Protect suicide prevention

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Suicide prevention

In the UK,, during 2017, there were 5,821 suicides registered (Office of National Statistics, 2017). This equates to a rate of 10.1 deaths per 100,000 population. Whilst this is the lowest rates recorded since records began in 1981, there is definitely more work to be done and that's why we have created this resource full of suicide prevention information and support services.

Many more people still die from suicide than from road traffic accidents for example, and suicide is the most common cause of death for men aged 20-49 in England and Wales. Every suicide is a tragic loss of life, and the effects can be devastating. Behind every statistic there is a personal story, and every suicide is one too many.

What makes people want to end their life?

Most people who have suicidal thoughts or who go on to act on those thoughts do not want to die. Typically people are in intense psychological and emotional pain, and can see no other solution. They have often lost hope, and feel trapped by their situation or feelings. Suicide is often a desperate attempt to solve the problem the person is faced with – whether this is a difficult situation in their own lives or painful feelings and emotions. Suicidal thoughts often start in reaction to difficult events in our lives. These can be as varied as life itself, but common examples include the breakup of a relationship, bereavement, financial difficulties, the loss of a job, chronic pain or other physical health difficulties, bullying or stress at work or school, or exam pressures. It is important to understand that having suicidal thoughts is not in itself a mental health problem. While having a mental health problem like depression might make us more vulnerable to having these kinds of thoughts it is not the cause.

We also know some groups of people are more at risk of dying from suicide. For example, men account for 75% of all suicides in the UK, and this has been the case since the mid-1990s. This is particularly true for middle-aged men. Other groups are also at higher risk – for example people with a history of drug or alcohol abuse, people experiencing mental health difficulties, people who are unemployed, and people who feel socially isolated are all more at risk. However, anyone can be affected by suicidal thoughts, and although certain groups are more at risk, the vast majority of them do not go on to take their own lives.

What can help or make a difference?

First and foremost it is important to understand that effectively preventing suicide is a whole community approach. Everyone has a role to play and potentially each and every one of us can make a difference in a whole range of different ways.

Although there are some encouraging signs of change, talking about suicide is often still a taboo subject in our society. People often feel ashamed and stigmatised if they have suicidal thoughts, and those around them are often afraid to ask or talk about suicide. We may feel uncomfortable or afraid of saying the wrong thing or making it worse. If as a whole community we can begin to talk about suicide more openly, and feel less afraid to ask and talk about suicide then we will begin to reduce this stigma and make it easier to reach out for help.

There are lots of myths about suicide, some that you may have heard. One of the fears is that we will somehow get it wrong, or make it worse, and therefore you need to be a highly trained professional to even begin the conversation about suicide with someone. While training can be helpful, we would encourage you all to reach out to a person you are worried about. Many people who have experienced suicidal thoughts or behaviour say, it was the kindness, compassion and humanity of those around them that made the difference. Often people experiencing suicidal thoughts say they feel isolated, uncared for and cut off from the world around them. We don’t need special training to show people that we care about them, that we are willing to listen and to push through the taboo of talking about suicide.

About safety plans 

More specifically, it can also be helpful to develop a “safety plan”, or to help someone else to do this. While we may experience suicidal thoughts over a short or longer period of time, research tells us that the urge to act on these thoughts usually only lasts for the relatively short time of a few hours. If we can make a plan to help us hang on, and keep safe during these times, we can help someone stay safe from suicide. There are a number of resources on this page that can help with this, and the “Stay Alive” app includes a digital version of a safety plan that can be done individually or with the support of someone else.

A lived experience of suicide

Ever Grateful There  Were No Ripples.

There have been many points in my life when I have reflected with gratitude how good it feels to be free of the absolute distress and mental turmoil that severe mental illness inflicts on every fibre of your being but it’s with regard to the ultimate expression of self harm that some of my more memorable reflections have been formed. Some have been at significant moments in my life whereas others have been at moments so unremarkable that they actually add weight to the fact that no one should ever take life for granted. Life is precious and I’m certainly glad that my mental illness didn’t succeed in deceiving me to take my own life.

