As we welcome spring in all of her glory, I can’t help but reflect on the intensity of April. The winter months are officially behind us, but its residual effects are still very much felt.
People are struggling mentally, emotionally, and financially.
The world we live in is not what it once was, and it’s becoming increasingly difficult to access the resources we need in order to take care of ourselves.
Last week, in the wee hours of the morning, the police showed up to my neighbourhood. I wasn’t sure what was going on until the next morning when a neighbour of mine found something startling on the sidewalk. Upon speaking with the authorities, I discovered that there had been a suicidal person in need of support the night before which is why law enforcement had been called.
This is one of many crises I have encountered this month, all within the realm of self-harm and suicide.
It breaks my heart to know that so many people are struggling, at their wits end, and feeling so utterly hopeless that they are contemplating or attempting to end their own lives.
And yet, I understand this to the very depths of my core.
I know what it’s like to feel alone, unwanted, helpless, and in such excruciating pain that you just can’t bear it any longer. To want it all to stop and not know any other possible way out.
I know this feeling because I’ve been there.
I was that thirteen year old girl being rushed to the emergency room three times in one year after attempting to take my own life. The young woman that had to wear long sleeves in the middle of summer to hide the scars on my arms.
I wore my pain externally because there was so much of it that I couldn’t possibly keep it contained.
I am very fortunate to still be here. And some of my friends are not.
They lost their lives to suicide and will never get to experience the beauty this world has to offer because their pain won the battle.
This is a big part of the reason why I decided to become a counsellor. Why I show up everyday and do this work.
What Causes Suicidal Ideation?
There are many reasons why someone will contemplate ending their own life or harming themselves.
Unresolved trauma
Physical, mental, emotional, spiritual abuse
Heartbreak
Lack of connection/support
Substance abuse issues
Mental health disorder
Concurrent disorder
Lack of resources
Chronic pain
Emotional pain
Grief and loss
When someone’s pain becomes too overwhelming, suicide can feel like the only way out. The only way to make it stop.
How to Assess Client Risk of Self-Harm + Suicidal Ideation?
When working with at risk clients, I like to focus on the 4 P’s.
Plan - Do they have a plan to harm themselves?
Pain - How much emotional/physical pain are they in?
Previous - Have they made previous attempts to harm themselves or take their own life?
Positive - Help them discuss positives (resources/reasons to live).
When discussing the positives, it can be useful to help the client identify upcoming events in their life that they have to look forward to. Even if it is something seemingly as small as waking up tomorrow to feed their dog.
Creating a Safety Plan
It is important to create a safety plan with your clients to make sure you are prepared in the event of an emergency.
This can also come in handy if your client doesn’t show up to session and you are concerned for their well being or have been working together to prevent self-harm.
By including your client in this process, the two of you can come up with a game plan that best supports their needs.
In your safety plan, you will need to address the following,
Possible triggers
Warning signs
Coping skills
Planned interventions
Self-care strategies
You will also want to obtain an emergency contact number and get your client’s consent to reach out to this trusted individual in the event of an emergency.
I make sure to provide client’s with the appropriate resources and numbers for the Suicide Crisis Helpline in the event that they experience distress outside of session and require immediate support.
Check in with your client during your sessions to gauge where they are at on a scale of 0-10 (0 being no risk, 10 being high risk).
Low risk doesn’t mean no risk!
The Benefit of Asking Powerful Questions
When I was in school working towards my Professional Counsellor Diploma, as the naturally curious person that I am, I asked my instructor how to address what’s really going on for someone experiencing suicidal ideation?
His answer has stuck with me and continues to be extremely useful when working with at-risk populations.
“Is it your life that you want to end? Or something in your life that you want to end?”
This to me is pure brilliance!
Oftentimes when we are experiencing something painful in our lives, it can feel overwhelming and all consuming. The lines between our situation and our life itself become blurred and our ability to emotionally regulate and problem solve feel completely out of reach.
By asking your client if there is something in their life that they want to end, we can begin to separate the problem from the person. This creates space and allows us to come up with a solution while maintaining client autonomy and working towards self-empowerment, strength, and resilience.
Don’t Be Weird
I can’t think of a more sophisticated way to say this, and quite honestly, this feels the most on point.
Don’t be weird.
You lose your client when you become noticeably uncomfortable the minute suicide gets brought up and dip straight into protocol by asking a bunch of safety questions.
If your client can sense your discomfort, it’s likely they won’t bring up their thoughts and feelings again.
Let’s take a moment to normalize the client’s experience.
This is not to say that thoughts and feelings of self-harm are a good thing, rather that people experience them throughout the course of their lives. More people than we think choose not to disclose these feelings out of fear of others' reactions.
As practitioners, we have the honour of being a safe, nonjudgmental place for our client’s to disclose their deepest, darkest feelings. And this includes suicidal ideation.
if this is an area of practice that is out of your scope, please lean on your network and refer your client to someone that can better support their needs
I can’t tell you how many times my younger self was struggling with thoughts of suicidal ideation while going to counselling. And I told no one.
My fear of being locked up and highly medicated was so strong, I decided it was best to work through it on my own. As we know, a lack of connection, understanding, and support fuels client’s desire to isolate.
Providing an open, honest, and safe environment goes a long way and is crucial in supporting individuals struggling with thoughts of self-harm and suicide.
We can uphold our ethical responsibilities as counsellors while still showing up as a human being. From one person to another, with empathy, compassion, and understanding.
If you’ve built trust and rapport with your client, and they feel vulnerable and safe enough to disclose their feelings of self-harm and suicidal ideation, be with them in their pain.
Hear what is at the heart of what they are saying.
Validate their experience.
Assist them in coming up with a plan to end what is causing them pain in their life, rather than ending their life entirely.
The topic of suicide doesn’t have to be this big, scary thing. It is part of life and the human experience.
People are struggling. Life can be very challenging. Especially as we continue to move forward in this digital world that’s creating disconnection and loneliness.
You are not alone. I see your pain. Help is available.
9-8-8: Suicide Crisis Helpline
Book a discovery call if you are struggling with thoughts/feelings of self-harm or suicidal ideation:
https://www.keishaviragocounselling.com/booking-calendar/discovery-call?referral=service_list_widget
Keisha Virago RPC-C
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