World Suicide Prevention ‘Done’

Today is World Suicide Prevention Day for 2022. A day that I am normally happy to promote and have open conversations about suicide but this year is different. I feel frustrated with the suicide prevention space and wish that we didn’t have to do the work we do to stop others feeling suicidal. I feel tired with the state of the world.

Today, I don’t want to talk about suicide.

As an advocate for lived experience and someone who does work in this space, this post is hard to write. I am required to have answers and solutions to the problems but today I feel like I have none. I am asked to give immensely and this empties my cup. I am reminded of the need for self-care and finding ways to refill my cup and doing this takes practice and hard work. Some days the hard work seems too immense to manage.

I speak to a lot of other advocates and I know I am not alone in feeling this way. Call it compassion fatigue or burnout or whatever you want. These terms barely touch the surface of how a passion can quickly become a chore. These advocates scale back participation, offload to a sympathetic ear or even write a frustrated blog/social media post!

For me, self-reflection has been an integral part of my self-care practice and steered me through the ups and downs of recovery. Today I go back to basics and reflect on the reasons why I am feeling ‘world suicide prevention done’.

How we work together

I attended a meeting last week to talk about principles for effective lived experience engagement in a suicide prevention organisation. We talked about concepts like respect, valuing diversity, providing meaningful and equal opportunities, and systems that enable people to do work in the way they need. It frustrates me that this conversation is needed, that suicide prevention organisations need principles to lead them to be compassionate to those with lived experience. Further, having a nice diagram with pretty words does little to influence the culture within an organisation. It is the people, not the paperwork, that makes for an inclusive workplace.

A quick scan of the research lead me to find a great paper (1) that identified eight action oriented principles, copied from page 1 of the paper:

“- Ensure staff provide supportive and facilitative leadership to citizens based on transparency;

- foster a safe and trusting environment enabling citizens to provide input;

- ensure citizens’ early involvement;

- share decision-making and governance control with citizens;

- acknowledge and address citizens’ experiences of power imbalances between citizens and professionals;

- invest in citizens who feel they lack the skills and confidence to engage;

- create quick and tangible wins;

- take into account both citizens’ and organisations’ motivations.”

The key point to this paper, and a point that leads me on to my next frustration, is the power dynamics within an organisation and how they greatly influence meaningful participation. Organisations must be willing to give up decision making control to be flexible to the voice of lived experience.

Power players

In my experience in the suicide lived experience movement, we have traditionally had a cohesive voice. Although disagreeing at times, the compassionate approach has lead to understanding and reaching common ground. This has not always been the case in the mental health consumer movements, leading to dominant voices and divisions within the sector. As an observer, I see increasing tensions within the lived experience of suicide space as dominant voices arise and begin to discount the experiences and views of others who disagree. A recent comment to show this is a prominent lived experience of suicide leader who stated “but what he said is just wrong!”, when reflecting on the opinion of another lived experience leader. At the risk of sounding clichéd, divided we fall, united we stand.

A fantastic piece of work by Indigo Daya, Bridget Hamilton and Cath Roper (2) outlined these differing opinions in mental health consumer movements in a useful model. They described two axes of experience, experiences with treatment given and experiences with the care received. Their model demonstrates that different advocates have positive and negative experiences along these axes, and this diversity is normal and expected. So why then do we pin our faith on one loud voice over another? The authors of the paper call out for policy and practice to seek out those with challenging and oppositional voices.

There are no wrong lived perspectives, only different ones.

It takes a community

I hear other people with lived experience who do work in suicide prevention say “how do I get my family/friends on board with what I am doing?”. In my own experience, people who knew me before “coming out” as a person with lived experience, have trouble starting conversations about the work I do for suicide prevention. This leads to feeling like I am living two lives at times, one that I do with my suicide prevention family, and one that encompasses everything else. When I have success in the suicide prevention world, people in my non-suicide prevention world don’t understand the significance or simply fail to recognise the win. So how do we merge our two worlds?

Searching for resources on this topic is tough. It doesn’t seem that we have had these conversations in a structured way yet. In my attempts to integrate these two lives, I have gradually had small conversations with those around me about what I do in suicide prevention. My family have come to hear me speak and tell my story publicly and support my work in small ways. These small ways, however small, are a win. It is important to remember that suicide is a challenging topic for many and by virtue of your lived experience, you are thrown into the deep end. The people around you might be dipping their toe in and haven’t been forced into being comfortable with suicide the hard and fast way.

My only wish for those without a lived experience is to become allies and sit in the discomfort. It makes a world of difference to a person with lived experience to show interest and support for their suicide prevention work.

All in all, I don’t have the answers to solve my ‘world suicide prevention done' and that is ok. Today I am listening to what my mind and body are telling me and allowing myself to be done. In an unhelpful and condescending way, those who have thoughts of suicide are sometimes told, no feeling is final, but today I am reclaiming that, disengaging from suicide prevention and accepting that maybe tomorrow I might feel less ‘done’.

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(1) De Weger, E., Van Vooren, N., Luijkx, K.G. et al. (2018) Achieving successful community engagement: a rapid realist review. BMC Health Serv Res 18, 285. https://doi.org/10.1186/s12913-018-3090-1

(2) Daya I, Hamilton B, Roper C. (2020) Authentic engagement: A conceptual model for welcoming diverse and challenging consumer and survivor views in mental health research, policy, and practice. Int J Ment Health Nurs. 29(2):299-311. https://doi.org/10.1111/inm.12653