Looking back 

I can remember clearly walking hand in hand through a local wood with the person who would eventually be my wife. It was a summer’s day in July 1990 and I was looking forward to the expectation of England playing in the semi final of the World Cup, with all my future dreams of one day having a family unfolding before me and thinking how grateful I was in that moment not to have died by suicide as an inpatient four years before at the age of twenty seven.

I can equally remember a similar moment of reflection in 2009. I had just been involved in the successful resolution of a particularly challenging piece of case work for a teacher I had provided Union support for and was I was having a coffee in Cathedral Square in Peterborough. It was a warm spring afternoon and I was reflecting how much enjoyment I was gaining from the new Trade Union role, how lucky I was to be blessed with three children, who I loved beyond measure, for a successful career of some twenty eight years as a teacher and for the fact I could count on numerous people, both locally and across the Country, as good friends; with a number being very close indeed. My reflection was how lucky I was that I had not died back in 1986 as none of this would have been possible or how lucky I was not to have spent the following twenty three years paralysed in a wheel chair as a result of the outcome of one of the suicide methods I chose.

By this point in my life I had endured another three episodes of severe mental illness, all of which had featured significant periods of suicidal ideation and extreme risk. My safety plan throughout each of these periods of distress was my own insight into the most persuasive and negative thoughts that I was able to now counter until the mental storm subsided.

In 1986 I had no such insight. As I sat in the sun, on that Spring day in 2009, I simply couldn’t have envisaged that by March 2013 my life would have totally unravelled again and I would have made another five determined attempts on my life.

Just last week as I sat fishing on the bank of the River Nene with my son, reconnected fully again with him and my two daughters, my wonderful sister, my London cousins and with the numerous friends I am so fortunate to have, I reflected how ever grateful I am for both life itself but most of all for the fact that the negative impact my death by suicide would have had on others has not been realised. The ripples caused by my death would have impacted negatively in some way on well over a hundred people, or more, and I know it would have blighted the existence of my children in some way for the rest of their lives.

I know from hard personal experience that no one should ever take good mental health for granted or the fact that suicidal thoughts or intent will never come knocking on your door. I can well remember thinking as a teenager, at an age when many think they are bullet proof in life, how could anyone ever get so desperate as to want to end their own life? It was simply inconceivable that that could ever happen to me.

My suicide attemps and mental illness 

The life factors, the context, the past memories, the emotions, the thoughts, the triggers, the circumstances that result in any suicide are unique to each person. It’s one reason why the important work of suicide prevention is such a challenge. My brief insight here into what it feels like to be at that point of self destruction is simply my lived experience and relates to my mental health diagnosis and for others it may be different. Although it is estimated some ninety percent of suicides are linked to a diagnosable psychiatric disorder some are clearly not and it is a stark fact that some seventy percent or more of those who die by suicide are receiving no support from medical services.

In my own case on each of the occasions I was suffering from severe mental illness with the significant impact that the co-morbidity of Recurrent Depression and Emotionally Unstable Personality Disorder brings, along with the accompanying extreme anxiety, that I always experience, and the psychotic thoughts triggered by the clinical depression. With the “black and white” and “all or nothing thinking” I can now recognise as a feature of EUPD, my particular presentations, when very unwell, combine as a huge personal risk through the often lengthy unpredictable periods of Crisis.

How does it feel mentally? What is going through your mind? These are questions that people, who thankfully have never been in that place of extreme self harm, are curious about.

The following is just a brief capture as it relates to me. It probably doesn’t do justice to the absolute depths of despair and torment that is mentally involved and I recognise it will be different for many others. Mental illness at it’s core is very unique to each person due to the individuality of thoughts and combination of emotions.

