Sunday, May 10, 2020

The One We Do Not Speak Of

The impact of the COVID-19 pandemic has manifested itself not only in the deaths of thousands dying from the virus but those whose mental health is being compromised as a result of weeks of isolation and fear. CLAC members and staff have not been immune

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By Quentin Steen, Representative

We received a heartbreaking submission last week from the wife of a Local 66 member. She was responding to a question in our weekly national newsletter, “How are you filling your days off?” Her answer came as a surprise and a shock as she shared the heartbreaking loss of her son who died by suicide a few weeks earlier. She said that COVID-19 played a huge part in her son’s decision to take his life.

My heart goes out to all those who have lost family and friends to suicide, especially when our fears and stigma drive it underground, giving it the power to become the one we do not speak of. Suicide, no matter the reason, is a tragic loss to stare in the face of and try to make sense of.

Over the past five years, I’ve lost three members to suicide in my role as a CLAC rep. In the past few weeks alone, my colleagues have dealt with the tragic death by suicide of three other members. Each story is as sad and heartbreaking as the next. And each story hits home for me in a very personal way.

Why?

There are many reasons why someone chooses to take their own life. Those reasons only intensify with the presence of significant mental health issues, the most common of which are mood-related disorders, anxiety and trauma-related disorders, psychotic disorders, and substance-related disorders. The risk increases when more than one mental health problem is at play (e.g., anxiety and depression) and even more so when substances are used as a coping mechanism.

Many Canadians die by suicide each year. Out of all causes of death in Canada, suicide ranks ninth highest. It’s a sobering reality. According to Health Canada,

• 3,000-4,000 deaths per year are caused by suicide.

• 13.4% of Canadians over 15 have thought seriously about suicide in their lifetime.

• Up to 15 percent of those with with severe major depressive disorder will die by suicide.

• More women than men attempt suicide, because of the means they choose (e.g., medication overdoses), but more men than women die by suicide (3.5 times more than women), presumably due to the more lethal means they choose.

Choose Your Words Carefully

For those left behind, their feelings are often punctuated by shame, which is why it’s important how we choose our words when talking about suicide. Avoid using terms and phrases such as “he killed himself” or “she committed suicide.”

Instead, use phrases such as “he died by suicide or “she lost her life to suicide.” These words are a more accurate description of the tragedy, and dismiss the notion that suicide is a criminal offence, such as homicide, captured by the word “committed.” Suicide was decriminalized in Canada in 1972.

Words like successful or unsuccessful relative to a person’s attempt to take their life by suicide are also poor choices. Suicide is always a tragic end to anyone’s life.

The words we choose inadvertently feed into the stigma associated with suicide. Much of that stigma is embedded in our religious and moral frameworks, and it can be extremely damaging because it creates a significant barrier to open discussion of the topic and may prevent people who are considering suicide from seeking help.

Those left behind are often filled with self-condemning thoughts. How come I didn’t see this coming? Why didn’t they reach out to me? I thought I was a safe friend. If only I would have answered the phone, she may still be alive. If I would have known, I could have said something to keep him from taking his life.

People don’t usually come right out and say whether or not they are thinking of suicide. They typically imply or hint and sometimes even invite someone to ask them about suicide.

What to Watch our For

It can be very vulnerable for someone to tell you they are having thoughts of taking their own life. Watch for statements that can imply thoughts of suicide.

• I’m a burden.

• The harder this gets, the more I just want to give up.

• I just can’t cope with this anymore.

• Things are never going to get any better, so what’s the point of living.

• I won’t be missed.

• No one will care if I’m gone.

• My family will be better off without me.

• I just want the pain to stop.

Other warning signs to look for include

• Expressing negative comments about self

• Expressing intent to die by suicide, and having a plan to do so

• Expressing suicidal thoughts

• Repeated expressions of hopelessness, helplessness, or desperation

• A sudden drastic change from depression to optimism and positivity (usually connected to making peace with the decision to take one’s life with a plan to do so)

• A sudden change in appearance or behaviours for better, or worse.

• Putting personal affairs in order (e.g., updating wills)

• Giving away cherished items (e.g., CD collection, family heirlooms)

• Loss of interest or enjoyment, especially in things that previously provided interest and enjoyment

• Abruptly discontinuing mental health supports

• Withdrawing from others

• Loss of energy and/or appetite

• Change in sleeping patterns

Understanding Those with Suicidal Thoughts

The harsh reality is that often a loved one’s death by suicide takes us by surprise, and the opportunity to intervene does not present itself. Ultimately, the decision to take one’s life rest in the hands of the individual, a decision which at times can be the result of battling with a mental health problem that even the best efforts of loved ones are powerless to change.

However, when the opportunity does present itself, it’s critical to understand that people who experience thoughts of suicide are often in conflict with other parts of themselves. They can be very ambivalent or unsure whether they really want to die. Most people would choose to feel better rather than to die if they had the choice between the two.

