How Do We Talk About Suicide?
On 18 May 2011 the Mental Health Foundation began a new series of live and interactive online broadcasts aimed at answering the challenging question: How Do We Talk About Suicide? The series is in response to public demand for greater access to information and what actions you can take in your families and communities to assist with suicide prevention. Each webinar will be rcorded and posted here with a transcript. Sign up for our newsletter if you would like to be informed of future webinars.
Webinar 1: Professor Sunny Collings
Professor Sunny Collings is a psychiatrist who has spent over two decades working with people at risk of suicide, and their families. Her published research during that time has included a focus on people with experience of mental illness, their carers and supporters. She is interviewed by Christopher Banks, Senior Communications Officer, Mental Health Foundation.
Part 1: Identifying when someone is at risk, and how to get them to open up about their feelings of depression and self-harm. Transcript
Part 2: How to support a suicidal person, both before and after an attempt, explaining suicidal behaviour and depression to children, and how to help someone expressing suicidal thoughts online. Transcript
Part 1: Transcript
Sunny Collings: Kia ora, everybody; welcome to my office. I’m a psychiatrist, I’ve been working in psychiatry for longer than I care to add up really – probably about 25 years. For the last ten or so years I’ve been working in a service for people with severe personality disorders, and that’s involved me in a lot of work with people who are at risk of either self-harm or suicide. So I’ve got a lot of clinical experience from that point of view.
In my research I have had a focus for quite some years now also on suicide and self-harm, with particular interest in media, and also in talking about the topic in the community; and I’ve done a lot of work thinking about how to think about self-harm and suicide in a family context, so communicating with families.
Christopher Banks: To start with, is it ok to ask someone if they’re feeling suicidal?
Sunny Collings: Well yes it is, categorically absolutely is. And people are quite often fearful about raising the subject with people because they’re worried that talking about suicide, or even mentioning the word, will put the idea into somebody’s head. There’s lots of evidence that shows us that that’s just not true. It’s not true that talking about it puts the idea in people’s heads. If people are in a situation where they’re thinking about it, they’re thinking about it anyway.
What we do know, also, is that being asked about it is often a source of great relief for people who are feeling suicidal, who aren’t feeling safe; and so actually asking about it can be helpful.
Christopher Banks: So what about for people that perhaps aren’t being that open? What are some of the signs that families, friends, GPs, anyone can recognise that might help them to be able to intervene early?
Sunny Collings: In a sense that’s quite a tricky question to answer, because most people who are feeling desperate, and who in fact are at risk of suicide, don’t end up dying by suicide; so we can always look back and see that there were signs, or indicators, that the person was at risk and wish we’d perhaps done something differently. But it’s not the same the other way round; it’s very difficult to predict exactly who of those who are at risk will actually die. So while it’s important to be thoughtful about how you can support people to be safe, it’s also important not to feel totally responsible for not getting it right if that’s the unfortunate outcome. So that’s the first thing I wanted to say in response to that question.
But there are some things that we know maybe signals that a person’s at risk; so in the context of a person having a mental illness of some sort, for example, or being very depressed, profoundly depressed, profoundly anxious and/or alongside that perhaps some major stressor – so that’s a stressor that’s major for the person – it’s immaterial whether other people think it’s a major stressor, but a stressor that’s important for the person that you’re concerned about.
If a person in that sort of context starts talking about things not being important because they won’t be there next week or next month; if they start doing things that... fixing things up, you know, finalising things, giving their things away, giving their treasured possessions away; making things right with people, you know, maybe doing the rounds of close friends and sort of putting things right, those kinds of things. Obviously if people are talking obviously about suicide, or that they’re fearful of harming themselves, that obviously needs to be taken very seriously.
Christopher Banks: So it’s always... because often suicide is seen as ‘oh that person’s just attention seeking’, so when someone’s actually directly talking about these things, it should always be taken seriously?
Sunny Collings: Yeah, I mean absolutely. If a person’s talking about ending their life, or indeed if they’re talking about harming themselves, or they’re fearful that they’re harming themselves, or they are harming themselves, you know, with cutting or other kinds of self-harm, then it does need to be taken seriously.
