Beyond the Hotline: New Approaches to Suicide Prevention

If I mention suicide prevention, it’s a fair bet that the first thing you think of is some sort of telephone hotline. The first call to an official suicide helpline was made in November 1953 to the Samaritans. The first US Samaritans branch was established in Boston in 1974. Helplines run by charities and other bodies around the world are a vital part of the safety net for people in crisis or thinking of suicide, as well as offering support to friends and family members.

As vital as they are, hotlines are not enough. World Suicide Prevention Day reminds us of the need to raise awareness about suicide and suicidal thinking. It also challenges us to think how we can do more, individually and collectively, to help people stay safe. In this blog post, we’ll explore a range of approaches to suicide prevention. We’ll see how modern technology, community initiatives, and wider policy changes all play a role in developing more holistic strategies for saving lives. Technological approaches in particular are not without potential issues and we’ll look at those too.

The Role of Technology

Modern technology impacts almost every aspect of our lives, and health and mental health are no exceptions. Information, help, and support are now widely available, often with just a few taps on our phones. It’s important to acknowledge the risks of relying too much on online resources and services, but they can offer significant benefits if used wisely.

Mobile Apps for Mental Health Support

“There’s an app for that” was launched as an advertising slogan by Apple in 2010. It’s been widely parodied, but there’s a truth behind the joke. It would be wrong to imagine any and all aspects of human live can be coded to run our mobile devices, but apps can make information, help, and support available to people living with a wide range of mental health conditions. Text and chat lines offer alternatives to traditional telephone hotlines. These are more accessible for anyone living with speech or hearing difficulties, and allow people to reach out in ways they may be more familiar with, or which feel less intimidating. Text-based services also mean it’s possible to access support without the risk of conversations being overheard.

Despite their convenience, services such as these have some potential drawbacks. The relative anonymity they offer can be a barrier to providing more personalised care and offer appropriately targeted support and guidance. There’s also a risk that we may come to rely too much on such tools, rather than seeking support from professional mental health services.

There’s a growing range of apps which offer a broader support to people at risk of suicide or self-harm. Funded by teenage mental health charity stem4, the Calm Harm app aims to help people manage urges to self-harm by offering coping strategies developed from Dialectical Behaviour Therapy (DBT). Apps such as Better Help act as a front door to licenced therapists who offer online counselling sessions. These technologies are part of a growing trend focused on preventative care to manage mental health symptoms, rather than relying solely on crisis management. Potential issues include the quality and regulation of apps and the coping strategies and support they offer.

The Role of Artificial Intelligence

Artificial intelligence (A.I.) and machine learning are likely to play an increasing role in suicide prevention. Social media providers and search engines are already developing tools to identify people who may be struggling or at risk, based on their online activity. As valuable as such approaches may be, they raise legitimate questions about privacy and the potential for malicious or discriminatory misuse of the information gathered. Setting aside the uncertain distinction between monitoring and surveillance, there are risks of bias and misinterpretation by the A.I. engines themselves. These could lead to people being incorrectly referred to crisis services, or someone at genuine risk being missed. The latter might appear more serious, but the former is no less important. Someone who has been incorrectly subjected to a mental health intervention might avoid accessing information or support in the future, in case the same thing happens again. Not everyone experiencing thoughts of suicide or self-harm, or seeking information about such topics online, is at immediate risk or in need of intervention.

Similar technologies underpin chatbots such as Woebot and Wysa, in which people can engage in chat conversations about how they’re feeling. These apps us A.I. to provide respond in real-time depending on what the person has shared about their situation. These tools are no substitute for talking to a real person — a friend, family member, or professional — but they can offer an outside perspective, especially if the person feels unable to discuss what they’re going through with family or friends. In addition to the risks and limitations already mentioned, these services can only be considered a partial solution. No matter the sophistication of the machine learning involved, a chatbot is unlikely to be capable of responding appropriately in highly complex or emotional situations. This limitation applies to humans too, of course. No matter how much we care and want to support our friends and loved ones, we may not always pick up on the clues or respond in the most helpful or appropriate way. Human professionals are not infallible either.

It Takes a Community

Technology has an important role to play, but human connection will always be at the heart of effective strategies to keep people safe.

Peer Support

Whether online or in person, peer support networks offer space for people to share their experiences and support one another. Groups are often led by professionals or trained volunteers, and counter the isolation many people feel concerning their situation, experiences, thoughts, and feelings. Community initiatives often offer social activities such as local walks or other events, building a sense of belonging in addition to providing emotional support, advice, and guidance.

The Role of Education

There’s an increasing acknowledgment that mental health education needs to start early. Integrating mental health awareness into our schools, colleges, and universities helps combat the stigma and discrimination that still surround mental ill health. It also helps equip young people with the information and tools they need to recognise when they, or their friends and loved ones, may be struggling and need additional help and support. A generation of people brought up aware of and educated about mental health is the best strategy for suicide prevention in the long-term.

