Updated: Sep 12, 2021
A one stop guide to everything you need to know about suicide, how to get help, how to help a loved one with suicidal urges and how to create a safety plan to prevent suicide. This article is honour of world suicide prevention day (9/9/21). It is never too late to educate yourself on suicide and protect yourself and loved ones. I will also talk specifically about suicide in Malaysia, and how to get the help you need.
I know that suicide is a sensitive and difficult topic to speak about but it is an important topic because suicide is preventable. I want to start off by saying that educating yourself about suicide and speaking to loved ones about suicidal thoughts will NOT increase their risk of of suicide.
What are Suicidal Thoughts?
Suicidal thoughts are any thoughts, urges or images someone has around taking their own lives. It is important to know that not all thoughts of suicide reflect an urge to kill oneself. Most often, I hear about suicidal thoughts which are more a reflection of someone wanting pain or an unwanted situation to end. Thus, we separate suicidal thoughts into 'passive' and 'active' ideation. Passive ideation includes thoughts about death and thoughts such as "It would be better if I wasn't around" or "I wouldn't mind dying." These reflect a persons sense of helplessness and hopelessness about their situation. Active ideation is when a person thinks about killing themselves. It is important here to differentiate if a person has thought about how they would act on their plan and to know how strong their urges are. In either case, suicidal ideation reflects a need for psychological intervention. A therapist can conduct a thorough assessment of someones risk and help formulate a plan of how to help a person feel better or get the support they need.
What Will Happen if I Tell a Therapist I have Suicidal Thoughts?
Fear of being locked up or sent to a 'mental ward' are the biggest barriers I hear when people hesitate to share thoughts of suicide. Often they have never shared their suicidal thoughts before, and these thoughts feel too scary to voice out loud. A therapist will not send you straight to a hospital, and no one will be locking you up for suicidal thoughts. As said above, suicidal thoughts vary greatly in intensity and risk. Usually, suicidal thoughts are something to work on in therapy. It helps to have someone hear you and offer compassion, understanding, useful ways to cope and most of all, hope.
A therapist is there to help you create a plan to manage suicidal thoughts. Speak to your therapist about confidentiality and when it can be broken. I make sure to tell clients that I will always be transparent about when a hospital is the best setting for them but that my aim is always to help them in every way possible that works for them first. If suicidal urges ever warrant hospitalisation, this usually includes a brief evaluation and at times a stay of on average a few days to week until you feel safe enough to leave.
Raising Awareness through the Numbers
Statistics of suicide are notoriously underreported, many countries do not have reliable ways to report and track suicide. The extent of reliable reporting depends largely on a country's approach to suicide prevention and tolerance about educating the public on suicide awareness. Take a second to think about what that means for countries where speaking about suicide is heavily stigmatised and suicide is criminalised.
Let's talk about some worldwide stats:
Females attempt suicide 4 times as many times as males
Males complete suicide 4 times as often as females.
Suicide is the 4th leading cause of death in 15-19 year olds
The most frequent methods of suicide is use of pesticides, hanging, and firearms with pesticides being used most often in rural areas (WHO)
About one in every 25 attempted suicide is completed (CDC).
1708 individuals took their lives between January, 2019 and May, 2021.
51% of those individuals were aged 15-18 (Royal Malaysia Police)
Suicide has doubled across all age groups within the last year.
Four suicides a day in the first 3 months of this year.
Who is Most at Risk?
Suicide is a worldwide phenomenon, even though countries approach suicide in different ways. Suicide attempts are most often linked to psychiatric disorders like depression, bipolar disorder and substance abuse disorders. Someone with a major stressor or prolonged stress like abuse, and a violent environment are more likely to push a person towards suicide, particularly if they do not feel a way of escape from the situation. In fact, hopelessness and a sense of helplessness are two major predictors of suicidal thoughts.
Vulnerable populations like BIPOC, LGBTQA+ and marglanized populations who face discrimination, limited resources, high stress and isolation. LGTBTQ kids and teenagers are 3 times more likely to attempt suicide and 41% of transgender adults have committed suicide. Yes, that is 4 in every 10 transgender adults have attempted suicide.Similarly, those who are widowed or divorced, particularly if they are male, over 50 and live alone are at risk.
