Last Breath Left

Last Breath Left

Suicide is an issue that hits close to home for too many New Zealanders. We have the highest suicide rate in the OECD, and an estimated 3% of our population considers suicide every year. Debate rages in the media about how we should approach and treat this problem. Critic's Zane Pocock delves into the major issues surrounding suicide, its treatment in the media, and what it is like for those that have considered taking that final breath.

WARNING: The following article contains graphic discussion of suicide

Pressing Issues

One of the greatest challenges when writing any article about suicide is the risk of “copy-cat suicide” — the imitation of suicide as reported in the media. Reports of both celebrity and non-celebrity suicides have long led to increased suicide rates, which peak three days after the first media coverage. You would think then, that the Ministry of Health would have some solid media guidelines for reporting on suicide. They don’t.

In 1990, New Zealand produced a set of guidelines that were so thorough and well researched that they were used as a model by other countries. When these guidelines were produced, Ministry officials were strongly advised to enlist the support of the media before promulgating them. This advice was not followed, and guidelines were imposed on the media with minimal consultation.

A decade of bickering within the media about the validity and worth of the guidelines ensued. Ultimately, Peter Dunne, the Minister responsible for suicide prevention, convened a round-table meeting in 2011. Minimal research was reviewed and too many media representatives were present, resulting in an incredibly watered-down version of the earlier guidelines. The extensive research on the subject was summarised in a one-line statement: "In some circumstances, reports of an individual's suicide, particularly the suicide of someone newsworthy, might increase the risk of further suicides among some people." The meeting was intended to provide a way for the media to make a positive contribution to suicide prevention policy. Instead, it was the beginning of an ongoing conflict between media representatives and the mental health research community. The problem is that media coverage does increase the risk of suicides. Regardless of your views on media censorship, when it comes to people killing themselves "might" just doesn't cut it.
Concerns about the treatment of suicide in the media are echoed by those that have had to deal with suicidal thoughts: According to Vivian (not her real name), "one of the reasons that it took me so long to seek help was due to the way that mental illness is presented in the media. Self harm and feeling suicidal is particularly stigmatised as something that is engaged in if you associate with being emo. Revealing to my doctor that I was self-harming was the hardest thing I have ever had to do, and subsequently discussing it in counselling and with my family was extremely difficult … Self-harm has been a means of staving off suicidal thought. For me it is an extremely secretive act, and there are very few people in my life who know, or even suspect, that this is something that I engage in." The last thing that people like Vivian need is the sensationalisation of their suffering by uneducated and irresponsible media outlets.

Fleur, who has also been suicidal, strongly agrees that "it's vital that the media never report how someone kills themselves. If I happen to read how someone [does it], even when I am happy, I am like 'Oh no … I will remember that next time I am suicidal … I wish I never read that.” However, she thinks it's, "a travesty that they do not report just how huge the problem is in NZ. If people knew how much of a problem it was, they would be less likely to mock and dismiss someone's suicidality as 'all talk', 'just to get attention’, or 'they will learn mature ways of dealing with life's problems in time'. People have to sit up and take notice and ask themselves why we as a society are failing all these people so badly that they can't bear to live anymore."

The Wrong Side of the Road 

An estimated 90% of suicides in New Zealand can be linked to significant mental health problems such as depression, alcohol and drug dependencies, anxiety disorder, and psychotic disorders. Other factors which are known to exacerbate the risks of suicidal behaviours include adverse life events, such as relationship breakdowns, problems with the law, and bereavement; exposure to childhood adversity, including sexual abuse; and dysfunctional family circumstances. Professor David Fergusson of the University of Otago Psychological Medicine Department in Christchurch says that, “as with many psycho-social conditions, the development of suicidal behaviours is the end point of an accumulation of adversity.”

Talking to Vivian, it is clear just how complicated and difficult it is to climb out of the depths of despair: "I felt ashamed that I had reached a point in my life where I felt so out of control, and felt like I was alone in the way I felt," she says. "For me, feeling suicidal is a result of feeling hopeless and guilty. I hid these feelings and this diagnosis from my friends and family, and it was only after counselling with Student Health staff and [taking] a number of different anti-depressants and neuroleptics that I felt I could open up to those close to me about what I was experiencing."

