Suicide risk and talking about suicide Jaelea Skehan Director Hunter Institute of Mental Health

The Hunter Institute of Mental Health is a leading

National organisation dedicated to reducing

mental illness and suicide and improving wellbeing

for all Australians.

Overview

• Brief recap of facts and statistics;

• Why people die by suicide;

• Talking about suicide;

– Individual conversations

– Group conversations

• Brief overview of media and suicide

What do we know about why people die by suicide?

Traditional approach of risk and protective factors

Modern theory by Thomas Joiner

Common misconceptions

• Most suicides occur without warning

• People who attempt suicide are just selfish or weak

• People who talk about it are just seeking attention

• Talking about suicide with someone will give them the idea.

Summary – risk factors

Protective factors for suicide

• Being connected or belonging to a family, peer group, or community;

• Having at least one person to relate to and bond with;

• Having the skills to deal with difficult situations;

• Spirituality and beliefs;

• Good physical and mental health;

• Effective treatment for mental illness and emotional problems.

Serious Attempt or Death by Suicide

Those Who Desire Suicide

Those Who Are Capable of Suicide

Perceived Burdensomeness

Thwarted Belongingness

Sketch of the Theory by Thomas Joiner

What do we know about ‘talking about’ suicide?

Some assumptions

• Given suicide is a preventable cause of death which is important to communities, saying NOTHING about how to prevent it makes no sense.

• If you are worried that someone may be at risk of suicide, saying NOTHING makes no sense.

• If you know someone who has experienced a loss, saying NOTHING makes no sense.

• Given suicide is an issue that affects everyone, having a media that reports NOTHING about the issue makes no sense.

But…

Talking about suicide

• Suicide is an important issue of community concern;

• It is important that as a community we are engaged with the issue;

• Often confusion about what is meant by “discussing” or “talking about” suicide, and confusion about the evidence;

• Need to ensure we are not “too afraid” to talk about suicide, while respecting and understanding the risks.

Talking about suicide

The risk associated with the “discussion” seems to be related to:

The focus of the information (about death, about how to cope with a death, about the broader issue);

The status of the individual receiving the information (little interest, vulnerable, bereaved by suicide);

The format they receive the information (face-to-face, media);

The place they receive the information.

4 broad groups for communication:

1. Not affected and not interested;

2. Some level of interest or connection to the issue;

3. Vulnerable, at risk; **

4. Those affected or bereaved.

What we know and don’t know

We know:

• Talking to someone, one-on-one, directly about suicide will not increase

their suicide risk (although the empirical evidence is weak);

• Media reporting of suicide deaths has been associated with increased

risk for those who are vulnerable to suicide;

We don’t know:

• Whether group presentation about suicide will increase or decrease

suicide risk (e.g. evidence from schools);

• Whether more general media reporting about suicide (or awareness

campaigns) will increase or decrease risk.

Stigma and suicide

• Many agree that there is a stigma associated with suicide. However, the approach to reducing stigma associated with suicide MUST be different;

• Need to reduce “ignorance” without reducing the “fear”;

• That is, we need to address the myths and misconceptions without inadvertently presenting suicide as something that should be feared less.

One-on-one conversations

• People have reported avoiding the conversation for fear of saying the wrong thing or most likely to talk to others about the person.

• If you are worried about someone or know someone who has been affected or bereaved by suicide it is better to reach out than avoid the person.

• Avoiding the discussion can lead to people feeling more isolated.

One-on-one conversations

Decide to talk to the person, preferably face-to-face;

Listen without judgement and don’t try to fix the situation. People want understanding rather than solutions;

If you are worried they are thinking about suicide, then ask directly and be prepared for the answer;

Talk to the person about who else to involve so they can be supported and encourage them to seek help.

Take care of yourself. These conversations can be difficult and you may need support as well.

Group conversations

Understand the purpose of the discussion and the setting;

Plan messages carefully – the larger the group, the less likely you can monitor the response;

– Messages will have different impacts depending on the group and the reason they are coming together

– We need to alert rather than alarm

Think about the words you use and details about suicide that are given;

Use an experienced facilitator who can manage responses;

Think about how you will support people.

What do we know about media reporting of suicide?

• Over 100 studies have looked at media reporting of suicide and its impact on suicidal behaviour;

• 85% of studies have shown an association between media reporting and increases in suicidal behaviour following;

• The risk of copycat behaviour is increased where the story is prominent, is about a celebrity, details method and/or location and where is glorifies the death in some way;

• Whilst healthy members of the community are unlikely to be affected, people in despair are often unable to find alternative solutions to their problems;

• People may be influenced by the report, particularly when they identify with the person in the report.

The evidence: media and suicide

Media challenges

• While talking about suicide will not generally increase risk, media is not a conversation, it is one way communication;

• Messages in editorial are not “market tested”. That is, we have no way of monitoring how the story is being interpreted by people sitting in their own homes;

• People may take away different messages than those that were intended;

• Raising awareness on its own (e.g. increasing reporting) is not enough to change behaviours;

• Not all media are the same – they don’t all have the capacity to cover the issues well.

Positive role of media?

• The media has a role to play in raising awareness of suicide, but there is generally a lack of evidence supporting any positive benefits.

• But some studies or expert opinion suggest that:

– Personal stories about someone who has managed suicidal risk as protective;

– Focussing on the impact suicide could be protective;

– Adding help-seeking information can be helpful;

– Adding information about risk factors and warning signs can be helpful.

Social media?

It is likely that social media is working across domains:

– One-on-one conversations (with or without onlookers);

– Large group communication about suicide deaths and the issues broadly (driven by the sector and individuals);

– Attempts at social marketing using social media are not evaluated and rarely driven by suicide prevention;

– There are many opportunities for connection and engagement, but little is known about the risks;

– Emerging evidence is mixed (e.g. moderated v non-moderated forums).

Social media?

TIPS: Whole service approach to supporting workers

• Create a supportive environment for staff through policies, culture, staff practices;

• Have clear and consistent policies around problematic behaviour – e.g. bullying, alcohol;

• Build in opportunities to develop connection and relationships;

• Have a system in place to identify and support staff who may be at risk of mental health problems or suicide;

• Develop broader partnerships with other health and community services and supports.

TIPS for peers

If you are concerned then ask about suicidal thoughts;

If the person is not having suicidal thoughts it can lead to a conversation about other support they may need;

If they do disclose suicidal thoughts, don’t panic and don’t dismiss the thoughts;

Listen without judgement and don’t offer solutions.

Never promise confidentiality about suicidal thoughts

Follow policies and arrange appropriate referral

Bookmark good resources you can access quickly

Conversations Matter

Community resources to guide and support safe and helpful conversations about suicide.

Available online at www.conversationsmatter.com.au

Conversations Matter

The resources will assist communities when:

They want to know how to talk about suicide more generally.

They are worried about someone and want to know what to say and do.

There has been a death and they want to know how best to handle individual and community level conversations.

Resources available as: • Online presentation • Printed fact sheets • Podcast

Also has: • Links to services • Supporting

factsheets • Research reports

Contact Us:

Email: Jaelea.Skehan@hnehealth.nsw.gov.au

Mindframe@hnehealth.nsw.gov.au himh@hnehealth.nsw.gov.au

Twitter:

@jaeleaskehan @HInstMH

@MindframeMedia

Websites: www.himh.org.au

www.mindframe-media.info www.conversationsmatter.com.au