COPING WITH SUICIDAL PAIN
SUICIDE PREVENTION IS COMPLEX
“I’m only a short time out of a psychiatric ward after a serious suicide attempt. Those around me, the professionals, the services all know that. Yet somehow, the onus still falls on me to “reach out” or share my struggles.
“But the truth is: I’m exhausted from the constant battle. I’m caring for my wife, permanently disabled after her stroke; trying to support two teenagers; managing my own mental illness; and navigating multiple trauma whilst trying to repair relationships and fighting through isolation.
“Real suicide prevention isn’t awareness days, hashtags, or kind slogans. It’s proactive support. It’s patience for messy recovery. It’s compassion that continues after the spotlight fades. It’s professionals and communities reaching in, not waiting for the most broken people to reach out again and again.” Mark Gallagher, living experience advisor
“SUICIDE IS A COMPLEX PROBLEM THAT CANNOT BE “SOLVED” OR COMPLETELY ELIMINATED USING APPROACHES THAT WORK FOR CONVENTIONAL PROBLEMS.
“SOME STRATEGIES AND SOLUTIONS WILL WORK BETTER THAN OTHERS (...)
“BUT NO SINGLE SOLUTION OR COMBINATION OF SOLUTIONS CAN BE CONSIDERED “RIGHT” OR “CORRECT”
“IF WE WANT TO BE BETTER AT PREVENTING SUICIDE, WE MUST ADOPT A DIFFERENT MINDSET
“WHEREIN WE BECOME COMFORTABLE WITH THESE COMPLEXITIES.”
Individual preferences for coping with suicidal pain
General principles for understanding coping with suicidal pain
DIVERSITY OF COPING Medication
Nature
Talking therapy
Literature
Peer-support
Music
Solitude
Learning
Family
Sports
Friends
Volunteering
Self-management
Activity
PROXIMAL RISK COPING WITH DYSREGULATED PAIN
SURVIVNG THE STORM
How to stay safe when your pain is at its limit?
SIGNS OF SUICIDE CAN BE DIFFICULT TO READ
Bereaved mother, UK: “The idea we have of someone who is at risk is someone who doesn’t leave the house, doesn’t see their mates, spends all their time in their room, doesn’t communicate. He was nothing like that, nothing like that.”
UK male, who has attempted suicide: “It was a beautiful crystal clear November day, and it just came to me - die. (...) I felt euphoric. All the anger was gone from me, all the bitterness, all the hatred, all the fear, because it was all going to end. “All the pain I was causing, all the pain I was feeling, was just going to stop and I was happy that last 8 or 9 hours because I knew it was all ending. (...) “Some people respond in horror when you say what you did. They think you didn’t mean it, that it was a cry for help. No. It was exactly the opposite. I’ve tried everything. I don’t want any help. This is the answer: my death.”
Distress visible
Distress hidden
Difficult to reach
Pushing people away
Aggressive
Limited emotional tools
Talking when drunk / as a joke
No signs of “mental illness”
Uplift in mood
Erratic difficult to interpret acute risk
Loved ones acclimatising to despair
Loved ones not knowing how to intervene
BARRIERS TO PROFESSIONAL SUPPORT
MEN WHO THINK ABOUT SUICIDE 61%
725
PARTICIPANTS
MEN WHO HAVE ATTEMPTED SUICIDE 39%
“How likely would you be to seek professional help for your mental health if you felt you needed it right now?” ‘Not likely’, ‘Somewhat likely’, ‘Very likely.’
“If you answered that you would not be likely what would be some of the barriers to you accessing professional support?”
Looking for common patterns
1. MOTIVATION
2. OPPORTUNITY
3. CAPABILITY
1. NO MOTIVATION:
2a. NO OPPORTUNITY:
2b. NO OPPORTUNITY:
4. NO CAPABILITY:
SUPPORT DOES NOT HELP
SUPPORT IS PHYSICALLY INACCESSIBLE
SUPPORT IS SOCIALLY STIGMATISED
SUPPORT IS PSYCHOLOGICALLY OUT OF REACH
NO MOTIVATION
SUPPORT DOES NOT HELP
1. NO MOTIVATION:
SUPPORT DOES NOT HELP
Negative Experiences Accessing Support
British man, 27, thoughts of suicide in the past week: “The ‘barriers’ are that it doesn’t work. I have tried this nonsense in the past for the best part of a decade and none of it does anything for me. The problem is not with me, it is the so-called “support” offered and how shit it is.”
