Suicide - supporting someone else

About suicidal feelings

How does someone who is suicidal feel?

If you want to support someone who is feeling suicidal, a first important step can be to stay with that person, listen and try to understand what is going on for him or her.

Some people have a strong, clear desire for death. They may feel hopeless and believe that things will never get better and it's beyond their power to do anything about events and pressures in their life.

Mum thought I should try for college. Dad urged me to get any job. My sister called me a wimp for not travelling the world. My mates reckoned I should stick with our band... My girlfriend nagged me to...become a salesman. I used to bottle up my feelings. Who knows what I wanted? I just couldn't see the point of struggling on.

When someone is feeling so helpless and hopeless, it may be comforting to them to think that death is still within their control. Personal beliefs about what death will bring – nothingness, a place in heaven, reunion with the dead, reincarnation – may also bring comfort. Suicide may seem to be the only way of solving problems, once and for all, and ending the emotional pain of living.

However, self-destructive emotions, thoughts and behaviours are often far more confused than this. In the weeks beforehand, depression, hopelessness and irritability often build up. Under pressure, people may become desperate, but may still feel confused. They may not want to die. Rather, they may see death as the only way to escape an impossible situation, to relieve an unbearable state of mind, or to convey desperate feelings to others. Some may be past caring whether they live or die. An important fact for you to recognise is that, however wavering and confused their feelings may be, they remain life threatening.

Causes

What causes suicidal feelings?

The underlying causes of suicidal feelings are likely to be a complex mix of personal and social factors: a run of problems or bad luck may feel overwhelming; a sudden personal crisis may trigger despair; or despair may build slowly.

The pressures and hurts of many years can wear down a person's self-esteem. It can also be anger that is bottled up and turned inwards. There may be an incident or problem just before a suicide attempt – but this is rarely the real cause. Just as a sense of despair can take years to build up, so suicidal feelings often develop gradually.

... when I was ten I was badly abused by a family friend. I've never told anyone. Since then I've kept myself to myself and have tried to take overdoses of painkillers. Whenever I'm at home with the family, I'm scared and feel lonely. I'd like to leave my family and start afresh... at the moment I feel like doing something I should have done years ago – to stab myself.

People who may be more at risk

Some groups of people appear particularly vulnerable to suicidal feelings.

People with mental health problems

People with serious mental health problems, such as bipolar disorder (manic depression) or schizophrenia, have a higher risk of dying by suicide than the general population. Delusional ideas may contribute to suicidal thoughts (people may hear voices, for example, urging them to kill themselves); however, this is not the most important factor. Depression is a common feature of such disorders and, when combined with a lack of social support and a sense of hopelessness about the future, can often lead someone with a serious mental health problem to take their own life.

There is a particular risk of suicide when someone is just beginning to recover from depression. They may have the energy to kill themselves that they lacked when they were severely depressed. One study estimated that 70 per cent of recorded suicides were by people who experienced depression. See 'Useful contacts'  for a list of organisations that can provide support on different conditions.

People with physical health problems

If someone has a long-standing or painful physical problem, they may become depressed, and this, in turn, makes them more prone to suicidal feelings. It is therefore important that carers and professionals are aware of this.

People who self-harm

People who deliberately harm themselves are not necessarily suicidal; however, research suggests that people who have self-harmed are more likely to try to kill themselves. Sometimes people may die of injuries caused by self-harm, even if they did not intend to kill themselves. Whether or not death is the objective, self-harm is not about seeking attention or playing games. Like suicidal feelings, self-harming behaviour may express a powerful sense of despair, and should be taken seriously. (See Understanding self-harm.)

People with a history of physical or sexual abuse

This puts young people at increased risk of suicide or deliberate self-harm.

Those experiencing relationship problems

Relationship problems, especially when there are disturbed family relationships, are sometimes in the background when someone attempts suicide. A number of people kill themselves after a serious argument with a partner.

People who misuse alcohol and drugs

People who misuse alcohol and drugs are at increased risk of suicide, especially if they are young men. These difficulties may already reflect painful, traumatic experiences, such as sexual abuse or early bereavement. (See Mental health effects of street drugs.)

People in poor social situations

Attempted suicide is higher among the unemployed than those in work. This is also true for homeless people.

Men

Men are more likely to take their own lives than women. The reason for this is not certain. It may be partly because men are less inclined to be open about their feelings. Women tend to talk more about their problems, and may therefore get help more often.

Young gay, lesbian and transgender people

Young gay men and lesbians are at risk too, possibly because of the discrimination they face in our society. Transgender people are also at increased risk of self-harm and suicide. In particular those who are visibly transgender.

What are the warning signs?

What are the warning signs?

Someone’s suicide attempt can seem to come suddenly, without warning, and family and friends may feel mystified about why someone has taken, or tried to take, their own life. Yet, it is likely that the person’s suicidal feelings have developed over a long period of time, without others being aware of them. The person may have found it hard to talk about these feelings, perceiving them as forbidden, and therefore disguised them.

Some time ago, the young son of my friends died by suicide. His parents are beside themselves with grief. They live with that terrible helplessness that comes from feeling that there was a soul so troubled, but perhaps so self-contained, that no one knew.

Some things to look out for are:

• major setbacks e.g. failing exams, being made redundant
• loss of self-esteem
• isolation and hopelessness
• sleep problems – particularly waking up early
• a sense of uselessness and futility – feeling "What's the point?"
• taking less care of themselves e.g. eating badly or not caring what they look like
• suddenly making out a will or taking out life insurance
• talking about suicide. It's a myth that people who talk about suicide don't go through with it. In fact, most people who have taken their own lives have spoken about it to someone
• a marked change of behaviour. Someone may appear to be calm and at peace for the first time or, more usually, may be withdrawn and have difficulty communicating.

