R U OK? Day is a national day of action designed to inspire and empower us to meaningfully connect with others, and start a conversation with people in our lives who might be struggling. But what do we do if they actually tell us they’re not okay? How can we support someone who might be struggling, or even thinking about suicide or self-harm?
Suicide and self-harm is becoming increasingly common. In 2019:
Suicide was the 13th leading cause of death. For Aboriginal and Torres Strait Islander people, suicide was the fifth leading cause of death
The highest proportions of suicides occurred among young and middle aged people
Suicide was the leading cause of death for people aged 15-49, and the second leading cause of death for those aged 50-54
Suicide was the leading cause of death for children (5-17yrs) in Australia, with 80% of child suicides in 2019 occurring between ages 15 to 17
Male suicides made up three-quarters of all suicides
Why do people do it?
Most self-harming behaviour or thoughts of suicide are in response to feelings of intense pain or distress. Often people feel a sense of shame or embarrassment, and will try to hide these behaviours from others. These feelings can be in the context of school or work problems, difficulties in relationships, bullying, low self-esteem or poor body-image, alcohol and drug abuse, stressful life events, knowing others who self-harm or mental health issues. There are a variety of reasons underlying why a person may harm themselves, including:
To relieve distress or cope with feelings
To feel physical pain instead of emotional pain
To alleviate feelings of numbness/emptiness
To gain a sense of control
To avoid acting on suicidal thoughts
To punish others
To express emotional suffering
Escaping distressing situations
To gain a sense of relief/calm
How do I know if someone is struggling?
There are a number of signs you can watch out for in family and friends. Firstly, pay attention to what your loved one is saying. Do they seem concerned about being a burden? Are they lonely or lacking self-esteem? Do they talk about feeling trapped or in pain? Do they seem moody, irritable or unable to switch off? Or, are they saying less than they used to? Do they shut you out and not want to talk about anything?
Secondly, consider what they might be doing. Are they withdrawing from things they used to do? Having trouble getting out of bed to go to school or work? Are they having trouble concentrating, behaving recklessly or spending more time in bed? Have they become less interested in things they used to love or taking care of themselves?
Thirdly, think about what might be going on in their life. Are they experiencing pressure or constant stress at school or work? Are they having relationship issues or major health problems? Have they lost someone or something they care about? Are they having financial difficulties? Are they being bullied?
How can I help? What should I say?
The most important aspect of supporting someone who is struggling is to take time to really listen to what they are saying, without judging. It can be easy to get caught up in thoughts like “what will I say next?” or “I don’t know what I’m doing” which can take us away from being able to focus on our loved one. Often just having someone to talk to can be a huge relief for someone who is struggling.
Ask them how they are feeling
Tell them you are worried about them and why
Let them know that you are there
Stay calm and don’t judge them. Your loved one might seem upset, angry or irritated but this might mean that they are feeling ashamed, guilty or worried about what you might think
Ask the person if they would like your help - if so, you could suggest some of the following ideas to cope with urges to self-harm:
Holding an ice cube
Short burst of intense exercise (like jumping jacks)
Drawing on the area of the body the person might usually harm themselves
Have an ice cold shower
Punch a pillow or punching bag
Develop a ‘distraction box’ - this might include things like photos, fidget toys, a nice-smelling candle, a soft blanket, colouring in or word-searches
Don’t give the person an ultimatum or force them to stop - this could make the situation worse
Ask your loved one directly if they are considering suicide (asking about it will not make it more likely to happen)
Encourage your loved one to seek professional support. This can often be avoided due to fears that others won’t understand, no one will be able to help, feelings of shame or guilt, or worries about how others will react. Remind your loved one that effective support is available, and that you can help them make contact with support if needed.
Often the best initial point of call is your local General Practitioner (GP). They can support in undertaking a brief assessment of what support your loved one might need, and can also complete a Mental Health Care Plan (MHCP) for a referral to a private psychologist.
Other alternative supports are listed below:
eHeadspace (online web chat) - https://headspace.org.au/eheadspace/
Lived Experience Telephone Support Service (LETSS) - phone/webchat support available 5pm-11:30pm every day - 1800 013 755 or https://www.letss.org.au
Mental Health Triage 24/7 phone support - 13 14 65
Lifeline 24/7 phone support - 13 11 14 or webchat 7pm-midnight via https://www.lifeline.org.au/crisis-chat/
Beyond Blue 24/7 phone support - 1300 224 636 or webchat 11am-midnight via https://www.beyondblue.org.au
Kids helpline 24/7 phone support - 1800 551 800
If it’s an emergency:
If you need urgent support, call 000 or take your loved one to your nearest emergency department.
‘Causes of Death’, 2019, Australian Bureau of Statistics, https://www.abs.gov.au/statistics/health/causes-death/causes-death-australia/latest-release#intentional-self-harm-suicides-key-characteristics