Understanding warning signs of suicide: How to deal with mental health crises?

Despite not having a mental illness, facing negative emotions can sometimes feel overwhelming, leading to thoughts of despair. What are the signs that someone may be contemplating suicide? How should we respond when mental health warnings arise? As September 10 marks World Suicide Prevention Day, psychiatrist Dr. Cheung Hon-kee explains common signs of suicide and methods to address suicide crises.

Globally, nearly 700,000 people die by suicide each year, averaging almost three deaths per day. According to reports from the Coroner's Court, there were 1,092 cases of suicide in 2023, reaching a ten-year high, which means nearly three people die by suicide each day. Each year on September 10, World Suicide Prevention Day is observed with a changing theme every few years. The theme for 2024-2026 is "Changing the Narrative on Suicide," encouraging greater awareness and proactive efforts to intervene in the process leading from warning signs to despair and ultimately to action—making it crucial to recognize these signs.

Dr. Cheung notes that behaviors leading up to suicide often indicate thoughts and plans, such as entrusting beloved items or pets to others, distributing assets, or expressing a desire to do things they previously hadn't. Emotional signs to watch for include feelings of hopelessness, guilt, worthlessness, and the sense that no one cares.

Dr. Cheung also emphasizes that studies show nearly half of suicide cases are linked to mental illness, with depression being the most common. Treatment for depression usually involves medication, and with correct diagnosis and medication, individuals can significantly improve and may eventually stop treatment.

He suggests that one of the goals of World Suicide Prevention Day should be to raise awareness about normal depressive emotions versus genuine warning signs of depression. Understanding when professional intervention is necessary, such as consulting doctors or psychologists, is essential to prevent worsening conditions that could lead to self-harm.

Signs of Behavior Before Suicide: Depression, Anxiety, Lack of Support

- Depression and Anxiety: Many suicides occur during extreme emotional distress. Early treatment for depression can reduce the risk of self-harm, as many individuals with severe depression may see ending their life as the only solution.

- Isolation: Those who feel unsupported may become more hopeless and helpless. Deliberately distancing oneself from friends and family can lead to deeper immersion in negative thoughts.

- Anger and Resentment: Individuals filled with anger toward themselves or others may pose a higher risk of self-harm or harming others.

- Substance Abuse: Some may turn to alcohol or drugs to cope with negative emotions, which can eventually worsen their situation. Misuse of substances diminishes self-control and the ability to address problems effectively.

- Hallucinations: Extremely depressed individuals may experience hallucinations, making the risk of suicide more pronounced.

We Should: Actively Show Care and Do Not Dismiss Feelings

- Express Concern and Support: Let them know, "I may not be able to help much, but I'm willing to listen and accompany you to seek help."

- Listen and Understand: Try to empathize with their emotions and validate their feelings, but make it clear that suicide is not the best solution.

- Recognize Depression: Most people with suicidal thoughts are emotionally distressed, unable to cope with changes, or suffering from depression. Avoid blaming them for being "down" or "sad over trivial matters"; instead, encourage them to face challenges and seek help.

- Be There: Quietly accompany them; calm and gentle support is often more effective than hasty advice like "don't think so much" or "just forget your worries."

- Actively Address Issues: Do not dismiss indications of suicidal thoughts. Instead, ask directly if they are having such thoughts and address them appropriately; open discussions can show your concern.

- Seek Professional Help: Those with suicidal thoughts need timely treatment and counseling. Encourage them to consult family doctors, emergency services, social workers, clinical psychologists, or psychiatrists.

Also, here are some tips for people who are friends or family members of someone who suicide:

- There is no shame in experiencing the suicide of a loved one.

- You can express your emotions safely, such as crying or talking to friends and social workers.

- Learn to let go of questions.

- Do not blame yourself for their suicide; even if you are still grieving, believe that this pain will pass.

- Feelings of anger, guilt, and confusion are normal; acknowledge these as part of the grieving process.

- It's okay to feel angry at someone, something, or even fate; express your feelings to someone you trust.

- Having thoughts of self-harm doesn't mean you must act on them.

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