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I wish I had known

by | Sep 9, 2020

Banner that reads 'Suicide Prevention Month' in white on purple background with textured green paint splatters in background

I wish I had known that the last time I saw my brother would be the last time.

Losing a loved one to suicide is one of the most devastating fatalities one can experience. Whether spouse or sibling, child or colleague, the helplessness, shock and anguish of survivors that follows may be because it seems suicide can be preventable or foreseen.

The World Health Organization estimates that approximately one million people die by suicide each year – about one person every 40 seconds. How can you determine if someone you know is considering ending their lives? Are there definitive signs to look for? Hopelessness appears to be a strong predictor of suicide. A suicidal person may also lose interest in day-to-day activities, neglect their appearance, and show big changes in eating, hygiene or sleeping habits.

Carol (left) posing for the camera with Young Adult Council Member Victoria (right)

Carol (left) posing for the camera with Young Adult Council (YAC) member Victoria (right) (Photo by Daniel Fast)

I noticed some of these changes with my brother. I wish I had known how to engage him. Sitting in a psychiatrist’s office for an appointment my brother asked me to attend with him, I trusted the ‘professional’ to help him navigate through this crisis. After 45 minutes of an outpouring of his despair, my brother was offered nothing but a shrug. What’s next when the psychiatrist literally says, “I got nothin’.”? After the session, my brother stormed off without speaking to me. That was the last time I ever saw him.

Public institutions and therapists are not necessarily set up to help everyone that needs help or in the way that they need it. Whether they are not accessible, affordable, or culturally responsive, the mental health care system is difficult to navigate at the best of times. There is still some stigma and shame attached to disclosing suicidal thoughts, and fear in communities of colour, already grappling with complex-PTSD, that calling law enforcement will end in death.

Dr. Bjug Borgundvaag, Emergency Physician and Researcher, Mount Sinai Hospital, spoke of a 17-year old student who tried to handle her crisis in a reasonable way: she called the distress line at the urging of authority figures, and ended up in a psychiatric assessment room with a guard at the door. By the time she had finished an hours-long ordeal in the emergency room, she was left with nothing but a distrust of the system and an oath never to reveal her distress again. Dr. Borgundvaag admits,

“there’s often a mismatch between the care that’s available to people and what they’re expecting…often all we can do is either make a referral to somebody for the patient to follow up…or admit them.”

Dr. Bjug speaking at a podium in front of a crowd of people at the World Mental Health Day panel event, 2019

Dr. Bjug Borgundvaag speaking at the World Mental Health panel event in 2019 (Photo by Daniel Fast) 

I wish I had known about community resources and culturally responsive supports to suggest to my brother, a young Black man. Suicide is often misunderstood and deemed to be selfish, when in fact, it is often seen as a means for the sufferer to free loved ones of a perceived burden. Kind and thoughtful people, like my brother, entertain thoughts of themselves as weights, and long to release others as much as themselves.

Whether suffering situational or clinical depression, most suicidal people are deeply conflicted about ending their own lives. They just want the pain to stop once and for all, especially if their mental illness crises are cyclical and chronic.

Laughter is therapeutic and can diffuse tensions and cut through despair. I once explained to a girlfriend in crisis, “you’ll never get to shag Idris if you peg it…” The belly laugh that exploded from her was enough to let me know that her state had effectively shifted.

When faced with someone in pain, I’ve learned that it’s best to gently ask questions using an outcome frame. For instance, “what’s bothering you?” or “what’s wrong?” can often install emotions instead of processing them. Asking instead, “what do you want?”, or “how do you want to change things?” allows the conversation to be directed toward a solution. “How can I best support you right now?” is a great way to ease into a difficult conversation.

"Whether they are not accessible, affordable, or culturally responsive, the mental health care system is difficult to navigate at the best of times." quote on light green rough paper textured background

Then listen – with compassion, without judgment, without anxiety, without the need to respond. Try to stay neutral without imposing your values or expectations. Hear between the spaces and pay attention to body language. Finding the right words is not as important as showing your concern and being present.

Stella’s Place has created a space where youth feel safe to talk about suicide. Our unique and effective approach to suicidality is a listen first, act second, non-reactive response, and supports a sense of control, choice and autonomy in a peer-driven environment.

Dr. Borgundvaag asserts that “peer support is an effective way to positively impact people with mental health and addiction problems”. He has been a driving force behind the new Pathways to Peers initiative at Mount Sinai hospital that has just supported their 100th patient in partnership with Stella’s Place.

Pictured here is Mahalia, the RBC Pathway To Peer Worker, Dr. Organek and Dr. Prucnal of Mount Sinai Hospital’s Emergency Department team who referred the 100th patient.

Pathway to Peers program celebrates its 100th patient.

Peer support and co-design are the alchemy that are helping to remove the taboo from directly addressing suicide, providing trauma-informed responses for our participants. While there are no guarantees while navigating these precarious circumstances, these approaches and resources have proven effective. Suicide is prevalent and preventable.

I wish I had known.

Carol Clarke is a staff member at Stella’s Place working passionately to raise funds for young adult mental health. 70% of the young people accessing our services screen at high risk of suicide. To support our life-saving programs, please make a donation below: