December 21, 2014 marked three years since Cliff's death. For the past six months I've been cycling, kayaking, and climbing, feeling strong. This year I made plans to go snowshoeing with one friend on the 21st and have dinner with another. I thought I would try being social on the anniversary of his death instead of isolating as I have done. But those plans fell through a few days before. Even an outing the previous day was aborted when our car hit black ice and spun into the ditch, leaving us stranded for a couple hours until a tow truck came to rescue us.
So events conspired to ground me. I'm never sure what to expect on these anniversaries. I think I'm doing well. I felt pretty normal as the day approached, other than noticing a decline in my physical stamina. That seems to be the most predictable sign of on-coming grief. Then I find myself feeling easily irritated and running into obstacles (like the car going into the ditch, things just not working out). Until I simply accept that grief is here and I might as well hole up for a while and ride it out, not try to make things any different than they are.
I get frustrated with that, too, that grief lasts longer than a day or two, that I'm not being as active as usual and I'm eating more, that I cry at unpredictable and often inconvenient times, that I know I seem rude or awkward at work when everyone else is excited about Christmas, that I'm not able to just put all this aside and be "normal". I guess this is a skill like any other -- learning how to be compassionate with myself through this and eventually, I hope, as a result being kinder and less irritable with others who are having a very different experience at this time of year.
Grief is another side of love, a different facet of the same diamond. I don't understand it, I don't yet have the wisdom to handle it skillfully, I don't know what to do with it. I love you, Cliff. I miss you. I wish more than anything that you were happy and healthy and here.
Thursday, December 25, 2014
Sunday, September 21, 2014
Express Your Support for Bridge Suicide Prevention Barriers
Dear friends -
Many of you may know that one of the most effective ways to prevent suicide is to restrict the access to means. Recently Dr. John Carsley, medical health officer for the city of Vancouver, wrote a letter to the mayor and council in support of the installation of suicide prevention barriers on Vancouver bridges.
In his letter, Dr. Carsley states that between 2000 and 20012, 122 people died by jumping from bridges in the Vancouver area. Others who did not die suffered grievous injury. He cites evidence that suicide barriers have been proven to be effective in preventing these deaths, and that there is no displacement to other means or locations. He cites the societal cost of a single suicide as being estimated between $800,000 and $1,000,000.
In light of this information, the case for investing in suicide prevention barriers seems clear. If you live in the Vancouver area, please consider contacting the mayor and councillors to express your support of this decision. You can reach the mayor and council by email at mayorandcouncil@vancouver.ca and the city manager, Penny Ballem, at penny.ballem@vancouver.ca
Below is the email of support I sent. You're welcome to plagiarize!
Many of you may know that one of the most effective ways to prevent suicide is to restrict the access to means. Recently Dr. John Carsley, medical health officer for the city of Vancouver, wrote a letter to the mayor and council in support of the installation of suicide prevention barriers on Vancouver bridges.
In his letter, Dr. Carsley states that between 2000 and 20012, 122 people died by jumping from bridges in the Vancouver area. Others who did not die suffered grievous injury. He cites evidence that suicide barriers have been proven to be effective in preventing these deaths, and that there is no displacement to other means or locations. He cites the societal cost of a single suicide as being estimated between $800,000 and $1,000,000.
In light of this information, the case for investing in suicide prevention barriers seems clear. If you live in the Vancouver area, please consider contacting the mayor and councillors to express your support of this decision. You can reach the mayor and council by email at mayorandcouncil@vancouver.ca and the city manager, Penny Ballem, at penny.ballem@vancouver.ca
Below is the email of support I sent. You're welcome to plagiarize!
Dear Mayor Robertson and Councillors,If you're not in the Vancouver area, you could contact your own city council to express support for a similar measure in your municipality.
As both an executive board member of the Crisis Intervention and Suicide Prevention Centre of B.C. and someone who has been bereaved by suicide, I am writing you to express my strong support of Dr. Carsley's recommendations on the installation of suicide prevention barriers.
A number of studies have indicated that when lethal means are made less available or less deadly, suicide rates by that method decline, and frequently suicide rates overall decline. In fact, some of the most dramatic reductions in suicide rates have been due to means restriction. Dr. Carsley provides excellent data on the effectiveness of bridge barriers in this regard.
