You Are Not Alone

Many People Feel Suicidal
but there are ways in which Suicide can be prevented.

Keeping Silence On Suicide Makes Dealing with it More Difficult
Patrick Mc Gorry & Jo Robinson

The Age, Friday 27th of April 2007 pg.13

And the internet may be a source of support to young people at risk, writes Patrick McGorry and Jo Robinson.

This week our community managed briefly to lift the veil of silence that conceals the extent and impact of suicide within our community. The widespread coverage of the tragic deaths of two young women this week from suicide is a rare event. Contrast this with the nightly reporting of road deaths on television news and the consistent nationwide campaign to prevent these. Suicide, a bigger killer of Australians, remains under a primitive taboo. Because of the fear and shame it generates, suicide is scary and difficult to talk about, even for health professionals, and usually it is reported in code: "there were no suspicious circumstances".

Let's consider the extent and personal experience of suicide. Suicide is a major public health problem, accounting for 2101 deaths in Australia during 2005. There are 40 deaths a week and rates for young males are particularly high. Suicide is on a par with the road toll as a preventable cause of premature death. We are struggling to make a real impact. Over the past 20 years, there has been a welcome yet modest reduction of 11 per cent in suicide, compared with the larger 64 per cent decrease in road traffic deaths.

From 1994 to 2004, suicide accounted for more deaths than traffic accidents. In Victoria, the body count was 505 in 2005. From the coroner's perspective, this is 10 bodies every week. For each suicide there are many bereaved, some intensely and permanently affected. What of the experience of suicide? As each of us knows, morbid thoughts of death and fleeting suicidal ideas are common in the human condition. Roughly half of us will experience depression to some degree during our lives and if this becomes more severe, suicidal thoughts are inevitable. What releases actual suicidal behaviour? If emotional pain is intense and there is no relief, especially if there seems no way out, this is a potent force. Younger people with less life experience, and a limited coping repertoire and vocabulary to communicate their distress and seek help, are at particular risk. Crucially, as suicidal thoughts deepen, help-seeking often lessens - in technical terms, the "help-negation effect". Survival then depends on others and luck. Not all suicides are the same.

The only common feature is the ultimate death of the individual, however unrecognised or under-treated mental health problems are the major preventable source of risk. In reducing the suicide toll, a fundamental strategy is communication. This has not got to first base in Australia. The suicide taboo is alive and well and has been reflected in well-intentioned "responsible media policies" in relation to suicide. This seems justified by the copycat or contagion phenomenon, which is real enough and must be taken seriously.

However, fear of this effect has effectively inhibited any reporting of suicide except in code. The internet has come under fire this week as a potential pathway to suicide. We have almost no scientific evidence on its effects, except we can say that in parallel with its rise in influence, we have seen a modest decline in rates of suicide in young people. This argues against the view of the internet as a risk factor. Some suicidal behaviour may be fuelled by internet contact, and not only in the young. But MSN and MySpace are used by young people to strengthen and extend their social bonds and peer relationships in the real world. This reflects the potent sociability of young people and others and adds another dimension to it.

Personal websites, youth-oriented internet sites and text messaging are likely to be a protective factor in suicide risk by providing a kind of electronic safety net. There are many helpful websites for young people who are troubled or suicidal and these may be an easier form of help-seeking for some than talking to someone, or using traditional helplines. The best example is Reachout! , which was established by the Inspire foundation specifically to tackle the youth suicide issue through the internet. The catch-22 is that we can't measure the benefit of this because we don't know how many young people use websites successfully for this purpose.

Proving a causal link is difficult and we should resist prematurely seizing on easy targets. Placing unrealistic pressures on anxious parents to somehow intrude into private conversations of young people with their friends seems at best impractical and ill-advised whether these occur face to face or through the internet. We have heard a lot from adults on these issues. It would be good to hear from young people.

Our key message is that we must find better ways to communicate as a community about suicide, as we in Australia have about mental health issues in general over the past few years. The road toll is the model. The community owns the problem, takes it seriously and provides appropriate sympathy and support to the survivors. We must also do a lot more to prevent those suicides that are more easily preventable, by earlier recognition of people with emerging mental disorders and much better care of people with already diagnosed mental illness. Data show that early detection and better mental health care for young people will not only improve recovery but will halve suicide rates. Australia is beginning to tackle this issue through its initial investment in Headspace, the national youth mental health initiative, a Victorian-led program establishing 30 youth mental health centres across Australia .

If we strengthen mental health care across the whole life span and talk freely about suicide and its causes and effects, we may be able to reduce the suicide toll as we have done with the road toll. Patrick McGorry is professor of Youth Mental Health at the University of Melbourne and director of ORYGEN Research Centre. Jo Robinson is co-ordinator for suicide prevention research at ORYGEN.