Suicide

Sadly, our industry has seen a steady increase of suicides year over year. The pressures of hospitality – the long hours, the “keep smiling, it’s showtime” mantras, the abuse of alcohol and drugs as a coping mechanism, harassment from co-workers, bosses and customers, and the financial stress, create a perfect storm for suicidal tendencies. Most of us know someone who has attempted suicide, if not succeeded. World-wide attention to this crisis was caught by the sudden and tragic death of Anthony Bourdain, but veterans of this business know it has been rampant for a long time. This is one of the major factors to the building of this foundation – to get us talking, to get us help and to get us healthy.

If you are feeling suicidal:
- Call 9-1-1 immediately! 
- Reach out to a friend and stay in contact in person or on the phone.

If you think someone is contemplating suicide:
- Call 9-1-1 immediately! 
- Find your friend and try to stay in touch with them.

Symptoms

The underlying motivation for suicide is the feeling of utter despair and hopelessness; how a person reaches that point is what varies from individual to individual. Some symptoms include:

  • Depression or sadness all the time
  • suicide prevention experts say untreated depression is the #1 cause of suicide
  • Talking or writing about death or suicide
  • Writing a will, taking extreme steps to prepare for your death
  • Giving away possessions, especially those the person holds most dear
  • Dramatic mood changes
  • Change in eating or sleeping habits
  • Loss of interest in activities – especially those previously enjoyable
  • Poor work or school performance
  • Abuse of drugs or alcohol
  • Change in personality
  • Withdrawal from family members and friends
  • Feelings of hopelessness, being helpless or feeling trapped
  • Demonstrating strong feelings of anger or rage
  • Acting impulsively or recklessly
  • Feeling excessive shame and/or guilt

Increased Risk Factors

In addition, suicidal people who are demonstrating warning signs are at greater risk if there has been:

  • A recent loss of a close relationship
  • A change (or anticipated change) in work circumstances
  • A change in health, diagnosis of disease or chronic pain or illness
  • Increased misuse of alcohol or other drugs
  • A history of suicidal behaviour or history of suicide attempts in the family
  • Current major depression

Protective Factors

Protective factors are skills, strengths, or resources that help people deal more effectively with stressful events and reduces the likelihood of attempting or completing suicide. They enhance resilience and help to counterbalance risk factors.

Strengthening these factors should be an ongoing process to increase resiliency during the presence of increased risk factors or other stressful situations.

Protective factors include:

  • Coping skills
  • Resiliency
  • Reasons for living
  • Being married or a parent
  • External/Environmental Protective Factors
  • Strong relationships, particularly with family members
  • Opportunities to participate in and contribute to school and/or community projects/activities.
  • A reasonably safe and stable environment
  • Restricted access to lethal means
  • Responsibilities/duties to others
  • Pets
  • Attitudes, values, and norms prohibiting suicide e.g. strong beliefs about the meaning and value of life
  • Social skills e.g. decision-making, problem-solving, and anger management
  • Good health and access to mental and physical health care
  • Cultural, religious or spiritual beliefs that discourage suicide
  • A healthy fear of risky behaviors and pain
  • Hope for the future; optimism
  • Sobriety
  • Medical compliance and a sense of the importance of health and wellness
  • Impulse control
  • Strong sense of self-worth or self-esteem
  • Sense of personal control or determination
  • Access to a variety of clinical interventions and support for help seeking

Self-Care Strategies

Story of Emotion

This skill is used to understand what kind of emotion one is feeling:

  1. Prompting event
  2. Interpretation of the event
  3. Body sensations
  4. Body language
  5. Action urge
  6. Action
  7. Emotion name, based on previous items on list

Opposite Action

This skill is used when you have an unjustified emotion, one that doesn’t belong in the situation at hand. You use it by doing the opposite of your urges in the moment. It is a tool to bring you out of an unwanted or unjustified emotion by replacing it with the emotion that is opposite.