We do know that people who engage in self-harm that we might think of as ‘minor’ because it may be superficial cutting or burning or something like that that’s obviously not going to be fatal, that people who engage in those behaviours are at risk of completing suicide at some later time in their life if circumstances lead to that, so it’s very important that it’s taken seriously.
Christopher Banks: I was actually going to come to you next on that, in terms of the difference between self-harm and a suicide attempt, because there are some people who will engage in cutting behaviours and so forth, and that might be something that’s going on for quite a while. So how do you know when it’s crossed the line into something that actually is getting more serious?
Sunny Collings: Well this is something that I deal with all my time in my clinical work, because the people I work with quite commonly have that sort of issue. It’s quite individual, it depends a lot on the person, but the way we think about it in the team where I work is we think about chronic risk and acute risk of suicide.
So a person who’s in a situation where they are repeatedly harming themselves, maybe they’ve got into a pattern of doing that as a way of managing their own distress. And it may be distress about their internal world – the way things are inside their skin, in their mind; or it may be stress to do with their social world – either way that quite commonly that just sort of rides along in a sense, and isn’t necessarily an indicator that there’s an acute risk.
But then if such a person... if there’s a crisis that happens, or for some reason they flip back into maybe an early pattern of substance use and get disinhibited from alcohol, from being drunk, or something else happens in their life that changes things, then that can flip that person into a state of higher risk.
When you look at large groups of people who self-harm in the way that you’ve described and the way that I’ve described in terms of maybe as a stress-relieving act, and people who’ve made serious attempts on their lives where clearly there is a likelihood of a fatal outcome, it’s actually quite difficult to tell them apart; so they’re not... we don’t assume that they are completely different groups of people.
Having said that, there is some emerging evidence now that among some groups of young people, there are some social practices around self-harm – most commonly cutting – that seem to be more of a social practice than the kind of usual self-harm that we’re used to thinking about in the Mental Health and Social Services professions. So it’s unclear what that is, and obviously there’s quite a lot of work going on to try and understand exactly what the nature of that is, and how it relates to other risk behaviours for young people.
For instance it might, rather than being linked to suicidal behaviours, it may actually be part of a spectrum of other risk-taking behaviours among young people, and we don’t have... although having said that, risk-taking behaviours among young people – you know, if a young person shows a number of risk-taking behaviours, you know, that can be linked to suicide risk, and in fact if there are other aspects of their situation that are also linked to suicide risk.
In the absence of any evidence that it’s nothing to worry about, I would personally, and professionally, put it in the group of self-harm and think well it needs to be looked at really carefully until we’re certain it’s not something to worry about. So my bottom line is still all self harm needs to be taken seriously.
Christopher Banks: So what about, you know, say somebody is expressing suicidal thoughts, and this might be something that lives with them every day as part of how they experience depression; how at risk are they if they don’t have a specific plan of how they’re going to do it, but they’re just talking about ‘I don’t want to be here anymore’, say?
Sunny Collings: Yeah, I mean that is a difficult question to answer. Quantifying risk, I should say, is not an exact science; so these risk assessments that we talk about, that we do as part of our professional practice because that’s what we should be doing, and that’s good practice – they are not exact; and one thing that we do know about suicidality is that it can fluctuate quite quickly. You know, within the one person it can fluctuate quite quickly from moment to moment, hour to hour, day to day, week to week. I guess week to week’s not that quickly, but the point is that it can fluctuate.
So if there’s a person who’s got a kind of... I guess a chronic low level of risk - which without knowing anything else about this hypothetical person, that’s how I’m framing the person you’ve described – you’d want to work with them to develop some way of understanding how they would know, and then how they would communicate to you if the risk was increasing. So if they’re thinking about suicide changes in some way – if it starts to... they do start to think about a plan, or they start to become preoccupied with ways of ending their life whereas perhaps they haven’t thought about that before.
Christopher Banks: So looking for changes in behaviour in a person you know, definitely.