Courses such as the internationally recognised Mental Health First Aid (MHFA) certification, Applied Suicide Intervention Skills Training (ASIST), and many other mental health and suicide prevention courses are now widely available. These are often provided free or with costs subsidised by employers or other organisations. It’s never been easier to learn more about how to recognise the signs that someone might be struggling, and offer meaningful help and support.

Policy Changes

As important as these approaches are, they do not and cannot operate in a vacuum. Policy changes and advocacy are needed to create and maintain a culture in which mental health is prioritised, with appropriate resources available and accessible to everyone who needs them.

National and Global Initiatives

National governments and international organisations such as the World Health Organisation (WHO) are increasingly focusing on mental health. In many countries, recent policy changes have aimed at improving mental health services by expanding access to care, increasing research funding, and incorporating mental health into their broader public health policies. It remains to be see how effective these changes will be, but it’s encouraging to see initiatives such as the WHO’s Mental Health Action Plan and the United Nations’ Sustainable Development Goals highlight how crucial mental health is to humanity’s overall health and well-being.

Advocacy and Awareness Campaigns

Awareness events such as Time to Talk Day (February), Mental Health Awareness Month (May), World Suicide Prevention Day (September 10), and World Mental Health Day (October 10) play an important role in changing how we think and talk about mental health and suicide. Social media campaigns like #StopSuicide and #ItsOkayToTalk help reduce stigma and encourage open conversations about what have for too long been taboo subjects. These campaigns often go viral, reaching millions of people and spreading messages of hope and support. Grassroots movements are driving change at the local level. Organizations like To Write Love on Her Arms (TWLOHA) and Project Semicolon have built strong and committed communities around the message that suicide is preventable and help is available.

Drawing it all Together

Preventing suicide needs a broad approach that goes beyond the provision of traditional mental health hotlines. While these will always remain a vital resource for people in crisis or needing immediate support, building a robust and effective safety net for everyone at risk requires us to think and act creatively and on a wider scale. On this World Suicide Prevention Day, let’s recognise the importance of both innovation and caution in developing effective strategies. By supporting comprehensive suicide prevention efforts that include both traditional and modern methods, we can work towards a world where everyone has access to the support they need when they need it most.

Further Reading

You can find details of World Suicide Prevention Day at the International Association for Suicide Prevention. Our resources page includes links to crisis lines, support organisations, training resources, and books. UK mental health charity Mind offers a range of help and information if you need support or are concerned for someone else.

Photo by Jenna Anderson at Unsplash.

In a World of My Own: The Gentle Art of Losing Myself

In what the misusers are fond of calling Real Life, Escape is evidently as a rule very practical, and may even be heroic.

— J. R. R. Tolkien, “On Fairy Stories”

Most of my blog posts are inspired by conversations but this time it was an e-mail. My friend Karl got in touch to let me know he’d achieved his black belt distinction in martial arts. One sentence in his e-mail really caught my attention.

Going to the gym is my “quiet place” where, despite the blasting music, I can shut out the noise of external life and just focus on one thing.

You’ll hear more from Karl because I invited him to expand on what his martial arts sessions mean to him. For now, though, I want to explore that one line. I’ve never been inside a gym and can’t imagine doing so. Nevertheless, what Karl said resonated strongly with me. The focus. The sense of being in a world of one’s own. In my case, it’s not gyms and martial arts, though. It’s coffee shops and writing.

I’m there almost every Saturday. (Here, in fact, because that’s where I’m writing this piece right now.) After breakfast I order a second coffee to see me through the coming hours. I catch up on my diary, then set that aside and assemble my writing station. Android tablet and phone on their respective stands. Bluetooth keyboard and headset. I hotspot my tablet to my phone, open the document I’m currently working on, and begin writing. It’s not uncommon for four or five hours to go by. That’s not four hours writing without a break, but for most of it I’m heads down, lost in what I’m doing. In the past I’ve said that the main reason I write is because I’m scared to stop. Karl’s e-mail helped me realise, however, that there’s more to it than that. I value the process of writing, the getting lost in the moment. My Saturday session at the coffee shop is the highlight of my week. I take days off work and spend them there, in this world of my own.

Now that I think about it, writing has always offered me this opportunity, no matter what I was working on at the time. Poetry, articles, short stories, the books I co-wrote with Fran, and now my blog posts. It happens less with my diary. That may be because that’s focused on the here and now of my life, rather than being a creative escape from it. It hasn’t only been writing, though. I remember my six-month university placement in Norwich, losing myself each weekend in the novels I picked up at the market. In Bradford and London, hours dissolving as I worked on painting portraits of my friends. When I first moved to Newcastle, my house-mate and landlady calling goodbye in the morning as I settled down at the dining table to work on my clay models. She’d return in the evening to find me still sitting there as though no more than an hour or so had passed. In more recent years, I remember losing myself working with Photoshop and web design.

The phenomenon is hard to describe from the outside, because by definition it’s characterised by being divorced from present reality. For me, the key features are an intense focus on what I’m doing, and an environment such that I’m not disturbed or jolted out of it. Although I’m focused on what I’m doing, I’m not consciously thinking about the next step. I’m more or less on auto pilot, following my creative instinct wherever it leads. I find background noise a boon rather than a hindrance. I’ve always found low level sound relaxing, especially conversation at a volume just below my ability to follow what’s being said. The background hum of the coffee shop helps me enter the almost meditative space I need. I’ve tried ambient noise apps but there’s no substitute for the real thing.

