With the rising amount of stress we face in our daily lives, the workplace has become a crucial space for suicide prevention. In this article, the third in a series of four on preventing suicide at the workplace, Sriranjitha Jeurkar explores how organizations can prevent suicide and offer support to employees who may be vulnerable.
When a person is distressed, depressed or has suicidal thoughts, it is the people who are closest to them who are able to pick up cues from their behavior. In our workplaces, we spend more time with our colleagues than we do with our team leaders or HR managers. We’re the first to know when a colleague is feeling out of sorts, or has some problems at home or work. Being sensitive to these situations can help us play a critical role in helping our colleagues and preventing suicide.
Who is a gatekeeper?
A gatekeeper is someone who believes that suicide can be prevented and is willing to give time and energy for this cause. It maybe a teacher, hostel warden, parent, neighbor, employer, watchman, bus conductor, shopkeeper or a community leader. As a gatekeeper, you have to keep a watchful eye and be able to sound the alarm when you identify someone who is very distressed, provide initial emotional support and then refer them to a mental health professional. If you think that the person may be suicidal, a question like – “Do you sometimes get thoughts that life is not worth living?” may help a person discuss their suicidal thoughts with you. Contrary to what most people think, asking such a question never induces suicidal thoughts. In fact, it makes it easier for the person to reveal such thoughts. Often a person who is getting suicidal thoughts is also ashamed of such thoughts and feels relieved about being able to talk about it without being judged or labeled weak.
Identifying who is at risk
Suicide is not something that happens out of the blue. There is usually an event or a phase of difficult events that makes a person think of suicide. These are usually life-changing events such as losing a loved one, ending a relationship, losing property or money, or any experience that the person sees as shameful or humiliating. In India, depression, relationship issues and severe losses are the most common triggers.
A person who is contemplating suicide may display some of these behaviors: they may withdraw into themselves, behave out of sorts, or get intensely emotional over events that seem routine to others.
Here are some behaviors that could alert you to suicidal ideation:
Mentions of dying, ending their life, not wanting to live, or life losing all meaning
Excessive interest in details about dying, or killing themselves
Talking about being useless or being a burden on family and friends
Researching methods of suicide, considering or analyzing pros and cons of different methods
Being uncharacteristically subdued or depressed for long periods of time
Having very frequent mood swings
Getting overly dependent on substances such as alcohol or drugs
Uncharacteristic neglect of work, personal hygiene and responsibilities
Showing interest in practical matters related to death: making a will, benefits of a life insurance policy, planning their funeral
If you pick up hints that your colleague is agitated or distressed, and know that they are going through a bad phase (relationship issues, sudden bereavement, conflict with spouse or parents, financial difficulties), you can offer your support to them.
HR and managers can also keep in mind that there are other cues that can be picked up from someone who may be vulnerable to suicidal ideation:
Sudden absenteeism, or change in work patterns. Eg., a person who was usually on time and finished work much before deadlines is suddenly struggling to cope with office timings or work schedules.
During downsizing or changing of roles: employees who stand to lose their jobs, or who may face a significant change in responsibilities
Employees who are not from the region, and who have to make significant lifestyle changes to adapt to their new roles
It’s essential to remember that these risks don’t always make a person vulnerable to suicide. Rather, they indicate that the person may need additional support to cope with their new circumstances.
Breaking the ice
Many of us are willing to approach or help someone who seems to be vulnerable, but there are some concerns or barriers that hold us back. We are not sure if the other person would like us to ask if all is okay, or offer to help; we may also be afraid that offering support may make it our job to help them put their life back together.
As gatekeepers, before approaching a colleague or friend, it helps to understand our own barriers, and the barriers in the institution to begin with. Our own barriers are our fears and concerns:
What if I offer help and the person becomes angry?
What if the person mentions their problems and I don’t know what to do about it?
What if I feel overwhelmed by their distress and don’t know what to say?
