Frustrated tired businessman having strong headache at diverse team meeting

Suicide Prevention: Uncovering the Signs

Suicide Prevention: Uncovering the Signs


Frustrated tired businessman having strong headache at diverse team meeting

During these unprecedented times of COVID-19, the importance of mental health and our overall well-being has received more attention than normal. Throughout the pandemic, people have felt the overwhelming sense of loneliness, isolation and experienced multiple disruptions in their daily routine. The added economic concern, with realized job loss or threat thereof, has layered new realities and complexity to our individual and collective mental health. Although not necessarily the primary cause for one to consider ending their life, COVID-19 has become a contributing factor that influences one’s decision to consider suicide.

On average, we’re spending more than a third if not half of our waking hours at work. Colleagues often become friends rather than just colleagues and will offer you glimpses of their inner lives. Suicidal thoughts and plans are the last thing you would expect to be shared. However, what if you become aware that a colleague is contemplating suicide?

In this article, we’ll be looking at:

  • What are the predisposing and contributing factors of suicide
  • What are potential signs of suicidal risk in a co-worker
  • How to provide support while respecting confidentiality and safety issues
  • How to promote self-care and seek outside support if needed

But first, some facts…

For every death by suicide there are 20 to 25 attempts, 5 self-inflicting injury hospitalizations and 7 to 10 people deeply affected by grief.

On average, suicides claim the lives of 12 Canadians per day. In 2015, 3,269 Canadian men and 1,136 women died by suicide. (1) However, women make up to 3 to 4 times more suicide attempts than men. The actual suicide rate for women has risen by as much as 50% from 2000 to 2016 in the U.S. (2) and a similar trend has also been observed in Canada. Overall, the prevalence of suicide is growing. According to Fardous Hosseiny, the national director of research and public policy at the Canadian Mental Health Association, the percentage change over 2011 and 2015 shows an increase of 12% in males and 15% for women. The largest population of suicides in Canada are from working aged men and women between the ages of 30 to 64 with a peak occurring between 45 and 59. (3) The suicide rate among the U.S. working-age population increased by 34% between 2000 and 2016. (4)

Workplace suicides have also increased. Approximately 1,719 male and female workers ended their lives on the job in the U.S. between 2003 and 2007. (5) In 2016, the American Bureau of Labor Statistics reported a steady increase in workplace suicides from 2007 to 2013. In 2018, the Mental Health Commission of Canada published a study that found Canadian employees reported workplace stress as the primary cause of their mental-health concerns. (6) Steve Bittle, an associate criminology professor at the University of Ottawa states that between 10 and 17 per cent of annual suicides in Canada could be classified as work-related, representing a range of 400 to 800 fatalities each year. (7)

In November 2018, the CDC (Centers for Disease Control and Prevention) reported that the top 3 major occupational groups by suicide rate among males in 2015 were:

  • Construction and Extraction
  • Arts, Design, Entertainment, Sports and Media
  • Installation, Maintenance, and Repair

For women:

  • Arts, Design, Entertainment, Sports and Media
  • Protective Service
  • Healthcare Support

For both genders, the lowest suicide rates in 2015 were observed in education, training and library occupations.

In general, occupations with higher suicide rates involve one or many of the following factors: easy access to lethal means, exposure to chemicals, high workplace stress and risk of trauma, job insecurity, low wages, inconsistent work schedule and isolation in the workplace.

Rising workplace suicide rates shouldn’t come as a surprise in an era crippled with progressively increasing levels of pressure and stress among employees. Now the added complexity of COVID-19 has created new factors that influence the rising statistics. According to the HR Digest, the obsessive focus “on targets and deadlines, race for profits and excessive individualization as well as informal competition amongst colleagues are some of the causes of suicidal tendencies. They lead to psychological problems in the workplace which have a negative impact on the way employees work.”

When a suicide does occur, work and/or business related colleagues can be emotionally impacted with feelings ranging from anger, grief and guilt. These feelings can last far beyond the initial shock and reaction time span. Feelings and reactions may also surface within colleagues who weren’t close to the employee who took their own life. Often, death by suicide leads to rumors and speculation about why it took place. These rumours may include work-related factors and could potentially affect the morale of employees.

Predisposing and Contributing Factors

Causes for suicide are a complex cocktail of factors, including relationship breakdowns, financial difficulties, chronic physical illness, major losses, major social disruptions or a lack of social support. Some factors can be work and career related. It has been found that for every 1% increase in unemployment, there is a 0.79% increase in the suicide rate. (8) During the Great Depression, the suicide rate in America increased by 21%.

A common predisposition is an underlying mental health disorder, as 60% of completed suicides involve people dealing with a diagnosed depression. Moreover, 90% of people who take their own lives suffer from a mental health disorder. (9)

When professionals estimate the risk of suicide among employees, they will take into consideration some of the following predisposing factors:

  • Access to lethal weapons
  • Past suicide attempts
  • Capacity to hope for positive change
  • Self-help capacity, including diet, quality of sleep, medication and professional follow up
  • Chronic mental health suffering and/or physical pain
  • Self-control and impulsivity
  • Substance usage and/or abuse
  • Support network, which serves as a protective factor.

