Self-harm and Suicide Prevention

Ministry of Health Vanuatu

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September 2019 Newsletter

The 10th September 2019 is World Suicide Prevention Day.

Suicide

According to the World Health Organisation, a person dies from suicide somewhere in the world every 40 seconds. This means that nearly 800,000 people die from suicide across the world every year.

Guyana has the highest suicide rate of any country in the world, with 44.2 per 100,000, but South Korea (28.9 per 100,000), Sri Lanka (28.8 per 100,000), Lithuania (28.2 per 100,000) and many other countries are also way too high.

76% of those who died by suicide were male, a ratio of more than 3:1. This ratio stays pretty steady for nearly all age groups, with men always dying from suicide at a higher rate than women.

The most alarming thing about these findings is that our suicide rate is increasing, an extra 2.1 per 100,000 in only five years. The percentage of suicide has also grown in the US by 24% from 1999 to 2014, after consistently declining the 14 years before that, according to data from the Centers for Disease Control and Prevention (Aboujaoude, 2016).

In the US it’s meant to be increasing due to the increasing use of antidepressants and their link to suicidality, to inadequate health insurance coverage, to the global financial crisis, increased divorce rates, higher opiate drug use, and the internet (Aboujaoude, 2016).

While it is good that many of these factors do not apply in Vanuatu, there are still over 11% of suicide-related search results on the internet that are pro-suicide (Recupero, Harms & Noble 2008). This means that we need to provide as much material as possible that shows people that suicide is neither the best option or the only option.

Warning signs of suicide:

After a completed suicide you will hear everyone in the family and community ask the same questions – Why? Why did this happen? What could I have done differently so that they would still be alive right now? These are natural questions that we all go through so that we can try to make sense of something that doesn’t make any sense. It is part of the grieving process, and these questions do become less frequent and less intrusive over time.

While some suicides may occur without any warning signs, most people who are suicidal do give warnings, such as:

  • Increasing their alcohol and/or other drug use
  • Taking unnecessary risks and impulsivity, e.g. suddenly overtaking in a dangerous situation
  • Threatening suicide and/or expressing a strong wish to die
  • Exhibiting rage and/or anger often in helpless situation
  • Talking about wanting to die or to kill oneself
  • Being preoccupied with the topic of death
  • Researching ways to die
  • Buying equipment such as guns, weights, ropes or sharp instrument
  • Talking about feeling hopeless or having no reason to live
  • Talking about being a burden to others
  • Acting anxious or agitated often; behaving recklessly
  • Isolating or withdrawing oneself
  • Displaying mood swings frequently
  • Telling loved one’s goodbye
  • Setting one’s affairs in order
  • Giving things away, such as prized possessions
  • Referring to death via poetry, writings and drawings
  • Exhibiting dramatic changes in personality or appearance
  • Big changes in eating or sleeping patterns
  • Noticeable decline in performance at school, work or other important activities

Why do people attempt suicide?

There are many reasons why people die from suicide but untreated Depression is probably the main reason.

Here are some other reasons why people attempt suicide:

  • Untreated mental illness
  • The death of someone close
  • Loss of a child or custody of children
  • Divorce or major relationship issue
  • A serious illness
  • Chronic pain
  • Intense emotional pain
  • Bullying, both adults and children
  • Trauma from and an accident, rape, assault or loss from a disaster
  • Feeling trapped in a stressful situation
  • Inability to deal with humiliation
  • A serious business or financial loss
  • A terminal illness
  • Inability to deal with failure
  • Alcohol or drug abuse and confusion or false perceptions
  • Inability to accept growing old
  • Need to protect someone else
  • Not be a burden on someone
  • Not feeling connected or a sense of belonging with others
  • To punish someone or make a point
  • Uncontrollable impulses
  • Major legal problem/embarrassment or financial burden
  • Loss of hope
  • Copycat suicides where someone has died by suicide and someone else follows the example. This usually happens where people have looked up to the person who died and/or identified strongly with them.

