It’s world suicide prevention day today so I thought I’d pen (type) a few words on the way in which we can work safely with suicidal clients online. I’ll be talking about problem gamblers specifically as they’re the client group I work online with.
It will come as no surprise to anyone that problem gamblers can sometimes be suicidal….people who are addicted to gambling are often able to hide the addiction for quite some time, maybe even years, from those closest to them. If you’re in a relationship with a problem gambler you might get the sense that something is wrong…your partner might be distant, anxious, depressed and even have angry outbursts for reasons you can’t identify but none of these things would necessarily lead you to the conclusion that he or she was a problem gambler.
Thoughts of suicide thrive if the thinker feels no one cares and in their distorted view of the world a problem gambler might interpret a loved one’s lack of understanding as apathy. Of course it’s pretty difficult to show understanding regarding a situation you know nothing about! Another contributing factor to the consideration of suicide as an option for many problem gamblers is the fear of being “found out”. Think about it….you’ve spent a long time hiding your addiction….getting rid of the betting slips…clearing your browser history….taking the bills away and putting them somewhere “safe” before they even have a chance to hit the mat and you’ve managed to keep all of your balls in the air BUT you know that tomorrow you’re going to get caught.
If a problem gambler knows that the secret is going to come out because there is some form of communication on the horizon that can’t be controlled heading in the direction of a partner, such as a call to the bank the partner intends to make to find out just what the hell is going on, they may feel utterly desperate! The idea of facing someone they love as the extent of the chaos they’ve created is unearthed before they’re very eyes can be too much to bear for some and there only seems to be one way out.
I work for an international online counselling and support site for problem gamblers and sometimes I “meet” people who have reached the exact state of mind I’ve described. Now, I don’t want to go into the ins and outs of what can and can’t be done to get help to people in distress when working online because although there may be a few things, involving IP addresses etc, they are very limited if you’re working on a “drop in” basis to provide emotional support. Obviously if you’re working in a structured way, with a contract and details of Doctors and next of kin, which you would have if counselling someone, you have greater control over what you can and can’t do. So, for the purpose of this Blog, let’s focus on the people who click a button and get through to us without having had any prior contact with our staff team.
First and foremost and in the words of Hitchhikers Guide….DON’T PANIC! If you receive contact from someone who implies or explicitly states that they are suicidal. The service user is seeking help by speaking to you which is a positive thing. There’s no empirical or anecdotal evidence to suggest that talking about suicide or indeed naming it, if service user talks about “not wanting to carry on” etc, will increase the likelihood of a suicide attempt. In fact, quite the opposite is true as many people report feeling relieved at being able to explore their feelings about the subject.
Discussions around suicide should be handled sensitively and if your client hasn’t mentioned the word “suicide” explicitly, word your questions carefully and seek clarification about what they’re trying to tell you. Questions such as “You seem to be saying to me that you don’t want to be here anymore, would I be right in thinking you’re having thoughts about ending your life?” can offer the client the opportunity to open up because it shows them suicide isn’t a “taboo” subject. You don’t want the client to think they’ll freak you out if they tell you what’s really going on after all.
When a suicide risk has been identified the first step to take is to find out where they are and who, if anyone, is with them. The primary aim of the conversation at this point is to encourage the client to get some face to face help…whether that’s from a friend; family member, mental health professional or doctor is irrelevant. If the caller tells you they’re alone and have no one to turn to it’s important to make sure they have a link or telephone number for services such as the Samaritans or Befrienders (outside the UK) before the call comes to a close. If you build up a rapport they may even give you an address or telephone number you can use to get help to them if it comes to that, which in my experience it very rarely does.
One thing you can do to take the pressure off both of you is to employ a brief “no harm” contract that applies to that particular session. This means that the service user agrees not to act on suicidal thoughts during or immediately after the session and they agree to access additional support from a friend, family member or organisation following the session. Without this commitment from the service user you may struggle to have peace of mind and should decide for yourself if you can be effective with such uncertainty in the air.
Some suicidal thoughts are fleeting and vague and occur only when an individual is in crisis whereas other thoughts can be constant and well considered. In order to help the service user to better understand their feelings you could ask them to rate the intensity of their suicidal thoughts on a scale of 0 to 10 (0 being no strong thoughts and 10 being a determination to act on their feelings in the immediate future). This will help you determine the level of risk you’re working with.
Another method of assessing risk is to ask the client whether they feel this way as a result of a prolonged period of depression or whether they may be feeling this way as a response to another situation which will pass. If the feelings are being driven by current circumstances allow the client to explore the possibility of resisting the feelings until their circumstances change. The emphasis here should be on the way in which circumstances change, has the service user considered coping strategies that are flexible and can change along with their situation instead of employing such a permanent solution? You can do this by looking at different scenarios with the service user such as talking to the people in their lives that they find to be supportive and helpful. If the clients’ feelings appear to be more prolonged, encourage them to access a mental health service or their GP to assess whether they may be clinically depressed and identify potential treatment. Whether clinical or reactive we know that depression can be treated and the low feelings will eventually pass, so try to focus the client on the fact that however painful, their feelings are temporary and death is permanent so wouldn’t it be more logical to look for ways in which to cope until they pass?
Encourage the service user to look at times in the past when they may have felt this way, ask them about what coping strategies they employed before in order to survive. When working with our client group we have to be aware that the answer to this question may be “I gambled” in which case exploration of other methods of coping in a healthy way should take place.
Always remember that if someone decides to end their life it’s their decision. I know it’s sad and monumentally frustrating but there are no magic words we, or anyone else, can pluck out of the air to “fix” anyone. By letting a person talk about suicide openly and without judgement you’re giving them something very special, you’re accepting them….and maybe that’s what they need.
When ending the call the service user should have a clear idea of what to do next and what methods of support are available to them and you should make a note of your experience so you can talk it through with your clinical supervisor.