This is a blog post that I originally wrote a few years ago for another website and I'm posting this updated and edited version today, for this World Suicide Prevention Day in 2023.
Many of you reading this will already be familiar with the fact that eating disorders have one of the highest mortality rates of any mental illness but perhaps some statistics you are less familiar with are that around 1 in 5 of the people who die from eating disorders are deaths by suicide and beyond that, one quarter to one third of people with eating disorders have attempted suicide. These statistics have to be taken seriously. Suicide is preventable and as an eating disorder community, one step we can all take to help reduce these figures is to increase awareness, talk more openly about suicide and support people so they feel able to seek support when they need it.
In this post, I share some of the more general facts about suicide and consider potential means to identify a person at risk and how, as a community, we can work together to reduce suicide rates both in the eating disorder community and in the wider world and population.
Often in the posts I write I include my personal experiences and thoughts and feelings behind the subject I am writing about. But in this post, due to how emotive it is, I am conscious not to trigger anybody or cause upset to loved ones. Therefore, despite having some personal insight into how a person's brain can take them to the point of taking their own life, this post is really to just take this opportunity to reach out, in this small way, to help raise a little more awareness of suicide and how we can prevent it.
STATISTICS
According to the World Health Organisation suicide is a global phenomenon with 700,000 deaths attributed to suicide every year.
Suicide is the fourth leading cause of death amongst 15-29 year olds, although it occurs throughout the life span and men continue to have a higher rate of death by suicide than women, although in some parts of the world, rates in women are now rising.
Estimates are that for every death attributed to suicide in the world, there may have been more than 20 others attempting suicide (World Health Organisation, 2017).
Statistics can often seem cold and hard but do highlight how large a problem suicide is globally.
It's imperative to remember though that behind every one of these numbers is a human life - a person with a life story and somebody who to a greater or lesser extent is part of a wider family, community and society.
The personal stories and the real impact of these deaths on those left behind can often be lost in the numbers.
WHO IS AT RISK OF SUICIDE?
Suicide is often attributed to mental illness and some statistics do cite that 90% of suicides are associated with a psychiatric disorder (source) but despite this strong correlation the two do not always coincide.
Suicides can also occur in moments of personal crisis and on impulse, often due to a life stress such as financial problems, relationship break down or physical health problems.
People who have experienced conflict, disaster, violence, abuse or loss; or people who are elderly or who have a sense of isolation are also more at risk of suicide.
Individuals with a history of suicide attempts or self harming behaviour are also at increased risk.
WHY?
This is a question everyone asks when a loved one or a friend dies from suicide.
There is never a simple answer to this question and the answer for each person will be unique. However, when mental illness is a contributory factor, it's vital to remember that the person in considerable inner pain and turmoil. And that pain, although not visible, was real and unimaginably distressing for them.
Feelings of hopelessness and helplessness, despair and isolation were very likely to have been present and so suicide is attempted NOT as a means of attention seeking or for sympathy but in order to end the pain that had become intolerable.
Many people who attempt suicide do not want to die but cannot fathom continuing to live with the pain and suffering they are experiencing (source).
"The weird thing about depression is that, even though you might have more suicidal thoughts, the fear of death remains the same. The only difference is that the pain of life has rapidly increased. So when you hear about someone killing themselves it’s important to know that death wasn’t any less scary for them. It wasn’t a ‘choice’ in the moral sense. To be moralistic about it is to misunderstand.” ― Matt Haig, Reasons to Stay Alive
WARNING SIGNS OF SUICIDE:
For some people who are planning suicide, there may be warning signs; for others these signs may not be present.
Potential warning signs that someone is at increased risk of suicide include:
Talking about wanting to die or to kill oneself;
Looking for a way to kill oneself;
Talking about feeling hopeless or having no purpose;
Talking about feeling trapped or being in unbearable pain;
Talking about being a burden to others;
Increasing the use of alcohol or drugs;
Acting anxious, agitated, or reckless;
Sleeping too little or too much;
Withdrawing or feeling isolated;
Showing rage or talking about seeking revenge;
Displaying extreme mood swings. (Source)
WHAT INTERVENTIONS CAN HELP TO PREVENT SUICIDE?
The take home message if nothing else from this post is that SUICIDE CAN BE PREVENTABLE!!
Measures can be taken at individual, community and wider society levels to prevent suicide and suicide attempts.
At an individual level—according to the International Association of Suicide Prevention (IASP), people who have survived a suicide attempt often describe realising that they did not want to die but instead wanted someone to intervene and stop them.
Many say that they actively sought someone who would sense their despair and ask them whether they were okay. Some say that they made a pact with themselves that if someone did ask if they were okay, they would tell them everything and allow them to intervene but no one did ask.
These personal accounts show that a simple intervention of just reaching out with a small 'how are you?' to a person you might be concerned about or who could be isolated or at risk might be enough to start a conversation and allow measures to be put in place to prevent a suicide attempt.
On a wider scale, measures that are recommended by the World Health Organisation include:
Reducing access to means of suicide (e.g. pesticides, firearms, certain medications)
Reporting by media in a responsible way (i.e. minimising sensational depictions about suicide has shown there is probably less subsequent suicide done by imitation)
Alcohol policies to reduce the harmful use of alcohol
Early identification, treatment and care of people with mental and substance use disorders, chronic pain and acute distress
Training of non-specialised health workers in the assessment and management of suicidal behaviour
Follow-up care for people who attempted suicide and provision of good community support
Of course all these measures are ideally part of a in integrated and comprehensive approach and introduced through national health priorities and strategies.
WHERE ELSE ARE THE OBSTACLES?
One large obstacle to preventing suicide that's identified time and again comes down to the issue of stigma and taboo. The amount of stigma associated with suicide and with mental illness prevents individuals who are struggling from seeking help.
The fact that suicide is often deemed a taboo subject in wider society also prevents the issues surrounding suicide and the wider measures that could help prevent it from being openly discussed and put in place.
This is where one of the key ways to help and to reduce suicides on every level can be by speaking out. The more we talk about these very real issues, the more chance we have of making change happen and the people suffering get the help they need which might prevent their unnecessary death.
On an individual level, what can you do to help?
The focus this year of World Suicide Prevention Day is 'Creating Hope Through Action'… This is to remind us all that through our actions, we can encourage hope and strengthen prevention.
If you notice someone struggling, a key action to take is to just take a moment to check in with them. This alone could be enough to stop them acting on suicidal thoughts.
It's known that people who are concerned about another, often don't say anything as they either don't know what to say or don't want to 'say the wrong thing' and make things worse.
This is where I will bring my personal insight into this. I'd argue that for me, when in times of dark inner distress and it was left as the 'elephant in the room', it created even greater feelings of isolation and despair. People did not need to say anything of any great meaning—they didn't need to give answers to how I was feeling but just acknowledge that all was not well and offer a hand of comfort, as that can make all the difference.
And in response to the concern about, 'making things worse', my argument would be that, as in the words of Matt Haig, if someone is at the point of contemplating suicide, things are probably about as bad as they can get. If a person is so low that they are considering suicide then things cannot get worse but things could improve, just slightly, by someone saying something—offering a small word of support.
Therefore, on an individual level, let's start to make the small differences that could help, offering support and hope to anyone you are concerned about.
That small gesture of support might just be enough to change and save a life.
Links to Resources and References:
** If you are experiencing any thoughts of self harm or suicide, please make contact with the mental health crisis helplines or emergency services in your country. Help is available and your life can be different, even if you can't imagine that to be true now.**