Barriers to Help-Seeking for Suicidal Ideation

There’s lots of information out there about crisis resources for people thinking about suicide, but resources accomplish very little if we don’t reach out to access them.  There are many potential barriers to help-seeking, and I wanted to talk about a few of them here based on my own experience with major depressive disorder and suicide attempts.

Fear of being a burden

No matter how much anyone might say “you’re not a burden”, I wouldn’t believe them.  The suicidal thoughts were such a heavy burden for me to carry, so why would I want to place some of that burden on anyone else?  And it doesn’t feel like it is with pack animals where I can shift my rocks to someone else’s donkey and make it lighter for my donkey.  It feels more like extra rocks would be getting dumped on both donkeys, so I’ve got extra weight that I have to carry as well.

Fear of others’ responses

There’s a lot of stigma out there in the world, about mental illness in general and suicide in particular.  When the word “selfish” gets tossed around in relation to suicide, that’s only going to add to barriers to help-seeking.  Being judged is the last thing someone needs when they’re feeling desperate.

For those of us who have been open with others about our illness, even if we’re not necessarily worried about stigma there’s still uncertainty about how others might respond.  People say well-meaning but just plain stupid things about depression all the time, so what kind of supportive idiocy is likely to come out of their mouths when faced with the topic of suicide?  That I should be grateful for what I have, even though none of it matters?  Or maybe something along the lines of oh, you should go out for a walk in nature?  #SickNotWeak #FuckTheWalk

Hopelessness

My illness makes me feel like there is no hope for the future, and it’s when that hopelessness gets particularly intense that I want to end my life.  I’m not thinking oh, if only I could get help things would be so much better.  At that point, I have given up and don’t want anyone trying and failing to help and in the end just making things more difficult.

Over the entire course of my illness it has proven to be very hard to treat.  In the past, I was able to achieve full remission eventually, but now it seems like that may be a thing of the past.  Because of my professional background I know what my options are, and I know there aren’t a lot of them, which tends to really reinforce those feelings of hopelessness.

Worthlessness

When mental illness steals away your whole sense of worth as a human being, it can start to feel like people would barely notice, much less care, if you weren’t around anymore.

Crisis lines/services

The only time I’ve ever used a crisis line myself was in the first few weeks after my first hospitalization.  I had discharged myself against medical advice after they decided not to renew my involuntary committal.  I’d been in hospital for 2 months, and out I went, with no discharge plan in place.  I was cutting as a strategy to cope with suicidal thoughts, and mostly when I called the crisis line I talked about the cutting rather than what was underlying it.  I guess it was nice to have someone to talk to, but I remember feeling like their responses were kind of formulaic, as if they’d been told these are the things you should say in these situations.

A lot of crisis lines have volunteers providing support.  I’m sure they’re great, they care, they want to listen, but they don’t have the level of expertise of mental health professionals.  Part of that is that they don’t have training in assessing mental status, which makes me inclined to think they have a lower threshold of concern to call the police.  I may be overestimating the risk of this, but if I’m thinking about ending my life the last thing I want is the police banging on my door.

In some ways it works against me that I’m a mental health professional, because it means I know a lot of people working in local emergency and non-emergency mental health services.  I have no desire to call the emergency mental health service or go into the hospital emergency department and have to deal with some asshole that I’ve worked with before and know is useless at their job.

Fear of hospitalization

This is the single biggest reason I keep my mouth shut when I’m thinking about suicide.  I’ve been hospitalized four times, and these experiences were extremely difficult.  Those experiences serve as significant barriers to help-seeking.  When I’m at my lowest, given the choice between death and hospitalization, realistically death is going to win out.  This reflects fundamental flaws in a system that disempowers and traumatizes patients, but there’s also a sense of personal failure that I connect with hospitalization.

This isn’t a judgment I pass on others, but probably part of why I apply it to myself is that three out of four of my hospitalizations were involuntary, so it’s kind of a failure to maintain the ability to make choices for myself.  This fear of hospitalization is deeply ingrained in me, and over the years it has made me tell lies and keep secrets.  I realize that this is something that puts me at risk, but I don’t see that just spontaneously changing.

I know that reaching out for help dealing with thoughts of suicide is the right thing to do, and it’s certainly what I would urge to anyone reading.  But realistically it’s just not always that simple, and I think it deserves some thought when we’re not in the midst of our deepest lows.

