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Suicide in Australia
Suicide means not only a tragic loss of a life but also great sadness and soul-searching amongst the family and friends of the person who has died and the community at large. Around 2,000 Australians die from suicide every year. For every person who dies in this way, there are a least another 30 people who attempt suicide. The risk is highest for men between 25 and 34 and those over 80. Although suicidal behaviour is more common in women than men, more men die by suicide. The rate for single people is twice that of married people. There is no doubt that depression is a major cause of suicidal behaviour. Of those who do kill themselves, many have experienced major depression, bipolar disorder or schizophrenia.

Suicidal behaviour and mental illness
Around 20% of Australians are affected by some form of mental disorder at some time in their lives. Approximately 6% are affected by major depression, and 3% by illnesses such as bipolar disorder and schizophrenia. Suicide is the main cause of premature death among people with mental illness. Over 10% of those affected die by suicide within the {rst 10 years of diagnosis. Yet many of those who have attempted or seriously thought about ending their lives will – with effective treatment, social support and time – go on to live full and productive lives.

Why people feel suicidal
For people with a mental illness, the pain and distress of the illness can be so great they may feel an overwhelming desire to end their life. People recently discharged from psychiatric care are at higher risk of suicide, as are those recently bereaved by the suicide of someone they know. An attempt may be an early sign of a mental illness developing, and it is important to get help from a doctor if this is the case. For someone with a mental illness, the following may contribute to suicidal behaviour: –

Depressive illness
The majority of people with mental illness who die by suicide will have experienced major depression or bipolar disorder.

Psychotic symptoms
Some may attempt suicide because they are confused or even directed by their hallucinations, or to bring relief from untreated psychotic symptoms.

Borderline personality disorder (BPD)
People with Borderline Personality Disorder may harm themselves or behave in a suicidal way. Some find self-harm brings temporary relief from their distress. This is a symptom of the disorder and requires treatment from a health professional.

Drugs and alcohol
The abuse of drugs (such as marijuana, heroin or amphetamines) and alcohol is closely related to suicidal behaviour.

Why people self-harm
Self-harm means any behaviour which involves the deliberate causing of pain or injury to oneself. This includes cutting, burning or hitting oneself, overdosing on prescription or illegal drugs, or even binge-eating or starvation, abuse of drugs or alcohol or repeatedly putting oneself in dangerous situations.

Self-harm is usually a response to distress – often the distress associated with mental illness. In the short-term, some people find that it provides temporary relief from the psychological distress they are experiencing. While people who self-harm do not necessarily mean to kill themselves, it often becomes a compulsive and dangerous activity, and requires careful professional help.

The majority of people who give warning signs about their suicidal intentions.
Some of these warning signs are:

•    expression of hopelessness or helplessness

•    written or spoken notice of intention, saying goodbye

•    dramatic change in personality or appearance

•    irrational, bizarre behaviour

•    overwhelming sense of guilt or shame

•    changed eating or sleeping patterns

•    severe drop in school or work performance

•    giving away possessions or putting affairs in order

•    lack of interest in the future

•    self-harming actions, such as overdoses, which can be lethal to the person.

If you think a friend or relative is seriously thinking of harming or killing themselves, do not worry silently, but discuss your concerns openly and non-judgmentally with the person and other relevant professionals such as a doctor or school counsellor, for example.If you or someone you know is seriously at risk, it is important to have a crisis service phone number such as Lifeline (13 11 14) or local hospital handy in case of an urgent need for help.

After a suicide attempt
Understanding what has happened can help the person involve, family and friends to cope with a suicide attempt. A doctor should know about mental health professionals in the area who can provide education and support. They can also advise how to reduce the risk of further attempts, helping the person to work out strategies to manage suicidal thoughts.

It is important to realise that the responsibility for an action ultimately lies with the person who carries it out. It can be hard to accept, but if everything possible has been done and someone is still seriously determined to end their life, it can be dif{cult to prevent this happening. Family and friends should receive information and support to get through this very distressing and confusing time

After self-harm
For the person involved, it is helpful for them to understand why they harm themselves, as well as ways of dealing with thoughts of self-harm. A doctor can advise about mental health professionals in your area who can help family and friends as well as the person who is self-harming.

Treatment and further prevention
An important step in preventing suicide is to treat the mental disorders that lead to self-harm or suicidal thoughts and actions. Currently the most effective ways to treat mental illness are medication and psychosocial rehabilitation programs. Talk about these with the professionals concerned and try to encourage a treatment plan which involves cooperation between the professionals, family and person concerned.

How do I find out more?
It is important to ask your doctor about any concerns you have.
SANE Australia also produces a range of easy-to-read publications and multimedia resources on mental illness.
For more information see other SANE Factsheets and:

- The SANE Guide to Staying Alive
Provides practical step-by-step hints and advice for consumers, carers and health professionals on dealing with suicidal thoughts and behaviour.

To order visit the SANE Bookshop at www.sane.org or call 1800 18 SANE (7263)

SANE Australia . . . Suicidal behaviour and self-harm

©SANE Factsheet 14a and 14b  This Factsheet may be freely downloaded, copied and distributed on condition no change is made to the contents. SANE Australia is not responsible for any actions taken as a result of information or opinions contained in the Factsheet. SANE Australia is a business name of Schizophrenia Australia Foundation.