Frequently Asked Questions
If someone is seriously contemplating suicide, do you really think it is possible for them to make a decision to live?
We know that those at risk for suicide do not necessarily want to die, but do want help in reducing the pain they are experiencing so that they can go on to lead productive, fulfilling lives. There is a lot of ambivalence surrounding the decision to take one’s own life, and by recognizing this, and discussing it, we can help the suicidal person start to recognize alternative options for managing their suffering. Often suicidal people are experiencing intolerable emotional pain, which they believe to be unrelenting. They often feel hopeless and trapped. By helping them to recognize and explore alternatives to dying, you are planting the seeds of hope that things can improve.
There is no research evidence that indicates talking to people about suicide, in the context of care, respect, and prevention, increases their risk of suicidal ideation or suicidal behaviours. Research does indicate that talking openly and responsibly about suicide lets a potentially suicidal person know they do not have to be alone, that there are people who want to listen and who want to help. Most people are relieved to finally be able to talk honestly about their feelings, and this alone can reduce the risk of an attempt.
It is best to treat talk and threats about suicide seriously. Research indicates that up to 80% of suicidal people signal their intentions to others, in the hope that the signal will be recognized as a cry for help. These signals often include making a joke or threat about suicide, or making a reference to being dead. If we do take them seriously and ask them if they mean what they are saying, the worst that can happen is we will learn that they really were joking. Not asking could result in a far worse outcome.
At some level, all suicide attempts are cries for help by individuals experiencing a high degree of desperation. It is important to treat all attempts as serious. Once an attempt is made at any level of lethality, the risk for future and more serious attempts and completion increases significantly.
If a person who was depressed and suicidal suddenly seems to feel better, does this mean they are no longer at risk for suicide?
Hopefully, if a person seems better, they are indeed feeling better and are no longer considering suicide. HOWEVER, this apparent upswing in mood could also be an indicator of an increased risk of suicide. Sometimes, a suicidal person might feel relief that they have finally come to a decision – the emotional conflict over living or dying has been resolved. The best way to determine if a person’s improved mood is related to decreased or increased risk of suicide is to have a direct and open discussion about suicide.
Most suicidal people are desperately seeking a way out of unbearable emotional pain and are ambivalent about ending their own lives. After receiving help to overcome this pain, many people go on to live rewarding and meaningful lives, never again seriously contemplating suicide. For others, a current suicidal crisis may be overcome and the risk of suicide significantly lowered or eradicated for a period of time. This period of time can range from minutes, hours or days, to possibly months, or even several years.
About 80 per cent of people who attempt or complete suicide send out warning signs to those around them, although they may not make a direct plea for help. Some warning signs may include:
- Talking or joking about suicide or dying;
- Making preparations for death such as giving away significant possessions, making a will, writing a suicide note, clearing up loose ends;
- A previous suicide attempt; the suicide of someone important;
- Being persistently depressed or down for more than a couple of weeks; protracted anxiety or agitation; extreme mood swings/bipolarity; outbursts of rage, grief, violence;
- Isolation, withdrawal from previously enjoyed relationships and activities;
- Lethargy, lack of interest, low energy, insomnia or over-sleeping;
- Increased use of alcohol or drugs;
- Uncharacteristic high risk activity, impulsive behaviours
- Expressions of hopelessness, helplessness, purposelessness
- Low self-esteem, low self-worth, self-contempt, anger toward self;
- Significant loss(es), such as important relationship, health, identity, economic security, freedom.
It is important to show a potentially suicidal person that we care and that we are concerned for their safety. It is also important to directly ask the person if they are considering suicide. This shows that we are taking their feelings seriously, and helps to establish if the risk for suicide is real. If you feel uncomfortable asking, it is important that you get someone else to ask. We need to listen to the person – without judgment and by showing empathy. If the person says they are considering suicide, we need to get help for that person by enlisting the help of professionals, such as a family doctor, a mental health professional, a 24-hour crisis line, or even a hospital emergency room if the person is imminently at risk. It is also important to enlist familial, friendship and social supports. If the person is at imminent risk of harming themselves, do not leave them alone until they have been assessed and received help from a competent and trustworthy professional, or until another trustworthy adult arrives to stay with them.
Don’t suicides happen fast, and usually as the result of one sudden traumatic event, so that it is hard to prevent them?
Suicides can appear to happen fast, or “out of nowhere,” when we have not noticed any indications of a person’s suicidality. Although most people (80%) present a range of indicators to the people around them, few of us have been educated to recognize these warning signs and we miss them.
Suicides are also rarely the result of a single traumatic loss or change. Usually, there are many contributing factors and events that have developed or occurred over a period of time. A sudden traumatic event may be the ‘trigger’ event that moves a person to end their life, but it is unlikely the only cause.
It is likely that many suicides could be prevented if we educated ourselves about the immediate, short term, and long term indicators of suicidal risk, as well as how to reach out and get effective help for someone who is letting us know they are in serious distress.
Research suggests that 70 to 90 per cent of people who have made a lethal attempt, or died by suicide, were suffering from one or more unmanaged mental health issues – such as protracted depression or anxiety, bi-polarity, psychosis, and/or substance abuse. While the presence of an unmanaged mental health issue is strongly associated with suicide, it is important to note that most people assessed with a mental illness are not at risk of suicide, and that few suicides are wholly the result of a mental illness.
Yes, there is evidence to show that ‘copycat suicides’ do occur under some circumstances. If someone is already vulnerable (depressed, anxious, isolated, has made a previous attempt, and/or is showing other warning signs), one suicide can trigger another. “Copycat suicides” or “suicide contagion” is most pronounced when someone loses someone close to them. Youth also appear to be especially vulnerable. Other conditions that can increase the risk of ‘copycat suicides’ are high profile, sensational portrayals of suicide in the media, or inadvertent glorification of a suicide victim.