Suicidal ideation means thinking about suicide or wanting to take your own life and it can occur repeatedly for some people. Not everyone who thinks of suicide will attempt to end their life. That needs to be really clear.
Suicidal ideation is in fact an early warning sign. The question I always ask of people experiencing thoughts of suicide is “What is it that you’re hoping will end? What is it that you would like to see die?” Oftentimes it was around circumstances that they were experiencing, living with, or an inability to actually articulate what they were feeling.
Absolutely not. Some of the research would identify that those at a high risk in a crisis are more often given intervention than people who are deemed lower risk. In other words, people identified or assessed to be at lower risk had a higher chance of dying by suicide than those who were assessed and deemed higher risk.
Suicide is incredibly complex and unique for each individual, so prediction at an individual level is extremely difficult.
The thing about early warning signs is that there are so many of them and they interact in different ways, that just having, what you would identify as those warning signs, doesn’t necessarily mean that someone is going to die by suicide.
The whole area of biology and neurobiology has really taken off in terms of studying suicidality and what we’re finding is that it’s still incredibly complex. There is not a single determinant that is going to predict if someone is going to experience thoughts of suicide or if they’re going to make an attempt or die by suicide. So you’ve got the intersection of biology, family predisposition, mental illness, environment; they all contribute in some way … and still, you can have two people with exactly the same history, like twin studies, and the thought might never enter their mind. We have all of these predisposing risk factors, but we still can’t come to a place yet where we can say “this is it”. I think that’s a stay tuned over the next 10 years.
It’s being exposed to suicidality around either your family, peer group, and even media. It can increase suicide and suicidal behaviors. We can see that with celebrity suicide, particularly when the media identified means and methods. I’ve heard of people who are jealous when a celebrity died by suicide where they have been trying so often and they are still alive. You’ve got different clusters, [meaning] multiple suicide behaviors that would happen in an accelerated time frame and sometimes those happen within a defined geographical area.
We don’t have those numbers yet. There is some real concern about an increase in ideation and or suicide attempts, based on the extreme issues that people are experiencing: financial, housing, food insecurity. If they are also known for having a mental illness: Is their depression going to get worse? Are there resources to get them through? That’s a huge issue. For example, not being able to see people individually and having to do it remotely. Some people are afraid of going to hospitals because they think they are COVID-infested, thus not reaching out for help.
As it stands, it’s still to be determined what the long-term impacts of the pandemic will have on rates of suicide-related thoughts and behaviors or deaths by suicide throughout society. What we do know is that some people are truly suffering.
It’s really important to break down the “wall of silence” because suicide is heavily stigmatized. If you notice that someone doesn’t seem to be themselves or they’re taking more time off, say “Hey, is there something I can do to help you?” [Don’t] overreact, offer a listening ear and some compassion, without the threat of [job loss].
It would be nice if workplaces could provide support or flexibility, some do that through EAP and sometimes colleagues will be the most supportive. [Do not be] afraid to say “Hey if you need to take a mental health day” or offer, “If you need to flex your hours because your meds are all wonky, you’re super tired and drowsy in the morning, and you’re better off working in the afternoon, early evening…” Is there that kind of flexibility that you can allow?
There is some research that identifies that if someone in the workplace learns about another person’s history with mental illness, it can severely impact the relationship. For example, if a colleague says “they must be having a mental health crisis if they’re not here,” that sarcastic jabbing creates an emotionally unsafe work environment, particularly if it’s coming from a manager.
There’s a lot of stigma about suicide. It’s recognizing how we use language around suicide. It’s not a criminal offense. It’s not about “committing” suicide, you commit a BnE [breaking and entering]. Also, not saying it’s a “failed” suicide or a “successful” suicide because the person would hear that as “I am a failure” or that only dying by suicide is a success, therefore think of themselves as, “I am unsuccessful.” We don’t talk about committing suicide, we talk about dying by suicide or “suicide.” An attempt is neither good, bad, failed, successful, it’s an attempt; you can take the adjectives out of it. We’re talking about somebody who is in an incredible amount of pain, that needs to be heard and validated.
We also have an issue around myths, like people who die by suicide or who make an attempt are cowards, selfish, manipulative, or attention-seeking. It would do well if people could educate themselves around dispelling those kinds of myths. It’s about the pain; having so much pain that one’s only perspective is to end their life in order to end their degree of pain.
Don’t dismiss someone after they have survived an attempt. Listen and believe them. You might not agree, [yet] it’s their experience and we cannot judge the experience of another person. [Do] not participate in the wall of silence because you’re afraid. If someone has had an attempt or it is made known that they have some sort of ideation, say “I hear you’re having a real hard time, how are you?”
There’s a lot out there on bereavement and postvention support. It’s a different kind of grieving and shock and it’s equally devastating to anybody who experiences a suicide loss. You don’t have to be in the family to be impacted. It’s again, staying compassionate, empathic, acknowledging that it happened and for some people, it means being practical, saying “Hey can I call some people to tell them they have died or died by suicide (however you want me to frame it), can I look after your kids, do you need help with funeral payment,” etc.
There’s a whole range of emotions that can be experienced; it’s important to remember that this isn’t about you, this is their experience. Let them talk about it, for as long as they need to. If they say “No I don’t want to see you,” how can you keep in contact through messaging or over the phone, so as to not abandon them. So often, they feel like they have to do this alone and that’s incredibly painful.
Invite them to talk about the person who died, using that person’s name, being patient, and letting them tell their story without asking a ton of questions or interrupting. Acknowledge those times that might be significant, like the anniversary of the death or birthdays.
Saying things like “you’re so strong” or” time will heal” or “the person is at peace now.” That can in fact minimize or really trigger somebody. We do it with the best of intentions and yet it doesn’t necessarily mean that they will hear it that way.
When you are supporting someone who has been bereaved by suicide, it’s important to take care of yourself too. Recognize that you need to have your own limits and that doesn’t mean you’re being mean. “Can I offer to do the grocery shopping or sit with you?”, but you don’t have to do it 24/7. Accept and acknowledge for yourself how you feel about it. Whatever you’re feeling is whatever you’re feeling. There’s no good or bad.
Recognize you can share the load with other people, it’s not just your burden as a support person.
If you or someone you know is struggling with suicidal ideation, there are ways to get help. Use these resources to find help for yourself, a friend, or a family member:
Dr. YVONNE BERGMANS, MSW, RSW, PHD, has worked as a suicide interventionist for the past 21 years with a focus on working with people with recurrent suicide attempts. Her role has included crisis intervention, assessment, community and care provider education and training, supervision for clinicians working with clients with suicidality, research focused on responding to and understanding suicidality and psychotherapy with people at risk of dying by suicide. The 20 week group intervention, Skills for Safer Living: A Psychosocial/Psychoeducational, created in collaboration with clients with recurrent suicide attempts, has been implemented in Ireland, British Columbia and several sites in southern Ontario.