Suicide is a topic that gets a lot of media airtime; however, not many people are able to talk about it in their personal lives with friends or family.
This is not surprising, considering the nature of the topic and the stigma and helplessness that many people experience when talking about suicide. At this point in my career as a psychiatrist, I believe that almost everyone has been affected by a suicide or suicide attempt.
You just have to ask.
According to the World Health Organization, about 700,000 people die from suicide every year. In Australia, that equates to around nine deaths a day, with 65,000 people attempting suicide each year.
As part of a psychiatric assessment, we ask our patients whether they are feeling suicidal or have made plans to end their lives.
In the earlier years of my training, I was often surprised when people were relieved to be asked these questions and stated that no one had asked them this before.
During the first year of my psychiatry training, I was working an evening shift when I received a call from the doctors in the emergency department to review Anna, a 19-year-old girl who had overdosed on pills.
When asked if she had been suicidal previously, she told me about bullying and bulimia in high school three years prior. She had been at her lowest point at that time, and often thought about ending her life. Some people may be surprised by how long someone can think about ending their life without making any attempts.
Somewhat reluctantly, Anna provided her parents’ contact number and they came to the hospital shortly after. Eventually, Anna was cleared to go home with her parents with a referral to see the community mental health team in the coming week.
Patrick, her father, came to me separately and asked: “How can I stop this from ever happening again? What do we do now?” I knew what he wanted to hear, but couldn’t provide any answer that offered that certainty – the certainty that a parent would never receive a phone call from the hospital telling them that their child had attempted suicide.
He had been aware that Anna had been struggling but had never expected that she would attempt to end her life. I gave Patrick some information sheets and emergency numbers he could use, but paper provides very little solace to worried parents.
Even years into my training, there are few harrowing scenes that compare to parents leaving the hospital with a child who has had their first suicide attempt.
Suicide awareness has increased over the years and has permeated our pop culture (13 Reasons Why) and social media (TikTok and Instagram). People are more comfortable with the idea that suicide is a major health concern. But this has not translated to people feeling more comfortable with bringing up the topic of suicide with a distressed person.
If you have had a sibling, parent, or partner attempt to end their life then you might be able to bring up this difficult topic, but we need more people empowered to ask anyone who is struggling.
Not everyone gets a second chance and the people most hurt by suicide are those who are left behind.
My first psychiatrist supervisor once told me: “If you’re a psychiatrist long enough you will have your fair share of patients take their lives and there’s nothing you can do to change that.” My initial reaction was that of defiance, and I thought the mental health service could be doing more.
Many doctors, for better or worse, have a saviour complex and feel helpless when they can’t help their patients, or lose a life under their care. With time, mental health services have continued to provide more education and support for people and families on mental health issues. Knowledge, destigmatisation and empowerment are fundamental tools for mental health services when engaging the public.
Mr Ansari was a 64-year-old man who presented to our community mental health service with significant depression following the suicide of his only son, Omar, two years earlier.
Omar had taken his life at the age of 30. Mr Ansari and his wife had divorced shortly after, partly due to his depression and mostly due to parental grief. Not all relationships can survive the death of a child. Burying your child is a specific type of traumatic grief with no easy roadmaps to acceptance.
Mr Ansari had been admitted to a mental health ward due to increasing suicidal thoughts. He started on antidepressants and was referred to see a psychologist on discharge. The medications and therapy were effective and while he was no longer suicidal, I couldn’t help but think of him as a lonely, sad man.
During a regular review, he brought up his son and we spoke about the final weeks of Omar life. Mr Ansari knew that his son had been struggling mentally and had one previous overdose in his early twenties. I asked Mr Ansari if he had ever spoken to his son about suicide.
He became angry and said: “Isn’t that your job? How’s a parent meant to ask their child if they want to kill themselves?” A valid question and very commonly asked – mostly by fathers, I should add.
I apologised and let him vent his frustration at mental health services. He eventually was able to be followed up by his GP and psychologist. I like to think we ended on good terms in later reviews, but I’ve never been able to ask him about that. A few years later, I asked a colleague what had happened to him and was told he had returned to Pakistan to be with his siblings as there was little left for him in Australia.
The public often raise the question of who is the most qualified to ask questions around suicide. Anecdotally, many people would prefer if the “professionals” (GPs, psychologist, psychiatrists, nurses, etc) did this, which we are more than happy to.
The question I ask is: If we all asked about suicide, wouldn’t that be better for everyone?
I truly believe that more campaigns should centre around the destigmatisation of suicide and self-harm. This would involve the average person being able to begin discussions around suicide or self-harm in an open and non-judgmental manner. The goal would be for suicide to be talked about in the same way people talk about diabetes, heart attacks or strokes.
If we reach a point where people can make mainstream jokes about suicide, then we would be close to the mark. We make jokes about several medical conditions (which kill people), but we find it uncomfortable to do the same with suicide.
My point is not to be flippant – but the less taboo discussions around suicide are, the more likely people will feel comfortable talking about it. This might lead to earlier detection of significant mental distress or illness which could be a deciding factor in getting people into treatment earlier, with the idea of potentially reducing the chance of people ending their lives.
When you open your web browser or turn on your TV screen, you will often come across a story of a person who has ended their life. We often feel helpless and empathise and then move on. Suppression is a coping strategy, after all. Instead, I want you to feel empowered to lean in and get educated and be able to ask the difficult questions or share your own experiences where appropriate.
We need to talk about suicide.
Dr Xavier Mulenga is an addiction psychiatrist based in Sydney
To read more on how to approach conversations about suicide you can access: “Understanding Suicide”; “When someone is thinking about suicide”; “Having a conversation with someone you’re worried about”; and “How to talk about suicide with young people”.
Patient examples are not real people and are amalgamations of situations often seen by psychiatrists
• In the UK, Samaritans can be contacted on 116 123 and the domestic abuse helpline is 0808 2000 247. In Australia, the crisis support service Lifeline is on 13 11 14 and the national family violence counselling service is on 1800 737 732. In the US, the suicide prevention lifeline is 1-800-273-8255 and the domestic violence hotline is 1-800-799-SAFE (7233). Other international helplines can be found via www.befrienders.org.
