How to help someone considering suicide

So here we are. It is the 30th of September, the last day of Suicide Awareness Month. And that's really why Alex and I are here today to have a chat. I've known Alex for a good few years. We both work in mental health, but come at it from slightly different angles. And I know Alex has some tragedy in his background. But what I'd really love you to share with others and to, you know, again, clarify for me, what is it that led you to do what you do now? And tell us a little bit more about the work that you're doing within mental health.

Thanks, Caroline. Thanks for having me on. Um, lovely to speak to you as always. Um, so what led me to get to where I am now? So I guess, yes, might as well start with the tragedy. So when I was a kid, I grew up in a domestically abusive relationship. Um, which resulted in my, um, mum being killed by my stepdad in the room next to— next door to me while I was— I was only 8 years old at the time. Obviously rocked my world massively, as it would for any person going through that. Um, and but beyond that, my recovery from that wasn't ideal. Kind of grew up in very much a dysfunctional family, so kind of my emotions were dismissed, shut down. I felt like I had to be someone I wasn't, very much fell into the trap of people pleasing and kind of lost the core of who I was. Now, how I got into mental health was literally an accident because at the age of 21, not knowing what I wanted to do, not because I didn't know who I was, I wasn't happy. That part of me, that kind of, that child that was meant to be nurtured and encouraged to be whoever they want to be to an extent. Um, was hidden away. So I was like, well, I was looking to everyone else to decide for me what I should do. And someone just said, oh, you should go do your mental health nurses training. And now I didn't know what I wanted to do, and they paid me to do my training, so I thought, well, I've got nothing to lose. And I actually loved it, you know, it was amazing. I had the greatest time doing it. And so I became a registered mental health nurse and have done a variety of roles within that, with that, within that in the NHS, from inpatient to crisis to community mental health to working in GP surgeries, the university Facilities over the years, but I've kind of kind of niched it down in more recent years. And even though I am in the NHS and I work in primary care doing the bulk of my work, because I, I strongly believe that people access to healthcare and support should be free to an extent. I know we pay taxes, but that kind of got me going back there. But, um, about six, seven years ago, I had literally everything that ever happened to me reared its head. when I was in a relationship at the time and that ended. At the time, it basically signified to me that I was nothing, I was worthless, and what was life if, you know, I didn't have like a house, a relationship, all these things I kind of put on a pedestal as things I needed to achieve to mean something. Um, and yeah, I was experiencing suicidal ideation, I was making plans, and I was struggling to manage that at the time. But what that caused me to do is, at the time, I was looking to do some work for the people I was working with around kind of prevention, around what can people— what do people need to know to help them to recover from the variety of setbacks we face that knock us down, that really impact our mental health? And in doing so, while I was struggling with all this suicide ideation, I read Viktor Frankl's book, Man's Search for Meaning.

Amazing.

Now, it didn't change everything in my life, but there was a line in it that said, um, everything can be taken from you except your ability to choose how you respond, your ability to choose your own way. And in hearing and reading those words, it suddenly dawned on me that I had never done that. And it was like, you know, I just assumed that there was something wrong with me because my mum was murdered, because, you know, I, I didn't matter because my emotions weren't important, my needs weren't important. And suddenly I was like, my life had been built around that. And then suddenly I was like, well, if I had chosen my own way, If I, you know, if it— if I had, like, from this moment forward, what would my life look like? And it just suddenly was like, okay, I'm gonna start trying to do this. So it meant obviously delving into what happened and understanding why I show up in the world the way I do, but also looking at what do I want to show to the world, what do I want to bring forward, what do I want to create. So it kind of led me to being a speaker a little bit, like, and that's how we met. But also just kind of realizing that a lot of, you know, I just love helping people and I love helping people who hit rock bottom get back up. So now essentially what I talk about is how to get people back up in my talks, but also literally help people work through that process from the moment of whether it's a failed relationship, whether it's like, oh, they're at risk of being homeless or addiction or lots of trauma, abuse, family dysfunction, whatever. And that's what I do now is help people through that process, trying to keep things really, really simple and actionable so people actually feel like they have some control and agency over their life.

Um, so yeah, and people, people can get to that point of, um, I, I basically see suicide as a, as a lack of hope. There is no hope left.

100%.

Um, and you put a post up on LinkedIn that really sort of sparked me to reach out to you and have this conversation talking about shame and the role of shame In, in suicide. So, you know, whether you're coming at it from your own personal experience or that in your professional, or probably it's a mixture of both, tell us more about how you see shame as a, uh, creator and influencer on people losing hope.

