- Suicide is a preventable public health issue, but talking about it risks unintentionally increasing suicide in vulnerable groups. Careful consideration is needed regarding the focus, audience, format, and location of any discussion. - One-on-one conversations with those considering suicide or affected by loss can increase understanding and prevent isolation, if the listener avoids judgement, asks directly about thoughts of suicide, and encourages help-seeking. - Media reporting on suicide methods and glorifying death can increase risk of copycat behavior in vulnerable groups, so care is needed in story details and focus on prevention resources. Social media may both help connections and pose unknown risks regarding moderation. - Workplace programs should identify and support

1. Suicide risk and talking
about suicide
Jaelea Skehan
Director
Hunter Institute of Mental Health

2. The Hunter Institute of
Mental Health is a leading
National organisation
dedicated to reducing
mental illness and suicide
and improving wellbeing
for all Australians.

3. Overview
• Brief recap of facts and statistics;
• Why people die by suicide;
• Talking about suicide;
– Individual conversations
– Group conversations
• Brief overview of media and suicide

4. What do we know about why people
die by suicide?
Traditional approach of risk and protective factors
Modern theory by Thomas Joiner

5. Common misconceptions
• Most suicides occur without warning
• People who attempt suicide are just selfish or weak
• People who talk about it are just seeking attention
• Talking about suicide with someone will give them the
idea.

6. Summary – risk factors

7. Protective factors for suicide
• Being connected or belonging to a family, peer group, or
community;
• Having at least one person to relate to and bond with;
• Having the skills to deal with difficult situations;
• Spirituality and beliefs;
• Good physical and mental health;
• Effective treatment for mental illness and emotional problems.

8. Serious Attempt or Death by Suicide
Those Who
Desire Suicide
Those Who Are
Capable of Suicide
Perceived
Burdensomeness
Thwarted
Belongingness
Sketch of the Theory by
Thomas Joiner

9. What do we know about ‘talking
about’ suicide?

10. Some assumptions
• Given suicide is a preventable cause of death which is
important to communities, saying NOTHING about how to
prevent it makes no sense.
• If you are worried that someone may be at risk of suicide,
saying NOTHING makes no sense.
• If you know someone who has experienced a loss, saying
NOTHING makes no sense.
• Given suicide is an issue that affects everyone, having a media
that reports NOTHING about the issue makes no sense.

11. But…

12. Talking about suicide
• Suicide is an important issue of community concern;
• It is important that as a community we are engaged with the
issue;
• Often confusion about what is meant by “discussing” or
“talking about” suicide, and confusion about the evidence;
• Need to ensure we are not
“too afraid” to talk about
suicide, while respecting
and understanding the
risks.

13. Talking about suicide
The risk associated with the “discussion” seems to be related to:
 The focus of the information (about death, about how to cope
with a death, about the broader issue);
 The status of the individual receiving the information (little
interest, vulnerable, bereaved by suicide);
 The format they receive the information (face-to-face, media);
 The place they receive the information.

14. 4 broad groups for communication:
1. Not affected and not interested;
2. Some level of interest or connection to the issue;
3. Vulnerable, at risk; **
4. Those affected or bereaved.

15. What we know and don’t know
We know:
• Talking to someone, one-on-one, directly about suicide will not increase
their suicide risk (although the empirical evidence is weak);
• Media reporting of suicide deaths has been associated with increased
risk for those who are vulnerable to suicide;
We don’t know:
• Whether group presentation about suicide will increase or decrease
suicide risk (e.g. evidence from schools);
• Whether more general media reporting about suicide (or awareness
campaigns) will increase or decrease risk.

16. Stigma and suicide
• Many agree that there is a stigma associated with suicide.
However, the approach to reducing stigma associated with
suicide MUST be different;
• Need to reduce “ignorance” without reducing the “fear”;
• That is, we need to address the myths and misconceptions
without inadvertently presenting suicide as something that
should be feared less.

17. One-on-one conversations
• People have reported avoiding the conversation for fear of saying
the wrong thing or most likely to talk to others about the person.
• If you are worried about someone or know someone who has
been affected or bereaved by suicide it is better to reach out
than avoid the person.
• Avoiding the discussion can lead to people feeling more isolated.