If you are noticing some warning signs of suicide in someone who has also had some big changes or significant events happen to them recently, it is important to check in with them, ask how they are doing, and get additional support if they are having suicidal thoughts and are considering different ways that they could end their life. Treatment with a mental health professional can make a big difference and reduce the risk of someone dying from suicide.

What is Self-Harm and How Can We Manage It?

The terms self-harm and suicide often get grouped together but actually mean two different things. Both are infliction of pain and sometimes people who begin with selfharm may later commit suicide. Generally, people who selfharm do not wish to kill themselves; whereas suicide is a way of ending life.

Self-harm is the intentional and deliberate hurting of oneself

Most common methods of self-harm include:

  • Cutting
  • Burning
  • Picking at the skin
  • Pulling hair
  • Biting
  • Deliberately hitting one’s body so that they feel pain or break something, e.g. punching a wall
  • Placing oneself in some danger where they won’t die but are likely to sustain an injury
  • and other less common ways

Indicators of self-harm

If you are worried that someone you care about is self-harming, there are signs that you should look out for:

  • Many cuts/burns on the wrists, arms, legs, back, hips, or stomach
  • Wearing baggy or loose clothes (e.g., wearing hoodies or long sleeves during hot days to conceal the wounds)
  • Always making excuses for having cuts, marks or wounds on the body
  • Finding razors, scissors, lighters or knives in strange places e.g. in a bag or under the bed
  • Spending long periods locked in a bedroom or bathroom
  • Isolation and avoiding social situations more frequently than they used to

Why do people self-harm?

  • To escape their feelings
  • To cope with life stressors
  • To express their pain
  • To punish themselves for some perceived guilt
  • Some people lack self-esteem and feel that they deserve what they are doing to themselves because of something they did wrong or something someone said to them that proves to them that they are “bad” or “no good”
  • To feel “high”. When we get hurt, endorphins are often released into the blood stream, resulting in a mild feeling of euphoria. Self-harming behaviours can become addictive and habit forming.
  • To feel more in control. Some people have said that “when they hurt themselves” they reconnect with their body or are able to focus on the pain they feel from the harm they have caused rather than feeling disconnected or overwhelmed from all the other issues in their lives.

So in a strange kind of way, many people who self-harm are doing this as a means to try and cope with their distress rather than commit suicide. Self-harm is a response to painful emotions and experiences. Unfortunately, self-harm is dangerous, and can lead to people accidentally killing themselves. It may also become a habitual way of coping with any stress, and is therefore considered a maladaptive or unhelpful coping strategy. Consuming too much alcohol, or junk food, or even social media are other maladaptive coping strategies.

Adaptive or helpful coping strategies for dealing with distress include:

  • Socialising with friends
  • Problem solving
  • Journalling about the issue and writing about how you feel and what you could do
  • Talking to someone that you trust and that can help you to solve your problem
  • Being proactive about addressing the issue if there is something that you can do to fix it
  • Any form of exercise or movement, including walking, running, dancing, yoga, sports
  • Getting outside into nature and connecting with the world around you
  • Listening to music
  • Eating healthy foods including lots of fruit and vegetables
  • Learning relaxation techniques including deep breathing, progressive muscle relaxation, imagery or visualisation exercises and meditation
  • Pray or go to church or discuss how you are feeling with a spiritual or community leader
  • Seek professional help from the mental health team in your province.
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What Else Can You Do?

Self-harm and suicide are complex matters and sometimes difficult to talk about. Some people believe that if you raise your concerns with someone you may increase the risk that they will attempt suicide. This is not the case.

If you become aware that someone is self-harming be gentle and ask them what is leading to them self-harming and if there is anything else is wrong in their life at the moment? Don’t criticise or judge them as they may not be willing to talk to you about the topic again. Be patient and ask how you can help. Suggest a referral or a meeting with other people that the person accepts.

If you think that someone is suicidal ask them what they are planning to do. Sometimes it’s just a passing idea so stay connected and talk gently and suggest seeking help. If they are just talking about suicide it means they have some ideas but may not act.

