On a freezing afternoon in February 2013, 21-year-old Becky decided to take her own life. She had depression and had been experiencing flashbacks to the abuse she suffered as a child. “I’d been managing, but things came to a head when I broke up with my partner, who had also been abusive,” she says. “I started to feel that I was a burden to my friends and it would be better for everybody if I wasn’t around.”
Thankfully, at the last minute, she changed her mind: “I started to feel scared, and I thought that if I felt fear, I shouldn’t be doing this. I realised that I didn’t want to die. I just wanted to stop hurting.” She called 999 and was helped.
Every year, 6,000 people kill themselves in the UK and the Republic of Ireland, and tens of thousands more attempt to. Now, inspired by a pioneering programme in Detroit that has reduced suicides by 82%, the NHS is funding a number of pilot projects of its own. The Detroit programme has been running within the mental health system there for eight years – and in some years, there have been no cases of suicide at all.
Central to the UK scheme is reducing the stigma attached to suicide, and encouraging people – not just patients and doctors, but all of us – to talk more openly about it. Aly Anderson, the director of development at Mind in Cambridgeshire, says: “Seventy-five per cent of people who kill themselves are not in touch with mental health services, so the people in the best position to intervene are often their family, friends, neighbours and colleagues. There is an idea that if someone is going to end their life, there is no way to stop it – but most suicides are preventable.”
Anderson’s team is working with local communities, as well as GPs and other primary care workers, to raise awareness of signs of suicidal thoughts – and how to ask someone directly about it. “Most people who are thinking about suicide will give out warning signs, either consciously or subconsciously,” she says. “Sometimes people have made a decision and can appear to be ‘recovered’ and in a good mood.” How people respond at this point is crucial, she says – yet too often we are afraid to raise the subject. “Part of that is down to this myth that we will put the idea in their head. But there is no evidence that talking about suicide is going to make people want to do it.”
The Detroit programme, which was developed by Henry Ford Behavioral Health Services, encourages talking openly about suicide at all stages, coordinating everyone from social workers to therapists to family members. “It is always poignant, but it leads to fruitful discussions,” says Dr Doree Ann Espiritu, a psychiatrist who jointly runs the programme. “I learn a lot about what is happening in the back of the patient’s mind, and it allows them to look at ways to cope if they feel like that again.”
Research shows that one of the most important aspects of suicide prevention is restricting the means to do it. This is illustrated by the so-called “British coal-gas story”. In the 1950s, suicide rates were climbing in the UK and putting your head in the oven was a common method. When we switched to natural gas in the 60s and 70s – less toxic because of its lower carbon monoxide content – suicides dropped by a third, and have remained close to that level ever since. In Detroit, means restriction often equates to working with at-risk patients to ensure weapons are removed from the home.
While professional support is essential for someone with a mental health problem, anyone can help during an acute episode, says Anderson. “It’s not a science. You just have to listen and keep them safe. We all have the capacity to save a life in that way.” If you have serious concerns, the next steps may be to arrange an urgent GP appointment or go to A&E.
The Samaritans reiterate that the most important thing is to talk. Joe Ferns, the Samaritans’ executive director of policy, research and development, says: “It can feel awkward to start a conversation. People are afraid they will say the wrong thing or make things worse, but silence is the greater danger. There isn’t really a right or wrong thing to say in these situations. The most important thing to remember is that the person needs to feel that you will listen to them, they are safe with you and you care about them.”
Becky had told doctors and friends she was feeling depressed, but hadn’t revealed how severe it was – partly, she says, out of fear that she would be sectioned. “I didn’t want to tell my friends how bad I felt because I was scared they would try to stop me. And the depressed part of me was scared they would try to encourage it. If you are considering ending your life, it is a very personal and intimate thing and it is really hard to talk about.”
Afterwards she was fast-tracked for psychotherapy and prescribed antidepressants. She is now back at university. “I’ve been suicidal since then, but in therapy I’ve worked on letting myself have those feelings, so I can separate them from actual intentions.” She gives talks to students about her experiences. “It’s an uncomfortable subject. I think people feel powerless to help – that if you feel your life isn’t worth living, they can’t convince you otherwise. I tell them it doesn’t have to be that way.”
Some names have been changed. For more information, visit mind.org.uk or stopsuicidepledge.org. The Samaritans helpline is open 24 hours a day: 08457 90 90 90.
