eNewsletter - November 2020
Behavioral Health Partners
Starting the Conversation Around Suicide
Carissa Sabal, LPC, CADC
It was just like any other day at work. A patient came in reporting suicidal ideation with little to no mitigating factors. We called 911 for this particular patient. I am the point person for our staff to greet and inform first responders of the situation and debrief them of any important patient details.
After speaking to responding police officers, some left to encourage the patient to go to the hospital. I was alone with one other officer when he sparked a conversation with a question: "If they're so suicidal, why would they tell anyone?"
This question is asked so often by various people who can be confused about the act of suicide. When the officer asked me this question, I was eager to answer it, solely because of the opportunity to share with someone the knowledge of why suicidal ideation occurs.
Suicide is a complex and emotional experience for all those who come into contact with it. Confusion is a fairly common emotion that is felt by those who may not have experienced suicidal ideation or who lost a loved one to these intense thoughts. However, there is a way out of the confusion and intensity of suicide, which is simply to talk about it more.
While discussions of mental health are growing, there can be some hesitation when it comes to suicide. The officer I spoke with did not seem as eager as I was to have the conversation. It is definitely a difficult conversation to have due to the severity, and possible finality, of the action.
In addition, many cultures or religions look down upon the action of suicide as immoral or sinful. For example, Thomas Aquinas, one of the most notable Catholic theologians, said the act of suicide was contrary to nature itself, saying it was sin against one’s self, neighbor, and God (Phipps, 2020).
These impressions can impact the general understanding of suicide and the various emotions attached to it. When emotions such as shame, guilt, embarrassment or confusion attach to the concept of suicide, the conversation about it becomes quieter and quieter. This is usually due to the fact that most don’t really feel comfortable with those emotions, let alone the idea of “everything would be easier if I just didn’t wake up tomorrow.”
A common, but incorrect, belief that if you talk about suicide you are placing the idea in the other person’s mind has been used to avoid conversation about suicide. As a therapist, we are taught that avoidance does not solve the problem. We cannot “just say no,” we cannot continuously turn a blind eye to the elephant in the room, because as we all know, whatever we have been avoiding will rear its ugly head and will usually come back with a thriving vengeance due to our negligence of its presence. Not talking about suicide doesn’t make it go away, nor does it prevent someone from having suicidal thoughts or acting upon them.
A study conducted in Kings College of London acknowledges that actually talking about suicide helps reduce the intensity or frequency of these thoughts for those currently struggling with them (Dazzi, Gribble, Wessely and Fear, 2014). Many third-wave talk therapies have taken this stance on emotions: that we have to address the issue at hand and work through the emotion that is felt in order to overcome it. That is, focusing on the context, process and function of an individual’s experience rather than focusing on reducing or eliminating negative psychological symptoms often has the added benefit of reducing or eliminating psychological symptoms.
This is a foundational tool of Acceptance and Commitment Therapy that allows patients to understand that our emotions are to be accepted and given permission to be present, while identifying ways to limit their intensity and duration (Hayes and Lillis, 2012).Talking with someone about their suicidal ideations can be intimidating, however, it reminds us that having the conversation can be beneficial to their own healing and mental health.
In answering the police officer’s question, I began by sharing why people struggle with suicidal ideation. I explained that those thoughts are a symptom of a worsening mental health diagnosis. One of the most common DSM-V diagnoses is Major Depression Disorder, one of the symptoms listed is suicidal ideation (5th ed.; DSM–5; American Psychiatric Association, 2013).
When depression goes unchecked, and the lack of motivation, energy, interest in things, and isolation intensifies, that is when suicidal ideation can present itself. When presented in this manner, suicidal ideation can provide information with a much more formidable cause rather than a surprise out of nowhere.
There were many avenues that I could have taken in my conversation with this officer, and there are many ways to approach someone struggling with suicidal thoughts. One way we communicate with someone struggling with suicidal ideations is truly to do our best to come from a place of empathy. The best that we can do for those struggling with these thoughts is to encourage the conversation.
Not everyone is going to be willing to open up about their suicidal ideation, however, acknowledging their struggle and severity of those thoughts can be enough for someone to feel comfortable to share. We may not know what it is like to struggle with an intense depression symptom, but it can be truly helpful if we try our best to think back to times where we felt lost or hopeless in a situation.
As behavioral health professionals, we are constantly having these types of conversations. In these situations I always advocate for leaving the individual with more resources. There are plenty of non-for-profit organizations that help promote the conversation and safety of those struggling with suicidal ideation. One of these organizations is Applied Suicide Intervention Skills Training (ASIST) through LivingWorks. Another organization we support at Linden Oaks is Mental Health First Aid.
The conversation that I had with this police officer was enlightening and encouraging and he seemed appreciative. Once I finished talking, he remained silent and did not elicit more conversation. He was not wrong in his response, but rather experienced a very real feeling that many people have when suicide comes up in conversation. Conversations like these can encourage all of us to take care of one another.
Each year on the Saturday before Thanksgiving, we acknowledge International Survivors of Suicide Loss Day, where loved ones of those who have lost someone to suicide can come together and heal.
In your practice, school, or organization, I challenge you to mark this remembrance day by doing something to further open the conversation around mental health and suicide. As behavioral health professionals, it is our responsibility to make it easier for those struggling with suicidal thoughts, support those who have already lost a loved one and continue to normalize this conversation.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Publisher.
Dazzi, T., Gribble, R., Wessely, S. and Fear, N., 2014. Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence?. Psychological Medicine, 44(16), pp.3361-3363.
Phipps, W., 2020. Christian Perspectives On Suicide – Religion Online. [online] Religion-online.org. Available at: <https://www.religion-online.org/article/christian-perspectives-on-suicide/> [Accessed 9 November 2020].
- Text citation: (American Psychiatric Association, 2013)