Dr. Carsley provides a quantified estimate of the societal cost of a suicide death. As someone who has been bereaved by suicide I can testify to how devastating a loss that can be, especially when there is evidence that the loved one's death was preventable, as many suicide deaths are. In light of both the financial and emotional toll such deaths take, the return on investment of installing bridge barriers seems clear.
I hope to see a favourable decision by council on this matter in the near future.
Sunday, January 5, 2014
Understanding how trauma affects the brain
Dear friends -
The theme of the Canadian Association for Suicide Prevention conference that Andrew and I attended in Winnipeg this past fall was traumatic experience and its relationship to suicide risk. Someone said to me recently that mental illness or injury is what happens when a person’s central nervous system is overwhelmed. I like the simplicity and concreteness of this definition. It brings it down to the level of a physics equation: If enough force is applied to a bone in a particular direction, the bone will break. The amount of force will depend on the shape of the individual bone, how strong or brittle it is, and the direction in which the force is applied. The same applies to people’s minds.
Some at the conferences talked of people they had known who had survived incredibly tumultuous and traumatic childhoods and many ups and downs in their adult years, but then died by suicide following what seemed like a much lesser event such as the end of romantic relationship or (as in Cliff's case) a perceived threat to job security. They hypothesized that this was because it was the straw that broke the camel's back, something that finally overwhelmed the person's remaining inner resources.
Since attending the conference, I’ve read an excellent book, Traumatic Experience and the Brain, in which David Ziegler describes the neurological damage that can be caused by traumatic experience and childhood neglect. He provides a helpful description of what traumatic experience does to a brain and the long-term consequences that can result. One presenter at the conference spoke about the increased suicide risk that occurs for some people with mild to moderate brain damage. Ziegler seems to be talking about a similar degree of neurological damage occurring as the result of trauma or childhood neglect.
Ziegler comments at several points in his book about the length of time it takes to do neurological reparative therapy with children who have experienced severe long-term trauma or neglect, and that government is increasingly reluctant to pay for that type of long-term treatment. If it takes one to three years for a young child to develop more functional relationships and more adaptive ways of responding to the world, how long might it take for an adult for whom beliefs, emotional responses, and patterns of reaction have become deeply ingrained? And where in our health care system are the provisions for that type of treatment and the people equipped to provide it?
He also says, "The most serious finding concerning the effects of trauma is that neglect appears to be the most pervasive and persistent form of trauma when considering implications with a lifelong trajectory.... The implications for safety, nourishment, and the pivotal issue of attachment can be profound." (pp.40-1) Yet those of us who haven't experienced childhood neglect, including many therapists, don't understand the reality of that experience and its affects, don’t take it as seriously as more dramatic events such as physical or sexual assault, and aren't equipped to treat it.
Not all people who are at risk of or have died by suicide were neglected or abused as children or have experienced traumatic events. For some, perhaps particularly teenagers and young adults, the onset of a severe mental illness can, in and of itself, overwhelm their internal and external resources leading to a suicidal crisis. For others, repeated or ongoing experiences of mental illness, particularly schizophrenia, bipolar disorder, and mixed anxiety-depression, lead to the same outcome.
It’s also apparent that mental injury in and of itself doesn’t necessarily heighten someone’s suicide risk. Victims of torture, for example, are generally found to still have a relatively low risk of suicide, while war veterans and victims of childhood neglect and abuse have a markedly higher risk. I wonder whether the difference is the degree to which each takes the blame for the trauma and their ability to cope with the resulting mental injuries — that is, the amount of shame the individual experiences.
What’s been important for me to learn through this:
The theme of the Canadian Association for Suicide Prevention conference that Andrew and I attended in Winnipeg this past fall was traumatic experience and its relationship to suicide risk. Someone said to me recently that mental illness or injury is what happens when a person’s central nervous system is overwhelmed. I like the simplicity and concreteness of this definition. It brings it down to the level of a physics equation: If enough force is applied to a bone in a particular direction, the bone will break. The amount of force will depend on the shape of the individual bone, how strong or brittle it is, and the direction in which the force is applied. The same applies to people’s minds.
