What Can I Do To Help?

Step 1.  Stay with the person

• The suicidal person must not be left alone. The suicidal person needs to feel assured that it is possible to get help. This will relieve some of their stress. 
• Help by being calm.   Being there will help them feel safe.
• Stay in control and keep yourself safe. The helper must be prepared to set him/herself as the support person who will be willing to take charge at this time. The suicidal person’s life is often at a point of despair so the helper needs to be in control and directive. 
• Be aware of personal space and that touching may not be appropriate.

Step 2.  Establish rapport

• Listen to their story - this can be the most important thing you will do!

• Allow silence for them to think and consider what they are saying.  Don’t fill their silences with talk. Don’t rush into asking questions.
• Be aware of their emotions.
• Don’t allow yourself to get caught up in the other person’s feelings of hopelessness, despair or depression.  Make sure that you understand their story from their point of view without feeling sorry for them.
• Be accepting and non-judgmental.
• Be caring, concerned and patient.
• Be positive and hopeful.
• Don’t talk about your own or other people’s problems.
• Don’t try to reason the person out of it.

Step 3.   Identify the problem

• Ask simple questions when you’re not sure or if something isn’t clear. 
• Give advice only when it is asked for.
• Ask relevant questions to find out how the person is feeling. 
• Appear comfortable speaking about suicide.
• Note physical signs of discomfort.
• Be sensitive to age, gender and culture issues.
• Don’t use guilt, or try to make the person feel guilty.
• Ask if anything stressful has happened to them. 
• Encourage the person to talk about what is so bad that it makes them want to die.

Step 4.  Evaluate the suicidal potential

• Do remember “this person does not want to die”.
• Assess if they are expressing feelings of despair or hopelessness.
• Find out if they are receiving treatment for mental illness/emotional problems. 
• Ask if they use drugs or alcohol.
• Ask if anyone in their family has suicided or anyone else they know.
• Check if they have attempted suicide before. 
• Ask if they are thinking of suicide. Be aware that if a person is not suicidal, asking them will not put the idea in their head.
• If they say yes, ask if they have a suicide plan.

• Ask how they intend to kill themselves.
• Ask if they have got what they need for that plan. (e.g. gun/rope/pills)
• Ask when they intend to carry out the plan.

All of the above will help you to evaluate the level of risk for the person. 

Step 5.  What to do next

• Reduce the means of suicide by checking out the house or their environment.

(e.g. If they have pills at hand, ask them to flush them down the toilet.  Help with this.)

• If the suicidal person has a weapon or is behaving aggressively towards you, seek assistance from the police.
• If the person has already done serious harm to his/herself … ring 000 and ask for an ambulance… or go to your nearest emergency department…
• There is no confidentiality in suicide. Explain this to the person.
• Inform them that you need to get help. Do not take full responsibility for this issue on your own. 
• Ask who they would like you to contact – family, friends, doctor, health-worker, elders etc.
• Find out what has supported the suicidal person in the past, and whether these supports are still available - someone/something important to them – even a pet.
• Seek professional help if person is agreeable (see insert in back cover for list of crisis and counselling services).
• Stay with the person until you can get other help or you are sure that he/she is safe.

• Don’t avoid or discount the consequences of their actions.
• Don’t dare the person to suicide.

• Don’t make promises.
• If possible, give ongoing support via visiting or phoning, even though you have put other supports in place.
• When the person has received other help or you are sure he/she is safe, take care of  yourself .  Speak with someone you trust or a support service if you feel the need.

It has to be noted that when we attempt to evaluate suicide potential, research suggests that it is very difficult to predict who might suicide.  Therefore, even with your best effort, prevention of suicide cannot always be assured.

DON’T FORGET

• People rarely suicide in company
• Taking away the means significantly reduces the risk of suicide
• Thwarting impulsivity, by getting someone through a bad patch, significantly reduces the risk of suicide
• Having a strong sense of hopelessness is a major risk for someone with suicidal thoughts.
• Having the idea to suicide for the benefit of others is an even greater risk factor.

Individual Strategies To Reduce Risk Factors

• Reduce time spent unoccupied
• Increase connection with community and family
• Become familiar with who is available to assist in your community – elders, respected community members, police, ambulance
• Increase sense of responsibility for impact of their suicide on others
• Organise the presence of a significant other adult for a young person, or a spouse or partner
• Increase personal resilience
• Enhance problem solving skills - acknowledge suicide is never the best option
• Strengthen the belief that suicidal thoughts are a risk to life
• Improve physical and mental health
• Strong spiritual or religious faith[1] or a sense of meaning and purpose to life is protective
• Remove any means that can be used for self-harm

[1] De Leo, D., Hickey, P. A., Neulinger, K., & Cantor, H. (2001). Ageing and suicide. Canberra, Australia: Department of Health and Aged Care.

