A cry for help


The word suicide, if uttered, is not to be taken lightly. It could be someone’s cry for help, and if the signs are recognised early, lives could be saved.

Suicide is preventable and suicide prevention should be everyone’s business, says Dr Abdul Kadir Abu Bakar, president of Malaysian Psychiatric Association. “We need to work together to bring down the suicide rate in Malaysia.”

suicide

Authorities who can co-operate towards this goal include the Health Ministry, Education Ministry, Ministry of Women, Family and Community Development, as well as frontliners like police and firemen.

“Various parties (family members, colleagues, students) can also play a role in preventing suicide by understanding the symptoms of depression,” says Dr Abdul Kadir.

“Be a good listener when someone expresses hopelessness. Get help for the troubled person, either by helping him cope or solve his problems.”

He gives examples of how society can make a difference in preventing suicides and saving lives.

A young girl feels suicidal after her boyfriend had dumped her. Her friends rallied around and encouraged her to call a helpline. When that failed, they brought her to see a psychiatrist.

Or a middle aged man with chronic pain gets on the roof. He threatened to jump off the building. A friend saw him and persuaded him to abort his suicidal plan. Not only that, the friend brought him to seek help at the hospital.

The Health Ministry, Dr Abdul Kadir said, has a suicide prevention plan which is being reviewed for approval. “Among the strategies are improving advocacy among relevant agencies; public education; working with the media; improving data collection; improving early treatment and detection; and promoting awareness of mental health in schools,” he says.

Reasons for suicide

Common factors in suicide include stressful life events, substance abuse, physical or mental illness, stigma and discrimination in getting treatment for mental illness, and lack of social support, cites Dr Abdul Kadir.

Early treatment will help treat depression and reduce a sense of hopelessness. It will also reduce the stigma associated with such illness and encourage people to go for treatment and not suffer alone.

“Data from the National Suicide Registry shows 425 cases last year (2010). We do not know whether suicide cases are on the rise. Data from The Malaysian National Health Morbidity Survey III (NHMS III) showed that 6.4% Malaysian adults had suicidal ideas,” he cites.

“Classification of suicide is a problem. The statistics do not reflect the actual number of suicide cases. There may be more suicide cases.”

Out of concern for the rising suicide rates worldwide, and to create awareness for suicide prevention, Sept 10 was declared International Suicide Prevention Day by the WHO and the International Association for Suicide Prevention (IASP), says S. Gangadara Vadivel, chairman of Befrienders KL.

“The Befrienders has observed International Suicide Prevention Day annually by organising awareness campaigns (conferences, seminars, workshops, exhibitions) at national and district levels,” he says.

In conjunction with this year’s International Suicide Prevention Day, the Befrienders organised a national level public seminar and workshop on yesterday in Johor Baru (JB). The event was hosted by Befrienders JB.

Gangadara said: “People who are suicidal have ambivalent feelings. Their mind is divided; on one hand, they want to kill themselves; on the other, they don’t want to.”

What the Befrienders would do is not to tell them: “Don’t do it,” he says. Usually, the person contemplating ending his life will say, “If I had a way out, I want to live.” So, the Befrienders volunteer will talk to him tactfully and ask. “What will stop you from doing it?”

Usually, the suicidal person will open up and share his feelings.

Closer family ties

Half the battle is won in suicide prevention if parents are close to their children and understand what they are going through in their lives, says SC (pseudonym), 43, a teacher at an international school in the Klang Valley.

Many parents today are too busy to really “communicate” with their children and understand their needs and frustrations.

“They need to know about their children’s activities in and out of school, who their friends, are and how they perceive things.”

Nowadays, students are a lot smarter than their peers of yesteryears. She says they get a lot of information from the Internet and feel “empowered” and “brave”.

But then, today’s teens are rather “impulsive” and do things at the spur of the moment.

“Living in a fast-paced world, they do not pause and think things through before taking action,” she says.

Parents, she says, also place “too much emphasis on their children’s academic achievement rather than personality development or character building.”

Where social media is concerned, quick response to a cry for help can help prevent suicide.

She says a 16-year-old teenager posted a message on her Facebook. The teen said she was sad and felt like jumping down from the window of her room. A teacher from her Sunday Dhamma (Buddhist teachings) class in Petaling Jaya, Selangor, saw the message and called her a few times.

When the girl did not answer her calls, the teacher SMSed her and advised her not to do anything drastic but to approach her or her friends for help, or just to talk.

The girl was calling for attention when she wrote the message on her Facebook wall. She felt somewhat consoled and felt there were people who cared for her when she saw the message and calls from her teacher. Apparently, the girl felt her parents were giving her too much pressure.

