Tips to deal with suicidal ideation

Suicide might be an uncomfortable topic, but talking about it is necessary because it could help prevent tragic, untimely deaths.

World Suicide Prevention Day, an annual awareness day on September 10, highlights the importance of ongoing awareness and public education to help reduce suicide rates and reach those needing professional support in time.

“Suicide is complex, and there is rarely a single deciding factor. However, depression, anxiety, and substance abuse, as well as interpersonal conflicts or a crisis, are often underlying risk factors,” says Megan Gonsalves, Netcare Akeso’s crisis line and marketing manager.

“While some suicides are planned carefully months in advance, many appear to be impulsive and might be acted on within hours or minutes of being conceived.

“A study by the Harvard School of Public Health found that one in four survivors of almost lethal suicide attempts deliberated for less than five minutes before acting on the impulse, and a mere 13% of those interviewed had thought about suicide for more than a day.

“Other studies suggest almost half of people attempt suicide within just 10 minutes of the thought entering their minds, while Australian research indicated 40% acted on suicidal thoughts within the first five minutes,” Gonsalves says.

“It is disturbing that in a mere five minutes, a person can decide to end their life forever. Netcare Akeso is creating awareness with a campaign called ‘One call – the difference between now and forever’ to intervene in these crucial minutes when a person might be contemplating suicide.”

This campaign aims to help suicidal individuals break free from the ‘fog’ they might feel trapped in and move into a clearer and brighter space where they can find hope beyond the immediate crisis they are experiencing.

“One call to check on a friend, colleague or family member going through a difficult time, or placing one call to a mental health resource for help can make the difference between life and death for someone who is suicidal,” Gonsalves says.

“It can be challenging to know how best to approach someone who might be having suicidal thoughts. However, remember that this conversation needs to be direct to ascertain the risks and determine what can be done to help the person,” Gonsalves says.

Practical steps when you are concerned someone might be at risk:
• Ask: Be direct in asking the person if they are thinking about suicide or have plans to harm themselves.

• Be there: Listening without judgment is vital to understanding more about what the person is thinking and feeling. Remember, this is not an easy conversation for them either. You don’t need to give advice; just listen and be there for them.

• Help them keep safe: Do not leave the person alone. Where possible, reduce access to harmful items or areas where they might attempt suicide. Asking the person if they have a plan can help to identify these factors and help keep them safe if suicidal thoughts occur.

• Connect with professional help: One can contact many resources and suicide helplines, including the Netcare Akeso 24-hour crisis line on 0861 435 787 and the South African Anxiety and Depression Group (SADAG) 24-hour suicide crisis helpline on 0800 567 567. Help guide the person to a safe place for support and, if possible, help them reach out to these resources.

• Follow up: Stay in touch with the person after the crisis or after they have contacted a professional. Ongoing support is crucial to mental health and well-being.

“Tragically, stigma remains the main barrier to people seeking help when they are at potential risk of developing suicidal ideation. The taboo many feel when discussing mental health and a misplaced, though widespread, societal belief that suicide should not be spoken of could influence this. This only perpetuates feelings of shame or failure that stand in the way of people reaching out when they need support and treatment.

“The more people who speak up to encourage suicide prevention strategies and know how to offer support to someone who could be at risk, the greater our chance of dismantling the stigma and reducing the unquantifiable burden of tragedy the suicide rate represents.”

Suicide facts by numbers:
• Suicide accounts for about 700 000 deaths annually worldwide.
• For each suicide that succeeds, there are an estimated 20 suicide attempts.
• In 2019, suicide was the fourth leading cause of death among 15- to 29-year-olds globally.
• It is estimated that one in five people has suicidal thoughts in their lifetime.
• SA is ranked in the top 10 countries by suicide rate, with 23.5 suicides per 100 000 people, and this represents about 14 000 suicides each year.

The World Health Organisation’s (WHO) goal for suicide is to decrease the rate by one-third globally by 2030. To achieve this, countries with high suicide rates must prioritise interventions because they are proven to be effective.

Acting to intervene in the space of opportunity before somebody takes their life can be as simple as making a phone call. Don’t hesitate to reach out if you know someone who might be at risk of suicide.

Addressing myths about suicide:

Myth one: Talking about suicide will encourage suicidal attempts.

“Talking about suicide can help reduce suicidal ideation. Talking about these difficult topics increases the likelihood of someone seeking help. Having a conversation around suicide can help to provide alternative views for someone struggling to see beyond their specific existing circumstances,” says Gonsalves.

“Asking someone in crisis if they are thinking about suicide can help to open a conversation they otherwise may not know how to begin.”

Myth two: Suicides happen without warning.

“While people do not always share their thoughts, some studies have found that almost 50% of people do tell someone about their suicidal thoughts or behaviours. This is not always obvious or direct but could be through non-verbal gestures or subtle comments.

“Even if someone doesn’t directly say they might be experiencing suicidal thoughts, there are often warning signs to look for,” she says.

• Talking about suicide, statements such as “I wish I were dead”, “I wish I hadn’t been born”, or preoccupation with death or dying.
• Having access to weapons or means to take their own life or engaging in risky or self-destructive behaviour.
• Withdrawing from social contact and isolating from others.
• Feeling trapped, hopeless or helpless about a situation.
• Increased use of alcohol or drugs.
• Giving away belongings or getting their affairs in order and saying goodbye to people as if they won’t see them again.
• Personality changes, severe anxiety or agitation.
• Extreme changes in usual routine, such as sleeping patterns.
• Previous history of suicide attempts.
• Experiencing trauma or crisis.

Myth three: Once a person is intent on suicide, you cannot stop them.

“Suicide can be unpredictable, but in many cases, it can be preventable. A person thinking about suicide is often experiencing hopelessness or extreme emotional pain, and helping them to address those feelings and seek support can make a lifesaving difference,” Gonsalves says.

Myth four: People who threaten suicide are seeking attention.

“Any threat or talk of suicidality should be taken seriously. Some people open up to those around them about how they feeling, which can be a way of asking for help. If someone talks about feeling suicidal, it is important to be kind and sensitive, avoid blame or judgement, and ask direct questions to understand the risks,” Gonsalves says.

“Connecting with professional mental health or medical support should be encouraged and facilitated if necessary.”