Understanding Suicide

September 10 is Suicide Prevention Day and the recent death of Robin Williams has shone a great deal of extra light on this topic. His death affected a large number of people who may not have thought about the subject until Mr. Williams decided to end his life. The death of a celebrity had a profound impact on people and Robin Williams’ passing has made all of us more aware of suicide.

The question about why a person, blessed with enormous talents, who had found fame and fortune, chose to end his life has a complicated answer. Robin Williams had it all in the eyes of the public, but his private life was a different matter, because he fought issues of depression and subsequent substance abuse as a coping strategy.

There are some basic facts about suicide that are relevant to this discussion. In Alberta, we lose about 500 people a year to suicide and 75% of them will be men, most of them between the ages of 30 and 60. Women may attempt suicide more often than men, but men are four times more likely to die by suicide because they choose more lethally effective methods.

Men are reluctant to seek help and are directed by conventional societal pressure to avoid emotional expression. They are encouraged to compete for power and success as a male-oriented goal where outward strength is a big part of the game. Men are supposed to “cowboy up” and show few signs of weakness as a male, including how to cope with emotional issues in their lives. Sadly, the men who most need help are the least likely to seek it.

Suicide notes are rarely left by people; in fact only about 12-15% of people leave behind a suicide note. Talk about suicide is a major red flag, because suicidal thoughts lead to suicidal talk which escalates to suicidal acts, without intervention. Past attempts at suicide elevate the risk for future attempts by 40% in most cases.

Contrary to popular belief, Christmas is not a peak time for suicide. That distinction goes to the period after the holidays in January and another peak in early spring.

The aftermath of suicide is extremely painful for the people who were close to the person. There are lingering feelings of acute loss, sometimes mixed with guilt, and the survivors can be seriously impacted by the experience. Questions get asked: “Why didn’t I see this coming?” “Could I have done more to prevent this?” “Why wasn’t I there for them?” It is natural to ask these questions and it is very important to provide proper support for the survivors of a person who committed suicide.

A recent Calgary Herald editorial letter written by Dr. Michael Trew, Alberta’s Chief Addiction & Mental Health Officer, emphasized the support structure available to people who are potential suicide candidates; as well as the people in their lives. Dr. Trew offered many choices such as Alberta Health Services (AHS), Canadian Mental Health Association, Center for Suicide Prevention and the United Way among others here in Alberta.

These services offer a variety of health professionals, such as psychiatrists, psychologists and counsellors, as well as support programs. Also, the Center for Suicide Prevention has a variety of online toolkit resources available to the public.

Dr. Trew believes that we need to bring the topic of suicide out into the open and avoid discussions about it in “hushed terms”. Dr. Trew wants to “reduce the stigma and see suicide as an unfortunate outcome of feeling hopeless”, in his words.

There was a belief that a direct conversation with a person who has contemplated suicide may escalate the risk, but now the best approach may be a direct question about the person’s suicidal intentions or plans. Open communication about suicide is an important step for prevention and the people closest to the person in distress can be the biggest protection against suicide.

We also need to look for signs of suicide risk in people close to us and watch for signs of depression (men may become easily irritated, angry or hostile), risky behavior or social isolation. Changes in behavior such as excessive substance abuse by a loved one should be noted and prompt a frank conversation with that person about the changes. Suicide is also a manifestation of other issues such as schizophrenia and should be closely monitored by family and friends close to the person.

My final point is pretty basic: we can prevent suicide if we spot the danger signs and immediately open up clear lines of communication with the person, including the tough question (Are you thinking about killing yourself?) when we see the changes in them. The most important step in suicide prevention is the first step and that first step is a frank conversation.

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