Use Your Words: Exploring the Power of Narrative for World Suicide Prevention Day

TW: Mention of suicide and suicidal thinking.

Be brave enough to start a conversation that matters.

— Margaret Wheatley (Turning to One Another)

Established in 2003 by the International Association for Suicide Prevention, World Suicide Prevention Day (WSPD) is observed each year on September 10. The theme identified for 2024–2026 is “Changing the Narrative on Suicide”.

Changing the narrative on suicide is about transforming how we perceive this complex issue. It’s about shifting from a culture of silence and lack of understanding to one of openness, empathy, and support. Changing the narrative on suicide aims to inspire individuals, communities, organizations, and governments to engage in open and honest discussions about suicide and suicidal behaviour. By initiating these vital conversations, we can break down barriers, raise awareness, and create better cultures of understanding and support.

Last year in Beyond the Hotline I discussed a range of approaches to suicide prevention. I explored how modern technology, community initiatives, and policy change are vital if we are to develop more holistic strategies for saving lives. This year, I want to focus on the power of language to change the narrative on suicide. Our words are important. We can employ them in various ways to influence how suicidality is perceived and talked about. We can make a difference.

What’s Wrong With the Current Narrative?

The call to change the narrative on suicide implies the existing narrative is unhealthy. What is that narrative and why does it need to be changed? In their post for WSPD 2024, the UK suicide prevention charity Papyrus identified a number of key elements in the prevailing narrative on suicide. Misleading myths and stigmas make it harder for people to reach out for help. These include labelling people who have ended their life as “selfish” or “taking the easy way out.” Other myths include the idea that suicide can’t be prevented, or that asking someone if they’re thinking about suicide will put the idea in their head. As Papyrus put it, “These myths are not true and need to be dispelled to end the stigma.” They also highlighted the fact that suicide awareness and prevention are not obligatory in the [UK] school curriculum. In their words, “It is vital our young people know how to support themselves, keep themselves safe and look after one another.”

Inconsistent reporting and representation of suicide and suicidality also needs to be challenged. Treated sensitively, TV dramas, movies, news, and other media offer valuable opportunities to educate and inform. Explicit or sensationalised treatment, however, can reinforce unhealthy stereotypes. There’s some evidence it can even lead to an increase in suicide rates. According to one recent research study, “The association between suicide reporting in the media and [rates of] suicide appears to be particularly strong following coverage of a celebrity suicide, especially when the suicide method used by the celebrity is reported.” These concerns were highlighted in a 2023 article in Missouri Medicine which focused on how suicide is discussed on social media. The article concludes, ”As far as the authors are aware, there are no formally vetted guidelines created for social media. Guidelines can help ground conversations and lead professionals and creators to discuss suicide safely and more easily.”

Online and offline, inappropriate language reinforces the stigma that already surrounds suicide. The clearest example is the continued use of the term “committed suicide.” This implies suicide is a crime, despite it being decriminalised in the UK in 1961. The lack of a healthy shared vocabulary is highlighted by Papyrus. “Many people are not aware of how to talk safely about suicide. Words have the power to heal, but they also have the power to harm. It is important we speak about suicide sensitively to avoid adding to the stigma and shame that surrounds it, as this can lead those who are having suicidal thoughts to not reach out for the help they need.”

What Would a Healthy Narrative on Suicide Look Like?

A healthy narrative on suicide would be characterised as confident, open, honest, informed, non-judgemental, supportive, and engaged. It would respect the thoughts, feelings, and needs of those in such pain and distress that suicide seems like a viable option. Crucially, it would be underpinned by practical, accessible, and appropriately funded medical, psychiatric, and other support services. This may seem a long way off, but we all have a role to play in moving towards that goal. We can begin by asking ourselves how we think and feel about suicide. This is our personal narrative. We all have one, whether we’ve thought about it before or not. Consider asking yourself the following questions.

What comes to mind when someone mentions suicide?

What are you feeling right now, reading this blog post?

Are you open to talking about suicide? If it’s a difficult topic for you, why is that?

If you learned that someone you know lives with suicidal thoughts, how would you respond? Would it affect your relationship with them?

What do you think when you discover a famous artist or celebrity has taken their life? Does it change how you feel about them and their artistic legacy?

This exercise isn’t about self-criticism or judgement. It’s about being honest about your thoughts, feelings, and perspective on a topic that affects more people than you may realise. As I wrote in a post for WSPD 2023, if you imagine no one you know lives with suicidal thinking, you’re almost certainly wrong.

One in five people in the UK have suicidal thoughts and one in twenty will attempt suicide. Statistics such as these can be hard to grasp, but there will be people in your life — your friends, family, neighbours, and colleagues — with direct experience of suicidal thinking. You might not know who or how many, and it’s not a comfortable realisation, but it’s the simple truth. Many of my friends have had, or still have, thoughts of suicide. Some have made attempts to end their life. Others have not. I know this because it’s not a taboo subject for us and comes up in conversation whenever it needs to.

