Author: Rahma A. Azmi
Trigger Warning: The following article contains content about suicide
Important fact: anyone who is feeling suicidal can bring themselves to the nearest government hospital (not private hospitals), approach the emergency ward, and inform the nurses that they are struggling with suicidal thoughts. The hospital will take over and provide relevant care and support until the person is stabilised.
The World Health Organisation (WHO) estimates that approximately one million people (close to 800,000) die by suicide each year (WHO, 2019). This represents a worldwide death rate of 16 people per every 100,000, or one death by suicide every 40 seconds. People often resort to suicide when they believe that there are no other solutions to the difficulties they are facing.
The COVID-19 pandemic has witnessed an upward trend in suicide cases and crisis hotline calls. According to The Strait Times, the police recorded 468 instances of suicide while Befrienders received 20,575 calls in the first five months of 2021. Amid such distressing times, many people are facing mental health crises. However, despite our best intentions, we may be at a loss at how to react and care for others. The mental health professionals at Thrive Well share their expertise and experience on ways to talk to someone in times of crisis.
Q1. How do I know someone is going through a mental health crisis?
By Chase Tan
A mental health crisis occurs when one experiences sudden, extreme, or prolonged stress. During a mental health breakdown, one may feel like they're losing control of their feelings and give in to stress, anxiety, or worry. The symptoms may include feelings of worry, nervousness, fear, anxiety, crying, or stress.
There is no one fixed cause of a mental health breakdown. It may be caused by the body's stress response when one's fight-or-flight response goes into overdrive. When one is exposed to abnormal or long-term stressful situations, the body may be unable to react appropriately.
However, everyone experiences or reacts to a certain situation in different ways. In essence, anything that leads to excessive stress can trigger a mental health crisis. Some events that may lead to a mental health breakdown include: a tragedy, a major life change, poor sleep, financial stress, prolonged stress, bereavement etc.
Q2. What should I do when I witness someone going through a mental health crisis?
By Anum Sofea
When you see someone experiencing a mental health crisis, you may feel alarmed and freeze up. You may experience panic, confusion, and stress about what to say and how to react appropriately. There's always a worry of saying or doing the wrong thing.
However, it is okay to feel stressed and panicked. It is completely natural for us to react with anxiety and fear in times of crisis. It is the body signaling that our attention is required, and for action to be taken.
Start by inhaling deeply and taking a few seconds to calm yourself.
Then, proceed with centering yourself and figuring out what you need to do. Collect your thoughts, and focus on the present situation at hand. This allows you to gather yourself and be ready to help and support the person to the best of your abilities.
Once you have prepared yourself, it is a good idea to ensure both of your safety. Find a safe space一a private, calm, and quiet place away from harm that allows the person to feel safe to open up. Calmly and empathically listen to their thoughts and feelings, provide time for the person to slow down their breathing, and when things have calmed, slowly work together to find a safety plan that is best for the person. It is also good to have an idea of any emergency hotlines that can be beneficial in that situation.
Q3. How should I respond to someone in crisis?
By Afaf Omar
A mental health crisis can be defined as an instance when an individual's capacity to cope is temporarily overwhelmed due to an extreme amount of stress, leading to mood swings, inability to perform daily activities, isolation, etc. It is typically characterised as acute, time-limited, and consists of overwhelming emotional reactions, such as agitation, paranoia, irritability, etc.
It is paramount to perform de-escalation exercises in response to any mental health emergency. The main aim is to reduce the person’s agitation and aggression as well as give a chance for the person in crisis to calm down. It is best to attempt verbal de-escalation prior to calling emergency services (physical). Done right, verbal de-escalation can help establish rapport with the person in crisis.
Basics of de-escalation techniques:
Create a safe environment:
Bring the person to a quiet space to help reduce their stress and frustration. It is important for the person to feel calm, comfortable, and at ease.
Remain at two-arms length distance from the person in crisis, and maintain an unobstructed path out of the room for both you and the person in crisis. If you are unable to be there in person, try to ask them to be around someone who can ensure their safety. Conversely, they may also go over to another place to avoid being alone.
Minimize provocative behaviours (i.e., confrontational body language)
Establish verbal contact, use concise and simple language, be careful not to trivialise or diminish the person’s concern.
Practice active-empathetic listening throughout the entirety of the conversation with the person in crisis. This allows a better understanding as well as builds trust, leading to compliance
Be optimistic and offer choices to help the person in crisis regain control of their situation, but do not make unrealistic promises.
If possible, develop a safety plan together with the person, respecting their autonomy and not directing them
If the situation escalates and thoughts of suicide arise, stay present and support them but also get help immediately. Do not promise a person going through a suicidal crisis (ideation and/or thoughts) that you'll keep their secret safe because it places an unhealthy amount of pressure on you. You must get the relevant help for them by reaching out to professionals through emergency hotlines or informing a mental health care professional.
Read What is a Mental Health Crisis (Part 2) to learn more about how to take preventative and safety measures for someone in crisis as well as how to take care of yourself!
References: Hassan, H. (2021, July 7). Malaysia sees rise in suicides and calls to helplines amid Covid-19 pandemic. The Straits Times. https://www.straitstimes.com/asia/se-asia/malaysia-sees-rise-in-suicides-and-calls-to-helplines-amid-covid-19-pandemic
World Health Organization [WHO]. (2019, September 2). Suicide. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/suicide