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What should I do if I feel suicidal?
Although suicidal thoughts are frightening and hard to cope with, they are also common. Mind estimates that one in five people will experience them during the course of a lifetime. Experts and people who have recovered from depression discuss how to cope in a crisis.
Andrew Baines-Vosper, 39, had experienced periods of anxiety and depression throughout his life. But two and a half years ago, his mental health problems reached a new peak.
"I became a completely different person," he says. "Even with what I knew about mental health and well-being, I still experienced the challenges.
"I'd overreact to small things - become irrationally irritable at home. I would find myself in my car sometimes crying at a song on the radio and not really know why - my emotions were so fragile. My social life disappeared as I withdrew, and my physical health suffered too."
In particular, he says, he was finding it increasingly difficult to think straight: "Negative emotions and irrational thoughts would almost consume me from the minute I woke up to the minute I went to bed, and it was just constant. My head felt like a tumble dryer with thoughts and feelings going round and round, and I couldn't stop long enough to "take things out", as it were. It feels absolutely exhausting.
"I cried a lot at that time. I went out on my own for drives and would often end up in tears, and the same on the way to work or on the way home. I'd lose time and I couldn't do even the smaller tasks, whether it was at home or work and I stopped taking care of myself. I would also be down, snappy, and irritable, and then I would feel guilty ... I started to wonder whether I'd feel like this forever."
At this point, Andy began to justify his feelings to himself. He felt that if he continued to feel that bad, he wouldn't be strong enough to cope with it if he was going to feel that way forever. He began thinking frequently about death, and felt he was in a very hopeless place.
Coping in the short term
In emergencies, a person might need the help of paramedics - but every situation is different.
Jo Mildenhall is an experienced paramedic and now specialises in paramedic mental health at the College of Paramedics.
The paramedic's role in a mental health crisis depends on the situation, she explains - for example, whether someone has harmed themself or is thinking about doing so, she explains.
"The first thing a paramedic would do, which is generic to any mental health call, is to try to build a rapport with that person, and to try to understand what's going on with them," Mildenhall says. "Obviously, if someone is in a life-threatening condition we will provide immediate medical care but we always try to work from a patient-centred focus so that the patient will always be at the centre of everything that we do. We want to work with them."
In an emergency, she says, the paramedic would try to build a rapport with the person in crisis to find out what's led up to this point, and how they are feeling now. Then, paramedics see what they can do to help - for example, accessing services such as the local mental health crisis team, or immediate care at an emergency department.
Mental health first responders
In some areas, Mildenhall adds, ambulance teams have introduced mental health specialists to first responder teams, and added mental health nurses on emergency lines to triage mental health calls and provide the most appropriate care for mental health emergencies.
If the person who feels suicidal can keep themselves safe for a bit longer, she says, call handlers and paramedics would encourage them to reach out to friends, family, Samaritans, or a mental health crisis team if they're already in touch with the person. Another option is to ask the GP for emergency appointment, she adds: "I know it's hard to get through at the moment but it is still an option."
Whatever the situation, the suicidal person or someone who's with them can call 999 (in an emergency) or 111 (when it's urgent) for support.
When suicidal feelings last, or when they are present but don't feel overwhelming, there are a range of evidence-based interventions that work around treatment like talking therapies and medication.
Dr Julia Coakes is a consultant clinical psychologist at Insight Therapy Centre in Leeds. She works with suicidal clients, some of whom have experienced trauma or 'complex trauma' (which means traumatic experience that might have happened across several incidents) rather than depression.
"Suicidality isn't always about wanting to die," she says. "Sometimes it's that you can't solve the problem in front of you."
Exit left - small support steps
"One of my clients calls suicidal feelings 'exit left'," says Coakes. "If the world feels overwhelming, and it feels like there's not a solution to a problem, instead of her brain going, 'Well, I'll just sit with this, and a solution will come', it goes, 'Therefore I shouldn't exist'.” Dr Coakes says that some clients find it easier to describe suicidal feelings with a code word expression like 'exit left'.
Experts recommend that people worried about suicidal feelings can write a support plan, and Mind suggests that it might be a way for a person who's worried about a friend or relative to support them. A recent study in The British Journal of Psychiatry showed that suicidal behaviour fell by 43% for people who had a safety planning-type intervention.
"We talk about a skill we call 'diffusion’,” Dr Coakes says, "which means stepping away from the suicidal thought a tiny bit. And that step away is the first step into not acting, and acknowledging that this is a feeling, not a solution."
What others can do
Simon Blake is the chief executive of Mental Health First Aid England (MHFA), a social enterprise that has trained millions of people in the UK to support people who are having or are worried about having a mental health crisis. A recent meta-analysis found that far from triggering a suicide attempt, asking people about suicide is safe and can reduce suicidal thoughts.
"The one really straightforward question, which may seem counterintuitive, is: 'Are you thinking about killing yourself?'," he says. "Evidence shows that that is one of the most important questions that we can ask. I wish I'd known that a long time ago."
New at-risk groups
In 2019, the latest stats available on suicide in the UK counted 5,691 deaths in England and Wales. Statisticians warned that rates of suicide are rising for under-25s, and increasing significantly amongst 10- to 24-year-old women and girls.
There's no clear evidence yet that suicidal thoughts increased across the population during the pandemic. Nonetheless, Samaritans highlights that young people, those with a diagnosed mental health condition, people from ethnic minority groups, and those with lower incomes consistently reported higher rates of suicidal thoughts.
During COVID-19, healthcare workers of all kinds faced stress at work - for example, a study published in 2020 found that paramedics reported stress at work both from supporting people who were suicidal, and supporting colleagues who themselves felt suicidal. Services like Our Frontline (0300 303 4434, 8 am-8 pm), a specialist phoneline for essential workers, and Practitioner Health have also encouraged healthcare workers to seek support.
Andy now works and volunteers for Samaritans. He is keen to stress that he still faces challenges, but knowing what affects his mental health, and what he can do to cope, prevents crises.
Andy says he now sees a distinction between someone wondering what it would be like if they weren't here, and feeling like they want to die, but when he was in crisis that distinction was not clear.
"Recognising the signs and talking to someone are so important. As someone who has experienced depression and as a listening volunteer, I really understand the value of it," he says. "Whether it's a loved one, your company's employee assistance programme (EAP), a trusted colleague, your GP or Samaritans - please talk to someone.”
- Samaritans: call 116 123 (free, 24/7) or email firstname.lastname@example.org
- Shout: text SHOUT to 85258 (free, 24/7)
- YoungMinds Crisis Messenger: text YM to 85258 (free, 24/7)
- Mind info line: 0300 123 3393
- CALM: 0800 58 58 58 (for men)
- Rethink: 0300 5000 927