1. NO MOTIVATION:
SUPPORT DOES NOT HELP
Negative Perceptions of Support as Futile
British man, 51, thoughts of suicide in the past week: “(...) In my case, you can take all the pills you want, talk for as long as you want, but ultimately, it’s all a pointless exercise that doesn’t alleviate the financial yoke constantly tied to your neck. It’s band-aid on a gunshot wound.”
1. NO MOTIVATION:
SUPPORT DOES NOT HELP
Seeking Help will Undermine Autonomy, Agency, and Control / Preference for Self-Reliance and SelfManagement
British man, 31, who has made a suicide attempt in the past year: “Having my agency removed from me and being placed in an institution (...)”
1. NO MOTIVATION:
SUPPORT DOES NOT HELP
Mistrust of Professionals
American man, 19, thoughts of suicide in the past year: “(…) I feel like doctors don’t really care about me or any other person, they just act caring for money or just because their profession requires so (…)”
Australian man, 64, thoughts of suicide in the past week and has made previous attempts: “I have worked in health care for more than 30 years, and have personal knowledge of the attitudes of many HCW [Health Care Workers] to men and boys. [...] Why, when I need help and am at my most vulnerable, would I expose myself to such a demoralising experience.”
NO OPPORTUNITY SUPPORT IS PHYSICALLY INACCESSIBLE
British man, 46, thoughts of suicide in the past year: “I know how bad the NHS waiting lists for therapy are. My past therapy was private and I can’t afford that right now. So, I’ll just muddle through and hope I make it”
NO OPPORTUNITY SUPPORT IS SOCIALLY STIGMATIZED
NO OPPORTUNITY: SUPPORT IS PHYSICALLY INACCESSIBLE
Prohibitive Costs & Inaccessible Services
NO OPPORTUNITY: SUPPORT IS SOCIALLY STIGMATIZED
Harm to Social Value and Relationships
Australian man, 19, thoughts of suicide in the past week, and has made previous attempts: “I would encourage men to go to therapy or get any other help because I would never judge them for that but I could never go myself.”
NO OPPORTUNITY: SUPPORT IS SOCIALLY STIGMATIZED
Seeking Help is Shameful
Singaporean man, 18, thoughts of suicide in the past year: “Cultural norms “brown people dont go to therapy””
NO OPPORTUNITY: SUPPORT IS SOCIALLY STIGMATIZED
Seeking Support Would Impose Problems on Others
American man, 23, thoughts of suicide in the past week, previous attempt in the last year, and has made over 5 previous attempts: “(...) I don’t want anyone to worry about me (...)”
NO CAPABILITY
CAPABILITY CONSTRAINTS: SUPPORT IS PSYCHOLOGICALLY OUT OF REACH
Poverty of Emotional Language and Expression
20, thoughts of suicide in the past week, 3 previous attempts: “Feel like I’m wasting their time as there are people who have it worse”
Swedish man, 20, thoughts of suicide in the past week, over 5 previous attempts: “I don’t like talking and it makes the pain so much worse so i rather bottle it up since that makes me feel a bit better”
CAPABILITY CONSTRAINTS: SUPPORT IS PSYCHOLOGICALLY OUT OF REACH
Poverty of Trust, SelfEsteem, and Energy
Canadian man, 27, thoughts of suicide in the past week: “I can barely brush my teeth, imagine spending 5 fucking hours trying to figure out if my insurance covers some asshole who’s going to tell me to improve my diet and go for a walk (...)”
British man, 23, thoughts of suicide in the past week and previous attempt: “(...) I have severe anxiety problems with going outdoors in public or to new places and I don’t think I could manage it without engaging in extensive self harm to cope with the stress. (...)”
RELUCTANT / POOR HELPSEEKERS
COST
STIGMA MISTRUST
BAD EXPEREINCES
ENERGY POVERTY
EMOTIONAL EXPRESSION POVERTY
LOSS OF AUTONOMY
SEEKING HELP
SERVICES READY
MOTIVATION OPPORTUNITY CAPABILITY
SUICIDAL AMBIGUTIY
“the desire to die” can “coexist with the desire to obtain help.” Roy Baumeister, Social Psychologist and Suicidologist, Suicide as Escape From Self, 1990.