Exploring our personal narrative on suicide is a good start, but what comes next?

How Can I Contribute to a Healthy Narrative on Suicide?

The first thing we can do is pay attention to the language we use. UK charity Samaritans publish media guidelines for reporting suicide. Equivalent media guidelines are published by Papyrus. Although written for journalists and other professionals, they’re relevant to all of us. The authors of the previously mentioned Missouri Medicine article proposed eight “key strategies to encourage people to responsibly report and discuss suicide on social media.” In brief, these are as follows.

1. Include a content notice or trigger warning
2. Limit details
3. Take care with use of images
4. Take care with the use of language
5. Don’t sensationalise
6. Don’t assume you know why someone died by suicide
7. Monitor and curate comments that other people post
8. Provide messages of hope

I recommend reading the original article for more details. These guidelines are relevant to all of us who post and comment on social media, or any other public platform. Beyond paying more attention to how we talk about suicide, what else can we do?

Consider contributing to the narrative on suicide by sharing your story. This might include your experience of suicidal feelings, your thoughts on suicidality more generally, your experience supporting someone through suicidal thinking or attempts to take their life, or as a suicide survivor. Personal testament can be transformational, whether it’s shared publically or in private conversation and discussion with those we know. This is true generally, not solely with regard to suicide and suicidality. In the words of American inspirational speaker and author Iyanla Vanzant, “It’s important that we share our experiences with other people. Your story will heal you and your story will heal somebody else. When you tell your story, you free yourself and give other people permission to acknowledge their own story.”

This is something I’ve found to be true in my journey as a supportive friend to people whose challenges including mental illness, past trauma and abuse, self-harm, and suicidal thinking. I’ve learned so much from them and from the shared experiences of others. Through our books and this blog I offer my experiences in return in the hope they may inform and help others. As I’ve expressed it elsewhere:

SPEAK YOUR TRUTH. WHISPER IT. SCREAM IT. LIVE IT. YOU NEVER KNOW WHO MIGHT NEED TO HEAR WHAT ONLY YOU CAN SAY. THIS STUFF MATTERS. YOU MATTER.

Perhaps you have little personal experience, or don’t feel confident talking about it. You still have a role to play. Use whatever platforms you have to demonstrate that suicide is not a taboo subject. Follow mental health and suicide prevention accounts. Share other people’s words and posts that treat suicide and suicidality in healthy and positive ways. Challenge and report stigmatising, ignorant, or intolerant behaviour, online and offline.

Consider wearing badges or clothing with positive messages concerning mental health or suicide awareness. A number of organisation offer such merchandise, including Boys Get Sad Too, Live2lives, and To Wear Love On Her Arms. As I’ve written previously, wearing t-shirts is not enough on its own. It nevertheless demonstrates to those around you that you’re a safe person to approach or talk to about subjects which so often are considered taboo.

It’s important to acknowledge that not everyone feels able to share their experiences or engage openly in discussing such personal and sensitive topics. Respecting this is part of a healthy narrative too.

Talk About It If It Keeps You Here

I’ll close with a short but incredibly powerful video by Lauren Nicole Jankowski which was shared on Instagram by NSG (Never Stop Growing).

I met someone at a bar last night and he said the most profound thing I have ever heard. It hit me right in the chest. The conversation was about mental health and grief and how they go hand in hand. And I said I just feel like all my friends are annoyed with me because it’s all I talk about lately. I feel like I talk about my loss too much. And do you know what he said? He set his drink down and he looked at me and he said. “Talk about it if it keeps you here.”

I literally had goosebumps. I didn’t even know what to say back. How true and important is that statement? There’s no such thing as talking about mental health too much, talking about your struggles too much, talking about your loss and grief too much, if that is what’s keeping you here. If that is what is helping you heal. If that is what is getting you through the damn day. Talk about it. Talk about it so you stay.

Lauren captures perfectly the power of words, of talking about our pain, of sharing our story. And of holding space for others to do so, whether it’s someone we know well or someone we meet once in a bar. Make your words and spaces kind. You might give someone the hope to go on for one more day. You might just save a life.

 

Photo by Andreas Fickl on Unsplash.

 

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.

Breaking the Silence: Talking About Suicide to Create Hope

Suicidal ideation has less power when it is verbalised. — Fran Houston

To mark World Suicide Prevention Day our book High Tide Low Tide: The Caring Friend’s Guide to Bipolar Disorder will be free on Kindle between September 10–14, 2023.

Established in 2003 by the International Association for Suicide Prevention in conjunction with the World Health Organisation, World Suicide Prevention Day (WSPD) is observed each year on September 10. The theme for WSPD 2021–2023 is Creating Hope Through Action. According to the World Health Organisation, this “serves as a powerful call to action and reminder that there is an alternative to suicide and that through our actions we can encourage hope and strengthen prevention. By creating hope through action, we can signal to people experiencing suicidal thoughts that there is hope and that we care and want to support them. It also suggests that our actions, no matter how big or small, may provide hope to those who are struggling.”