Problem Solving

This is used to solve a problem when your emotion is justified. It is used in combination with other skills.


P.L.E.A.S.E.

This skill concerns ineffective health habits can make one more vulnerable to emotion mind. The idea here is healthy body = healthy emotions:

PhysicaL illness 
Eating 
Avoid mood-altering drugs 
Sleep 
Exercise

A.C.C.E.P.T.S.

This is a skill used to distract oneself temporarily from unpleasant emotions:

Activities - Use positive activities that you enjoy 
Contribute - Help out other or your community 
Comparisons - Compare yourself either to people that are less fortunate or how you used to be when you were in a worse state
Emotions - Cause yourself to feel something different by provoking your sense of humour or happiness with corresponding activities 
Push away - Put your situation on the back-burner for a while. Put something else temporarily first in your mind 
Thoughts - Force your mind to think about something else 
Sensation - Do something that has an intense feeling other than what you are feeling, like a cold shower or a spicy candy

Self-Soothe

This is a skill in which one behaves in a comforting, nurturing, kind, and gentle way to oneself. You use it by doing something that is soothing to you. It is used in moments of distress or agitation.


I.M.P.R.O.V.E.

This skill is used in moments of distress to help one relax:

Imagery - Imagine relaxing scenes, things going well, or other things that please you 
Meaning - Find some purpose or meaning in what you are feeling 
Prayer - Either pray to whomever you worship, or, if not religious, chant a personal mantra 
Relaxation - Relax your muscles, breathe deeply 
One thing in the moment - Keep yourself in the present 
Vacation - Take a break from it all for a short period of time 
Encouragement - Reassure yourself. Tell yourself you can make it through this!

How To Help - Someone Who is Having Suicidal Thoughts

Know the signs

Suicide has a deeper stigma surrounding it than other mental health issues. Someone might be willing to share that they’ve been struggling with depression or anxiety but hold back about thoughts of suicide because they are afraid of how someone might react. Therefore, it is important to recognize the signs that someone might be planning their suicide.

Some of these signs include:

  • a preoccupation with death
  • getting their affairs in order
  • saying goodbye
  • withdrawing from others

Most of the signs connect around hopelessness. The person feels hopeless about their life or aspects of their life and doesn’t see their situation improving, therefore suicide begins to feel like an option.

If someone does share with you that they’re having suicidal thoughts, try to remain calm and be attentive as they tell you what they’re experiencing. Any talk of suicide should be taken very seriously, be calm and do not to freak out, as it may prevent them from talking to you in the future.


 

Start the conversation

If a person does not come right out and tell you, but you suspect they may be suicidal, you need to start the conversation. It is important to be direct in your questioning. Use the word suicide. By asking about it you are letting them know that they can open up to you. For someone who has been experiencing thoughts of suicide but has been too scared to tell someone, having you broach the subject first can be a huge relief.


 

Evaluate the danger

After someone tells you they have been thinking about suicide, you need to evaluate how urgent the situation is. Does the person have a plan? How detailed is that plan? Do they have a where and when? How lethal is their means? Is it available?

Have they attempted suicide before? Another myth is that someone who has attempted will not attempt suicide again. Someone who has previously attempted is actually more at risk of suicide.

Ask them what kind of support(s) they have in their life right now (besides you). Are they seeing a counsellor? Are there other people in their life who they feel comfortable talking to?


 

Recognize you can’t do everything

Sometimes when you feel you’ve done all you can to help someone who is having suicidal thoughts, you can still end up feeling a sense of emptiness – that you’ve done everything you can and your friend is still struggling.

Understand that you can only do your best, and even when loved ones and health professionals have done all they can to intervene, a person may still choose suicide. It is important that you don’t blame yourself for anything that happens.

Do everything you can, but understand that you can’t do everything.

Helping a friend or loved one through a crisis of this measure can be exhausting. Make sure you’re practising your own self-care, and ensuring you have supports in place so that your mental health does not suffer. You have to take care of yourself to be able to help someone else.