18. One-on-one conversations
 Decide to talk to the person, preferably face-to-face;
 Listen without judgement and don’t try to fix the situation.
People want understanding rather than solutions;
 If you are worried they are thinking about suicide, then ask
directly and be prepared for the answer;
 Talk to the person about who else to involve so they can be
supported and encourage them to seek help.
 Take care of yourself. These conversations can be difficult and
you may need support as well.

19. Group conversations
 Understand the purpose of the discussion and the setting;
 Plan messages carefully – the larger the group, the less likely
you can monitor the response;
– Messages will have different impacts depending on the
group and the reason they are coming together
– We need to alert rather than alarm
 Think about the words you use and details about suicide that
are given;
 Use an experienced facilitator who can manage responses;
 Think about how you will support people.

20. What do we know about media
reporting of suicide?

21. • Over 100 studies have looked at media reporting of suicide and
its impact on suicidal behaviour;
• 85% of studies have shown an association between media
reporting and increases in suicidal behaviour following;
• The risk of copycat behaviour is increased where the story is
prominent, is about a celebrity, details method and/or location
and where is glorifies the death in some way;
• Whilst healthy members of the community are unlikely to be
affected, people in despair are often unable to find alternative
solutions to their problems;
• People may be influenced by the report, particularly when they
identify with the person in the report.
The evidence: media and suicide

22. Media challenges
• While talking about suicide will not generally increase risk,
media is not a conversation, it is one way communication;
• Messages in editorial are not “market tested”. That is, we
have no way of monitoring how the story is being interpreted
by people sitting in their own homes;
• People may take away different messages than those that
were intended;
• Raising awareness on its own (e.g. increasing reporting) is not
enough to change behaviours;
• Not all media are the same – they don’t all have the capacity
to cover the issues well.

23. Positive role of media?
• The media has a role to play in raising awareness of suicide, but
there is generally a lack of evidence supporting any positive
benefits.
• But some studies or expert opinion suggest that:
– Personal stories about someone who has managed suicidal
risk as protective;
– Focussing on the impact suicide could be protective;
– Adding help-seeking information can be helpful;
– Adding information about risk factors and warning signs can
be helpful.

24. Social media?
It is likely that social media is working across domains:
– One-on-one conversations (with or without onlookers);
– Large group communication about suicide deaths and the
issues broadly (driven by the sector and individuals);
– Attempts at social marketing using social media are not
evaluated and rarely driven by suicide prevention;
– There are many opportunities for connection and engagement,
but little is known about the risks;
– Emerging evidence is mixed (e.g. moderated v non-moderated
forums).

25. Social media?

26. TIPS: Whole service approach to
supporting workers
• Create a supportive environment for staff through policies,
culture, staff practices;
• Have clear and consistent policies around problematic behaviour
– e.g. bullying, alcohol;
• Build in opportunities to develop connection and relationships;
• Have a system in place to identify and support staff who may be
at risk of mental health problems or suicide;
• Develop broader partnerships with other health and community
services and supports.

27. TIPS for peers
 If you are concerned then ask about suicidal thoughts;
 If the person is not having suicidal thoughts it can lead to a
conversation about other support they may need;
 If they do disclose suicidal thoughts, don’t panic and don’t
dismiss the thoughts;
 Listen without judgement and don’t offer solutions.
 Never promise confidentiality about suicidal thoughts
 Follow policies and arrange appropriate referral
 Bookmark good resources you can access quickly

28. Conversations Matter
Community resources to guide and support safe and helpful
conversations about suicide.
Available online at www.conversationsmatter.com.au

29. Conversations Matter
The resources will assist
communities when:
 They want to know how to talk
about suicide more generally.
 They are worried about
someone and want to know
what to say and do.
 There has been a death and
they want to know how best to
handle individual and
community level conversations.
Resources available as:
• Online presentation
• Printed fact sheets
• Podcast
Also has:
• Links to services
• Supporting
factsheets
• Research reports

30. Contact Us:
Email:
Jaelea.Skehan@hnehealth.nsw.gov.au
Mindframe@hnehealth.nsw.gov.au
himh@hnehealth.nsw.gov.au
Twitter:
@jaeleaskehan
@HInstMH
@MindframeMedia
Websites:
www.himh.org.au
www.mindframe-media.info
www.conversationsmatter.com.au