Single parent Peggy Ho, 52, stresses that tauntings from classmates can bring tragic consequences to academic-driven students. Other unhealthy influences are TV, Facebook link-ups or even certain songs.

Ho has a 12-year-old daughter, and both mother and daughter have a strong bond. That is a good thing because they “talk” to each other, including what happened at school.

Well, some parents don’t have time for that.

Says Ho: “Parents should notice the behaviour patterns of their children. When you sense that something is amiss, don’t try to extract information from your child. Slowly coax him to speak up; otherwise, he will clamp up even more.”

If the child still refuses to speak up, wait a few hours.

She heard about a Year Five pupil who was treated terribly and ostracised by her classmates. “The girl was of the same age but looked very mature physically. She was quiet and an introvert. These qualities also probably made her classmates shun her,” she says.

Ho says that if a mother hears of such tales from her daughter, she must advise her to be strong (so as not to be victimised) and try to be friends with everybody.

Former teacher Tasha Doran thinks some youths commit suicide due to the absence of a family unit and associates the suicide attempt with “the maid syndrome”.

She says: “Where are the parents? There seems to be an absence in the family unit. Parents give their children material things when what they want is time with their mum and dad.”

To prevent suicides in schools, she suggests a better support system of counsellors who play an important role of counselling children with problems, at home and in school.

The topic of suicide should also be discussed in schools because these days, children can get all kinds of information off the Internet.

Teachers need to keep them informed on what suicide is really about and emphasise that it is NOT fashionable because a Korean pop star did it!

“When children are armed with the right information and taught in the right context, they’re able to make sensible choices.

They should also be made aware that if they feel suicidal, there is support out there and it’s ok to ask for help!”

Help is a call away

A person with suicidal intentions will not admit his problems or intentions openly. Often, the person will often give hints that may be overlooked by untrained persons.

Befrienders

“The suicidal person is afraid of being labelled as weak. He also fears being ridiculed. Imagine telling someone you want to commit suicide and getting laughed at. He is also unsure if he can trust the person he wants to confide in,” says S. Gangadara Vadivel, chairman of Befrienders KL.

There are “warning signs” of people contemplating suicide. “They use words like, ‘I wish I can sleep forever’; ‘I am at the end of the road and can’t see any way out’; ‘I don’t think anybody can help me anymore’; or ‘I’m losing hope in life’. They would clean up their room, put things in order, and give away things,” he says.

Psychologists say 90% of people who committed suicide or attempted suicide hinted about their intentions.

“Dr Edwin Schneidman, a pioneer in suicide research, lists four key factors that drive a person to suicide. They are helplessness, hopelessness, isolation, and unbearable emotional pain,” says Gangadara, “and, he opines that suicides can be prevented by addressing these factors through emotional support.”

The Befrienders is a non-profit organisation offering emotional support to the depressed and suicidal through the telephone, e-mail and by letters. Befrienders centres with 31,000 volunteers in 40 countries work to reduce suicides worldwide.

The Befrienders are also an outreach programme to young people in schools and colleges.

Besides providing onsite counselling, volunteer trainers from the Befrienders conduct workshop sessions, seminars and talks on Capacity Building, Managing Stress & Depression, Active Listening Skills, Suicide Prevention and Girl-Boy Relationships.

The Befrienders has adopted “the way” (to prevent suicide) as put forth by Dr Schneidman.

Gangadara says: “The caller who contacts the Befrienders is made to feel accepted, respected and cared for. After establishing rapport, the caller is encouraged to share his emotions. Confidentiality is assured to enable him to share his innermost emotions and problems that are causing the pain.

Befriending is “non-judgmental” and “non-directive”, he says, of volunteers (the Befrienders) who handle distress calls.

Quite often, the Befrienders receive calls late at night because the callers are unable to sleep or feel lonely.

Says Gangadara: “The Befrienders don’t directly ask the callers to see a doctor, but instead empower them to make decisions towards solving or coping with their problems to get rid of their pain.

“We stand by them, and often befriending results in improved self-esteem and capacity for growth. “The caller eventually feels less isolated, relieved from emotional pain and realises there is help and hope.”

All Befrienders volunteers are trained to offer emotional support and have the guidance and support of professional consultants.

However, befriending has its challenges, such as reaching out to groups at high risk of suicide, creating awareness in the community on suicide prevention, and responding to suicide messages in the social media.

“It is not easy to monitor a person’s cry for help in the workplace. However, if you come across a suicidal message on Facebook, you can respond by giving the Befrienders helpline,” he says.

