-harm attempts or evidence of planning suicide.
- Hopelessness, self-hatred and feeling trapped.
What you can do to help?
If the individual is at risk and exhibits signs that may suggest a possible escalation, it is important that friends and family are prepared and act. There are a range of strategies that can be employed to mitigate risk of suicide and to promote recovery. Plans that can be facilitated by friends and family of the ‘at-risk’ individual during the crisis, intervention and recovery phases of suicide prevention are as follows:
- Be available and open – Encourage the person at risk to discuss their concerns openly. Ask calmly, but straightforwardly about suicide. Are they considering harming themselves? If so, how? Do they have the means to carry out the plan? It is important that the individual feels they have permission to discuss these issues openly without judgement or fear of offending. In this instance, it is much better to run the risk of overreacting than to under-react.
- Be prepared, know what services and resources are available in your area – This will typically include the location and phone number of the local hospital and emergency department (ED), the local mental health crisis team, the individual’s mental health clinician’s details, which can include a mental health nurse, psychologist, case manager, and social worker, as well as an occupational therapist, general practitioner, and psychiatrist. Other relevant community resources are the community mental health centre and local non-government organisations. In New South Wales there is a government run state wide crisis line (1800 011 511) that can access and intervene with services if appropriate.
- Assertively involve services – As difficult as it can be, it is essential to involve professional’s when dealing with situations that involve suicide. This may involve a friend or family member calling services themselves, even if this is against the expressed wishes of their loved one. In these situations it is most important that the individual be kept safe. At all times, however, services act in a way that promotes the least restrictive environment for the person. If you do not feel the individual is safe, ask them to accompany you to the local ED, call the local crisis team or call an ambulance.
- Be an effective and resourceful listener – Throughout a crisis, being an open, kind and attentive listener can make all the difference. You should openly offer support and care. Using a sense of non-judgement, assist in exploring alternatives to the problems in the life of the individual contemplating suicide and alternatives to self-harm. Assist in identifying coping strategies and external support, while simultaneously validating the distress the individual is experiencing.
Experienced professionals utilise a range of different techniques that vary in intensity depending on their assessment of the situation. This can occasionally lead to hospital admissions but most often consists of regular therapy sessions with an initial focus on ensuring safety, providing support and considering alternatives to suicide. Some clinician’s seek commitment to a plan via contracting, although these remain controversial due to the current lack of clear efficacy in the scientific literature. Once the immediate crisis has been averted, treatment will often consider those psychological vulnerabilities that may have contributed to the person’s behaviour.
Peter Walker has over 12 years experience working as a clinical psychologist. He has worked in both public and private practice, having specialised in complex presentations. He established his private practice, Peter Walker & Associates, clinical psychologists, in 2002 as a service to provide psychological treatments for those experiencing difficulties with anxiety, depression and couples in distress. In addition, the practice was relatively unique in that it offered specialised treatments for those experiencing psychotic disorders and bipolar disorder. At the time Peter Walker & Associates was established the develop