Someone who has thought about suicide in the past, however vaguely or rarely, is more likely to resort to it as a means of coping when life becomes stressful.

How to help

What can I do to help?

• be there for them
• talk to them
• look at options for solving their problems
• be accepting of them.

Don't dismiss expressions of hopelessness as a 'cry for help' or try to 'jolly them out of it'. Talking openly about the possibility of suicide will not make it more likely to happen. But just being there for the person and listening in an accepting way can help the person feel less isolated and frightened.

Even when someone appears to be absolutely determined to take their own life, it is important to talk to them and examine every possible option and source of support. Encourage the person look at options to see if there are other ways of resolving their problems.

Encourage them to get help

The difficulties that nurture despair are usually complex and don't vanish quickly. Therefore, it is important to encourage someone who is feeling suicidal to get some outside support. Their GP is a good starting-point. He or she can arrange for the person to get professional help, such as psychotherapy or counselling, and may prescribe antidepressants, if appropriate. There are also organisations, such as Samaritans, that offer emergency helplines for people who are feeling suicidal. Some organisations may offer ongoing support, self-help groups, general advice and information (see 'Useful contacts').

Discussing strategies for seeking help and creating a ‘personal support list’ is a useful way of reviewing options with the person you are concerned about. The list may include the contact details of family and friends, helplines, organisations and professionals available for support. Encourage the person to keep this list by the phone and to agree to call someone when they are feeling suicidal.

Some people may resist sharing their personal feelings and problems. If they are reluctant to seek outside help, helping them make a personal support list may provide some things to think about, allowing them to consider the options when they feel ready.

In an emergency

If you feel someone is in real danger of suicide, has a mental health problem and will not approach anyone for help, you may want to think about contacting social services. Under the Mental Health Act 1983, a person can be treated without their consent. This is, inevitably, a heavy responsibility and can lead to the person being detained under the Mental Health Act (see The Mental Health Act).

Coping with someone's suicidal feelings

How can I cope with someone’s suicidal feelings?

Some people make repeated suicide attempts and appear to express a strong, unwavering wish for death. Accepting that someone has such feelings can be difficult and how you feel about their wishes may be different to how other people feel. You may come to accept that death is the inevitable outcome of so much emotional anguish. You may feel relieved that the person will not have to face further suffering.

A part of me always knew he was dying, even though his body remained alive despite eight suicide attempts. The agony he experienced had caused a kind of death inside, already, and however much he struggled to believe that life could win through, ultimately it could not and he made his choice accordingly.

You may feel guilty, upset or angry with the person who wants to end his or her life. If you are in a close relationship with someone who has suicidal thoughts, you may feel that what is going on for the suicidal person is your fault.

After he made the first two suicide attempts in the space of 24 hours, I felt completely wiped out. I felt, overwhelmingly, that it must be so awful being married to me, he'd rather be dead.

Get support for yourself

Accepting your own feelings about someone who is suicidal can be difficult. Therefore, don’t be afraid to ask for help to deal with the emotions you may be experiencing. If you feel that you need support, it is important that you find someone – whether a friend, family member, a professional, or a carers' support group – in whom you can confide in. You could compile your own personal support list to keep handy when you need it. See ‘Useful contacts' for more information on organisations that can offer support.

Useful contacts

Bipolar UK
web: bipolaruk.org.uk
tel:  020 7931 6480
Support for people with bipolar disorder (including hypomania) and their families and friends

British Association for Behavioural and Cognitive Psychotherapies (BABCP)
tel:  0161 705 4304
web: babcp.com
Can provide details of accredited therapists

British Association for Counselling and Psychotherapy (BACP) 
tel:  01455 883 300 
web: itsgoodtotalk
For practitioners in your area

The British Psychological Society 
tel:  0116 254 9568 
web: bps.org.uk 
Produces a directory of chartered psychologists

Carers UK
advice line:  0808 808 7777
web: carersuk.org
Independent Information and support for carers

Cruse Bereavement Care
tel:  0844 477 9400
web: crusebereavementcare.org.uk
Helpline and advice for those affected by a death

Depression Alliance
tel:  0845 123 2320
web: depressionalliance.org
Information and support for anyone affected by depression

Hearing Voices Network 
tel:  0114 271 8210 
web: hearing-voices.org 
A support group providing nformation, support and understanding to people who hear voices and those who support them

Mental Health Law Online
web: mentalhealthlaw.co.uk/Mental_Health_Act_1983_Overview

Rethink
advice line:  0845 456 0455
web: rethink.org 
Information and support for people affected by severe mental illness

PAPYRUS (Prevention of Young Suicide)
helpline:  08000 68 41 41
web: papyrus-uk.org
Advice for young people at risk of suicide

Samaritans 
24-hour helpline:  08457 90 90 90 
email: jo@samaritans.org 
web: samaritans.org
Freepost RSRB-KKBY-CYJK, Chris
PO Box 90 90
Stirling
FK8 2SA
Emotional support for anyone feeling down, experiencing distress or struggling to cope

Survivors of Bereavement by Suicide (SOBS)
helpline:  0844 561 6855
web: uk-sobs.org.uk
Emotional and practical support and local groups

Published 2012
To be revised 2014
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