How to Help - Someone Who is Experiencing a Traumatic or Suicidal Episode

If someone is imminently in danger of taking their own life:

  • Call 9-1-1
  • Take them to the Emergency Room
  • Contact a Crisis Centre and connect them with other resources

Listen actively to why they want to die. Let them to speak openly and honestly and remain calm as they do so. Allow them to say their reasons out loud because this can release emotions and help give them a different perspective about their reasons for dying. By listening to their reasons you can also begin to identify reasons for choosing life.

Listen to what they have to say before you respond. Don’t talk over them in your eagerness to change their mind. By listening attentively you can convey to the person that you care and are empathetic to their situation.

Gently challenge their reasons for considering suicide and push them towards a more hopeful place. Exude hope in your response through your tone of voice, your gentle approach, and your genuine belief that things can get better. Even if no obvious reasons emerge, the fact that they’re speaking to you at all is an indication that they are unsure about this decision.

Be insistent in your response but not too insistent, as they may cause them to feel resentment and shut down. Paraphrase what they have said in combination with the reasons for choosing life.

It might sound like, “Right now suicide appears to be the answer because…. But I also hear you saying that there is a part of you that wants to live because of…

Offer to help them make a safety plan. This includes things like, removing any easily available means, staying with them through the night, making sure they stay sober and helping them come up with coping methods. One coping method is to create a list of phone numbers of loved ones who they can call when they’re struggling, as well as a list of contact information for crisis lines and emergency services, in case they can’t get a hold of loved ones.

Also talk about long term plans, like connecting them with a counsellor or making an appointment if they already have a one.

Check in on your friend frequently in the next days, weeks and months. Mental health issues are not fixed quickly, and checking in on them shows that you care and that you’re available if they want to talk again.


 

Here are a few important things to ask when consoling someone:

 

“What do you need right now?”

Try to meet a basic need (water, food, comfort) and or facilitate connections to what is needed (ride home, calling a support person).

 

“Can I call someone for you?”

Providing a phone, siting with the person if they want while they make a call to a support person.

 

“Who and what has helped you before during a difficult time?”

A supporting family member or neighbour, a counsellor, a spiritual care provider or self-care strategies.

 

“This is a very difficult time for you, can I help in anyway?”

This validates the person’s experience and opens the door to offer access to resources such as basic needs, security and comfort, connecting the person to help resources if needed.

 

“Would it be helpful for you to talk about what has happened?”

Taking the time to listen, and be present with the person allowing them to share as much as they want. Validating and normalizing their feelings can contribute to feeling heard, understood, and supported. Respecting the person’s privacy if they chose not to talk and op up about their feelings is very important.

 

“________ can be a traumatic, shocking and overwhelming. Your reaction and feelings are quite normal and understandable”

This recognizes the range of reactions and emotions that are understandable.

 

“When you are ready, you may want to talk to someone who can help you sort through this experience and all the feelings and thoughts you are having.”

Letting people know that is it okay to reach out for help. Sometimes, knowing that they are not alone, and that there are help resources who work with people every day who have gone through what they have, can make a difference.

How to Help - Someone Who's Had a Traumatic or Suicidal Experience

The best way to help someone process a traumatic or suicidal experience is:

  • Recognize, acknowledge, and allow he survivor to feel what they are feeling
  • Respect the person’s needs, allowing the survivor to be in control of the pace of the conversation and the decisions to be made
  • Let the person know you are there to listen IF they need to talk
  • Let the person share their experience only IF they want to
  • Don’t force them to disclose or share anything they’re not ready to
  • Offer support and information about who else they could talk to such as people they have turned to for support in the past, resources in the community that help people are bereaved by suicide

Statistics

In Canada, suicide accounts for 24% of all deaths among those age 15-24 and 16% those age 16-44.

Suicide is the second leading cause of death for Canadians between the ages of 10 and 24.

73% of hospital admissions for attempted suicide are for people between the ages of 15 and 44.

