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Risk Factors

While no single risk factor predicts suicidal behaviour, it is helpful to be aware of circumstances that could contribute to being suicidal. A combination of these factors that would contribute to increased vulnerability of risk are as follows:

  • Previous attempts
  • Having a family member or a person close to them die by suicide
  • Exposure to family violence, including physical or sexual abuse
  • Substantial drug or alcohol use
  • Eating disorders
  • Significant life transitions (e.g. death of a partner, job loss)
  • Mental health diagnoses (e.g. bipolar or other depressive disorders, schizophrenia, borderline personality disorder)
  • Serious physical illness
  • Severe and long-lasting pain
  • Living with few or no significant social contacts
  • Feeling of being a burden to others
  • Feelings of hopelessness and helplessness
  • Few or no significant sources for stress management and relief

 

Warning Signs

In addition to recognizing a pattern of risk factors in someone you know, it also helps to pay attention to warning signs—indicators, messages or behaviours that could be suicidal communications.

  • Threatening to hurt or kill him/herself, or talking of wanting to hurt or kill him/herself; and/or, looking for ways to kill him/herself by seeking access to firearms, available pills or other means; and/or, talking or writing about death, dying or suicide, when these actions are out of the ordinary.
  • Saying they have no hope, feel trapped or feel there is no point in "going on".
  • Drinking more alcohol or using drugs, including prescription medicines.
  • No longer wanting to see people and spending increased time alone.
  • No longer taking care of themselves or following medical advice.
  • Giving away their things and/or hurrying to complete a will or settling other financial affairs.

 

How you can help yourself

Start a conversation

If you think that you might do something to hurt yourself, tell someone. Make sure you are around someone you trust. If you live alone, ask a friend or family member to stay with you. Connect with professional help if needed. If you don’t know anyone or can’t reach friends or family members, call your local crisis line. 

Try and think about it as any other conversation. You can describe what has happened, how you feel and what you help that you think you need. 

Ask for help to find support; in person, online or over the phone.

 

Make a call

If you feel you are at imminent risk of harming yourself, call 911 or go to the local hospital emergency department.

If you need to speak to someone. We're here to listen. Please call 416-408-4357.

For crisis lines outside of Toronto, visit Distress and Crisis Ontario for Ontario or http://suicideprevention.ca/?s=crisis+centre for Canada.

 

Have a safety plan

  • Keep your home safe by getting rid of ways to hurt yourself

  • Remember things that have helped in the past

  • Get treatment for mental health concerns

  • Identify high-risk triggers or situations

  • Work on a safety plan

  • You can find a safety plan here: Coping With Suicidal Thoughts

  • Think of reasons for living

  • Self-care: Take good care of yourself, including doing things you enjoy      

 

How you can help others

It is incredibly important for us to take time with the people in our lives to listen to what they're saying and really try to understand what they're experiencing. Starting a conversation with someone, asking how they're doing and sticking around to hear the answer with genuine concern can change someone's hour, day or life. 

Using language that is accepting, non-threatening and non-judgemental allows people to open up and express what they're going through. 

Guidelines for approach someone who may be considering suicide: 

  • Start by expressing your concern about the person using specific examples of your observations like, "I noticed that you haven't been to game night in 3 weeks," or "the past several times I've seen you, you've seemed worried and distracted".

  • Don't be afraid to ask directly. If you seem comfortable discussing your concerns abotu the person's well-being, he or she may be more likely to discuss his or her experiences with you. "Are you having thoughts about hurting yourself" may open the conversation lines for the person.
  • Ask how you can help the person. None of us are mind-readers, so asking the person how you may be of help to them is the best way to know what they need from you during this hard time for them.
  • Be familiar with resources before the conversation. If the person admits to thinking of harming themselves or being suicida, you will need to act quickly. Go into your conversation ready with a list of emergency resources and crisis centres nearest you. We can help provide resources to you if you call our 408-HELP line at 416-408-4357 (HELP). 
  • Offer to go with the person while they seek help. He or she may be more likely to follow through with asking for help or getting it if you are there as built-in support.
  • If the person denies wanting to hurt themselves or being suicidal or does not want to talk, remind him or her that you are there if he or she needs you in the future. You can also provide them with the resources you brought to the conversation. They may feel comfortable speaking to someone on their own time. 
  • Follow up after the conversation. It's important to check in from time to time to see how the person is doing.
  • If you feel the warning signs are escalating, reach out to our helpline for additional support on how to help. 
  • Never put yourself in danger. Although those who are navigating difficult times or have mental health problems are more likely to be victims of violence than to initiate it, there are times when someone who is suicidal might be violent. They could be distressed. They could have a weapont they intended on using. In times like these, it's important to call the police and remove yourself to safety until they arrive.
  • Never make a promise you can't keep. It's important to never promise to keep the suicidal thoughts of someone a secret. Explaining that you can't keep it a secret, because you care about them and want to ensure they're safe can help. Mentioning that you would only speak to people who can support and help them is also important. Many people who confide in you will have a concern of being gossiped about. Indicate to the individual that is not your intention and any/all conversations you will have will be with trusted people who can help them navigate what they're going through. Offering to go with them to get the support they need will remove their fear in most cases because you will be together when any discussions about them are taking place.

