Why we need to talk about suicide

Eugene Farrell, Mental Health Consultancy Lead, AXA Health

10 July 2023

There is a powerful statistic about suicide that tells us that it is the biggest killer of men aged under 50 years; Office for National Statistics figures for England show that 15.4 per 1000 population men died by suicide compared to 4.9 women, with men aged 45 – 49 having the highest rate overall (24.1) .1 This data is for 2020 and is the latest data available from the ONS. It is a tragic and shocking story; but suicide is so much more than a story about men.

Suicide represents some 5, 224 deaths in England and Wales and 753 in Scotland. Across the UK there is variation in the data with the North East having the highest suicide death rate of 13.3 per 1000 population and London the lowest rate at 7.0.1

The suicide narrative is not all about men, higher risk groups include LGBT communities where suicide ideation, attempts and completions are disproportionately higher. According to Stonewall, one in eight 18 – 24 year old LGBT people attempted to take their own life in the last year,2 and furthermore, 44% of the LGBTQ people reported suicidal thoughts, compared to 26% of heterosexual non-trans respondents.3 The Trevor Project reported that LGBT youth are more than four times as likely to attempt suicide than their peers. One mental health provider has reported a recent 26% increase in suicidal thoughts in children and young people of BAME origin.4

The ONS data also identifies that the age group 45 – 49 of Women have the highest rate of suicide deaths of those women dying by suicide. Meaning that both women and men of the same age group are higher risk. 

The way that we talk about men and suicide seems to make it a man’s problem, which it is not. It is true that more men die by suicide, and by quite a margin, but the problem is not limited to men alone. In addition, we must not normalise suicide in men as if it accepted and we can do little about it. Suicide is about all of us, and it is important that we talk about how it affects all of society, and in particular the effects and devastation that it can cause for families.

1 in 5 people think about suicide in their lifetime, that is a really big number.5 It is the same number as those in the workplace affected by mental health. The huge increase in attention given to mental health in the workplace has resulted in programs, support and stigma reduction. Yet suicide seems only to get mentioned when the annual World Suicide Day comes along. Suicide deaths happen every day, in fact some 18 deaths per day.

A suicide doesn’t just happen, it is part of a series of events that lead to that final crisis.

Research data suggests that there are 30 attempted suicides for each suicide death and some 200 people have thoughts about suicide for each death.6 Clearly there is a lot of suicide ideation happening around us. The journey from suicide ideation to completing suicide is not terribly well understood. There are factors that we should consider and are important.  Suicidal ideation is third highest predictor of death by suicide.7 According to the Samaritans, most people who attempt or complete suicide will have told someone something like their life not being worth living.  Therefore, thoughts about suicide are important and not to be dismissed.

Self-harm is another risk we should be aware of. Those who self-harm are 145 times more likely to attempt suicide while only 12% are referred for support and help.8 Anyone who is self-harming should seek support.

People think that those who take their own lives always have a mental illness. Only about a half of those dying by suicide have a mental health disorder,5 however psychiatric hospitalisation is a leading predictor of suicide, with suicide ideation being one of the most common reasons for hospitalisation.9

Rarely does suicide happen out of the blue, it is often proceeded by a complex mix of problems. A shift from considering suicide to planning is a huge increase in risk, another risk step is from planning to active planning and seeking means. Data shows that those who think about completion and acting upon that thought, can be as short as 5 minutes in 40% of cases and other data shows 50% act within 10 minutes.10

The shift from planning to action can be triggered by events such as relationship or financial issues, it can also occur due to reduced inhibition from alcohol use and drug taking. In more than one study it has been shown that in 60% of cases an interpersonal relationship issue had been the trigger to act on suicide.10 

It is true to say that ideation in itself, does not necessarily lead to suicide, it is an important factor, and we should treat it seriously, it is also very scary and isolating for the person experiencing such thoughts. Research has shed light on other risk factors that are important too. These include:

Social isolation Inability to generate positive thoughts
Hopelessness Previous suicide attempt
Psychological Pain Family history of suicide
Perceived burdensomeness Co morbid medical illness such as HIV or Cancer
Perfectionism Social of financial crisis
Self-criticism Major depression
Feeling trapped

Any or all of these are linked to suicide for some people, which is a good reason to have an open culture where people can talk about their personal issues and how it is affecting their mental health. Wishing you were not here can be a natural reaction to unpleasant feeling or experiences, it can also be part of some mental health conditions such as depression. It is also true to say that thinking about suicide varies in intensity and duration from fleeting thoughts to intense preoccupation. 

