The Healthcare Series is a Health Expert feature where medical professionals share their thoughts and views with the public to raise awareness and educate others on health concerns, medical issues or general views from healthcare staff.
Recently there was a news report that was highly publicized about a man stopping his car on a bridge and jumping off, killing himself in the process.
For most Malaysians, suicide is something that is spoken about in hush terms. Perhaps some would have heard of a friend of a friend either committing or contemplating suicide. It is considered “Illegal” in this country, which means if a person were to attempt to commit suicide in Malaysia, and does not die, they can be charged with a crime.
To most people, this seems ridiculous and it has led to some prominent politicians and health care advocates calling for the abolishment of Section 309 of the Penal Code, in an attempt to reduce the stigma of suicide. This could lead to people seeking the mental health care they need instead of punishing them and pushing them further into despair.
Besides attempting to advocate for mental health care on a national level to change policies, as individuals, it is perhaps even more important to learn about how to react when someone is suicidal.
How To React When Someone You Know Is Suicidal
Let’s do a thought experiment, if a family member, or a friend, were to come to you today and tell you that they were feeling depressed and spent last night thinking about how their families would be better off without them here, what would you do?
The majority of my patient’s family members would tell me they would be in shock, they would get nervous, and we’re not sure of what to say. They considered just telling the family member to not think about it and ignore it. On some occasions, they panic and bring them to the emergency room or sometimes, they just become awkward when they are around the person, resorting to Google hoping to find some answers online.
What can we do when someone we know comes to us saying they are thinking of suicide?
1) Keep calm
This seems intuitive, but it is probably one of the hardest things to do because, unless you are a mental health clinician, you probably would not hear of people wanting to hurt themselves very much. The news could be very alarming and will likely be a shock, but it is important to remember that your family or friends have NOT hurt themselves or taken their own lives yet. It is a thought. There are a lot of things you can do to help at this point.
2) Take time and listen
Having them tell you about it means they are looking to you for help. We might not think that we are “qualified” or “empathetic” enough to help, but for some reason, they trust you and that is enough.
Sit down with them and ask basic inquisitive questions. Questions do not have to be groundbreaking, just a true personal curiosity and from a place of care. Some examples are as follows:
- “Why are you thinking of suicide?”
- “How long have you felt this way?”
- “Did you tell anyone else?”
- “Have you done something to hurt yourself already?”
3) Offer to get them to help
There are professionals who are trained to help people with suicidal thoughts, and there are cures. Some people might be afraid, or shy to seek help, and having you encourage them to do so might be all they need. If you are able, perhaps consider helping them call for an appointment, or bring them to the clinic.
You may even offer something as simple as offering to help them call a suicide hotline if they are open to it. Now, if they are saying that they cannot control themselves and think that they will definitely want to commit suicide, which is rare, then it is time to call 999 or bring them to an emergency room.
Here are some numbers which may be helpful:
|Police and Ambulance||999 or 112 (from mobile)|
|Persatuan Pengasih||03-6201 3179|
4) Come up with a safety plan
Perhaps the appointment with the “professional” will take some time, or perhaps your family/friend is refusing to talk to anyone else, but you can still help. Most clinicians are taught to work with their patients on a safety plan. It is a fairly straightforward discussion to have.
First, ask them about “warning signs” that they might have.
Things such as dreams, thoughts about their loved ones that are lost, or just noticing that they have no appetite, that could serve as an indicator that a crisis might occur or they might be triggers, meaning that they likely will start thinking about suicide. Only when we can identify a problem, can we then act to solve it?
Second, help them think about what they can do to distract themselves or stop thinking about suicide.
There are some “internal strategies” that we can use, such as deep breathing techniques, meditation, and even something simple like eating ice cream or taking a shower. I would try to get them to list down at least three things they would do if they have suicidal thoughts.
Third, if those strategies did not work, help them think about how they can change their environment.
Perhaps they might feel it is helpful to go out for a coffee or meet a friend for paintball. The goal would be to break the fixation on suicidal thoughts. Again, list down three activities or places they would want to go that could help them feel better. Preferably these places are filled with people or at least with constant traffic, although I do note that frequently patients would tell me their places are hilltops or the pier. There are certain places that I would ask my patients to avoid, including places such as a bridge or train tracks that are high risk.
Fourth, know who to call.
It would be important to help them plan out who they should call in case they feel strongly about hurting themselves and nothing they do can help how they feel. It is important to list down at least three people that they trust and who are responsive to phone calls. It may be harmful to come up with a person who does not answer the phone call when needed. It would need to be dependable people.
On top of having three people to call, you would also want to help them think about professional people they can call in case those 3 are not able to help or answer. Professional organizations such as Befrienders or Lifeline would be important numbers to ensure they have with them at all times. If you can, save these numbers on their phones for them.
5) Checking in before leaving
We might not feel comfortable leaving them alone after a conversation about suicide but if they have proven themselves to be able to call for help when they need you, and if you have done everything you can to help, we have to trust that your family or friend will be fine and will let you know if they need you again. It would be important to ask them directly “How are you feeling now?” or “Do you feel better?”
Answers might vary from “Yea” to “A little” to “No, but I’ll be fine”.
If they have mentioned to you that they have obtained some item/s in preparation for hurting themselves, do make sure that you have helped them get rid of the items or stop their access to the items before ending the conversation (such as pills or knives).
Most people think of suicide as a natural result of clinical depression. That is highly possible. However, there are many reasons that could lead people to think about suicide from relationship issues such as breakups, financial difficulties or for some, incurable diseases such as cancer. In general, they do not see a way out of their “troubles” and think that suicide is their only option.
A majority of people who attempt to commit suicide come to regret it. During interviews with survivors of suicide, some would describe their experience of feeling regret and fear the moment they stepped off the ledge or a bridge, wishing they did not jump, and feeling grateful that they have survived the fall.
Our goal as their friends/family members would be to stop them from committing the act even if the thought occurs to them so that they get a chance to work on breaking out of that “state”, which most do, some even within the hour.