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Suicide First Aid: mental health, trauma-led care and what to say

Making connections between suicide and mental health issues may not be as straightforward as one might initially imagine. It is not always the case that, in order to contemplate suicide, you must be experiencing fragile or negative mental health. In fact, fewer than 5% of people treated in hospital for depression go on to take their own lives[1]

Some mental health conditions do increase the risk of a person being prone to thinking about suicide. These can include schizophrenia, major depressive disorder, bipolar and substance misuse disorders[2]. However, in the majority or cases, mental health alone is not a prerequisite to suicide. There are usually other risk factors to take into account. Thoughts around suicide can often arise from a reaction to a sudden, traumatic loss, for example, a stressful event or an impulsive response to a difficult situation within a personal relationship or at work.

Going through a trauma can raise the risk of someone taking their own life in a similar way to struggling with mental health can. There is evidence to suggest that a person who has experienced childhood abuse or sexual trauma could be at a greater risk of suicide[3]. Veterans who have been wounded during combat have also been identified as being at a higher risk. Levels of risk are affected by how intense and how often the trauma was.

Troubling memories, anger and pain can be factors, as can adversely affected impulse control and unhelpful ways of handling stress. Handling these traumas should be done very carefully, in order to help the person affected unpack their feelings and reactions around the trauma and separate them from any considerations about suicide.

What is trauma-led care?

A key part of suicide intervention is talking therapy; speaking to someone who is thinking about suicide and helping them to explore and understand their feelings. In cases where trauma is known about – or suspected – considering the trauma and how it has contributed to the person’s state of mind is key. Putting the trauma front of mind changes how to address the person and what to focus on. Plus, perhaps more importantly, what not to say or focus on.

Adopting a trauma-led approach to care ensures that the person feels safe talking about their experiences and that they will be taken seriously. As trust develops, so any interventions around suicide can become more effective. Examples of trauma-led care might include making sure the person knows why they are being asked certain questions, or taking more time than you might have originally thought necessary to explain why someone might be experiencing certain symptoms of stress or thought processes, as a direct response to what they have lived through[4]. It helps show understanding and empathy for the person and allows them to explore their experiences with someone they are able to trust, despite what traumatic experiences they might have previously been exposed to

What to say and how to say it

Some basic advice is to remain calm when talking to someone who has expressed thoughts about suicide[5]. Let them know about mental health and suicide intervention services like the Samaritans helpline, which can be accessed on 116 123 or by texting SHOUT 85258. Making contact with resources like these can be difficult for someone doing so for the first time. So, your calm, practical help could be invaluable in providing support to help boost someone’s courage, clarify their thinking and signpost them in the right direction to ask for professional help.

Open questions are most effective when talking about what can be hugely traumatic subject. Asking closed questions that require ‘yes’ or ‘no’ answers can make a person feel trapped or like they are being tested to see if they know the right answer or not. This can feel scary and incline someone who is already in distress to stop opening up. Closed questions can also bring conversations to a sudden stop, while more open-ended ones tend to open discussions up to other topics and directions. For example, try inviting people to tell you their story – they may not wish to, but the simple invitation will help make them feel listened to and like they are worth your time and attention.

Give people a sign that you are listening to what they are saying by using non-verbal signs, such as nodding, gestures and facial expressions. Use non-judgemental body language to encourage people to open up and trust you. Practise reflective listening, e.g. repeating back what someone has just said to you to show that you have heard and understood them. Sit facing them so they have your full attention and try not to fidget or appear bored or defensive. Helping people feel validated and listened to is a powerful way to support them in their darker moments.

Reflective listening, empathy and support

Finally, give concise overviews of what you are hearing from time to time. This not only strengthens the reflective listening you are doing, but it gives the person a chance to correct your understanding if necessary or elaborate on a point they have already made but may want to discuss a bit further. This can especially help when discussing something more complex, or when you want to transition to another, related topic or direction.[6]

Always use empathy and compassion in your discussions and do not judge, minimalise or object to anything that is said. As mentioned above, the aim is to provide a safe space and to encourage the trust of the person who is thinking or talking about taking their own life. Try talking about identifying internal coping strategies, if the person is open to such discussions, to help them relax and cope better with troubling thoughts. For example making a cup of tea, having a bath or going for a walk outdoors.

If you feel that you need support yourself when talking about these difficult topics with someone who is thinking about ending their life, reach out to professional people and groups who provide suicide intervention resources and advice. 

Suicide First Aid

Suicide First Aid is a course created, licensed, and owned by the National Centre for Suicide Prevention, Education and Training (NCSPET) devised to help people prepare for these exact scenarios. It covers several aspects, from understanding suicide risks and trigger factors through to learning what to say, what not to say and when to seek emergency medical or specialist support.[7]

For more information about the course and to sign up for your place, please get in touch today. You never know when your understanding, listening ear could mean all the difference in the world to someone going through a very dark stage in their life.


[1] Source: When it is Darkest, by Rory O’Connor,2021, p81

[2] Source: When it is Darkest, by Rory O’Connor,2021, p51

[3] Source: https://www.ptsd.va.gov/understand/related/suicide_ptsd.asp. Accessed 30 September 2021

[4] Source: https://www.kingsfund.org.uk/blog/2019/11/trauma-informed-care. Accessed 30 September 2021

[5] Source: https://www.ptsd.va.gov/understand/related/suicide_ptsd.asp. Accessed 30 September 2021

[6] Source: When it is Darkest, by Rory O’Connor,2021, pp201-2

[7] Source: https://www.ncspt.org.uk. Accessed 30 September 2021

Post Author: Gayle Young

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