If Internal + External Resources > Trauma, the result is Coping or Thriving
If Internal + External Resources < Trauma, the result is Mental Injury or Illness
Some at the conferences talked of people they had known who had survived incredibly tumultuous and traumatic childhoods and many ups and downs in their adult years, but then died by suicide following what seemed like a much lesser event such as the end of romantic relationship or (as in Cliff's case) a perceived threat to job security. They hypothesized that this was because it was the straw that broke the camel's back, something that finally overwhelmed the person's remaining inner resources.
Since attending the conference, I’ve read an excellent book, Traumatic Experience and the Brain, in which David Ziegler describes the neurological damage that can be caused by traumatic experience and childhood neglect. He provides a helpful description of what traumatic experience does to a brain and the long-term consequences that can result. One presenter at the conference spoke about the increased suicide risk that occurs for some people with mild to moderate brain damage. Ziegler seems to be talking about a similar degree of neurological damage occurring as the result of trauma or childhood neglect.
Ziegler comments at several points in his book about the length of time it takes to do neurological reparative therapy with children who have experienced severe long-term trauma or neglect, and that government is increasingly reluctant to pay for that type of long-term treatment. If it takes one to three years for a young child to develop more functional relationships and more adaptive ways of responding to the world, how long might it take for an adult for whom beliefs, emotional responses, and patterns of reaction have become deeply ingrained? And where in our health care system are the provisions for that type of treatment and the people equipped to provide it?
He also says, "The most serious finding concerning the effects of trauma is that neglect appears to be the most pervasive and persistent form of trauma when considering implications with a lifelong trajectory.... The implications for safety, nourishment, and the pivotal issue of attachment can be profound." (pp.40-1) Yet those of us who haven't experienced childhood neglect, including many therapists, don't understand the reality of that experience and its affects, don’t take it as seriously as more dramatic events such as physical or sexual assault, and aren't equipped to treat it.
Not all people who are at risk of or have died by suicide were neglected or abused as children or have experienced traumatic events. For some, perhaps particularly teenagers and young adults, the onset of a severe mental illness can, in and of itself, overwhelm their internal and external resources leading to a suicidal crisis. For others, repeated or ongoing experiences of mental illness, particularly schizophrenia, bipolar disorder, and mixed anxiety-depression, lead to the same outcome.
It’s also apparent that mental injury in and of itself doesn’t necessarily heighten someone’s suicide risk. Victims of torture, for example, are generally found to still have a relatively low risk of suicide, while war veterans and victims of childhood neglect and abuse have a markedly higher risk. I wonder whether the difference is the degree to which each takes the blame for the trauma and their ability to cope with the resulting mental injuries — that is, the amount of shame the individual experiences.
What’s been important for me to learn through this:
Neurological injuries are as real and debilitating as physical injuries, but more difficult to recognize.Knowing that one is injured — that there are real, physiological reasons for one’s experience and behaviour — and having others recognize this, too, can provide immense relief in and of itself. Knowing that it’s not your fault — that this isn’t just an individual failure to think positively enough or see things from the right perspective, it’s the symptom of a physiological injury — and that there are things you can do to mitigate or ameliorate your experience is a message that many more people who have survived neglect and trauma need to hear.
Two people can experience the same event and emerge with different injuries, or one may not be injured at all — this is just as true mentally as it is physically.
Effective treatment for neurological injuries is possible. As for most injuries, the potential for healing is greatest when treatment is received soon after the injury occurs, but treatment later in life can also be of great benefit.
The length and intensity of the treatment required is relative to the severity of the injury. Brief or solutions-focused therapies are not effective treatments for severe or long-standing injuries.
Wednesday, December 11, 2013
Right by You
Dear friends -
It's been a busy fall and I'm finally getting to a place where I'm ready to take the time to write to you again. In the next few weeks I would like to tell you about the Canadian Association for Suicide Prevention conference last October, about Andrew's and my experience hosting a Survivors of Suicide event on November 23, the networking connections we've made, and about the work our Washington friends at Forefront are doing.
In the moment, though, I want to forward you an appeal for action by Partners for Mental Health, a new organization that is taking a very active role in advocating for much-needed strides forward in mental health care and suicide prevention. Please see their president Jeff Moat's email below.