Uncovering the Signs

Depending on how close you are to a co-worker, you may or may not know of the above predisposing factors but some signs can give you hints as to the potential risk of suicidal thoughts or plans. None of these, on their own, can reveal suicidal risk, but a combination of some of the following signs can reveal a significant level of distress within your co-worker. About 75% of those who die by suicide do exhibit some suicide warning signs. 10

Work-related signs or situations to look for are isolation, performance and stress-related anxiety, conflicts with management or colleagues, job insecurity, intense expressions of job dissatisfaction, deep and long-lasting fatigue, workload issues, and presenteeism or absenteeism. It’s important to recognize that some of the previous symptoms can also be traced back to personal problems affecting the well-being and mental health of a colleague. Mental health disorders influence feelings, thoughts, behaviour and abilities. Employees dealing with a disorder may show losses in confidence, concentration and patience. It might impair their decision making, judgement and people skills. Their personality can be altered and subject to mood swings and extreme shifts in behaviours and attitudes.

More typically linked to suicide are comments on being a burden to others who they say would be better off if they weren’t there; or employees becoming suddenly very happy after a depression or despite everything crumbling down around them. More obvious warning signs require more immediate action, such as someone expressing the desire to die or to end their life and having a plan to do so. (11)

It’s estimated that up to 25% of people do not exhibit signs before ending their lives. It’s important not to blame yourself or others if a colleague completes suicide without any visual or behavioural cues. However, if you recognize any of the signs mentioned earlier, don’t hesitate to engage in a conversation with your co-worker. If you happen to be right, starting that conversation might just save your colleague’s life.

How to Provide Support

If you approach a colleague you believe might be suicidal, tell them you’ve noticed changes in their behaviour. Be respectful and share your concerns. Ask if the person is okay. It’s normal to feel uneasy and it can indeed be scary. But asking someone about suicide doesn’t put the idea in their head. Instead, according to the Ontario Suicide Prevention Network (OASP):

  • It breaks isolation which can distort their fears, hopelessness and embarrassment.
  • It breaks the silence and sends a powerful message that they are not alone, that you care and that it’s okay to talk about their thoughts and feelings.
  • Opening up a conversation about suicide is the first step towards hope and almost always helps reduce the risk.
  • It lets people the opportunity to let their fear out and to consider and talk about other options. Suicide is often less about wanting to die, and more of a feeling or belief that they have run out of options.

Be cognizant of the individual’s right to privacy and never jump to conclusions. However when you genuinely believe there is a risk of suicidal thoughts or plans:

  • Don’t hesitate to ask your colleague directly if they are having difficulties. If the answer is yes, ask if they have thoughts or plans of suicide.
  • If they do have thoughts or plans of suicide, first acknowledge that this is serious. Don’t act right away. Keep the person talking and keep listening. This shows empathy and understanding. It creates the necessary bond you need to build before you even mention outside help.
  • Foster hope by exploring potential options for help. Seek to find supportive people like professionals or important persons in their lives that are well suited to identify better options. Remember, the suicidal person is seeking a way out of a painful situation. They are often in the dark and have lost hope, shedding light on a different road map can help them to recognize and consider other pathways.
  • Check on prior attempts. You can ask you colleague if they has tried to hurt themselves in the past. If they have, the risk of suicide increases making it more urgent to get professional help.
  • After your conversation, don’t let this rest upon your shoulders. You can express your concern about needing to get help in order to keep your colleague safe. Refer them to resources in your workplace (HR, EFAP), or to a mental health professional or a community resource, like a crisis centre.

The person has to be put in contact with the chosen resource as soon as possible. It is important that a person entertaining thoughts of suicide be linked to a well-trained professional that can perform a comprehensive suicide assessment and intervention within the day. (12) In the meantime, make sure your colleague is not left alone. Either stay with your colleague or ask if they have a close friend or family member that can be with them. Be sure to let your colleague know, they need to tell someone and seek help if risk of harm exists.

Remember that security issues always outweigh confidentiality considerations if a person is deemed in danger of inflicting imminent harm to themselves in a way that can threaten their life or the life of others.

Self-care

Providing support to a suicidal colleague is not easy. It can affect you emotionally, put you in a state of constant worry and make you feel responsible for one’s well-being. Crisis and suicide prevention centres most often offer support services for people who are themselves a support to a suicidal person. Your EFAP and HR resources might also offer such services. Your personal network of family and friends is also an important resource, but go to a professional support system first. It will make you better informed and should lift much of the weight of responsibility off your shoulders.

If you would like more information on suicide alert programs or training to develop skills in suicide intervention, many local and provincial suicide prevention community resources offer training and even workplace gatekeeper programs.

A positive aspect of COVID-19, one’s mental health has become more accessible. Free to all Canadians, Homewood Health is a proud partner in Wellness Together Canada. This online portal offering free resources, tools and mental health support services in both English and French. It can be accessed at wellnesstogether.ca or by phone by calling 1-866-585-0445.

