Studying the final words of those who died by suicide can help teach mental health-care workers important lessons, a new study published in the Canadian Journal of Psychiatry says.
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The study, conducted by the Centre for Addiction and Mental Health (CAMH) and Sunnybrook Health Sciences Centre, examined 1,565 cases of suicide in Ontario. While hundreds of cases, which occurred between 2003 and 2009, had suicide notes attached, researchers focused on 36 specific ones that mentioned experiences with mental health care.
Dr. Juveria Zaheer, a psychiatrist and researcher at CAMH, explained to Global News that there are a lot of statistics surrounding mental health care and even suicide.
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But qualitative research — which offers a deeper look at why things are happening — is more difficult to come by, she said.
“What are people’s experiences? What are the contexts? What are they going through?” Zaheer said, outlining some questions researchers wanted to be answered.
“People who are suffering can be the greatest teachers. These notes provide us with a unique insight into the mindset of people who we weren’t able to help.”
Insights from suicide notes
Using the notes, researchers found three common sentiments of those who died by suicide.
The first was a feeling of “powerlessness,” Zaheer explained.
“Some of the people who died by suicide, they felt that they had no control over their mental illness,” she explained, while others had control but still felt unsuccessful in their attempts to get better.
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The report highlights one sentence from a suicide note, which expressed such loss of control: “Looking back, there were times I should have changed the course of my life but I didn’t and now there is no hope left.”
Others felt a “battle between the ‘real self’ and mental illness,” the report highlighted.
It provided an example from a note, that read, “I fought against my thoughts, depression and alcohol constantly. I am too tired to keep going.”
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Zaheer explained that with mental illnesses, unlike physical illnesses like cancer, there tends to be a focus on fighting one’s own self rather than an illness.
“You can feel really exhausted, like you’re fighting yourself,” she said.
The third message found in several suicide notes was of hopelessness in mental-health treatment, with messages such as “I’ve tried everything,” in notes.
“There are very good treatments for mental-health conditions. Most people who have suicidal thoughts don’t die from suicide. But for some people, seeking help and not getting better can make them feel hopeless,” Zaheer explained.
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What health-care workers can learn
With these three takeaways from the letters, researchers noted there are things health-care providers can learn.
“We want this to be a hopeful message — by understanding the experiences of people, we can provide better care,” Zaheer explained.
One key reminder the research offers is how important it is for health-care workers to remind patients that the illness is biological and not just a problem with who they are.
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Health-care providers should also address and acknowledge the “exhaustion” patients feel, and assure them they are getting care for an illness that is treatable.
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They should also screen for feelings of hopelessness, Zaheer said, and use therapy specifically geared toward helping it.
“Don’t just focus on the symptoms, but understand the person as a whole,” she said.
Advice for family and friends
Hilary Sirman, who works with the Canadian Mental Health Association’s Centre for Suicide Prevention, explained suicidal thoughts and tendencies can range widely, but there are some more common ones.
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The first is someone who expresses suicidal thoughts, others include substance abuse, purposelessness in life, anxiety, feeling trapped, anger and recklessness, and mood changes, she explained.
“Ask them directly, mentioning the changes in behaviour and that you feel concerned,” she told Global News.
Sirman added that if someone is concerned about suicidal behaviour, they should speak up about it.
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“Asking directly if an individual is considering suicide, contrary to what people may think, it actually is a protective factor against suicide, it actually reduces the likelihood of death.”
Another important aspect is to listen, and let the person talk. Then encourage them to access help, or call 911 if there is imminent danger.
“It’s important to keep the lines of dialogue open, continue to check in with that person, continue to show your support and seek their input on how you can help.”
How to get help
If you or someone you know is in crisis and needs help, resources are available. In case of an emergency, please call 911. For mental-health programs and services around Canada, please refer to the list here.
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