The Befrienders are very concerned with the increase in suicides among young people in all communities. Gangadara says, “According to a Health Ministry survey, the groups at high risk of suicide are teenagers (aged 16 to 20), young adults (21 -25), senior citizens (65+) and those in the plantation community.”

An increase in suicides, he says, has also been reported among young people from native communities in Sabah and Sarawak.

The national suicide rate is 10 to 13 per 100,000, or seven suicides per day (according to Professor of Psychology Dr T Maniam, Universiti Kebangsaan Malaysia, and the Malaysian representative in the International Association for Suicide Prevention).

But the official figure quoted by the National Suicide Registry of Ministry of Health is 1.3 per 100,000.

Gangadara explains: “The Ministry admits that this figure is grossly understated.

“Many suicide cases are not classified as such by the authorities concerned due to stigma, compassionate, cultural and religious considerations.”

The Health Ministry has formulated the National Strategy and Action Plan for Suicide Prevention (NSAPSP) with input from various government agencies, professional resource persons and the Befrienders, with the aim of reducing suicides and attempted suicides. The plan is expected to be implemented soon.

Gangadara says: “While NGOs like the Befrienders are striving towards improved mental health and suicide prevention, the Health Ministry has to play the lead role. There is a need for greater action from the ministry for suicide prevention at national level.”

In Malaysia, the Befrienders have centres in Kuala Lumpur, Penang, Ipoh, Seremban, Malacca, Johor Baru and Kota Kinabalu.

“Befrienders KL receives about 70 calls daily from people seeking emotional support. Some 23% of callers shared they were feeling suicidal because of their problems,” he says

“The email befriending service is very popular with young callers, below age 30. Some 37% of those who emailed shared suicidal thoughts.

“And the reasons for suicidal thoughts are adverse events in life, relationship problems depression and psychiatric problems.”

The impact of suicide goes far beyond the death of a person. Gangadara points out: “For every life lost to suicide, it’s estimated 20 persons attempted suicide and survived. For every suicide, 20 family members, friends and associates are emotionally affected and traumatised.”

Befrienders helpline: (03) 7956-8145 (24 hours daily)

http://www.befrienders.org.my/

Suicidal teens and youth

Teenagers today are compulsive and impulsive. They live in the world that requires them to do things quickly. Ironically, when they can’t solve their problems, some of them want the easy way out: suicide.

Suicide is symptomatic of a very dysfunctional society,” says suicidologist Adnan Omar. He explains that even though today’s teens are “very techno-savvy”, they have become rather impulsive.

suicidologist

“They want solutions to life’s problems delivered quickly, like fast food delivery!” says Adnan, who is also manager of Counselling and Psychological Services Centre, Taylor’s University, in Petaling Jaya in an email interview.

He says in today’s society, technology thrives on speed. But the downside of technology is that it “shortens rationality and truncates emotionality”.

In other words, he reckons that teenagers want “super quick” solutions to life’s problems. “As a result, they thrive on temporality, immediate gratification, and the now culture.”

But in terms of emotional intelligence, teenagers, he feels, have become impulsive. “They are not able to control their emotions properly. Hence, they explode in a destructive manner, including attempting suicide when things don’t turn out. They get frustrated easily over simple things, which results in many unhealthy doings!”

With Facebook and social media, he feels that human relationships have become more shallow and temporary.

Then, Adnan feels that a teenager’s life is further complicated by the way his parents live. It appears that there are NOT enough hours anymore in a day to work.

He concedes: “Parenting becomes a biological ritual. We contract our love and care to maids, money, and the Internet. Parents are no longer idols; they have apparently been replaced by singers and actors, who are also teenagers themselves!”

Teenagers, he feels, don’t have strong and responsible adults and role models who can guide and teach them about life, resilience and self-awareness. Schools and families still play tug of war; each blames the other.

“It’s time for the society to reflect, pause and analyse the way it’s breathing and living. It’s time for various parties such as schools and families to seriously restructure to accommodate the real needs of teenagers so that we can begin understand their pain, agony and happiness,” he emphasises.

School authorities need to develop protocols, processes and procedures on how to handle suicide emergencies and cases, says Adnan.

“They need to look into aspects like which school personnel should be the first responder, who should inform the parents, and who needs to handle the media and other authorities such as the police,” says Adnan in response to questions on how school authorities should handle suicide prevention and whether they are equipped to tackle such situation.

Schools also need to have a comprehensive programme for debriefing and counselling students and staff who are affected by suicide.

“An effective follow-up programme needs to be in place because people react differently to suicide and death,” he says.

Asked if talks about handling emotional crisis, boy-girl relationships and suicide prevention should be held in schools, colleges and tertiary education centres to create awareness, Adnan opines: “The more informed we are about things, the better we can manage situations.”