That sounds great, but what can we possibly do as individuals to help someone thinking about ending their life? What difference can we make? In this post I’m going to focus on one way we can all contribute to keeping each other safe, which is by having open conversations about suicide and suicidal thinking.

The Power of Conversation in Suicide Prevention

According to suicide prevention charity Grassroots, approximately 120 people die by suicide every week in the UK. One in five people in the UK have suicidal thoughts and one in twenty will attempt suicide. Statistics such as these can be hard to grasp, but there will be people in your life — your friends, family, neighbours, and colleagues — with direct experience of suicidal thinking. You might not know who or how many, and it’s not a comfortable realisation, but it’s the simple truth. Many of my friends have had, or still have, thoughts of suicide. Some have made attempts to end their life. Others have not. I know this because it’s not a taboo subject for us and comes up in conversation whenever it needs to.

Whether it’s talking someone out of a dangerous situation, helping to counter the stigma of suicidality, or holding space for a friend or loved one to share what they’re going through, talking matters. Listening matters even more. Conversations can literally be the difference between despair and hope, between death and life. Fran expresses this well in the epilogue to our book.

It’s true when I say I would be dead if Marty hadn’t come along. So much hurt, so much pain, so much rejection, it made no sense to stay. [...] Friends like Marty who are willing to be with me in the darkness are the ones who give me light. Yes there are medications. Yes there is therapy. Yes there is personal responsibility. But caring friendship is the best medicine of all. Then life begins to have purpose.

She ends with a call to action that captures the essence of WSPD for me. “Stick around. It may not be easy but you can help someone make a life worth living. Maybe even save a life.”

Overcoming the Fear of Discussing Suicide

There are many reasons someone might not want to talk about their mental health but there are also reasons we may hesitate to open a conversation with someone who’s struggling or feeling suicidal. The most obvious of these is fear. It’s scary to hear someone we care about tell us they have thoughts of hurting themself or putting their life at risk. Once someone has shared that with us — and doing so represents a huge leap of trust on their behalf — there’s no way to unhear it. There’s no shame in admitting we feel afraid to go there. It’s an important step towards overcoming those fears, or setting them aside for the moment, and offering support to those we care about.

On the other hand, don’t worry if you don’t feel scared about discussing these things. In the early days of our friendship Fran was intensely manic and more or less constantly suicidal. Many people, including some who had known her a long time, were fearful and worried about her behaviour. I didn’t feel that way, but was unsure whether my ability to remain calm meant I was ill-equipped to support her effectively. I came to realise that my ability to remain calm made me the person she needed. As I wrote at the time, “[p]ositive, supportive and vigilant care is far healthier for Fran than any amount of fear-based worrying.”

Another reason we might hold back is the thought of being responsible for the person’s safety. I’ll cover suicide awareness and prevention training in the next section, but something I’ve learned from Fran and others is that not every conversation about suicide is a crisis situation. I think this fact is often overlooked. Holding space for someone to share their thoughts and feelings when they’re not actively suicidal is profoundly protective, not least because it demonstrates you’re someone they can feel safe with. We need to normalise talking about suicide because it’s such a common experience, and yet is so often stigmatised as dangerous and taboo, or solely the responsibility of professionals.

Of course, sometimes the person is actively suicidal and we need to be prepared for that possibility. One of the first things you’re taught in any suicide awareness or prevention training is that asking someone directly if they’re thinking of suicide won’t put the idea into their head or push them to do something they otherwise wouldn’t have done. If they say yes, ask if they’re planning to take action. If so, treat it seriously and be prepared to involve appropriate professional services if necessary. I’ve asked these questions on various occasions. Most times, the person wasn’t in immediate danger, and we’ve talked about what was going on for them and what steps they might take to stay safe. I’ve also called an ambulance for a friend who told me they’d taken an overdose and needed immediate medical assistance.

Being friends with someone who talks about wanting to die can be stressful, so remember to pay as close attention to your well-being as to theirs. Check out our article How to Take Care of Yourself When Your Friend is Suicidal for suggestions and tips.

Promoting Understanding and Empathy

As well as having private conversations, we can promote wider understanding and empathy in other ways. A good place to start is to be aware of the words we use when discussing suicide. The most obvious is to stop saying “committed suicide” and to challenge the term wherever we encounter it. A social media post by NAMI Bucks County PA puts the case powerfully.

People can die from the unbearable weight of life, people can die from broken hearts, and people can die from not understanding how to navigate a complicated mental health system. People do not, however, commit suicide. Suicide is not a crime. People die by suicide. Let’s update our language and fight to Improve our mental health system. Mental health support and improved access to better treatment IS suicide prevention.