I was interested to note that Karl’s experience in the gym takes place in a noisy environment (“despite the blasting music I can shut out the noise of external life”). That probably wouldn’t work for me, although at times I’ve achieved success listening to certain music tracks on my headphones, loudly on repeat. I mentioned that I’d asked Karl to expand on his experiences. He gave me permission to use any parts I found relevant but I want to share it in full.

As a friend put it the other day, my Sensei is my other MH [mental health] doctor. Going to the gym is my “quiet place” where, despite the blasting music, I can shut out the noise of external life and just focus on one thing.

Outside of the gym, I’m a father of two, a husband, a specialist in my role at work, but most of all a 45 year old man who suffers with anxiety, depression, anger and low self worth. Inside the gym, I don’t need to be any of those things. I’m accepted for who I am — I’m eternally grateful to the owners of my small Martial Arts gym, who have fostered such a community amongst their members — but I don’t have to “be” anything. If I want to be quiet, and only speak to the person I’m training with, that’s fine. If I want to interact with the rest of the class, that’s fine too.

All of the stresses of the day, whether they are financial, work or familial, stay off the mats. My own personal rule is that my phone is on do-not-disturb for the hour I am in class. My smartwatch remains on my wrist, but when it is tracking a workout, it blocks notifications. For that one hour, to quote Metallica, “Nothing else matters.”

It’s not even about getting rid of aggression, although there is that too, when needed. It’s the scalpel-like focus required to throw a leg-kick which lands in just the right place to impact the lateralus muscle, but to do it without the force to disable the person you are working with. It’s the challenge of doing something better this time than you did last time.

I recently completed my 1^st Dan Black belt examination, and sparring was part of the assessment. For those who don’t know, that means donning protective gear, extra padded gloves, and fighting one on one with a focus on technique and limited power. One of the instructors, who I also view as a friend, was helping out as a sparring partner and he countered almost every move I tried to make. Every punch or kick was blocked, evaded or answered with one of his own. I spoke to him afterwards, and he told me he was deliberately trying to provoke me, to get me to lose my cool, to get me to be out of control. He couldn’t, because I couldn’t — my training is my escape. I find my Zen in violence.

— Karl Douglass

I’m grateful to Karl, not only for contributing to this blog post, but for opening my eyes to a world I know little to nothing about.

As I check the time, I see that a couple of hours have passed since I began working on this post. For this all-too-brief period I’ve experienced what I call the gentle art of losing myself. I wonder whether it’s myself I lose at such times, or my attachment to everything other than myself. Karl writes of setting aside the roles of father, husband, and IT specialist, as well as labels relating to his health and wellbeing. I share some of those, and have many of my own. All are left behind when I enter my creative space, as Karl’s are when he enters the gym. I am, perhaps, more truly me, myself, and I when I’m in my little world than at any other time.

Several of my short stories — written years ago and unpublished beyond a small circle of friends — relate to people losing themselves in parallel worlds. In “Poser,” the portal to this alternative realm is a rogue computer program. The interplay between physical and virtual reality is explored further in “The Palantir of Josef Betz” and “Homeopathy has a word for IT.” In these tales, the alternative realms are perilous, to say the least. They’re a long way from the kind of inner world I’m describing here. There’s a link, however, in the quotation I opened with. In various ways, my short stories are all related to the fictional world of Middle-earth created by J. R. R. Tolkien. His 1947 essay “On Fairy Stories” was written as a defense of the genre and a repudiation of the derogatory charge of escapism levelled against it. It’s something I might explore further on another occasion.

Another hour has slipped by in the coffee shop, in my little world. It’s time to emerge, to re-engage in the real world. Whatever that is.

 

Photo by Hannah Wei at Unsplash.

 

Our Top Posts of the Month (August 2024)

Check out our top posts for the past month. Posts are listed by the number of page views they attracted during the month, most popular first.

1. Shhhhhhh! A Friend’s Guide to Secrets
2. The Box on the Shelf: A Strategy for Handling Difficult Issues and Situations
3. It’s Not Enough / Never Enough
4. I’m Weak and What’s Wrong With That?
5. I’m on My Way: Thoughts Inspired by Ed Sheeran’s “Castle on the Hill”
6. I Believe You. It wasn’t Your Fault. You Are not Alone. Being There for a Friend Who’s Survived Rape or Sexual Abuse
7. I Hope We All Make It
8. One Must Imagine Sisyphus Happy: Encounters With the Absurd Man
9. Why Bucket Lists Don't Work for Me (But a Things I’ve Done List Does)
10. Thank You Anyway: The Gift of Ingratitude

Our most visited pages were:

1. Contact Us
2. Resources
3. Our books
4. About Us
5. News and Appearances
6. Testimonials

 

Photo by Nikolett Emmert at Unsplash.