Get to know the warning signs
Recognising how you are feeling and when you need to do something about it is important for everyone. It matters even more when you have a mental illness, and may feel very down at times.
Being able to tell whether your feelings are out of the ordinary can be hard to work out sometimes. It helps to know that changes in behaviour can provide a clue.
Suicidal thoughts can come and go, and may seem to come out of nowhere, but they often follow a time of gradual change in how you feel or things you do.
Take a look at this list and note those things which are true for you when you start to have suicidal feelings:
- Spending less time with friends or family than usual.
- Eating less, or more, than usual.
- Sleeping problems – sleeping too little or too much (and still feeling tired).
- Thinking or talking about death as an ‘escape’ or ‘relief’ from feeling distressed.
- Feeling ‘trapped’ – that there is no way out from feelings of distress you have.
- Feeling or acting less enthusiastically than usual about things.
- Being more reckless than usual (for example, spending too much money, driving dangerously).
- Talking about the future in negative or hopeless terms.
- Not looking after yourself (for example, not bothering to wash or to brush teeth).
- Feeling less interested in sex.
- Losing or gaining a lot of weight rapidly.
- Having difficulty concentrating or making decisions.
- Feeling guilty for no reason.
- Having little or no interest in the future.
- Taking unnecessary risks that could cause harm, or feeling like harming yourself.
- Giving away possessions, putting affairs in order, or suddenly seeming inappropriately at peace.
If a number of these statements are true of you, talk to someone about getting help. If more than three apply to you, it is very important that you talk to your doctor or case manager about how you feel.
Stressful events can make life difficult for anyone, especially if you have a mental illness.
For some people, this stress may lead to thoughts of suicide because of how they feel and behave in response to it. Most people who have these thoughts do not actually take their own lives, but cannot see any other way out of the distress they feel.
A change in treatment (such as discharge from psychiatric care) can be a time of higher risk. Knowing that getting stressed can affect you this way means that you can be prepared, and take extra care of yourself if they happen.
Some events can add more stress to your life – have any of these happened in your life recently:
- Changing school or workplace.
- Coming off or changing the dose of antidepressant, antipsychotic, or mood-stabilising medication.
- Moving house or neighbourhood.
- Ending a close relationship.
- Experiencing the death of somebody close.
- Being unemployed for a long time.
- Moving to live alone.
- Being abused or bullied.
- The anniversary of a sad event in your past.
- Difficulties with school or work.
- Coming to terms with sexual issues.
- Going through teenage years, menopause, or other changes in life.
- Being diagnosed with a physical or mental health problem.
- Feeling unable to manage pain.
- Difficulty with the law.
- Financial problems.
- Problems with alcohol or other drugs.
- Having someone close to you die by suicide.
Sometimes positive things can be stressful too, such as the birth of a child, or a new job or relationship.
Everyone who experiences stressful events does not become suicidal of course. However, they can lead to suicidal thoughts and feelings in people who are vulnerable to them, so it is worth taking extra care of yourself when they do happen.
Discover what help is available
If you become suicidal, staying in touch with other people, and with treatment and support services, is really important to help get you through this period.
When someone experiences suicidal thoughts, they often feel isolated and alone, and that nobody understands or can help their distress. That’s why it’s worth the effort to try and get a support network in place beforehand – to help get through a period of suicidal feelings.
This can include clinical care, psychological therapy, and support services in the community. Your own informal network of family, friends, or other people you know who can be supportive, is very important too.
Having good clinical care means receiving the best treatment you can get for your mental illness. This includes a doctor and other mental health workers who help you manage your symptoms, who listen and respond to your concerns, and are supportive and respectful.
For further information on the different kind of clinical treatments available, please see ‘Clinical care’ in the Treatments for mental illness guide.
Talking to a psychiatrist, GP, psychologist or other suitably qualified person about suicidal feelings can help you work out new ways of managing them.
For further information on the different kind of psychological treatments available, please see ‘Psychological treatments’ in the Treatments for mental illness guide.
Getting help is not just about treating symptoms. Mental illness can sometimes affect the way people are able to get on with their everyday lives too. Community support services work to minimise the effect of this psychiatric disability – helping people live as full a life as possible in the community.