For more on this check out Language Matters by the Public Health Agency of Canada and CNN’s article The words to say — and not to say — about suicide.

Reading or listening to other people’s experiences is another powerful route to understanding. My friend and fellow mental health blogger Aimee Wilson writes with great honestly about her lived experience including suicidality and self-harm at I’m NOT Disordered. Kevin Hines is an American suicide prevention speaker and author who attempted to take his life in 2000 by jumping from the Golden Gate Bridge in San Francisco. You can read his story on his website which links to a great deal of inspiring and educational content. Jonny Benjamin’s book The Stranger on the Bridge tells the story of finding himself on Waterloo Bridge in London in 2008 and his search to find the passing stranger who talked him down to safety. I met Jonny in 2019 at an event he attended with other speakers. You can read my account of the event in The Stranger on the Bridge and Other Stories of Friendship and Support.

There are also a number of excellent online courses on suicide awareness and prevention, many of which are free to take.

The single most important thing I’ve learned about suicidality is that it’s not the same for everyone and can take many forms. In our book we describe several ways suicidal thinking manifests for Fran. These include relentless thinking, situational and stress-induced thinking, hopelessness and despair, and suicide by proxy. All are serious, but they’re amenable to different forms of intervention. A change in medication dramatically decreased the frequency and impact of her relentless thoughts but had less impact on the other forms.

This isn’t unique to Fran. I’ve learned from other friends that coping strategies which counter some thoughts of suicidality and self-harm are ineffective in other situations. It’s not that the person isn’t trying hard enough to stay safe. The techniques available to them are simply not strong enough to counter the impulse to put their health, or their life, in danger. I can never truly understand what it’s like to be in such a situation but talking about it helps me appreciate that suicidality is never as black-and-white as it’s often portrayed.

Insight can be found in unexpected places. I recently came across a short video by Taylor Swift in which she talked about her song “This Is Me Trying.”

I’ve been thinking about people who, if they’re either suffering through mental illness, or they’re suffering through addiction, or they have an everyday struggle, no one pats them on the back every day but every day they are actively fighting something. But there are so many days that nobody gives them credit for that. And so how often must somebody who’s in that sort of internal struggle wanna say to everyone in the room “You have no idea how close I am to going back to a dark place.”

Keep your eyes and ears open when you’re online or talking with the people around you. Opportunities to grow, to learn, and to promote greater understanding are everywhere.

Navigating Sensitive Discussions with Empathy

Talking about suicide might be healthy and helpful, but what about the conversations themselves? What are they like? Our book High Tide, Low Tide contains many examples of our actual conversations, including times when Fran was suicidal. I’ve also written about this previously in What Does Having a Conversation about Mental Health Look Like? For now I’ll focus on two of the most important skills: not interrupting and asking questions.

Listening without interrupting is something I find particularly difficult, as Fran and other friends of mine can attest. The impulse to interrupt their story with suggestions and advice can be almost overwhelming. Interruptions are rarely appreciated, however. They can come across as me not paying attention, dismissing their concerns, or intervening with well-meaning but not necessarily helpful suggestions. Resist the temptation to say “I understand” unless you truly do have relevant lived experience. I’ve never had thoughts of suicide or self-harm, and although I’ve talked with many people who do, I’d never presume to know what it’s like to be in such a situation.

Asking questions might seem contradictory when I’ve just stressed not interrupting the person who’s talking, but asking the right questions at the right time in the right way is an important skill. The following passage from Sometimes We Need to Ask the Questions relates specifically to conversations about suicide and suicidal thinking.

Asking questions is not a passive activity. A question invites a response, and you may not get back what you anticipated or are comfortable with. [...] If your friend appears to be struggling, be prepared to ask the important questions.

Are you feeling suicidal, or thinking of doing something to harm yourself?

Do you feel you are safe right now?

Do we need to think about how to help you stay safe?

Also ask how your friend would like you to proceed if you become concerned for their safety. Respect their wishes and opinions, but be clear that you will involve other people or support services if necessary. That way you both know where you stand.

I was talking to a friend a few weeks ago about their recent experiences with mental health services. They mentioned that sometimes the crisis team was helpful and sometimes not. I was interested to know what advice or suggestions had helped. My question led to a valuable conversation about what my friend finds protective and what doesn’t work for them. I’ve had similar discussions with other friends. Such conversations increase my awareness of what my friends are going through. More importantly, they foster trust and normalise talking about things they live with on an ongoing basis.

As I wrote in Eight Things I’ve Learned about Suicidality and Self-Harm if you’ve never been in so dark a place, think about it this way. If there was something that was always or often in your mind, a part of your lived experience, and there was no one you could mention it to or talk to about it, how alone would you feel?

Further Reading and Resources

For more information and resources relating to World Suicide Prevention Day, suicide awareness, and suicide prevention, visit the International Association for Suicide Prevention, the World Health Organisation, Samaritans, and Grassroots Suicide Prevention.

