Reflect

You might not have come across PAPYRUS before, but for almost 30 years, it was a UK charity which provided specialist suicide prevention support to young people, as well as advice for parents, carers and professionals worried about a young person. It was established in 1997 by a group of bereaved parents who had lost children to suicide. Most recently, its HOPELINE247 service offered free, confidential support 24 hours a day, 365 days a year, and was listed by the NHS (and by us at Tooled Up) as a national source of support for anyone experiencing thoughts of suicide, or concerned about someone who was.

The closure seems to have been abrupt. The organisation’s website was immediately switched off and, according to a report in the local press, staff providing support by phone, text and webchat found conversations with distressed people seeking help cut off almost mid-flow.

The closure of Papyrus seems particularly upsetting during a week in which we have been encouraged to talk more openly about suicide prevention, to “change the narrative” on suicide, and shift “from a culture of silence and lack of understanding to one of openness, empathy and support”. Frontline services like PAPYRUS’s helpline have undoubtedly been vital for many people, helping to mitigate immediate crises, reduce suicidal ideation and refer those in need to other support resources within their communities.

Over the last year, at Tooled Up, we’ve also found ourselves aiding families and school communities where suicide has become a very real part of their lives. We’ve received questions from parents worried about things their children have said or done, from educators wondering how best to help pupils experiencing suicidal thoughts, and, sadly, offered support to schools navigating the devastating aftermath of a death within their community.

We know that, for young people, asking for help with their mental health can be particularly difficult. A new outreach brief from the International Association for Suicide Prevention reports that more than 80% of teens who self-harm or experience suicidal thoughts don’t seek professional help, and many who experience suicidal distress may fear being judged, misunderstood or not believed. They may worry about what will happen if they tell someone, feel shame about how they are feeling or believe that they should be able to cope alone. By the time some young people reach out, their distress may already be severe.

All of this reinforces the central message of this year’s World Suicide Prevention Day, that conversations about suicide prevention can’t be confined to awareness days or campaigns. Many of us feel understandably frightened of talking about suicide. We might worry about saying the wrong thing, making things worse or even putting the idea into someone’s head. We might be concerned about someone, but feel unsure or uncomfortable asking if they need help. We might feel in crisis ourselves, and not know how or where to turn.

Perhaps changing the narrative means becoming a bit more empowered to engage with these uncomfortable conversations. It might mean understanding a little more about suicide and suicidal thoughts, knowing what might help protect the mental health of ourselves and others before crisis point, recognising when someone needs more than everyday wellbeing advice and, crucially, knowing what to do when we are seriously concerned about someone’s safety. Suicidal distress is not always visible, even to those who love and know someone best. There may be no obvious warning signs. People may conceal their feelings and suicide is a complex issue. We don’t want anything we say to leave anyone who has been bereaved feeling that they should have somehow known or done more. At the same time, whilst we can’t rely solely on someone in distress finding the words to tell us how they are feeling, we can try to get more confident in checking in and asking if something doesn’t seem quite right.

Research has repeatedly found that asking about suicidal thoughts does not increase suicidal behaviour. In fact, Professor Dennis Ougrin, a psychiatrist who specialises in the prevention of self-harm, made it clear to us at Tooled Up that it is protective, reducing the likelihood of future incidents. We don’t need to avoid the word ‘suicide’ or rely on vague questions if we are genuinely concerned about someone. Asking calmly and directly can help enable young people to tell us what is really going on.

Motivate

Experts note that one of the most useful things we can do at home is take any emotional distress seriously, even when we don’t fully understand what has caused it. During our conversations with Professor Ougrin, we’ve learned that self-harm and suicidal attempts are often associated with emotional dysregulation (when individuals struggle to regulate their emotions). For some young people, something that might appear relatively minor to us can provoke an intensely painful emotional response for them, and it may take them much longer than we expect to return to their usual emotional baseline.

Our instinct as adults can sometimes be to reassure with well meaning but minimising comments: “It’s not that bad.” “Try not to worry about it.” “You’ll feel better tomorrow.” For a young person feeling distressed, our attempts at offering a sense of perspective may be less helpful than simply acknowledging and validating their feelings, which can help to communicate that it’s safe for them to talk about challenging thoughts and emotions. (If you’d like to learn more about why ‘validation’ is such a powerful parenting tool, check out this video).

In short, when emotions are running high, Professor Ougrin encourages adults to pause, listen and attempt to put ourselves in the young person’s shoes in order to look for the ‘kernel of truth’ in their perspective. We might say, “I understand why you are so upset” or, “I can see why that felt really difficult”. We don’t have to agree with everything a young person says or does, but ideally we want to communicate that we have heard them and are genuinely taking their emotional experience seriously. Another of his top tips is to use ‘and’ rather than ‘but’ where possible: “I understand that you’re really angry and we can think together about what happens next” has a very different tone to “I understand that you’re really angry but we can think together about what happens next”. This all might feel a little awkward at first but validation is a skill, and Professor Ougrin promises that it will become more natural with practice.