Men commit suicide at a rate 4x higher than that of women. Women, however, make 3-4x more suicide attempts than men do and women are hospitalized in general hospitals for attempted suicide at 1.5x the rate of men.

Studies indicate that there is a significant correlation between a history of sexual abuse and the lifetime number of suicide attempts, and this correlation is twice as strong for women as for men.

Late July and August have the highest suicide rate out of all the months of the year. Some studies suggest that the increase is due to seasonal change and that this period is one that often brings about changes in personal situations. It is suggested that all these elements of change – whether dramatic changes are happening in someone’s life, or if they feel defeated because their situation seems never to change – can lead people to suicide.

Approximately 25% of people who complete suicide will have been in contact with a mental health agency in the year before their death. Specific mental disorders that have been linked to suicide include depression, substance abuse, schizophrenia, and personality disorders. Substance abuse and personality disorders are more common among men, and depression is more common among women.

High suicide risk is particularly associated with acute episodes of illness, recent hospital discharge (almost 50% commit suicide before their first follow-up appointment), or recent contact with a mental health service.

People with mood disorders are at a particularly high risk of suicide. Studies indicate that more than 90% of suicide victims have a diagnosable psychiatric illness, and suicide is the most common cause of death for people with schizophrenia.

Both major depression and bipolar disorder account for 15-25% of all deaths by suicide in patients with severe mood disorders.

Worldwide, many of those (65-95%) who complete suicide have a mental disorder. Indeed, the risk of suicide is up to 15x higher among people who have a mental disorder compared to those who do not. Although mental disorders are considered a risk factor in Asian countries as well, there is evidence that they are not as frequent in suicidal behaviours, but that impulsiveness plays a greater role.

Co-occurring conditions are particularly common among those who complete suicide. For example, depression combined with alcohol abuse occurs in about two-thirds of those who complete suicide.

Therefore, the presence of a mental and/or substance use disorder is one of the strongest predictors of suicide, making the identification and treatment of psychiatric and substance use disorders an important prevention strategy.

Resources

Crisis Services Canada
Canadian Association for Suicide Prevention
Canadian Mental Health Association
Find A Therapist

Regional Support Services

British Columbia

BC Crisis Centre & Mental Health Support 
310-6789
1-800-SUICIDE (784-2443)
#211

Crisis Intervention & Suicide Prevention Centre of BC
Vancouver Coastal Region: 604-872-3311
Sunshine Coast/Sea-to-Sky: 1-866-661-3311

Vancouver Island Crisis Society 
1-888-494-3888 

North Island Crisis & Counselling Centre Society 
250-949-6033

Reduced Cost Counselling Options in Vancouver

Alberta

Mental Health Helpline
1-877-303-2642

Distress Centre 
1-403-266-HELP 

Distress Line of Southwestern Alberta 
(Serving Chinook health region)
1-888-787-2880 
(403) 327-7905 

The Support Network Distress Line 
(Serving Edmonton and surrounding areas) 
1-800-232-7288

Manitoba

Reason to Live 
1-877-435-7170

Klinic Crisis Line 
1-888-322-3019 

Crisis Stabilization Unit 
(Serving Winnipeg Health Region) 
204-940-3633 

Mental Health Crisis Service 
(Serving Central Regional Health Authority) 
1-888-310-4593

Saskatchewan

Saskatoon Crisis Intervention Service 
306-933-6200 

Saskatchewan HealthLine 
#811 or 1-877-800-0002 
306-766-6600

Ontario

Connex Ontario 
1-866-531-2600 

Good2Talk 
1-866-925-5454  

District and Crisis Ontario Helplines 
416-486-2242 

Gerstein Crisis Centre 
416-929-5200 

Mental Health Crisis Line 
Ottawa: 613-722-6914 
Greater Ottawa area: 1-866-996-0991

New Brunswick

Chimo Helpline 
1-800-667-5005 
Fredericton area: 450-HELP (4357)