Sunny Collings: So it’s change, yeah. And it’s also change in thinking, and changes in thinking aren’t visible, so that’s why it’s important to be having a dialogue with the person, or to establish the possibility of the dialogue. The last thing you want to be doing, particularly as a family member or a friend, is badgering the person because you’re so concerned about them. You don’t want the person to feel badgered, obviously; you just want them to feel supported and that they have permission and the opportunity to talk about things when things are different, when things change, and that it will be... it’s a safe thing to do to share that.
I mean the other thing that you can do – I’m probably running ahead and answering some of the other questions – but the other thing that you can do, that I think is quite useful if you’re the family member or the health professional, is to set that up in the other direction; so set up with the person how you can have permission to ask, so that they don’t experience feeling harassed or badgered, but you feel satisfied that you have permission to ask, you know, ‘what are some ways that it’s ok for me to talk to you about this without you feeling hassled’, ‘are there some times of day when it would be really bad for me to do this’; you know, quite simple things that sound sort of trivial, but then you can set up some kind of rules for it, for the exchange of the information, and I think that can really help, be quite helpful. It gives permission and sets limits.
Christopher Banks: As someone who lives with Bipolar Disorder, and has experienced suicidal thoughts from time to time, I can definitely appreciate what you’re saying about that whole fluctuating risk thing; because, you know, when you’re feeling at your lowest, sometimes you can be sitting on the couch and be thinking sort of quite dark things, and you can walk to the kitchen to make a cup of tea, and suddenly you’re like ‘I’m going to make a cup of tea now’, and it’s... this is quite a confusing and frightening thing for the person that’s experiencing it – to be bouncing backwards and forwards. And being able to talk to somebody about it, and knowing, also for a family member knowing that it’s ok to ask.
We have a question here – what are the things that would indicate the need to escalate the person’s care to the level of a Crisis Team or a CAT Service.
Sunny Collings: Ok, so this is a good question, and it’s actually quite difficult to answer in the abstract because it depends a lot on the person. So it depends, your threshold for... and I don’t know is this a person asking as a family member or a health professional – but your threshold for referral on... you know, escalating to a higher level of care, is determined partly by the characteristics of the person you’re concerned about, but also partly by how well you know them, and how well you know what’s happened in the past for them.
So I mean my bottom line is always if in doubt, seek extra support and extra professional input.
Christopher Banks: The person’s qualified that they’re from a Primary Care Service, so this is in a context of a Primary Care... when do you...?
Sunny Collings: Ok, thank you. That’s helpful. So if you’re in Primary Care, look, if you’ve got a person who’s talking about ending their life and it’s any more than a vague thought of a possibility, if they have a plan; and in order to determine whether or not they have a plan you need to ask questions about it, so... and you need to ask quite detailed questions, actually; so it’s not sufficient to just say ‘and have you thought of how you might do this’. Ask specifically, ‘and if you have thought about how you might do this, what is it that you’re going to do exactly, and have you got a time for doing it, and have you got a particular setting you’re going to go to to do it, and have you got the means to do it’ – and that obviously depends on what the means are, but, you know, if it’s some of... there are patterns around that, that you can know if you know a bit about the person. You know if it’s a person from a farming community then you must ask if they have access to a firearm – that’s sometimes less relevant for people in an urban environment, so it depends a bit on the setting.
But definitely if they’ve got a plan, if they’ve got access to the means, if they’ve made an attempt on their life before – that’s really important information that puts them at higher risk. If they’ve got a family history of death from suicide, or if somebody close to them has died by suicide, that’s important. There are some other things that aren’t specifically suicide-related too – so sometimes things like the anniversaries of deaths of people who were important in their lives arise as significant stressors, and there’s a desire to join the person who’s died – particularly if the person’s had difficulty with the grieving process.
So I mean that’s not a complete treatment of the question, but I mean those are some sort of examples that you would need to take into account; but it does depend a bit on the person.
If a person is psychotic, now... and you do, sometimes you know you do see people with psychotic presentations in primary care; and if they’re psychotic, and in particular if any of the psychotic symptoms are suicide-related then that really is an emergency – so that needs to be attended to right away. So if a person’s hearing voices, for example, that are commanding them to harm themselves, or kill themselves, that is an emergency and must be absolutely treated as such.
