The Richard Nicholls Podcast

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Episode 174: Suicide Prevention

Over three quarters of a million people each year take their own life. That's one every 40 seconds.
It's one of the biggest causes of death in people under 30 and by not talking about it people can't gain the knowledge needed to help prevent it. But it is preventable!
No matter who you are there might be something you can do that saves someones life. Maybe even your own.
I believe it starts by being more open about suicide. It's a difficult topic of conversation to have, but the more open we are the less of a stigma there is.
It's interesting that we can talk about other ways of dying relatively easily in comparison. Imagine a conversation in a pub about parents, and someone says "My dad died when I was 18 years old" If someone asks "How?" And they replied "Meningitis" there might be a big discussion about it, it would open up a conversation all about the mysteries of Meningitis.
But if the reply had been "He killed himself" It would be like that scene in An American Werewolf In London where everything just stops and goes quiet.
Even though suicide is nearly 3 times more common a cause of death than meningitis is.
But people don't like talking about suicide, it makes them embarrassed. Maybe because they just don't know what to say. But if this fictitious person's Dad had died of Meningitis what would we say then? Would we just say "Sad, what a shame mate." Probably, and talking about suicide shouldn't be any different.
This reminds me of the myth that talking about suicide encourages people to do it. No it doesn't. If you're genuinely worried about someone then actually straight up asking them "Have you had any thoughts about killing yourself?" Is not going to give them permission to do it, instead it gives them permission to talk about it, to open up to someone.
Usually someone who's suicidal feels that it would burden people by talking about it, so they hide how they feel. So by bringing it out into the open for them can give them a huge sense of relief. That's probably the biggest myth about suicide I'd say, that and the idea that it's selfish. It's not selfish to not want to live, if someone opens up to you about suicidal ideation they don't need a guilt trip, they don't need reminding about what it would do to their family if they died, they already know!
I think some people wrongly assume that in order for someone to kill themselves they mustn't care about their loved ones. Of course they do, it's just that they genuinely believe that the world is a better place without them. Depression can do that, its a crappy trick of the mind and we need to be aware that its a trick, that our brain is conspiring against us.
It might feel as if there are no other options except suicide, but there are, it's just that emotional pain prevents us from seeing them. Depression distorts our thinking so that we can't see any solutions to our problems, that's why we need other people to be there, to help us to see alternatives. Because often someone who is suicidal doesn't want to die, they just don't want to live.

So how does this start? Because if we can nip this in the bud as soon as possible we're going to save lives.
First off, suicidal ideation is different from simply thinking "I could kill myself right now" most people at some point in their life will have that thought, they will think "You know what I could just end this and all my problems would go away." If it's an occasional thought that pops in, that's probably not a big issue. Challenge it by all means but don't worry about it too much. But monitor how you feel because, before it becomes what we call Active Suicidal Ideation, which is making plans and deciding how to do it there's Passive Suicidal Ideation which is simply wishing you were dead. Such as regularly asking yourself :

"What if I was never born?"
"What if I just ceased to exist?"
"What if this bus crashed and I died? Wouldn't that be great?"

Passive Suicidal Ideation can be there for years and not become active, but it's a sign that someone needs help, needs therapy, maybe needs medication.
Sometimes Passive Suicidal Ideation turns into dangerous behaviour, as if tempting the universe to make them die, so that they don't have to formally do it themselves. Things like:

Drug taking
Drinking too much alcohol
Driving under the influence
Speeding
Running red lights
Not wearing seat belts

If someone starts acting this way they might well need to open up about their mental health to someone.
But if they start giving away their possessions and stop making plans for the future. If they're planning their funeral and writing a will even though they're only 30 then they probably need immediate help. Right now!

That starts with listening, letting them talk about how they're feeling. No matter how bad they feel let them get it out!
Talking about how bad they feel doesn't make them feel worse, sometimes people mistakenly think it does because before they spoke about it they weren't acknowledging how they really felt and so by "getting it out there" it means they can't hide it any longer. Yes that might upset some people, and on the surface it seems as if they're taking a step backwards but they're not. They're on the first step to getting well again.

