November 4th, 2015
Recently, I had a discussion with a remote area health manager who reckoned that “we have young people threatening suicide but no-one does.” That’s a dangerous premise. The region has a high rate of suicide. For every suicide it is estimated there are 30 attempted suicides, and a thousand people ideating suicide. Suicide is a culmination of various distresses that by far too many go unacknowledged. Recently, I also spoke to a few counsellors whose ‘lived experience’ was their only knowledge basis – but in discussing suicide I found they were not helping anyone, they were still grieving, feeling the loss of a loved one years ago. There are those with the lived experience who have translated their loss and grief to be able to help others and then there are those who keep us in loss and in trauma at all times, who in effect insist that suicide is not preventable.
There are those who no matter what we do we will lose but there are those many who what we do will save them, change them, improve them, validate them.
Suicide prevention is about trauma recovery, about healing, about ways forward.
Suicide prevention is about the light of day, not about staying in the darkness, It is about understanding.
I can state that there are many people – young and older – whom I have helped, whom I have kept alive. It is a dangerous myth to suggest that people who scream suicide do not mean it. It is dangerous, very dangerous, to suggest that suicides are not preventable. Many lives can be saved. There is no laying fault or blame here, just that it is a myth that we cannot make a difference where we have the opportunity.
It is important to listen to people. It is imperative. It is a dangerous myth that people who talk about suicide do not mean to do it. For goodness sake, people who talk about suicide are in trouble, they are screaming out for help. People need people. Suicidal ideation journeys grief, anguish, anxiety, depressions, the sense of failure, identity crises, the sense of hopelessness. The majority of people who are talking about ending their lives are thinking about doing this. There needs to be calm and patience but concomitant with a sense of urgency, even if this means just being there, even if a word is not shared – but people need people. We may not get our words right but what we must get right is that the other understands, even in any silence, that we are there for them.
Suicidal behaviour does not mean that someone wants to die, this is another dangerous myth. Suicidal behaviour is a scream for help – people need people. It is a fallacy to presume ‘self-responsibility’ as a way forward for someone in a dark place. People need people to strengthen their resolve to the ways forward. Suicidal behaviour is destructive behaviour that can lead to impulsive actions such as a suicide attempt.
Access to emotional support can save lives. It may never be realised this was the case but person to person support is a huge factor in the improving and saving of lives. Resilience and empowerment are gradually accumulated over time, to the point there comes a time that there is no looking back. It is not true that once someone has exhibited suicidal behaviour that they are forever trapped in the heightened vulnerability to recurring suicidal behaviour.
It is true that a powerful indicator to future risk of suicide is a prior suicide attempt however this does not mean that the heightened risk shall be there for life. Indeed, with the coming together of emotional wellbeing and meaningful contexts, there develops resilience within the individual that can make one stronger than ever before. With the right sort of support, protective factors can guard people against the risk of suicide.
Suicide prevention should not be focused alone on reducing risk factors but just as focused, if not more so, on increasing protective factors. The most powerful protective factors include building a connectedness with other people – they do not need to be about direct and targeted support. This connectedness with other people should include the types of engagements that allow the individual to directly and indirectly draw information about wellbeing, about navigating ones journey through society, and therefore predominately focus on self-worth, identity and conflict management.
Most importantly, healthy relationships will contextualise a meaningful life, an honest life, and this in itself is a relief from the conflict and discord that arise from unhealthy levels of expectations. Personal relationships are important, where the support person can understand that they are about support and not about any particular targeted responsibility to the individual. More research needs to be disaggregated on suicidal behaviour and mental disorders, but it appears the majority of suicidal behaviour is not linked to mental disorders and rather to a sense of deep unhappiness. Therefore families and communities can contribute significantly to the improving of the life understandings of a troubled person.
The risk of suicidal behaviour increases when individuals suffer various discord – such as relationship conflict or from a sense of loss or from a sense of failure. People need people. Isolation is dangerous. The best support comes from ones closest social circle. Protective factors, support comes from the development of ones context of meanings but these too are contributed to by ones social circle. Where whole of communities are at heightened risk of community distress, the greatest success found in reducing the levels of communal distress is when the social circle that is the community comes together to support one another – therefore inherently highlighting the context of their meanings. Inherently rather than troubled individuals isolated and effectively judged, they are understood and supported. This type of coming together by families, friends and/or communities to a troubled and isolated individual is about wellbeing. There may have been childhood trauma, interrupted childhood development – a series of emotional instabilities and turmoils that have affected personality traits which have given rise to unhappiness and suicidal risk factors. But good self-esteem and protective wellbeing factors will come from people coming together with the troubled individual at whatever point in time. These developmental interruptions, life stresses and unhappiness are not mental disorders that require specialist health practitioner support. Rather this is all about people coming together to secure healthy and positive relationship building, to patiently assist one with their self-esteem, to contextualise the path to positive self-identity and the pathway to positive outlooks. Attitude is imperative but it is something shaped by the individual and by those around the individual. People do listen; they listen to the negative and to the positive. Positive adaptive outcomes must be patiently but relentless educated and shaped, and the familial and community support self-evident and generous. Once positive attitudes and positive coping understandings settle in as personality traits, the formerly troubled individual is effectively ‘safe’.