Lynn
From: Partners for Mental Health
Date: December 10, 2013 11:05:54 AM PST
Subject: Your action is needed now
Right By You - Partners for Mental Health
Dear Lynn,
We’ve come to a crucial point in our Right By You campaign in support of greater funding for youth mental health and suicide prevention.
Action is needed now. Every day, we lose 2 young Canadians to suicide. Almost 90% of people who die by suicide have a mental illness, yet the majority of children and youth – 3 out of 4 – who have a mental health problem or illness won’t get the treatment they need. And the average wait time before children with diagnosed mental health issues receive treatment is 12 months. This is unacceptable, and we need to work together to fix this.
In order to drive real change, we must show the government that this is an issue that matters to all Canadians. Local politicians need to hear directly from the people they represent – people like you.
It’s time to raise our voices with government. And we’ve got the tools and resources to easily help you get started.
First, sign the Right By You petition to show your support.
Then, contact your local politician using our toolkit to further amplify your voice and put pressure on our elected officials to act.
Specifically, we are calling on:
Federal government – to create a $100 million national suicide prevention fund.
Provincial and territorial governments – to provide access to mental health services, treatment and support to all children and youth when they need it, no matter their ability to pay.
These changes can happen but we need your help today.
Thank you,
Jeff Moat
President, Partners for Mental Health
Sunday, August 25, 2013
Take Action to Save Someone's Life
Dear friends,
The September 2, 2013 issue of US Weekly, prominently displayed at grocery magazine stands, features a front-page story on the suicide death of Gia Allemand. You may be aware that sensationalized stories of celebrity suicide deaths are frequently followed by a spike in suicide deaths by the same method. The "Bachelor Suicide" story, which describes the cause of death and normalizes suicide as a response to difficult life events, is a classic example of this type of story.
Please join me in taking action to defend people at risk of suicide from this type of destructive media coverage. I have written letters to grocery story managers asking them to remove copies of this magazine from their shelves, and to US Weekly to ask them to revise their editorial practices. Copies of these letters are included below. You are welcome to use these or variants of them to help lobby for these changes.
Please, if at all possible, do not buy this magazine and ask others not to buy it. I would hate for US Weekly to experience a spike in sales as a consequence of publishing this story, and for them to financially benefit from media coverage that could cause a spate of tragedies. You can skim the story on page 46 to confirm the violations in ethical journalistic practice.
Lynn
Letter to Grocery Store Manager
Re: US WeeklyIssue 968, "Bachelor Suicide"
Dear Store Manager;
I am writing to ask you to immediately remove copies of US Weekly Issue 968 featuring the cover story of Gia Allemand's suicide death from your magazine stands.
You may be aware that sensationalized stories of celebrity suicide deaths are frequently followed by a spike in suicide deaths by the same method. The "Bachelor Suicide" story, which describes the cause of death and normalizes suicide as a response to difficult life events, is a classic example of the type of story that results in these deaths.
You, like many others, may be under the mistaken understanding that someone who dies by suicide has made a choice, or that if someone really wants to kill him or herself there is very little that can be done to prevent this. If this were true, we would expect that changes in journalistic practice or restrictions to the means used to cause death would have little effect on the overall number of suicide deaths. Someone who really wants to die would go to whatever lengths were necessary to gain access to lethal means or substances.
The truth is, though, that fewer than 10% of the people who survive a suicide attempt will eventually die by suicide. Over 90% will not. Research also shows that when access to common methods of suicide is restricted, the overall number of suicide deaths declines significantly and often dramatically and remains lower over decades.
For example, when the gas used in U.K. homes was changed from coal gas to less toxic natural gas in the 1960s, suicide deaths suddenly and rapidly declined by 30-40%, and have remained lower through over 40 years. After the Israeli Armed Forces changed protocols to prevent reserve soldiers from taking firearms home on the weekends, suicide deaths dropped by 40%. And after the Sri Lankan government banned a set of highly toxic pesticides commonly used in self-poisonings, suicide deaths overall dropped by 50% and have remained lower over a decade later.