We’ve shared a number of relevant articles over the years, including our curated list of posts for mental health awareness days and events, and a selection of articles for World Suicide Prevention Day.

Our resources page has links to international suicide 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 Etienne Boulanger at Unsplash.

 

How Are You, Really? Eight Things I've Learned About Suicidality and Self-Harm

Suicidal ideation has less power when it is verbalised. — Fran Houston

I’ve written a few “things I’ve learned about” articles, including Three Things I Wish People Knew about Loving Someone with Mental Illness, Three Things I’ve Learned About Mental Health Medication, and Four Things It’s Hard for a Mental Health Ally to Hear. This time, I want to talk about two of the most challenging topics of all, suicidality and self-harm. In doing so I’ll draw on my experience with Fran and other friends over the past dozen years or so, as well as training I’ve undertaken including Mental Health First Aid (MHFA), ASIST, and a range of other suicide prevention and awareness courses. I’ll close with a selection of relevant articles we’ve shared previously, and links to crisis lines and other support resources.

1. You know someone who lives with thoughts of suicide or self-harm

According to suicide prevention charity Grassroots, one person in four in the UK experiences mental ill-health in their lifetime, one in five thinks about suicide, and one in fifteen attempts suicide. Young Minds, a UK charity working for children and young people’s mental health, says that in 2018-19 almost a quarter of seventeen-year-olds reported having self-harmed in the previous year, and seven per cent reported having self-harmed with suicidal intent at some point in their lives.

I struggle to get my head around numbers like this, but most of my friends live with a diagnosed mental health condition. Many have experience of suicidal thinking or self-harm. Some have hurt themselves or attempted to take their life. I know this because we’ve talked about it. Whether you realise it or not, whether they mention it to you or not, you know someone who lives with thoughts like these. Probably more than one. That may or may not be an easy realisation, but it’s true.

2. There are many kinds of suicidality and self-harm

I have no first-hand experience of suicide or self-harm. Before talking with Fran and others, I had only the most naive idea of what these terms represent. If I thought of them at all, I thought only of desperation and crisis. I’ve learned how dangerous such naivety can be, and how important it is to appreciate the variation in people’s experience.

In our book Fran and I explore five kinds of suicidal thinking: relentless thinking, suicidal thoughts triggered by situations and stress, hopelessness and despair, suicide by proxy, and focus on suicidal methods. Our discussion is based on how suicidality presents for Fran, but every person’s experience is different. The same is true of self-harm. There are many ways someone might hurt themself, and a wide range of motivations for doing so.

3. Focus on what’s happening not the labels

The distinction between suicidality and self-harm isn’t always clear-cut. As described by the Centre for Suicide Prevention, some researchers place all forms of self-injury on a “suicidal continuum” whilst others consider suicidality and self-harm to be completely different behaviours.

Part of the problem with labeling someone’s behaviour or actions as suicidality or self-harm (or both, or neither) comes down to intention. That’s never easy to gauge. Is my friend suicidal or just having a really rough time? Are they handling suicidal thoughts and feelings with no intention of acting on them, or do they have a plan? Was my friend’s injury self-harm, an attempt at suicide, an accident, or a symptom of something else? It’s important to respect the perspective of the person concerned. I’ve written about this previously.

When it comes to something as complex as suicidality and self-harm, the best approach is to start from the individual person’s perspective, experiences and needs. And if we cannot guess what those are — and we cannot — we need to be prepared to ask the questions.

This is important because while labels have their uses, they can also get in the way. A few years ago I wrote a blog post that explored how I felt when one of my friends hurt themself badly. I was proud of the article. It was raw and honest, and paid due regard to my friend’s experience and mine. We agreed to publish it, but at the last moment we clashed over my labeling it self-harm. By insisting on my interpretation of events, I lost the opportunity to share my experience of a challenging, but ultimately valuable, episode in our relationship as friends.

However we label them, these thoughts, feelings, and impulses arise in situations characterised by distress. I wrote the following notes while taking Carolyn Spring’s online course Dealing with Distress: Working with Suicide and Self-Harm:

The assumption that suicidality is driven by mental illness (rather than by distress) leads to a focus on treating the illness (medical model). The suicidal person doesn’t want diagnosing and treating. They want relief from their pain, and the hope that their pain can get better in the long run. So the focus should be on relieving their pain.

I’ve learned to pay attention to what my friend is going through, and what that means for them, rather than worrying too much what we call it.

4. Holding a safe space is profoundly protective

It’s easy to react out of fear if someone tells you they have thoughts of suicide or self-harm. Knee-jerk responses are unlikely to help, though, and can be unhelpful. As Fran told me recently, “[t]he worst thing someone can do is to be shocked. A much better response is ‘tell me more about how you feel.’” If we’re prepared to listen without judgment we open a space in which both people can feel safe.

