Dealing with suicide – expert advice

Suicide is a global problem. Recently it's been in the spotlight with people such as Anthony Bourdain, Chris Cornell and Kate Spade taking their own lives.

According to South African Anxiety and Depression Group (SADAG), 9% of all deaths among teenagers are due to suicide in South Africa, and every day 22 people take their lives.

Dr Scheepers, a psychiatrist based in Cape Town, warns with the incidence of depression rising globally, suicide rates are predicted to increase.

We spoke to him about how to best prevent suicide and how to cope with the suicide of a loved one.

What are the common causes of suicide?
“Depression is the commonest cause of suicide, and with the incidence of depression rising globally suicide rates are predicted to increase. Other mood disorders such as Bipolar 1 and Bipolar 2 are also associated with a higher rate of suicide. Certain personality styles, due to impulsivity and difficulty in managing distress, lend themselves to an increase in both suicide attempts and completed suicides, the most notable being Borderline Personality Disorder. Suicide may occur during a psychotic episode and often occurs in the context of intoxication with alcohol or other illicit substances. There is also a worrying trend of suicide in teenagers and adolescents associated with being victims of bullying and in the context of not achieving desired academic results,” Dr Scheepers says.

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He warns that suicide is not always preceded by signs, but a person feeling suicidal might express hopelessness and become socially withdrawn.

“Signs such as becoming socially withdrawn, loss of interest in activities, expressing hopelessness, and unsuccessful suicide attempts or deliberate self harm may be present. Evidence of getting their affairs in order such as checking that their wills are current, seeking forgiveness from others with whom they have had conflict in the past, writing a suicide note (note that there may be several drafts in the dustbin) and the procurement of items intended to commit suicide are all major signs of an imminent suicide attempt.”

“Research into the various means of suicide may occur, as well as expressing a desire to not want to live with statements such as " I'd be better off dead" and " the world would be a better place without me." Of note is that the expression of suicidality may also occur solely on social media with little evidence thereof during personal interaction. At times there may be very little if anything to indicate an imminent suicide attempt, particularly if it is an impulsive act or if it is an act of self-harm that has inadvertently led to death,” he adds.

He warns that when dealing with someone who is suicidal you should avoid sympathising with them but instead be empathic.

“The suicidal person is often in an extremely vulnerable emotional state and one has to be aware of this when engaging with him or her. Do not ask why they feel suicidal if they do not volunteer the reason, but instead be supportive and offer help. Even though you may feel shocked at your loved one's suicidality, try to contain your response and remain as calm as possible to avoid them withdrawing from you. You want to make the interaction as comfortable and non-threatening for them as possible. Do not agree to keep any secrets but instead, offer to help and take action. Irrespective of the circumstances try not to sympathise but instead be empathic (show an ability to understand and share the feelings).

Dr Scheepers says you can help your loved one who is feeling suicidal by being vigilant and advising them to get professional help.

“If the suicidal person confides in you, listen attentively and tell them you want to help them. Offer them advice about whom to go to, emphasising that professional help is both available and necessary.

“Contact with those who provide care such as family members, community caregivers or medical staff, and having the internal skills to solve problems. Being social creatures, a feeling of connectedness to others on both individual (family, friends, colleagues) and group (community, social institutions) levels has been shown to be protective.

“If possible assist them in arranging an urgent (preferably same-day) appointment with their doctor or counsellor. Accompany them or make arrangements for them to be accompanied to a hospital Emergency Centre or have them call the SADAG Helpline. Try as far as possible to not leave him/her unattended until help is obtained.”

Is there professional treatment for suicidal thoughts and behaviour?
“Yes, treatment may take several forms and may include medication and/or therapy. Treatment is aimed at the underlying problem or disorder causing suicidality, as suicide itself is more appropriately regarded as a potential final common pathway of a variety of conditions and not a disorder in and of itself. Treatment may occur in both inpatient and outpatient settings, and the legislation makes provision for treatment to occur both voluntarily and involuntarily.”

Instead of taking one’s life, Dr Scheepers advices that those who feel suicidal should reach out for help from their loved ones or seek professional help.

“Reach out for help. This may be to a family member, a friend, a trusted colleague, a minister of religion, a teacher, a counsellor or your doctor. Alternatively, there are several organisations that can be contacted toll-free. The most well-known being the South African Depression and Anxiety Group (SADAG) on 0800 567 567. It is a big step to admit that one is feeling suicidal, but help is available when the burden is shared.

"Save the Suicide Helpline to your cellphone so it can be accessed instantly should you or someone else feel suicidal. Accessing the relevant help urgently is imperative."

When it comes to coping with the suicide of a loved one, Dr Scheepers says it’s important to permit yourself to grieve.

“The grief process can be a tumultuous experience encompassing emotional, psychological and oftentimes physical distress. There is no specific singular approach to coping with the suicide of a loved one, but there are common experiences that one will need to process. Questioning and wondering why and searching for answers to this question is inevitable, particularly when no note is left or when there was no identifiable trigger for the suicide. Permit yourself to question and wonder, even though the answer may not be found. Feeling angry at your loved one's act and even blaming yourself are part of the grief process and it is important to allow these feelings. They will diminish with the passage of time.

“It is important not to isolate yourself while grieving, even though social interaction may not be something you'd be keen to do, but staying in contact with your support network of friends and family help maintain your wellbeing and can reduce your own chances of becoming depressed while grieving.

“Remember to consider yourself, how you're feeling and to consider what your own needs are. The grieving process will be shared by a community of family, friends and colleagues and it is all too easy and unhealthy to place everyone else's needs ahead of one's own. Taking time out to be alone, doing an activity that commemorates your loved one's life (for example a shared hobby, lighting a candle in a place of significance, planting a tree with a note written to your loved one buried in the soil) and even going away to process one's thoughts and feelings in a clearer space free from the intrusion of others may be useful.

“Lastly, seeking professional help or even counselling with your minister of religion may be necessary should you feel completely overwhelmed and in need of additional help.”

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