By Dr Nihara Krause, Consultant Clinical Psychologist, Founder and CEO stem4
Suicide Prevention Day is important because it’s a day to be reminded of or to learn what steps can be taken to mitigate the devastating loss of life. Suicide is one of the leading causes of death in young people, particularly young men and we all have a responsibility to know what we can do as a first step.
Knowing who might be at risk is the first step to prevention. Some signs may be talking about wanting to die, not always in the heat of the moment. Sometimes young people show they are at risk by their Internet history, which may reveal searches on ways to kill themselves. They may talk about how they think things may be when they are dead, give away prized and valued belongings and start writing or posting goodbye notes to family and friends. If these signs are present, do not be afraid to ask whether they have thoughts of self-harm or are considering suicide and offer to support them to access immediate help.
The behaviours they exhibit, especially if high risk, are another indicator. Self-harm also increases risk, as does a history of previous suicide attempts. There are many effective techniques to help manage self-harm including ‘Calm Harm’ the stem4 app to help manage urges. However, an assessment of underlying factors and managing clinical depression in a young person is essential and should always be carried out by a qualified mental health professional.
The thoughts and ideas that are expressed are often an indicator of suicide. Most commonly thoughts are negative, accompanied by depression or extreme sadness, numbness or not caring. Occasionally there may be irrational anger. First line treatment for clinical depression includes Cognitive Behaviour Therapy (CBT) sometimes combined with antidepressant medication.
Fluctuating or difficult to bear emotions make some young people very vulnerable to suicidal thoughts or behaviours. This may be due to a diagnosis such as bipolar disorder or emotionally unstable personality disorder or because the young person finds emotions hard to tolerate or express or is impulsive. Getting the right treatment, such as Dialectic Behaviour Therapy (DBT) and medication is essential for this group together with long term mental health support as well as a tight network of care from a range of sources.
Social and relationship factors are another contributor, for example, if there is significant distress or loneliness around not having friends or an intimate relationship, withdrawal from people due to feeling different or being left out. Connecting at these times with the person and making sure that friends and family are aware that they are in a vulnerable place is useful.
Some young people are sensitive to certain triggers. Commonly these include struggling to deal with a big loss or disappointment in their life, an anniversary of a significant breakup or bereavement or an important person, especially family member, taking their own life. Whilst these experiences don’t trigger suicidal thoughts or intentions for many people, a small proportion of young people are more at risk if they find it particularly difficult to deal with loss or emotions, stay upset for much longer and don’t want to seek support or lack coping strategies. Being aware of these triggers, noticing negative changes, reaching out and offering to help or getting help for them in this instance will be effective.
In general – ask anyone you are concerned about if they are ok or if they are thinking of hurting or killing themselves. Contrary to popular belief this will not trigger suicidal behaviour. Listen to them with compassion and let them talk. Let them know you have heard them by reflecting what you have understood of what they have told you and tell them they are not alone. Make sure they are safe by putting away sharp objects and help them get some support and tell someone responsible to keep an eye. Learning to leave behind or tolerate hopeless and helpless feelings and learning new ways of thinking and behaving is a slow process but it is definitely achievable.
Emergency numbers for the UK are 999 or 111.
See stem4’s Asking for help leaflet for teenagers.