In England, one person dies every two hours as a result of suicide. And it is the leading cause of death for young people, both male and female, in the UK – every year around 1,600 children and young people aged ten to 34 take their own lives.
Childline receives an average of one call every 30 minutes from British children with suicidal thoughts – that works out at 19,481 in the last year alone. This is more than double the number of five years ago. And yet, we still aren’t talking about it.
Part of the problem is that people are scared of having conversations about suicide. So while relatives and friends may be able to recognise that something is seriously wrong, they may be afraid to intervene for fear that they might say or do “the wrong thing”.
And it isn’t just relatives and friends who don’t know what to say. After 25 years of NHS nursing experience, I have also seen that in clinical practice nurses and medical staff remain silent when they are faced with suicidal patients. In my experience, it is not uncommon for nurses to be afraid they will say something wrong if they discuss suicide, or what triggered a patients’ suicidal thought at that time. And the lack of training given in nursing programmes on suicide can leave nurses feeling like there is a risk of further harm to the patient.
This is where suicide intervention training could really make a difference and help those frontline staff – such as nurses, doctors and paramedics – know how to talk and help someone with suicidal thoughts, feelings or plans.
The skills learned on these types of courses include how to talk to someone about their feelings in a way that makes them feel listened to and understood – without judgement, and without trying to “problem-solve”. Suicide intervention training also teaches staff not to be afraid of these types of conversations, and helps to raise awareness of signs and symptoms of suicidal behaviour which might otherwise go missed.
What also needs to be addressed through education and training programmes is the beliefs and attitudes of nurses toward suicide and suicidal behaviour. University nursing programmes should include scenarios involving suicide – and include suicide assessment, conversation starters, evaluation, and referral skills – regardless of speciality.
This type of training would benefit any one who has daily contact with a wide range of children and adults in a health setting – and could be a mandatory component of training for nurses, physicians, mental health professionals, pharmacists, teachers, counsellors, youth workers, police, first responders, correctional staff, school support staff and clergy.
Knowing how to have these conversations is vitally important because there are very significant difficulties for family members and friends in trying to recognise and respond to a suicidal crisis. This is often because signs and communications of suicidal crisis are rarely clear – they are often oblique, ambiguous and difficult to interpret.
And rather than getting the help they need, people with suicidal thoughts and feelings often bottle them up and try to get on with things. So although there are sources of help readily available, it is not always accessed or used.
When someone takes their own life, the effect on their family and friends is devastating, and it can also have a profound impact on the local community. But because there is still such a sense of shame around suicide, many families feel unable to talk about it.
The shame and negative associations with this type of death – known as suicide stigma – has been around for centuries, mainly from a religious and legal standpoint. And despite all we know about depression, and societies’ more accepting views of mental health problems, suicide stigma continues.
Suicide stigma can cause bereaved people to feel unable to talk about the death of their loved ones openly and freely. Families and relatives can often feel guarded in the dialogue that they have with others. And this silencing potentially denies those who are bereaved the opportunity to make sense of their loss, maintain connections with their loved one or share memories of happier times. All of which can compound their grief and as research shows, negatively influence the recovery process.
To change this, suicide has to be spoken about more openly. And by building a community of people who have developed skills through suicide intervention training we are more likely to be able to identify someone at risk and intervene to keep them safe.
As well as across the board training for healthcare professionals, raising awareness of available professional and voluntary support is needed in schools – at an early age – to ensure children know there is help and support available to them if they need it. Personal, social, health and economic education (PHSE) lessons are very well placed to discuss issues related to mental health and well-being without the risk of “putting suicidal thoughts into someone’s head”.
The sessions could also help children, parents and teachers understand how to talk about suicide and how to ask questions about negative feelings without feeling sacred or uncomfortable. Because it is by encouraging the wider public to have these types of discussions and conversations that the stigma of suicide can be reduced.
Alongside the reduction of stigma surrounding suicide we also need to ensure that the media deliver sensitive approaches to suicide and suicidal behaviour – because what’s seen on our televisions and read about in newspapers or magazines can have a significant influence on behaviour and attitudes of young people.
The more we talk about suicide openly, the sooner we reduce the stigma that surrounds it. Suicidal feelings do not have to end in suicide – talking openly about suicide saves lives.
People who would like someone to talk to in confidence can contact the Samaritans by calling 116 123.