Talking about suicide

The NICE definition of self-harm is non-fatal intentional self-poisoning or self-injury. It includes acts to deal with overwhelming thoughts or feelings, as well as attempted suicide.

There is no one typical person who hurts themselves. Self-harm can take many forms, including self-injury, self-poisoning and sometimes risky behaviours such as getting into fights or abusing alcohol.

When people are suffering acute distress, self-harm can be a way to release the feelings; or feel something more manageable. It can reduce overwhelming thoughts or help escape distressing memories. It can help overcome feeling numb or disconnected.

While self-harm can be an indicator of increased risk of suicide, in itself it does not mean that a student actively wants to die. With the right support, such as talking therapy, students can learn to understand themselves and create better alternative coping strategies.

Suicidal feelings can mean having abstract thoughts about ending your life or feeling that people would be better off without you. Or it can mean thinking about methods of suicide or making clear plans to take your own life.

Suicidal feelings can occur in response to a range of situations, including when someone is depressed or highly anxious, hopeless, lonely, or struggling with major transitions, for example, including the move to university.

The term ‘suicidal ideation’ is used to describe a situation where a person may be having thoughts about suicide but have not made plans to act on those thoughts.

‘Suicidal intent’ is used when someone has thoughts of suicide which have developed further into thinking about how they may end their life. This could include specific, detailed plans about what they will do and when, or a stated intention to act on their thoughts, even if some of the details are not decided on.

These increase the likelihood of suicide. There are many known risk factors including:

• having attempted suicide previously
• having a family member or close friend who has died by suicide
• social isolation
• financial stress.

Additionally, it should be a concern if a person talks about a feeling of hopelessness, if they say they feel trapped and unable to consider improvement in their situation or mood, if they mention that they feel that those around them would be better off without them, or if they are having a crisis of faith when cultural or religious beliefs have kept them safe in the past.

Protective factors reduce the likelihood of suicide and improve a person's ability to cope with difficult circumstances. Sometimes it can take just one thing to stop a person from attempting suicide.

There are many potential protective factors, including:

• Having loving and supportive relationships.
• Not wanting to hurt the people they love.
• Cultural or religious beliefs that discourage suicide.
• Being able to access support.
• A willingness and capacity to talk about experiences, at least to some degree.
• Making future plans. 

While protective factors are important, it is crucial to be aware that they do not necessarily mean that a person will not attempt suicide.

This plan should be used if you have concerns about a student and think they may be having thoughts of suicide - either because of something they have said or other signs that you have picked up.

This action plan can help you open a conversation with a student you’re concerned about:

• Take the student somewhere private and safe and talk to them in a direct and caring manner.
• Explain your reasons for concern.
• Don’t guess – ask them if they are considering ending their life: “Have you had thoughts about ending your life?”
• Let them know that you care for their safety.
• Encourage them to seek help via their parent, carer or another trusted adult. Their GP or university counselling service.

Sometimes just having an honest supportive conversation can avert a crisis.

This plan is for if a student confirms that they are thinking about ending their own life but are not in immediate or imminent danger or crisis – perhaps because they have suicidal thoughts but no plans to act on them. In this case you need to act and to share the responsibility with the staff who are in charge of safeguarding or wellbeing. It is important that the university has this information clearly available for all staff. 

• Offer to help the student arrange an emergency appointment with their GP or university counselling service.
• Offer to accompany them to arrange the appointment.
• Offer to make the initial telephone call, explaining the urgency of the situation and then passing the phone to the student to arrange an appointment.
• Give them the contact details for Samaritans and other relevant contacts. If the situation occurs outside of office hours this might contain the situation for the student until the office reopens.
• Contact the appropriate member of safeguarding staff in your university and update them on the student’s welfare.
• Make a written note of key points and action taken for the safeguarding team so that follow-up support can be initiated.
• Speak with your line manager about your concerns and your actions as soon as possible.
• Contact HR or the counselling service manager to arrange a debrief so you are supported in this difficult work, make sure you make written notes of what has taken place and see they are given to the appropriate support.

Action plan 3 is for when a student has confirmed they are at urgent risk of suicide.

• Enlist the help of someone else so the student isn’t left alone, and you aren’t left alone with the student.
• If the student is willing, arrange for them to go to the nearest Accident and Emergency Department. Telephone 999 and explain the situation.
• If the student is very upset or uncooperative and you are on campus, call reception and ask them to call the police. The police can arrange for an ambulance if necessary. If you are not on campus, call the police yourself.
• If you are on your own with the student stay with them until the ambulance arrives and you are able to hand over to the paramedics. It is not necessary for you to accompany the student in the ambulance to hospital.
• Alternatively, where possible contact the appropriate member of safeguarding staff in your university and ask for them to join you (there should be a duty person at all times).
• Once you have introduced the safeguarding colleague and the student is safe with them, excuse yourself.
• Make a written note of key points and action taken.
• Speak with your line manager about your concerns and your actions as soon as possible.
• Contact HR or the counselling service manager or equivalent to arrange a debriefing session and hand over written notes so that follow-up support can be initiated. If the incident occurs out of office hours follow up with them as a priority.

It is important that the university supports students who’ve been identified as being at risk of suicide, and that they have a follow-up plan.

• Once the student returns to university or their accommodation, don’t ignore what happened – ask the student how they are.
• Ask the student who they want to know about the situation but don’t tell anyone who doesn’t need to know.
• Involve the learning inclusion team or student support who can work with the student to put a personal support plan in place. This is developed in full collaboration with the student to make sure that it meets their needs.