It’s hard to overstate how important this can be. Fran’s told me many times over the years that she wouldn’t be here if it wasn’t for our friendship. I take her at her word. We all have a role to play in normalising talking about suicide and self-harm. I agree with Fran when she says, “[t]he most important message is not keeping suicidality in the dark, because when it’s kept in the dark people either have to shut down or shut up. Suicidal ideation has less power when it is verbalised.”

If you’ve never been in so dark a place, think about it this way. If there was something that was always or often in your mind, a part of your lived experience, and there was no one you could mention it to or talk to about it, how alone would you feel?

5. It’s not easy to hear but it’s harder to live with

It’s not easy to listen as someone we care about shares thoughts of suicide or self-harm. It’s okay to acknowledge this. Our feelings are valid. But if it’s difficult for us, imagine how much harder it is for them. What your friend or loved one is going through may be a one-off. It may be the first time it’s happened, or a repeat of something they hoped was behind them. It might be something they deal with all the time or on a recurring basis. Whatever it is, this is part of their reality. If they trust you enough to tell you about it, that says a great deal about your relationship. How you respond says a great deal about you.

6. It’s not selfish and it’s not a failure

This one divides opinion but for me there is no moral component to suicide or self-harm. People who live with suicidal thoughts and feelings, people who have attempted to take their lives or have hurt themselves in the past, are not worse for having done so. They haven’t committed a sin. They’re not being selfish. They’re not attention-seekers. They’re not weak or failing at life.

I’ve always told Fran I’d do anything I could to help her stay alive, but if she took her life, I wouldn’t hate her for it. My promise may seem naive but it was instinctive and heart-felt. I feel the same to this day. I explored my response to friends telling me about self-harm or other “failings” a few years ago, in a post titled I Wasn’t Disappointed in You When.

I wasn’t disappointed in you when you told me you cut yourself. Although maybe it seemed that way when I said remember I’m here. Don’t ever feel you’d be a burden or that I’d be too busy or asleep. As though I can make the demons go away.

Although I’m not disappointed in my friends if they experience a set-back, they might well be. Their feelings, be they of frustration, anger, or shame, deserve my respect, whether I agree with them or not. As I’ve written elsewhere, “[i]t takes enormous courage to acknowledge you’ve resorted to behaviours you’re trying to leave behind, to pick yourself up, and continue the journey. That’s the hallmark of a hero, not a failure.”

7. Don’t assume it’s a crisis

Suicidality and self-harm come up regularly when I’m talking with friends. They’re not in danger. They’re simply sharing what’s going on for them, the way any of us might discuss issues we’re dealing with. In my view, this aspect is overlooked in almost all public discussion and awareness training. As valuable as these are, they tend to treat any mention of suicide or self-harm as requiring intervention. I believe people need to feel safe sharing their thoughts and feelings without it leading automatically to someone pulling the emergency cord.

I’ve had friends wary of talking to me at all because they were scared I’d escalate things and call the police or an ambulance. Fran expressed this perfectly in a recent conversation. “People seem to want to fix us,” she said. “We don’t need fixing. We need acceptance, just as we are.”

8. Be prepared in case it is

That said, sometimes it is a crisis, and we need to know what to do. Supporting someone in crisis can take many forms, from calling an ambulance, giving them a ride to hospital, or keeping them company in person or online. It helps if you’ve discussed in advance what your friend or loved one might need in such a situation. They might have a crisis plan they’re happy to share with you. Examples include Fran’s travel wellness plan which we describe in our book, and the Wellness Recovery Action Plan (WRAP) developed by Mary Ellen Copeland.

It’s a good idea to keep a few emergency contact details close to hand, such as those listed on our resources page. I have a number of local hospitals in the GPS (satnav) app on my phone in case I need to drive there at a moment’s notice. Consider taking some self-harm or suicide awareness training. Many such courses are low cost or free to access online.

Once the immediate crisis is past, let them know you’re there for them if they want to talk about what they’ve been through. Respect the fact that they might not wish to do so, at least not immediately. Being there when things were desperate doesn’t give you an automatic right to an explanation.

Further Reading

We’ve shared a number of articles dealing with suicidality and self-harm over the years.

Selected Articles for World Suicide Prevention Day 2020

17 Online Suicide Awareness Courses and Podcasts

A Heap of “S” Words and an Aitch: Stigma, Suicide, Self-Harm — and Hope

She Is So Not OK: Being There When Your Friend Is Suicidal

Self-Harm, Addiction, and Recovery: Thoughts Inspired by My Friend’s 365 Day Milestone

How to Take Care of Yourself When Your Friend is Suicidal

Attending a Self-Harm Awareness Session at ReCoCo

Our resources page includes links to suicide 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.

Over to You

In this post I’ve shared some of the things I’ve learned about suicidality and self-harm. I’d welcome your thoughts and experiences on these subjects, whether in the comments below or via our contact page.

