24 July is Samaritans Day. They chose this day to emphasise that they’re there to help 24 hours a day 7 days a week.
When someone close to us experiences depression or has suicidal ideations, we can often feel that we don’t know the best way to help. We don’t know what to say or how to provide support.
Tim Cantopher blogs for us about the best ways to help someone who has suicidal feelings.
Some of the hardest parts of my job as a Consultant Psychiatrist were predicting which of my patients was going to be at risk of making an attempt on their life and then deciding what to do to help. I didn’t always succeed as people suffering from major depression don’t always make their intentions known and predicting their actions can be difficult. Each occasion when I failed to keep the sufferer safe is etched in my memory with sadness and regret. How much worse it must be for their loved ones. With the aid of retrospect we usually feel there is something we could have done differently which would have led to a different outcome. It isn’t always possible to prevent suicide, however alert, kind or loving you are. If someone is determined to end his life he will do so and he will ensure that you are unaware of his intentions. But more often there are warning signs and risk factors which can alert you to the danger your loved one is in. There are also dos and don’ts in how to deal with them.
The basics about feelings of suicide
Having a mental illness as Major Depression (Depressive Illness), Bipolar Disorder, Schizophrenia or a Personality Disorder is the prime risk factor. While women attempt suicide more commonly, men succeed mor
e often (take this with a pinch of salt; both genders are at risk). Other factors include suffering from a chronic physical illness, particularly involving pain, addiction to alcohol or drugs, unemployment, isolation, divorce, bereavement, poverty, bullying and most important of all, having previously made a suicide attempt. Don’t waste time trying to work out whether the previous episode of self-harm was a genuine suicide attempt or merely an act of manipulation; it doesn’t matter - the ‘seriousness’ of previous attempts is a poor predictor of future risk. Any suicide attempt is serious.
Signs that the risk is increasing include the obvious ones, such as expressing thoughts of guilt, depression, despair, worthlessness or life not being worth living, but also an uncharacteristic loss of interest in things, events and people, an increase in recklessness and actions taken to put affairs in order such as making a will out of the blue. Many people who commit suicide have in fact talked about wanting to die in the year or so before they do so, to friends, family or professionals. Always take such talk seriously.
So if you are alerted to a loved one being at risk, what should you do?
First, some don’ts:
Don’t laugh it off, try to cheer them up, distract them or tell them to pull themselves together or how lucky they are. Don’t tell them it will all be OK, because you don’t know that. Don’t reach for facile quick-fix solutions to make it all go away and be all right. Depressive illness is a terrible, impenetrable blackness which, hopefully, is way beyond your experience and understanding. Don’t tell them you understand what they are going through, because you don’t. Don’t get persuaded to keep it all a secret, even if they say that’s the only way they can trust you. Some things can’t be kept secret and this is one of them. You don’t have to broadcast your concerns to all and sundry, but you do need to pass them on, at least to their GP or, if they have one, a mental health professional.
Now the dos:
Do listen. Ask them to tell you more. Make it clear that you can bear their pain and that you want to try to share it with them. Many sufferers from major depression feel worthless and guilty and that their depression and even their presence is repugnant and unbearable. The fact that someone wants to be with them, experience their feelings and is apparently unharmed by them can be immensely comforting and healing. Try to persuade them to go with you to see whichever health professional they are in contact with (if in doubt their GP). Don’t take their word for it that they will go. If they say they are offended by your lack of trust in them, reply that it isn’t them you distrust, but the illness. If they refuse, tell them honestly that you are going to call their GP, whether they like it or not. Love doesn’t always mean agreeing and when a person’s perception is distorted by clinical depression, it’s you, not them, who needs to make the crucial decisions, such as who to get involved.
Helping your loved one
I’m not going to deal with coping with someone suffering with addiction to alcohol or drugs here, as it’s too big a subject, but I will say this. You may trust the person, but don’t trust their addiction. They need treatment and you need not to take no for an answer. This is ‘Tough Love’ as recommended by the 12 step movement (AA and sister organisations).
Once your loved one is getting treatment, try to stay involved. Health professionals have a duty of confidentiality, so you may not always be kept in the loop. But make it clear that you are there for your loved one and wanting to listen and help whenever you are needed, for as long as it takes. Major Depression usually passes, particularly with effective treatment, but it sometimes returns, so keep your antennae sharp for warning signs in the future.