At the core of the issue for me would be a desire to escape from the unrelenting, crushing anguish and debilitation that clinical depression brings. It engulfs your very being, removing any semblance of positivity, destroying your short term memory, your self esteem, your confidence and any ability to make decisions. For me in turns it would take me to a place where I felt totally detached from the normal feelings associated with being alive. I would be largely locked into a place of either unemotional detachment; as I observed life around me going on that I felt no part of. This feeling would fluctuate with heightened painful negative emotions such as extremes of sadness, anger, jealousy, hating of self and a sense of abject hopelessness. Unable to either read, listen to music or watch the television due to self referencing thoughts that both locked me into the past or into into an almost obsessional focus on morbid thoughts of death my very existence minute by minute would be intolerable. Depression is a powerful liar and in this state of mental distress those untruths would take me to a place where I saw absolutely no hope of recovery and no way that the constant mental torment would ever stop. All of my suicide attempts were underlined by the unfounded self conviction that I was incurable and that the only solution to stop the tormenting thoughts and to prevent me becoming a burden on my family was to take my life. The level of self justification for this ultimate form of self harm can be so comprehensive that it removes any consideration of the impact it will have on loved ones and others; indeed the mind persuades you that your death will actually be somehow beneficial to them. Any protective factors are eventually totally invalidated and dismissed as an individual draws nearer to an attempt on their life. In my own case the decision making would be infused with psychotic thinking linked to religious themes such as perceived possession by the devil, that I was a sinner who was somehow unworthy of life and on one occasion my final trigger thought was that it was “God’s Test” that, if carried out, would mean I went to heaven and not to hell. If Depression is a convincing liar than psychosis can be an immovable force of delusional untruth that provides an unnerving framework of intent. All of this to an extent featured prominently and in combination leading up to my seven suicide attempts. For me suicide ultimately presented as a solution that carried no emotion or fear and absolutely no regard for self or the huge negative impact it would have on others. It was a self justified solution to an intolerable situation and set of issues that I saw no conceivable end or alternative option to. I am certain that this is a place that any individual can find themselves.

On the emotive topic of suicide personal complacency or public indifference is the enemy.

There is always the question posed about did I access or embrace support leading up to the attempts I made on my life. In the case of the two made as an inpatient in 1986 it was my first real experience of severe depression and psychosis. Apart from a couple of visits to the GP I sought no help, hid my emotions regarding suicidal thinking from my parents and for their part they too had no real concept of what was going on or what mental illness was. I didn’t really seek appropriate help for months and even then it was only due to a friend’s intervention and practical help that saw me voluntarily admitted to Addington Ward and into an environment where help was at hand to prevent my death; which I would not have received if the method had been replicated in a community setting.

How safety planning helped me

After the episode of mental illness, when I was twenty seven, I was changed as an individual in the sense I was more open with sharing my emotions and was more aware of the support I could access if I became mentally unwell. As mentioned before my insight was my Safety Plan and I kept myself safe during the periods of suicidal ideation that featured in the following three episodes. During my last most protracted episode, of some five and a half years, I certainly sought and received help but during the most extreme Crisis periods the risk assessment process would have been extremely problematic as my requests for help were also masked by perceived coping due to my apparent fluctuating mood; perhaps due to the EUPD aspect of my dual diagnosis. Certainly it may have been a factor that my requests for a hospital admission were combined with a reluctance on my part to express suicidal intent because I was already well into the planning stage at this point of engagement with the Crisis Team and deceit was now a powerful aspect of my approach. The articulation of needing to go to hospital was the one remaining part of my insight for self preservation, calling out for help, in the knowledge I’d soon reach a stage where I would no longer seek help; but in doing so in this way it was perhaps not explicit enough for a meaningful risk assessment to take place.

Is there such thing as a turning point?

I have often been asked what was the turning point that meant you were no longer suicidal? For me there was never a clear turning point as it was a feature of being very unwell mentally. I recognise that not all suicides are linked to mental illness and not all those who suffer from mental illness go on to make an attempt on their life. However, as previously mentioned, it is estimated some ninety percent are related to diagnosable psychiatric disorders with some sixty to seventy percent being associated with depressive states. For this reason the turning point was more a product of personally enduring the mental storm long enough for recovery to slowly take me out of that place of risk. Time in recovery can also allow an individual to see life events that have impacted negatively in a different perspective or for time to allow some of these negative factors to be mitigated or resolved by appropriate support. During my last episode from approximately May 2013 to November 2015 I lived with suicidal thoughts virtually every day until being involved in the therapeutic support of the Structured Clinical Management Programme finally initiated the start of a slow but sure recovery. The most pertinent point regarding turning points, however they manifest themselves for different individuals, is they can only happen if you are alive. There is absolutely no recovery possible after death.

