We all know someone – whether it’s a friend, family member, or even ourselves – who has struggled with mental health.
The Victorian Department of Health and Human Services tells us that one in five Australians has a mental illness or disorder, and 45% of us will experience a mental health condition in our lifetime.
Mental illness has no boundaries.
It can affect a young child, a grandparent, the rich, the poor, people of all races, genders, religions and faiths.
Denise Lacey, CatholicCare’s Gippsland Regional Manager, knows this all too well. She sees how prevalent mental illness is within the programs and services she manages in Gippsland – Counselling, Emergency Relief, and Parenting After Separation Support in particular.
Denise recently spoke at the Loved and Worthwhile event in Gippsland – a free community event hosted by Mindful Australia, offering support and resources for people experiencing mental health challenges and for those supporting a loved one.
‘It was quite an amazing experience as the focus was on suicide and coping with bush fire recovery,’ says Denise. One of Denise’s colleagues, Narelle, also attended the event - ‘It was an incredibly emotional and confronting day. The event was attended by nearly 200 people and many of those attendees were young people. It was so humbling to be there and be part of the day.’
It is particularly relevant to discuss suicide today, on World Suicide Prevention Day.
Suicide has always been, and will continue to be, a difficult and challenging topic. But ignoring it will not make it go away.
In fact, talking about suicide can save lives.
So what can you do if you’re seriously worried about a someone’s mental health?
Some people are reluctant to ask someone if they have had suicidal thoughts, for the fear it could put the idea into their head. Research shows that this is simply not true*.
So how do you talk to someone about their mental health, and how do you ask them if they have had suicidal thoughts?
Mental Health First Aid courses teach the ALGEE method**, by which you:
Approach the person, Assess and Assist with any crisis
Listen and communicate non-judgementally
Give support and information
Encourage the person to get appropriate professional help
Encourage other supports
Depending on the situation, you may not follow these steps in order, but it is important to consider them all when addressing a mental health related concern.
Approach, Assess, Assist
If you’re worried about someone’s mental health, approach them about your concerns and make sure this is done privately. You can choose a suitable time for you both to chat, or you can let them know that you are available to talk when they are ready.
As you talk with them, assess them and look out for any indication that they may be in crisis. If you’re concerned that the person may be having suicidal thoughts, you will need to ask them directly and provide assistance.
How to ask about suicidal thoughts
It’s important to consider how you may ask someone about suicidal thoughts, because you don’t want to ask in a leading or judgemental way - saying something like “You’re not thinking of doing anything stupid are you?” could hinder your discussion and break trust with the individual.
Some suggestions for asking about suicidal thoughts are:
“Are you having thoughts of suicide?”
“Are you thinking about killing yourself?”
It is also recommended to never use the phrase “commit” when discussing suicide. “Committing suicide” makes it sound like a crime and has negative and judgemental connotations. We don’t want to make the person feel ashamed of having these thoughts - it is not their fault.
Just remember that it’s more important to ask the question rather than worrying about how you ask or word it. Asking the question shows the person that someone cares about them, and provides them with the opportunity to talk about their thoughts, feelings and issues.
It can be very difficult and emotional to ask someone about suicidal thoughts, so try saying the question out loud when you are by yourself. This will make it easier to ask when speaking to someone directly.
If there appears to be an immediate risk to the person’s life (if they are threatening to kill themselves, if they are looking for pills, weapons or other means to end their life (or if they already have one of these means), or if they are enraged and angry, it is important to provide immediate assistance. If the person is relatively calm and non-threatening, you may call the emergency SuicideLine on 1300 651 251 or call for an ambulance by dialling 000. If the person is threatening and enraged or has a weapon, call 000 and ask for police.
Be aware that the person may feel betrayed and show anger towards you for making any of these calls for professional help. Make sure you do not put yourself in danger, and remember that what you’re doing is in the best interests of the suicidal person.
Listen (and communicate non-judgementally)
If the person says that they are having suicidal thoughts, try to appear calm and maintain composure. Show empathy and acceptance, and truly listen to what they tell you (not only to what they’re telling you, but also how they say it). You can learn about good listening skills here.
After listening to what they have to say, you can ask whether they have a plan for suicide, whether they have decided when they will carry out that plan, and whether they have already taken steps to secure the means to end their life.
You can also respectfully ask if they have been using drugs or alcohol, if they have attempted suicide in the past, whether they have told anyone else about their feelings, and whether they have received any treatment for mental health problems.
If the person wants you to promise not to tell anyone what they have told you (about their suicidal thoughts or plans for suicide), you must never agree to this. Keeping this secret may place their life at risk, and lying to them will betray their trust.
Instead, you can give them an explanation as to why you can’t promise to keep it secret – “I care about you too much to keep a secret like this. You need help and I am here to help you get it” or “Your wellbeing and safety is really important to me, and I know that with extra help we can get through this together. Let’s discuss who we can contact for help.”
Involving them in decisions, and telling them you can make decisions together, can coax them to agree to access further support. If the person refuses to give you permission to disclose their information, you will need to be honest with them and tell them who you will be notifying or contacting. They may be angry at you, but it is more important to get help and prevent losing them to suicide.
Give support and information
Once the person has had a chance to fully express their feelings and issues, the next step is to discuss possible actions.
If a person has told you they have had suicidal thoughts, they must not be left on their own. Work collaboratively with the person to find solutions, rather than acting alone.
Remind the person that suicidal thoughts need not be acted on – tell them that there are solutions to problems and there are ways of coping other than suicide. Give them hope by telling them that with time and treatment, they will feel better. It’s important to give evidence as to how things can get better, because merely saying “things will get better” sounds like false reassurance.
Focus on what the person should do, rather than what they shouldn’t do. Provide contact numbers for them to call if they feel suicidal, including their doctor’s or mental health care professional’s number (eg: a counsellor), a 24hour suicide/crisis helpline, and any friends or family who can help in an emergency.
Encourage support (professional, and other)
Encourage the person to get professional help, and offer your support to help them do this. They may not want to talk to someone face-to-face, so helplines or over-the-phone counselling may be an alternate option.
If the person does not want to seek further help, keep encouraging them, but don’t come across as forceful. You can contact a suicide hotline to ask for guidance in encouraging the person, or if the person is an adolescent you should contact one of their family members or loved ones to tell them about the situation.
As mentioned earlier, if the person has plans for suicide, immediate action needs to take place. If the person is reluctant to seek help, ask their permission for you to contact their doctor or mental health professional. If they don’t give permission, you may call a helpline or, in an emergency situation, call 000.
Additional to seeking professional help, you can inform the person about self-help strategies. This may not be appropriate for all people, and often won’t be helpful for people with severe depression, but it can be helpful for people with less-severe depression if they are reluctant to seek professional help.
What if the person has already acted on suicidal thoughts?
If the person has harmed themselves, administer first aid and call for an ambulance by dialling 000. Try to remain calm, and make sure that you put your safety first, always.
After helping someone who has suicidal thoughts or has acted on those thoughts, make sure you get help for yourself too. Self-care is important, because providing support to a suicidal person can be exhausting and distressing.
Talking to someone to debrief can be helpful, but remember to respect the suicidal person’s right to privacy. It is recommended that you also do things to improve your mood and mental health, including eating well and exercising, getting enough sleep, and practicing relaxation techniques.
And remember that you have done an important and courageous job in protecting the life of another.