Most people who kill themselves are of working age and the workplace has the potential to effectively address suicide prevention and intervention, as well as the crisis that often follows a suicide death or attempt, writes Dr. Eoin Galavan.
Every home, family, school and organisation has been visited by suicide either directly or indirectly at some point. Most people who kill themselves are of working age and the workplace has the potential to effectively address suicide prevention and intervention, as well as the crisis that often follows a suicide death or attempt. Each workplace should have an understanding of how to identify and respond to family members and co-workers who may be experiencing suicidal thoughts or feelings.
There are many tragic elements to death by suicide. Talking about suicidal thoughts or feelings invariably leads towards help with whatever is causing these thoughts or feelings in the first place. Knowing how to navigate this conversation and to help people access appropriate support is vital. People spend a huge amount of their time in work, and as such whatever is going on in their personal lives invariably finds its way in some form or other into the office.
The dark cloud hanging over someone’s head in the morning, the conversation that seemed to end very abruptly, the despondency about a new project that would usually generate enthusiasm, may all signify that something deeper or more troubling is going on.
There is a lot we can do, particularly in the work environment, about the desire for death.
The bridge between the private world of someone who may be on a trajectory towards suicide and the conversation about this with a manager is by no means a certain journey, however it is one that must be crossed on occasion. It requires both manager and employee to be able and willing to have this conversation. This demands an organisational culture which encourages and permits this conversation. It requires managers to take responsibility for having this conversation at times, in turn modelling the willingness to enter into conversation about suicide or other more general struggles.
Managers can demonstrate a willingness to ‘go there’ with their employees by sensitively enquiring about how things are, and by not being fearful of naming suicidal thoughts. Many people visit suicide in their minds, and most people who do will not die by suicide. Most who talk about suicide, will not die by suicide. To the best of our knowledge there is no risk generated by encouraging someone to talk about it. People who are thinking about suicide and are asked about it are often relieved that someone has taken the step to opening the conversation. Everything we know about suicide suggests that if we talk about it with people, this can generate the possibility of change and hope.
Having an understanding of what’s going on in the suicidal mind is the base information required to help navigate this conversation. There are three key elements to the suicidal mind, all of which are potentially related to working life and organisational culture. The first two create the desire for death i.e. perceived burdensomeness and thwarted belongingness and the third refers to the acquired capacity for lethal self injury.
Perceived burdensomeness is captured by the idea ‘they’d be better off without me’ and speaks to the deep innate human need to feel purposeful and effective in our lives. Work is often the channel through which people meet this need. When people start to feel ineffective or useless, they can start to feel like they are a burden on those around them, and suicide can be seen as a means to relieving others of this burden. Feeling effective, like we play an important role in the world, is a vital element to our well being and motivation.
Thwarted connectedness refers to the experience of being loved or cared for or valued in our relationships with others. The need to be cared for, loved, respected, wanted etc is another basic human need, which when thwarted, can give rise to the desire for death. It is captured in the idea ‘nobody cares’ or ‘nobody would miss me if I was gone’. These two together can very powerfully drive the desire for death: ‘they’d be better of without me’ and ‘nobody cares.’
However this is not enough as people are still, rightly, fearful of death. People have to do things to override their innate fear of death. Over time people can think about a certain means of lethal self injury so that it stops eliciting the protective fear response and instead seems like a source of relief. It is in the context of decreased fear that the desire for death becomes most dangerous. Fortunately there is a lot we can do, particularly in the work environment, about the desire for death. Helping people to feel useful and connected in work is already a good idea for all sorts of self evident productivity and organisational culture based reasons. As such the conversation that identifies the presence of suicidality is critical to allow consideration of how to try and increase a person’s sense of connectedness and effectiveness as well as directing them toward peer support, EAP counselling or appropriate mental health care when needed.
For decades in Ireland the issue of suicide has been hidden beneath stigma generated by its previous status as illegal in the eyes of the law, and immoral in the eyes of the church. It still carries myths such as ‘suicidal people are selfish’ and ‘suicidal people are cowardly’. Neither stands up to much rational scrutiny. What is now required is a brave and bold stance across our society demonstrating a willingness to talk about suicidality and the knowledge of how to do this well. Managers in health care can be leaders in this endeavour.
Eoin Galavan is a Senior Clinical Psychologist and Clinical Lead in the Suicide Assessment and Treatment Service, HSE Adult Mental Health services. Dr. Galavan is also a Senior Supervising Psychologist with the Doctoral Training Program in Clinical Psychology TCD.