RAGE, devastating grief, helplessness and immense guilt are among the gamut of emotions that assail me almost every time I read a death by suicide in newspapers or social media. Isn’t this being over dramatic, one might wonder, coming from a psychiatrist who should have “toughened up” and gotten used to dealing with suicide as one’s bread and butter, so to speak?
According to the World Health Organization (WHO), “every suicide is a tragedy that affects families, communities and entire countries and has long-lasting effects on the people left behind.”
The WHO also estimates that each suicide intimately affects a minimum of six other people. Psychiatrists and other healthcare providers are far from immune in terms of the psychological toll that patient suicide exerts on their personal and professional spheres.
Let me come out as a suicide survivor. Almost a decade ago, I lost my patient to suicide. Words that were meant to comfort and reassure, such as “if you haven’t had a patient die by suicide, that means you haven’t seen enough patients,” hit me like a punch in the gut.
There were endless ruminations about what I could have done to prevent it, but I was too emotionally raw then to address that painful but necessary issue, or to even adequately support the bereaved family.
With time and support, I thought the wound had somehow healed and strove to do whatever it takes not to lose another patient to suicide. I wish I could say that it was the first and last loss, but it wasn’t. And the news of another colleague’s patient’s suicide recently reignited waves of unresolved traumatic grief all over again.
That brings us to the question, can suicide really be prevented, and if yes, whose responsibility is it? The answer is a resounding yes, suicide is preventable – if each and everyone of us took ownership and played our part. Suicide is a complex phenomenon that is multi-factorial: nature and nurture, genetic factors interacting with the environment, with many players at the micro (individual) and macro (societal) levels.
Reams of scientific research papers have been published regarding the risk and protective factors for suicide. More importantly, what can we do to prevent suicides, especially in this era of global connectedness through the World Wide Web and social media, besides important proven strategies like reducing access to lethal means and improving access and quality of healthcare services, specifically mental health services, by beefing up resources such as human capital and funding, as well as reducing the stigma of mental illness in general?
The media plays a powerful role. And this does not refer only to professional media reporting of suicide in the news. It applies to practically anyone who discusses, shares or viralises any content related to suicide, also known as citizen reporters.
This absolutely applies to mental health professionals as well. In the zeal of creating awareness with the well-intentioned desire to reduce stigma and bring the issue of suicide to the forefront of public discourse, advocates may unintentionally increase harm or risk to those most vulnerable to suicide if safe messaging is not practised.
The National Action Alliance for Suicide Prevention in the United States conceptualises safe messaging based on four core principles (http://suicidepreventionmessaging.org/):
1. Safety: Avoid using content that is unsafe or undermines suicide prevention. For example, reporting in the news or sharing on social media explicit and/or graphic details about how a suicide happened can further increase the risk of suicide in people who are already at risk. Be sensitive and respectful to suicide survivors i.e. bereaved family members who are already undergoing tremendous anguish.
2. Guidelines: Use specific existing guidelines or best practices. Our Health Ministry has published guidelines on responsible reporting of suicide-related content in the media based on the WHO guidelines and summarized by Laman Minda, a Malaysian social media mental health advocacy platform by mental health professionals.
3. Strategy: How the message is framed and put across needs to be carefully planned so that suicide prevention messaging is effective.
4. Positive narrative: This is a powerful protective factor that the media can promote in terms of suicide prevention. For example, narrating real life stories about how someone has overcome and recovered from a suicidal crisis offers much needed hope in tangible ways. Sharing resources on where and how to seek help can be life-saving.
For the few but painful patient suicides that I have experienced, there are many more stories of people who were once suicidal and have now recovered, living full and meaningful lives with psychiatric treatment that includes medication and psychological therapy (“talk therapy”), much-needed support from their loved ones as well as conducive working and social environments, plus 24/7 access to crisis helplines like Befrienders (03-79568145) when the need arises.
Let us all do our part in preventing suicide by talking, reporting, sharing, WhatsApping, FBing, Instagramming, Tweeting (you get the drift) safely about suicide, as that can save many precious lives.
DR CHAN LAI FONG
Interim Malaysian Representative of the International Association of Suicide Prevention (IASP)
Associate professor and consultant psychiatrist,
Department of Psychiatry
UKM Medical Centre