If we can, therefore, increase the likelihood of someone surviving a suicide attempt or provide treatments and interventions to prevent those attempts, we are not just prolonging the inevitable -- we are saving lives.
"My brain is trying to kill me," one woman wrote in her journal a few months before her death. In the crisis of suicidal despair, that brain will use whatever information and means are readily available to try to inflict death. Stories of celebrity suicide deaths that describe the means of death and normalize suicide as a response to difficult life events, such as the one US Weekly has published about Gia Allemand, inadvertantly provide support for the suicidal urges against which someone at risk is desperately battling. These stories are typically followed by a spike in suicide deaths by the same means.
The following changes to a story such as the one published by US Weekly could save lives:
- Not reporting the means of death.
- Emphasizing the likelihood that the victim was suffering from depression or some other life-threatening mood disorder, mental illness or injury, elevating their suicide risk, and that these conditions are treatable.
- Providing crisis line contact information for readers who may be at risk.
- Providing information or links to resources on signs of depression and suicide risk.
The vast majority of people at risk of suicide experience the equivalent of a mental health heart attack, a temporary crisis of despair during which they are at high risk of acting impulsively to cause their own death. People at risk of suicide battle desperately against these urges, fighting against their own brains to try to preserve their own lives. These people deserve whatever support we can provide them.
In the interest of preventing suicide deaths among your customers and their children, please remove this magazine from your shelves. Please let your magazine distributor know what you have done and why. Please help prevent future tragedies.
Sincerely yours,
Letter to US Weekly Editor
Letters to US Weekly1290 Avenue of the Americas
New York, New York
United States of America
10104-0298
New York, New York
United States of America
10104-0298
Re: "Bachelor Suicide", Issue 968
Dear Editor;
I was appalled to read Eric Andersson's story on Gia Allemand's suicide. You and your colleagues may be aware that stories of celebrity suicide deaths are frequently followed by a spike in suicide deaths by the same method.
You, like many others, may be under the mistaken understanding that someone who dies by suicide has made a choice, or that if someone really wants to kill him or herself there is very little that can be done to prevent this. If this were true, we would expect that changes in journalistic practice or restrictions to the means used to cause death would have little effect on the overall number of suicide deaths. Someone who really wants to die would go to whatever lengths were necessary to gain access to lethal means or substances.
The truth is, though, that fewer than 10% of the people who survive a suicide attempt will eventually die by suicide. Over 90% will not. Research also shows that when access to common methods of suicide is restricted, the overall number of suicide deaths declines significantly and often dramatically and remains lower over decades.
For example, when the gas used in U.K. homes was changed from coal gas to less toxic natural gas in the 1960s, suicide deaths suddenly and rapidly declined by 30-40%, and have remained lower through over 40 years. After the Israeli Armed Forces changed protocols to prevent reserve soldiers from taking firearms home on the weekends, suicide deaths dropped by 40%. And after the Sri Lankan government banned a set of highly toxic pesticides commonly used in self-poisonings, suicide deaths overall dropped by 50% and have remained lower over a decade later.
If we can, therefore, increase the likelihood of someone surviving a suicide attempt or provide treatments and interventions to prevent those attempts, we are not just prolonging the inevitable -- we are saving lives.
"My brain is trying to kill me," one woman wrote in her journal a few months before her death. In the crisis of suicidal despair, that brain will use whatever information and means are readily available to try to inflict death. Stories of celebrity suicide deaths that describe the means of death and normalize suicide as a response to difficult life events, such as the one you published about Gia Allemand, inadvertantly provide support for the suicidal urges against which someone at risk is desperately battling. These stories are typically followed by a spike in suicide deaths by the same means.
The following changes to a story such as the one written by Andersson could save lives:
- Do not report the means of death.
- Emphasize the likelihood that the victim was suffering from depression or some other life-threatening mood disorder, mental illness or injury, elevating their suicide risk, and that these conditions are treatable.
- Provide crisis line contact information for readers who may be at risk.
- Provide information or links to resources on signs of depression and suicide risk.
The vast majority of people at risk of suicide experience the equivalent of a mental health heart attack, a temporary crisis of despair during which they are at high risk of acting impulsively to cause their own death. People at risk of suicide battle desperately against these urges, fighting against their own brains to try to preserve their own lives. These people deserve whatever support we can provide them.