 

Ways to start a conversation:

"I have been feeling concerned about you lately."

"Recently, I have noticed some differences in you and wondered how you are doing."

"I wanted to check in with you because you haven’t seemed yourself lately."

 

Questions you can ask:

"When did you begin feeling like this?"

"Did something happen that made you start feeling this way?"

"How can I best support you right now?"

"Have you thought about getting help?"

 

What you can say that helps:

"You are not alone in this. I’m here for you."

"I may not be able to understand exactly how you feel, but I care about you and want to help."

 

Try to avoid

  • Panicking - Ex. "This can't be happening. I don't know what to do - what do we do?"

  • Name-calling - Ex. "You're a real psycho."

  • Criticising - Ex. "That was such a stupid thing to do."

  • Preaching or lecturing - Ex. "You know you shouldn't have done that. You should've asked for help."

  • Ignoring - Ex. "Let's pretend this didn't happen."

  • Abandoning the attempt survivor - Ex. "I can't take this, I'm leaving you to figure it out."

  • Punishing the attempt survivor - Ex."I'm not talking to you until you straighten this out."

  • Dramatising - "This is the worst possible thing you could have done!"

  • Simplifying things or using a 'quick-fix' approach - Ex. "You just need some medication, and then you'll feel yourself again."

  • Being angry or offended - Ex. "I can't believe you'd try that!"

  • Making the person feel guildty or selfish - Ex. "How did you think this would make me feel?"

 

How to support an attempt survivor

Research shows that people who have attempted suicide are at greater risk to attempt suicide again. However, support and care from a strong social network can significantly reduce this risk and increase their reasons to live. Your loved one is likely to need considerable time and support from a range of people in order to manage the problems and feelings that first led to the suicide attempt. While safety is ultimately their responsibility, the following may be helpful in supporting them.

 

Define a Safety Plan

A safety plan is a set of instructions that is followed when someone has thoughts of suicide. The plan works best if it is created when the person at risk for suicide is well and NOT in crisis. Those involved in creating the plan should involve the person at risk, their doctor, therapist, or other professional helpers, and yourself. Some elements to include in the plan are:

  • When the plan could be used – i.e., signs your loved one can identify that indicate a risk for suicide. - 19 -
  • A list of calming or comforting things that they can do.
  • A list or pictures of reasons for living.
  • A list of people to call or talk to.
  • A list of professionals and resources to call.
  • Ways to make home or work safer.
  • Other things to do if nothing is helping – emergency numbers, directions to the nearest hospital, what to say to emergency personnel.
  • Your role – e.g., how often can I check on you, how safe do you feel, when do we need to intervene.

Sometimes you may notice that something is not quite right before the person does. Discuss what to do if this happens so both of you have a clear understanding of what your role is in that case. When the person is in crisis, they may tell you to ignore the plan. DON’T. Remember that it is a plan they agreed to when they were feeling well. Make sure your loved one has a card listing the phone numbers for your local 24-Hour Crisis Line.

 

Ensure safety at home

In order to help keep the home safe for you and your loved one:

  • Remove access to any means of suicide.

  • Keep only small quantities of alcohol, drugs or medications in the home, or none at all.

  • Give your loved one plenty of opportunities to talk about the attempt.

  • Let them know it’s okay to tell someone if they feel suicidal in the future.

  • Ask them if meeting with a professional would be helpful, and encourage them to follow through with this.

  • Offer to help them connect to supports, resources, culture and/or spiritual beliefs.

  • Get support for yourself – you don’t need to do this alone.

  • Have the safety plan in writing and in a place where it is accessible to you and your loved one.

 

Know that there may be another attempt

After your loved one’s first attempt, you may feel shocked and surprised. The intensity of these and any other feelings will fade over time, and you may eventually look at life in a different way, or it may appear to go back to “normal.” Know that everyone responds differently to a suicide attempt and you are not wrong for any feelings you have. 

Unfortunately, some people who attempt to end their lives have either tried in the past or will try again. Whatever has or does happen, it is NOT your fault. In anticipation of what might happen, you may likely experience feelings of exhaustion and hopelessness, and find yourself being hyper-vigilant. Remember to reach out for support and guidance and to take care of yourself.  

 

Connect to hope

Victor Havel wrote, “Hope is not the conviction that something will turn out well, but the certainty that something makes sense regardless of how it turns out.” As we struggle with darkness, fear, despair and apathy, we sometimes feel that there is no hope. Hope can come in many shapes and sizes. It can be as simple and profound as the voice of another human being who appears to hear our fear; the knowledge that the sun will rise tomorrow; the smell of fresh spring rain, the first snowflake in the fall, or the photo of someone we love. The source of hope is different for each and every one of us, so try to identify what hope is to you and then hold on to that.

