Debunking common myths and misconceptions
The myth
Talking about suicide with a patient will make them more likely to act on such thoughts.
The reality
Some nurses struggle to talk about suicide because they fear it will induce or exacerbate suicidal thoughts, or because it goes against their beliefs, values or cultural norms.1 But evidence has found that asking about suicide does not induce or exacerbate any thoughts. In fact, asking about it may reduce suicidal thoughts.2
Alongside the myth that talking about suicide could put the idea into a patient’s head, there is also the myth that those who talk about suicide won’t go through with it.3 Again there is no evidence for this. Patients who talk about suicide will generally be experiencing suicidal ideation, indicating a risk of suicide.4 While most people who think about killing themselves do not take their own lives, all will be experiencing psychological distress and will benefit from supportive interventions.
Suicide is three times as common in men than women and men are less likely to approach services, ask for help or talk about their suicidal thoughts.5 Warning signs may include excessive alcohol use, recklessness, anger or hopelessness, as well as more obvious indicators such as accessing means or rehearsing attempts. It is important that nurses recognise and respond to potentially risky behaviours.6
Always be direct when asking about suicide to ensure there is no ambiguity. However, being direct does not mean being blunt, so any discussions must be compassionate. If patients feel the enquiry is insensitive they will be less likely to disclose their true feelings. People who struggle to overcome the stigma they associate with suicide, and those who find it hard to express their distress, will be put off by insincerity.
Suicide is highly complex and we need to recognise this in our interactions around it. As with any sensitive issue, our dialogue should fit with the patient’s frame of reference and communication style to reduce their distress. A stepped approach to the conversation, guiding the patient to talk about their feelings and possible suicidal thoughts, may help.7
Conversation about suicide should also be taking place within the supervisory setting, through nurses talking about their experiences of discussing suicide with patients. Suicide is an emotional issue and supervision can be a useful way to understand feelings of discomfort, challenge preconceptions and receive support.
Discussion around suicide should not be limited to those who directly experience suicidality. Those who have lost a loved one to suicide may also have suicidal thoughts.8 Many bereaved individuals experience stigma after the suicide of a loved one, which can lead to withdrawal, self-stigmatisation and isolation, increasing risk of depression and therefore suicide.9 Nurses working with patients we know to be bereaved by suicide should encourage open conversations to help the bereaved feel supported and connected.
Healthcare professionals have been identified as an occupational group at higher risk of suicide, suggesting we should seek support if we find ourselves feeling depressed or developing suicidal thoughts.10
Also, if you think your colleague might be depressed or thinking about suicide, ask them about it.
Talking about suicide may interrupt a planned act of suicide, facilitate the desire to seek help, reduce stigma and engage individuals and groups who are at risk.
However, the discourse around suicide must be broader than conversations with vulnerable people. It must also be political. Social circumstances have a huge impact on suicidality – financial difficulties, unemployment, housing issues and loneliness have all been found to be contributory factors.5 As nurses we see evidence of these hardships in our practice on a daily basis and therefore can draw on this knowledge to contribute to local and national political debate around social deprivation.
Karen Lascelles is a nurse consultant for suicide prevention at Oxford Health NHS Foundation Trust
References
- Bolster C, Holliday C, Oneal G, Shaw M. Suicide Assessment and Nurses: What Does the Evidence Show? Online J Issues Nurs 2015;20:manuscript 2
- Dazzi T, Gribble R, Wessely S, Fear NT. Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Psychol Med 2014;44:3,361-3
- Joiner T. Myths about Suicide. Massachusetts;Harvard University Press:2011
- McAuliffe CM. Suicidal ideation as an articulation of intent: A focus for suicide prevention? Arch Suicide Res 2002;6:325-38
- Department of Health and Social Care. Preventing suicide in England: A cross-government outcomes strategy to save lives. London;DH:2012
- Rudd D. Suicide warning signs in clinical practice. Curr Psychiatry Rep 2008;10:87-90
- Mayo Clinic. Suicide: what to do when someone is suicidal. Minnesota;Mayo Clinic:2018
- Pitman A, Osbourne D, Rantell K, King M. Bereavement by suicide as a risk factor for suicide attempt: a cross sectional national UK-wide study of 3432 young bereaved adults. BMJ Open 2016;6:e009948
- Seguin M, Lesage A, Kiely MC. Parental bereavement after suicide and accident: a comparative study. Suicide Life Threat Behav 1995;25:489-98
- Department of Health and Social Care. Preventing suicide in England: Third progress report of cross government outcomes strategy to save lives. London;DH:2017