For further information on the different kinds of support services available, please see ‘Support services’ in the Treatments for mental illness guide.
Financial and employment support
Minimising stress can play an important part in helping you avoid or overcome suicidal thoughts.
Worries about money are a common source of stress for everyone, so it makes sense to get help to organise this side of your life.
Talk to your Centrelink Advisor or Social Worker, and attempt to build up a good relationship with them. Try to get the best advice and support you can on benefits, community support and help in getting back to work or study.
Who to contact in a crisis
Recognising warning signs can help avoid a crisis situation, but it’s not always possible to do this. It may be that when you feel suicidal you hide these feelings, so that others don’t realise. Sometimes you may not realise how unwell you are. That’s why it’s a good idea to discuss preparing a crisis plan beforehand with a trusted person.
This can be as simple as making a list of essential names and numbers to call if you feel at risk. It could include your local mental health crisis team, a doctor or other health professional, a family member or friend you’ve agreed to contact if you become suicidal, and relevant crisis helplines.
For further information, please see ‘Crisis plan’ in this guide.
Crisis teams – sometimes called Crisis Assessment and Treatment Teams (CATT) or Psychiatric Emergency Teams (PET) – are responsible for helping people when they become extremely unwell. Most Community Mental Health Services have a crisis team available 24-hours-a-day.
Crisis Teams can assess people in their own home or at a clinic, and may arrange treatment, including admission to hospital if appropriate. They should also provide information and support to family and friends.
If you have harmed yourself or attempted suicide, you should be taken to a hospital Emergency Department as soon as possible for medical treatment.
If you refuse to accept help (because you do not understand you are unwell, for example) and are at risk of harming yourself, then you may be treated as an involuntary patient.
It’s possible to be treated involuntarily either in hospital or while living at home. In either case you are legally bound to accept treatment because otherwise your situation would be life-threatening.
For further information, please see ‘Clinical treatments’ in the Treatments for mental illness guide.
How others can help
Here are some tips to show your family and friends in case there are times when you are unwell and feeling suicidal, and may even be refusing support. Having a mental illness can sometimes make it diffcult to accept that you are ill or need support – these tips will help them to help you.
Acknowledge fears or concerns
When people are unwell it is common for them to feel that the whole world is against them. The first step in encouraging someone to accept help is to acknowledge their fears, even though you may not feel the causes are real.
Offer to assist in seeking help
When people are suicidal they can often feel helpless and unmotivated. Offering to assist someone in seeking help – by making an appointment or driving them there, for example – can make it seem that little bit easier to get help.
Encourage open communication
People who are unwell or distressed often put on a brave face to cover how they feel. That is why it is important to reassure them that you value their honesty and that you will listen and not judge them, regardless of how they are feeling.
Emphasise that having suicidal thoughts is not something to be ashamed of; is something experienced by many people with a mental illness, and that talking about it does not increase the risk of someone taking their own life.
Maintain a sense of hope
When people feel suicidal it can seem like nothing will ever feel good again. Telling them that they will feel better if they take steps towards getting help may be just the incentive they need to move forward.
Remind them that even small steps matter, and they are already making a good start by talking to you.
Find support for yourself
When people feel suicidal, it is naturally very distressing for family and friends too. All too often, everyone ends up feeling guilty or inadequate for no reason.
At times like this it is especially helpful to contact a carer support organisation. Contact the SANE Help Centre on 1800 18 SANE (7263) for referral to a group in your area.
For further information, please see the Guide for Families.
Tackle negative thoughts
When people are depressed they may even see ‘getting support’ as something negative.
Encourage the person to turn these thoughts around and see support in a positive way. Reassure them that this period of feeling bad will pass, and they can get through it.
Here are some common examples of things people say and helpful responses to them:
- ‘Nothing makes me feel better anymore.’
When someone feels depressed it can be difficult for them to remember a time when they enjoyed life. Remind them of times when they did feel better.
- ‘No one would care if I died.’
It is common for people to feel alone and abandoned when they are down. Try to think of ways to remind the person that you and others care for them, and that it is important that they like and look after themselves too.
- ‘If I ask for help I am weak.’
Remind the person that asking for help is a sign of courage and not weakness. Admitting that they want support to get better shows the kind of strength and perseverance that it takes to get through hard times.
