This blog post focuses on applying first aid recommendations for only 1 possible crisis situation, however, acknowledges that other crisis situations that can occur include:
- Suicidal thoughts and behaviours
- Non-suicidal self-injury
- Panic attacks
- Following a traumatic event
- Severe psychotic states
- Severe effects from alcohol use
- Severe effects from drug use
- Aggressive behaviours
For detailed strategies regarding other possible crisis situations, please visit www.mhfa.com.au
Suicidal Thoughts and Behaviours
Facts on suicide in Australia (Source: Lifeline https://www.lifeline.org.au/resources/data-and-statistics/)
- Eight Australians die every day by suicide. That’s more than double the road toll.
- 75% of those who take their own life are male.
- Over 65,000 Australians make a suicide attempt each year.
- Suicide is the leading cause of death for Australians between the ages of 15 and 44.
- The suicide rate in Aboriginal and Torres Strait Islander peoples is twice that of their non-Indigenous counterparts.
- LGBTI+ community members experience significantly higher rates of suicide than the rest of the population.
- For each life lost to suicide, the impacts are felt by up to 135 people, including family members, work colleagues, friends, first responders at the time of death.
First Aid for Suicidal Thoughts and Behaviours
How to assess
Important signs that a person may be suicidal are:
- Threatening to hurt or kill themselves
- Looking for ways to kill themselves: seeking access to pills, weapons or other means
- Talking or writing about death, dying or suicide.
- Rage, anger, seeking revenge
- Acting recklessly or engaging in risky activities, seemingly without thinking
- Feeling trapped, like there’s no way out
- Increasing alcohol or drug use
- Withdrawing from friends, family or society
- Anxiety, agitation, inability to sleep or sleeping all the time
- Dramatic changes in mood (including sudden improvement of mood following an episode of depression)
- No reason for living, no sense of purpose in life
People on this list may show one or many of these signs, or they might show signs not on this list.
If you are concerned the person may be at risk of suicide, you need to approach them and have conversations about your concerns.
Preparing yourself to approach the person
It is important to be aware of your own attitudes about suicide and the impact of these on your ability to provide assistance e.g. belief that suicide is wrong or that it is an irrational option. You must also take into account if the person is from a different cultural or religious background to your own, and their beliefs and attitudes about suicide might differ from your own. Be aware that it is more important to genuinely want to help than to be of the same age, gender or cultural background as the person. If you feel unable to ask the person about suicidal thoughts, find someone else who can.
Making the approach
Act promptly if you think someone is considering suicide. Even if this is only a mild suspicion that the person is having suicidal thoughts. Tell the person your concerns about them, describing behaviours that have caused you to be concerned about suicide. However, it is important to understand that this person may not want to talk with you. In this case, you should offer to help them find someone else to talk to.
Anyone could have thoughts of suicide. If you think someone might be having suicidal thoughts, you should ask that person directly. Unless someone tells you, the only way to know if they are thinking about suicide is to ask. For example, you could ask:
- “Are you having thoughts of suicide?” or,
- “Are you thinking about killing yourself?”
While it is more important to ask the question directly than to worry about the wording, you should not ask about suicide in leading of judgmental ways e.g. “you’re not thinking about doing something stupid are you?”
Sometimes people are reluctant to ask directly about suicide because they think they will put the idea in the person’s head. This is not true. Similarly, if a person is suicidal, asking them about suicidal thoughts will not increase the risk that they will act on these. Instead asking the person about suicidal thoughts will allow them the chance to talk about their problems and show them that somebody cares.
Whilst it is common to feel panic or shock when someone discloses thoughts of suicide, it is important to avoid expressing negative reactions. Do your best to appear calm, confident and empathetic in the face of a suicide crisis.
How can I tell how urgent the situation is?
Take all thoughts of suicide seriously and take action. Do not dismiss the person’s thoughts as ‘attention seeking’ or a ‘cry for help’. Determine the urgency of taking action based on recognition of suicide warning signs.
Enquire about issues that affect their immediate safety by asking the suicidal person:
- Whether they have a plan for suicide
- How they intend to suicide i.e. ask them direct questions about how and where they intend to suicide
- Whether they have decided when they will carry out their plan
- Whether they have already taken steps to secure the means to end their life
- Whether they have been using drugs or alcohol
- Whether they have ever attempted or planned suicide in the past
It is useful to find out what supports are available to the person. Ask the person:
- Whether they have told anyone about what they are feeling
- Whether there have been changes in their employment, social life or family
- Whether they have received treatment for mental health problems or are taking any medication.
Be aware that those at the highest risk for acting on thoughts of suicide in the near future are those who have a specific suicide plan, the means to carry out the plan, a time set for doing it, and an intention to do it. However, the lack of a plan is not sufficient to ensure safety.
How to assist
How should i talk to with someone who is suicidal
It is more important to be genuinely caring than to say, ‘all the right things.’ Be supportive and understanding of the suicidal person and listen to them with undivided attention. Suicidal thoughts are often a plea for help and a desperate attempt to escape from problems and distressing feelings.
