Mental Health First Aid for Suicide

TW: mention of suicide and  harm to others/self, specific means and motives behind suicidal thoughts, intent and behaviours

Suicide as an occurence is known to be entirely preventable – however prevention may not be possible without awareness of the warning signs and risk factors associated with this occurence. Some of these factors that are commonly observed in individuals experiencing suicidal thoughts, intent and behaviours are mentioned thus:

• Dramatic change in mood, behaviour or appearance: Such a change may be directly observed by another person as being distinctly and obviously different from their usual behaviour
• Negative View of Self: The individual may as a result talk about feeling like a burden to others, and how others might be better off without them
• Isolation of Self: They may also withdraw from their loves ones and stop or limit engagement in activities that were earlier of interest to them
• Feelings of hopelessness, worthlessness and/or helplessness: expressing, in their own words that they feel trapped or unable to look for alternatives or solutions to their problems
• Talking about or expressing the wish to take their own life: such communication may be direct or subtle – for instance, they may joke about death and/or suicide in an unexpected manner
• Making preparations for their passing: They may look for a way to kill themselves, give away their possessions or write up a will, in order to do so
• Self-harming behaviours: deliberate behaviours that cause harm to the self (such as cutting, use and abuse of substances, banging one’s head on the wall) may not decidedly lead to suicide but can be indicative of the same
• Possessing means of suicide: being in possession of means such as a rope, knife, etc. and associated research around different methods may also be indicative of suicidal thoughts and intent

While individuals may show one, a few, all or none of the signs mentioned above, the simplest and most direct way to support someone is to ask them, without avoiding or shying away from usage of the word ‘suicide’. That doing so will somehow implant the idea about taking one’s life in the other person’s mind is a myth; it is rather likely to create a space wherein they feel comfortable in speaking about the concerns they’re dealing with in more honest and open manner. Whether their communication indicates a wish to do harm to themselves or not, it is meant to be taken seriously, and not to be judged as a ploy for seeking attention. 

The seriousness of their intent can also be observed, by asking them about whether or not they’ve given thought to specific means of suicide, and whether they’ve already secured said means, and other such questions. Generally, the higher the level of planning, indicates a higher level of risk. Even so, absence of a plan should not be taken lightly. 

Certain factors that can increase said risk and should be paid attention to include:

• The individual has a past history of attempting suicide
• Experience of mental illness such as depression, schizophrenia, substance use disorder, etc. 
• Experience of chronic and persistent pain
• There is a family history of a mental disorder or substance use/abuse
• There is a family history of suicide
• The individual has faced exposure to violence, abuse and/or other kinds of trauma
• Presence of means of suicide within one’s home
• Getting exposed, either directly or indirectly, to others’ suicidal behavior, such as that of family members, peers, celebrities or public figures

As observations are made, various steps can be taken to help and support the individuals in distress:

1. If the individual has expressed a wish to harm themselves and take their own life, do not leave them alone. You may need to help distract them for a time while helping them engage with others to form an adequate support system for their recovery. 
2. While it is imperative that they be involved in making decisions about their treatment, in case they are unable or refuse to do so (for instance, if they are inebriated at the time of this conversation), you may need to contact their family or other emergency services for them. 
3. It is best to try to remove the means of suicide if it is present at the time of this conversation, but do not attempt to do so at the cost of your own safety. 
4. Deal with the person and their concerns with an empathetic attitude, with an open expression of your concern for them. 
5. Listen to their concerns without interruptions and judgement, thus making space for them to speak freely. 

Remember: one can learn to make their best efforts at providing support, however some individuals might still die by suicide without it being anyone’s ‘fault’. In order to reduce the occurence of such events, it is beneficial to create safer spaces to talk about mental health concerns. The earlier they are talked about along one’s journey, the easier it might be to prevent deterioration of one’s mental health to the point of suicide. 

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This article includes guidelines adapted from an evidence-based research study developed for the Indian population by Mental Health First Aid Australia, that can be accessed here. 

But we were humans long before we trained as professionals, and so are always looking to learn better! If you found that any of the above is inaccurate, irrelevant or unhelpful, or would like to suggest ways to make this article more helpful in any way, please let us know in the comments below.