As a nurse working in the emergency department, I frequently see people come in for suicide attempts. I’ve noticed there’s a stigma surrounding some attempts, and many colleagues agree there’s a difference in the way patients are treated depending on the type of attempt.
From what I’ve seen, a patient whose attempt is more “serious,” with visible life-threatening injuries or potentially deadly pathology results, is more likely to be treated with understanding, compassion and patience. It’s as if serious injuries validate the mental illness, making the inner turmoil visible to the outside world.
But the “less serious” the attempt is (for example, taking a non-lethal amount of medication or self-inflicted injuries that aren’t fatal), the less sympathy I’ve seen patients receive. This can also be said for patients who have repeat suicide attempts. I’ve heard these patients referred to as “time-wasters,” “attention-seekers,” “taking up beds,” and they’re described as “crying out for help.” Although it’s acknowledged as wrong, there’s still anger and frustration felt towards the patient. I’ve heard many question the reason for their behavior. But I believe anyone who intentionally puts themselves in harm’s way needs help, regardless of the intended outcome, and are still entitled to be treated with dignity, understanding and kindness.
When I was 23, I tried to jump off a cliff after being discharged from a psychiatric hospital. I have bipolar affective disorder. I rarely call this a suicide attempt, although I would’ve jumped if it weren’t for a person walking past. If that person didn’t talk me down from the edge I wouldn’t be here today. I didn’t end up in an emergency department that night; instead the person called the local psychiatric triage team for advice and made sure I got home safely. The next morning my psychiatrist arranged for me to have electroconvulsive therapy (ECT).
I was determined to take my life. However, just because I didn’t end up in the emergency department didn’t make my determination to kill myself less serious. For weeks afterwards I remained suicidal. It’s because of my wonderful family and excellent psychiatrist I got through those weeks alive.
According to the World Health Organization, 800,000 people die by suicide every year, and for every successful suicide there are many more people who attempt it. About 20 percent of people who die by suicide have made a prior suicide attempt. But the stigma attached to suicide can be isolating and discourages help-seeking behaviors.
When I was suicidal I was too embarrassed to ask for help from emergency services because I thought I would be judged. That night I stood on the cliff, dying seemed like the only way out. Like a lot of suicidal behaviors, the decision was driven by desperation and impulsivity. The method didn’t matter — only the end result. I was only seconds from death. By complete luck I survived that depression.
In seems people are fearful if we talk about suicide we’ll trigger risky behaviors. But if we don’t talk about it, how are we going to understand it? If we don’t understand it, how can we be compassionate and empathetic? And if we don’t treat those at risk with compassion and empathy, how do we expect them to seek help?
Most importantly, we need to make it known reaching out for help is one of the bravest and best things someone can do.2 I’ve heard nurses say it’s “heartbreaking” when patients die from a suicide attempt. But what’s more heartbreaking is how often I hear families say the person they lost had been “been unhappy for a long time’” or that “they tried suicide before.” We need to talk about suicide to offer people hope. The courage it takes to reach out must be recognized.
Every suicide attempt needs to be taken seriously. People don’t kill themselves, mental illness does.6 The sooner we start understanding this, the sooner we can combat the stigma surrounding suicide. Decreasing stigma encourages help-seeking behaviors and leads to more widespread and compassionate treatment for those who need it. And this treatment needs to be available for everyone however long they need, not just for the people who end up with serious injuries in the emergency department.