At the beginning of my studies in psychology, I remember a lecturer advising the class to always ask their clients when they last experienced having suicidal thoughts or a will to harm themselves. The reason she gave for asking this was that most people have considered committing suicide or harming themselves at some stage of their lives. Our lecturer assured us that the majority of clients would be relieved to finally be able to speak about their feelings and experiences without feeling judged, and would generally disclose the time and context of the last time they felt suicidal.

“Suicide is a permanent solution to a temporary problem” – Phil Donahue

A useful resource when it comes to suicide is from SADAG (the South African depression and Anxiety Group) who suggest that the risk factors for suicide include the presence of a mental illness, further described as conditions such as depression. In addition, alcohol and drug dependence factor strongly in the risk of being suicidal along with those people who have previously attempted suicide. It’s estimated that 8% of all deaths in South Africa are as a result of suicide as reported by academic hospitals; however the actual figure may be somewhat higher than this. The numbers are staggering, in that an actual suicide occurs every 40 seconds and an attempt every 3 seconds according to the World Health Organisation. With such regular occurrence, suicide and suicidal thoughts remains largely a secret with many people dealing with this alone. This should not be the case as the more we talk about, the more support can be provided.

Some cases of suicide occur without any pre-warning of problems, however most do not and the most effective way to prevent a suicide is to begin to recognize the signs that you, or someone close to you is at risk. This also means to take the signs seriously, to act when the signs appear and not to ignore them.

According the SADAG some of the warning signs include having a previous suicide attempt, because between 20 and 50% of people who attempt suicide have previously done so and are at a greater risk. This means that those who have many serious attempts are a greater risk of doing so again. People who talk about death, dying or not being around anymore are often sending a message that they are contemplating suicide as an option. Another factor is depression. However, as a word of caution not all depressed people are suicidal; but most suicidal people are depressed. Depression can present in many ways with the most obvious as being sadness for extended periods. It’s important to act if you are experiencing a loss of pleasure or withdrawal from activities that you previously enjoyed. Some other thoughts and feeling that someone who may be suicidal can experience may include hopelessness and helplessness; not being able to see a way out of depression, sadness, pain or problems you are facing; not feeling able to think clearly, see any other way out, not being able to sleep, eat or work, not seeing yourself as worthy, not feeling in control. A Psychology Today article written by Dr. Neel Burton lists some of the thoughts that may accompany suicidal thoughts which may include:

• I want to escape my suffering.
• I have no other options.
• I am a horrible person and do not deserve to live.
• I have betrayed my loved ones.
• My loved ones would be better off without me.
• I want my loved ones to know how bad I am feeling.
• I want my loved ones to know how bad they have made me feel.

Whatever thoughts you are having, and however bad you are feeling, remember that you have not always felt this way, and that you will not always feel this way.

The risk of a person committing suicide is highest in the combined presence of suicidal thoughts, the means to commit suicide, and the opportunity to commit suicide. If you are prone to suicidal thoughts, ensure that the means to commit suicide have been removed. This may mean giving tablets and sharp objects to someone for safekeeping, or put them in a locked or otherwise inaccessible place. At the same time, ensure that the opportunity to commit suicide is lacking. The surest way of doing this is by remaining in close contact with one or more people, for example, by inviting them to stay with you. Share your thoughts and feelings with these people, and don’t be reluctant to let them help you. If no one is available or no one seems suitable, there are a number of emergency telephone lines that you can ring at any time. You can even ring for an ambulance or take yourself to a hospital. Do not use alcohol or drugs as these can make your behaviour more impulsive and thereby significantly increase your
likelihood of attempting suicide. In particular, do not drink or take drugs alone, or end up alone after drinking or taking drugs.

“Suicide doesn’t solve your problems. It only makes them infinitely, un-accountably worse.” —Sinead O’Connor

Many sources recommend the creation of a safety plan which includes; making a list of all the positive things about yourself and a list of all the positive things about your life; including the things that have so far prevented you from committing suicide (you may need to get help with this). Keep the lists on you, and read them to yourself each time you are assailed by suicidal thoughts. On a separate sheet of paper, write a safety plan for the times when you feel like acting on your suicidal thoughts. Your safety plan could involve delaying any suicidal attempt by at least 48 hours, and then talking to someone about your thoughts and feelings as soon as possible. Discuss your safety plan with a mental health professional and commit yourself to it. Sometimes even a single good night’s sleep can significantly alter your outlook, and it is important not to underestimate the importance of sleep. If you are having trouble sleeping, speak to a doctor.

An example of a safety plan includes:

1. Read through the list of positive things about myself.

2. Read through the list of positive things about my life and remind myself of the things that have so far prevented me from committing suicide.

3. Distract myself from suicidal thoughts by reading a book, listening to classical music, or watching my favourite film or comedy.

4. Get a good night’s sleep. Take a sleeping tablet if necessary.

5. Delay any suicidal attempt by at least 48 hours.

6. Call Thandi on (phone number). If she is unreachable, call Julia on (phone number). Alternatively, call my mental health professional on (phone number), or the crisis line on (phone number).

7. Go to a place where I feel safe such as the community centre or the sports centre.

8. Go to the hospital nearest to you.

9. Call for an ambulance.

Once things are a bit more settled, it is important that you address the cause or causes of your suicidal thoughts in as far as possible, for example, a mental disorder such as depression or alcohol dependence, a difficult life situation, or painful memories. Discuss this with your doctor or mental health professional, who will help you to identify the most appropriate form of help available. So when it comes to suicide it’s more common than you think; people should be talking about it more but don’t, and there remains a significant amount of stigma attached to it. Know yourself and those around you and take any signs seriously, and seek help.

Some useful resources include:

National HIV/AIDS Helpline: 0800-012-322.

Stop Gender Violence Line: 0800-150-150

Lifeline National Crisis Line: 0861-322-322.

Lifeline website: http://lifelinesa.co.za

South African Depression & Anxiety Group: 011 234 4837

Akeso Psychiatric Response Unit 24 Hour: 0861 435 787

Suicide Crisis Line: 0800 567 567: SMS 31393