Do not avoid using the word ‘suicide’
Do not avoid using the word ‘suicide’. It is important to discuss the issue directly without dread or expressing negative judgement. Demonstrate appropriate language when referring to suicide by using the terms ‘suicide’ or ‘die by suicide’, and avoiding use of terms to describe suicide that promote stigamatising attitudes e.g. ‘commit suicide’ (implying it is a crime or sin) or referring to past suicide attempts as having ‘failed’ or been ‘unsuccessful’ (implying death would have been a favourable outcome).
Ask the suicidal person what they are thinking and feeling. Reassure them that you want to hear whatever they have to say. Allow them to talk about these feelings, and their reasons for wanting to die and acknowledge these. Let the suicidal person know that it is okay to talk about things that might be painful, even if it is hard.
Thank them for sharing their feelings
Remember to thank the suicidal person for sharing their feelings with you and acknowledge the courage this takes. Please see Figures 2.10 and 2.11 on ‘Listening tips’ and ‘What not to do’.
- Be patient and calm while the suicidal person is talking.
- Listen to the suicidal person without expressing judgement, accepting what they are saying without agreeing or disagreeing with their point of view.
- Ask open-ended questions e.g. questions that cannot be answered with ‘yes’ and ‘no’ to find out more about suicidal thoughts and feelings and the problems behind these.
- Show you are listening by summarising what the suicide person is saying.
- Express empathy for the suicidal person.
What not to do
- Do not argue or debate with the person about their thoughts for suicide.
- Do not discuss with the person whether suicide is right or wrong.
- Do not use guilt or threats to prevent suicide e.g. do not tell the person they will ruin people’s lives if they die by suicide.
- Do not minimise the suicidal person’s problems.
- Do not give glib ‘reassurance’ such as “Don’t worry”, “cheer up”, “You have everything going for you”, or “Everything will be alright”.
- Do not attempt to give the suicidal person a diagnosis of a mental illness.
How can I keep the person safe?
Once you have established that a suicide risk is present, you need to take action to keep the person safe. A person who is suicidal should not be on their own. If you suspect there is an immediate risk of the person acting on suicidal thoughts, act quickly, even if you are unsure. Work collaboratively with the suicidal person to ensure their safety, rather than acting alone to prevent suicide.
Reassure them that there are solutions to problems or ways of coping other than suicide. When talking to the suicidal person, focus on things that will keep them safe for now, rather than the things that can put them at risk. To help keep the suicidal person safe, develop a safety plan with them. See Safety Plan box 2.13. However, do not assume the safety plan by itself is adequate to keep the suicidal person safe.
Important to remember
Although you can offer support, you are not responsible for the actions or behaviours of someone else and cannot control what they might decide to do.
A safety plan is an agreement between the suicidal person and the first aider that involves actions to keep the person safe. The safety plan should:
- Focus on what the suicidal person should do rather than what they shouldn’t.
- Be clear, outlining what will be done, who will be doing it, and when it will be carried out.
- Be for a length of time that will be easy for the suicidal person to cope with, so that they can feel able to fulfil the agreement and have a sense of achievement.
- Include contact numbers that the person agrees to call if they are feeling suicidal, e.g. the person’s doctor or mental health care professional, a suicide helpline or 24-hour crisis line, friends and family members who will help in an emergency.
Find out who or what has supported the person in the past and whether these supports are still available. Ask them how they would like to be supported and if there is anything you can do to help, but do not try to take on their responsibilities.
What about professional help?
Encourage the person to get appropriate professional help as soon as possible. Find out information about the resources and services available for a person who is considering suicide, including local services that can assist in response to people at risk of suicide such as hospitals, mental health clinics, mobile outreach crisis teams, suicide prevention helplines and local emergency services. Provide this information to the suicidal person and discuss help-seeking options with them. If they don’t want to talk to someone face-to-face, encourage them to contact a suicide helpline.
Take care of yourself
After helping someone who is suicidal, make sure you take appropriate self-care. Providing support and assistance to a suicidal person is exhausting and it is important to take care of yourself. It can be helpful to find someone to talk to about what has happened. If you do this though, you need to remember to respect the person’s right to privacy. If you talk to someone, don’t share the name of the person you helped, or any personal details which might make them identifiable to the person you choose to share with.
It can also be good to do things which can improve your own mood or mental health after caring for someone who is distressed. Activities which are known to be helpful for improving mood and reducing anxiety includes: eating well, keeping regular sleep habits, practicing relaxation techniques, being physically active, letting other people know how you are feeling, scheduling enjoyable activities and doing other things you know have been helpful in the past.
Three key actions for helping a suicidal person
- If you think someone is suicidal, ask them directly.
- Work together to keep them safe for now.
- Connect them to professional help.
Remember, if you or anyone you know is experiencing difficulty call Lifeline on 13 11 14.
Always call triple zero (000) in an emergency