Can you save someone from suicide? Here's an in-depth guide to becoming a mental health ally

Every question you may have wanted to ask but didn’t know how

Sushant Singh Rajput’s tragic death by suicide opened the floodgates to a sea of messages with a common underlying sentiment – what could we have done to prevent this? Could having a mental health ally have saved the person?

Approached rationally, it’s close to impossible to answer the question. However, this sense of accountability and shared guilt mirrors the sentiments of every single person who loses a loved one to suicide.

Sometimes, you don’t spot the signs until it’s too late. Or maybe you don’t know how to bring it up and worry about unwittingly making it worse.

We turned to psychiatrist Dr Syeda Ruksheda and psychologist Prachi Vaish to answer all the questions you might have about being a better mental health ally and possibly preventing a suicide.

What signs might give away the fact that someone is suffering from mental illness or contemplating suicide?

Sudden changes in mood could be a sign of mental illness. Red flags shouldn’t just go up when a person is low and out of sorts for an extended period of time, but also when the person acts uncharacteristically cheerful.

“A sudden positive mood shift could indicate that they think they’ve figured out a way to end their pain, and must be taken as seriously as sadness,” explains Vaish.

Other signs include extensive communication with a large group of people or radio silence. Erratic changes in social media activity too might be a tell.

“As a mental health ally, it’s important to work on your ability to identify emotions accurately because a lot of the times, the same emotion can be expressed in multiple and varied ways,” says Ruksheda.

A high functioning adult would not cry or use “sad” to describe their state of mind. For them, phrases like “I don’t feel like doing anything,” “I feel tired even when I shouldn’t be tired,” and “I’m doing everything but not enjoying it as much” are the giveaways.

Are signs of mental illness in children the same as those in adults?

The indicators of mental illness in children are considerably different because often they “might not be cognitively developed enough yet to understand and identify their emotions accurately. So other symptoms might surface,” explains Ruksheda.

Children will not say that they are feeling sad, but might complain about aches and pains with no apparent cause.

Sulking, tantrums, cranky behaviour, not wanting to studying or a lack of interest in playing can all be symptoms of mental illness. Other signs include tics, twitches or habits such as biting nails.

Even though a lot of these signs can pass off as an unruly phase in your child’s life, pay close attention. “One in five people have a mental illness, and 50% are diagnosable by age 14,” says Ruksheda.

Can someone seem positive and upbeat but still be depressed?

“Smiling depression and high-functioning depression are forms of mental illness where people are able to hold down a regular job and go about their daily lives without it actually showing on their faces,” explains Vaish.

That makes it very difficult for a mental health ally to recognise when their loved one needs help.

“But remember that people can’t put up an act round the clock. So at some point or another, loved ones will definitely be able to tell that there is something wrong, but there are obviously cases where the mental illness has gone undetected,” says Ruksheda.

As a mental health ally, you should be vigilant but don’t put undue pressure on yourself by expecting to sense a problem when it is actively being hidden from you.

Do mental health issues manifest differently in men and women?

“Rather than a gender difference, it should be looked at as a coping style or personality difference. Two people of different genders but similar personalities could manifest the same behaviour,” explains Vaish.

Having said that, there still are trends that have been observed.

Vaish explains that women are usually more vocal, and often resort to extreme measures in fits of rage. Men on the other hand, succumb to depression more insidiously and are better at hiding behind a mask of normalcy. “Women do hide their depression but they tend to engage themselves to keep it at bay,” she adds.

Ruksheda explains that in an Indian context, mood disorders are more common in women. Conditioned to be expressive, women are also likely to be more proactive when it comes to asking for help, but because of lack of access, often find themselves seeking treatment from a general physician.

An Indian male on the other hand has easier access to mental health professionals, but is less likely to reach out for help. “Similarly, there are more boys with ADHD than girls, however, the debate surrounding that is whether girls are in fact under-diagnosed,” adds Ruksheda.

What is the best way to broach the subject of mental health?

It is common for a mental health ally to feel apprehensive about reaching out. The reasons range from not having the right words and information, to the fear of making matters worse.

“Majority feel that asking someone if they are okay can potentially act as a trigger,” says Ruksheda. “This is untrue. It is scientifically proven that an open communication style is more effective. This also reduces the risk of suicide more than anything else,” she adds.