PROTECTIVE FACTORS: Connection as anchors
Fear of afterlife
Fear of passing pain onto others
Suicide is hard to do - Lack of means/energy / privacy
Fear of making pain worse
Living as revenge
Distractions
Mastering pain / will power
Suicide sense-making
Self-actualisation
Pakistani man, 20, who has attempted suicide: “Failure. Being left in a vegetative state and withheld death is the only thing more horrifying to me than the act.”
UK male, 47, who has attempted suicide: “What happens if its even worse when I’m dead…”
UK male, 23, who has attempted suicide in the past week: “Unable to acquire the items to die painlessly and quickly. (...) Apart from that, there is nothing stopping me, just the mental preparation of it. It feels like one final task that requires so much energy to prepare yourself for. ”
American man, 42, suicide attempt in the last year: “My only coping method that has had success is to tell myself, hundreds of times a day when I am having an episode, that all things pass.”
German man, 22, who has attempted suicide in the last year: “Self-Medication with cannabis has helped me to escape a suicidal mindset on more than a few occasions.”
UK male, 21, who has attempted suicide in the past year: “I feel like my skill set and mentality would allow me to help people, which I can’t do if I’m dead.”
SUICIDAL CRISIS ARE TIME LIMITED
“A person can be suicidal on Tuesday (i.e., an activated suicidal mode) and at low risk on Wednesday if the mode is effectively deactivated.” David Rudd, Professor of Psychology and Suicidologist, Fluid Vulnerability Theory, 2006.
SAFETY PLANS
suicidesafetyplan.com/forms
UK male who has attempted suicide: “When you’re in the midst of this stuff, and some fucker comes up to you and says, “This too shall pass.” You want to punch them. “But it’s true. “When we’re in the midst of being caught by the darkness, the darkness of the world closing in, and the only option seems to be to opt out, you cannot see that it’s going to be any different: but this too shall pass, whatever you’re going through will change.... cont’d....>
“The human condition is to make meaning. It’s realising that I’m okay in the world, to understand that life just happens, and you have to meet life, on life’s terms. It’s not that there aren’t ideas of suicide, and ending, but it’s also to know, that this too shall pass, and I’ll come out the other side, and I might not understand what’s happening in this very moment, but there’s always a lesson to be learnt if you listen.”
DISTAL RISK REDUCING PAIN
Exposure to Pain DISTAL RISK Background risk
PSYCHOLOGICAL PAIN TANK
Regulation of Pain
MEET THE NEED REDUCE THE PAIN
WITHOUT RESOLVING UNDERLYING UNMET NEEDS, INTERVENTIONS MAY FAIL TO RESOLVE THE ROOT CAUSE OF A PERSON’S PAIN
TARGETS FOR INTERVENTION. RECOGNISE, RECONNECT, REGULATE
SOCIAL NEEDS
SELF NEEDS
EMOTIONAL NEEDS
SELF NEEDS
EMOTIONAL NEEDS
SOCIAL NEEDS
Individuals at risk Significant others
MEETING NEEDS
Community Services
Society / Culture Research
INDIVIDUALS AT RISK
Learning to understand pain
Acknowledging and talking about problems and emotions
Understanding triggers for stress and distress
Exploring past experiences and their impact
Strengthening selfcompassion
Emotional regulation and control
UNDERSTANDING HOW MEN UNDERSTAND THEIR PAIN UK, male, 50’s, attempted suicide: “You get a diagnosis of depression, simply because that’s the only way society and the medical profession can explain why somebody would want to die. Depressed? I don’t know. Overwhelmed by life? Yes.”
British man, 27, who has attempted suicide: “Emotions are there for a reason. If you bottle it up it is still there and it will take its toll on you, it just will. It’s just not good for you; it’s just not good for you at all. “For me it’s not about being a man or being a woman, it is about being human, and denying people their emotions is denying part of your humanity. That’s what you are doing. You’re not living fully because you’re cutting part of yourself off.”
UK man, attempted suicide: “When I did have therapy, you go back through events and put them all together. I was just bawling my eyes out. It was horrible. [However] If you’ve got root causes that haven’t been dealt with, then they will always be there. (...) if you don’t release things at some point you’re going to explode.”
