Do take care whilst reading this blog and if for any reason you feel like you need immediate support, please call the Samaritans on 116 123
For 15 years I’ve sat with clients, mostly in an emergency service setting, whilst they have explored the depths and edges of their emotions, searching for the flickers of healing, growth and positive change which can breed within a therapeutic relationship. Suicidal thoughts and ideation have distinctly intertwined within these explorations for many.
Some clients experience agonising emotional pain, sending ripples through the body – our unfaltering vessel for feeling. Thoughts and beliefs such as “everyone will be better off without me” fill the room and it can feel like we could both be consumed by a dark, dank, vast chasm. Depression whispering its lies into the ear of the client.
Other clients may be more hyper-aroused, talking about suicidal ideation in stark, pin point clarity that will cause my heart rate to spike, knowing that there is an impulsivity present which feels out of control for both of us. But we stand firm and I will hold the hope until the client is ready to take it for themself.
Some clients slip into a dissociative state whilst searching for words that just aren’t there, they become almost unreachable, fading in and out of the here and now. No matter their presentation, I am still and offer space where I listen without judgement, making gentle enquiries to understand the depth and gravity of behaviour and planning. In the face of empathy, shame struggles to survive and the sharing of suicidal ideation in a therapeutic setting can take the potency away, bringing respite to the nervous system, offering another layer to the build up of resilience, no matter how fragile that layer may seem.
The truth is, many of us can experience suicidal thoughts or ideation at some point in our lives. With over 60,000 thoughts per day, it is reasonable to expect a vast amount of thoughts in our lifetimes are negative and potentially harmful. Which thoughts we pay attention to the most will have a knock on effect with how we feel and how we behave.
You don’t have to have a mental illness to experience suicidal thoughts or ideation and you don’t have to have suicidal thoughts if you have a mental illness. Our mental health is governed by many factors, such as our environment, genetics, biochemical imbalances, childhood experiences and other aspects. A lot of the time there is a cumulative impact of many presenting issues exceeding our ability to cope in a ‘healthy’ way. Our physiological responses are activated more regularly and survival mode kicks in, inviting a pull to default coping strategies which is helpful if they are positive. However, like many of us, they will probably consist of a mix of positive and negative mechanisms like avoidance, exercise, overeating, social support and overworking as some examples. For some, thoughts of self harm and/or suicidal ideation may present themselves. These can be fleeting or become more progressive towards behaviour changes and perhaps even planning creeps in or being consumed by the ‘how.’ If that is the case, I recommend you get some support straight away.
Many years ago, before I began my counselling training, I used to believe some people were on a collision course with completing suicide and that ultimately nothing would change this fate – it was just about timing that this end would catch up with them at some point. However, I’ve seen so many people recover from the depths of this despair that I now agree with the quote “Suicide is not inevitable” used within many suicide prevention trainings. Conditions for recovery however, can be long and arduous for some, especially if suicidal thoughts or ideation have been a default position for a long time. Also, recovery can still be thwarted with suicidal episodes, therefore my take on ‘recovery’ in this instance is the gradual build up of fragile layers of resilience fusing together over time to form a bed of ‘other’ coping strategies to choose from when the episodes occur.
It is true the more you focus on and practice positive self care strategies, the easier they become to call on as a norm. If or when the suicidal thoughts creep in and become prominent, there are ways of reducing the impact they have to stop them gathering pace until the episode has passed. The following is not an exhaustive list of ideas but it is certainly some things clients have shared with me over the years that has worked for them and a couple that I would recommend personally:
Talk to someone
Talking to someone may sound obvious but many of us will retreat and withdraw as a survival mode, which normally means barely functioning and saving what we do have to ‘put on a brave face’ or mask for work. Just doing what needs to be done to evade anyone noticing that something isn’t right. However, if you are feeling as though you want to die, it is so important that you share this with someone by calling a helpline (Samaritans – 116 123), talking with someone you trust (friend, family member, neighbour, colleague or manager) or calling NHS 111 or going to see your GP.
There is no text book way of saying how you feel – I know finding the words can be tough – but please make a start and let the communication and connection take its form. My blog #itsokaytotalk may help with finding the words to reach out.
Write / Be creative
A strategy I’ve used since I was a child is to write when the going gets tough. It can be anything from diary entries, short stories, blogs, letters or even tapping words into my notes app on my smart phone. If you are experiencing suicidal thoughts, it can be a relief to write them down. This might be a completely private process or you could consider writing to someone that you would like to seek some support from. It’s up to you what you do with the writings. You may enjoy artwork, in which case, have you done any lately? I know many adults who enjoy lego building as a form of distraction and relief from the incessant negative thoughts. Being creative is very much a part of us that can be inhibited as we become adults, however it is an effective form of boosting self awareness and an outlet with underrated survival value!
Focus on what you need today
Keep overwhelm at bay by not thinking too far ahead. What do you need in the here and now to stay alive? I recommend a few different distractions (you may only be able to do one of these or something else entirely which is absolutely okay) as useful tools from pottering around the house or garden, resting when you can, reading, watching a movie, texting a friend (or calling if you prefer), going for a walk, having a good cry (release the tension), spending time with pets, taking a bath. I know life doesn’t always present itself with opportunities for rest, especially if you have a busy home life but building in a bit of protected time somewhere in your day can bring some sharp focus back to taking care of yourself (again, this takes practice!) – even if this is just a few minutes in your day.