Warning signs

Those who talk about self-harm or suicide are at risk. If they say their death would benefit others, the risk may be higher. Someone who expresses a keener than usual interest in suicide may be hinting that they may attempt suicide. Warning signs are the clues that alert us that an individual may be contemplating suicide.  These clues can be divided into 3 categories.

1. Verbal warning signs

With these statements the suicidal intention is made clear and occurs in the context of other clues that indicate an individual may be contemplating self-harm or suicide.  Statements such as:-

"I've had enough. I don't want to live anymore."

"I've had it. I give up. Life's beaten me."

"Life sucks. I'm getting out."

"You won't have to do anything for me anymore. I won't be around."

"Nobody will kick me around anymore. I won't be here."

1. Non-verbal signs

Observing behaviour tells about an individual's affective and cognitive (emotional and mental) state. Some non-verbal warning signs to be aware of are:

• Indicators of depression are sadness, teariness, lethargy, loss of focus, poor sleeping and eating. Other indicators may be aggressive outbursts, frenetic and oppositional behaviour.
• Feelings of hopelessness, ambivalence about life, and loss of control have been found to be predictors of suicidal intention.[1]
• Isolating self and withdrawing from others.
• Sudden changes in behaviour. (eg. increased risk taking)
• Preparing for death. Such as making sure bills are paid up, making out a will, making arrangements as if they were going on a long trip, giving away treasured possessions to loved ones, and preparing notes.
• Collecting means to attempt suicide. Such as obtaining a gun or gathering medication.
• Over-use of alcohol and/or drugs.
• Previous attempts. One of the most important indicators is an attempt that has been previously made by the individual themselves or someone they consider close to them. A previous attempt can be a suicidal gesture, and is when people do not want to die, but try to alert others to get help for them. The method, timing and place of their attempt will typically be such that they will not die and will be found by others. We must, however, see that these people may have an unintended lethal consequence if help does not arrive.

1. Unclear statements

Some statements give no clear signal of the intent to engage in self destructive behaviour.  However, in the context of additional risk factors and other warning signs the hidden intention can be obvious.

Statements may be:

"I'm not the man I used to be."

"I never feel good any more and I bring everybody else down."

"No one cares about me any more, I don’t even care about myself."

"How much does life insurance cost."

In themselves these statements may be harmless, but in conjunction with other risk factors and warning signs, and if checked out directly, we may find these benign statements are lethal in nature.

Men particularly are often ashamed of having suicidal thoughts and feel guilty for having them. They are often reluctant to express the thoughts directly.

[1] Australian Government, Department of Health and Ageing. (2008). Living Is For Everyone: Research and evidence in suicide prevention. Canberra, Australia: Commonwealth of Australia.

Community Strategies To Reduce Risk Factors

Community strategies help in addressing issues that reduce risk factors.  Opening up the avenues of communication to those seeking help is paramount in the community - to listen, to heal, and to act.

• Strengthening communities, increasing connections within communities. (eg. sports clubs, arts groups, service clubs, church groups, support groups, focused school programs).
• Health promotion

• Increasing community knowledge through booklets, media and a wide variety of resources.
• School based programs that promote resilience and self-esteem.
• Having a sense of responsibility for the children is a major protective factor
• Improving family communication skills[1]
• Increasing the number of positive experiences for children.
• Improve connections and support for elderly[2]
• Improve connections and support for parents.
• Providing support for families to find a balance.
• Maintain strict regulation of firearm licensing, storage and accessibility of guns.
• Promote change to car exhausts systems that cannot be used to suicide.
• Erect barriers at suicide sites where appropriate.
• Decrease the number of tablets of dangerous medication sold per packet and improve practitioner education on the dangers of certain medications.
• Policies to minimize substance abuse risks.

• Strengthening families

• Social media and technology

• Reducing the means – community strategies

[1] Australian Government, Department of Health and Ageing. (2008). Living Is For Everyone: Research and evidence in suicide prevention. Canberra, Australia: Commonwealth of Australia.

[2] De Leo, D., Hickey, P. A., Neulinger, K., & Cantor, H. (2001). Ageing and suicide. Canberra, Australia: Department of Health and Aged Care.