Christopher Banks: Do we have any advice for Counsellors working with young people in relation to social networking technology such as Facebook. So obviously the great thing about social networking technology is that it’s allowed people to communicate with people in ways that they weren’t able to previously. And people who are isolated – I know this as I run a support page myself, but people are able to express suicidal or depressed thoughts – what would your advice be about addressing that in the online environment, because I mean you’re removed in that situation. Say, you know, you’re a young person and you might notice things being expressed through chat rooms, or on Facebook, what would you advise then?
Sunny Collings: I’m pleased this has been raised, because actually I’ve recently been doing some research on this; and what we’ve found – we interviewed quite a large number of young people... this research isn’t published yet, but we interviewed a number of young people about their engagement with social media, and, you know, with a focus on self-harm and suicide. And what the young people overwhelmingly said was that they view these social media as, you know, it’s just part of their lives, so it’s generally seen as a source of being connected... a way of being connected, and a potential source of support.
And what I was also very impressed by was the number of young people who we interviewed who talked about how they would, if somebody, I don’t know, in a text or on a... any kind of exchange over the internet, you know, somebody communicated some ideas about self-harm or suicide in some live, real-time communication, they would say ‘oh, that’s really not a good thing to do’, you know, ‘you should tell so-and-so, or somebody’, or ‘you should ring this number’, or ‘have you tried this website’, or ‘wait till I come round’, or ‘I’ll ring you’, you know, ‘I’ll phone you’.
And so I think there’s a tendency among those of us who are older – which I count myself in this group – to be slightly mystified and not have a good understanding of the importance of social media in the lives of younger people, that it’s just... it’s not... it’s deeply embedded in the way the social world operates among people under a certain age, and that’s... I mean it’s not a hard and fast cut-off in age obviously, but...
Christopher Banks: Because I would say that, for instance, on the Facebook page that I run, we’re talking about adults here, and people opening... you know, expressing their feelings there. And there are sometimes occasions where there are quite clear warning signs that will flick up that someone’s not in a good way, and people will immediately jump in and support, which is great. But it’s a question of what do you do when you think ‘hmm, that’s going a little bit further’ and you’re concerned about the safety of that person.
Sunny Collings: Well I mean you can only really support people to... I mean presumably in those circumstances, if you don’t know that person, you can’t contact them directly or anything, and they’re not inviting you to do that, so you can only encourage them to get help, you know ‘Oh, it sounds like you’re in a really bad way’ and I mean maybe you reflect on your own experience, I don’t know, you know ‘I’ve been in that position too, and what I did was such-and-such and so-and-so and that really helped me’ or ‘is there anybody online at the moment who actually knows who this is, and if so, could you encourage this person to get help’ or, you know, nip next door if they’re next door, or whatever, call them. You know, there are other things that you can do to support the person if, you know, there’s somebody online who does actually know who they are.
Christopher Banks: Yeah. In terms of the help lines that we were discussing earlier too, that Youth Line do actually do a text counselling services, so that for younger people that are more comfortable communicating by text, that’s also been pointed out to remind the audience that that is also a good referral mechanism.
Sunny Collings: I would urge young people, if they are concerned, and, you know, they don’t have to take responsibility by themselves; so there’s the sharing online, but there’s also, you know, talk to an adult that you trust about it. It may feel hard; it may feel hard to do that, but it’s really worth doing because there may be some other ways of working out and solving the problem – particularly if it’s around... it’s a bit difficult if it’s an online community and there’s people all over the world and so on, but if it’s texting, and it’s within the social group of people that you more or less know, then it’s more local, and other things might be able to be brought to bear to support.
I mean I heard a great story where a young person who was texted by another young person that they wanted to die, this young person told her mother, and the mother actually went round and saw the parents of this other person even though she didn’t know them, and the person had help the next day. And that was just a nice chain of events where everybody did what felt really hard, but it had a really good outcome.
Christopher Banks: Yeah. Which we’ve also just had the point expressed again by someone that online networking is widely used by older generations as well; and yes, that is most certainly true, as I was making the point before from a support page that I run myself, and also that the Mental Health Foundation, the Nutters Club Radio Show which also has quite a strong Facebook component attached to that – there are a lot of older people, so this isn’t just a youth issue and....
Sunny Collings: No, no; that’s very true. That’s very true.