This leads me on to the final reflections based on my lived experience and it’s with respect to the all important area of suicide prevention. As I write this one person, at least, will have died by suicide. One person on average dies every two hours by suicide in the United Kingdom. Just as one in four will suffer from mental illness, and virtually everyone knows personally someone who has suffered in this way, so to is the fact that a significant number of people have been impacted in some way by the suicide of another.

Suicide Prevention is a huge challenge but is one that has to be embraced by families, communities and all supporting services; including successive governments who have, as yet, never provided parity of esteem for the funding of mental health care generally; let alone sufficient specific resources for Suicide Prevention.

Let's get rid of the stigma

Mental Illness generally still carries significant stigma, myth, prejudice and discrimination and this is certainly true with respect to suicide. Until the 1960’s those who made an attempt on their life risked prison as it was regarded as a criminal offence. For hundreds of years the Church regarded suicide as a mortal sin and those who died by suicide were buried outside of the sanctified land of their churchyard. With this historical legacy, as well as it’s understandably raw emotive dimension, suicide remains a topic that is far too often avoided or faced both within families or within local communities; indeed by society in general. This fact has to change. For effective suicide prevention to develop in its widest sense, within families, within the work place or in supporting medical services it has to become a topic that is openly addressed without stigma, prejudice or discrimination. It is a topic that should never be associated with any sense of shame or embarrassment and it should always validate the extreme emotional distress or mental illness that drives the overwhelming majority of individuals to feel they have no other option but to take their life.

People being able to openly talk about the topic of suicide is the fundamental  starting point for suicide reduction. People should never be afraid to ask someone if they are having thoughts of self harm or suicide. It is the fundamental question that should be freely asked directly as both the key to suicide prevention and to providing immediate emotional and practical support for anyone who expresses that desire;simply to keep them safe. I’m a firm believer that the question about suicidal intent should be asked for a second time in response to a no answer by an individual as the instinct, if you are in that desperate place, is to either deny those thoughts or to deceive others as part of a plan that may already have been formed. For this latter reason if anyone has serious concerns they should also ask the follow up question of are you hiding thoughts or suicidal intentions from me?

In any such dialogue realistic hope that things can and will get better and recovery from such thoughts is possible should be an essential part of the conversation. Suicidal thoughts should be validated with appropriate empathy, as far as that is possible, but always balanced by a  practical focus on how to keep that person safe from themselves.

Advice if you are feeling suicidal 

I have often been asked the question what advice would you give to someone who is feeling suicidal? My response would be for them to ensure they share these intentions with a loved one or a friend they can trust to keep them safe or for them to allow me to pass this information on to those people. I would also warn them not to be complacent as suicidal thoughts, however fleeting, have to be addressed as they can escalate into planning and self justification sometimes very quickly particularly if the impulsivity often associated with substance abuse or alcohol could be a factor. My advice would also be for them to seek medical support immediately. I would also advise them that they are essentially good people, that they are loved by others and that the thoughts they are having, however real to them, in time will pass and that recovery from such thoughts will happen. Hope that a better situation emotionally is possible is a key message for anyone in a suicidal mindset.

On reflection

As I approach the end of my reflections and thoughts about suicide it is important to address the topic of safety planning. Safety planning has to be a central aspect of suicide prevention. My feeling is that everyone by the age of eighteen and earlier for some, should have a Safety Plan to guard against either self harm or suicide. There is a direct link between any aspect of self harm and an eventual suicide attempt and safety planning should include addressing the wider issue of self harm as well. I also believe that all GP training should include a compulsory focus on mental health and they should all be capable of providing a patient with some form of safety plan. Those who are experiencing their first major psychiatric illness are very likely to be most vulnerable as they will have little if any protective insight into their thoughts and this should be factored in to any risk assessment or safety plan considerations.

