Suicide is a public mental health problem with significant personal, social and economic implications. Globally, approximately one million people die by suicide annually, with experts estimating that for every person who dies by suicide, 20 more make an attempt to take their lives. The loss of someone as a result of suicide leaves a huge gap on many levels, with family members and loved ones left with feelings of devastation, unanswered questions and trauma responses.
The journey towards suicide can be swift (sudden and impulsive) or gradual. In most circumstances, suicidal behaviour occurs on a continuum, ranging from thoughts of killing oneself (suicidal ideation) to more active, focused behaviour directed towards ending one’s life (planning a suicide or engaging in deliberate self-harm with intent to die, for instance) and ultimately to actions that lead to death. Adversities such as poverty, marital/relationship problems, work stress, bullying, physical illnesses, psychological disorders and sexuality stigma could all be implicated in suicide. The COVID-19 pandemic – with its impositions such as job losses, the death of loved ones, the anxiety of being infected or gender-based violence – is yet another significant factor.
Whether or not someone attempts suicide depends on how they appraise or evaluate situations. Adversities in life can hamper personal growth and well-being by shattering the hope and personal beliefs of individuals. This tends to cause an oscillating process of feelings of defeat and trying to deal with the pain and distress. Most people will return to previous levels of functioning and well-being, or can positively accommodate adverse events by finding ways to deal with it. However, others might negatively appraise adversities and find it difficult to move forward. Someone who is stuck in negative appraisal of stressful events or circumstances could resort to suicidal behaviour as an act of shutting off consciousness or escaping from psychological pain. An individual’s decision to take their life is often fuelled by feelings of hopelessness, helplessness, an attack on their self-esteem and a negative outlook on their capabilities.
Psychological resources or strengths such as hope, resilience and social support can buffer against suicide. While some might be able to mobilise hope and resilience, and garner social support on their own, others may need professional assistance to develop or strengthen these psychological strengths to prevent suicide and to address their current concerns.
Unfortunately, society still tends to maintain silence around mental health problems. This could be due to the stigma attached to admitting painful experiences and emotions as well as seeking professional help. Preventing suicide has to start with destigmatising mental health consultations or the act of seeking support. Public mental health policies that support programme development for suicide prevention are necessary. For example, community healthcare workers and other caregivers should receive training in basic counselling skills so that they know how to respond to and support community members who are experiencing psychological distress.
Preventing suicide is a tough feat because not everyone who eventually takes their life verbalises this intent or shows any warning signs of contemplating suicide. Furthermore, suicide is unpredictable. However, some behavioural indicators communicate distress and require further intervention:
- Talking about suicide: Statements like, “I just want to disappear,” “I’d be better off dead,” or “If I see you again…”
- Change of behaviour: Becoming socially withdrawn, easily angered or disengaged
- Seeking the means: Trying to get access to guns, pills, rope or other objects that could be used in a suicide attempt
- No hope for the future: Feelings of helplessness, hopelessness and being trapped, or believing that things will never get better
- Self-loathing and destructive behaviours: Feelings of worthlessness, guilt, shame, self-stigmatising, self-hatred or self-harm
- Getting affairs in order: Giving away valuable possessions or planning for family members
- Saying goodbye: Unusual or unexpected visits or calls to family and friends; saying goodbye to people as if they won’t be seen again
It is vital not to perceive individuals who exhibit such behaviour as simply “seeking attention”, but to acknowledge that they could be experiencing increased distress. They should receive psychological assistance urgently.
Even with all the resources available, it is also important to recognise that seeking help is not always easy, especially for those who come from cultures where silence is sanctioned and emotions are not expressed. Talking with a mental health professional can relieve emotional pain and bring a new perspective to life’s problems. Taking the first step to do this can put one’s life on a new trajectory.
Where to find help:
The University of Pretoria provides counselling resources to students and staff through UP’s Student Counselling Centre and Staff Support. Other available resources include the SA Depression and Anxiety Group (0800 567 567) or Lifeline (0800 121 314). These services are available 24/ 7, are free, available to anyone and are confidential.