Have you ever wondered what goes through the mind of a person suffering from depression? Let’s rephrase that: have you ever wondered what the person next to you, smiling, might be thinking when alone?

The past year has not been easy for anyone. We have seen endless news reports, webinars and articles on mental health and the importance of self-care.

Suicide is a complex phenomenon. It is not, put simply, a mental health diagnosis – it is a human condition. Over time, mental health services have increased and there is more awareness and, yet, death by suicide still happens. One cannot simplify it to assume that it is the end point of severe depression and/or the inevitable reaction to an adverse life event. It can happen unexpectedly, taking you by surprise and makes you wonder whether you missed the signs at any point.

Survivors of suicide attempts indicate that they did not necessarily want to die but, rather, that it was perceived as the only way to end unbearable emotional pain. It is well documented that even people who are determined to end their life still often wish for an alternative solution, giving professionals the opportunity to act on rebuilding their hope for recovery.

To understand suicide, one needs to understand the facts. Various risk factors have been identified as potentially increasing the risk. Various demographic factors show a higher incidence of suicidality, such as teenagers and/or middle-older age groups, being male, single/separated/divorced/widowed, socially isolated in rural areas and unemployment. An underlying mental health condition can also increase the risk, especially depression, bipolar affective disorder, psychotic disorders, certain personality disorders, substance misuse and also chronic, debilitating physical illnesses.

Having a family history of suicidal acts, major adverse childhood events, domestic violence and an unstable family life are other predisposing factors worth mentioning. Moreover, thoughts of suicide can be brought about by triggering life events such as financial losses, relationship break-ups, loss of employment, death of a family member and any other experience that is perceived as traumatic for the individual.

How can I help?

One cannot fully predict if a person will die by suicide – no matter how much you know about them or how long you’ve known them. However, the first step is to learn to recognise the warning signs so as to try and reduce the risks as much as possible.

Suicide is a complex phenomenon. It is not, put simply, a mental health diagnosis – it is a human condition- Daniela Zammit

Hearing someone joking, talking about or threatening death and/or suicide might be perceived as being nonsense; however, pay attention to the subtle signs as there may be an element of truth in it. Asking the individual directly about suicidal thoughts will not trigger them to act out. It might feel uncomfortable and you might not know what to do but, actually, talking about it will help the person to speak up. Many survivors of suicide attempts admit that if anyone had shown interest or compassion right before their act they might not have done it. Joking or not, all suicide threats should be taken seriously.

Pay attention to the content of their conversations. Talking about feeling hopeless, being a burden, having no purpose in life, feeling trapped or in unbearable pain should make us all alert. Someone’s behaviour may become increasingly anxious, restless or reckless, or they may use more drugs and/or alcohol. If you notice a change in someone’s personality such as becoming more withdrawn, isolated and thoughtful, reach out and talk to the person.

Many of us feel at a loss when someone expresses suicidal thoughts. You may not be sure what to do to help, whether you should take it seriously or if your intervention might make the situation worse. If you suspect it, ask the right questions. Listen attentively, be sensitive but direct, such as: “How are you coping with everything that is going on?” “Do you feel like giving up?” “Do you feel life is not worth living anymore?” “Are you having thoughts of dying or wanting to hurt yourself?” “Have you thought about suicide?” “Have you thought how and when to do it?” These questions will give you a better understanding of the severity of the situation and how to act.

What should I do?

If a friend or a loved one makes you suspect they are at risk to themselves, do not try to handle it on your own. Talk calmly with the person, support them and say that you are concerned for their safety. Tell them that he/she should reach out for help and involve a trusted family member and ask for professional help.

Suicide is not a sign of weakness and it isn’t about seeking attention or being selfish. If you are or someone you know is experiencing mental health problems or suicidal thoughts, speak up. If it is urgent, you can call the emergency number 112 and the Accident and Emergency Department will have a mental health professional and medical help available 24/7.

If you need further support and guidance, call Richmond helpline 1770, Appoġġ helpline 179 or the online support service on www.kellimni.com.

Daniela Zammit is a specialist trainee in psychiatry and writes on behalf on the Suicide Prevention Sub-Committee of the Maltese Association of Psychiatry.