Research — 06 July 2015

For years, we’ve been told that speaking openly and honestly about suicide could encourage suicidal thoughts and behaviours. Yet there is little evidence to show that the code of silence around suicide prevents people from harming themselves. In fact, it could do more harm than good.

Terry is quiet, Terry loves to read. If you make him pick a favourite book, it’s Anna Karenina. Like a lot of folk who come to Tolstoy, it’s that first line that gets him: ‘All happy families are alike.’

Terry’s first suicide attempt was at age 13. There’s that other part of the Tolstoy sentence: ‘All unhappy families are unhappy in their own way.’

Every year in Australia, close to 65,000 people attempt suicide. There are almost seven deaths by suicide each day. When, as a teen, Terry saw his best friend pass away after being hit by a car, he didn’t handle it well (who could?). Six months later came his first attempt. It was not his last.

Think about percentages. If a young woman—aged anywhere from 15 to 19—dies in Australia right now, there’s a 25 per cent chance that death occurred due to suicide. ‘It’s atrocious,’ the director of the Black Dog Institute, Helen Christensen, has said, ‘and we really should be doing something about it.’

And we are. In the year 2012-2013, the Commonwealth allocated close to $10 billion on mental health and suicide prevention programs. In April, the federal government released a national review of mental health programs—one of its nine goals was to halve the rate of suicide attempts over the next decade.

Suicide is the biggest single cause of death for all Australians up to the age of 35 to 40, and Australia’s suicide rates, despite this money and goodwill, stubbornly refuse to shift downwards. In the words of another leading mental health expert, professor Patrick McGorry: ‘The public do not realise what a huge health problem [suicide] is.’

We do not realise, because we do not talk about it. Suicide is taboo; there is no ice bucket challenge for taking your own life. The hesitance to talk about suicide stems partly from the belief that the mention of suicide could embed dark thoughts in those vulnerable to suicidal ideation.imagesS58IJC80

It’s unclear where this idea began, but many point to irresponsible media reporting of suicidal events increasing the number of suicides. The largest reported effect was found when Marilyn Monroe suicided in August 1962, and that month, suicides in the US increased by 12 per cent. In general, though, highly publicised stories of suicide increase the national suicide rate by around 2.5 per cent in the month in which they occur.

Despite this, Professor Helen Christensen says it’s about ‘being more nuanced’ in our discussions of suicide. ‘If you’re talking about sensational reporting of suicides by celebrities, then that’s definitely still not the thing to do,’ she says. ‘If you’re talking about proper engagement with young people about what suicide is, the risk factors for it, how you can manage it, how important it is to seek help, that has to be a positive thing.”

Nicola Fear, professor of epidemiology at Kings College in London, agrees. She has recently completed a review which found that talking to people about suicide did not increase suicidal thoughts. ‘It is a misperception,’ she says.

Professor Fear’s research identified 13 studies on the topic. Some asked participants how they felt when asked about suicide-related behaviours. Others asked questions relating to suicidal behaviours and then followed up with their participants, asking the exact same questions and measuring any increase in those behaviours.

‘None of these studies found a subsequent increase in behaviours,’ Fear notes. ‘We felt that was pretty strong evidence to support the fact that there is no increase in behaviours if you ask people about suicide or related behaviours.’

The historical avoidance of mentioning suicide has left a mark, however, and that mark is stigma. With suicide, as with other mental health problems, silence leads to the impression that it is a problem that occurs only on the margins. ANU research has shown that there are strong negative views of people who suicide, with one of the strongest negative views being that people who attempt suicide are selfish.

According to people who know even a little bit about the literature and the nature of suicide, like Helen Christensen, ‘it is not the case at all—it’s a question of pain, and feelings of hopelessness … or that you’re trapped and your choices are limited.’

How should we talk about suicide? For a start, we can cease with euphemisms. ‘One of the worst things we can do is fluff around a subject without actually using the word suicide,’ says Dr Jo Robinson, head of the Suicide Research Prevention Unit at Orygen, the National Centre of Excellence in Youth Mental Health in Melbourne.

Robinson says young people with suicidal thoughts are often afraid of their feelings, and afraid of what response disclosing their suicidal ideations may engender. ‘So it’s important for us as professionals and as adults to model safe and careful ways: be direct, but be empathetic and be sensitive.’

There’s evidence to suggest this direct approach to discussing suicide may have worked elsewhere. For over a decade, the Henry Ford Health System in Michigan has utilised a program that asks patients about their suicidal thoughts.

‘When we first implemented the program, our suicide rate for patients who came in from mental health conditions was over 100 per 100,000 in the population,’ says Brian Ahmedani, a research scientist involved in the UK trial of the program. ‘It is now consistently less than 20 per 100,000. It’s about 20 per cent of what it used to be.’

The program Ahmedani is involved in asks each participant whether they’ve considered suicide, and if they have the means to carry it out. Treatment is then tailored based on their responses.

For his part, Terry—of Anna Karenina fame—has some advice. ‘It does get better, and this is from someone that has lived it and seen it. I’ve made attempts on my own life, I’ve lost friends to suicide … if I actually had taken my own life it would have been a waste.’

‘It’s exciting that I can live through 30, 40, 50, 60 years and still know that I can challenge and I can get through anything, no matter how dark it gets.’

This article first appeared on ‘ABC‘ on 3 July 2015.


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