So I think shame plays a massive part because obviously shame is, is literally linked to who you are as a person. And you, you are right, hopelessness is one of the main things we look for when we're assessing for risk when it comes to suicide. Suicide ideation being something I ask about and explore in every single appointment I have. But really, you know, when you think about hopelessness, when you think about helplessness, when you think about loneliness, when you think about all these things that kind of make people quite high risk, and often the events that contribute to people wanting to maybe, you know, end their lives, like relationship breakups, financial insecurities, um, suddenly becoming physically unwell, addiction, all this sort of stuff. All of that stuff and everything, it kind of comes from that feeling of, ah, there's a problem with me.

Okay.

There's a problem with me. I'm the problem here. You know, if you think about, um, you know, let's look at hopelessness. It's kind of like, well, no, things can't get better. There's nothing I can do about it. There's nothing anyone can do about it. I mean, that might be nothing I can do about it because I don't— I'm not good enough. I don't have what it takes to overcome this. And there's nothing anyone can do about it because I'm not worth the help. I mean, being a feeling of a burden, right? We know that's a really common high-risk thing for people with suicide. Well, people— we talk— we often tell people, well, you need to talk about suicide, you need to talk about it, ask help. But if you feel like a burden, you know, if you feel there's that feeling of shame, how easy is it for you to go out and reach out for that help? So when it comes to why I believe shame being the main— one of the main things behind it, and it's different for everyone, but generally being there is because People who tend to have a better relationship with themselves don't tend to want to just check out life. You know, it's usually like, I don't have a role to play. Yeah, I don't have— if you, if you feel like you don't have a role to play, that things can't get better for you, that you can't lead a good life, and you're the problem, the main problem behind that, even if loads of other stuff's gone on around you that have caused you to feel that way, you know, you tend to be like, well, what's the point?

Okay. And if someone is, is listening to you and they're resonating with it and saying, yes, exactly where I am, What's your advice to them?

Well, it's different. It's different. I mean, often, or every part of supporting anyone is kind of always trying to understand their story. And I know in mental health, especially people who work outside of it, tend to think that we just stick labels on people and just say, you're the problem, get on with it. That's not what happens. But I know people like to talk about that. But, you know, it's trying to understand why you feel like you do? Why are you showing up this way? What's happened to you in your life? So really trying to get— first of all, get an understanding so we can try and help them see that maybe they're not the problem here. Yes, of course we're humans, we all make mistakes, we all do things we maybe shouldn't do, but they're our behaviors. They're not who we are. They're just as a result of often the beliefs we have about ourselves, right? And most of the beliefs we have about ourselves are generally wrong because they're just what we've been taught from the environments around us. So if you can actually say to people, for example, start by going through their story and go, okay, well, this happened to you, this happened to you, this happened to you. You know, if anyone else had gone through that situation, they'd feel shit about it, right? You'd feel shit about it. Excuse my language. Sorry if you don't want me to swear for your audience there. But, you know, it's kind of making it really compassionate and like, um, kind of just making them first of all realize that. Second thing is also to try and make them normalize suicidal ideation and the fact that it's so much— it's much more common than anyone realizes. You know, it's, um, it's something our brain will naturally go to when we're stuck in a situation we can't find for too long, that we can't find an escape out of, you know. And I always use an example of being stuck in a dark room with no light switch, don't know where the door is, you're on your own, you can't see anything around you, you don't— you just don't want to be there. You don't necessarily want to die, but you're like, well, I don't want to be here anymore. And that's often what people are. They don't want to be in their situation.

Yeah.

They don't— may not necessarily want to die. Some do, but they may, you know, it's just, I don't want to be in this situation. So your brain would naturally Look for ways out. And then it's just trying to, like, for most people, I know it's not always helpful. You, you know, we have to look at the context behind it, but it's always trying to, like, try not to make a permanent decision out of a temporary problem. Yes, there are people who have permanent problems. You know, we know that in some situations that's not always going to be helpful. So it is taking it by situation by situation. But often when people are reaching out for support for the first time, they haven't even become aware that they're not even aware up until that point that actually there are solutions to their problems and there's support out there, that they're not alone, that they're not I'm not the only one suffering from this. And actually, sometimes reaching out helps them to realize that, oh, okay, maybe I can get through this. They say, don't they, a problem shared is a problem halved? And of course, that's not exactly how it works out, but, you know, just to speak to someone about it, um, even if you do feel like a burden, because I guarantee you're not the only one who feels like a burden, you know, in life. It's just, it can help kind of maybe open up doors. and solutions that maybe you hadn't become aware of at the time. But in the midst of that, a lot of it is just— it's a lot of safety planning, which I'm sure you're aware of. It's how can I keep myself safe in the midst of this chaos that maybe I'm experiencing right now? And that will be whatever's, you know, who've I got around me, who can support me, who do I need to talk to, what sort of things can I use to distract myself, what sort of things can I do to keep myself safe, you know? You know, for instance, One common thing that people often do, maybe not necessarily always to end their lives, but as a form of self-harm as well, is take overdoses. But, you know, if, if that's something you're thinking of doing, is it worth getting rid of medication or having them stored safely? Stuff like that. So quite a lot there. But it's all about, you know, kind of reframing their perspective of what's going on, helping them realise that there is a way forward and keeping themselves safe in the midst of all that whilst we go on that journey together.

