In my practice I work with people experiencing suicidal thoughts almost every day. These individuals range on a continuum from low risk for suicide, to very high risk for suicide and the way I approach them differs greatly depending on their degree of risk. Some individuals are at low risk. They have thoughts of dying, but they have never considered how they would go about doing this and have no intention of following through with their suicidal thoughts. These individuals are not overwhelmed by hopelessness and despair and are able to find other means of solving their problems or dealing with their difficult emotions. Significantly, they are able to appreciate that life can get better and that whatever is causing the suicidal thoughts will pass. Importantly, these individuals are not abusing any substances and are not impulsive in their behaviour. They have stable and supportive relationships with significant others. A person in this situation does not require emergency intervention but it would be useful to help them gain professional help to assist them with the underlying feelings that are causing the suicidal thoughts. On the other side of the spectrum are individuals who are at high risk for suicide. These individuals have a very high degree of hopelessness and significant despair about their current circumstances and their future. They feel that life will always be emotionally painful and they long for the peace that death can offer. These individuals have thought in detail about how they will kill themselves and may even have researched various options. They might have started making preparations for their death such as writing letters to loved one’s and sorting out their affairs or giving away special belongings. These individuals may or may not have attempted suicide in the past. Also at high risk, are individuals who may not be as determined and organised as the above individual, but who are abusing substances and/or are impulsive in their behaviour. These individuals may attempt suicide ‘in the heat of the moment’. Especially concerning are individuals who feel socially isolated or whose relationships are characterised by a high degree of conflict. Unfortunately, people who are at high risk do not always tell anyone how they are feeling and they take action in private. Still, you might notice certain behaviour changes that could alert you to the fact that someone is suicidal. These include: Social withdrawal. An individual starts spending much time alone or isolated. In the case of teenagers, parents might notice that where their child was once spending time engaged in family life, their child is now isolating himself permanently in his room. To be clear, this alone does not suggest suicide, but can can be an indicator that there is a problem and it might be worth connecting and communicating with the individual in order to understand how they are feeling and why they are withdrawing. Giving away special belongings. Taken out of context, this might appear that the individual is being generous or sentimental and this very well might be the case. However, it is worth probing and finding out what is motivating this behaviour.   Change in mood. A person who is suicidal is more often than not depressed. You may notice that an individual who used to be well put together and functional suddenly appears lethargic, sad, irritable or angry. They may loose interest in previously enjoyed activities and their performance in work or school might decline. They may appear slightly dishevelled and you may notice a change in their sleeping patterns….sleeping a lot more than usual or being unable to sleep. They may lose weight or alternatively gain weight.   Expressions of hopelessness. Hopelessness is one of the strongest risk factors for suicide. Some people may be direct in their expression of hopelessness saying things such as ‘what is the point’. They may talk about death and dying. Or they may be more subtle. You might start noticing that they have stopped making plans for the future or that their attitude towards themselves has become very negative ‘I’m worthless’.   Substance abuse. Substance abuse alone does not make an individual at risk for suicide. But, if they are experiencing thoughts of suicide or have an unstable mood, substance abuse can often lower an individuals inhibitions enough that they act on their emotions whilst in an inebriated state. If an individual is experiencing suicidal thoughts and using substances, they are at greater risk for suicide.   Planning their suicide. Obviously if you find direct expressions of suicide you should take these very seriously. Letters, notes, evidence of research into suicide methods, stockpiling medication, accessing knives, rope, guns, or poison, should be taken very seriously and professional help should be sought immediately. What should you do if you have noticed these warning signs and are concerned that a loved one might be suicidal? As this year’s slogan suggests, connect, communicate and care. Do not be afraid to talk about your concerns directly to the person involved. I often hear loved one’s saying that they are scared to talk about it, in case they put idea’s into the individuals head or in case they are wrong and they cause offence. This is not the case at all. Talking about it can help the individual feel less isolated and more understood. This alone can make a significant difference but it can also enable you to assess the level of risk so that you can get the individual the help that they need. Questions to ask include: Do you have suicidal thoughts? Have you thought about how you would do it? Do you have access to the things required to carry out your plan? Have you decided on when and where you would do it? How hopeless do you feel about the future? If there are positive answers to these questions, the person is at high risk. Practically, it is important to remove any means of suicide – weapons, poison, medication, knives, rope to name a few.

Underneath anger is hurt and pain. Underneath tears is hurt and pain. It is the same emotion, just expressed differently…. Anger is a signal that something is wrong, we are in a state of stress/distress and are being triggered. Whatever it is that we are facing needs to be resolved in order for us to function again. If we don’t resolve or channel our anger it can affect our productivity, well-being and even lead to long term effects such as illness. We face conflict everyday throughout our lifetime: When we are facing a crossroad or decision we need to make = inner turmoil In our relationships with our partner = relationship problems With our children and families = family issues With our friends and in the workplace with our colleagues, customers and suppliers = peer pressure and social norms At times we also have turmoil on a spiritual level where we question our faith and beliefs. Conflict can result in a number of emotions being expressed as everyone deals with conflict differently. Some try to avoid it by shutting down, disengaging and withdrawing (a Minimiser). Others are seen to attack and/or become aggressive (a Maximiser). Both of these reactions are defensive mechanisms to protect us from being exposed and vulnerable on an emotional level. Anger can become a major health issue. Seeing as our childhood forms the foundation of our emotional intelligence (this is where we are taught how to express ourselves, to communicate, to show affection, how to manage conflict and more) we need to help children find healthy ways of dealing with their emotions, especially anger. Parents typically respond to their child’s outbursts with punishment, rejection or their own outbursts.  They might give their child time-out in their room or the naughty corner, high school kids are given detention, suspended or even expelled. But children don’t understand where their anger comes from, we have to help them identify their underlying emotions and how to express their emotions in a way they understand e.g. they might be feeling left out, rejected or misunderstood. If children are not taught how to do this, they will find ways of dealing with what they are feeling that will become their adaptive patterns in adulthood and by then these traits are well entrenched. The key to understanding our emotions is self-awareness.Becoming self-aware – We all have a trigger system that gives us clues as to what is going on inside of us. The sooner we identify these triggers (e.g. increased breathing, knot in the stomach, heart rate etc), the sooner we can do something about it. Self-regulate – The quickest and easiest way to self-regulate is to focus on your breathing. So if you need to count to 10 (or 100), walk away and do a quick breathing exercise then do that. It is the body’s natural way of self-regulating. Consider your options – In every situation we always have a choice. By weighing up the options and consequences for all the options we can make an informed decision and ultimately better choice than one based on pure reactivity. When we learn to Embrace Conflict and not see conflict as a bad thing but rather be curious as to what is going on and what is triggering us, real change can happen vs. repeating the same patterns over and over again.  As adults, we owe it to ourselves to learn these basic skills in order to provide a better emotional foundation for our children and future generations.