Finding hope

People attempt suicide after long or intense periods of hopelessness, so it is wrong to attribute it to a single cause or incident. However, the actual act may be impulsive if they find themselves with the means to try it, or a collection of precipitating factors pushes them into completing the act.

Clinical psychologist Victoria Siewnarine-Geelalsingh said most suicidal thoughts grow from continuous feelings such as hopelessness, fear, a lack of support, pain, helplessness, and isolation, but not necessarily mental health problems.

“It’s not that they’re not trying. Sometimes they try but they don’t know what else to try. Sometimes their backs are against the wall. Sometimes their minds are so clouded that they can’t even organise their own thoughts. They cannot articulate what they’re feeling... They just want to crawl into a hole and then we are there judging them because ‘Why?’ or ‘Yuh stupid or what?’ And that’s not going to make them want to come out of that hole.”

Speaking at the TT Association of Psychologists (TTAP) Suicide Awareness and Prevention seminar at the Eric Williams Medical Sciences Complex, Mt Hope on April 27, Siewnarine-Geelalsingh said listening and talking to such people is important. Talking to someone about suicide, she stressed, will not make them attempt suicide.

In fact, Dr Katija Khan, psychologist and senior lecturer in the MSc programme in Psychology at the University of the West Indies, explained the Papageno effect. She said if a suicidal person sees cases of mastery of crisis or alternatives to suicide – individual stories of hope and healing, sharing the science and systems or programmes of what works – it helps.

“But for that to happen we need to break down the stigma to allow people to be able to say, ‘I tried but then I got help.’ Because a lot of people don’t want to expose themselves because of the stigma and taboo.”

Khan said suicide is stigmatised for several reasons. It is often condemned for religious or cultural reasons and in some countries it is illegal, so if a person survives an attempt, they can be prosecuted. Because of factors like these, suicide is driven into the shadows and considered taboo. It also leads "death by suicide" to be mis-classified for insurance and other reasons, which skew the statistics. “The actual figures are, in all likelihood, probably higher than what is reported. And for every completed death there are many more attempts, so we are not sure what the magnitude is.”

Khan said that while talking about suicide can be beneficial, sensationalising it can do the opposite – a phenomenon called the Werther effect. "When people are given graphic details of or glorify suicide incidents it usually leads to a spike in suicide attempts." However, this is preventable. She described it as a public health crisis, comparable to heart disease, hypertension, or diabetes, where people need to go to the doctor and find out what they need to do to address it.

HEED THE SIGNS

It is important to pay attention to what people talk about, Khan said. For example, people saying things such as feeling hopeless, having no reason to live, that things would be better if they were not around, or that they are feeling trapped are all indicators.

It is also necessary to look at people’s behaviour after life changes or loss. Some signs are increased use of drugs or alcohol, withdrawing from activities, sleeping too much or too little, visiting or calling others to say goodbye, giving away prized possessions, and mood changes including rage, humiliation, anxiety, depression, and loss of interest.

There are also numerous variables that could increase the risk of someone attempting suicide. These include health factors such as trauma, serious or chronic health problems or pain, anxiety disorder, bipolar disorder, schizophrenia, and more. Historical factors include previous suicide attempts, childhood abuse, neglect or trauma.

In addition, there are environmental factors such as prolonged stress caused by harassment, bullying, unemployment, or relationship problems; stressful life events like job loss, death, or divorce; and access to means to kill themselves, such as firearms and drugs. Concerning the latter, she gave the example of one village in another country where the most popular means of completing suicide is by ingesting weedicide. Researchers gave each farmer a lockbox in which to place the weedicide and that simple move led to a significant decrease in attempts.

There are also factors that can protect people from attempting suicide. Among them are personal resilience; social connectedness; a significant other; a positive sense of self; spirituality, values and beliefs; mental and physical health; access to treatment; a healthy fear of risky behaviours and pain; responsibilities and duties to others; pets; and support for help-seeking where someone could make the doctor’s appointment for them, give them a ride to therapy, or even go with them. Khan said public means of support and encouragement, such as billboards saying, “Suicide is not the option” is also a positive move.

“There is another myth that if somebody tries, that’s it, there is nothing you can do... No. When they attempt, they are at their most hopeless but afterwards, when people reflect, they want other options but can’t seem to find them. So we need to keep at it and keep intervening. Keep speaking up, reaching out and supporting each other.”

DOS AND DON’TS

Siewnarine-Geelalsingh said anyone can give a person with suicidal thoughts hope through active listening, empathy, and compassion. She said most of the times people just want someone who will listen – it is not about giving them advice or finding a solution. “One of the best ways to help someone experiencing suicidal thoughts is to engage them in conversation. Let them talk about it. Speak to them privately in a space where they feel comfortable... Build a rapport and encourage them to get help.”

Empathy, she said, is about going into their hole and sitting with them, just be there for them, be non-judgmental, and cry their tears with them. It makes people feel accepted, as if they are no longer isolated, she said, and will let them know they have support and give them the motivation to climb out of the hole and that they do not have to do it alone.

She also gave some tips for active listening using the acronym SHUSH.

1. Show you care – Put away your phone; use verbal and non-verbal cues such as maintaining eye contact, nodding your head, saying yes or okay in the right places; and resolve not to talk about yourself even if you had a similar experience.

2. Have patience and be non-judgemental – Do not make them feel rushed or they may think it is not a safe environment. If they pause then wait. It is not your signal to talk. They may be thinking, reflecting, or trying to settle or process their emotions.

3. Use open questions or statements – For example, "Tell me more." It encourages them to talk and think.

4. Say it back to check that you understand – It is a way to check that you understood what they meant to say and they could correct you if you had anything wrong. It reassures them they have your undivided attention, and validates their emotions.

5. Have courage – Do not be afraid to talk to the person or ask them questions. Do not be discouraged by a negative response.

Siewnarine-Geelalsingh said if you believe someone is considering suicide, ask them directly. Ask them if they have a plan and counter that plan if possible. She said some may agree to reveal their plan if you promise not to tell anyone but you should never enter a pact with them.

In addition, Siewnarine-Geelalsingh said you should not sensationalise suicide and make it feel attractive as many movies and TV shows do. “It’s not all that great. You don’t just do it and then your family decides that they love you, that people would think about you a lot more or are going to feel bad for all the ways that they hurt you. It doesn’t happen like that. That is not real life.”

People should also try not to normalise suicide. Instead, remember it is a problem and professional help is needed. They should also realise it is not caused by a single incident, nor go into the details of another suicide as that could give them ideas.

Lastly, do not react negatively to what they tell you and remember to be mindful of your facial expressions as well. “What we see are the risk factors. What we see are the little bit that they tell us but then there is a whole well that they can not explain. So what they may be saying is, ‘My cat died. I can’t live anymore,’ but there may be so many things under that. And if your face and your words and your initial communication with them puts up a barrier, you’re never going to find out what else is under there.

“Remember you don’t have to be an expert to help someone. There are people for that. Just being there for them and letting them know you care provides the support that they need. If they are suicidal or are at risk of inflicting self-harm or harm on others, don’t leave them alone. If you do not feel equipped to handle a situation on your own, call someone.”

Anyone interested in support or professional intervention can call the suicide hotlines Lifeline at 645-2800, and Alive at 688-8525 and 650-5270. You can also call an ambulance at 811; any accident and emergency centre; visit a mental health clinic; or contact your spiritual leader, trusted teachers, coaches, supervisors, close friends, or family.