Christopher Banks: But it’s, as you say, the rules are the same that if you notice that someone is getting past the point where you think that they need help, but you’re not directly connected to them, there are a number of things that you can do which you were suggesting – asking if anyone knows the person, suggesting to the person that they get help because they sound like they’re in a bad way, and perhaps sharing some of your own experiences to show that they’re not alone – might be a good kind of summary of things that you could do online.
Sunny Collings: Yeah, that’s a really good summary.
Part 2: Transcript
Christopher Banks: Ok, so coming on to families then, what if you’re in a situation where within a family where you have a mother, a father, a brother or sister who is... has attempted suicide, is at risk of suicide, and you’re in the position of having to explain that to children of varying ages – say from between two and ten – what are some of the things that come up there?
Sunny Collings: Ok, so this is talking about somebody who’s at risk, not somebody who’s died?
Christopher Banks: This is... yeah, somebody who is actually... let’s start with that, somebody who’s actually at risk, and kind of trying to explain what’s going on to a child.
Sunny Collings: Ok. Well I think it’s really important first of all to realise that it’s generally a good idea if children know things, because if there’s commotion going on behind the scenes and all the adults are very tense, and not behaving in their usual way, then kids know that something’s up; and quite often what they imagine is far worse than the truth. So it’s important that children have information. It’s important that it’s information that’s appropriate for their developmental stage though; it’s a bit like talking about sex with children – to some extent they really only... you know, you need to give them the appropriate accurate information, but they’ll come back to you later – again and again and again – because they didn’t really process some of the stuff that they weren’t ready to process, and it’s a very similar thing.
I mean children can have different ideas about death, for example, and the consequences of the end of life than adults do; so to a child it may be quite an abstract sort of thing – the idea of being at risk of suicide – I mean what does that mean. So you’d have to really be thoughtful about how much information you really try to convey.
So what I would do is I would talk about... I’d keep it very specific to the person who was at risk, and presumably the child would know that there were some issues, ‘so you know how...’ – I’ll just say it was the dad, I mean, you know, ‘...that dad’s been feeling really, really sad lately, and it’s a sadness that’s a sickness and he’s been getting help from the doctor; but sometimes he feels so sad and sick that he feels that he can’t go on anymore because it just feels too hard. And then when dad’s feeling like that, then we need to do these certain things...’ and maybe talk about what safety plan the family’s got in place for taking care of the father, for example.
And then the child can actually be sort of part of that, but without feeling... it’s important to... kid’s will tend to feel responsible; you know, kids feel that it’s their fault that their parents’ marriage broke up, that, you know, it’s their fault that all sorts of things happen – it’s quite important to make sure that the kids don’t feel responsible for any outcome, but that they can participate, ‘...and, you know, in this family we look after each other, and this is what we’re doing’
Christopher Banks: Picking up on that point then, about safety plans within families; I mean sometimes there can be a sense that in terms of a person’s clinical care, it can vary; sometimes someone isn’t seeing the best doctor or the best professional, and the burden can come back on the family to support that person.
So in a situation like that, what would you suggest that some of the things that families can do to support a suicidal or at-risk person on a day-to-day basis?
Sunny Collings: Well I think some of the things I was saying before about having permission to have an open channel of communication about it is really important, because I think that can actually make it... it can help it feel a bit less burdensome to the people on both sides of the equation. And communication is... and, you know, the sharing of information about it is pretty critical really, because if the family member doesn’t know, then they can’t do the things that they would want to do to support.
And supporting might be leaving the person alone for an hour, you know; supporting may not be hovering; the tendency would be to... because you’d be very concerned, the tendency would be to hover; but that needs to be negotiated. The right thing to do for a person might be that they just need a bit of space, and that needs to be respected – unless of course, you know, you think the person’s really an escalating risk, or at very high risk, and that being alone means that they may have an opportunity that they wouldn’t otherwise have. In which case they really need to be receiving professional care at that point.
Christopher Banks: We’ve had a question here from someone who works with an at-risk person that experiences suicidal thoughts, doesn’t have a plan, is actually kind of self-aware of this fact, and as a coping mechanism this person will keep themselves very busy or concentrate on activities. Would you say that that works as a coping mechanism and it’s a...?