Vaish agrees, “There is a common myth that if you ask someone about suicide, you will plant the idea into their heads. That doesn’t happen. Instead, if you ask, you’re creating an open channel for any such thoughts to come out. It is best to approach the person confidently, gently, and in a straightforward manner.”

Here are some direct questions that you can ask while broaching the subject:

• You don’t look fine, are you okay?
• Is there anything that is bothering you?
• Can I help you with something?
• You told me the other day that you weren’t feeling okay, are you still feeling the same way?

Another important factor is your reaction to the information the person is sharing. As a mental health ally, try not to be judgemental. Judgement indicates disapproval, which will make your loved one retreat.

Shock and desperation are other emotional reactions to stay away from. Respond gently using statements like “I can understand how you might feel that way. Want to talk about it?”

Definitely don’t minimise what they’re feeling by saying  “What do you have to be sad about?” or “You should be grateful for everything that you have”.

How do you react to someone sharing their problems and become an active listener?

The first thing to do is to try and be non-judgemental. Rid yourself of biases by understanding the biology behind mental illness.

“It’s simple, the brain needs to function properly for the mind to function. Your thought processes and emotional reactions won’t change unless your brain functioning changes, much like your heart won’t skip a beat without a physiological stimulus,” explains Ruksheda.

Understanding this automatically helps you become more comfortable, and because you are better informed, you become more accepting.

Vaish encourages the use of supportive expressions such as “Hmm.,” “Yeah,” “Tell me more about that.” Or solution-oriented responses such as “How can I help?” and “How can I make it easier for you?”

One very important aspect of being an active listener is to learn how to sit through silence. “Sometimes people don’t express very well by talking, but they do need to comfort of being with someone,” says Vaish.

“Don’t push them to talk if they aren’t comfortable. Be silent when they cry, but stay with them. Don’t say things like “Don’t cry, it will all be okay,” she adds.

Don’t ever use comparisons. Drawing parallels with inspirational stories or quoting people who have overcome challenges often makes matters worse.

Toxic positivity in the form of statements like “Be grateful for what you have” or “Other people have it much worse” makes them feel like they are ungrateful, and adds to their emotional burden.

How do you gauge the intensity of the situation?

Step one is learning how to differentiate between the terms mental health, mental health issue, and mental illness.

Simply put, mental health is the equivalent to being physically healthy, a mental health issue can be compared to a slight cough, while the intensity of a mental illness is the same as when a person is diagnosed with tuberculosis.

“The intensity and urgency can also be gauged by assessing a person’s intent and plan,” says Vaish.

For example, if someone says “Sometimes, I think it is better to die.” You should counter that with “Have you ever thought about doing it?” If the answer is yes, then ask them about how they want to do it.

And if the person has a method in mind, or has made an effort to find out about it, then the situation is urgent and they may be contemplating suicide.

If you are worried about a loved one, you can also employ this suicide screening tool called ASQ developed by the National Institute of Mental Health, USA. “This test includes four simple questions that are arranged in the order of escalation to assess intent and plan,” explains Vaish. The questions are as follows:

• In the past few weeks, have you wished you were dead?
• In the past few weeks, have you felt that you or your family would be better off if you were dead?
• In the past week, have you been having thoughts about killing yourself?
• Have you ever tried to kill yourself? If yes, how? When? (to test for plan as well as recency)

As a mental health ally, you must consult a professional after assessing the intensity of the situation. Your job is to provide support, but you are not equipped to make a diagnosis and putting that kind of pressure on yourself is unfair.

What do you do if someone reacts badly when you initiate a conversation about their mental health?

Most importantly, as a mental health ally, you must never take these negative reactions personally.

Also, all you can do is just keep showing up, and wait for them to open up. Your consistency will help increase their comfort level.

Once you’ve established that a person is suffering from mental illness, how do you talk to them about getting help?

“Talk about examples of people around you who took professional help and recovered. Don’t talk about how if they just fix their attitude or their routine or eat well, they will snap out of it,” advises Vaish.

Small gestures matter – offer to find them a therapist, fix the appointment and even accompany them to it, if that’s what they need.

What do you do if someone is not open to the idea of getting help?

The only thing you can do is to support them until they are ready.

Let them know that it’s okay to take the time to make that decision. Maybe even offer to do their chores and lighten the load, to give them more time.

Let them know that you will keep checking in on them, and suggesting therapy — but first, ask them if they are okay with you doing that.