Listen to them
Put your phone away so that they have your full attention and listen
Dont interrupt
Don't feel under pressure to offer advice as such
Don't talk about yourself unless it's genuinely in their interest and just listen to them
Make eye contact
Learn about them

Sometimes that's all they need to create a domino effect that makes them say "I need to see someone don't I?"
Be patient and be ok with silence, we don't have to fill in the gaps when they're quiet. It can take a while to put into words how we're feeling, to pluck up the courage to say what's going on.
Try and avoid closed questions. Closed questions have answers that are just "Yes" or "No" Whereas open ended questions get them talking. "How are you feeling today" is open "Are you feeling ok today?" Is closed.
Practise reflective listening. This is when you confirm what someone has said by repeating back to them and summarising certain important aspects. It's useful for 2 reasons. Firstly it makes sure you've understood them correctly and stops you from making assumptions, but more importantly it proves to them that you're listening. It shows them that that their voice is being heard.
But remember this, it's not your job to fix them. You can help them fix themselves, but there's only so much you can do. Just respect them, listen to them and hard as it is to see someone you care for hurting you must validate how they feel. You'll probably want to say "But you have no reason to want to die, you're great, everyone likes you" But that's not how they feel. They need to tell you how bad they're feeling, and you might invalidate that if you disagree with them.

Help them to find a therapist, take them to their appointments if you want to help. Maybe help pay for their sessions if that's an issue. Ask them to check in with you on a daily basis, if they don't contact you then message them to say you're thinking about them and to let you know how they're getting on.
You might need to prove their depression wrong for them, so often people don't tell their friends how badly they're doing because they think it will push them away. Prove them wrong by being there for them.

It might be hard work doing this so make sure you look after yourself too. I often see people in therapy who are only there because they need a safe place to offload how scared they are for their best friend. So see your own therapist if you have to. You don't need to be suicidal to need support. And if you are? If this is actually you that is going through this. What possible advice can me or anyone offer to you that saves your life?

Well. First off quite simply…

WAIT!

Don't take any action yet. If you're so serious about this that you're moments away from taking your own life. Do it tomorrow instead. It's probably impossible to tell yourself that you're going to rule it out completely, so acknowledge how bad you feel and don't lie to yourself but put it off for a bit.
Tell yourself you'll make a cup of tea first if you have to and procrastinate!
Finish watching that TV show you like first, tell yourself that you'll die at some point but just not today.
If you've been there before, been so low that you felt you had to die right there and then yet you didn't and your mood lifted, then remember that!
If you've thought about killing yourself before and you didn't, recognise that since that point there would have been times that you were glad that you didn't. There would have been some good things have happened since the last time you thought this way, no matter how small. Think about those things because your emotions are not fixed! Your emotional state is in constant flux. How you feel right now might not be the same as how you felt yesterday or how you’ll feel tomorrow or next week.

Do something that would make it as close to impossible to kill yourself. Get out of the house maybe, don't be alone, go somewhere where there are people around you.
Go for a walk
Sit in a coffee shop.
Go to the library
Do anything to feel in some way connected to the outside world

But most importantly. Reach out to someone. Call a friend. Call a hotline. Call the samaritans or Mind or Sane UK, their numbers are below.

Talk to someone and tell them that you need some help making yourself safe. You might need to make your home safer, you might need a friend to look after your medication for you if you have it and be honest with them say "You need to give it me one pill at a time and watch me take it so that I don't hoard it, because I don't trust myself."
Honesty is so important. If you've made that commitment in the moment that "OK I'm not doing it today. I promise myself that it will be tomorrow not today." Then use those 24 hours to explain to people what's really going on. And explain it, don't be vague. Don't just say "I can't go on like this" that's only half the truth.
If the truth is that you are making plans to die then tell them that. Shocking as it is, it's the truth and your friends deserve to know the truth about how you feel. Because suicide is permanent. There's no going back from it.

But it's a permanent solution to what might be only a temporary problem, remember that.


Samaritans UK
116 123
www.samaritans.org

Sane UK
0300 304 7000
www.sane.org.uk

Mind
0300 123 3393
86463
www.mind.org.uk

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