We know that a past suicide attempt is the most reliable predictor of a future suicide attempts. However, I will say that I frequently work with clients who have suicide attempts in their pasts when they were teenagers and have not gone on to have suicidal thoughts or act on thoughts as a adult. This is related to a significant point in suicide awareness, we know who is at most risk but there is a significant percentage of suicides that occur impulsively, provoked by circumstances like a break up or loss. This is particularly the case for teenagers who are developmentally more impulsive and not yet capable of thinking through consequences until their brains are developed around the age 21.
What to do about Suicidal Thoughts?
A safety plan is crucial to create before you are at a point of crisis. You don't have to create a plan alone. Make one in a session with a therapist and include family members, teachers and/or friends. The more people you trust who know about your safety plan and can help you access it as a resource at a time of distress, the better. Reach for your safety plan before your suicidal ideation intensifies past a 4 out of 10. The purpose of a safety plan is to help you ride out the urges to act on suicidal ideation and to help you feel like you are once again in control. Please remember that suicidal urges are like a wave, they intensify and then will recede, you just have to get through that wave.
Identify who to call if your suicidal ideation worsens or intensifies. Write down your therapists name (if you do not have one, that is your first item to take care of!). Include supportive friends, family, or teachers.
Write down warning signs that precede suicidal ideation. This may include situations that usually make you feel stress and unsafe, like seeing a toxic family member. Warning signs could also increased thoughts of death, googling ways to act on suicide, taking care of yourself less like skipping meals, not sleeping etc.
Identify resources to access if you need to talk. Suggested resources in Malaysia below.
Identify which hospital or urgent care settings you can go to just in case.
Remove sharp objects, poisonous substances and other ways you could harm yourself. It is better if a family member does this for you.
Ask a family member to hold onto your medications and manage them until you are in a safer place.
Print out sayings or mantras you can access easily and repeat to yourself.
Create a self care kit of objects and activities that help calm you down.
Keep a list of reasons why you would not act on suicidal thoughts, keep it accessible.
Identify coping skills to distract and shift your thoughts away from suicide, here are some ideas.
Take a bath, uses items like candles and scents to ground you
Go for a walk, listen to music and/or focus on putting one step in front of the other
Call someone from your support network
Schedule an earlier or extra appointment with your therapist
Go out to dinner or a movie. If you don't want to or can't go with someone, take yourself out on your own date.
Spend time with a pet, pets can be very grounding
Listen to music or watch a favourite show
How can Loved Ones Help?
Loved ones are crucial to helping support people they care about experiencing suicidal thoughts. Nothing is more lonely than having the thought of having your own life. It can be terrifying to speak these thoughts out loud in fear of someone's reaction and their acceptance of your thoughts. It is important that you ask compassionately but do not compromise on asking the question, "are you having thoughts of suicide?" directly. There is a lot of room for misinterpretation here. Based on what your loved one says, talk about options and how you can help. Here are some ideas:
Ask compassionately, non-judgementally and remain open to how your loved one needs help, versus how you perceive they need help
If your loved one has suicidal thoughts, ask them if they have a plan they are thinking about AND if they feel in control or urges they may have.
Be prepared to call emergency services if you need to. Remember this may cause a rupture in trust, but ultimately your goal is to care for this person and keep them safe.
If they feel like they are able to control suicidal thoughts, engage in their safety plan, if they do not have one, help them make one.
Reach out to their therapist with them to seek extra support and help. All therapists are there for emergency calls.
If they do not have a therapist, know that depression can make finding a therapist and reaching out difficult. Offer to help them find a therapist and accompany them if they need.
Help them engage in alternate activities from their safety plan.
Remove harmful objects, substances and ask if you can manage their medications until they are in a better place.
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I am Dr. Cassandra Aasmundsen-Fry, Psy.D. If you are experiencing distress or want to improve your well being, please reach out to me to book a session over Zoom or in person. I can be reached by WhatsApp at +60125472408 or at Cassandra@Mindwell.biz. I am a Clinical Psychologist with a Doctorate in Clinical Psychology who sees both individuals and couples in Mont Kiara, KL, Malaysia. In addition, I provide talks, workshops and content creation.