Because of the importance of this issue, several U.S. suicide prevention agencies have collaborated to publish guidelines for reporting on suicide: http://reportingonsuicide.org/Recommendations2012.pdf In the interest of preventing suicide deaths among your readers, I encourage you to incorporate these into your editorial practices.
Sincerely yours,
Monday, August 12, 2013
International Connections
Dear friends -
As mentioned in a previous update, early in June Ileah and I attended World Congress on Suicide 2013 in Montreal. It was a very rich international research conference, with researchers, academics, and government representatives from the United Kingdom, the United States, Australia, New Zealand, and Canada -- the vast majority of them leaders in this field, some with decades of experience to share.
I felt very privileged and sometimes overwhelmed to be attending seminars on topics ranging from micro-RNA variations and stem cell research to debates on national strategies and debates on fifth edition Diagnostic and Statistical Manual (DSM V) classifications. Here is a synopsis of the overall meaning I was able to make from that immersion: an overview of some of what has been found to be effective and ineffective in reducing suicide deaths.
I developed this as a presentation and have delivered it a couple times now. If you find the speaking notes leave you with questions or are unclear, please let me know and I'll be happy to clarify.
September 10 is World Suicide Prevention Day. This year that date also marks the launch of FOREFRONT, a University of Washington initiative to advance innovative approaches to suicide prevention through policy change, professional training, school-based interventions, media outreach and research. It is one arm of the work being done by my dear friend Jennifer Stuber, who has also been a driving force behind recent legislative changes in that state.
I'll be in Seattle to attend FOREFRONT's launch, and warmly welcome you to join me. I promise that it will be a moving and inspiring occasion. Please see the invitation for logistics and links to more information. I would be delighted to have you with us.
As mentioned in a previous update, early in June Ileah and I attended World Congress on Suicide 2013 in Montreal. It was a very rich international research conference, with researchers, academics, and government representatives from the United Kingdom, the United States, Australia, New Zealand, and Canada -- the vast majority of them leaders in this field, some with decades of experience to share.
I felt very privileged and sometimes overwhelmed to be attending seminars on topics ranging from micro-RNA variations and stem cell research to debates on national strategies and debates on fifth edition Diagnostic and Statistical Manual (DSM V) classifications. Here is a synopsis of the overall meaning I was able to make from that immersion: an overview of some of what has been found to be effective and ineffective in reducing suicide deaths.
I developed this as a presentation and have delivered it a couple times now. If you find the speaking notes leave you with questions or are unclear, please let me know and I'll be happy to clarify.
Invitation: FOREFRONT Launches September 10 in Seattle
September 10 is World Suicide Prevention Day. This year that date also marks the launch of FOREFRONT, a University of Washington initiative to advance innovative approaches to suicide prevention through policy change, professional training, school-based interventions, media outreach and research. It is one arm of the work being done by my dear friend Jennifer Stuber, who has also been a driving force behind recent legislative changes in that state.
I'll be in Seattle to attend FOREFRONT's launch, and warmly welcome you to join me. I promise that it will be a moving and inspiring occasion. Please see the invitation for logistics and links to more information. I would be delighted to have you with us.
Saturday, July 6, 2013
Correcting Misconceptions about Suicide
Dear friends -
Last weekend I learned that a colleague had died by suicide the Friday before. I only knew him through conversations with others, had never met the man, but the news of his death has been very painful. A lawyer in his mid-50s, someone who had been successful in his career and risen through management levels, he had been struggling with anxiety and depressions for at least a year before he died. In contrast to Cliff, the organization he worked in is very aware of mental health concerns and suicide risk. He received the best support the people working in the organization knew how to provide.
I wrote the following in the wake of his death, an attempt to help others cope and a reflection of how my understanding of suicide has changed over the past 18 months.
Last weekend I learned that a colleague had died by suicide the Friday before. I only knew him through conversations with others, had never met the man, but the news of his death has been very painful. A lawyer in his mid-50s, someone who had been successful in his career and risen through management levels, he had been struggling with anxiety and depressions for at least a year before he died. In contrast to Cliff, the organization he worked in is very aware of mental health concerns and suicide risk. He received the best support the people working in the organization knew how to provide.
