A Sane Australia study reveals the mental health system is missing a key ingredient – the advice of survivors
Survival stories from those who attempt suicide should drive mental health interventions but have been missing from policy discussions, Australia’s national mental health commissioner has said. Prof Ian Hickie said this omission was partly because of society’s often callous view towards suicide.
A study of 31 people who had attempted suicide was released by the mental health charity Sane Australia and the University of New England on Thursday.
The interviews revealed people overwhelmingly attempted suicide because they believed they were a burden, and that their family and friends would be better off without them, a national suicide prevention conference in Perth was told.
Almost 90% of those studied reported having been diagnosed with at least one mental illness, and 11 people reported making multiple suicide attempts.
Triggers for the attempts included symptoms of mental illness, a lack of professional support, being bereaved by suicide, and drug and alcohol use, the study found.
“Like many people who have been through a difficult health experience, people who have attempted suicide often have profound insights into the difficulties of others in a similar situation and how health systems have helped or hindered them,” Hickie said.
“There is no lack of stories about cancer survivors, or stories of people living with HIV and other illnesses, but we have tended to shun suicide stories as too hard.”
The result had been a lot of theorising in society about the reasons for suicide, said Hickie, who is also the executive director of the University of Sydney’s brain and mind research institute.
“Everyone talks about why they think someone may have attempted suicide, and you sometimes hear people who have never been directly affected by a suicide say, ‘it must be what they wanted’ or that the person is just ‘selfish’,” Hickie said.
“But what we overwhelmingly hear from people who have attempted suicide and survived is that they wrongly believe they are acting out of selflessness because they see themselves as a burden, and that they are so grateful they were not successful at their attempt.
“People who attempt suicide, who have thankfully survived through some stroke of luck, often report having this profound realisation during their attempt that they want to live.”
They also realised the devastation they would have caused their loved ones had they killed themselves, he said.
“Historically we have been callous toward those with a mental illness, and while I think that attitude is shifting for people with depression, some people, including the medical profession, still struggle with feeling empathy towards extreme cases of mental illness like schizophrenia and suicidality,” Hickie said.
Understanding people’s distress could help drive greater empathy. But empathy was only achievable through education if that education included the stories of people who had attempted suicide, he said.
The study found that access to effective treatment and developing a trusted relationship with a health professional, such as a psychiatrist, was crucial in helping people recover, as was support from family and friends.
“We’ve learned to handle stories of other illnesses sensibly and sensitively,” Hickie said. “And in Australia the media has been very good at reporting on suicide in a sensitive and non-ghoulish way. But there is a difference between appropriate reporting of suicide stories and no reporting at all.
“We do want to disapprove of the action of suicide, while making it clear we don’t disapprove of or reject the person. We don’t want people to suicide, we have to make that clear, and that’s why we need good first person accounts of people who have attempted it because, overwhelmingly, they regret it.”
Suicide is the leading cause of death for Australians aged 15-44, with the highest rate among middle-aged men, Australian Bureau of Statistics data shows. More than 2,500 people killed themselves in 2012 – the highest number in a decade. It has prompted Sane Australia to call on Australian federal, state and territory governments to commit to a goal to halving the suicide rate in 10 years as a matter of urgency.
Terry – not his real name – lives in regional NSW and has attempted suicide twice. On both occasions he described himself as “mentally unwell”. After his first attempt, he said he was admitted to the emergency department of a large regional hospital, but saw a psychiatrist for the purpose of discharge only, and was giving no referral or information about follow-up.
At the time, he said he had severe depression and was working in a “very difficult job, highly paid, but with very difficult staff and clients”. He sought support from his manager, he said, but was not offered any help.
His second suicide attempt was during detox for drug and alcohol addiction, during which he said his mental health problems were never addressed.
He said he took part in the research in the hope of helping others. Much healthier now thanks to ongoing support from his psychiatrist, he said the psychological support “made me a lot stronger and more stable”.
Sane Australia’s suicide prevention manager, Sarah Coker, led the research and said stories such as Terry’s highlighted flaws in hospital care and gaps in access to mental health services.
“The biggest barrier in our sample was finding effective treatments and ongoing professional support, and while some people had positive experiences of support, many said they experienced stigma, including from health services,” she said.
“The aspect they most often spoke about was feeling like they weren’t being taken seriously or that they were too quickly discharged or dismissed from health services, whether at an emergency department or by doctors.”
She said there was a lack of research in Australia that encompassed those experiences.
“Many studies have focused on prevention or clinical and expert opinion, neglecting the personal and lived experience of people who have survived a suicide attempt,” she said.
• Readers seeking support and information about suicide prevention can contact Lifeline 13 11 14 or Suicide Call Back Service 1300 659 467.
• Sane Australia Helpline 1800 18 SANE (7263)