World Sui­cide Pre­ven­tion Day is ob­served an­nu­al­ly on Sep­tem­ber 10. The in­ter­na­tion­al theme for 2024 to 2026 is “Chang­ing the Nar­ra­tive on Sui­cide.” It seems mun­dane to ask the ques­tion: “How are you?” but if your gut tells you some­thing is wrong, ask again.

Try this in­stead: “You haven’t seemed like your­self late­ly. I’m wor­ried about you. How are you re­al­ly do­ing?”

The World Health Or­gan­i­sa­tion es­ti­mates that 727,000 peo­ple died by sui­cide in 2021, and it was the third lead­ing cause of death among peo­ple aged 15 to 29. Most fa­tal­i­ties oc­curred in low- and mid­dle-in­come coun­tries. Guyana nev­er re­cov­ered from the in­fa­mous Jon­estown mas­sacre in 1978 and still has one of the high­est sui­cide rates in the world.

Loved ones left be­hind of­ten car­ry grief, anger, guilt and a litany of unan­swered ques­tions. They need care too, al­though many peo­ple wrong­ly re­ceive blame.

Sui­cide is some­times de­scribed as a “self­ish” act, but that is both cru­el and clin­i­cal­ly use­less in this sit­u­a­tion. In the midst of a cri­sis, some peo­ple de­scribe want­i­ng their pain or cir­cum­stances to stop, but ex­pe­ri­ences vary.

De­pres­sion, past trau­ma, sub­stance use, se­vere anx­i­ety, psy­chosis, chron­ic pain, se­vere ill­ness, dis­crim­i­na­tion, ac­cess to lethal means (in­clud­ing health­care work­ers), fi­nan­cial dis­tress, be­reave­ment, vi­o­lence and iso­la­tion al­so con­tribute.

“Just be strong” is poor ad­vice as feel­ings of hope­less­ness, help­less­ness and worth­less­ness in­vade the mind.

“Oth­er peo­ple have it worse” is no bet­ter. Health is not a com­pe­ti­tion. Prayer, pas­toral care, a sup­port­ive faith com­mu­ni­ty, psy­chother­a­py, med­ica­tion, prac­ti­cal as­sis­tance and a safe place to sleep are cor­ner­stones in ini­tial man­age­ment.

Many peo­ple fear that men­tion­ing sui­cide will put the idea in­to some­one’s head, but re­search doesn’t sup­port that con­cern. In­deed, ask­ing di­rect­ly can cre­ate the open­ing a dis­tressed per­son has been wait­ing for.

“Are you think­ing about sui­cide?”

If the an­swer is yes, lis­ten. Thank them for con­fid­ing in you. Ask whether they have a plan or ac­cess to some­thing they could use to harm them­selves.

If the dan­ger ap­pears im­me­di­ate, stay with the per­son. Don’t promise se­cre­cy, but re­duce ac­cess to any­thing that could be used for harm if this can be done safe­ly and take them to the near­est emer­gency de­part­ment.

If the risk isn’t im­me­di­ate, con­tact a doc­tor, men­tal health pro­fes­sion­al or cri­sis line. Make the call to­geth­er if they are over­whelmed and check back again.

There is no per­fect check­list, but changes are im­por­tant: with­draw­al, per­sis­tent hope­less­ness, marked ag­i­ta­tion, ma­jor changes in sleep, in­creased al­co­hol or drug use, giv­ing away val­ued pos­ses­sions, talk­ing about death or say­ing that oth­ers would be bet­ter off with­out them.

Dis­tress in men may ap­pear as anger, reck­less be­hav­iour, drink­ing, dis­ap­pear­ing from friends or erec­tile dys­func­tion. Caribbean mas­culin­i­ty has long re­ward­ed en­durance as “big boys don’t cry”.

Aca­d­e­m­ic pres­sure, re­la­tion­ship is­sues, bul­ly­ing, fam­i­ly con­flict and life mea­sured through “likes” on so­cial me­dia can make ado­les­cence feel treach­er­ous. Some re­sort to “cut­ting” their fore­arms or thighs as the fleet­ing phys­i­cal pain dis­rupts the con­stant emo­tion­al tur­moil. This type of non-fa­tal de­lib­er­ate self-harm must nev­er be dis­missed ei­ther.

There is now an­oth­er place where peo­ple dis­close dis­tress: ar­ti­fi­cial in­tel­li­gence (AI). AI is not a ther­a­pist or a trust­ed hu­man re­la­tion­ship. It can­not re­li­ably know what is hap­pen­ing in the room, as­sess every change in tone or guar­an­tee that help ar­rives.

The WHO rec­om­mends a broad­er ap­proach: re­strict ac­cess to lethal means, sup­port re­spon­si­ble me­dia re­port­ing, build emo­tion­al and prob­lem-solv­ing skills in young peo­ple and iden­ti­fy peo­ple at risk. These mea­sures re­quire gov­ern­ment, health­care, schools, work­places, fam­i­lies and the me­dia to do their part.

Schools need coun­sel­lors, trained teach­ers and a clear re­sponse when a stu­dent is at risk. Work­places need con­fi­den­tial sup­port. Clin­ics need enough pri­va­cy for a per­son to say more than “I came for tablets.”

The me­dia must re­sist turn­ing a death in­to a spec­ta­cle. Sto­ries of sur­vival, treat­ment and re­cov­ery may help. Fam­i­lies al­so need per­mis­sion to speak af­ter a sui­cide. Shame and stig­ma dri­ve grief un­der­ground.

Per­haps you are read­ing this be­cause some­one you love has changed. Call or vis­it them.

Per­haps you are the one strug­gling. If so, don’t wait un­til you can ex­plain every­thing neat­ly. You can say, “I’m not safe by my­self tonight.” You can send that ex­act sen­tence as a mes­sage.

A sui­ci­dal cri­sis can pass, even when the prob­lem be­hind it takes longer to solve. Treat­ment can help.

In Trinidad and To­ba­go, Life­line pro­vides free, con­fi­den­tial sup­port 24 hours a day at 800-5588 or 866-5433 for bMo­bile and Dig­i­cel callers, and 220-3636 for FLOW-to-FLOW calls. The Na­tion­al 24-Hour Sui­cide Pre­ven­tion Hot­line is 800-COPE (2673). Chil­dren and young peo­ple can con­tact Child­Line at 800-4321 or 131.

If some­one is in im­me­di­ate dan­ger, go to the near­est emer­gency de­part­ment.

Chang­ing the nar­ra­tive on sui­cide will hap­pen with care, con­cern, treat­ment and love.

Ask once be­cause it is po­lite… Ask again be­cause you mean it.