World Suicide Prevention Day was commemorated on 10 September under the theme of ‘Creating hope Through Action’ as per the World Health Organization (WHO). Each year the World Suicide Prevention Day focuses attention on the matter of suicide, reducing stigma and raising awareness among organisations, governments, and the public, giving the singular (and powerful) message that suicide can be prevented.
According to the WHO, an estimated 703,000 people die by suicide every year around the world, and for every (reported) suicide, there are 20 other suicide attempts. The organisation emphasises that each death by suicide is a public health concern with a profound impact on those around them, noting that it is by raising awareness, reducing the stigma around suicide, and encouraging well-informed action, that we can reduce instances of suicide in our communities.
How suicidal ideation may manifest
According to the Teaching Hospital Peradeniya, “Every 40 seconds, someone loses their life to suicide”. Speaking to Institute of Mental Health (IMH) Founder, Counselling Psychologist and Clinical Hypnotherapist Dr. Romesh Jayasinghe about the root of suicidal thoughts or suicidal ideation, The Sunday Morning Brunch learned that it could stem from any number of reasons.
“Suicidal ideation can occur when a person feels that they are no longer able to cope with an overwhelming situation,” Dr. Jayasinghe said. “This could stem from financial problems, the death of a loved one, the end of a relationship, or a debilitating illness or health condition, etc.”
Stating that it was not exhaustive in its reasoning, Dr. Jayasinghe also noted that even certain life events such as grief, sexual abuse, remorse, rejection, and unemployment could potentially cause suicidal thoughts, many of which could increase the chances of suicidal ideation.
He also shared that there were certain conditions that researchers had linked to a higher risk of suicidal ideation such as depression, schizophrenia, bipolar disorder, Borderline Personality Disorder (BPD), Post-Traumatic Stress Disorder (PTSD), and even conditions that involve chronic pain. These conditions are not precursors to suicidal ideation or prerequisites.
How can we tell when someone we know is contemplating suicide?
“One is body language. Facial expressions will show if they are depressed or suicidal. It will show up in their physical appearance as well. Another is a change in their behavioural patterns. People who were bubbly and talkative will no longer be as they used to. Of course, this can be symptoms of depression and not necessarily suicide, but the public must be aware of these changes, since contextually we are often able to tell,” Dr. Jayasinghe explained.
“In present times, you can also look out for people who are suddenly disconnected from their social media or unreachable over text or phone – this can potentially be an indication that they are not in an emotional state to establish communication. They can be otherwise busy or incapacitated in some way, but there is the likelihood of them being withdrawn and this can be a sign to look out for.”
Explaining that signs of suicidal ideation were often quite subtle, Dr. Jayasinghe stressed that we, as the general public, should be sensitive to these symptoms so that we could effectively intervene, and be vigilant in this regard if our loved ones were experiencing challenging times.
Most importantly, when identifying someone who may be at risk, Dr. Jayasinghe shared that people who may be struggling with suicidal thoughts almost always mentioned it out loud to someone. “It has been found that, whether it is a work colleague or even a stranger, around 70-80% of people have always mentioned their intentions of suicide to someone else.”
However, these expressions of suicidal ideation are not always cut and dry: “They may say that they do not see meaning in living anymore, that they feel as though there is no more hope for them, or that they don’t see any purpose of being alive,” Dr. Jayasinghe explained.
“They feel that they are in darkness – in an abyss. They may even express that they wish to reunite with some loved ones who have passed away. These are some expressions that people with suicidal thoughts might say to somebody.”
Part of the struggle around this is that these expressions of vulnerability or distress are often overlooked or taken for granted.
“We tend to think ‘oh they say this but they will never actually go ahead with it,’ or ‘they are just looking for some attention,’ and yes, these expressions are indeed asking for attention – they are a cry for help and we should not dismiss these expressions but be empathetic,” Dr. Jayasinghe stressed.
“As social creatures, the likelihood of us spiralling into negativity is often caused by this lack of attention. When we are not getting that love, that care, or when we do not have anyone who will listen or someone to hear us, these feelings might emerge. We try to share our pain.”
This said, there is certainly a percentage who will not make any indication at all, but if we remain vigilant then we have a better chance at intervening before more drastic action is taken.
Listen and be aware
Sri Lanka College of Psychiatrists President Dr. Gihan Abeywardena shared: “What we see in clinical practice, not only in Sri Lanka but all over the world, is that females attempt suicide three times more than men but men succeed three times more than women. Males are more vulnerable and they suffer death by suicide in larger numbers,” he said, adding: “Especially elderly males – when they express suicidal ideas it must be taken very seriously because they are the demographic that is at the highest risk.”
“The reason why males tend to have higher numbers is that when they attempt suicide, they go for more lethal methods – hanging or running in front of moving trains or vehicles – where the chance of saving them is minimal. Whereas women will go for more non-lethal methods like overdoses, poisoning, or they may take a non-lethal dose,” he said.
Dr. Abeywardena also stated that there was a concern about desensitisation when it came to expressions of suicide: “We talk about it everywhere. In the media, in television, in day-to-day life. We hear this expression of ‘I want to die’ or ‘I feel like dying’ for the slightest thing. Because we are so overexposed, we take this expression for granted. When someone says this we are now used to thinking, ‘oh he is just frustrated’. So, when somebody does express suicidal ideas, even in a casual manner, we must take it in context.”
Both Dr. Abeywardena and Dr. Jayasinghe stressed that what was most important was to listen – to pay attention to these signs of suicidal tendencies.
“One of the main issues is a lack of support. In Sri Lanka, we see that those who commit or attempt suicide are often people who do not have family support or have no one to talk to when they are in distress,” Dr. Abeywardena said.
He noted that people who had a tendency to feel disconnected from the world could often be triggered by something very trivial and they may act on their thoughts out of frustration. “Often in our part of the world, particularly in Sri Lanka, poor coping skills are the cause for many deaths by suicide.”
This is compounded by the fact that while Asians are incredibly resilient in almost all other ways, when it comes to mental health, they lack somebody to go to. They lack infrastructure – be it a 24-hour helpline, a clinic, or a counsellor.
“One of the major obstacles that prevents someone from seeking help is the stigma around mental health. It is considered a weakness to be suffering from a stress of the mind. This prevents people from readily accessing help when they are unable to cope on their own,” Dr. Abeywardena noted.
What can we do?
Dr. Abeywardena shared that when encountering someone who is suffering from suicidal thoughts, the best thing to do is try and de-escalate – to show them that they are in fact heard and that there is help available. He further advised to reach out for professional help if it felt as though they were in urgent need of professional help, because lay people were not well equipped to deal with a person who may be suffering from a precarious mental state.
Speaking about the services available in Sri Lanka, Dr. Abeywardena noted that many of the psychologists in Sri Lanka were “quacks” and that they were not professionals, adding: “Many of them can do more harm than good if they intervene as they lack real training or learning.”
If a loved one is in need of psychiatric help, then they should preferably be encouraged to call 1926, which is a 24-hour hotline courtesy of the Sri Lanka College of Psychiatrists. They may also find other resources on the website slcpsych.lk, which provides a list of board-certified psychiatrists to reach out to.