Yeah. Yeah. So as you know, I work, um, in anxiety and increasingly a lot with teenagers.

Hmm.

Um, and I tend to be, I guess, at the earlier end of the chain as opposed to you in the preventing people, because anxiety can slip into depression, can then lead to that.

Hmm.

But, um, you know, we're all seeing, and the, all the statistics are reinforcing the escalation in, in teenage mental health. Uh, there was a something in The Guardian released some statistics recently. Every 3 minutes now, a child is referred to CAMHS. The Childhood and Adolescent Mental Health Service, for those that are not familiar with the acronym. Is this something that you are seeing now increasingly as well, that more people who are getting into that suicidal ideation or even attempting it are getting younger and younger?

Yeah, I think we're seeing— I mean, I work with generally 18 and upwards. But obviously, you can see, we have access to all their medical records, all their notes, you can see generally that obviously, sometimes it does just surface, like, you know, first time they've ever approached people. You can see there's more and more people, young, at a younger age, are struggling with their mental health. Now, there's a variety of reasons probably for that. I don't think we actually know 100%. But things like social media.

Yeah.

You know, probably higher expectations on people than they've ever been before. You know, a lot more comparison, isn't there, to other people? I mean, when I was a kid, I'm not— and I sound old when I'm saying this— I luckily didn't get my phone till I was 16. By the way, I'd done most of my running around growing up to an extent. I didn't know what people around in the village, the other side, the village only 10 miles away from where you're up to, unless I saw him at school, you know. Whereas now, yeah, absolutely constantly comparing yourself, aren't you? Like, even now I will experience anxiety if I look on social media and look at someone doing something that I want to be doing, and then like feeling like, oh, I need to be doing this, I need to get, you know, I get worried, am I doing enough? You know, we all do it, and we never had that before.

Um, so it may well be, um, quite a few parents listening to you and going, okay, yeah, I can, I can see some early signs in my teenage— in my teenager, in my children. What can people do at that earlier stage to prevent that escalation? Because I'm, you know, I would argue that once it's got to that, once they get to you, it's not too late, but it is a long, long, long journey to get back. Whereas if you can divert them off that path a little bit earlier, Then perhaps that's the way to start reversing this trend, is almost treating it early rather than waiting until people are at the suicidal point.

Yeah, I think it's just— I mean, it's so hard because I know what it's like being a parent. I know what it's like with parents who haven't worked with them and trying to support teenagers. For instance, teenagers being the people who seem to know, think they know everything. We do. I was a teen. I knew everything. I have all the answers. So do you parents. We know our brain's evolving because we're trying to separate parents and create our own identity.

Yeah.

But I think it's just going to be like, is there any changes in behavior, you know, sort of stuff like that? It's like being— just be more vigilant. I don't— we don't want to have a bunch of parents worried that their kids are struggling with their mental health, but we just want to become a little bit aware of what may be going on. What's happening? Are they struggling at school? Are they having any— do you find they're withdrawn? Are they trying— are they not doing the things they usually would that would keep them happy? And then it's just being there for them and listening. Yeah, like, I think again, listening isn't the answer because some— I often hear people come to me said, oh, they went and spoke to someone who just listened, they didn't give them any advice. They were like, why am I here then? You know, we, we often want— we all want sometimes a little bit of guidance. But I think just being kind of that non-judgmental listener to your child or whoever is in your life and just saying, you know, I've noticed that, you know, you, you don't seem yourself at the moment, what's going on? It's just being there for them. Yeah, but I always think, you know, when it comes to mental health and emotional health and suicide and risk and stuff like that. You know, if you have any worries, you know, you've got your doctor, you've got, you've got whoever, you know, speak to your GP. I know we've, like, you've touched upon, you know this as well as me, Caroline, that accessing CAMHS and specialist mental health support, especially for young people, it takes ages, you know.

