Columnists, Mental Health, special needs

#WMHD: Preventing suicide in young people

#WMHD: Preventing suicide in young people

‘You will be too much for some people – Those aren’t your people’

Meme

It’s #WorldMentalHealthDay 2019 and the focus this year is Suicide Prevention. Suicide devastates families and the ripples go on for generations, impacting every fibre of those left behind and it ranks among the top 20 leading causes of death globally for people of all ages each year. 

It’s also the most preventable cause of death.

The World Health Organisation (WHO, 2019) estimates that suicide accounts for over 800,000 deaths per year. That’s right, 800,000 deaths per year, worldwide. This figure equates to one suicide every 40 seconds. Although suicide occurs throughout the lifespan, it's the second most common cause of death among young people aged 15-29 years old. 79% of all suicides occur where incomes are less than the national average, meaning that financial difficulties are a significant contributory factor.

Tip of the iceberg

While the number of those who take their own lives is distressing, it's are only the visible tip of the iceberg. Research suggests that for every individual who dies by suicide, there may be more than 20 other individuals attempting to end their life.

Furthermore, for those left behind after one person dies by suicide, approximately 135 people suffer intense grief or are profoundly affected in other ways. This amounts to 108 million people per year who are significantly impacted by suicidal behaviour  (IASP, 2019).

Until 1961 suicide was illegal in the UK and those who took their own life were said to have 'committed suicide'.  Although this is a term still widely used today, understanding is growing into the acute emotional distress a person is experiencing to take them to the point of feeling that the only course of action is the end their lives.

Better training needed for health professionals

Through emerging research, we have learnt that autistic people are much more likely to experience poor mental health or be poorly supported with their mental health, and therefore have suicidal thoughts or consider suicide as their only option. 

Therefore we have to learn and understand more about this increased risk and act upon how we can provide effective and timely help to prevent more deaths of our autistic community. 

Too many mental health frontline workers do not have an adequate understanding of autism and therefore assume that depression, anxiety, obsessive-compulsive disorder (OCD), dyslexia, dyspraxia and hyperlexia are all a natural aspect of being autistic. THEY ARE NOT – they are separate and distinct conditions but can occur alongside autism.

We were dismissed time and again by health professionals we consulted over my autistic son. We were told we had to expect that my son would be anxious as it was a natural part of being autistic. Actually, unpredictability, abuse, trauma, and feeling like a failure for not understanding the unspoken expectations of others, are a contributory factor in developing anxiety, not being autistic itself!

From experience, much of this will be down to how society treats autistic individuals, and how the autistic community are enabled to discuss their feelings. It is imperative, as a healthcare professional or advocate, to have an understanding of alexithymia, interoception (better still if the professional or advocate is autistic themselves), and a strong knowledge of psycho-educational theories. Almost all of the autistic young adults I have worked with find understanding the theory behind how their brains work helped enormously with understanding their reactions and responses to real life situations.

The figures are alarming

Studies have shown that up to 66% of autistic adults have thought about taking their own life, while an alarming 35% have attempted suicide. Around 1% of people in the UK are autistic, yet up to 15% of people hospitalised after attempting suicide have a diagnosis of autism. (Autistica, 2019)

“When you lose someone, the hole they leave stays forever. When you lose someone to suicide, they leave a bag full of guilt and regret, maybes and if onlys. It is NEVER easier without them. It will never be easier on your family and friends without you. Suicide is a permanent solution to a temporary problem. 

The Brick Castle, 2019

The recent, tragic and untimely deaths of two Surrey young autistic adults Sasha Forster and Joel Langford demonstrate this strongly.

Autistica, the UK's leading autism research charity, say autistic people have told them that when they are feeling suicidal, they may not show signs that people typically expect. This is because of:

  • their differences in communicating and interacting with other people
  • difficulties communicating their thoughts
  • they might not want to talk about it

If an autistic person tells you that they are suicidal, it is important to believe them.

Autistica say it's unknown whether factors leading to suicide in autism are the same as in the general population, because there are many different reasons someone may consider taking their own life, including overwhelming feelings, life events that are intolerable, and additional physical or mental health conditions such as OCD, anxiety (all types) and depression.

Autistic people are between 20%-40% more likely to experience anxiety. ADHD is being recognised by some researchers as a co-morbid risk factor of suicidality in autistic people

Other contributory factors that autistic people have told us may increase their risk of suicide include

  • delays in receiving a diagnosis
  • difficulties accessing support
  • poor physical health 
  • high levels of unemployment

Cry for help

Most people who are suicidal don’t actually want to die and most people who harm themselves don’t want to physically injure themselves. They just want the emotional distress to stop.

