The Befrienders track three stages – ideation, intent and behaviour– that could lead to suicide as they try to get people off this path.
THERE are three phases on the dark path to suicide, and it starts with people just thinking about it.
This is the “ideation” stage.
While some people may have intermittent thoughts of suicide, they usually manage to address them.
But those who are unable to deal with this may suffer chronic, unsolved daily conflicts, and just need a non-judgmental voice to listen to them.
In this case, they call the Befrienders.
The 24-hour free service hotline receives numerous calls daily, where 36% of the callers are in the suicidal ideation stage.
Befrienders volunteers, especially those who have been doing this for decades, know how to identify these callers.
“They start by telling us what is troubling them, and from there we identify a few things.
“There are some distinctions used by psychologists and psychiatrists – these are suicide ideation, intent and behaviour,” said Befrienders KL chairman Justin Victor.
Suicide ideation, he said, was where people were at a point where they think they should die.
“They have ideas about wanting to end their life or that their life is worthless,” he said, adding that this was the least intense stage.
The next stage, suicidal intent, is when the caller thinks about actually doing it, and is already thinking up ways to do so.
Then comes the most critical stage: behavioural.
“This is when they are going to do it and have the means or methods to do it,” said Victor.
However, most callers don’t reveal they are suicidal from the get-go – sometimes because they themselves do not know it.
After a short process of identifying themselves by name (more often a pseudonym), age and occupation, they start by telling the Befrienders what is troubling them, according to Victor.
The depth of their pain soon comes to the fore, where they can start by simply saying they have had a bad day.
“We don’t dismiss the actual situation as too small a problem. It can be a simple thing like their cat died, and they want to die too because their life is meaningless.
“For some, this may seem like a small matter, but we (at the Befrienders) never take that line of thinking.
“You never know what the mental processes of the other person is,” said Victor.
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From the way the caller is speaking, the Befriender can sense if there is helplessness or hopelessness, and they can gauge the caller’s general emotional state before determining if that person is suicidal.
The Befrienders have their own protocol when it comes to asking questions to engage such a troubled caller.
“Questions are framed in different ways, which explicitly ask about their suicide ideation – for example, have they come to a point where they feel they cannot go on?
“Some say yes and explain with details, while others really haven’t thought of suicide.
“We have to ask them what is their actual intent – do they have plans and the means to end their life?” said Victor.
The Befriender at this point will ask the caller when they are planning to carry out their suicide to check how imminent the danger is.
The idea is to get the caller to acknowledge this, and this is where the emotional support comes in.
“We ask them what brought them to that particular stage, because our rationale is to release their deepest pain – but we are not doing any psychoanalysis,” said Victor.
The Befrienders practise the philosophy of “active listening” when helping a distressed caller.
“It is unconditional positive regard and a non-judgmental approach, and we don’t direct or tell people what to do.
“Some people ask, what is the point of talking? But we need to look at the suicidal person and the 10 commonalities of suicide,” said Victor.
One of the end stages is constriction, he added, where they are unable to see that they have options.
“They have tunnel vision, like a horse with blinkers on.
“What we do is lift the cloud through a thinking process – not by suggestions, but when they are feeling better and in a resourceful state where they can help themselves,” said Victor.
The most intense part, he revealed, is when callers are on the edge and say they have the means to end their life.
“We will ask them to distance themselves from the means so we can talk more.”
Most callers, he said, feel better after talking to a Befriender, while others may just feel unsure of their aims but may still feel suicidal. Some, sadly, will choose not to talk further.
Before the call ends, the Befrienders will check on the caller’s emotional state and urge them to call back the next time they feel suicidal.
What if the caller is just “seeking attention”?
“We do not know and do not call their bluff.
“Callers are anonymous, and there are some who have tested and ‘pranked’ us to see our response,” said Victor.
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Mental illness or mental health problems?
The above two states are very different. The 2015 National Health and Morbidity Survey by the Health Ministry found that one in three Malaysians suffer from mental health problems.
“Many people jumped out of their skins after hearing this, but (mental health) is understood as a person’s inability to cope with normal daily living, like completing simple tasks over a period of two weeks or more, because of emotional or psychological conditions.
“The persistence of these problems can result in ‘mental illness’. It becomes not only psychological, but physiological – for example, clinical depression – and this has to be diagnosed by a psychologist or psychiatrist,” said Victor.
The Befrienders offers emotional support that gives people an outlet to work through their emotions.
“Our volunteers are not trained to diagnose, but they understand there is more to it than talking about the caller’s emotional state.
“If a caller reveals they have had depression for five years, for example, it is time to see a specialist.
“We will not shut them down but work in the suggestion that they should see a professional,” he added.
Victor also cited schizophrenia and bipolar disorder as examples of mental illness.
“Some callers self-diagnose, so we take note and recommend that they check with a professional to see if they are really suffering from those conditions.
“We have some basic training in understanding the main mental illnesses and know that they need more help than we can give them,” said Victor, who has been a member, volunteer and trainer for over 20 years.
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This is where one might think reaching out to family members is useful, but many callers do not do this.
“Most callers prefer not to confide in family members for various reasons, mainly because they are afraid of being judged or that the other person might not believe that they are suicidal or depressed.
“They find it uncomfortable to reach out to family,” he added.
The Malaysian Mental Health Association website has a directory of services that lists where people can call for free consultations or those that are offered at a minimal fee.
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The Malaysian government is considering decriminalising attempted suicide in a serious attempt to address mental health, especially among youths, by reviving the National Suicide Registry.
Under Section 309 of the Penal Code, a person could be punished to a year imprisonment, a fine or both, for attempting suicide.
While Section 309 remains in the statute books, there would be under-reporting of suicide cases and the registry would not be complete, Deputy Health Minister Dr Lee Boon Chye said in Parliament recently.
He proposed that Sections 305, 306 and 309 of the Penal Code (see below) be reviewed so that the law would not punish a person who needed help.
Dr Lee also said that the 2017 National Health and Morbidity Survey showed that suicidal thoughts among youngsters aged between 13 and 17 rose from 7.9% in 2012 to 10% in 2017.
Police statistics also show that from 2014 to June this year, 356 suicide cases were reported nationwide, he added, while lauding the initiative taken by some insurance companies to extend their coverage to include mental health.
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The Penal Code (PDF)
Abetment of suicide of child or insane person
305. If any person under eighteen years of age, any insane person, any delirious person, any idiot, or any person in a state of intoxication, commits suicide, whoever abets the commission of such suicide shall be punished with death or imprisonment for a term which may extend to twenty years, and shall also be liable to fine.
Abetment of suicide
306. If any person commits suicide, whoever abets the commission of such suicide shall be punished with imprisonment for a term which may extend to ten years, and shall also be liable to fine.
Attempt to commit suicide
309. Whoever attempts to commit suicide, and does any act towards the commission of such offence, shall be punished with imprisonment for a term which may extend to one year or with fine or with both.