Yeah.

And often you have to get really bad before people start noticing, which has always been the case. And that's just, you know, the way it is because of funding and not having the resources to meet everyone's needs. But I think if you're worried, just go down that route of getting support, go the GP. If you can afford to go private, go see people like yourself just to get some ex— you know, to get some, um, to get some clinical expertise on the situation. But, you know, don't feel like you have to deal with this on your own. And, you know, and try not to think of it as something like anything you've done wrong or anything your kid's doing wrong or anything like that. You know, we're all susceptible to struggling with our mental and emotional health. Anxiety affects us all.

I think that's a really good point. I often hear from, from the parents of the teenagers that I work with, have I done something wrong? Is it my fault? But if your child had, well, I don't know, God forbid, got pneumonia, would you blame yourself for that? No, it's just something that happens.

Yeah.

And mental health, it's just another part of our body that sometimes goes wrong. So, you know, that would be something that I would definitely say to parents is, is don't blame yourself. But again, as parents, there are things that, that we can do. Everyone is under a massive time pressure.

Yeah.

You know, most parents, 2 parents have to work in most households now to even keep their head afloat, which means that kids are coming home to an empty house or they're just having to get on. And something that I found really worked for me is that just carving opportunities to have conversations. And it's not about having the conversation, it's creating the opportunity. So I've got a dog, so I would encourage my kids to come out for a walk with me.

Yeah.

Because when you're sitting face to face, it's quite confrontational. Whereas when you're walking along and you're both facing the same way, it creates an ambience, an environment that just makes having a chat easier. And I never used to say, well, you seem a bit down at the moment. We just walk along in silence. And the first walk, nothing may happen. The second, the third, then suddenly they go, um, I'm really unhappy at school.

Hmm.

Well, the other thing I do with my son, which he always used to go, oh, Mum, is, um, when I went to kiss him, good night, I'd just lay on the bed behind him. And initially they would be like, what are you doing? You're weird. And I'm just like, I'm just really tired. I'm just going to snuggle for a little bit. And then again, second night, third night, or third time, I wouldn't do it every single night. He would just say, you know, there's someone that's been really horrible to me at school, Mum. So you just create, and it took 10 minutes.

Yeah.

And it just creating that environment to mean that if there is a worry, you make it easy for them to speak.

Yeah.

And I know with my daughter, she, she didn't want to talk to me for fear of me worrying, which I think again is a common thing. I don't burden— you're back into that exactly what you started with. I don't want to be a burden on my mum. So I created relationships with some of my friends and said, look, if you can't speak to me about something, and it may be something that you're embarrassed to speak to me about, it may be something sexually related, or something about your physical body, you can go and talk to, you know, Auntie Karen or, you know, Auntie Louise, or— we just call everyone Auntie, it's just a family thing, you know— just someone that's a family friend. And had that relationship with that person that said, if my daughter came to speak to you, the confidence is there.

Yeah.

You don't come running back to me and go, oh, Nadia's just done this. But it gave my kids an opportunity of someone else that they could talk to Where trust was implicit. Yeah. That could, they could reach out to. And I think that again is a, it's a simple stepping stone that can be put in place that just makes the conversation, if they want to have one, easier to have.

It's a really good point you made there. Cause I think that's so often people come to people like me cause they don't want to share with family because of the emotional connection. So yeah, it's really good that sometimes we want to know cause we're parents. Of course, my little girl, whatever she goes through growing up, I'm going to be like, I want, I probably want to know, but Equally, I just want her to know that she has someone she can go to and talk to where she feels safe to express what's going on. And like you said, it's helpful to have people who aren't emotionally connected because they can give— when it comes to like listening and advice, they tend to give better. Because, you know, we're naturally going to say, aren't we, to our kids the thing we want that's gonna— we think is going to benefit them.

Yeah.

Um, because we're emotionally attached rather than what's actually probably going to help.

Yeah. And even as a therapist I cannot be a therapist to my kids. I'm mum. So when they've needed help, I have taken them to someone else.

Yeah.

Because you're right, you, you can't detach that emotional thing. But when you operate from a place of love, do the best for your child.

Yeah.

And that may mean pointing them to talk to someone else. It's not abdicating responsibility or failing.

No.

