According to The Hong Kong Jockey Club Centre for Suicide Research and Prevention, suicide is the leading cause of death in 15- to 24-year-olds in Hong Kong. Earlier this year, there was a worrying number of teenagers who took their own lives, and several more who tried.
Some people may worry that talking about suicide encourages people to harm themselves, or puts dangerous ideas into young people's minds. However, organisations such as the Samaritans and The American Association of Suicidology encourage young people to be open about their feelings and to talk about "taboo" subjects, explaining that this offers an opportunity for them to get help.
A 2003 University of Hong Kong study supports the idea that it can be helpful to talk. The study found that less than 10 per cent of teenagers experiencing depression or suicidality had received any counselling or professional support, and suggested that earlier help and intervention would lead to a lower rate of tragedy.
I first spoke to Shiva*, 18, when she was in a heightened state of anxiety.
"I don't want to be here," she said. Shiva felt it was safe to express her feelings in the counselling setting, but if she were to have said this to a friend, it may have been quite scary or confronting for the friend to hear. Sometimes shocking information can be met with humour or misinterpretation, for example, not hearing the distress, or not wanting to; or anger, such as berating a person for having "dark" thoughts.
The important thing for Shiva was that she wanted to be heard; this also signalled the fact she also wanted to be helped. When it comes to suicidal thoughts and feelings, it's important to get the right kind of help.
Often, it will take a team of people to provide this help, and so if a friend confides in you about suicidal thoughts, don't panic and think you have to solve the issue all by yourself. There are plenty of people who can help, and we'll look at some of these options here.
Practical steps to getting help
1 Safety first
Talking about feelings, and feeling heard, is always important. However, for someone who is feeling suicidal, their immediate safety has to come first. If you, or someone you know, feels unable at any moment to keep themselves safe, it is vital that you get help.
If you are feeling in danger of hurting yourself (or you're with someone who is), you can call 999. If someone you know has contacted you and alarmed you with something they've said, such as saying they are about to do something that may end their lives, you can call someone in their family or someone you know is near them.
If you call 999, explain that you believe someone is suicidal. They will immediately send an emergency unit, and a negotiator and/or doctor as required.
Calling a helpline like the Samaritans or the Suicide Prevention Services (see below) is a great option for support in moments where a person is not feeling safe. If you're with someone who is feeling suicidal, perhaps you could dial the number for them, and pass them the phone, while sitting with them to provide comfort.
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It's important for family or trusted adults to make sure the suicidal person is not able to harm themselves. This might mean hiding away pills or anything that can be used as weapons, and definitely means staying with the person and keeping an eye on them to make sure they are not able to hurt themselves. It might mean visiting a hospital and requesting immediate psychiatric support, such as observation or drug intervention.
2 Thoughts and plans, and understanding the difference
It may surprise you to learn that having thoughts of harming yourself are not uncommon. However, there is a big difference between fleeting thoughts, and having repetitive, strong thoughts that lead to planning or acting on them.
In Shiva's case, she was past having just thoughts about suicide, and had moved into planning how to end her life. Clearly, she was at a stage where talking therapy alone was not going to keep her safe. Until she could ensure her safety, the priority was to ensure her physical well-being. For this to happen, Shiva came up with a "Safety Plan" for what actions she would take when she felt particularly concerned about her ability to keep herself safe.
3 Making a Safety Plan
Shiva wrote out her Safety Plan when she was feeling calm, and put it in her wallet, as a reminder of what to do if and when she needed it.
Her first step was to recognise warning signs of when she might be starting to feel at risk. Noticing changes in her mood, thoughts and behaviour, and noting down what these had been the last time she felt suicidal, helped her feel more prepared if these came up again.
Next, Shiva planned who to call if she felt suicidal. She had tried calling the Samaritans before, and knew it was a helpful resource for her, so she made sure she had their number stored in her phone. She then made a shortlist of people she knew were good at keeping her calm, and wrote their names down, too.
Shiva also thought about how she could help herself in those moments of high distress, and decided she needed distractions to take her mind off it. She added watching funny videos on YouTube and painting to her list. Other options might be exercise or simple breathing exercises. (The upcoming article on Anxiety will have more on this. )
Writing down her reasons for living was very helpful for Shiva. She wrote down her dreams for the future, and what friends and family meant to her.
Finally, Shiva wrote down how she could make sure her surroundings were safe. This included being in a place with other people, and away from any means by which she could harm herself. Often, this meant being around others or staying at home with her family.
4 Seeking professional, longer-term help
So far we've mainly looked at what to do in extreme situations, when a person is actively suicidal. It's important to understand that while a person can successfully bring themselves down from such a distressed state, they may well experience a similar episode at another time.
To address this, it's important that anyone who experiences suicidal thoughts or feelings reaches out for professional support. This can be through a talking therapy (with a counsellor, a psychologist) or with the help of drug intervention. Often, a combination can be very helpful.
The first step to sourcing support is to talk to your GP. It may be helpful to write down some of the thoughts, feelings and behaviours you have been experiencing, so that you can help your doctor understand what you need. If you don't feel your doctor is giving you enough support or directing you to good resources, please seek a second opinion. It's great that you reach out for support, but unfortunately it can sometimes take more than one try to get what you need.
5 Things to bear in mind with drug interventions
It may be helpful to understand that drug interventions such as anti-depressants can take time to take effect. Sometimes it takes trial and error to find the correct dosage and drug combination. As our brains are all different, it can take some tweaking to get this right.
Be patient if you've been prescribed anti-depressants, as they can take some time to take effect, but also don't be scared to tell your doctor if you feel something isn't right, or isn't helping the way you'd hoped. It is a collaborative process to get the best intervention.
Shiva's doctor put her on one type of anti-depressant, then changed her onto another after a few months, when both she and the doctor decided the first was not helping enough. Shiva took several weeks to notice a change, but saw some great results with the second prescription.
For friends and family of someone experiencing suicidal thoughts
It can be incredibly upsetting to learn that someone you care about is suffering so much they are thinking of taking their own lives. It can be a shock, too. Even people who seem to have "perfect" lives can become depressed and have dangerous thoughts, and hearing about this can be really distressing.
Remember, it is not your job alone to make things better, but know that you are an important person in your friend's life if they have chosen to confide in you.
If possible, stay calm if your friend shares some challenging information about themselves. Although this can be very difficult, presenting a calm front is very helpful and can be reassuring to someone who is in a highly distressed state. Helping someone who is actively suicidal to de-escalate and calm down is incredibly powerful, and can turn a scary situation into something that seems more manageable.
It is very rare for a person to feel suicidal 100 per cent of the time, with no respite. Thoughts and feelings of harming themselves, as with all thoughts, can come and go.
While the most important step is safety, it can be reassuring to know that there will be moments when a suicidal person is much more rational and able to consider their feelings, and can engage in ways to help themselves. In these moments, you may want to support them as they take the steps above, to ensure they get the right support they need to get better.
* name has been changed
If you believe you, or someone you know, is at immediate risk, call 999. An emergency unit will be deployed immediately.
- The Samaritans (2896 0000/samaritans.org.hk) is a 24-hour hotline for people who are in emotional distress and want to talk to someone. Calls are confidential, and can be made in English, Cantonese or Mandarin.
- Suicide Prevention Services (2382 0000/www.sps.org.hk)provides a 24-hour hotline and a Youth Link number. They promote "Caring, Listening, Acceptance and Companionship".
- Youth Link 2382 0777
- Further options for support can be found on HKJC Centre for Suicide Research and Prevention's page: www.depression.edu.hk