Sunny Collings: For some people having some alternative distracting activities can be very useful. For some people it may be something like going for a walk, which may not seem like a distraction from thoughts, but it’s a physical activity which, in itself, can in a sense be a distraction – it can just reduce that preoccupation.
But everybody’s different in terms of what will be successful in that regard, and so again it’s something that sort of needs to be discussed. Of course some people have a lot of experience of having these thoughts, and I mean maybe this person who’s being referred to here actually has developed their own mechanisms and approaches to managing their own suicidal thinking, and obviously that needs to be supported and respected.
Christopher Banks: What if you’re a person who’s experiencing suicidal thoughts or depression and you’re ready to talk to your family about it; you talk to them and they don’t take it so well?
Sunny Collings: Yeah. Well perhaps I could talk... that’s unfortunate... perhaps I could talk first about how you might prepare to do that, if you’re concerned that people might not take it so well.
You might... I mean you can understand why people might not take it so well, especially if it’s coming completely out of the blue – they’re probably going to be upset and worried – that will probably be their first concern. I mean most... I mean almost without exception families want to help other family members, they want to support them.
So I have thought about some things that you could do; I mean first of all I think it’s really important for the person doing the telling to feel really clear about why they’re doing the telling. And you can then tell your family why you’re telling them; so why’s it important that they have this information. It might be because it’s been going on for a long time, and you’ve been seeking help, and you just think it’s time they knew about what was going on for you; in which case that’s a different scenario to a person feeling really desperate and wanting their family to help – sort of maybe provide some sort of immediate help.
So first be really clear about why you’re wanting to tell them, and then you can communicate that as well to your family members, because it gives them some guidance about how they might respond then. You may want to talk it through first with a friend, or a health professional, or counsellor, social worker, just to talk it through what different scenarios might be... ‘well if my dad just really, really loses his temper, you know, that’s going to be really horrible; so what would I do if that happened’.
I mean, you know, some people... and I have... I’ve done this with one person where we actually role-played, and I had to pretend to be some different family members, and the person practiced with me so that they could just get some practice saying out loud the things that they needed to say.
Christopher Banks: And that’s a really interesting scenario, because we did actually have a question from the other side of the coin – from a GP – who was asking how do I talk to my patient about how they might approach their family. So is that something that you would suggest to GPs, perhaps, is perhaps role play?
Sunny Collings: Possibly. I mean it might be a bit difficult for a GP because they have such a short time for their consultations, but it’s definitely worth suggesting because the person might want to practice with a friend or something. The other thing...
Christopher Banks: Do you think maybe... I’m sorry, I was just going to say though, because I often... know that too, because I primarily see my GP with concern to my mental health issues, because that’s the person with whom I feel most comfortable; so would you suggest that... either to patients or to GPs themselves suggesting that the person book say a back-to-back, or a longer appointment if they’re needing to discuss that?
Sunny Collings: Oh yes. Yes.
Christopher Banks: Yeah.
Sunny Collings: Yes. Absolutely.
Christopher Banks: So being aware of that short timeframe.
Sunny Collings: And it is possible to do that.
Christopher Banks: Yeah.
Sunny Collings: Yeah, to book a longer appointment; but I mean usually the receptionist would want to know what that was about, so you might want to do that by a phone call rather than in the waiting area – it depends how it’s arranged – in terms of privacy.
But can I just say, because I had a couple of other ideas about how other people might do this, because I think this is a really important question and there’s actually not much information about it; you know, you can look on the internet for ‘risk assessment’ and you’ll get any number of hits, but there’s nothing really much about this.
Write things down. If you think that it’s going to be difficult to sort of manage the conversation with your family, then it can be useful to make some notes about the important points that you want to get across to them so that you’ve got it in front of you. Look, it sounds artificial, but it can be really useful. And sometimes I even recommend that people do this when they go to the doctor, actually, when they go to their GP; or indeed if they come and see me. Because sometimes, you know, conversations go on, and especially in this setting with the family, emotions can get a bit heightened, and people can sort of lose track of the threads – but you’re telling your family members for a reason, and it’s important to sort of keep it anchored in that. So writing it down can be helpful.
And the other thing is you might want another support person to be with you; I mean that’s also another option. You need to make decisions about whether you’d want to tell family members one by one, or whether you want to do it in a setting where people are together as well. Now that will depend on what your customs in your family are about how you communicate important information, so those are some things that I think are useful to think about.
Christopher Banks: Now what about situations where you’ve got someone that really is on a rollercoaster ride – they slip forwards and backwards – they might have made multiple suicide attempts across a period of time, say years. How does a family kind of stay strong in that kind of situation, and keep the hope for that person?
Sunny Collings: Well I mean that’s really challenging, and I think you’ve hit the nail on the head there that it’s about keeping hope, because hope is absolutely critical. And hope not only for the family, but also for the person who’s feeling suicidal, because it’s that sense that there can be a more positive future is what gets many, many people through – and it’s remembering the idea that suicide is essentially... well it’s a permanent solution to what is almost certainly a temporary problem, and trying to keep that perspective.
So it’s important for... you know, the communication within the family we’ve talked about, and that’s obviously important. It’s important that families feel supported by professional services, and that they feel that they’ve got access to that support. And sometimes that has to be negotiated – it depends on the service, and it may or may not be a mental health service, it may be some other health service, you know, it might be a primary care provider, it might be a counselling service, you know, it might be...
Christopher Banks: People might not find the best person the first time either, mightn’t they?
Sunny Collings: That’s right; that’s a really good point. They may not find the best person the first time, and it’s important to keep trying a not to just feel that trying to access the right services is futile because it... you know, many people have told me, I’ve worked in mental health services a long time, and, you know, I’ve had lots of feedback about the futility of trying to get access to services.
I will say that the people who work in mental health services in New Zealand are doing their best. Without exception I think people are doing their best, and they work in a big complicated system, and there’s a lot to do, and it’s really worth persevering from outside to try and get the support that you need.
There may be other sources of support too, maybe church groups and other community groups; but it’s important for families to set up their own support and not feel that they have to ride this rollercoaster with the suicidal person all alone.
Christopher Banks: Sudden improvements – someone seems really bad, and then suddenly the sun comes out – that can be a warning sign, can’t it?
Sunny Collings: It can be a bit of a warning sign. It’s a really tricky one, of course, because it’s what everybody really wants; it’s what everybody really wants for the person to feel better. If somebody who’s been really troubled for quite some time suddenly feels better, you know, over a period of a couple of days, and there’s no apparent explanation for it, then I think you do need to view it with some caution and have that important conversation.
Christopher Banks: And someone’s made the point here that consumers will often access the family and whanau support services for their children, but won’t think about actually accessing this for other members of the family; and these services are there for everyone, aren’t they?
Sunny Collings: Oh I see, Family Whanau Support Services, not support from...
Christopher Banks: Yes.
Sunny Collings: Yeah. Ok.
Christopher Banks: Yeah, actually services that are set up for this.
Sunny Collings: Yes, ah yes, yes, yes. Ah yes, absolutely. I mean those services are for everybody of any age.
Christopher Banks: It’s recognising that your own needs as an adult are...
Sunny Collings: Are legitimate.
Christopher Banks: ...as legitimate.
Sunny Collings: Absolutely.
Christopher Banks: Yeah.
Sunny Collings: Your needs as an adult are legitimate. And, you know, if this is a long rollercoaster ride then it’s important to have support that’s going to help you to last the distance, so that you can support your family member who’s at risk.
I just think that the most important thing in this is about feeling connected, and people who are feeling suicidal generally feel pretty disconnected from their relationships and, you know, the people who are important to them. And it’s about getting over that hump, that feeling of it being really difficult to remake those connections; and so that’s part of why it’s important to try and talk to the people around you, the special people around you in your life. Even if it’s just one person. I think making that connection is really critical for keeping hope alive.
Christopher Banks: You have been with Professor Sunny Collings of the University of Otago School of Medicine, and I’m Christopher Banks from the Mental Health Foundation. So thank you very much for attending this morning, and we hope we will see you again on a future webinar. Thank you.
Sunny Collings: Thank you.