It's absolutely facilitating a conversation that needs to be had. But if the child can't have it with you for whatever reason, Yeah, make it easy for them to have it with someone else.

I mean, we want our kids, don't we, to be able to feel that they can come to us or someone else with their problems, not the automatic thought being, oh, I don't want to go to them because I'm worried about their reaction or getting told off or doing something wrong. And that's really how we need to be thinking as parents, isn't it? Like, how can I create that environment? What can I put in place that enables them to feel like they can just go talk to someone or anyone about what's going on and get the help they need? Um, easier said than done, but it is easier said than done.

And I think in your professional capacity, you're there to give advice. Um, and I, I, it always makes me laugh if I speak to a mum, for example, and she says, you've just told my son exactly what I've said to them. I'm like, yeah, I'm not mum. And I'm speaking to them as a therapist that they willingly come to. Um, and it's having that acceptance that if you're in a situation talking to your child, do your best not to give advice because the natural thing is you're going to rebel against whatever your parents say. Because as you rightly said, the whole point is, you say left, I'm gonna go right.

Yeah.

And a technique that I found worked really well is saying, well, if I were in your shoes, this is what I would do. So it's presenting them the solution but not telling them that's the solution they have to take.

Yeah, yeah.

And is that something, again, professionally that you do, or do you have that ability to say, as a professional, I say you should do this?

Might sometimes, I will. I mean, we're— I'm a trained professional, been doing it for 20-odd years, so if people come to me for advice, of course I'm going to give advice. But generally we try and, uh, we know, get the answer out of them, because we all know if it comes from us, like you just said, if we think— if we're the ones who think we've got the idea we're more likely to follow through with it. Not a lot of us don't like to be told what to do, but sometimes I will tell them what I want, what they need to do. Like the other day, I had someone who was coming back over and over again in a difficult work situation, and it was just kind of— it was like we're not really getting anywhere. So I just said, look, you basically, you need to leave your job. You need to quit your job. You know that's what you want to do, but the anxiety is stopping you from doing it. Um, and there's various reasons why that was the case. But it was like, look, you— I just said, I'm going to lay out on the table, this is what needs to happen, because nothing is going to change while you're kind of in the fire and you're still in the fire. You need to get out the fire and then we'll deal with whatever consequences of that are left. And that— so I had to give him advice because otherwise it was going to keep going every session, the same old conversations, the same thing was going to happen. But generally, yes, we try and encourage people to come up with their own solutions, not say, you know— but that's a way of— that's just questioning, isn't it? A way of questioning and saying, well, what do you think you should do? What don't you think you should do is a great question, I think, because often what Wouldn't help, which we often don't ask ourselves. And usually people come up with the thing they're actually already doing and you're like, oh yeah, that's probably not going to help. So, but again, it's about putting it back in them and getting them to maybe have the questions. And like you say, with kids, ask them what they think they should do. They'll probably come up with stupid answers sometimes, but we all come up with stupid answers. That's part of growing up, isn't it? And even with growth in general.

Yeah.

But yeah, try and put it back in their, in their court.

And if they want your advice, There's ways to think of other options apart from taking their life.

Yeah, yeah, yeah.

And where there's other options, there's hope.

Yeah. And but sometimes, you know, people will be stuck. That's the only solution. You know, I've seen it many times. And then it is just about keeping them safe. It's always about keeping people safe. And that will be literally, if you're a parent, you ring your GP, you ring 111, because you can access crisis mental health support via that. Um, even if you had to ring the police. It's just, even if that all feels a little bit extreme, if you have any concerns, you just do what you can to keep your child, your relative, your family member, whatever age they are, you just do what you need to keep them safe if they're in that— if you're thinking this isn't— this is potentially going to end in disaster. Um, yeah, and if you end up temporarily damaging the relationship in the short term, which is often a risk of what people worry about I think, you know, you have to think longer term here. That relationship can be repaired, but ultimately, if people choose to end their own life for whatever reason, um, and they're successful in that, then you'll never get that opportunity back.

So yeah, I think that's an amazing, uh, amazing piece of advice. And probably, I know you and I could talk about this until the cows come home, um, but I think that's a great place to end this. So thanks ever so much for your time, Alex. And again, just reiterating, if you are really scared for your child, for a partner, for anyone that you love, don't worry about anyone's reaction. If you call 111, the police, the GP, they are not going to berate you for being silly. And even if you do get a bit of backlash, better that, but you still get some help than the other alternative.

Yeah.

So thanks ever so much for your time, Alex. I've loved it.

It's been a pleasure. Thank you.