Sadly, 1 in 4 suicide attempt survivors will re-attempt and 14% of attempters will die by suicide. But we must not miss the fact that 60% of those who die by suicide had not previously attempted.11

Being alongside

Being alongside each other is a great way to see how we can all support one another.

Men are identified as a group who find difficulty in talking about emotions, while women are more positively oriented toward emotional talk. This sometimes makes it easier for women to talk, while men get trapped by masculinity. While there have been some changes in men being more emotionally open, it may be more of talking the talk about emotions as a way seeking approval in relationships. To make a real difference, men need to move from a doing the talk perspective, to being more alongside with others. Women do seem to be more alongside each other, to be there and accept without judgement, where men fear being judged as unable, incompetent and not a real man. But we must not be complacent about women, thinking they will talk it out or get support.

What do I do if I suspect someone might be thinking about harming themselves?

We know that talking about suicide does not lead people toward completion, quite the opposite, people will often feel relieved to have it out in the open. Having thoughts about suicide is scary and difficult to deal with and being able to share that and get support can save lives. 

People with suicidal thoughts do not want to die, they will most often want their pain to go away.  

The taboo that is suicide has no place in our society, if you suspect someone is feeling suicidal, or they have expressed thoughts or feelings about hopelessness or life not being worth living then ask them directly – Are you considering harming yourself? Or Are you having thoughts about suicide?

Signpost them towards support and help, like EAP, or their GP.

What if I am feeling suicidal?

If you are feeling suicidal in any way, you should seek support and help. In AXA we have our EAP program where you can speak with a professional counsellor 24/7. You might speak to a colleague, line manager or Mind Ally. All the Mind allies are listed here https://axa365.sharepoint.com/sites/MyWellbeing/Lists/Mind%20Allies%20Directory/AllItems.aspx 

What if someone says they have serious intent or are active in suicide right now?

If you are seriously concerned about someone you should call 999 immediately. It is better to be safe about this. 

  • You can—and should -ask someone who could be suicidal how they're feeling
  • Don’t be afraid to say the word “suicide” 
  • It’s OK if you don’t know what to say to someone
  • Suicide isn’t always about wanting to die, but stopping the pain
  • There isn’t a typical type of suicidal person
  • Having suicidal thoughts is very scary and isolating.
  1. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/suicidesintheunitedkingdom/2020registrations
  2. https://www.stonewall.org.uk/media/lgbt-facts-and-figures
  3. https://www.gmmh.nhs.uk/news/why-is-the-lgbtq-community-disproportionately-affected-by-mental-health-problems-and-suicide-4240
  4. https://www.youthsporttrust.org/media/4ckfvnyd/the-impact-of-covid-restrictions-on-children-and-young-people.pdf
  5. https://www.samaritans.org/how-we-can-help/if-youre-worried-about-someone-else/myths-about-suicide/
  6. https://www.cdc.gov/mmwr/volumes/71/ss/ss7101a1.htm 
  7. https://nocklab.fas.harvard.edu/files/nocklab/files/franklin_2016_riskfactors_metaanal50_psychbull.pdf
  8. https://www.manchester.ac.uk/discover/news/older-people-who-selfharm-at-highest-risk-of-suicide/
  9. https://www.wolterskluwer.com/en/news/high-risk-of-suicide-after-recent-psychiatric-hospitalization
  10. https://www.hsph.harvard.edu/means-matter/means-matter/duration/
  11. https://www.hsph.harvard.edu/means-matter/means-matter/survival/