When Someone You Love Is Suicidal

Suicide is an extremely serious matter, and so I hope we can all treat these thoughts with the seriousness they deserve. Suicide refers to the act of ending one's own life. We often link suicide closely with depression; yet not everyone living with depression is at risk of suicide, and not everyone who has suicidal thoughts has depression. There are many reasons a person might develop suicidal thoughts — it could be a mental health condition, it could be the experience of discrimination or bullying, it could be abuse, or it could be the result of any number of different circumstances coming together, none of which can be explained in a few words. More often than not, suicidal thoughts arise out of an intense sense of hopelessness, or a feeling of being useless and worthless.

What can you do as a family member or friend?

We all believe that life is precious, and we want to prevent tragedy from happening. Many of us may have had a family member or friend who showed signs of suicidal thinking, or who had already harmed themselves, and in that moment we may have felt at a loss, not knowing how to handle the situation. Since most of us are not professionals, in today's article I would like to begin by sharing a few actions you can take, along with some of the common misconceptions people hold about suicide.

Are you ready?

First, before you try to offer support, you should consider your own capacity. The issues surrounding suicide are highly complex; in supporting someone at risk, we need a sincere, non-judgemental attitude, and along the way we also need to earn the person's trust in order to keep the situation from worsening. On top of that, facing a loved one's suicidal thoughts places enormous stress on us, so if you feel you are not yet ready to help, you can discuss with the person whether to seek the support of others. The first step in dealing with suicidal thoughts or behaviour is something many people overlook, yet it takes real strength to take it.

Risk assessment

When someone develops suicidal thoughts, the following signs may appear:

• Saying they will take their own life or harm themselves
• Looking for methods of suicide
• Talking about death, suicide, or ending their life (such as writing a will)
• Saying that life has no meaning, or feeling hopeless
• Dramatic swings in mood (sudden anger, anxiety, or an abrupt improvement in depression)
• Unusual impulsive behaviour
• Increased misuse of drugs or alcohol
• Withdrawing from family or friends

When the person shows one or more of these signs, there may be a risk of suicide. As a family member or friend, one thing you can do is to ask the person directly whether they have already had thoughts of suicide. Many people feel that talking with someone directly about "suicide" or "wanting to die" will make the situation worse, and so they choose to avoid the subject altogether. In fact, using these words directly can help you understand the person's situation more concretely; by contrast, using terms like "doing something stupid" actually approaches the matter from a judgemental angle and casts doubt on the person. When we know that a family member or friend has already developed some suicidal thoughts, we can carry out a brief risk assessment. We can try to find out whether the person:

• Already has a suicide plan
• Has a plan for when, where, and how they would take their own life
• Has already begun parts of the plan (for example, buying medication, charcoal, rope, and so on)
• Is taking any medication or alcohol
• Has previously attempted suicide

The more detailed the person's plan, the greater the chance that they will turn their thoughts into concrete action, and medication and alcohol both have the potential to raise the risk of suicide. Carrying out even this kind of risk assessment is absolutely necessary.

Safety plan

If the person is willing, you can work with them to draw up a safety plan. The purpose of this safety plan is to give the person a clear set of guidelines to follow when a suicidal crisis arises. You can write down the following information together with the person:

1. Warning signs that a crisis is coming (for example, physical reactions, thoughts, external triggers, images surfacing in the mind). The appearance of these warning signs means the person may be about to experience a strong suicidal impulse; recognising these signs, on the one hand, lets the person understand more of the factors connected to suicide risk, and on the other hand gives them a signal so they know when to put the contents of the plan into action
   
2. Actions the person can take. When a suicidal impulse arises, there may be some actions that can help them relax a little, such as moving away from dangerous or high-risk places (like Tai Mo Shan's viewing platform).
   
3. Contact methods for trusted people. Social support is extremely important to the person, and when a suicidal crisis arises, having someone who can immediately understand the person's surroundings and situation likewise means appropriate help can be provided as quickly as possible. You can write down, together with the person, the contact details of several family members or friends, so that even if one of them is too busy to help right away, there will be others who can support the person.
   
4. Professional support. Professional support refers to immediate help provided by medical staff or a social services organisation. You can list, together with the person, the contact details of organisations you both trust (see the resources at the end of this article), so that when the person is in need they can seek a professional's help straight away.

A risk assessment and a safety plan alone are not enough to protect the person completely, but as people who are not professionals we have already done our utmost. In conversation, you can show the person your care and encouragement, and face the difficulties and emotions together with them.

Misconceptions or questions you may have

Some people believe that those who say they will take their own life are really just seeking attention, and do not truly have emotional problems or difficulties. This mindset is absolutely best avoided. As stated at the start of this article, suicide is a serious matter, and we should never assume the person is joking or simply trying to get attention, because emotional distress is often very hard for us, as outsiders, to perceive.

Some people believe that a person who wants to die has already made up their mind to end their life, and is very difficult to help. In fact, this is not the case either. When a person shares their thoughts with you, there is a real possibility that they are reaching out to you for help; the suicidal thoughts and the crisis are not something they wished for. So even when we observe certain signs in a person and the person admits they have a suicide plan, we should still offer support and do everything we can to prevent a crisis from happening.

If the person insists that you must not tell anyone else about their suicide plan or thoughts, including professionals, how should we respond? This is a highly complex question. In this situation we find ourselves in a dilemma: we cannot agree to the person's request, because we all know that when a crisis occurs it must be handled by professionals, yet refusing the person may make them feel hurt and turn around to blame us. What we can do is to explain to the person, as far as possible, why we cannot keep it confidential, and then choose, together with the person, an organisation they feel comfortable with, notifying them when necessary. In extreme situations, we may have to break our promise to the person and call an emergency hotline to stop them from continuing to harm themselves. Afterwards, when we are honest with the person, there is a strong chance it will bring their displeasure and reproach — but if you believe that their life is valuable, this decision is still the right one.

Practical resources

These hotlines are not only for people who are in the midst of a crisis to use. If your family member or friend refuses to seek help from these organisations, you too can try contacting them so that they can give you more detailed advice. After all, we are all ordinary people, and we all have times when we feel exhausted or under stress. Even when we put in all our effort, it is impossible to eliminate a person's suicide risk completely. If at all possible, the most ideal approach is to enable the person to receive the help of a psychologist or psychiatrist to improve their mental health. The author is not a professional support worker or psychologist; if you are interested in psychological first aid, you can further seek the help of professionals — because handling any mental health issue is, after all, not something that can be explained in just a few words.

References

The Mental Health Association of Hong Kong (2018). Mental Health First Aid Manual (Hong Kong Fourth Edition). Hong Kong: Advance Commercial Printing.