How can I keep things confidential, and support the person at the same time?
What if the organization views this person differently after finding out that the person is distressed, or is thinking about self-harm? What support systems does the organization offer?
What if the organization considers this an HR issue, and that colleagues should not get involved in such personal matters?
Offering help before considering these can leave you feeling overwhelmed or helpless.
It would be helpful to assess what resources you have at your disposal: once you have the conversation, how can you support them? Who can you refer them to? Is there a professional who can offer them help and treatment if needed?
Do’s and don’ts for gatekeepers
Don’t focus too much on fixing the problem or finding a solution. Sometimes, just listening to the person or validating their distress can be enough.
Don’t minimize the other person’s problem. We all have different tolerance levels, and different ways of coping with things that go wrong.
Avoid using platitudes like “I’m sure you’ll manage,” “Be strong,” “Suicide is not the answer,” or “Everyone has problems.”
Avoid using anything that sounds like criticism or judgmental: “Suicide is bad,” or “Don’t be a coward.”
Avoid suggesting strategies to the person: “Have you tried…?”
Try not to say anything that makes the person feel guilty or ashamed of their thoughts, “Imagine what your parents/ family will go through…”
Let the person know that you are concerned for them, and that they are valued. Try not to say things that can be picked up as criticism: “People have bigger problems than this and continue to live,” or “I think you’re overreacting…”
Avoid offering advice or suggestions, unless you are specifically asked to do so. It is preferable that you listen to the person and then offer suggestions (if needed).
Gently remind the person that they have handled things in the past, and that they can count on themselves.
Acknowledge the person’s distress, and ask them what makes life worth living. The person can create this list and use it as a reminder when they feel low.
Focus on their strengths and try to identify resources within the person and in their environment.
Identify the person’s positive coping skills and remind them how they have dealt with problems earlier.
Offer unconditional support
Be available and ask the person to call you at any time if distress becomes too high.
Suicidal thoughts arise from a person’s emotional turbulence and their inability to cope with it at that moment. If you can help decrease the person’s distress to a manageable level, they are less likely to attempt suicide. You can help them manage their distress by listening, offering help and creating a supportive network.
When gatekeepers feel overwhelmed
Sometimes, as a gatekeeper, you may feel overwhelmed with the idea that you are assuming responsibility for saving a person’s life. Here are some things you can keep in mind:
You don’t have to do it all yourself. Sometimes, a conversation of a few minutes can also have a great impact on the person, and make them reconsider their decision.
The person who is in crisis is aware that you cannot fix the problem. They approached you because they feel alone and helpless, and needed emotional support. You don’t need to fix all their problems; you can help by helping them tide over their current crisis.
It is the employer’s responsibility to set up a system in which a gatekeeper can approach a specific person - an HR professional or a mental health expert - who will support them.
Having a system is useful because it helps gatekeepers have a clear idea of how to follow up after the initial conversation. It also prevents such cases from becoming fodder for office gossip, with information being spread to everyone in the organization. Anyone can be a gatekeeper with some training. In the interest of employee welfare, the organization can create as many gatekeepers as possible, spread across several locations for better access.
Creating gatekeepers in the organization
Organizations such as SNEHA in Chennai and NIMHANS Center for Wellbeing in Bangalore offer gatekeeper training. The training focuses on identifying the risk for suicide, assessing level of risk, identifying resources and suicide counters or protective factors, sign posting to appropriate professionals, and techniques for decreasing emotional turbulence.
This series has been curated by White Swan Foundation with inputs from Dr Gururaj Gopalakrishna, head of the department (epidemiology), NIMHANS; Dr Prabha Chandra, professor of psychiatry, NIMHANS; Dr Seema Mehrotra, additional professor of clinical psychology, NIMHANS; Dr Poornima Bhola, associate professor, department of clinical psychology, NIMHANS; and Dr Senthil Kumar Reddi, associate professor of psychiatry, NIMHANS.
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