The Importance of Asking, “How Are You?”

“So, you are depressed. Let me get the questionnaire” says the GP, as they scrabble around with some papers in a drawer and the noise feels like a cacophony in your head because it’s so full already of everything that you are feeling. They start to fire off questions in rapid succession. Are you depressed? Are you anxious? Have you been eating normally? Have you cried today? On it goes. Until…

“Okay. Question eight. Are you feeling suicidal?”

How many times must this question be asked to people feeling unwell in their heads and how many times must it actually be answered truthfully? I’ve sat on that hard, grey chair as a harassed, over-worked, well-meaning but time poor GP has asked this question, barely looking up from the paper to see if my eyes flicker ‘yes’ as my mouth says ‘no’. I was asked it twelve times during my illness, and at least three of those occasions I wasn’t about to attempt suicide, but I was certainly having feelings that if I wasn’t here, it would be a hell of a lot easier on everyone.

It’s hard for me to remember fully that overwhelming feeling of breathing through the darkest thoughts I’ve ever had. Lying awake at night, my mind yearning for the darkness to come and envelope me forever. I didn’t have persistent suicidal thoughts, and I wasn’t going to commit suicide, but there were a small handful of times, over a four year period, when the hopelessness turned into deep darkness that just felt too much, too overwhelming and too heavy to deal with. I wouldn’t say I was ‘suicidal’, I would describe it as just a total acceptance in those moments of the hopelessness of depression. It’s not a part of my life I want to remember now, now that I feel well, recovered, and now that the light burns so brightly. It took me a long time to understand and acknowledge those feelings and not invalidate them. I would refer to those thoughts as a ‘dark place’, ‘darkest thoughts’ because I didn’t want to make people I loved feel scared or sad. I didn’t want them to feel that I didn’t want to be here for them because it was never about that either. I didn’t want to feel guilty for making them feel guilty. I didn’t want to answer the whys and I don’t like to reflect on the hardest time of my life now.

But suicidal thoughts affect at least 20% of the population in their lifetime and this is something we have to start validating, discussing and breaking the silent taboo that surrounds this subject.

Today is World Mental Health Day 2019, and the focus is on that big, scary S word. Suicide. 

It’s scary, because the idea of someone making that final resolution to end their life terrifies us. It terrifies us to think that someone close to us could be so bereft of hope that they would wish to make such a permanent decision. We are terrified of the guilt, of the punch-to-the-stomach emotions, to the loss, the grief and the spiral of devastation that suicide leaves in it’s wake. It’s a subject so big that we refer to it in hushed tones and behind trigger warnings for fear that it’s catching, that someone may read or pick up on another person’s depression and do the same.

For those amongst us though who have experienced suicidal thoughts, or perhaps have considered or attempted to take their own life, suicide isn’t necessarily a choice that is easily made. It’s not a choice particularly at all, more an inevitable conclusion, a break from the chaos of their mental health, an unleashing of the burden they feel that they are to their loved ones. It’s a moment of blue sky in a storm, a titbit of clarity amongst the whirlwind of depression and hopelessness. A positive decision, almost. A decision of control, not the loss of control of their mind.

Suicide touches many of us throughout our lives. It’s the silent killer that walks amongst us for fear of being sectioned if we talk about it. Fear of appearing ‘mental’, or fear of losing everything if we dare to discuss what is really going on in our heads, despite the outward appearance. Not everyone who attempts or commits suicide ‘looks’ like they might make that decision. Many appear outwardly ‘normal’ and doing ‘normal’ things –  a drink with friends before they take their lives, a laugh with family before taking that drastic step, a full day’s work with the usual demands before going home to take the ultimate action, all the while hiding their depression and suicidal thoughts. So when they take that step into the unknown darkness, loved ones, friends, acquaintances are left with questions that have no answers. Why? What for? Was there something we could have said, have done, have shared? The ifs, the buts, the maybes come flowing thick and fast as those ‘left behind’ make sense of the incomprehensible.

There are no answers when someone takes their own life. It’s such a human need to make sense of situations that make us uncomfortable or sad. A need to put the jigsaw together, find the pieces so that we can understand the whole picture. There may be reasons, triggers, warning signs, red flags – but answers are pretty thin on the ground, and coping with that, in grief, can be profoundly difficult and for many who have lost a loved one to suicide, bewilderment, anger, frustration and ‘how could you?’ are exceptionally normal, frequent thoughts and stages through bereavement. But amongst the taboo of suicide there is an even greater feeling that we shouldn’t be angry when someone takes their own life and that in turn causes mental health breakdowns and illness. We have to talk about the whole picture of suicide in an open conversation, to not only understand why someone might reach the point of taking their own life, but also to help those who are left behind to manage the emotional and physical aftermath.

This is of course all part of a bigger conversation, and actions like changing societal taboos may seem too mountainous and too big to take on, especially around difficult topics like suicide prevention. But there are smaller acts that we can do between us, little actions that can make a difference and many of them start with a simple ‘How are you?’. It’s a bigger question than it seems, because of course that person might open up a conversation that you aren’t prepared for and don’t really know how to deal with. Sometimes, you don’t need to do anything more than listen, hold someone if they need it, and allow them the space to talk. Don’t try and diagnose, or second guess their feelings. Just allowing someone to talk freely helps. Sometimes, gently advising them to speak to their GP, or wellbeing service locally might help. You can share websites like the NHS ‘Every Mind Matters‘. Ask them what might help too. But importantly, you don’t need to be an expert in mental health, or suicide, to help guide someone to safety and help support them in an hour of need.

The most important question of all though, is the simplest. How are you today?

Here’s some additional advice for safely helping someone who is mentally unwell: 

Supporting someone with mental illness:

Samaritans:
Tel: 116 123
www.samaritans.org
Mind
Mind Infoline: 0300 123 3393
The Mind Helplines support with a range of topics from mental health illness, where to get help in your local area, medication and alternative treatment advice, and advocacy.
https://www.mind.org.uk/information-support/helplines/

Facts and Advice for someone supporting a loved one or friend with mental health problems:
https://www.mentalhealth.org.uk/publications/supporting-someone-mental-health-problem

Advice for helping with mental health crisis

Your GP, or local A&E can help with mental health crisis.
If a loved one is feeling in fear of their own actions, please urge them, or take them to A&E for help, or call 999 if they are in immediate danger.

Other resources:
SHOUT Crisis textline: If you need help immediately, you can text SHOUT to 85258 and chat by text and trained volunteers will listen to you and help you take next steps.

Rethink : https://www.rethink.org/advice-and-information/carers-hub/getting-help-in-a-crisis/