- ‘Nothing will change how I feel.’
When people are depressed or distressed, things often seem hopeless and beyond help. Encourage the person to realise that things can be done to help them feel better, and that you will support them in any way you can to do this.
Discourage guilt after a suicide attempt
It’s common for people to feel guilt after a suicide attempt, especially about the distress they have caused others. Encourage the person to put these feelings aside as much as possible, and focus on the present and the future.
Making a crisis plan means preparing for what to do if you feel suicidal in the future, in order to stay safe and get the help you need.
Discuss with your doctor or other health professional what to put in your crisis plan. The content will vary from person to person, but may include the following suggestions.
If you feel immediately suicidal
1. Tell someone how you feel (for example, family member, friend, school counsellor). Ask them to stay with you until you get help. Being with someone, even over the phone, increases your safety or;
2. Contact a medical professional and tell them it is an emergency:
- call your local hospital and ask to speak to the Mental Health Team
- go to your GP or hospital emergency department – wait there until you see a doctor
- call 000 – the police or ambulance may be able to take you to hospital
- call your doctor, psychiatrist, psychologist, or other mental health worker or;
3. Call an appropriate crisis Helpline – see ‘Make a list of who to contact in a crisis’ below.
Other actions you can take
With help you should start to feel better and be able to keep yourself safe. Until then, there are things you can do to relieve some of the distress and reduce the desire to end your life:
- Try to distance your thoughts and actions – say to yourself, ‘I will wait 24 hours before I do anything’, so that you can seek help during that period.
- Put any items you could use to hurt yourself out of reach, or ask a trusted friend to look after them.
- Do something that has brought you even a small amount of pleasure before – such as taking a walk, listening to music, taking a hot bath, watching a funny movie, reading or some slow deep breathing.
- Get together with others – even if you don’t feel like it, to prevent isolation.
- Reduce drug or alcohol use – these can make it more likely that you may harm yourself, by making you more impulsive and increasing feelings of depression.
- Write about your thoughts and feelings – remember especially to write about the things in your life that you value and appreciate, no matter how small they may seem to you.
Make a list of who to contact in a crisis
Put together a list of essential names and numbers which you can call if you feel at risk, for example:
- Mental health service
- Local hospital
- Lifeline: 13 11 14
- Suicide Callback Service: 1300 659 467
- Emergency Services: 000
- SANE Help Centre: 1800 18 SANE (7263)
See also How to help in a crisis for what helps when you or someone else experiences a mental health crisis.
Take action for yourself
There are lots of things you can do for yourself to help fight suicidal thoughts, so that they don’t become overwhelming.
Plan a lifestyle that suits you
Once you’ve found out what support is available, the next step is to develop a positive lifestyle which gives a rhythm to your life.
Making a routine helps you feel balanced and purposeful. It makes it easier to get out of bed in the morning if you have an idea of what you will you be doing – if there is something to look forward to and achieve that means something to you, however small.
Enjoying what you do can give you the motivation to keep going and to develop a sense of purpose and of identity. Here are some suggestions to bear in mind when preparing your plan.
Stay in touch
Feeling isolated and lonely can encourage suicidal thoughts. When making your plan, include doing things that are sociable and maintain contact with others. As well as seeing health professionals and going along to a day program, being a member of a club, group or church can also be helpful in this way.
Take it easy at first
Getting back into a routine after a period of feeling suicidal can be a challenge. That’s why it’s a good idea to avoid over-doing it at first. Try to be active and do things you enjoy, but not so much that you feel stressed.
Find interests that suit you
The stress of doing things you don’t enjoy can make it harder to deal with suicidal thoughts. The more you enjoy something, the easier it will be to stick to a good routine.
Spend some time thinking about what really interests you, or trying out something you always meant to do – it can make a big difference to how you feel about your life.
Build on what you know
Recognise and build on things you know you enjoy. For example, if you like tennis, find out at your local Tennis Club or Neighbourhood House if they have any classes. Apart from being a lot of fun and good for your health, it’s also a useful place to meet people with similar interests.
Vary your activities
Don’t allow new activities to get boring – remember variety is the spice of life. For example, have some things you do on your own (like yoga or listening to music) and others you do with other people (like walking in the park or going to see a movie).
