Written: November 6, 2022
Recently I was watching a television documentary where someone had called 999, because they were having strong suicidal thoughts. Someone on the programme commented: “He is asking for help so he doesn’t really want to end his life.”
This is something we hear quite frequently. It’s perhaps understandable that someone might assume this if they don’t work in crisis services – but the reality is almost always much more complex.
The reality is that someone can have strong and genuine intent to end their life, but they may still be able to ask for help – because at that moment, a small part of them is still trying to survive. This is a very fragile situation because their ability and willingness to seek help may evaporate very quickly, and they may stop seeking help. It is why professionals need to seize the opportunity to help, while they can.
It can be really helpful to think of the situation in that way: the bigger part of them may have strong intent to end their life, but a smaller part is still trying to survive. That small part may be as little as 5% of them.
Clinicians will often express this in a different way. Clinicians will often talk about someone “feeling conflicted” about wanting to end their life, but that phrase alone may not always highlight the extent of someone’s risk. It may not always highlight that the “inner conflict” could be very heavily weighted towards ending their life at that point, in the way I have described.
We sometimes hear similar comments when someone makes a suicide attempt and asks for help afterwards – for example, they call emergency services in the hours afterwards. I have heard comments such as “they asked for help afterwards so they didn’t really want to end their life” or “it couldn’t have been a genuine attempt” or “it’s a cry for help”. Or even, worryingly, “it’s attention-seeking”.
Again, it’s complex. It is possible for someone to have strong intent at the time when they made the suicide attempt. Their distress levels (or their emotional pain and suffering) may have reached a peak at that time. At such times, someone’s clarity of thinking may have diminished. High levels of distress can compromise our ability to think clearly. We may act impulsively at this time, while our thinking is influenced by acute and overwhelming emotional pain or distress. In the hours that follow, someone’s distress levels may subside a little. This may mean they feel able to seek help at this point.
Even when the suicide attempt is planned, rather than impulsive, it is possible for someone’s thinking to change in the hours afterwards. When someone has a focused intent to end their life, it can be like having a kind of “tunnel vision” where everyone you care about, and everything that matters to you, has disappeared from your mind – you are no longer able to hold them in your mind. It is a very “disconnected” place to be in. In the hours afterwards, it is possible for something to happen that breaks through the barriers and reconnects them with life. That can mean that they are able to seek help, at this point.
Suicidal feelings are infinitely complex, and individual.
If professionals take too much assurance from the fact that someone is seeking help (either before or after a suicide attempt), they may not recognise the person’s future risk of ending their life. Someone who is seeking help today may stop seeking help later today, tomorrow or in a few weeks or months’ time. How professionals respond to them today may influence whether they ask for help again. If professionals appear to minimise or be dismissive of their risk, they may question the point in seeking help. It is really important to someone experiencing a suicidal crisis that we recognise their risk.
In our research into deaths by suicide in 2017, we found that most of the individuals who died had sought help from a medical professional in the days or weeks before they took their own life. We need to always be aware that tragically, even when someone has previously sought help many times, there may be a day when they stop doing so. They are much more likely to continue to seek help if professionals respond appropriately and compassionately. Whenever someone in suicidal crisis seeks help, it’s vital that professionals provide a response that recognises and acknowledges the person’s risk, and offers kindness, care, and ongoing support. We want to ensure that they continue to seek help.
We should always hold this in our minds: seeking help does not mean an absence of risk.
Joy Hibbins runs a Suicide Crisis Centre and is the author of “The Suicide Prevention Pocket Guidebook” and “Suicide Prevention Techniques” (available from most bookshops: the books are raising money for the Suicide Crisis Centre): Suicide Prevention Techniques | Suicide Crisis
For information about the Suicide Crisis Centre: https://www.suicidecrisis.co.uk
The Samaritans offer listening support in the UK on 116 123