Carolyn Spring of ‘Reversing Adversity’ runs a highly recommended course on suicide and self-harm. I would urge all healthcare professionals to consider looking up the details of this course or book to take the online version when it becomes available – the course resources are invaluable.

She presents through Dweck (2017) that it is possible to progress through suicidal thoughts and tendencies by developing and adopting a growth mindset*, something autistic individuals may struggle more than their non-autistic peers. Autistic individuals are often thought to have more of a fixed mindset** (because knowing what is happening is safer than not knowing). However, with appropriate (properly trained and regularly delivered) support, it's possible to develop a growth mindset over time.

  • *A belief that the abilities and personality you are born with are just the beginning
  • ** A belief that the abilities and personality you are born with are fixed and unadaptable or changeable

We could all help prevent suicide

Everyone has the ability to contribute to the prevention of suicide as it affects everyone. It’s universal and knows no boundaries, affecting millions of people directly or indirectly. The millions of people affected each year by suicidal behaviour have unique insights. Their experiences are invaluable in informing suicide prevention measures and influencing the provision of supports for suicidal people and those around them.

The involvement of people with lived experience of suicide in research, evaluation and intervention is considered effective and should be promoted in the work of every organisation addressing suicidal behaviour 4. (IASP, 2019)

Things to look for when concerned about adult friends or loved ones:

  • Isolating themselves from others
  • Not communicating with friends or family
  • Giving away their possessions or even writing a will
  • Reckless behaviour
  • Increased aggression
  • Increasing use of drugs and alcohol
  • Looking up methods of suicide online
  • Gathering materials (pills or a weapon)
  • Talking about suicide or feeling like they want to die

With young people:

  • Experience bullying
  • Losing someone close to them or even a favourite celebrity
  • Experiencing abuse or trauma, whether physical, emotional, or sexual
  • Abusing drugs or alcohol
  • Having a history of mental illness
  • Feeling uncertain or unhappy about their sexual orientation or gender identity
  • Feeling hopeless
  • Isolating themselves from others
  • Preoccupation with death, i.e talking about death or ways to kill themselves
  • Researching death online or reading material.
  • An academic drop in grades or refusing to go to school

Of course, the above does not mean a person will attempt to take their own life, but they are things to take note of, if, or when they occur and especially set against other behaviours or events in their life.

Things you can do to help and support your loved one are:

  • Believe them, and believe in them!
  • Talk to them. Talking about suicide isn't going to increase the risk of a person taking their own life, but it can provide some very welcome relief to how overwhelmed they are probably feeling 
  • Validate their fears and worries so they know they are taken seriously.
  • Do not stop an autistic person from self-harming – this can potentially increase the risk of suicide. Instead, talk to them about alternatives and keeping themselves safe or seeking professional support. Remember that the thought of visiting a hospital for support could be too much of a sensory overload so look at other ways to seek that support.
  • Find alternative ways of seeking support through support lines. Autistic people have often shared that talking on the telephone to support workers is an absolute no go and in fact, can increase distress.
  • Make sure they know where to go if close friends or family are unavailable to offer support.
  • And ensure they know they are entitled to seek support – another area that some autistic people struggle with is understanding that they are included when they are told of support services available (One autistic child said to me, why should they assume they were included after experiencing a life time of being excluded?).
  • More ways on Every Mind Matters

Other means of support

References 

  • Autistica. (2019). Suicide - Autism | Autistica | Autistica. [online] Available at: https://www.autistica.org.uk/what-is-autism/signs-and-symptoms/suicide-and-autism#possible-triggers [Accessed 5 Oct. 2019].
  • Castle, J. (2019). Life goes on.... World Suicide Prevention Day 2019 #WSPD. [online] Thebrickcastle.com. Available at: https://www.thebrickcastle.com/2019/09/life-goes-on-world-suicide-prevention.html#more [Accessed 5 Oct. 2019].
  • nhs.uk. (2019). People with autism are 'dying younger,' warns study. [online] Available at: https://www.nhs.uk/news/neurology/people-with-autism-are-dying-younger-warns-study/ [Accessed 5 Oct. 2019].
  • Wfmh.global. (2019). [online] Available at: https://wfmh.global/wp-content/uploads/WFMH-WMHD-Suicide-Prevention-and-Awareness-Article.pdf [Accessed 5 Oct. 2019].
Angela Kelly
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