I run a Suicide Crisis Centre in Gloucestershire where we support people every day who are at risk of suicide.
My reason for setting up the Centre was that I experienced suicidal crisis myself in 2012 and couldn't find the kind of help that I needed within mental health services or the voluntary sector. This lived experience has been a very helpful part of my learning. My negative experiences were the driving force which pushed me to set up something very different.
At times I was struck by the more unhelpful things which were said by professionals who come into contact with people who are at risk of suicide.
I have found the vast majority of hospital doctors to be compassionate, understanding and keen to help - some of them exceptionally so. However, occasionally it has been the opposite. I was once admitted to hospital following a suicide attempt and was having thoughts of attempting again. A hospital doctor spoke to me about the method I was considering using and said to me: "That's not the most effective suicide method." I hesitated and then asked him: "What is the most effective method?" I never imagined that he would reply but he went on to tell me what in his opinion were the two most effective suicide methods. He had just told me the best way to kill myself. A week later I was at the type of location that he had cited as a reliable way to end my life. I didn't attempt suicide but it's easy to see the acute dangers in providing a suicidal person with that information.
A phrase which is used quite often within statutory services when talking to a patient who is feeling suicidal is: "It's your choice to end your life" or "It's your decision". It is generally said when a person is deemed to have the mental capacity to make a decision. I have found this an unhelpful phrase. When it was said to me, I felt it somehow validated the "decision" to end my life. In my experience of supporting clients, I believe that most people who are at the point of suicide are either unwell or highly distressed and this impacts upon your ability to make decisions. Your thought processes and interpretations may be profoundly altered at that point.
Some of our clients at our Suicide Crisis Centre have told me how they felt when mental health professionals informed them that it was their decision to end their life. One told me: "It makes me feel that they couldn't care less if I do it." Another said: "It makes me feel that they want me to do it." It was alarming to hear a client say this. The staff member would of course never have intended that their words should be interpreted in this way, but it shows that a person who is at risk may interpret it in a very different way from that which was intended.
As part of my work I sometimes come into contact with the friends or loved ones of a person who is feeling suicidal and there are times when they express their fear of saying "the wrong thing". They are worried that they might say something which actually triggers a suicide attempt. From my experience of being suicidal myself, I found that if someone was concerned, caring and trying to help and understand, then it usually meant that if they made an occasional unfortunate comment, it was heard in the much wider context of overall helpfulness from a person who cared, and to whom your survival mattered very much.
There is, however, an exception to this. On a handful of occasions in the past 3 years a carer or friend of a person expressing suicidal intent has told me that they have said, in anger or out of frustration "Do it then." Occasionally it was said because they did not believe that the person had genuine intent. Please never say this. Every expression of suicidal intent needs to be taken very seriously. And many of us who are at the point of suicide believe, quite wrongly, that our loved ones would be better off without us. It is often part of a depressive illness to feel that you have become a burden. Being told to go ahead and end your life reinforces this.
I am a huge advocate of the Applied Suicide Intervention Skills Training (ASIST) course, a two-day course which trains you to intervene when someone is at risk of suicide. One of the reasons why I rate it is because it teaches you the right questions to ask in order to determine if the risk is imminent. The course teaches you to ask direct questions: "Are you feeling suicidal?" "Have you thought about how you would do it?" You are trained to ask further questions to find out if they have already got what they need to end their life and whether they have a time frame in which they are planning to do it. This course isn't just available to professionals. It's open to everyone and I believe local councils should ensure that the course is offered free of charge to as many people as possible. I wish there was a person in every street with this qualification.
I took the ASIST course in Bristol and there was a very powerful role play exercise in which someone was about to jump off the suspension bridge. We were told that in such situations the vast majority of people pass by without offering help. I am sure that this is through fear of saying the wrong thing, rather than not caring. The course gives you the confidence to approach the person and offer help and that is why I am so passionate about non-professionals doing it.
If you are a friend or work colleague worried about saying the wrong thing, then I can say from personal experience that if you let the person know how valuable they are, how much their life matters, how it matters to you that they survive and how much you care about them and care about their survival, then you will be making a huge and positive impact.
Information about the charity Suicide Crisis can be found at:-