Left Behind

The forgotten victims of suicide are the family and friends that are left behind. Karl (not his real name), whose brother committed suicide, feels that the mental health system has let a lot of people down. His brother's problems "started from a young age. He had really bad schizophrenia. For years doctors just ignored it, let it be and it caused all sorts of problems. He got expelled from several schools for doing crazy things he couldn't help." He got into trouble with the police for doing things like running down the streets naked (no, he wasn't involved with KONY2012), and freaking out at people he thought were following him. Eventually he had no choice but to leave school for a mental health institution. For a few years he bounced around a number of institutions, "before he finally escaped and committed suicide” says Karl. One reason for such failures of the mental health system is the shortage of beds in appropriate institutions. Instead of receiving a place at a suitable facility, mental health patients are often chucked into prison cells, or made to stay at home, where anything could happen. This is a risk to them and to others. Karl suggests that more must be done to, "identify mental issues at an earlier age, to try to help them as they are growing up. Suicide prevention should go hand-in-hand with mental health patients, as they are very interconnected. The system needs to provide more support to people outside of institutions, to make sure they can stay and take part in society a lot more effectively."

"I think people get suicidal mainly because they are scared," Karl says. “I think my brother committed suicide because he was scared of his mind, scared that it would never stop. In his case I believe he thought it was the only way to get away from the demons inside his head."

Suicide can even be driven by "absolutely nothing.” For Fleur, sometimes “everything in life is going perfectly, and then suddenly you're in this huge depression and you want to kill yourself. And if you're in that space, anything can bring it on." Anything from waking up on the wrong side of the bed to someone laughing at you can trigger a depressive episode. Without depression, everyone is mentally equipped to deal with much bigger issues than these. But “once you've tried [suicide] once, it's something you have to deal with your whole life. The triggers change and can be bigger or smaller depending on what space you're in at the time," Fleur says.

With a Little Help From My Friends

The best way to help those who are suicidal is to be alert for signs of mental illness or suicidal thoughts, to assist the person in seeking advice for their problems, and to support the person throughout the process of receiving treatment. Professor Fergusson advises that "in cases where the person is a family member, it may be useful to consider ensuring that fire-arms are securely stored and that potentially hazardous medication is not left lying around." Probably good advise at the best of times really.

According to Vivian, the worst thing to say to someone who is feeling suicidal is “cheer up”, or “we don’t really have it that bad”. Such responses were greatly upsetting, because they made her feel like she didn’t have the right to be depressed. She had an okay upbringing, attended a good school, does well academically, and has a good job. “What could really be so bad about that, right? I took me a long time and a lot of convincing from my counsellor that each person experiences life differently and it is the small 'cumulative traumas' that can lead to depression."

If someone tells you that they are suicidal or self-harming, it is important to listen. Contrary to popular belief, talking to someone about suicide does not increase the likelihood of a suicide attempt. In fact, having someone to talk to about these feelings, or knowing that there is someone out there who cares, can make a huge difference. "It is really important not to tell someone that they are overreacting or that suicide is selfish," Vivian says. "It just adds to the guilt that the person is feeling. In my experience, considering suicide feels like a means to end not only the pain, sadness and hopelessness that I am feeling, but to also remove the burden that I feel like I am placing on my friends and family."

The best things you can say to a suicidal person are “I care about you and want to help” and “What can I do to help you?” This must be done with no strings attached. You must be genuine. Taking action to “help” the affected person without their knowledge is unhelpful. You need to work with people to get them the help they need. "Try to get them professional help and offer to go along to the appointment... don't fob them off and expect the professional to do everything," Fleur says.

For students, the take-home message is simple: get your friend to Student Health. They have the best services in place to help students with these issues. It is also important to take care of yourself if you are dealing with a friend who is suicidal. It is a huge responsibility, and can affect you greatly if you don't have good support. It is okay to ask for help, whether it be from other friends, professionals such as Student Health, or emergency psychiatric services. And never promise someone who confesses that they are suicidal that you won't tell anyone. You will never be able to keep that promise.

Sigh of Relief

Vivian has days when she feels great, and days when she can’t see the point in living. "I think the most important advice I have for others is not to be so quick to judge. If someone tells you that they are feeling down, are missing classes or even something more extreme like self harming or feeling suicidal, take the time to find out why that person is feeling like that. Even a small gesture may make the difference between a person acting on their suicidal thoughts or not."
This article first appeared in Issue 14, 2012.
Posted 8:39pm Sunday 3rd June 2012 by Zane Pocock.