Self Harm And Suicide
As with any other context, mental health emergencies can occur at events. This can be related to factors such as challenging drug experiences, interpersonal conflict, preexisting mental conditions or distress, or a decision to stop taking prescription medication (for reasons such as like attempted personal growth or to enhance the effect of drugs). A person may voluntarily share information about both historical and/or present thoughts of deliberate self harm or suicidal ideation, including historical instances of actual self harm and suicide attempts. If someone shares this information, it is important to provide emotional support, explore their level of risk and seek appropriate support.
If a person is planning to actively attempt significant self harm or suicide, or they have made an attempt, seek immediate medical attention from medics, contact security, notify event organisers and emergency services (e.g. ambulance, police, mental health crisis team). Do not leave the person alone until emergency services advise that it is safe to do so.
Providing Support
Try to stay calm, positive and hopeful that things can get better without downplaying or making light of the situation, (whilst also giving space for dark thoughts).
Gently listen with non-judgement, empathy and curiosity. Give space for the person to share their thoughts and experiences. Shutting down these conversations or topics does not help!
Take the person seriously, and accept how they are feeling even if you don’t understand why.
Avoid interrupting with advice (even well intentioned) or invalidating the challenges they have faced (or are currently facing).
Ask the person what has helped or what they’ve done to cope with these thoughts in the past. This may include negative experiences in healthcare settings, or experiences of discrimination and stigma. This is an opportunity to gain valuable knowledge about how to best support someone if things need to be escalated to a potentially triggering setting or team.
Do not agree to keep the person’s thoughts secret, as they may have to be shared with care space coordinators or emergency services in order to keep them safe.
Do not leave them alone until you have determined their level of risk.
If the person is reluctant to talk, ask if they would like to talk to a different care space staff member.
Responding to High Levels of Risk
It is important to find out:
If the person is planning to harm or kill themselves,
If they have a specific plan and what it is.
If they have access to the means to complete the plan.
When they’re planning on doing it.
Don’t ‘beat around the bush’ by asking questions like “you’re not thinking of doing something silly, are you?”. Instead, ask questions like “are you planning to kill yourself?”. Asking these questions won’t escalate the situation or put the idea in their head.
If a person is planning to actively attempt significant self harm or suicide, or they have made an attempt, seek immediate medical attention from medics, contact security, notify event organisers and emergency services (e.g. ambulance, police, mental health crisis team). Do not leave the person alone until emergency services advise that it is safe to do so.
If the person is significantly intoxicated, consider whether it would be appropriate to wait until the effects of the drugs have lessened before reassessing their risk. Challenging drug experiences can lead to temporary thoughts of self harm and suicide which may subside as a drug experience ends. However, this should only be done if you are confident that they can be kept safe until then, and that there is no immediate risk to their safety. Do not leave the person alone .
If the person says they are not planning to harm or kill themselves, continue to gently explore the issue to ensure that they are safe. If significant concerns remain, contact a mental health crisis team for further support. Do not leave the person alone until emergency services advise that it is safe to do so.
There are sometimes situations where a person’s self-harming is symptomatic of an ongoing pattern of ‘minor’ self harm, such as small superficial cuts or hitting themselves in a way that doesn’t pose a significant risk to their safety or that is already being treated by a mental health support team. If there is a member of the care space who is experienced with navigating these situations in a professional mental health context, it may not be necessary to contact emergency services. However, if the care space staff are inexperienced with this matter or there is any doubt, contact a mental health crisis team for further support and do not leave the person alone you are advised that it is safe to do so.
If no significant concerns remain, encourage the person to access support from people they trust, including friends, family, spiritual/community/cultural leaders, or mental health professionals. Have a list of mental health crisis resources and contacts available if the person would like it.
Contacting mental health crisis teams can require long wait times and multiple calls. It is important to persevere until you can access the support you need, and keep a record of calls made (and other actions taken).
Resources
Mental Health Foundation: Suicide Prevention