When despair seems to overcome us, we can feel disconnected from ourselves and from hope, and this can make us feel lost and isolated. What we need most in these moments is a way to reconnect and to belong. If you are struggling to maintain hope, or to help your loved one have hope, here are some questions that may help to define the meaning of hope for you and for them: 

  • Who are the most hopeful people you have known in your life?
  • Who would you call to help with your hope right now?
  • What images or sensations do you have of hope: music, smells, objects, colours, etc.?
  • How do you nurture and care for your hope? What do you do to increase and strengthen it?
  • What most threatens your hope?
  • Where do you look for hope when you feel hopeless?
  • Can you remember a story of hope from your own life?
  • When you close your eyes and try to imagine a picture of hope, what do you see?
  • If right now a child asked you “What is hope?”, how would you respond?
  • Do you have a practice of hope? What if you began each day asking yourself, “What do I hope for in this day?” What if you ended each day with the reflective question, “Where did I find hope today?” 

Sometimes hope is too hard for your loved one to imagine, and talking about hope might be distressing for them. At these times, the best you can do is carry hope for them, and let them know you have it and will share it with them if and when they are ready.

Take care of yourself

Attempted suicide can be emotionally draining, stressful and exhausting. It is impossible to watch over someone 24/7. It is vital that you look after yourself and get the support you need. This is not something that you need to/should deal with alone. Ensure you have adequate support systems in place yourself. Identify trusted family members or friends that you can talk to, or join a local support group. If you are finding it difficult to deal with the strain of the situation, you may also wish to consider counselling or other professional support for yourself.

 

How to have conversations after a suicide attempt

If there has been a recent suicide attempt in your family, this may be one of the toughest experiences you and your children may ever face. It is important to take care of yourself, so that you are better able to care for your child. Below you'll find guides intended to provide you with some of that support, and also share other resources that may be helpful for you now and as your family recovers. The guides are not intended to replace professional mental health advice. In fact, it may be best to use this along with professional support if you or your child is struggling with how to talk about this difficult subject.

 

Speaking to a 4 to 8 year old

Without the support of family or other caring adults, a young child may try to make sense of this confusing situation on his own. Children this age have magical thinking, and their own ideas about what is happening can be more frightening than the situation itself. Because preschool children do not have the vocabulary to express all their thoughts and feelings, they may act out at times.

Small children, when stressed, may exhibit changes in behavior, such as temper tantrums. They may also have trouble sleeping, and may become clingy because they are feeling insecure, anxious, or fearful. Younger children are self-interested by nature, and so they may blame themselves and feel guilty because they think they have caused the problem. Children this age will need lots of reassurance from you, and a sense that problems can be solved. It is important to instill a sense of hope that their parent/relative, while struggling, can get help and get well.

It is important to consider your child’s level of development and ability to understand events when deciding how to talk with him. Sticking to the simple facts and answering any questions he asks may be all he needs. (“Dad was feeling bad and had to go to the hospital.”

Suggestions on how to speak to your 4 to 8 year old - CLICK HERE.

You can find additional information HERE.

 

Speaking to a 9-13 year old

It is important to talk to your child about the suicide attempt to help her understand what has happened. Without support of family/friends, children may try to make sense of this confusing situation themselves.

Sometimes children blame themselves for something they may or may not have done. When stressed, a child may exhibit changes in behavior, such as acting out, trouble sleeping, or becoming more attached due to insecure, anxious or tearful feelings. It is important to instill a sense of hope, that their parent/relative can get help and get well.

Suggestions on how to speak to your 9-13 year old - CLICK HERE.

You can find additional information HERE.

 

Speaking to a 14-18 year old

It is important to talk to your teenager about the suicide attempt to help him understand what has happened. Without support of family/friends, he may try to makes sense of this confusing situation himself. Sometimes teenagers blame themselves for something they may or may not have done.

Teenagers may not want to talk directly about their worries or feelings. Instead, they may show them in other ways. They may isolate, or not talk to their friends out of shame, uneasiness or fear of being misunderstood or rejected. It’s helpful to share a hopeful outlook, and when appropriate involve your teen in activities that may help make a positive difference. Also, it is important to consider your teenager’s level of development and ability to understand events when deciding how to talk with him about this issue. Discuss the details of the event as appropriate and help the teenager make sense of the situation while not volunteering unnecessary information.

Suggestions on how to speak to you 14-18 year old - CLICK HERE.

You can find additional information HERE.

 

SUicide postvention Resources

Blog Posts

Additional links

Distress and Crisis Ontario

416-486-2242

www.dcontario.org

 

211 Toronto

www.211toronto.ca

 

211 Ontario

www.211ontario.ca

 

Canadian Association for Suicide Prevention

www.suicideprevention.ca

 

Centre for Addiction and Mental Health

www.camh.ca

 

American Association of Suicidology

www.suicidology.org

 
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