Doing something to help others, such as volunteer work, can also be a useful way of distracting yourself from feeling down.
Be kind to yourself
Try to be a friend to yourself. Remind yourself about positive things about yourself, however small. Don’t fall into the trap of being critical of yourself all the time, and going over and over negative things in your mind. If you catch yourself doing this, make an effort to stop, and try to think of positive things in your life.
It’s not always easy to settle into a routine, especially if you are not used to it. Treat your plan as ‘a servant not a master’, and revise it depending on your changing needs.
A weekly plan
Here is an example of a weekly plan. Remember it is meant to be a guide not a rigid routine – simple things like phoning someone or watching a favourite TV show are important parts of your life too.
- Swim at local pool.
- Do washing.
- Appointment at clinic.
- Computer class at day program.
- Volunteer work at op shop.
- Take neighbour’s dog for walk in park.
- Walk to local market.
- Yoga class.
- Library to change books.
- Meet friend for coffee.
- Supermarket shopping.
- Meet friend to see movie.
- Tidy house.
- Free concert in park.
Plan to avoid stress
Stress is the name for a feeling of anxiety that can threaten to overwhelm us. While a little stress may be stimulating, too much can make it hard to cope and lead to suicidal thoughts in people with a mental illness.
Planning your life to avoid too much stress is a good way to reduce the chance of having suicidal thoughts in the future. If you do experience suicidal thoughts, you will be in a better position to deal with them.
Here are some tips to reduce stress.
Work out which situations make you feel stressed and try to avoid them. For example, if you tend to feel stressed or lonely at the weekend, you could plan to do more relaxing or sociable things on these days. While you can’t always choose when you have company, making sure you are active is a good way to help take your mind off any feelings of stress or isolation.
Take time out
Making time to do things you enjoy is a great stress-reliever. There are lots of enjoyable things to do that are free or cost little, and do not harm your health. For example, go to your local cinema on the day when tickets are half-price (often Mondays).
Talk it over
Talk over how you feel with a family member, friend or health professional – you’ll be surprised at how things can seem a lot easier after you’ve spoken about them. Remember that listening to how others feel is important too.
Take one step at a time
Trying to do lots of things at once is likely to make anyone become stressed. It is even more likely to cause problems if you have a mental illness and have periods when you feel suicidal. That’s why it’s important to learn to prioritise – doing just a few things in a day that you really need or want to do.
Find new ways to deal with old problems
When you’re stressed or feeling depressed, it can seem like there’s no way out from problems that trouble you.
Try to take a fresh approach which helps you look at the problem from a different angle. For example, if there is conflict with someone you share a house with – instead of going through the same arguments with them, talk to someone who isn’t involved about how to deal with the situation, such as a case manager or worker at a day program.
Being physically active and eating healthy food can make a big difference to how you feel. There’s now scientific evidence that exercise really does make you feel better mentally as well as physically. This doesn’t mean going to the gym every day – simply going for a walk a few times a week can make a big difference.
Try to include plenty of fruit, vegetables and other healthy, low-fat food in your diet too. Eating fresh food is not only good for you, it tastes better and makes cooking and shopping more enjoyable and satisfying as well.
For further information, please see the Healthy Living guide for more suggestions and information about this topic.
Get your life back on track
Recovering from a suicide attempt is a major challenge, but one you can use to help yourself.
With support, a plan and good advice, you can learn to move on from an attempt, better able to deal with any suicidal feelings you may have in the future.
Advice from the experts
Here are some tips from people who have ‘been there’ for getting back on track after a suicide attempt.
Get to know your warning signs
Before someone becomes suicidal they often experience a similar pattern of symptoms – warning signs that form their so-called ‘relapse signature’.
If you or others can learn to recognise these signs, you can tell your doctor so that action can be taken before things get any worse. Think about what your warning signs are – make a list and discuss them with your health worker, family or friends.
Reflect on small achievements
While it may be tempting to feel that you have taken a turn for the worse, take time to look at how far you have come. For example, you may have felt like taking an overdose again, but instead gave the pill-bottle to your sister to keep safe, and called your case manager to talk about how you were feeling.
