Do you have thoughts of suicide or know someone who has? At least 10% of Canadians report having thought of suicide, and every day in Canada more than 10 people die by suicide, 250 people attempt suicide, 50 people self-injure resulting in hospitalization, and 100 people are profoundly affected by suicide loss (Stats Can).
These numbers are heartbreaking. As a province, a society, and a healthcare system – we need to do more. We need to do better. We need to help those who are struggling, thinking of suicide, planning suicide, and attempting suicide. But how can we do that when many people who are suicidal cannot access effective mental healthcare? Let’s consider the barriers.
5 barriers to effective mental healthcare around suicide:
There is societal, religious, cultural, digital media, social, and interpersonal stigma, blame, and shame around suicide and suicidal thoughts. People with suicidal thoughts may fear judgment, blame, shame, discrimination, or negative reactions from others and stay silent or stop trying to get help.
People might want to avoid police or paramedic intervention or hospitalization. Involuntary first responder intervention and hospitalization can put people’s education, occupation, livelihood, relationships, and safety at risk.
Mental health professionals might be afraid to lose a client by suicide and their actions are bound by their profession and the law’s duty to report, but these actions can further harm clients.
There is limited access to effective mental health care because of wait times, location, culture and language barriers, cost, and limits to health insurance coverage.
Not all treatment is effective for reducing suicidal thoughts and behaviors. Different therapeutic approaches decrease suicidal ideation, access to lethal means, or attempts, but rarely all three.
We can all contribute to a safer society where people can receive equal and dignified care without barriers. To prevent suicide, you need to understand it, talk about it with empathy, normalize and validate, treat people kindly, support people who have suicidal thoughts, and provide appropriate help for people planning suicide. Suicide can be prevented if people are supported, respected, and can access appropriate care in a dignified way.
5 Ways To Prevent Suicide And Respond To Suicidal Thoughts:
1. We need to normalize and understand suicidal thoughts.
10% of Canadians admit to having suicidal thoughts. Many more probably have them, so let’s all be honest. It affects people across all age groups and identities. People who have thoughts of suicide aren’t doing anything wrong. Suicidal thoughts are learned human responses to escape unrelenting suffering and shame. Consider the vast range of human thoughts:
I can’t do this anymore
I don’t want to live like this
There’s no point
I don’t want to suffer anymore
I’d rather die
There’s nothing I can do
Why bother
They’d be better off without me
I just want the pain to stop
No one cares
There’s no way out
I wish I were dead
I don’t want to be here anymore
Sometimes we don’t even recognize our thoughts as suicidal, since often it isn’t an urge to die, but rather an urge to escape or stop suffering.
Sometimes suicidal thoughts and urges come in moments of overwhelm, pain, hopelessness, rejection, anger, or isolation, other times the thoughts intrude in random places and times while driving, walking, or bathing. Sometimes they’re just a whisper, other times a shout. Sometimes it hurts just thinking about them, other times they feel like a relief…an option or a solution.
If you know someone who is struggling, ask if they have had suicidal thoughts. Asking about suicide does not make someone consider it if it wasn’t already a thought. Talking about suicide does not make it worse. Don’t be afraid to ask. If you know someone who has suicidal thoughts, normalize their experience. Share your own experience with suicidal thoughts or that of someone else you know.
If you experience thoughts of suicide, you are not alone. You are not weak, you are not broken, you are human.
Actions that Normalize:
Increase your own understanding and awareness of suicide and suicidal thoughts.
Read the personal stories of people who have struggled with suicidal thoughts.
Encourage discussions around mental health in schools, workplaces, homes, and communities.
Support mental health awareness campaigns that seek to normalize suicidal thoughts.
Access training on suicide prevention.
Avoid stigmatizing language to create spaces where people feel safe to discuss suicidal thoughts.
If you have reason to wonder, ask someone if they have thoughts of suicide.
2. We need to validate people who have suicidal thoughts or have attempted suicide.
It is important to validate both the person and their pain. Not everyone knows how to hear and hold suffering. Some people minimize, deny, deflect, reject, criticize, mock, ignore, compare, or trump other people’s pain. Some people and institutions will blame the person who is struggling. It should never be that way.
No one should have to be alone with their thoughts and feelings. Try to understand the person’s story. You can ask, listen, acknowledge, empathize, care, respect, accept without judgment, and hold space for pain.
It would be foolish to deny suicide is an option. It is. But it’s not the only option. It doesn’t have to be the only option, next choice, last resort, or backup plan.
All people deserve care and compassion, and when someone is experiencing suicidal thoughts, it is especially important to be kind and patient, show empathy, avoid judgment, be available and present, offer support, and follow-up.
Actions that Validate:
Acknowledge and empathize with someone’s thoughts and emotions.
Listen attentively and show genuine interest.
Hold your judgment and ask questions to increase your understanding.
Reflect their feelings and concerns without trying to provide solutions.
Validate their experience as real and valid and offer your support.
Ask if they have talked to anyone else about this or accessed professional help.
3. We need to support people who have suicidal thoughts and plans.
If someone tells you they are having thoughts of suicide or plan to suicide, stay calm. They are reaching out for help, and there are many ways you can support them. Talking about suicide does not make it worse, so don't be afraid to talk and ask questions. As mentioned above, normalize and validate their experience. Just try to stay present with them, showing you care and want to help. Don't minimize or deny their struggles, just try to understand their story. Be kind.
Sometimes people need someone to talk to, other times they just need someone who understands their experience to spend time with. You can talk with them about school or work or sports, watch a show, eat together, or do something they find fun. Distraction is okay when it helps increase moments of positive connection and joy.
