# MHApps Take Control – Suicide – Information On Suicide Prevention And Mental Health

Suicide
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- Supporting Life
- Suicide Prevention and Mental Health The experience of mental distress, coupled with the demands of 21st century life is a potent combination. Over the past twenty years, increasing efforts to reduce the number of suicides have mostly met with a stubborn refusal of the numbers to change in Ireland.
  Suicide is about ending the pain. The many and complex theories that surround the act of suicide can sometimes distance us from the simple idea that no one takes their own life unless there is something very wrong with it.
  It is often said that suicide is a permanent solution to a temporary situation. Many survivors of suicide speak of their desire to end the deep and desperate pain they felt, not necessarily to end their lives. At the time though, they could simply see no other way out.
  “We know from clinical experience and from research that people with schizophrenia are more vulnerable to suicide than any other group in the general population. In fact, they are 40 times more vulnerable to taking their own lives than people who do not have this particular form of human experience. These are disturbing statistics and understandably cause concern among service users and their families. Why does schizophrenia make a person more vulnerable to suicide? And what do these statistics say to those of us in mental health services whose role it is to care for them?
  Let us consider what we know about suicidal behaviour in general. We know that people reach a point of taking their lives when they feel trapped by their particular circumstances, with no possibility of being able to escape their predicament and no likelihood of rescue. Could it be that schizophrenia leaves a person more vulnerable to feeling this way? Research suggests that some 10% of those with self-experience of mental illness may well feel very trapped and overwhelmed by this disorder. Furthermore research has narrowed down the factors that suggest those who may be particularly at risk for suicidal behaviour. Being familiar with these factors should alert us to people who particularly deserve our attention. Knowing who may be vulnerable should encourage us to talk with them about the real difficulties they experience and prevent problems escalating to a point where they view self-harm as their only means of ending their pain.
  For example, we know that among key risk factors are: being young, being male, having a course of illness characterised by repeated lapses, short hospitalisations and also having a high IQ or higher education. In addition, we know there are times when these individuals are more at risk than other times, notably during their hospital admissions or in the weeks directly following discharge. What can we “read” from these cold “risk factors” that might inform us as to the state of mind of the service user, a state of mind that may lead them to feel despair and consider suicide?
  For some of these individuals their experience of mistrust of others become so intense that their paranoia and suspiciousness leads them to feel increasingly isolated and alone. It may be difficult to engage these individuals in counselling, and medication may be the critical intervention they require. For others, their repeated hospitalisations may suggest they are non-compliant with medication, perhaps because they refuse to accept that they need this kind of help. For this group it may be important to hear how they understand and make sense of their own experience and work with them to see how a variety of interventions, including medication, make sense. And finally, for those with high IQ and insight, it may be that they understand all too well what’s happening and see a future unfolding before them where their lives will be limited in painful ways by the experience of schizophrenia. This group particularly deserves an opportunity to grieve the life they may have wanted for themselves, and their crushed dreams.
  This is not to imply that all is lost and it is critical to maintain an attitude of optimism in these discussions. Adopting a “recovery” approach means being realistic about what has been lost, but also conveying a strong message that the experience of schizophrenia is never the whole story for any person. There is still a life to be lived. There are resources available both within and around this persona and these can help them achieve valued and meaningful goals in their lives.
  Finally, working from what research so clearly reports over and over again, the time of great risk is during and immediately after hospital admission. This highlights the need to engage people in hospital in some form of realistic care planning as soon as possible following their admission. Having a plan, particularly one that you personally have been part of constructing, gives a person a feeling of hope that something good can happen, even when things feel chaotic. This plan needs to take into account what the service users themselves want to achieve and to address the real and practical problems that are making it hard for them to find their place in the world.
  Even when a person achieves stabilisation in hospital and may feel very optimistic about their lives at the point of discharge, it is crucial we pay attention to ensuring continuity of care for them when they return to the community. The risk of suicide is not merely to do with how hard the experience of distress is for someone; it is also affected by those “protective factors” in their life, which support them in facing the challenges ahead of them when they leave hospital. Where these protective factors are not readily available, we should be alert to the risk of relapse and consider ongoing support after discharge for as long as it may be required.” (Dr. Tony Bates Supporting Life. Suicide Prevention for Mental Health Service Users. The full text of this document can be viewed on www.shineonline.ie. Occasional Papers.)
  Protective factors against suicide include:
  · High self-esteem
  · Social “connectedness” especially with family and friends
  · Having social support
  · Being in a stable relationship
  · Religious or spiritual commitment
  · Early identification and appropriate treatment
  · Interventions based on the principle of connectedness
  · Easy access to supports such as helplines, psychosocial interventions and suicide prevention centres
  People with self-experience of mental ill health have an increased risk of suicide if they are:
  · Young, single, unemployed males
  · In the early stage of illness
  · Depressed
  · Prone to frequent relapse
  · Highly educated
  · Paranoid (suspicious)
  People with mental ill health are more likely to be suicidal at the following times:
  · In the early stages of their illness
  · Early in their recovery, when outwardly their symptoms are better but internally they feel vulnerable
  · Early in a relapse, when they feel they have overcome the problem, but the symptoms recur
  · Soon after discharge from hospital
  (World Health Organisation)
  Remember you are not bound by any confidentiality agreement when there is a risk of suicide. If a person divulges to you that they are thinking about suicide always contact someone who is qualified to deal with it. Do not attempt to deal with it your self.

