Talking through the warning signs of suicide

A person who is contemplating suicide will sometimes provide warning signs or clues to those around them, including their GP. Exhibiting warning signs can mean the person is at immediate risk of suicide and warrants urgent intervention.

Beginning a conversation about suicide
A reluctance to discuss suicide is a significant factor inhibiting a vulnerable person from reaching out for help. If you are concerned a patient may be having thoughts of suicide, it is important to raise the issue directly and to ask the right questions to ensure you can act promptly to support the patient.

A calm, non-judgemental and empathetic approach can provide the opportunity for a patient to tell their story and discuss their suicidal thoughts. Normalising what the person has been experiencing may help them to feel more comfortable in discussing their thoughts.

Concerned about suicide: what to ask

• Have you had any thoughts of ending your life?
• How often do you have these thoughts?
• How intense are the thoughts?
• Have you made any plans and if so, what are you considering?
• How close have you come to doing something?
• What stops you from doing something?
• How does your future seem to you?
• Do you ever feel like giving up?

Suicide warning signs
Be alert to any of the following, and note this is not an exhaustive list:

• withdrawing from family, friends or quitting activities that were once important to them
• changes in eating or sleeping habits indicated by weight gain or loss and fatigue
• feelings of helplessness or indicating they have no hope for the future
• talking negatively about themselves
• drastic changes in mood or behaviour – may vary from aggressiveness and irritability to a sense of calm or even euphoria
• engaging in unusual risk taking behaviour including drug or alcohol use or self-harming
• feeling like a burden to others
• getting affairs in order – giving away possessions, writing a goodbye letter, making funeral arrangements.

Suicide tipping points
Tipping points are incidents that can lead a vulnerable person to suicidal ideation or an attempt. Be alert to the following:

• death of a family member or friend
• physical, mental, sexual or emotional abuse
• deterioration in financial security including loss of employment or loss of status
• a worsening in physical or mental health
• breakdown of a relationship
• an argument with a loved one.

To further develop skills in talking through the warning signs of suicide and building a whole of practice approach to suicide prevention, see page 7 for information on Wesley LifeForce’s workshops for GPs, practice nurses and practice staff or visit http://bit.ly/suicidepreventionworkshops.