I struggled with suicidal ideations as early as grade four. For me, it was a matter of wanting out of the pain I was experiencing emotionally trying to make sense of the trauma of my adoption and the constant bullying I experienced, both emotionally and physically, which followed me around while growing up.

As I grew older, these thoughts of suicide slowly intensified until they reached a peak in 2010. Through a series of events fuelled by depression, I reached a tipping point. It seemed easier for me to take my life by suicide rather than deal with pain that wouldn’t go away.

My brain was not right, and a few people around me began to notice. I was gently questioned about changes in my behaviour that seemed a little off to them.

At first, I blew them off, mostly because I was ashamed about having these thoughts, afraid that others would see me as pathetic, or worse, set me aside. It was the persistence of their concerned voices that eventually gave me the courage to speak up about the struggle I was having and to allow them to help me. Because I was asking for it.

Steps for Suicide Intervention

If and when you are faced with the suicidal thoughts of others, there are some intervention steps you can take. In my mental health first aid classes, I’ve adapted material by Cara Taylor, a mental health educator based out of Saskatoon, as a starting point for talking with someone who expresses thoughts of suicide.

1. Ask directly.

Suicide is a serious issue that demands a serious and empathetic conversation. Explore the risk of self-harm or suicide. Look for the signs and symptoms as listed above. Not everyone exhibits the same signs and symptoms. Avoid indirectly asking if someone is having thoughts of suicide (e.g., Are you thinking of ending things, harming yourself, or doing something that puts your life at risk?) If you use euphemisms for suicide, the person may think you don’t actually want (or care) to hear the answers. It increases the likelihood that the person will not answer. It’s also important to note the myth that asking direct questions about suicide will cause them to become suicidal.

2. Normalize thoughts of suicide.

Try phrasing your question like this: “Sometimes, when people [say or do X], they are having thoughts of suicide. Are you having thoughts of suicide?” This way of asking reminds the person that all sorts of people have thoughts of suicide, and that their thoughts do not demonstrate a defect or weakness in them. Avoid glib remarks and statements such as, “Come on, things can’t be that bad.” Or, “I can’t believe how selfish you’re being. Think about how the rest of us who care about you would feel.”

3. Make a plan for safety.

Engage the person in a plan for safety that provides a sense of hope, one that’s relevant to their situation. If they tell you they are having thoughts of suicide that are hard to ignore, ask them, “Would you be willing and able to make a plan with me to keep you safe?” Brainstorm together a way to keep them and you as safe as possible (e.g., remove firearms, medication, etc. from their home). Do not leave them alone. If they cannot keep themselves safe, and you cannot make a plan together for their safety, call 911 or accompany them to the nearest ER. In crisis intervention, it’s better to be wrong, make the call, and live with their feelings then to be right in your assumptions and not make the call to keep the peace at the moment.

4. Don’t underestimate the impact you can have.

Suicide is never an easy or comfortable subject to engage in even for those seasoned professionals or those who specialize in suicide prevention. But it’s essential that we do what we can when and if we are faced with the opportunity. Encourage the person to seek professional supports. Ask them to tell other trusted loved ones about their suicidal thoughts. Tell them you will follow up and when and do so. Remind them how deeply you care for them. Empathize not only with their feelings but with their struggle. Most of us are not professionals in suicide prevention, nor do we need to be. Even though you may stumble your way through, don’t underestimate the impact you can have just by starting the conversation. It’s the heart behind your intentions that matter, not the result that you can’t control.

One last thing. In circumstances like these, as with many others, always be mindful of your own mental health. Know and respect your limitations. Practice self-care. Be on the lookout for any changes in your habits, attitudes, and moods. Sometimes, changes to your mental health can sneak up on you in ways you never imagined.

Resources for Dealing with Suicide

• Living Works Education Inc.

• Centre for Suicide Prevention

• Crisis Services Canada

• Bounce Back

• Wellness Together Canada: Mental Health and Substance Use Support

Quentin Steen is a certified mental health first aid instructor for the Mental Health Commission of Canada.

Get your BRAIN right and your MIND will follow!

4 Mental Health Resources to Help You During the Pandemic

Stronger Minds features videos and quick reads from mental health experts, activities to help you gain resilience, and ask-an-expert videos in response to questions.
WellCan offers free well-being resources to help Canadians develop coping strategies and build resilience to help deal with uncertainty, mental health, and substance abuse concerns during the COVID-19 pandemic.
Wellness Together Canada: Mental Health and Substance Use Support provides free online resources, tools, apps, and connections to trained volunteers and qualified mental health professionals.
CLAC is also continuing to make available to all members and their families our employment and family assistance program. If you or your loved ones are struggling, please do not hesitate to reach out for help today.