With regard to those who are admitted to a secure inpatient setting during a period of crisis it is vital that they are engaged by staff about the emotions, triggers or circumstances that led to the crisis or self harm that resulted in their admission. If the person is too unwell to engage, or doesn’t want to at that stage, that is both understandable and should be respected but this engagement should certainly be attempted again as part of a Safety Plan before discharge. It is a myth that such engagement will either trigger an incident or make a Service User more likely to want to end their life. Those thoughts of self harm or suicidal intention are almost certainly already there and they need to be discussed, validated and countered. In crisis I know I would have considered such conversations difficult certainly but never the less an important sign of care and concern for me. After my first attempt on my life while on Addington Ward back in 1986 I was placed on arm reach observation for several days and never once, to my recollection, did anyone ask me why I had wanted to end my life or what was going through my mind when I carried out the actions I did. As a result those same suicidal thoughts stayed with me unresolved and directly led to my second inpatient suicide attempt some three weeks later.

Safety planning is best developed when a Service User is further on in their recovery journey and can better reflect with far more insight into what led to their self harm or suicide attempt. For this reason safety plans in my view should always be a topic for discussion when under PCART community care. There is a strong argument that no Service User should be discharged from Secondary Services without a Safety Plan.

Throughout several decades of care and six episodes of severe mental illness a safety plan was never discussed with me until I received the support of Structured Clinical Management therapy in 2015. For over twenty five years I was able to keep myself safe and had my own internal safety plan through the insights I gained from my episode in 1986. For this reason I believe any safety plan should include a reference to the unique emotions and thoughts of an individual. It should also be simple, practical and wherever possible shared with another person. The active involvement of a loved one or friend in helping keep an individual safe during Crisis, until the next point of professional medical support is vital. The importance of the role of a Carer in safety planning can never be over stated. It is very rare for any individual, even during a period of Crisis, to either self harm or make an attempt on their life while in the company of a loved one or a person they know cares about their personal safety. Finally any safety plan must also be accessible to a person in crisis and should contain reasons for living and a reminder that recovery and being in a far better place is possible.

I fully understand the requirement for due attention to be given by all services to the issue of risk assessment and I appreciate this has to remain as part of any Care Pathway. My belief is this risk assessment can arise effectively from a Safety Plan focus of engagement in most settings and most situations. An effective safety plan reduces risk and makes any risk assessment process more effective. It is now widely acknowledged that risk assessments should not be used to try and predict the likelihood of future suicide, but instead are much more useful in gathering information to guide care planning and inform a future safety plan. I know from lived experience that it is far easier for an individual to remain in a mind set of suicidal intent and to effectively deceive a risk assessment process than it is to do so when engaged in a meaningful discussion of emotions and thoughts infused with realistic hope and centred on the topic of personal safety.

It is time to draw these vey personal reflections to a close now and to emphasise there is no intention in any of my various musings to imply any form of criticism regarding the much valued care I have always received during my episodes of severe mental illness.

I have always taken full responsibility for the decisions I have taken in relation to any aspect of self harm or the suicide attempts that I have made; whilst also always placing them in the context that I was extremely unwell on those occasions.

Whenever I hear of a person taking their own life my immediate emotion is one of sadness and empathy for the level of distress that placed them in that terrible position. It also makes me immediately reflect that they could well have recovered and gone on to live a full life. You only get one life and this is why suicide prevention and reduction is such an important topic; with all the challenges and unique features it brings with it.

I mentioned at the start about my moments of unremarkable reflection, in relation to suicide attempts I have made. These unremarkable reflections are simply fleeting moments where I both mentally acknowledge and bless in that moment the simple fact that I am alive. I acknowledge that I have been very fortunate indeed. In 2012 my sister saved my life in a situation where I was less than thirty seconds from certain death. Almost every day since my sustained recovery started some two and a half years ago I have experienced these unremarkable reflections, almost daily, as I cherish life itself. I remain thankful for my recovery but certainly not complacent.

Most of all I remain ever grateful there were no ripples. Andy.