How do you monitor progress?

The change will be evident. More emphasis on self-care,  embracing a routine like showering, cleaning up the room, engaging in physical activities rather than vegetating in front of the TV, and eating better are signs of improvement.

Encourage their progress at every step by complimenting them, but don’t taint compliments by referring to how they are much better off than they were before they got help.

It is important to update the mental health professional your loved one is consulting to chart out actual progress.

How do you help them identify a good therapist?

Your first filter should be educational qualification. Pick a psychologist who has at least an M.Phil in clinical psychology from a recognised university, not a PhD. An M.Phil in clinical psychology certifies that the person is trained, whereas a PhD is merely academic.

It is always a better idea to consult a specialist. Says Vaish, “Try to find a specialist for the issue. There are many professionals who seem to do everything, that’s not a good idea.”

The patient’s rapport with the professional is another important factor to consider.

What if someone’s monetary situation comes in the way of seeking help?

Some mental health professionals do offer sliding scales, variable fees and discounts. Otherwise, group therapy is also a good option.

Online therapy has also come to be a more affordable and accessible form of treatment.

“There are many free avenues for temporary relief like helplines or people who do it for a nominal charge, but if you really want long-lasting healing, find a qualified, experienced therapist. It’s your life on the line,” says Vaish.

What’s the best way to ask for space, if your loved one’s mental health is taking a toll on you?

“It’s not easy to watch someone go through something, it’s not easy to be supportive, and it’s definitely not easy to keep on doing the right thing, and keep encouraging people,” says Ruksheda.

Self care is important because as a mental health ally, you can’t afford to burn out.

Take an off on one day of the week, take regular breaks, look after yourself, and keep reminding yourself that your life cannot revolve around this person.

It is also important to not enable your patient’s illness behaviour, which is separate from their actual illness.

“This means that you can’t allow them to bother you with their queries whenever they desire, unless it’s an emergency. Regulate this by setting a designated talk time sometime during the day, and ask them to jot down whatever they need to speak with you about, and tell you only during this time,” explains Ruksheda.

Also, just like people suffering from mental illness are advised to have a set of allies as opposed to just one, even a mental health ally should have back-ups who can take over in case they themselves are unavailable.

Is there a line that you shouldn’t cross when trying to help someone with their mental health?

Recognise that you aren’t a professional. If you feel out of depth, ask your loved one to reach out to a professional, who will be neutral and objective. A mental health ally is a supportive friend, you do not need to add another job title to that designation.

Another boundary that shouldn’t be breached is that of trust, explains Vaish. “Sharing information they shared with you in confidence under the pretext of asking for help or advice on their behalf is a big no,” she says.

How do you keep tabs on the medication your loved one might be consuming?

Unless you’re living with that person, this can be difficult. But if you are, then invest in pillboxes which can keep track of daily medicines, make tracking charts, check in once or twice a day to ask if they have taken their meds.

Ask their doctors to explain to you how the medicines work to better understand the underlying process — ask about dosage, side-effects, can it be consumed with alcohol, what happens if you skip a dose etc.

If the patient experiences side effects, offer to visit the doctor with them to resolve these issues instead of  toying with the dosage yourself.

If you notice shifts in mood or notice the condition deteriorating, they may not be taking their meds and you should address the issue with them upfront.

What do you do in case of you feel your loved one might be contemplating suicide?

Seek professional help — remember that you aren’t equipped to deal with such situations.

However, Vaish does share a couple of crisis management tips that can be employed after consulting an expert.

• Keep talking to them until you or someone else can reach their location.
• Get them to change their body chemistry by having them splash cold water on their face, hands and feet and the back of the neck.
• Do breathing exercises with them, but not meditation.
• Get them to go to where other people are as soon as possible. Suicide is an act of impulse, and even though it is premeditated for a long time, it is usually more likely to happen in isolation.

How do you cope with a loved one dying by suicide?

As a rule, seek therapy for yourself.

There is a lot that a mental health ally feels when their loved one dies by suicide – trauma, survivor’s guilt, regret, grief and a lot of questions. And the only way to deal with this responsibly is by enrolling in grief counselling to deal with the emotional baggage.

24-hour suicide prevention hotlines to call if you need help

Jeevan Aastha toll-free helpline: 1800 233 3330

HITGUJ helpline: 022 24131212

AASRA helpline: 9820466726