 

Photo by Finn at Unsplash.

 

Free Books for World Suicide Prevention Day

To mark World Suicide Prevention Day 2021 Fran and I are offering our book HIGH TIDE LOW TIDE for FREE on Kindle for five days between Friday September 10 and Tuesday September 14, inclusive.

Once the free offer is over the prices will go back to normal.

In High Tide, Low Tide: The Caring Friend’s Guide to Bipolar Disorder we share what we’ve learned about growing a supportive, mutually rewarding friendship between a “well one” and an “ill one.” With no-nonsense advice from the caring friend’s point of view, original approaches, and practical tips, our book is illustrated with real-life conversations and examples.

Buy it here.

World Suicide Prevention Day (WSPD) was established in 2003 by the International Association for Suicide Prevention in conjunction with the World Health Organisation. This year’s theme is Creating Hope Through Action:

Creating Hope Through Action is a reminder that there is an alternative to suicide and aims to inspire confidence and light in all of us; that our actions, no matter how big or small, may provide hope to those who are struggling. Preventing suicide is often possible and you are a key player in its prevention.

Through action, you can make a difference to someone in their darkest moments — as a member of society, as a child, as a parent, as a friend, as a colleague or as a neighbour. We can all play a role in supporting those experiencing a suicidal crisis or those bereaved by suicide.

This is a topic very close to our hearts and never far from our thoughts. Suicidal thinking has been part of my friendship with Fran since we met ten years ago, and we devote one chapter of our book to dealing with how to support a friend who is feeling suicidal.

For more information check out the following links.

• World Suicide Prevention Day 2021 (Rethink Mental Illness)
• World Suicide Prevention Day 2021 (IASP)
• Selected Articles for World Suicide Prevention Day
• Online Suicide Awareness and Prevention Training and Podcasts

 

Maybe Even Save a Life: Our Message of Hope for World Suicide Prevention Day

It may not be easy but you can help someone make a life worth living. Maybe even save a life. (Fran Houston)

World Suicide Prevention Day (WSPD) was established in 2003 by the International Association for Suicide Prevention in conjunction with the World Health Organisation. This year’s theme is Creating Hope Through Action:

Creating Hope Through Action is a reminder that there is an alternative to suicide and aims to inspire confidence and light in all of us; that our actions, no matter how big or small, may provide hope to those who are struggling. Preventing suicide is often possible and you are a key player in its prevention. Through action, you can make a difference to someone in their darkest moments — as a member of society, as a child, as a parent, as a friend, as a colleague or as a neighbour. We can all play a role in supporting those experiencing a suicidal crisis or those bereaved by suicide.

This is a topic very close to our hearts and never far from our thoughts. Suicidal thinking has been part of my friendship with Fran since we met ten years ago. Indeed, it’s how we met, when we each reached out to a young woman who was expressing suicidal thoughts on her social media page.

For WSPD 2020, we posted a selection of relevant articles from our blog. This year, we’re sharing an excerpt from the chapter of our book High Tide, Low Tide: The Caring Friend’s Guide to Bipolar Disorder which deals with supporting someone when they’re feeling suicidal. In the spirit of “creating hope through action” we hope it conveys the vital message that each one of us can make a difference to those we care about.

High Tide, Low Tide will be available FREE on Kindle for five days, September 10–14, 2021.

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How Can I Leave?

I remember clearly the first time Fran told me our friendship was one of the main things keeping her alive. I was profoundly moved, but had the presence of mind to realise this was not as simple as it appeared. In a moment of insight I said, “You may come to hate me for that, Fran.” Her reply was immediate and sincere. “I’m already there.” It has become something of a private joke between us, but it is a joke with edges.

Fran: I wish I hadn’t met you. I’d be gone already.

Martin: I told you long ago, Fran, that you would come to hate me for that. You’d better get used to it. You have years of hating me ahead of you!

I asked her once if she truly believed she would not be alive if it were not for me. “Yes it is true. You hold me here. You nag and pull and push at me all the time with your love and your care. How can I leave?”

Nagging aside, I help Fran best by staying with her, listening to what she is saying, and then engaging with her calmly. I bring negative or skewed thinking to her attention, offering positive alternatives wherever possible, but I never dismiss or trivialise what she is going through. I do not tell her not to worry, or that everything will be all right. I have never promised to keep our conversations secret if I believed secrecy would endanger her. Fran knows I would do everything in my power to keep her alive, including bringing in other people and agencies if it became necessary.

But it would be wrong to imagine I never feel scared or get things wrong. In the summer of 2013, Fran was traveling in Europe with her parents. At the end of a particularly hard day, we shared a thirty minute telephone call, the longest we had managed in several days. The following is from my diary, written later that evening.