- How do you live with a person who is home and argumentative?

- “He just stands there glaring at everybody, ready to fly off the handle. When my other brother Tony acts like that I give him a clatter, but no we can’t treat Greg like that, I know violence is never the answer, but he is ruling the roost. The worst part is when his brothers and sisters complain about Greg getting special treatment. He is not getting special treatment, just different treatment. Another mother in my support group found that when she gave her son a bit of time and allowed time for him to digest what is being said, and allowed time for the answer to come, everybody in the family started to get a grip on the thing. Trying to understand what was really being said, and not only hearing what each person wanted to hear, you have to learn a new way. I do find if I give it a bit of time, Greg does come along with his answer. Sometimes.”

- “We have not got a clue what happens in the home. It is only if they, the family speak about it. We are very limited in what we can do about a sticky situation at home. What we need is a home liaison worker available. Someone who can go out and work with the whole family, in their own home. ”

- “Why do they keep watching me, I can’t stand it, stop trying to second guess me, spit it out! Ask. I know it takes a long time for me to take it in and understand what is being said, and then for me to formulate an answer. I get so frustrated, I know what I want to say, all the words are in there, it is like they are all fired into a basket and when I try to speak they won’t appear in the right order, if they appear at all that is. I know I shouldn’t, but I do become aggressive with people, when in reality it is myself that I am angry at.”

- “When I came home from hospital I did what I liked, went to bed, got up to eat my meals whenever I decided. Even if it was two o’clock in the morning I would turn on the telly loud enough to wake the neighbours, let alone anybody in my own house. If I am honest I did not realise how disruptive I was being. I was just trying to blot out my thoughts, keep my mind occupied. Depression is like a big hole, which has unknown depths. I would think I was at the bottom of it, only to find there was further to go. If there was light at the top of the hole, it was so far I couldn’t see it; a bit like viewing stars at night, you know there is light but it is not much use to you.”

