Suicide prevention

Self-harm deaths are preventable

Friday, August 17 2018

It's difficult to understand what drives people to take their own lives. But a suicidal person may be in so much pain that they can see no other option. A number of high-profile suicides have been in the headlines recently and it is being reported that rates are rising across the country. Self-harm deaths are preventable, but it starts with knowing what to look for and what to do.

“Statistics reflect that the current suicide rate in South Africa is 10.7 per 100 000 people,” says Sarah Lamont, occupational therapist at Akeso Randburg, Crescent Clinic. “This is reportedly higher than some of our neighbouring African countries and is 62nd when we compare it to statistics globally. Reasons that have been attributed to the increase in suicide rates are a rising sense of helplessness and desperation. These feelings have been exacerbated by the rise in unemployment and economic hardship and poverty. Domestic violence and substance abuse are other factors that are indicated in increasing a sense of desperation that may have a direct impact on the rise of suicide in all countries.”

“Shame is attached to mental illness and that stops people seeking help,” adds Sandy Lewis, Head of Psychological Services at Akeso Clinics. “They are sometimes overly worried about others’ perceptions of how well they are coping. This is especially relevant for professionals like doctors who perceive depression as a personal weakness. They don’t want treatment to be visible to others so they often won’t agree to hospitalisation or other treatments that might impact on work or social perceptions. Suicide feels less shameful than visible treatment, and they believe it enables them to keep their pride intact. The real work lies in changing these perceptions.”

Why men might be at greater risk
The vast majority of suicide victims in South Africa are male, according to research conducted by Africa Check.1 In 2012, 5 095 men of all ages died due to suicide – equalling nearly 14 each day. The male death rate for suicide was 21 per 100 000 people, over 5 times higher than the female death rate by suicide of 4.1 Given the factors that lead to suicide, as well as an understanding of how most cultures have groomed men to believe they need to be strong and act as the provider for the family, Lamont says it’s easy to understand why suicide rates in men are higher than in women.

“Men in general place increased expectations on themselves to perform and succeed financially. In addition, men may feel uncomfortable about reaching out or expressing the negative feelings that they may be experiencing. They therefore prevent themselves from gaining healthy perspectives and healthier solutions to their problems. That may be when hopelessness, helplessness and desperation take over.”

Lamont notes that society perceives it to more acceptable for women to discuss their problems and express their thoughts and feelings than men. It is for this reason that more women access care and get the help they need in order to eliminate suicide as the first option. People need to be made more aware that suicide is a thought many of us experience at some point, as we have all faced desperate times for different reasons, she says. For some of us, the idea of suicide happens for a brief moment when we find ourselves wishing we could just end a current suffering and wake up to find ‘it’s all over’.

“If you maintain that way of thinking long enough, however, you may begin researching and making plans on how to end your life. This is a dangerous place to be in, as it shows a strong intent to follow through with the act. The fact that the internet enables access to sites that support suicide and offer tips on how to successfully end your life are also problematic; they offer support and a sense of universality to someone who is desperate. It is far more beneficial to seek out services that offer constructive help.”

Recognising the signs of depression

It is important to be aware of the signs and symptoms of depression. Depression is a clinical illness created by an imbalance in the neurochemicals that controls our moods, Lamont explains. When someone is depressed their mood is not only low but their thoughts are influenced and they are temporally incapable of seeing circumstances realistically and thus generating realistic solutions. Their low mood also impacts on their general level of functioning within all their areas of life and therefore a change or deterioration in any aspect of someone’s life could be a red flag.

Lamont says depression manifests the following signs and symptoms:

  • Change in personal hygiene that result in a more unkempt appearance.
  • Changes in appetite that can often lead to unusual changes in weight.
  • Changes in sleep routine, with the individual often feeling more exhausted and needing to sleep for extended periods of time, staying in bed all day or for an entire weekend.
  • Avoidance of social interaction and remaining withdrawn or isolated. They may be less active on social media, for example, and their posts might reflect less energy or positivity than previously.
  • People who are depressed develop poor coping strategies such as an increase in smoking, drinking, and substance abuse. They may also begin gambling as an attempt to find a quick fix to financial pressures. These only have further negative impacts on their levels of desperation and their inability to generate healthier solutions.
  • Work performance may deteriorate and attendance may become problematic. Low energy levels and poor level of motivation can make it difficult to attend to daily tasks, which is particularly evident in the work place and at home.
  • People who are depressed will also avoid their usual leisure-time activities and there may be increase in activities that allow them to isolate or engage in maladaptive/addictive behaviours mentioned above.
  • Their thoughts may also reflect a general sense of hopelessness that can leave those who engage with them feeling negative and hopeless too. They may avoid conversations and may give you the misleading answer that everything is ‘fine’.

“As a family member or close friend, if you witness any of these behaviours, you need to trust your feelings of discomfort, recognise what you are seeing, continue to be supportive and encourage the person to seek help,” Lamont stresses.

Both inpatient and outpatient treatment are available. What is most important is that the person concerned gets help and finds a connection with a professional who will ensure they get the assistance they need. Different layers of treatment exist, from medication and psychotherapy to ECT (electro-convulsive therapy) and TMS (transcranial magnetic stimulation), and ketamine drips. “It is important for the individual not to be ashamed to try these,” Lewis says.

If you are concerned about yourself or someone who you care about you can contact the following:

  • Your local clinic
  • South African Depression and Anxiety Group (SADAG):  0800212223
  • Lifeline: 0861322322
  • Your GP – they may refer you to an appropriate service
  • Religious, spiritual or community centres
  • Akeso Clinic Group: 0861 HELP US (4357 87) or Akeso Randburg: 087 098 0457
  • Befrienders South Africa: 051 444 5691
  • Any emergency medical service or your closest emergency room

Communities play a critical role in suicide prevention. They can provide social support to vulnerable individuals and engage in follow-up care, fight stigma and support those bereaved by suicide. We can all assist in reducing the suicide rate in our country by being more open and understanding with people who are struggling in the difficult times we are facing. Encourage anyone who you feel is struggling to access help.

Facts and Figures

  • Globally, more than 800 000 people die due to suicide every year.2
  • Suicide is the second leading cause of death in 15-29-year-olds.2
  • There are indications that for each adult who died of suicide there may have been more than 20 others attempting suicide.2
  • Suicide was the fourth leading cause of death for young people aged 15-24 in South Africa in 2012. That year, 1,665 young people died as a result of suicide.2
  • 78% of suicides occurred in low- and middle-income countries in 2015.2