Breaking the taboo - Talking about suicide and bereavement

The statistics on suicide are quite staggering. There are 800,000 suicides a year across the world. This equates to one every 40 seconds, and the rate has increased by about 45% in the last 45 years. It is the second leading cause of death in 15-29-year-olds. For every suicide, it is calculated that 20 people self-harm.

In England, there are 4,800 suicides every year (13 a day). Although 2006/7 showed the lowest-ever figures in England since records began in 1861, suicide has been rising again ever since the recession started. The highest rates are in the NW, NE, London, Cornwall, and Devon. Men have a three times higher rate than women. This is for a variety of reasons - it is said that "men don't ask for directions, never mind asking for help," they are more prone to addictions, are generally more impulsive, and tend to use more violent and immediate forms of suicide, where there is little chance of being rescued.

Men in their 40s and 50s are at the highest risk, though this is also a problem age group for women. There is also a very high rate of suicide among people under mental health care. This peaks one to two weeks after they are discharged from treatment, especially if they live alone. 50% of people who complete suicide have a history of self-harm.

There is a big problem with PTSD, depression, and suicide in the military services after combat. This is starting to achieve more recognition and attention - and much more openness. For a long time, it would be hushed up and veterans would get either no military funeral or a quiet one. Now it is recognised that combat can cause mental health problems and it does not bar personnel from military honours and funeral procedures.

Suicide is a public health problem but is not treated as such. People tend to avoid the subject of suicide - death is scary enough, but suicide is even more so - as is the link to potential mental illness that people imagine goes with it. This is a particular problem in the press and some of the headlines you see in papers surrounding it can be quite sensational and dramatised. Suicide was decriminalised in 1961, but many people, especially the press, still refer to it as "committing suicide". It is a good idea to get used to not using this phrase as it adds to the stigma.

A common reaction today is "You can talk about mental health, but not about suicide". Suicide has recently been removed as a topic from one of the Sociology A Level syllabuses, which, considering the need to remove the stigma and silence about the subject, seems nonsensical.

Remember that suicide is a point on the mental health continuum - albeit an extreme one. As such, we should all be encouraging each other to speak about our feelings, however difficult or despairing they may be. Mental health problems are now thought to affect one in four of us every year, and so it is worth considering the following quote:

"The average person lies four times a day, 1460 times a year, 87600 times by the age of 60. The most common lie is I am fine."

Suicide Bereavement

This has unique issues as well as the normal issues of bereavement - guilt, rejection, anger, shame, numbness, isolation, stigma, and despair are common and often never go away. It has been described as "grief with the volume turned up". A common thought from parental sufferers is that they "blame" themselves for the rest of their lives for not doing more to help their son or daughter.

Those who are left behind have a massive increase in mental health issues and well-being problems. There is a much-increased risk of suicide, dropping out of jobs, and poor social functioning. We need to normalise this because, for instance, the majority of parents suffering suicide bereavement have suicidal ideation themselves (and feel that they cannot talk about it and feel discouraged from talking about it). Society and the authorities do not encourage them to do so: IAPT offers no support at all for those bereaved by suicide; CAMHS will help children with ADHD but not those who find a family member dead by their own hand - however grisly the find.

The effects of suicide ripple out like a pebble in the water - individual, family, workplace/school/peers, community, society. Robin Williams is an obvious example of this - though it is true for every suicide. Every suicide affects us all eventually as it affects the society we live in.

Stigma is a particular problem as it prevents people from talking about an issue and thus breeds isolation, insularity, and despair. Although most stigma has very negative effects, it is important to note that there is also "positive stigma" - i.e. that type of stigma that encourages people not to take their own lives.

We need to move forward with reducing and eventually eliminating all forms of stigma about mental health, and Bill Clinton summed this up well with the following quote:

"We shouldn't be ashamed of mental health problems. We should be ashamed of the stigma about them."

Support for People Bereaved by Suicide

It has been recognised that more needs to be done for those left behind by suicide. The National Suicide Prevention Strategy was set up in 2002 and various organisations have been set up since. "Action is the antidote to despair," said Joan Baez and the following organisations have a variety of strategies in place to help with both practical and emotional support:

• Help is at Hand - a programme that produces booklets and has a website. Its message is "You are not alone."
• Support After Suicide Partnership
• Winston's Wish (for children)
• Survivors of Bereavement through Suicide (SOBS) (believes that everyone affected by suicide should be offered timely support.)
• Facing The Future

Counselling is a good place for those who feel suicidal or are suffering the effects of a suicide bereavement to start the process of moving to a better place. As far as bereavement goes, it is best to allow a little time to pass before starting counselling - as a bereaved person is initially likely to suffer feeling dazed, out of balance and not ready for talk. In time, although it is unrealistic to think anyone can ever fully recover from suicide bereavement, they can find some coming to terms, peace, and positivity about the future - and counselling is an excellent way of helping to bring this about.