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 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
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.
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.
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 there is defunding of police or some other model to remove routine police involvement from mental crisis, 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?
The Straight Talk on Suicide page covers a variety of topics related to suicide, including getting help and safety planning, from the perspective of someone who’s been there.