I was inspired to write this blog after watching a very brave, breaking the silence, TED talk by JD Schramm.
If you don’t click on the link, the talk can be paraphrased as: Surviving Suicide.
Suicide itself is something most of us have thought about, not necessarily seriously, but at least considered on some basic level of human curiosity. Many of us have also been directly affected by other people’s thoughts about suicide.
An ex-boyfriend once told me his plan if he were to commit suicide. He would first glue his hand to his head, tie some razor wire around his neck, tie a longer rope around his body, tie both rope and wire to a bridge, jump off- and voila. He’d go out looking like a nasty Halloween decoration, head literally in hand. Clearly, some people have thought about it more than others.
In fact, there are many websites that poll “If you were to commit suicide, how would you do it?” Go ahead, type it into Google. It’s a pretty interesting look into the human mind. The entries that have the word “comedic” “rape” or a smiley face at the end of them disturb me a little.
Here are some examples…
Now for some facts.
|Source: Adapted from Hamilton, 1997. (1)|
|Suicide happens without warning.||More than 80% of people tell caregivers about their suicidal impulses (American Foundation for Suicide Prevention, 2012).|
|People who talk about suicide rarely do it.||When people talk about committing suicide, they may be asking for help.|
|The suicidal act is a well-thought-out expression of an attempt to cope with a personal problem; suicidal people really do want to die.||Most suicidal persons are irrational at the time of their suicide and have strong ambivalent feelings.|
|People who have tried suicide and did not “succeed” are less likely to try again because they have “gotten it out of their system.”||Eighty percent of people who die by suicide have made at least one prior attempt; often they have cut or harmed themselves during a prior crisis.|
|Once people are suicidal, they are beyond help.||The crisis period may last only a short time; if people get help during the crisis period, they may be able to solve their problem.|
|Suicide is an inherited disorder.||There is no genetic basis for suicide; suicidal patterns in families are a result of other factors, including a belief that suicide is inherited.|
|Asking someone “Are you thinking of committing suicide?” will cause the person to do it.||Asking a direct, caring question may help relieve some emotional pain and give the person permission to ask for help.|
The chart below demonstrates the number of successful suicides per 100,000 people in Canada from 1990-1994 (a little outdated but I think you get the point). It also organizes the accounts by age, gender, and whether or not they were First Nations. Worth noting.
Suicide Rates by Age and Gender
First Nations & All Canadians: 1990 – 1994
Canadians are likely to more recently remember the faces of suicide victims Rehtaeh Parsons and Amanda Todd.
Like I said, lots of people are thinking about suicide.
In my experience, when the thoughts become more than just fleeting there are no smiley faces; less comedy, more tragedy.
However, as JD Schramm mentions in his talk, 19/20 people who attempt suicide DON”T DIE. Although they are almost 40% more likely to succeed the second time.
What is not talked about enough is what to say after someone threatens or attempts suicide…and lives. Consider what you would say to Rehtaeh if instead of being taken off life support, she woke up? Or what you would say if Amanda told you she was thinking about taking her own life?
Often EMS providers are some of the first people on the scene after threatened or attempted suicides. We are the ones who start the, albeit difficult, conversation- keeping in mind of course that we are not “trained” social workers or therapists. Likely during a trip to the hospital we won’t have the opportunity to convince them their life is worth living (maybe it’s not!?). But we can be one of the first links in the chain of survival and healing. As with any patient, we can choose to treat them with respect, dignity, and provide them with the care that may be missing in their life- if only momentarily.
During my preceptorship I learned a series of helpful questions/techniques to use with people who attempted or threaten suicide.
1. Do you have a plan to hurt or kill yourself? What is the plan? Timeline?
2. Do you have anything on your person that could be harmful? (needles, drugs, knives, gun, bomb)
3. Do you have access to weapons or other harmful objects?
4. Have you tried to hurt yourself before? How?
5. Do you have a psychiatric history (as well as any other medical conditions)? It’s a good idea to let them know you ask these questions to everyone (and are therefore not implying that they are crazy).
6.Are you on any medications? Have you taken them properly today? Be aware that anti-depressants can have an opposite effect. Many medications can have a depressant effect when mixed with other drugs/alcohol.
7. Is there someone you can talk to or have told your plan to?
8. Let them talk, and listen actively.
9. Actually ask how they are feeling, don’t just infer. Acknowledge their feelings. Let them know that even if they don’t believe it now, feelings can change.
10. Have you thought about getting help? How can I best support you right now?
11. Would you like to have someone arranged to talk to you? I tend to be quite persistent on the importance of this. (Often hospitals have a team ready to accept the patient, but sometimes it’s good to let them regain the feeling of control.)
12. Focus on short term planning: ex; what will happen when we get to the hospital, who will be meeting you there, etc.
13. Keep your voice low an slow. As mentioned in the fact/fiction chart, often people who attempt suicide have strong ambivalent feelings. “Talking them down off the ledge” is a pretty potent metaphor.
14. Screen for : violence, addiction, abuse, recent diagnosis, significant mood changes, changes in medication, psychotic symptoms, recent stress or traumatic event, history of suicide in social network, terminal illness/chronic pain, loss of independence, major life changes
15. Don’t judge and DON”T LEAVE THEM ALONE.
Of course it’s always the patients choice if they want to be forthcoming with you. Creating an environment of trust and privacy is key to gaining their confidence. Even if all you have are suspicions of your patients intentions, inform the hospital staff so a professional intervention can be arranged. Here are some more suggestions for caregivers on how to respond to suicidal individuals to keep them talking…
|Client Statement||Caregiver Response|
|Source: Adapted from Videbeck, 2011. (3)|
|Everyone will be better off without me.||Who would be better off? What would be better for those people?|
|I just can’t bear it anymore.||What is so hard to bear? What would make your life better?|
|I just want to go to sleep and not deal with it again.||What do you mean by “sleep”? What is it you don’t want to think about anymore?|
|I want it to be over.||Are you talking about life? Is that what you want to be over?|
|I won’t be a problem much longer.||How are you a problem? What is going to change in your life?|
|Things will never work out.||Are you saying there is no hope? What, then, do you propose to do?|
|It is all so meaningless.||What would make life more meaningful?|
|You have been so good to me. Remember me.||What do you want me to remember about you? Are you planning to end your life?|
What are your experiences with suicide?
Keep taking care of each other.