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. It’s not myself that I see as a burden; rather, it’s the suicidality. The suicidal thoughts were such a significant weight 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 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?
Hopelessness
My illness makes me feel like there is no hope for the future. 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’ve given up and don’t want anyone trying and failing to help; in the end, that would just make things more difficult.
Over the entire course of my illness, it’s proven to be very hard to treat. In the past, I was able to achieve full remission eventually; now, though, 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. That only reinforces 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 care and 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. 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 police involvement
If someone does call the police on you, that won’t necessarily go down well. Canadian Chantel Moore was killed by police during a “wellness check” in 2020. Another Canadian woman, Mona Wang, was handcuffed, dragged along the floor and into the building lobby with no shirt on, and had her head stepped on by a police officer. It doesn’t always go this badly when police get involved, but it certainly happens enough to make people hesitate.
Until twe remove routine police involvement from mental crises, the prospect of police involvement will be a barrier to help-seeking for some people who are experiencing thoughts of suicide.
Fear of hospitalization
This is the single biggest barrier to help-seeking for me, and the reason why 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 in a personal sense, it feels like a failure to maintain the ability to make choices for myself, which I have serious issues with. This fear of hospitalization is deeply ingrained in me, so instead, I 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.
Fear of getting blown off
Reaching out is all well and good, but if you reach out only to be kicked in the face, that doesn’t accomplish a whole heck of a lot. Yet that happens far too often; people show up in ER, they’re deemed not suicidal “enough,” and they’ve given the boot with nothing more than a pamphlet. England’s NHS even had a program euphemistically called Serenity Integrated Mentoring that involved denying frequent service users treatment in the ER, and in some cases used jail time as a penalty for something like showing up in ER after a suicide attempt.
So where does this leave us?
I know that reaching out for help dealing with thoughts of suicide is the right thing to do, and it’s what I’d 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. We need better choices to be available so that suicide is not a choice people feel the need to make, and the mental health care system needs to stop failing suicidal people.
What has been your experience of accessing help in a crisis? Are there any barriers to help-seeking that have affected you?
Related posts
- Failed/Successful Suicide: Do Words Matter? What’s the Real Failure?
- Is Suicide a Choice? (Regardless, It’s Not Selfish)
- Suicidal Posts on Social Media: What Should Platforms Do?
- Suicide Awareness Isn’t Enough for Prevention
- The New York Times’ Take on a Suicide Forum – My Thoughts
- What a 988 Suicide Hotline Can (and Can’t) Accomplish
The Straight Talk on Suicide page has crisis and safety planning resources, along with info on suicide-related topics from the perspective of someone who’s been there.
I hate to say this but I had an ex who threatened suicide and literally ran out the door in his bathrobe and his friends encouraged me to call 911. I did and asked that they send someone with mental health training, and instead they sent cops and forced him into involuntary hospitalization. I was told by so many people I did the right thing and that I “saved” his life but I don’t think that’s true.
This guy was totally abusive to me, and I STILL feel like garbage and a traitor for this. It’s been like 6 years and I haven’t talked to him for a long time, and I still wish I was dead when I think about it sometimes. I don’t know if he’s ever forgiven me. I was stupid. He doesn’t have to.
That being said, I have always low key had suicidal ideation, but never tried to act on it. I kept it to myself because my mom would either shut me down or threaten to have me committed. It wasn’t until my experience with my ex that I realized just how easy it is to be hospitalized or have a run in with the police. And it made me even worse. Now I am intensely suicidal because I’m queer under the Trump administration and live alone and the weight of isolation and hate is really piling up. There’s also a very specific issue with queer men where people are like “you’re men, lol, solve your own “”””isolation”””””. There’s an attitude of like “as if you have real problems” which comes at you from both sides. And don’t get me wrong, I know some of this at the center and on the left is a frankly understandable response to men’s mental health issues being used to promote frigging alpha male bro incel garbage. And I despise those guys for a lot of reasons but one is definitely that they’ve made it basically impossible for people like me to reach out into a space that would have otherwise been safe and say “I’m isolated and I don’t want to be alive anymore and I really need someone to talk to about it”. I do have friends but I can’t do that. All my friends are women, and they have their own problems. I don’t need to be adding the weight of emotional labor to that. But I can’t help but feel like it would help so much for people to ask how I’m doing sometimes, and for me to just be able to go “I feel like a broken vase and my water is all over the floor and my base is intact but I don’t know where to start with putting the pieces back together”.
So why don’t I call a hotline or something? Well it’s what you talk about. I’m glad you shared because no one ever talks about this. Fear of hospitalization is a huge reason I don’t ask for help. I hated those people for how they traumatized my ex. They also treat LGBT people worse. How is it supposed to help to take away your autonomy and cut you off from the outside world and not just talk to you like a sapient adult to sapient adult about strategies for feeling more control over your life and becoming less isolated? I’m sorry but whoever decided the solution to the stress of being isolated, broke, and feeling a loss of control is to ISOLATE SOMEONE, TAKE AWAY THEIR AUTONOMY, AND LAND THEM WITH THOUSANDS OF DOLLAR OF MEDICAL DEBT is patently insane enough to where they should be in that facility themselves indefinitely.
So yeah, I just don’t talk about anything. And then every time a high profile person kills themself, everyone around them is all like “oh no we never saw this coming” and I’m like “geez I wonder why”. Everything sucks. I wish there was a safe place to talk about this stuff to someone. I don’t want empty sympathy, what I want is for someone to give me survival strategies. I know you can get some of this in therapy, but I’ve stopped using insurance to pay for therapy because I was worried that if ACA is dismantled, I can be denied insurance coverage for having mental health issues, so I pay in a way that isn’t as traceable. But that means I’m pissing away like 200 dollars per session, and now that my mortgage is half my paycheck I just can’t afford it anymore, so I’ve had to stop. Not that finding a queer or TRULY queer informed therapist is easy in the first place. It takes a lot of time to establish trust with someone. And then. Again. There’s that issue of “how much can I talk about my feelings before it puts me at risk?” And then you stop talking. And you hide it. And you dont make progress. Like for crying out loud all I want sometimes is to say how much I want to die and freak out and cry about it and then we talk about how to make a live I don’t want to escape from every day. Because that’s what it’s about – death is about escaping. If there’s a way to escape the stress while I’m alive, I’ll take that option too. But it feels like there isn’t.