- The more warning signs/risk factors, the higher the risk. Always stress to your relative or friend that their life is important to you and to others and that his or her death by suicide would be a tremendous and upsetting loss to you, not a relief. If death by suicide is attempted, contact, the emergency services and phone someone to come and be with you.
  Asking someone if they have thought about suicide will not put the idea in their head if it has not been there previously, in fact they may be so shocked by you being so upfront they will give an honest answer.
- If you experience thoughts of suicide there are a number of things you can do. · The most important action is to be open and confide in other people you trust or talk to a trusted health professional
  · If the thoughts are associated with depression, delusions or other symptoms, then a change in medication may help to reduce or eliminate them
  · Keep a list of people who you know you can telephone when you are feeling really down
  · Also keep the numbers of 24 hour services that can help at these times
  · Make an agreement with one or more people that you will call them if you actually plan to attempt suicide
  · Remember that you do not have to act on that thought. With time many of the things that are making you feel that your life is too difficult to continue will pass
  · Distance yourself from any means of dying by suicide
  · Avoid alcohol and other drugs of abuse
  · Avoid doing things you are likely to fail at or find difficult until you’re feeling better
  · Make a written schedule for yourself every day and stick to it no matter what
  · In your daily schedule don’t forget to schedule at least two 30-minute periods for activities, which in the past have given you some pleasure
  · Take care of your physical health
  · Make sure you spend at least 30-minutes a day outside
  · You may not feel very social but make yourself talk to other people
- Some of the warning signs a person wanting to die by suicide may display: · After a period of depression and sadness, a sudden change of mood to one of smiling and laughing
  · Making statements like, “I won’t be here to see it”
  · Giving away treasured possessions
  · Having been recently discharged from hospital
  · Being withdrawn or unable to relate to people around them
  · Having definite ideas of how to kill themselves, and/or speaking of tidying up affairs or giving other indications of planning suicide
  · Talking about feeling isolated and lonely
  · Expressing feelings of failure, uselessness, hopelessness or loss of self-esteem
  · Constantly dwelling on problems for which there seem to be no solutions
  · Hearing voices, which may be instructing them to die by suicide
  · Early morning waking and loss of appetite
- What do you do if a person is in crisis? It is important to emphasise that people experiencing mental health problems are very rarely violent towards others. However, the degree of their emotional distress can look and sound more threatening than it may be.
  · First and foremost, remain calm. If you remain calm others will also
  · Make sure you are safe and have an exit route planned in the unlikely event that you need it
  · Adopt a non-threatening approach. When a person is in distress they will need quiet, gentle reassuring words and body movements
  · Do not approach the person from behind without warning
  · Don’t stare as this could be interpreted as threatening. But do make eye contact as often as you can
  · If there are other people around calmly ask them to leave the room or area
  · Some situations can be very frightening and distressing. If you do not feel confident approaching the person, don’t. Go and get help
  · If you stay in the room give the person breathing space, and do not touch them unless you are sure that they do not feel threatened by you. If you are unsure, ask
  · Explain your actions before you act and continue to reassure the person without being patronising
  · Tell the person you are listening to them and trying to understand what they are saying and feeling
  · Ask the person what would help in the situation. Allow them as much control as possible
  · If a person becomes severely distressed or unwell it may be necessary to call a GP and/or the Emergency Services (999). Do not hesitate if you believe the person’s life is seriously at risk
  · Calling the Emergency Services may be the first thing you have to do (Adapted from Garda Mental Health Awareness Training. Shine 2008.)

- “I don’t know what he is doing in the room all night. Whenever I do manage to get in, all I find are weeks and weeks of dirty cups, food plates; ashtrays that are so full you would not know they were ashtrays. The bed linen was like the Turin shroud, just an imprint of where James slept on the sheet. I mean why doesn’t he bother? I didn’t bring up a dirty child; I taught him better than that. He wears the same shoes day in and day out. They are falling apart. I wish he was normal. He is 43, what is he going to do after I die, his sister won’t look after him?”

- When a person with mental ill health is at home, either living on their own or with others, it is very difficult to appreciate how hard it can be for them to look after the basic daily things that we take for granted.

- “Then miraculously you wake up one morning and life seems ok. By no means good, but less difficult. This feeling of regaining energy, recovering control of my own destiny, moving forward, being part of the world or like a fog gently lifting, over a period of time, moving out of the tunnel, coming into the light, beginning to feel good, excited that there is such a thing as recovery, enjoying my family, food, washing, socialising. Now don’t get me wrong, life is still tough, when I am well I still have the problems everybody else has. Having a routine helps so much. The whole 8 years of my illness and how I am now, brings to mind the Winston Churchill quote “when you are in hell keep going.”

Suicide
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