I wrote the following in the wake of his death, an attempt to help others cope and a reflection of how my understanding of suicide has changed over the past 18 months.
Suicide Misconceptions
- Suicide is a choice.
Suicide is no more a choice than dying of cancer or cardiovascular disease is a choice. Someone who dies by suicide has been suffering from a severe, life-threatening disorder, and has not been able to receive the treatment or resources needed to survive.
- The person wanted to die.
It is the illness or disorder that puts someone in so much pain or distorts his thinking so that death seems to be the only option. Once people recover from a suicidal crisis, the vast majority are grateful and relieved to be alive, even if they survived a suicide attempt. This feeling may not come until the disease or disorder has been resolved, but when that happens it does come.
- A loved one or colleague found the body. Why would the person who died do that to them?
In trying to make sense of what's happened, we may wonder whether the person who died was trying to get revenge or express anger towards his loved ones, and particularly towards the person who found the body. While that may in some circumstances be a factor, it is more likely that the person who died was driven to act quickly, and wanted somewhere readily accessible where they had the resources to kill themselves and would not be interrupted. The suicidal crisis attacking him prevents him from caring about who will find the body, just as it prevents him from valuing his own life. - Someone who kills him or herself is weak.
Someone at risk of dying by suicide is under attack by her own thoughts and emotions. Everyday, she is fighting a battle to survive. This takes an enormous amount of strength and courage. If someone dies by cancer, that doesn't negate the strength and courage she or he demonstrated while living with the disease. The same is true for someone who dies by suicide.
- Why didn't he just take anti-depressants or talk to somebody?
Someone at risk of suicide has usually tried many types of treatment, therapy, and self-help techniques. Unfortunately, some forms of mood and anxiety disorders may only respond to specific medications, or may not respond to medication at all. Many mental health professionals, who we think of as experts in this area, have received little or no training in the treatment of suicidal crises. Someone in a suicidal crisis may question whether he is beyond or unworthy of help. Receiving ineffective treatment can reinforce those beliefs and worsen the crisis.
- Someone who is suicidal is beyond help.
Effective treatments are available. Dialectical behaviour therapy has been shown in randomized clinical trials to reduce suicidal thoughts and behaviours. Sometimes medication can be very effective in treating or preventing a suicidal crisis. Restricting access to firearms, poisons, medications, and other means of dying has been shown to be very effective in reducing deaths. Even a change in circumstances can relieve the suicidal crisis and enable the person to recover.
People being attacked by a suicidal crisis deserve the best possible treatment and support we can provide for them.
- Someone at risk of suicide should be in the hospital.
While hospitalization may sometimes be necessary, it has not been demonstrated to be the most effective treatment for a suicidal crisis. In fact, people are at very high risk of dying just after being released from hospital. These transition times must be managed very carefully. Highly effective treatment for a suicidal crisis is available outside of a hospital setting.
- Teenager girls are at the greatest risk of suicide.
Sensationalized news coverage of young people's deaths can shape our perceptions of suicide. While suicide is the second leading cause of death for teenagers in Canada (motor vehicle accidents is the first), males are at four times greater risk of dying by suicide than females, and men age 50 and over are the people most at risk. Suicide affects people of all ages and genders.
- There's nothing I can do.
There are many ways to help people at risk of suicide survive and recover.
a) Blame and fight the disease, not the person the disease is attacking.
b) Encourage the person to keep trying treatments until she finds something effective.
c) Take any suicidal crisis seriously. Help the person at risk find the treatment and support he needs to stay alive.
d) Remind the person at risk that you care about her and that you want her to be alive. In randomized clinical trials, non-demanding demonstrations of care by others have been shown to reduce deaths.
e) If you are the person closest to the person at risk of suicide, don't assume medical and mental health professionals have expertise in treating suicidal crises, or will provide you with the information you need to be an effective support. Ask questions; advocate for the person at risk; don't be afraid to get involved.
f) Take a suicide first aid course like ASIST or safeTALK.
g) Take care of your own mental and physical health. If you're not healthy, your capacity to support others will be diminished.
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