Fran was pretty drunk tonight and I got on her case about that without listening to her side of things. Towards the end of the call she suddenly became very weepy about how much she loves her Mom. I stayed with her until she was cried out, and then we parted so she could walk back to the hotel. I haven’t heard from her since. Given how tipsy and tearful she was, I could do with knowing she got back OK. I’ve texted her and left messages, but no reply yet.

What I failed to record in my diary, because I scarcely dared to, was that before bursting into tears Fran had said, “If I don’t make it back to the hotel, I need Mom to know how much I love her.” She had never spoken like that before, but I did not challenge her or ask what she meant, perhaps because I had already given her a rough time about her drinking. I said she could count on me to tell her mother if anything ever happened to her. That seemed to reassure her, but after we parted, I started to worry. Had she, even subconsciously, been hinting at something darker? I did not seriously believe she intended to kill herself, but it was a horrible feeling, which deepened as the hours passed. What if she had stepped into traffic, or thrown herself from a bridge? What if that conversation had been our last? What would her mother think of me? Her friends? Everyone would blame me for not keeping her safe.

I went to bed, but kept waking and checking my phone for messages. I finally heard from Fran around five thirty in the morning (six thirty for Fran). She had reached the hotel without incident, but had then been sick and still felt poorly. She had tried to contact me, but the hotel’s Internet service was down and she had only a poor phone signal. I mentioned our telephone conversation. She scarcely remembered it, but assured me she had definitely not felt suicidal.

The experience taught me to stay focused on what is happening whenever I am with Fran, and to bring any hint of dark or suicidal thinking into the open, rather than ignore or dismiss it. If your friend lives with suicidal thinking, or has made a suicide attempt in the past, I recommend educating yourself about a subject that can be difficult and painful — yet also extraordinary and courageous — to approach. We look at awareness and education later in this chapter. In an emergency, or if you are in any doubt as to your friend’s safety, do not hesitate to contact a doctor, hospital emergency department, or crisis helpline.

A Promise Is a Promise

Long before we met, Fran made a commitment to her psychiatrist that she would not kill herself without contacting him first. In her words, “It was a soul promise, made eye to eye.” She still considers it in force. It is arguable how much weight her word would carry in a time of crisis, but I knew from the beginning I would never ask her to make an equivalent commitment to me.

One thing, Fran ... and this is something I have wanted to say to you for a while. I will never ask you to give me your word not to kill yourself. That is a lie of course. In desperation I would beg you to promise. On my bleeding knees I would beg you. But if I cannot trust your word already given (and more importantly if you cannot), if you ever reach a place where that is not enough, what difference would a promise to me make?

I once told Fran that if she ever chose to leave, I would not hate her for it. That might seem at best naive, and at worst dangerously close to condoning her suicide, but my promise was instinctive and heart-felt. I also believe it to be protective. Fran later told me how important my words were to her. Paradoxically, they gave her strength to go on. Most people, she said, “try to lay guilt on you about how bad they’d feel if you killed yourself.” That argument would never persuade her, but dealing with it drained her of the energy she needed to fight to stay alive. My promise not to hate her finds an echo in the words a friend shared with us concerning her son’s attempt to end his life.

When I got to the hospital that night, I decided that if he died, today or any other day, it would be OK. But I needed to tell him that. So I told him, I cannot comprehend why he is the way he is, but, if he succeeds one day, I just want him to know. It will be OK, because alive or dead, happy or sad, no matter what ... I LOVE YOU.

Other Hands and Other Hearts

I am not the only person Fran has to turn to. In addition to a committed support team she has friends she trusts to help keep her safe. It is hard to overemphasise how important it is for your friend to have a trusted support network. In a moment of crisis, one person may be available to help when others are not. Early in our friendship, Fran was calling or e-mailing me many times a day. On one occasion I was busy at work and failed to respond. Thankfully, she called another friend who made time to talk with her. I contacted him the following day.

Fran told me you talked with her yesterday, and how important (literally life-savingly important) that was to her. How you know how to handle her like no one else can (I guess we each do in our different ways). I wasn’t available for her yesterday when she was trying to call me. I was at work and had to go Do Not Disturb. I didn’t know she wanted more than a chat. But it wasn’t me she needed, it was you.

I asked Fran what he had said to her. “He said, ‘You just need to stay alive until tomorrow, Fran. You can do it.’”

 

Excerpted from chapter 7, “The ‘S’ Word: Being There When Your Friend Is Suicidal,” of our book High Tide, Low Tide: The Caring Friend’s Guide to Bipolar Disorder.

 

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Resources and Links

World Suicide Prevention Day 2021 (Rethink Mental Illness)

World Suicide Prevention Day 2021 (IASP)

Selected Articles for #WorldSuicidePreventionDay 2020

Online Suicide Awareness and Prevention Training and Podcasts

If You Need Help

Our resources page has links to suicide crisis lines and support organisations, training resources, and books. UK mental health charity Mind offers help and information if you need support or are concerned for someone else. The IASP has links to international helpline and crisis centre organisations.