Andy Walton, North East Ambulance Service Staff Psychological Wellbeing Advisor
Thoughts of wanting to ‘end it all’ weave through people’s daily thinking patterns more commonly than we think. We need to encourage an openness about this, remind people it’s not their fault, that they’re not alone in feeling this way and that there is support available.
Suicidal ideation is a term for having thoughts about ending your own life. As a staff psychological well-being advisor within the ambulance sector, I am fully aware of its prevalence, with the Association of Ambulance Chief Executives (AACE), on the basis of Office of National Statistics’ research, reporting that there is indeed an increased risk of suicide in male paramedics compared to the general population. This can be for a variety of reasons including intensity of the role, trauma and stigma.
There can be a fearfulness of the topic of suicidal ideation. With such extreme expressions of despair, there is triggered sense of our own powerlessness faced with such an extremely emotive subject. But there are ways to approach the topic beyond panic and fear if we look beyond historically stigmatising assumptions.
Someone thinking about killing themselves is intense, painful and complicated but it is in no way something someone should feel guilty about. It is no more wrong than thinking about what you’re having for lunch or if you’re going to the gym or not. Thinking about suicide can already be a very difficult experience. This pain can be compounded further if people feel guilty with negative self judgement for feeling the way they do.
People are often scared to disclose suicidal ideation as they believe they are then deemed no longer capable of making thoughtful or rational decisions. This makes the assumption that suicidal ideation is experienced in the same way by everyone and that someone else knows what that person needs better than they do. This simply reinforces stigma and the fear of speaking openly, which increases isolation and therefore the chance suicide may be completed.
Society has historically labelled suicide as a selfish or thoughtless act. This is untrue. If anything, those with depression and suicidal ideation could do with thinking and caring a little less intensely. The assumption about thoughtlessness belongs to a collection of myths around the topic, including ’talking about it increases the risk of people doing it‘ and “only the ‘mentally ill’ think about killing themselves”. Or the idea that suicide is purely about being on the brink, waiting desperately for someone to intervene. When in fact suicidal ideation can linger and be an ongoing daily occurrence.
We often talk in statistics when it comes to suicide. It is straightforward to obtain and communicate how many people have completed suicide. What is harder to measure is suicidal ideation and how many people live with this at any one point. Research is limited by the stigma that it’s a bad, wrong thing, so people are less likely to report it. Without self-reporting and in the absence of the hospital visits or attempts that help us track active ideation, how can it be measured?
Suicidal ideation is a spectrum that people can move up and down and is divided into two categories; passive and active. Passive ideation is characterised by abstract thoughts of ending your own life, wishing for things to end. These thoughts can occur once, multiple times, or almost constantly. Active ideation on the other hand is more chronic and imminent, there could be a plan, intent and the feelings interfered with daily functioning of one’s life.
Wherever someone is on this spectrum, they deserve to be heard, for their thoughts to be taken seriously, soothed and to be reminded they’re not alone in feeling this way. Those living with suicidal ideation should be encouraged to learn ways of managing it, to learn to observe them, without them being all consuming, to know when they might be in danger and to keep themselves safe. We need to encourage and facilitate opportunities for conversations around the subject in a kind, calm, knowledgeable and non-judgmental way.
We can encourage those struggling by reflecting on and encourage asking themselves the question:
- What in your life do you need to change or stop?
· What are the triggers?
· What does your support network look like and how will you communicate with them?
· What crisis services are available in your area?
· How often would you like people to check in with you about your suicidal thoughts?
· What do your suicidal thoughts show you about how you’re feeling and what you need?
Actively engaging with talking therapies is highly recommended to help people find hope and empowerment moving forward. Surviving may also include:
- Becoming closely acquainted with your life rafts — the things and people you want to live for.
- Putting together your mental maintenance personalised toolkit and reflecting on it daily. The kit should also include instructions for how you wish to be supported if you are actively suicidal.
- Planning things for the future, holidays, hobbies and meet ups.
- Being gentle with yourself.
- Accept that some days you will come off track and feel full of negativity but that it’s ok and it will pass and everything is temporary.
- Create and maintain boundaries to remove people and places that do not feel good from your life.
- Nurture your friendships.
- Be kind to yourself always and know that you can be thriving and still have suicidal thoughts.
- Acknowledge the strength you have shown to demonstrate vulnerability and the positives of greater self awareness, growth and sense of compassion that can come from a struggle with our mental health.
Life is hard, working in emergency response is hard. Tending to our pain, normalising the conversation and inspiring a sense of open and honest connection can take the edge off. Something we can do, before we reach crisis.
Suicidal ideation resources:
Call the 24/7 Ambulance Staff Crisis Line Number on 0300 373 0898 if you’re having suicidal thoughts.
You will be given immediate contact with a mental health counselling professional who will take whatever steps are required to keep you safe.
If required, this will be followed by some additional sessions designed to help get you to a “safe place” alongside a long-term safety plan and recommendations for further support if required.
The service will operate independently and confidentially with no identifiable data being passed back to the ambulance service without express consent.
Reach out with any questions about the article by contacting Andy Walton, Staff Psychological Wellbeing Advisor, on 07813350083 / andrew.walton@neas.nhs.uk