He says: “Awareness programmes (talks, seminars, campaigns and conferences) are critical. These programmes need to focus on prevention, intervention and collaboration amongst various school authorities.”

“Some important awareness issues are: What is suicide? How is suicide different from other forms of self-destructive behaviours such as cutting oneself? What causes suicide? What are the signs that a student is suicidal? How can we help?”

An important component of the awareness programme, Adnan says, is to teach the students and staff about stress and depression.

“It is generally believed that depression causes suicide and depression may be the result of chronic stress. Since stress is a real challenge in our modern life, schools should, if possible, include in the curriculum the topic about stress.”

The discussion should include issues related to building emotional resilience and handling various emotional challenges such as academic failure and relationship break-ups.

Another critical issue is the stigma of suicide.

“The awareness programme also needs to focus on removing stigma of suicide or mental illness. For example, if you are suicidal, then you are crazy; if you seek counselling or psychiatric help, then you are suffering from mental illness; people who are suicidal are forever suicidal; suicide is inherited,” he says.

Beyond the programme, schools can also train a few school personnel and student counsellors to specifically manage suicidal cases.

Handling suicide attempts

Adnan says if a teenager is suicidal, intervention must be properly handled, says Adnan.

“If a suicide attempt is detected at school, the student should immediately be referred to a trained counsellor. If an attempted suicide occurs at home, the student should be referred to a psychiatric facility or hospital,” he advises.

On handling suicidal cases, he advises to follow these immediate steps:

1. Assess suicidality. One way to do this is by asking, “On the scale 0 to 10, 0 means you are not feeling suicidal at all and 10 means you are absolutely suicidal, how do you feel now?” Talk directly about suicide.

2. Ask about the means and remove the means!

3. Do a quick history check – mental illness, depression, attempts, coping skills, etc.

4. Develop support groups. With the student, brainstorm people who can help – parents, friends, etc.

5. Consider medication, if necessary.

6. Allow free expressions of feelings; don’t be judgmental.

At the end of the initial session, a comprehensive plan must be in place to monitor suicidality once the student leaves the counseling office.

A plan addressing the cause of suicidal thoughts or attempts must also be drafted together with the student, as well as a timely implementation of the plan. A regular follow-up must be scheduled to assess progress, or lack it.

Finding closure

Whilst the suicidal person can end his suffering tragically, he forgets that others will continue to suffer from his folly.

Adnan says: “Sometimes, we forget that many lives are affected by one suicide. It is estimated that about six to 10 significant others are severely affected by one suicide. These loved ones need to grieve and mourn the loss of the person who committed suicide.”

It is believed that finding closure or “coming to terms” with a loss to suicide is the most difficult when compared to loss of life due to natural death or accidental death.

Sometimes, it takes over six years for the survivors to find the closure.

Adnan shares ways which may be helpful to “survivors” of suicide:

1. Know that you can survive. You may not think so, but you can.

2. Struggle with “why” it happened until you no longer need to know “why” or until you are satisfied with partial answers.

3. Know you may feel overwhelmed by the intensity of your feelings, but all your feelings are normal.

4. Anger, guilt, confusion, forgetfulness are common responses. You are not crazy, you are in mourning.

5. Be aware that you may feel appropriate anger at the person, at the world, at God, at yourself. It’s okay to express it.

6. You may feel guilty for what you think you did or did not do. Guilt can turn into regret, through forgiveness.

7. Having suicidal thoughts is common. It does not mean that you will act on those thoughts.

8. Remember to take one moment or one day at a time.

9. Find a good listener with whom to share. Call someone if you need to talk.

10. Don’t be afraid to cry. Tears are healing.

11. Give yourself time to heal.

12. Remember, the choice is not yours. No one is the sole influence on another’s life.

13. Expect setbacks. If emotions return like a tidal wave, you may only be experiencing a remnant of grief, an unfinished piece.

14. Try to put off major decisions.

15. Give yourself permission to get professional help.

16. Be aware of the pain of your family and friends.

17. Be patient with yourself and with others who may not understand.

18. Set your own limit and learn to say no.

19. Steer clear of the people who want to tell you what and how to feel.

20. Call on your personal faith to help you through.

21. It is common to experience physical reactions to your grief, such as headaches, loss of your appetite, inability to sleep.

22. The willingness to laugh with others and at yourself is healing.

23. Wear out your questions, anger, guilt, or other feelings until you can let them go. Letting go doesn’t mean forgetting.

24. Know that you will never be the same again, but you can survive and even go beyond surviving. - Stories by MAJORIE CHIEW

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