Are you having thoughts about ending your life? The difficult question

I’m a mental health practitioner and nurse by background. In a professional and personal capacity I’ve been around quite a few people who have taken their lives. Over the years I’ve spoken to a lot of people, alot. From people with severe difficulties who have been detained in hospital, to people over the phone with more milder difficulties and people who are looking for some help with their wellbeing.  One question that I will always ask regardless of who I am speaking to is; ‘are you having thoughts of taking your life’. 

As a health professional, risk assessment gets drilled into you. You get various training about assessing risk; the 5ps risk assessment; presenting, predisposing, and precipitating, perpetuating and protective, mental health first aid, ASIST training and many hours in the lecture theatre or webinar. When I speak to someone I want to know about past risks, factors that make them vulnerable, do they have an illness associated with high risk, are they fixated on death and dying, have they stockpiled medication,  are they unemployed, are they isolated, rootless, hopeless, are they a man, do they have easy access to medication or methods to end their life, are they impulsive, do they have support, any pets to look after, what medication are they taking, are they depressed, do they have capacity, what support do they have, anyone else involved in their care? Then I make sure I document everything and get them the right help as soon as possible. Obviously all this is vital and as a health professional. it’s gotta be done.

But, you could know all this information and be no closer to knowing if the person in front of you is going to take their life. Sometimes people take their life who don’t immediately appear at risk, others appear to be at risk, yet never do. Predicting risk is very very hard. The most important thing to ask is ‘are you thinking about ending your life’. All the predicting, guesswork, formulation, discussions with other professionals is no substitute for a human interaction where one person asks another this question. I could talk about and debunk myths that asking the questions will make things worse, but trust me when I say that any potential negative outcomes of asking this question never overtake the slither of possibility that you may save someone’s life, whether it’s someone you know or not.

There are a few things I have learned that are pretty anecdotal but are reflected in statistics and reflected in what my colleagues experience too. Now, typically I will speak to people who have come to us for help with their mental health, most people we speak to are likely to be struggling with anxiety and/or depression and have a lot of stressors on their plates. Whenever I ask the question, I think most people say ‘yes’ or ‘sometimes’. I have spoken to around 2000 people in my current role, and to think most of them say yes. The answers tend to be ‘what’s the point…I just want to escape…the thought of not waking up tomorrow doesn’t bother me…if I could just turn the lights off’. I often tell the person that they are not alone, and these thoughts are very very common and I try my best to normalise, reassure and instil a little hope.  I will often try to explain why they may have these thoughts. Typically (not always) I  have conversations that go something like this; 

‘You have and are going through so much. When you feel depressed/anxious/stressed it affects everything. You feel awful, mood is all over the place, you isolate yourself, withdraw, avoid others and suppress thoughts and feelings, you probably have stopped doing the things that make you you. The way you think isn’t going to be happy or positive, you are not going to be skipping out the door at 7 am to take on new challenges. It makes sense that the thoughts you have follow how you feel. Your brain is a complex super computer that works very hard in solving problems, but it prefers to find solutions quickly with the least amount of effort, especially when you aren’t feeling yourself. If everything is tough; stress, low mood, physically feeling awful and you isolate yourself, your brain will look at options. Sometimes in these moments the thought of just ceasing sometimes sticks’.

‘Sometimes it can help people to view these thoughts as a symptom of depression/anxiety or stress. It might be a bit abstract but when you break a leg, it’s your leg that’s hurting because it’s damaged. ‘You’ aren’t hurting, your leg is. When you are very low, it’s your mood that is painful and it comes out with thoughts of not wanting to be here’. So this thought is a bit like a symptom of pain. You don’t want to die,  it’s your depression that does’.

‘If you were to imagine a compassionate version of yourself, a version who feels ok and is not struggling with the same difficulties. Would this version of you still have these thoughts’.

‘You may feel really down now, but when it comes to our mind and mental health, things change and it won’t be like this indefinitely. You have thoughts that you don’t want to be here now, yet maybe around the corner in a couple of days, weeks, months you may really want to be here’.

‘With some help, with learning more about depression/anxiety/stress, with talking to someone, perhaps this will improve the way you feel and reduce these thoughts. Lots of people get help and recover’.

Then I would ask ‘do you intend on ending your life, have you made any plans or preparation?’ Answering yes to this question is far less common, but does happen. The answer is typically filled with emotion and just by asking I may have saved someone’s life. Now I know I can ask specifics and I can try and get them to access the appropriate support, get them to lean on their protective factors, ask them reasons for dying and living. And ultimately, get them to the appropriate next step whether that’s their mental health team or to more urgent services.

If you know someone who is struggling. Don’t be afraid to ask the question; ‘are you thinking of ending your life’. There is help out there. If you are thinking about ending your life, nothing is strange or crazy about the thought. In fact it’s a thought that makes sense given the context of everything you have gone through or are going through. For those who are fearful of opening up because of stigma, there is so little stigma in society. The problem is the fear of being stigmatised. Time and time again I hear the relief and catharsis of people finally being asked the question and then the relief that it is ok and there is help out there.

About the author

Paul Regan

I have been working as a mental health nurse since 2016 and have been around the block working in a lot of different areas. At present I work in a service where I assess people and provide interventions. I love my job, I love learning and talking to people about mental health and wellbeing. This article represents my personal opinion and is certainly not medical advice. If you have concerns about your mental health please speak with a GP or health professional.