The period after a suicide attempt can be a good time to re-examine your goals. For example, you may have stopped taking medication because of side-effects, leading to a relapse and the suicide attempt. A better goal would be to talk to your doctor about tackling the side-effects, possibly lowering the dose slowly under supervision.
Don’t blame yourself
Feeling guilty about a suicide attempt is common and understandable because of the distress caused to family and friends. However, dwelling on feelings of blame and guilt doesn’t help anyone. It’s in everyone’s interest to dismiss these feelings, and focus on the present and the future.
For some people, certain stressful situations and how they feel about and respond to them can bring on suicidal feelings. Think about whether this is true for you, and what you can do to avoid these situations, or to deal with them in a more positive way that does not make you feel stressed.
Develop an action plan
Coming through a suicide attempt gives you a vivid lesson in what needs to happen if you become suicidal again. Use this lesson to draw up a crisis plan of what you and others need to do in this situation, in order for you to be safe and get help.
Some people find it helpful to sign a ‘contract’ with a health professional, family member or friend, agreeing to contact that person if they feel suicidal again. The other person could also write down what action they agree to take in order to get help.
When someone you know dies by suicide
It is always hard to come to terms with the death of someone you care about, especially if they have died by suicide.
Learn from others who have been in this situation about what can help, especially if you have experienced suicidal feelings yourself in the past.
There are no simple solutions to getting over the pain caused by the death of someone you care about. It is important to grieve, though, so that you can leave the person at peace and move on with your own life.
Here is some advice on what helps, from others who have been in this situation.
Make your farewell
When someone dies from a physical illness, such as cancer, we usually get a chance to say goodbye properly. This isn’t the case when someone dies by suicide, making it harder to deal with. Finding your own way to make a farewell – to say goodbye – can help you come to terms with all the emotions you are likely to be feeling.
It can bring some peace to organise a private or public commemoration for you to farewell the person who has died. It could be a formal funeral in which you make a speech, or an informal goodbye, for example by spending some time at their favourite place or writing them a letter. Do what feels most comfortable for you, giving you the peace of mind that comes with knowing you have said what needs to be said.
Accept the need to grieve
Don’t try to ‘be brave’ and bottle up your feelings. Express how you feel and find out about the grieving process, by borrowing a book from your local library for example. Talk about how you are feeling with someone you trust.
Draw on the support you need
Getting the help and support you need is a big help in dealing with grief. Talk to your GP, case manager or other support worker about where you can get this support, including referral to a grief counsellor. Carers Associations, bereavement support groups and churches can all be helpful. Simply being around understanding friends and family can make you feel better too.
These services may also be helpful:
13 11 14
- National Missing Persons Coordination Centre
1800 000 634
- Australian Centre for Grief and Bereavement
1300 664 786
- Salvation Army Hope Line
1300 467 354
- SANE Help Centre
1800 18 SANE (7263)
Don’t let anyone tell you how to feel
Grief and loss are topics on which people have lots of opinions. However, only you know how you feel, and what feels comfortable for you to do.
Everyone grieves differently depending on the circumstances around the suicide, what kind of a relationship they had with the person who died, and their own personality. Don’t be afraid to acknowledge what you are feeling, regardless of what it is, and that it may take time to go through the grieving process.
Be aware too that people often want to be helpful, but are unsure how to behave. Should they try to cheer you up? Should they talk about the person who has died? Let people know how they can be most helpful to you – they’ll appreciate it, and it will make things more relaxed for you.
You may find it useful to have some phrases ready for when people ask questions – words that you are comfortable saying, and which can acknowledge that the person died by suicide and the impact this has had on you and others. Equally, if you do not feel ready to talk about it, then do not feel obliged to do so.
Take time out
Dealing with the suicide of someone you know is bound to be stressful. Acknowledge this and make time to treat yourself. Going for a walk, having a massage, going away for a weekend, or simply spending a whole day reading or listening to music can help relax you, so that you are better able to cope.
Become aware of your stress-triggers
Being aware of what causes you to feel stressed is important for everyone. Get to know what events are likely to be difficult so that you can prepare yourself.
For example, anniversaries of birthdays, weddings or deaths can sometimes be hard to deal with. Think about what you can do to make these less stressful – for example, by making sure you are away from places that have painful memories, or that you are around understanding people.