He also told us that once emotions have settled, it can be helpful to gently reflect together on what happened. What was going on beforehand? What were they thinking and feeling? What seemed to make things worse or better? Was there anything that helped them cope? Over time, conversations like these can help young people become more aware of their own emotions and identify strategies that they might draw on when difficult feelings arise again. It can be equally useful to revisit times when a young person felt overwhelmed but managed to cope differently: what did they do, who or what helped, and is there anything from that experience that might be useful again?

These kinds of approaches can help young people feel heard, understood and able to talk about difficult emotions, but they do have limits. Validation, connection and the everyday things that we all know support good mental health are not substitutes for appropriate professional help when someone is experiencing persistent or severe distress.

If you are UK-based and need support or are worried about someone else, help is available 24 hours a day from the Samaritans – call 116 123, or by text from Shout – text SHOUT to 85258. For urgent mental health support you should always contact your GP or your local NHS urgent mental health service, and if someone is in immediate danger call 999 or go straight to your nearest A&E department.

Support

She went on to note that there are many understandable reasons why talking about suicide as the cause of a death can feel incredibly difficult. Our instinct may be to protect children from painful information, particularly if we are struggling with our own grief and the prospect of managing their emotions too feels overwhelming. Adults often fear that they don’t have the right words, that they might make things worse or that they will face difficult questions. Ongoing stigma and shame around suicide can make these conversations even harder.

Beck encourages any family in this position to recognise all of these very real barriers, whilst also considering what they are trying to protect children from and whether silence is ultimately the most helpful way to do that. She notes that when a child hears what has happened from an adult they love and trust, they don’t have to try to make sense of it alone, particularly if they already know (or think they know) some of the story. Without an honest explanation, children may spend time grieving for a different kind of death, only to have to revisit their understanding when they eventually discover what really happened. There is also a risk that they hear information elsewhere, perhaps through other people or online, where we have much less control over its accuracy or sensitivity. Trusted adults are better placed to correct misunderstandings, answer questions where they can and remain close enough to notice when a child might need additional support.

Beck recommends approaching these conversations as an ongoing process, and taking a gentle and unpressured approach. She suggests starting by finding out what the child already knows or thinks, then offering information gradually, at a level appropriate to their age, understanding and questions. She also encourages adults to use clear, factual language. Although we may instinctively want to soften what has happened, euphemisms can be confusing whilst using words such as “died” and, when appropriate, “suicide”, can help children understand what has happened.

Children or young people who are bereaved by suicide are also likely to have questions about why or how the person died. One simple activity Beck suggests is drawing a large question mark and inviting the child to write their questions around it. Together, you can explore which questions have answers and which are things that we simply cannot know. This can help children become a little more comfortable with uncertainty and understand that it’s okay for some questions to remain unanswered.

Beck stresses the importance of being honest about the fact that we can never fully know all the reasons why someone dies by suicide. Where appropriate, trusted adults might talk gently about some of the struggles or difficulties the person had been experiencing, whilst avoiding overly simplistic explanations. Children need to know that they are not in any way responsible.

Every child will live with loss differently, but one of the most important protective factors for bereaved children and young people in general is having a strong support network including at least one trusted adult who can be there for them with a listening and validating ear. This support can help children find ways to live alongside their grief, rather than feeling that it is something they need to ‘get over’.

When we spoke with Beck, she introduced a helpful model developed by grief counsellor Dr Lois Tonkin called Growing Around Grief. It imagines grief as a ball inside a jar. We might expect the ball to gradually shrink, but instead, it is the jar around it that grows. Whilst grief remains a significant part of a person’s life, there gradually becomes more space around it for new experiences, relationships, routines, learning, joy and all the other good stuff. Laughing, playing and enjoying time with friends can co-exist with grief, and helping children understand this can reduce any guilt they might feel. If a child or young person becomes highly anxious, withdrawn or unable to engage in everyday life for a prolonged period, this may indicate that they are struggling to process the grief and may need additional support. But for many children and young people, gentle encouragement, predictable routines and trusted relationships can help them gradually feel safer re-engaging with the world around them.

There are some excellent resources available for anyone supporting a child who has experienced the loss of a loved one through suicide. Take a look at Luna’s Red Hat, Beyond the Rough Rock, Safe Harbour and My Grief Handbook, written by Beck for teens. Whilst it does not focus explicitly on suicide, the teen advisor on the project had been bereaved by suicide and it’s a great, research-based book to help teens understand their grief.