Highlighting the issue of 'suicide-prevention' may actually encourage it, so perhaps it's time to switch the discussion to 'help-seeking', write DAVID JOYCEand STEPHAN WEIBELZAHL
Suicide-prevention campaigns have failed to reduce the number of suicides while commentators have recently asked if publicising suicide can, in some way, encourage it.
Research suggests that people suffering psychological distress are reluctant to seek help. Can publicising help-seeking encourage people to seek help? If so, should there be a shift from discussion on “suicide-prevention” to discussion on “help-seeking”?
Two important elements of the psychology of persuasion are social proof and external environment. There is a danger that “suicide-awareness” campaigns normalise suicide and, therefore, encourage it via the social proof mechanism while also saturating the external environment with references to suicide.
In seeking to change behaviour, in terms of help-seeking or, say, safer driving, it is usual to consider two types of communication, called downstream and upstream.
In the case of suicide-prevention, downstream communication involves communication with sufferers of psychological distress. Here, the emphasis must be on encouraging the sufferer to seek help and obtain treatment.
Accessing help
Upstream communication involves communication with policy-makers and other groups that may be able to assist in various ways, eg in providing funding for mental health initiatives or research.
Here, emphasis would be placed on the extent of the problem, by discussing the prevalence of suicide and the difficulties sufferers have in accessing help. The dichotomy here is that messages which encourage action upstream are likely to discourage action, or encourage the wrong type of action, downstream.
Research suggests that a majority of people who commit suicide do not seek help. We can take the example of recently released figures from the US regarding military suicides in 2011.
Of the 301 US service personnel who died by suicide in 2011, some 201 were not known to have communicated their potential for self-harm to others prior to dying by suicide. Another stark example comes from the US. Of a sample of 133 US college students who died by suicide in 2010, only 18 were known to the student counselling service at the college they were attending.
What is apparent from this and other studies is that the majority of people suffering from psychological distress, including the type of distress which may lead to suicide, do not communicate their distress and seek help from appropriate sources.
There is the possibility that “helpseeking” campaigns could normalise help-seeking and, therefore, encourage it via the social proof mechanism while also saturating the external environment with references to help-seeking.
Publicity is one aspect of “suicide-prevention” which may be counterproductive, but there are others.
Typical barriers to help-seeking include the fear of stigma and the sense that one’s problem may be too small to be worth bothering anyone about.
Let us consider the “too small” issue first. Some anti-suicide campaigns such as the one operated by 1Life invite people who are suicidal to make contact.
To encourage help-seeking, the message “no problem too big or too small” needs to be aired. Inviting people who are “suicidal” to seek help suggests that those who are less than suicidal need not, as it were, apply, and indeed generally raises the bar for individuals who may be contemplating help-seeking.
Publicity surrounding stigma may also be counterproductive. Two audiences exist for messages regarding stigma – sufferers and non-sufferers. Messages such as “Teenage depression was devastating, childish reactions made it worse”, from a recent Amnesty campaign, may lead non-sufferers to appreciate the effects of stigma, but will also highlight to the sufferer the risks associated with exposure.
Another way to deal with stigma is to guarantee anonymity to sufferers who seek help, while educating non-sufferers about the irrationality and untruth of attitudes which may express themselves as stigma.
‘Come in and chat’
Encouragement of help-seeking is non-trivial. Research has shown that individuals in a position to offer help consistently underestimate how difficult it is for someone to ask for help. As an example of this we may consider cyberbullying.
A young person being bullied may consider seeking help from a school counselling service. However, the young person may not be clear if what is happening actually constitutes bullying, or even if the school is the proper place to seek help.
One may consider that in these situations, such a young person would be welcome to discuss these issues with a school official.
However, looking at various school anti-bullying policies, we can see that the welcome is somewhat conditional.
Firstly, the bullying in question must take place within the confines of the school, or on the way to or from school.
Secondly, certain schools state that any improper reporting of bullying will be dealt with as a serious disciplinary offence. This is different to a welcoming “come in and chat” sense needed for the encouragement of help-seeking.
Encouraging help-seeking is essentially a marketing proposition and marketing is likely to be disregarded by certain professionals in the area of mental health.
Jackie Garrick, of the US Defense Suicide Prevention Office, recently told the US Defense Health Board that she wants to promote outreach instead of focusing mainly on reducing the stigma of seeking psychiatric care.
“Is it good enough to put a poster on a wall and wait by the phone? I don’t think so. We have to turn this paradigm around and get in front of this problem,” Garrick said.
Perhaps the public discourse could more beneficially be turned towards sufferers and away to some extent from policymakers and non-sufferers.
Potholes pitfall
The media influences public discourse and could usefully emphasise positive aspects such as the effectiveness of treatment and interventions and the very high likelihood of recovery.
Instead of explaining life with psychological distress to those who are living relatively contented lives, the discourse would seek to explain the advantages of a relatively contented life to those suffering from psychological distress, along with a discussion of the pathways from distress to contentment.
People learning to ride motorcycles are taught the importance of looking at where they want to go. To gaze at a pothole along the track is to go into it. A rider’s focus must shift from the pothole to a safer part of the road and the cycle will naturally follow.
Currently, as a society, we are focused on suicide. It may help if we shift our focus towards help-seeking.
Dr David Joyce has recently completed a PhD on mental health help-seeking at the National College of Ireland.
Dr Stephan Weibelzahl is a psychologist and lecturer at the National College of Ireland.