What has been your experience of accessing help in a crisis?  Are there any barriers to help-seeking that have affected you?

 

Safety Plan for Suicide Prevention from Mental Health @ Home Store

 

There a list of crisis resources here.

Visit the Mental Health @ Home Store to find my ebooks plus plenty of FREE downloads including this safety plan for suicide prevention.

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37 thoughts on “Barriers to Help-Seeking for Suicidal Ideation

  1. s.e. taylor says:

    I called (or did someone call for me?) a local crisis intervention team that came out to my house to check on me and put me in touch with community resources. I was in between psychiatrists and going without meds. It was a good experience under the circumstances. My experiences with going to the ER were not good. My one hospitalization was unpleasant but served it’s purpose. I’ve never called a suicide hotline, I’m not sure why though. Maybe I hate the idea of putting all that on someone else, and I’m with you on not wanting cops showing up at my door, that is a definite concern. But would they even know where we are at to do that if we don’t tell them? I’ve thought about calling self injury helplines when I’m struggling with the urge to cut,because it’s not something I can talk about with my “support system”. Came close recently and could really have used someone to talk to, in the midst of it it did not even occur to me to call.

  2. Raina says:

    My dear friend:

    You have started a phenomenon….a shift in the universe…
    Change is around the corner.

    Brilliant observations about the reality of us all…who are put in the Zoo…when we belong in the Circus!!

    Dr. Sues book…”put me in the zoo” is my favourite book!!
    Hugs n joy!
    R

  3. wellcolourmeyellow says:

    I’ve learnt to write things down and give it to someone and tell them ‘hey,force me to show this. I’ll fight you on it, but make sure I show this’. Showing those ‘things’ to a mental health professional, i mean. Though I tend to forget mostly. I just think it’s a disservice to yourself to lie about your mental health state. You deserve better than a symptom missed. It’s hard, sure. But as much as it sucks you need to Nike the fuck outta that shit and be honest. That’s just my view, and what i hold myself to

  4. Luftmentsch says:

    I’ve had much more positive experiences phoning crisis lines in the UK, although that hasn’t always been when I’m suicidal (The Samaritans are for anyone who needs to talk, not just suicidal people).

  5. Meg says:

    This is very informative!! All the times I’ve been suicidal, I wound up in the hospital after a short period of time, rather than feeling suicidal for long stretches, so a lof of this is stuff I didn’t know.

    If you ever feel suicidal again, you may always drop me a line! If I don’t answer, you can 100% assume I’m not at the computer. (I don’t have traveling internet.) I wouldn’t normally feel qualified to help, but given how you know everyone nearby who works in the anti-suicide industry, I want to make myself available as a resource!! Any time!! 🙂

  6. The Colour Of Madness says:

    What a fantastic post. Absolutely agree and I totally relate to every single point!
    I am lucky in that I have a psychiatrist who understands that if I were locked up every time I felt suicidal I would likely never leave the hospital and she instead offers coping strategies and support for getting through the feelings rather than jumping straight to hospital in return for my complete candour about my intentions. We have this as a verbal agreement and it is working well, she has not broken her word and neither have I (nearly 3 years since my last hospital stay).
    I did actually call the crisis line the other day for the first time (other than once when I was just sussing out how they operate) and the guy I spoke to was wonderful, more than anything I think I just needed to vent and he allowed me that opportunity. I wasn’t completely open with him about how suicidal I was feeling though as I wanted to talk about the underlying issue and I do get paranoid about the police turning up!
    xx Kate

  7. Lawrence Illoc says:

    Great post! The three-paragraph that I can relate the most, in order of importance, are hopelessness, worthlessness and fear of hospitalization. I am followed by a psychologist and a psychiatrist and under medication, despite all this support I still have dark thoughts but keep them for myself as I don’t want and will never go to a hospital.

  8. heatherjo86 says:

    Thank you so much for this insightful post! I look forward to the end of sickness, sorrow, and pain which I feel will only be brought about by God’s Kingdom (Revelation21:3,4). Thank you for providing insights that will help me to be more compassionate and helpful for those suffering with mental illness.

  9. hopehappypsychology says:

    This is great, some really good points made. I did my dissertation research on help-seeking attitudes in males and some of the barriers they face, and found the topic very interesting.

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