Sunday 19 January 2020

How to help our friends in the fight against suicide

Paul O'Callaghan on how to ask those impossible questions

Fashion designer Alexander McQueen was found dead at his London home. Photo: Getty Images
Fashion designer Alexander McQueen was found dead at his London home. Photo: Getty Images

Paul O'Callaghan

The suicide of Alexander McQueen -- a man always surrounded by family and friends -- raises the question: is there anything people can do to prevent such tragedies?

In 1983, a psychiatrist, a psychologist and a social worker from Canada and the United States met to answer such a question and, in their own words, "make suicide prevention training programmes widely available, cost effective, interactive and easy to learn".

Their flagship course is called Applied Suicide Intervention Skills Training, or ASIST, and is the most widely used suicide intervention training programme in the world.

Its goal is simple: to reduce the number of suicides by training ordinary people like you and me to recognise suicide warning signs and intervene.

Think life-saving without the swimming. In fact, ASIST's aim is to prevent people jumping into the water in the first place.

Their philosophy is based on a few simple principles.

Firstly, most people contemplating suicide may telegraph this to those closest to them.

These 'invitations' may be obvious, eg a note, a direct statement -- "I can't go on living like this" -- or an action, eg standing on the edge of a bridge.

Sometimes these are more subtle: a sudden catch in the voice, avoiding eye contact, giving away important possessions, cancelling mail order subscriptions or transferring money into family members' bank accounts.

Prior to McQueen's death, there were examples of such invitations: his growing depression, his refusing to leave his room and his Twitter feed on February 7 describing his "f****** awful week". But recognising these invitations is relatively easy. Doing something about them is not. Here comes the difficult part. If you suspect a person may be contemplating suicide you need to ask them directly.

It is one of the most difficult questions you'll ever ask. But indirect, roundabout or unclear questions won't do.

The most common alternative is a half-hearted, "sure, you're not going to do anything stupid now, are you?"

To which they invariably respond: "No, of course not."

But in dodging the issue, we forget that to a person caught in the nightmare of recurring suicidal thoughts, suicide doesn't appear stupid at all. This direct approach may appear counter-intuitive, but it is the bedrock of the ASIST course.

They claim that rather than increasing the possibility of suicide, talking about it actually reduces the possibility.

How? Openly talking about a person's suicidal thoughts reduces their mental torment and helps the mind process the implications of the intended action. Fudging the question leaves the person at risk of feeling more alone.

Yet, knowing that your boss, your boyfriend or your brother is contemplating suicide still leaves you with a dilemma: what to do next? Listening is a good start. The second ASIST principle is that almost all people at risk are unsure about suicide.

They have reasons for dying, but also reasons for living. You need to listen to both of these.

The temptation emerges to avoid the 'death side' and jump to the reasons for living. Don't. Stay in the moment while they explain why they want to kill themselves.

Once they've finished, summarise their reasons for dying and then move on to help them express, identify and confirm their reasons for living.

At this stage, the suicide risk needs to be reviewed. What should you do? Firstly, you need to contract a safe plan. The purpose of a safe plan is to get the person to agree not to act, at least until you've managed to get help for them.

This may involve handing over tablets, allowing you to remove rope they had bought or promising not to drink alcohol or take drugs for a week at least.

Clear, specific plans are best, e.g. phoning a doctor to arrange an appointment, booking a therapist session or writing down the numbers of key contacts a person can speak to when the pain becomes unbearable, e.g. the Samaritans, Console, close friends and family.

Once you've agreed on a safe way to disable the suicide plan you need to ask the other person to promise to stick to it.

ASIST, however, acknowledges that there is no silver bullet in suicide prevention.

Suicide can only be fought incident by incident; life by life.

But there can be no greater reward than to know that your actions have prevented a parent's greatest fear from coming to pass.

Paul O'Callaghan is studying Educational Psychology in Queen's University Belfast. As part of his doctoral training, he completed a suicide prevention training programme. For more info about ASIST, visit Phone Anne Callanan at 091 77 53 88

Irish Independent

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