UK male, 25, who has thoughts of suicide in the past week: “If I had not been able to speak out about what happened to me as a child I would have died from it. I made an active choice to live and chose not to die however this is a very tough choice somedays. “I never intended to tell anyone about what happened to me and I feel there are many males out there unable to speak about traumatic events they have endured.”
CONNECTION
Meaningful Connections:
Family, friends, partners, pets, colleagues, teachers, God
Deeping connections Feeling like you matter Feeling like you contribute
Belonging
CONNECTION: SIGNIFICANT OTHERS
A woman in Australia whose husband died by suicide: “How can somebody stab themselves one night, need 36 stitches, and say they want to be dead, and the next day they ring up and say, he’s fine to go home now? So that - I just couldn’t believe it. I stood on the phone, I said, “He’s what?” “Oh, yes,” he [hospital employee] said, “he’s fine now.”
An Australian man, whose nephew died by suicide, described how his family would be on “suicide watch” for several months: “Suicide watch sort of consisted of sitting in front of the telly, which was outside his bedroom, and just pretending to watch telly … turning the volume down really low, and just being in tune and in check with the different noises that were happening in his bedroom”
Whole family support:
Emotional & psychoeducation support for loved ones
Strengthening family bonds
Making use of family insight
CONNECTION: COMMUNITY
The power of peer support: Broaden ideas of masculinity
Build hope
Create connections Normalise struggles
Selfacceptance
UK man, attempted suicide: “When I spoke to this bloke who has tried to kill himself 9 times, it was one of the most valuable 45 minutes I’ve ever had, because he got it, and I got it, and we could laugh, and he said, “I’ve never been able to laugh about this before.”
STRENGTHENING SERVICES
Improvements to services:
Nonjudgemental listening
Training in gender norms Male sensitive services
actiononmalesuicide.org/professional
Community psychiatric nurse, 11+ years working: “This is such an important part of daily practice and in my experience of over two decades of practice, little attention and training have been provided.”
SOCIETY & CULTURAL CHANGE
UK man, attempted suicide: “When you’re standing on the edge and that’s literally the only way out you can see, then that’s when society has let you down, because people have been allowed to get to the point where that’s their only option.”
UK man, bereaved by his brothers suicide: “I missed out on things I shouldn’t have missed out on. And it wasn’t my brothers fault. It was the world, culture, education’s fault. If I was to blame it on anything, it would be that.”
COLLECTIVE REDUCTION OF SOCIETAL PAIN 1. Exposure to Pain
3. Pain Dysregulation & Distress Entrapment PSYCHOLOGICAL PAIN TANK
2. Regulation of Pain
PUBLIC HEALTH APPROACH
Multilevel Interventions
Housing & Homelessness
Stigma
Poverty
Susbtance Abuse
Work Stress
Financial Instability
Community violence
Access to services
Cross-service Interventions
“suicide prevention is more than just stopping people from dying; it’s also about reducing the social conditions that negatively affect quality of life while strengthening the conditions that promote and foster meaningful lives that are worth living.” (Bryan, 2022)
CULTURAL CHANGE
Challenging cultural norms:
Value men as emotional beings
Celebrate positive masculinity
Richer and more diverse masuline
Acknowledge and challenge gender bias
Value men as relational beings
Acknowledge male pain and societal harms to men Positive male role models
Gamma bias (Seager & Barry, 2019), is the hypothesis that our empathy is partly conditioned by cultural norms.
COMMON SOCIETAL VIEW OF MEN > Men as causing harm > Men as privileged
RARER SOCIETAL VIEW OF MEN > Men as harmed > Men as disadvantaged
Male, 29, thinks about suicide every 3 days, has had thoughts of suicide since he was 13:
Male, 29, thinks about suicide every 3 days, has had thoughts of suicide since he was 13: “The ever increasing feeling of hopelessness as I age and less people giving a shit now that I’m a grown man. At what age does society decide that a boy, worthy of love, care and protection, is now a man and no longer deserving of any?”
GROUP DISCUSSION 1. Challenges: What challenges are men experiencing locally, and where are the biggest gaps in support? 2. Success stories: What have you seen work well? Is there an approach, initiative or success story that others in the room could learn from? 3. Practical takeaways: What have you heard today that you could apply in your own work, organisation or community? 4. Priorities for change: If we want to make a meaningful difference to male suicide locally, what should the priorities for change be?
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TOO MANY MEN ARE DYING
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