But if they begin to become specific and say how they will hurt themselves or they have bought a rope or poison or have other means (a definite plan) then they are very vulnerable so its best that they seek professional help from a doctor, paramedic, mental health nurse or psychologist.

Remove the means if you can and be honest with them about seeking help. Try not leave them completely alone if they are not able to say to you that they they feel safe and want to live.  It is very difficult to watch someone all the time and people who are feeling suicidal can be impulsive.

Suicidal thoughts and feelings do change and can get better. It is mostly about trying to keep people feeling safe and as calm as possible until the thoughts and feelings pass and they begin to feel different.

If you are struggling with the fear of death, the following book can help:
  • “Staring at the Sun: Overcoming the Terror of Death” by Irvin D. Yalom.
If you are struggling with lack of meaning and purpose in life, the following books can help:
  • “Finding Flow: The Psychology of Engagement with Everyday Life” by Mihaly Csikszentmihalyi
  • “Finding Your Element: How to Discover Your Talents and Passions and Transform Your Life” by Ken Robinson and Lou Aronica
  • “Man’s Search for Meaning” by Viktor Frankl.
If you are being held back by fear and self-doubt, the following books can help:
  • “The Confidence Gap” by Russ Harris and Steven Hayes
  • “Feel the Fear, And Do It Anyway” by Susan Jeffers
  • “Daring Greatly: How the Courage to Be Vulnerable Transforms the Way We Live, Love, Parent, and Lead” by Brené Brown
If you are struggling with grief, the following books can help:
  • “Why Bad Things Happen to Good People” by Harold S. Kushner
  • “On Grief and Grieving: Finding the Meaning of Grief Through the Five Stages of Loss” by Elisabeth Kübler-Ross and David Kessler

DISCLAIMER: If the content of this newsletter upsets you or you are struggling with suicidal thoughts or self-harm and would like more information, advice or support, please contact:

Mind Care Clinic

Psychiatry Department

VILA CENTRAL HOSPITAL

SHEFA

VOIP: 1081

Namalinuan Clinic

LENAKEL HOSPITAL

TAFEA

Mental Health Clinic

NORTHERN PROVINCIAL HOSPITAL

SANMA

Mental Health Clinic

NORSUP HOSPITAL

MALAMPA

Mental Health Clinic

LOLOWAI HOSPITAL

PENAMA

Published by Dr Damon Ashworth

I am a Clinical Psychologist. I completed a Doctoral degree in Clinical Psychology at Monash University and a Bachelor of Behavioural Sciences and a Bachelor of Psychological Sciences with Honours at La Trobe University. I am passionate about the field of Psychology, and apply the latest empirical findings to best help individuals meet their psychological and emotional needs.

4 thoughts on “Self-harm and Suicide Prevention

  1. That’s one of the more insightful pieces I’ve seen written about these subjects especially self harm but it’s missing a couple of common reasons. I hope you don’t mind if I add to this useful resource.

    People who self harm either do it to feel the pain concentrating on physical pain is easier than feeling emotional pain. If the reason for self harm is pain than the ice cube method of holding/squeezing an ice cube in the hand is a non damaging way to have pain to concentrate on.
    The other main reason is to see the blood, this is not about pain, it’s about release and I’m afraid I don’t have any techniques like the ice cube for this.
    There are also some people who self harm before committing suicide, practicing the techniques/desensitising themselves to the pain for the final act which they do want to lead to their death This is practice reason is something professionals now tragically ignore.
    Finally self harmers do not like pain. I’ll say that again self harmers do not like pain but physical pain is easier to deal with than emotional pain SO to all A&E/ER professionals out there stitching up the arm/leg/stomach of the person for the upteenth time YES you DO have to USE LOCAL ANAESTHETIC.
    Healing from the addiction of self harm and failed suicides can and does occur BEST prevention is communication Speak to the person Your worried about if your sure something’s wrong don’t take “I’m fine for an answer” My life was saved many years ago because a friend refused to believe the “I’m fine” answer I gave.

    Liked by 1 person

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