The evening and night time can be tough for negative thoughts and worry as well as feeling isolated as we imagine everyone else to be in a peaceful slumber! Habits on the approach to bedtime can influence how you rest and sleep so it’s being mindful of the impact of social media, the news and adult themes on the television such as trauma, violence and/or loss. Also, moderate to high intakes of alcohol will impact on your hydration levels as well as act as a mood enhancer, amplifying symptoms of depression and negative thinking. Tweaking your lead up to sleep to be more conducive to rest and relaxation can have big wins. Gentle reflection on your day, choosing at least one thing that has gone well, that you achieved (this could be washing your hair or making the bed on some days) or made you smile.
Know your triggers
Try to work out what actions can cause you to feel worse, raising your awareness to them – not necessarily changing anything to start with. Are there actions or strategies you have that make things more difficult? Self sabotage can cause you harm emotionally and sometimes physically – daily life and the ability to achieve goals can be impacted. Common forms of self sabotage are procrastination to the enth degree or creating conflict within relationships which is possibly driven by a fear of rejection, yet somehow feel deserving of this regardless of a deep need to be loved and accepted. Being self critical, overindulgence in food, alcohol and staying up too late watching television night after night are other forms of self sabotage.
A common self sabotage issue I’ve experienced as a therapist is that some clients may stop medication without consultation with their GP, knowing that their symptoms of anxiety and/or depression may worsen, possibly including an emergence of suicidal thoughts. The reasons behind this can be complex and very emotionally painful, usually trailing back to a deep seated lack of self worth born in younger, formative years. Pushing through this pain barrier can be rewarding and the benefits to having counselling in this instance allows exploration of the pull towards the unhelpful strategies and what impact positive change could have, creating opportunity and options for new strategies over time.
Knowing some of your triggers for distress, irrational or suicidal thinking can be found in how you seek help and who from. Do you go to someone who doesn’t make you feel good about yourself? Sometimes an overly critical parent or friend won’t give you the much needed comfort and empathy you are seeking. They may be great in other ways, just not the person to help you at your time of need. Reaching out to someone who is going to listen and support you in a way that feels safe and not conflicted is imperative.
Recovery is not linear
Recovery will take as long as it takes but suicidal episodes will pass. Your journey is your journey and may feel like a snakes and ladders board game, never knowing whether you will find yourself back near the start at the next turn. Edging forward after a set back, bit by bit, is still forward. If you are working on building your positive coping strategies, then your bounce back-ability will start to respond and the gaps between episodes may broaden and how long you are in that difficult space may start to shorten.
Small baby steps are key. Even with ‘bad’ days, there is something in them that offers you respite from the pain if you choose to look. Slowly but surely, those bad days lessen and it’s only when you look back that you realise how far you have actually travelled. Allow yourself the bumps in the road.
Consider a talking therapy
Whilst seeking support from friends and loved ones when you are having suicidal thoughts and ideation is recommended, I understand that this can be very challenging to talk about with those you know and love. Some people may think they have to protect family members and worry that they are a burden. It is also common to be unsure what response they may receive (fearing further shame and possibly rejection), therefore it can bring relief to share these thoughts with someone you don’t know who is trained to listen and not jump to ‘fix’ mode. A counsellor or even someone who has peer support training can help you to talk through how you are in a non judgemental setting. This action can then kick start the wider social support if this hasn’t been easily attainable for you.
There are telephone, skype, text and email options for support out there too, if face to face feels like too much. Samaritans are not just great for immediate crisis, they are there at any time you need to talk.
For emergency service colleagues…
If you work in an environment where you are exposed to trauma at work, such as the emergency services, this can be an added hindrance to coping with a suicidal episode. The very nature of what you do for a living lends itself to helping and serving the public who are normally going through some of the worst times in their lives. However, you are human first and suicidal thoughts are not exclusive to those you serve but I know this factor can create a sense of shame, embedding a need to hide behind the smile or the uniform and the expectation is high from many to continue to fix, rescue and protect.
In my area of work, which is health and wellbeing for police officers and staff, I promote the actuality that being vulnerable and feeling and expressing emotions are not the opposite of being strong. You can be and do both. In fact, showing vulnerability is a strength, and should be normalised in emergency service environments as it is this element that fuels connection rather than breeding isolation (which kills). Showing vulnerability and our journeys toward recovery offer hope and clearer paths towards help seeking.
I will always advocate reaching out when you need help but I also offer a gentle challenge to all of us to think about how we can improve our workplace cultures to be more conducive to help seeking for mental health. Culture change can be slow as it is about embedding and maintenance, however, it is all of our responsibility to make it easier and better for ourselves and our colleagues. We can all become better at listening.
It may be shocking to know that research in the US/Canada shows that 80% of first responders who have completed suicide, gave signs or communicated their distress verbally or through behavioural changes. This means that there is opportunity to help so many more emergency service personnel by knowing the signs, creating an environment that is conducive for help seeking and just being kind and showing we care.
The following list (not exhaustive) may be signs of someone planning a suicide attempt:
- Talking about suicide / researching suicide / acquiring items such as rope, weapons or stockpiling pills
- Getting affairs in order (preparing a will, giving away treasured possessions, making arrangements for family members)
- Saying goodbye – unusual or unexpected visits/calls/texts to family and friends. The goodbye may sound as if they are not going to be seen again and be alarming or confusing to the receiver
- Withdrawing from others – an increasing social isolation and desire to be alone
- Self destructive behaviour – increases to alcohol/drug use, reckless driving and taking unnecessary risks
- Sudden sense of calm – presenting calmness and happiness following being extremely depressed can mean that someone has made a decision to attempt suicide over the coming days
Remember that suicide is not inevitable. You CAN help by spotting the signs and responding with care and kindness.
Connection, particularly empathic connection, is life saving. The below is a an effective short video – Brene Brown on Empathy and the impact it can have.
Further support for all