388 – Mental Health Services Helpline

- NT 1800 682 288 – Mental Health Line. Free and confidential 24-hour hotline for mental health inquiries from anyone experiencing a mental health crisis or concerned about someone’s wellbeing

- ACT 1800 629 354 – Mental Health Triage Service

 

If you think the person is at risk of self-harm, it is very important to stay with them until help arrives.

 

What if they confirm suicidal thinking?
First you need to determine the immediacy of the risk. Ask them if they have made plans for suicide. Ask them if they have the means to end their life with them. Take what they say seriously. The more detailed the plan the bigger the risk – if through a conversation you agree that they are not able to keep themselves safe, you may need to call additional support. This may be a member of their support team, family or friend, or you may need to call 000 to arrange a welfare check. Someone is at immediate risk when they are:


• Experiencing intense emotional pain and are ready to act on their suicide plan


• Have the means to end their own life


• Under the influence of drugs, alcohol or other substances


When arranging a 000-welfare check, ensure you inform the person first and ideally make the decision together. Stay with them until emergency services have arrived at the premises. If you are not physically with them, ensure you’re keeping in touch over the phone or via social media. Their safety is your number one priority. If you can go with them or meet them at the ED that is a good way to support them and stay by their side.

 

If there is no immediate risk, remain calm and show the person you care. Listen without judgement and ensure you are kind to yourself during the experience. Be careful not to make comments that invalidate their feelings, such as “there are people worse off than you are, think about them”, instead validating their feelings, such as “sounds like you’ve been having a really hard time as of late, I’m here to support you.”


If they haven’t engaged with any mental health professionals or services, consider encouraging them to use support services, such as Lifeline, Beyond Blue, Suicide Call Back Service or the state-based mental health triage lines.


Help them put in place their safety plan and ensure that they have people around them who understand and are supportive. With their permission, you may need to call people on their safety plan to let them know of the situation. Encourage them to see their GP.


It is important that you continue to support the person and regularly check-in with them to see how they’re going. But in addition to that, it’s important to take care of yourself, as these conversations can be extremely difficult to have.

Lesson 3: What if they don’t want to talk?

Be prepared if they don’t want to have the conversation. They may feel ashamed about their suicidal thoughts and need time to be ready to talk. Don’t judge them or be too pushy to talk. Don’t give up on them either. Keep checking in with them, just to say “Hi, how’s it going today?” Keep letting them know you’re there for them whenever they want to talk.

You could also see if there is someone else they would feel more comfortable talking with. If someone is at imminent risk of ending their life, their safety is the most important factor.

 

Look after yourself

Talking to someone about suicide can be confronting so make sure you give yourself a break to recharge and renew your energy and emotional wellbeing – take time out to reflect and debrief what you have been through, do something you enjoy like a massage, do a favourite activity or exercise class, or see a movie or have dinner with friends. Don’t be too hard on yourself – you’re doing as much as you can. Talk to other people you trust about how you’re feeling and the emotions you’re experiencing to give you a sense of perspective. Suicide is an intense situation to deal with, we can lose our sense of self and be overwhelmed by our thoughts.

 

If a person you’ve talked to has attempted suicide or has died by suicide please talk to a health professional, such as your GP or a psychologist. Receiving your own support is highly recommended.

 

You can visit your local community health centre for support or call the National Carers Counselling Program on 1800 242 636 that helps carers supporting people with a mental illness and suicide.

 

If reading this information has brought up feelings of distress or concern, please seek help by: Calling Lifeline 13 11 14.

 

Speaking to your GP or Psychologist (The Australian Psychological Society has a directory to help find a psychologist in your area) is really important and can make a huge difference to how you are feeling.

Important contact details and resources

• LifeLine – 13 11 14


• Beyond Blue – 1300 224 636


• Suicide Call Back Service – 1300 659 467


• Mental Health First Aid Australia - https://mhfa.com.au/sites/default/files/MHFA_suicide_guidelinesA4%202014%20Revised.pdf

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References

Australian Institute of Health and Welfare (AIHW) (2020). Suicide and intentional self-harm. Retrieved from https://www.aihw.gov.au/reports/australias-health/suicide-and-intentional-self-harm

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