There needs to be in society greater onus on shared understandings of contextual meanings of what it takes to shape positive coping strategies in overcoming childhood adversity – abuse, maltreatment, of exposure to domestic violence, of parent mental disorder. There should be less focus and judgment on the fact of any difficult past, it should not be the focal point but if you read newspapers it is the focus. This bent for the past is damaging because it is a trapping. The discourse needs to be focused on the ways forward and in not holding oneself hostage to any past, or in holding any person or any set of events as responsible for any ongoing damage. Positive meanings and positive attitudes will lead to an understanding and forgiveness of the past and that the present and future can be shaped.
Destructive and self-destructive behaviours should be understood as situational and that individual, familial and community attitudes determine the length of these behaviours. Governments investing their attention in helping resource communities for instance to support others is imperative.
Globally, on average, suicide is the leading cause of violent deaths. Self-destructive and suicidal behaviours are responsible for more hospitalisation and for the descent into more social ills than by any other behaviour. Most suicidal behaviours are linked, and usually exclusively, to unhappiness. Therefore suicidal behaviour is preventable. I would argue that suicide and suicidal behaviour are the major health problems society face but of all our major health problems suicidal behaviour is the most preventable. Yet adequate suicide prevention is not prioritised by Governments. Where causality is limited to relationship and social factors and to vulnerable individuals’ sense or feelings of hopelessness, the descent into a sense of entrapment and the responsive trait of impulsivity, then this behaviour can be addressed by positive mentoring.
Unhappiness is something that can be addressed holistically rather than it being compartmentalised as some sort of mental disorder manifestation and as of a runaway train risk factor to mental disorders. Unhappiness is a manifestation. The prevalence of suicide and suicidal behaviour is higher in high and middle income nations as opposed in low income nations. Similarly, rates of reported depressions and of hospitalisations from self-harm are higher in high and middle income nations. Life stresses that lead to suicidal behaviour in some cultures do not lead to suicidal behaviour in other cultures. Therefore the context of our meanings and our support groups are pivotal.
The outlier in the above are discriminated minorities and peoples. In nations, especially high and middle income nations, with relatively recent colonial oppressor histories, the descendants of First Peoples have been degenerated to discriminated minorities. Unless the descendants of First Peoples accept homogeneity and hard edged assimilation – the oppressor’s hegemony – they consequently experience a deep sense of discrimination. This goes to the heart of identity, to self-worth and esteem and their historical and contemporary identities become a liability. These disaggregated groups have the world’s highest rates of depressions, unhappiness, self-harms, suicidal behaviour and suicides. It is all about identity, whether for a vulnerable child, young adult, cultural group – the answers lay in respecting one another, being there for the other, empowering each other through meanings, relationships, freedoms and attitudinally.
Suicide prevention is about the positive self and any comprehensive response includes everyone. A comprehensive national response for suicide prevention requires understanding the above. Loose understandings will tighten if we begin to understand that the majority of suicidal behaviours are directly linked to trauma and unhappiness – to situational events. Contexts and understandings can be changed before dangerous reliefs from substance abusing are sought or before serious mental disorders set in.
The point is that suicides, our leading cause of violent deaths, which receive relative little mention in the news, are the most preventable violence. Self-destructive behaviours that can culminate in suicidal behaviours and distress families and communities are in fact a leading cause of familial breakdowns and of community distress. Once again, the point is that this behaviour is the most preventable of the various destructive behaviours that impact families and communities. These need to be prioritised in national conversations, by the media, by our Governments.
The average age of suicide in Australia is 44.5 years – that translates to an average of over 30 life years lost per person.
The average age of suicide standalone for Aboriginal and/or Torres Strait Islanders is 27 years – if on average Aboriginal and/or Torres Strait Islanders were to enjoy the Australian life expectancy median then that’s more than 50 life years lost.
The leading cause of death for Australian males aged 10 to 45 years is suicide.
The leading cause of death for Aboriginal and/or Torres Strait Islander aged 15 to 45 years is suicide – nearly one in three deaths in this age group will be a suicide.
One in 19 Aboriginal and/or Torres Strait Islander deaths is suicide – and I estimate because of under-reporting issues it may be as high as one in 10.
We need to support the ways forward and to be honest at all times about the ways forward – suicide prevention is a sensitive space but by the same token there can be no playing with people’s lives – suicide prevention has to be adequately understood and supported and at the forefront, whether the national landscape or the suicide prevention sector itself, it must be led and managed by the right people, those who understand not only suicide but so too the ways forward. An attempted suicide, suicidal ideation, psychological distress need us to be foremost in acknowledging there is something wrong and be about listening, about responding, about trauma recovery – about guiding those in need to be patient and also to pack life with understandings and experiences that can contextualise the trauma. Suicide prevention is about ensuring that trauma is not compounded, does not become multiple – if suicide prevention is not about the ways forward then it is not suicide prevention.
More to come…