This week is Suicide Prevention Week, to raise awareness about suicide prevention and teach people to recognise the warning signs.
Simply put, the better informed we are about suicide, the more confident we feel to speak to someone who may be at risk and the more lives can be saved.
Taking a few minutes to read this story could help save the life of a family member, friend or colleague.
In Hong Kong, the most recent data (2019) shows a suicide rate of 10 people per 100,000, but the number could be higher, as we cannot be not sure how many suicides are accurately recorded because of the stigma attached to taking one’s life.
“In Hong Kong, it’s quite shameful to have a family member die from suicide and deaths are often recorded as accidental,” says Dr Hannah Sugarman, a clinical psychologist with Central Minds, a private psychology practice in the city’s Central district, and a clinical adviser for non-profit organisation Mind HK.
For many, talking about mental health has long been taboo, and although that is changing, Sugarman says there is still some way to go. So what does the layperson need to know to be better equipped if someone they know is struggling?
How can you recognise someone who might be at risk?
Look out for changes, says Brenda Scofield, chairwoman of the suicide prevention NGO Samaritans.
In the case of a child, they may become distanced from friends and isolated, may perhaps not be focused on their studies and their eating patterns may change – they may show a lack of interest in food.
“The phrases we hear from young people on the (Samaritans) phone lines are, ‘I’ve let myself down, I’m a burden, I’m a failure’ or ‘Things will never get better for me, I can’t find a way out’,” says Scofield.
For the past year, the Samaritans has run a successful school suicide prevention programme designed to educate not only students as to what signs of distress to look for in their peers – it has also held workshops for parents and teachers.
“This is the multiplier effect – early prevention. The changes can creep up and mums and dads might not see the differences, they are busy, and it can be difficult to see the clues,” says Scofield.
A person who is suicidal might talk about wanting to die or be seeking out information on how to harm themselves, says Sugarman. Other worrying signs that should be acted on, but are not as urgent, are changes in people’s behaviour.
“They might be using more alcohol or drugs, be more anxious or angry, might be sleeping a lot more or withdrawing.
"You might hear them talk about things that indicate they are hopeless or a burden, the language suggests they are psychologically in a place where they don’t see a way out,” says Sugarman.
Is it safe to ask someone if they are feeling suicidal?
Yes. There is a lot of anxiety around asking, ‘Are you feeling suicidal?’ or ‘Have you thought of taking your life?’ – people often fear that by asking the question they may plant an idea in that person’s head. That is not the case, say mental health professionals.
“If you talk to them in a supportive and non-judgmental way, and are being empathetic, you will not make things worse, you will make it better,” says Sugarman.
If a person isn’t feeling suicidal, they will immediately respond, ‘No, I don’t feel like that’. And if they are, it’s an opportunity to have a discussion about how to get professional help to support them.
“(About) the idea that people who are suicidal want to die – what they are looking for is an escape from the way they are feeling, a way of escaping out a situation that is hard to get out of,” says Sugarman.
She says that suicide ideation – thinking about the idea of not being around any more – is quite common; it doesn’t necessarily reflect intent.
Scofield says she and her team at the Samaritans ask everyone who calls or emails their hotline that question.
“It’s a scary place, but by doing it you have opened up the possibility of speaking about it to a person who is at the end of their tether. The desire to die is very different from making it happen,” says Scofield.
How best to speak to someone who might be at risk?
You don’t need special training to show someone you care about them. You can offer emotional support simply by giving them space to talk and listening to how they feel.
You want to be listening non-judgmentally, not trying to talk them out of the problem or solve it, but being a container for their feelings. Although it can be upsetting to hear that someone you care about is distressed, try to stay calm.
Scofield suggests an opener such as, “I’ve noticed you’re not looking so good these days, would you like to talk about it?” and then sitting with the person and giving them the time and space to respond.
“You might suggest a cup of tea or going for a walk, nothing confrontational. Some of the best conversations are when you are walking together, not looking directly at the person,” says Scofield.
Don’t begin by asking, “Are you all right?” because everyone’s default response is, “I’m fine”. Use open questions and then allow the time and space for them to reply.
“If you can have that conversation that makes it clear you are not judging them, not being nosy, you care about them and want them safe, it offers someone a platform to talk about something that is hard to talk about and it might be the stepping stone to getting (professional) help,” says Sugarman.
What are common misconceptions about suicide?
There is a common misconception that talking about suicide is attention-seeking behaviour, but it’s never something to dismiss, says Nanki Luthra, programme coordinator at KELY Support Group, a Hong Kong-based youth support non-profit, and part of the mental health and well-being team.
“It takes a lot of guts for someone to talk about suicide ideation. Never dismiss it by saying, ‘cheer up’ or ‘it will go away’ – it’s not attention seeking, it’s something quite serious,” says Luthra.
She says there’s a common misconception that people who die by suicide want to die.
“They want to end the current suffering, which is more a temporary feeling of hopelessness, more about wanting the pain to end than wanting to die,” says Luthra, explaining that people who are feeling such intense emotions often find it difficult to see beyond the immediate bubble.
There is a common belief that if you feel suicidal then you can’t go back to not feeling that way. That’s incorrect.
“With the right support, you can come out of it,” says Sugarman.
Luthra adds: “It’s something that is very preventable. If you are feeling that way, go and talk to someone and express how you are feeling. We can’t solve everything by ourselves – it’s OK to seek help and tell someone, especially when your mind is blurry or cloudy.”
- Samaritans of Singapore: 1800-221-4444
- Singapore Association for Mental Health: 1800-283-7019
- Care Corner Counselling Centre (Mandarin): 1800-353-5800
- Institute of Mental Health's Mental Health Helpline: 6389-2222
- Silver Ribbon: 6386-1928
This article was first published in South China Morning Post.