You can ask if they have a safety plan and how you can help. Offer to listen, visit, or help them call a helpline. You can help them create or implement their safety plan, connect them to support and resources, and increase their hope of being helped through this challenge.
If they have a therapist, you can ask if they have told their therapist about their thoughts of suicide. Help them normalize these thoughts and feelings and encourage them to share their concerns with their current therapist.
You can also ask if they have a plan for how to kill themselves. If so, ask if they have access to the lethal means mentioned in their plan. If you feel comfortable, you can help them remove the lethal means or take the person to a friend's or family's or your own safe place.
Non-consensual emergency intervention and hospitalization can increase suicidality, so be thoughtful before you call anyone and try to engage the person in the decision. If the person feels they cannot keep themselves safe, or you feel they cannot keep themselves safe, you can call a mobile response or crisis team or 911 to come to them or offer to take them to the emergency room. Once there, they can be connected to resources, support, and professionals who can help.
4. We need to help people who are struggling with suicide to access appropriate care.
Looking for help while you are struggling with suicidal thoughts can be next to impossible. Offer to help the person research and find local resources, including emergency care, crisis care (24/7 and anonymous helplines), acute care (public short-term counselling services), support groups, or therapy (public or private long-term counselling services). You can help them call, book an appointment, and attend their first session. Continue to follow up and check in to show you care.
Mental health professionals also need to ask the right questions when supporting someone with suicidal thoughts. Counselling and therapy need to specifically treat suicidality (not just the underlying concern – for example, depression), and modify treatment according to the client’s presentation of suicidal thoughts, access lethal means, or previous suicide attempts. Professionals should normalize and validate suicidal thoughts, and collaboratively create a safety plan tailored to the individual’s concerns.
Therapy is only effective in the context of a safe therapeutic relationship where the person experiences respect, dignity, empowerment, and hope. If a person is afraid their therapist is going to dismiss their thoughts, reject their cry for help, or call for intervention, they might shut down and hide their emotions and urges.
5. We need to decrease non-consensual intervention and hospitalization.
People should be able to tell a distress line worker or their counsellor that they are experiencing suicidal thoughts without fear of non-consensual medical intervention or hospitalization. Involuntary first responder intervention and hospitalization has been shown to increase the risk of suicide.
First responder intervention should only occur when a person consents and has no other safe people or places to draw support from.
Hospitalization should be reserved as a last resort and only for those who can no longer keep themselves safe or intend to follow through on a plan with lethal means. Time in the hospital must focus on suicidality and provide specific and effective treatment.
How to Keep Yourself Safe if You have Suicidal Thoughts or Urges:
If you have thoughts of suicide or self-harm, you don’t have to tell everyone, but please, keep looking until you find someone you can talk to. Someone who will listen, not overreact, hold your trust, and help keep you safe. It is difficult to be vulnerable, and you can find someone who will see, hear, understand, and be with you even in the worst times.
There are many free resources across Alberta and Canada offering 24/7 anonymous, confidential, immediate, or short-term interventions for people in crisis or distress. If you need help or are experiencing thoughts of suicide or self-harm, please reach out. If you are concerned about your safety in a relationship, consider calling from a friend’s phone, a public phone, or a work phone.
If you are having thoughts of suicide or self harm, the ways of keeping yourself safe depend on your unique situation and experience. Here are some considerations:
If you don't have a therapist yet, look for one who you could see yourself trusting with your struggles;
If you already have a therapist, ask them to create a safety plan with you if you haven't made one yet;
If you are alone, you can engage in activities you enjoy or that keep you busy or distracted (music, tv, phone, outside, pets, art, hobbies);
If you don’t feel safe alone, but aren’t ready to talk, you can call a friend or family member who can help distract you, just by talking or going out or doing something fun;
If you need more help, you can contact someone in your life who you would feel comfortable telling that you are struggling with suicidal thoughts. Let them know what they could do to help, whether it’s listening, helping you with your safety plan, or visiting you.
If you don’t want to tell anyone in your life yet, you can call, text or chat with an anonymous distress line to speak with a trained peer volunteer or counsellor who can help you calm, regulate, reframe, create a safety plan, implement your safety plan, or access other resources and referrals.
If you have a therapist, you can contact them and they’ll respond when they get your message to either provide support between sessions or set up an extra session.
If you have access to the means to harm or kill yourself, you can tell someone who can take the means for now or bring you somewhere safe away from them.
If you feel you cannot keep yourself safe, you can call a mobile response or crisis team to come to you, call 911, or have someone take you to the emergency room. Once there, you can be connected to resources, supports, and professionals who can help you find safety and hope.
Co-creating a future everyone hopes to participate in:
Responding to suicidal thoughts requires a collective effort to overcome the barriers to better care for people and to prevent suicide. We must challenge the societal, cultural, and interpersonal stigmas surrounding suicide and normalize discussions around mental health. Validating different experiences fosters understanding, empathy, and support, providing safe and non-judgmental spaces for people to express and explore their pain. Appropriate mental healthcare should be accessible to all and should decrease the occurrence of non-consensual intervention and hospitalization, empowering individuals with agency and effective treatment. By working together, we can create a society where people feel safe and supported to access dignified care for mental health concerns, thereby improving overall well-being.
Hope is not lost. Hopefulness exists when you can imagine a future you wish to participate in. We can all contribute to a life where humans are safe to struggle, share their fears, and feel their suffering. When we feel together, we heal together. May we all co-create a future in which everyone wishes to participate.
Carol Korenowski is a mother, psychologist, and the founder of Therapy Alberta, a private group practice with psychologists, social workers, and counsellors offering trauma-informed individual, couples, teen and family therapy in Calgary and across Alberta.