No one is immune from suicidal thoughts and urges. If such thoughts should invade your mind, don’t isolate yourself, talk to someone you trust and ask for professional help. You don’t have to suffer in silence.

No one is immune from suicidal thoughts and urges. If such thoughts should invade your mind, don’t isolate yourself, talk to someone you trust and ask for professional help. You don’t have to suffer in silence.

References:

1. Statistics Canada, 2015, as reported by Global News. Source : https://globalnews.ca/news/4274136/suicide-rates-w…

2. Dr. Hedegaard, H., Suicide Rates in the United States Continue to Increase. National Center for Health Statistics (NCHS). 2018. Source: https://www.cdc.gov/nchs/products/databriefs/db309…

3. Statistics Canada, 2015. Source : http://dustinkmacdonald.com/canadian-suicide-stati…

4. Suicide Increasing Among American Workers. Centers for Disease Control and Prevention (CDCP) press release. 2018. Source: https://www.cdc.gov/media/releases/2018/p1115-Suic…

5. American Bureau of Labor Statistics (ABLS). Source : https://www.thehrdigest.com/workplace-suicides-ris…

6. Canadian employees report workplace stress as primary cause of mental health concerns. Mental Health Commission of Canada. 2018. Source: https://www.mentalhealthcommission.ca/English/news…

7. Job-related deaths in Canada dramatically under-reported, study suggests. CBC News, January 29, 2019. Source: https://www.cbc.ca/news/canada/workplace-fatalitie…

8. Stuckler,D. et al. The public health effect of economic crises and alternative policy responses in Europe: an empirical analysis. The Lancet. 2009. Source: https://www.thelancet.com/journals/lancet/article/…61124-7/fulltext

9. Public Health Agency of Canada, 2016. Source: https://www.canada.ca/en/public-health/services/pu…

10. Source : http://www.suicide.org/suicide-warning-signs.html

11. American Association of Suicidology, 2017. Source: https://www.suicidology.org/resources/warning-sign…

12. LivingWorks Canada, 2007. Source : http://www.ospn.ca/index.php/suicide-prevention/su…


Surviving Grief

Surviving Grief


In every type of job, eventually, we will experience significant loss either personal, professional or both, and therefore, grief. The grief may result from death in an individual’s family, or it may be the death of a coworker or employer. It may be the loss of employment, either from a single dismissal or a significant restructuring and lay off of workers. Whatever the source, the resulting grief can end up being problematic and disruptive to the ecosystem of the workplace.

Types of loss and grief

Some of us only associate grief with the death of a significant other or pet, but people can experience pain after any consequential loss that affects their life. Different types of loss include that of a job or relationship, and in some instances, after the diagnosis of an illness or other major health problems.

There is no one way, or right way, to grieve. However, there is a singularly effective way to receive and empathize with the grieving of others. Brené Brown, author of Daring Greatly, distinguishes between the disconnecting properties of sympathy and the connection we gain through empathy. She refers to nursing scholar Theresa Wiseman, whose research shows empathy to be: the capacity to recognize others’ perspectives as their authentic experience, to understand others’ emotions and articulate them, and to avoid judgment. (1)

Within today’s work environment, there are multiple cross-sections of cultures and religions. Each culture has a set of beliefs that describe how the world works and people’s roles in the world, including their roles in the grieving process. (2)

It helps to remember that each culture has particular and often unique views about the meaning of life and what happens after we die. In general, ideas about the meaning of death help people make sense of it and cope with its mystery.

Some cultures believe in life as a cyclical rather than linear phenomenon; that we return to life after each death. Others believe that the spirit of someone who has passed directly influences the living family members; after death, the spirit of the individual watches over them.

In each culture, death is associated with a set of rituals and customs to help people with the grieving process, offering ways to process and express their grief.

In some cases, a person’s experience of grief may differ with cultural norms; for example, in the case of someone who is quiet and reserved and not quick to cry or express their grief. Some may have a level of despair that feels out of step with the norm, but despite those norms, we need to allow individuals the space to grieve in a way that feels right to them. Although another’s rituals may seem foreign compared to those of our own, these routines provide a means for communities to support the bereaved.

People often adopt the beliefs and values of their culture to meet their unique needs and circumstances. As a result of this, grief responses within a culture can vary from person to person. A family with members from more than one cultural background may develop unique rituals and customs, combining elements from several cultures.

A person who is bereaved can often feel lost in the sense of chaos and confusion. Regardless of where they come from, rituals and customs provide a sense of routine and normalcy. They provide direction and structure at a time when the chaos of emotion could easily prevail. Consider the following when a co-worker is grieving:

  • What are the bereaved family’s beliefs surrounding death?
  • What emotions and behaviours are typical for the bereaved person’s culture?
  • Who should attend certain ceremonies, and how are attendees expected to act and dress?
  • What types of offerings, material or emotional, are expected?
  • Are there appropriate verbal or written condolences?

Consider talking with someone who shares that same cultural background, or you can start with internet resources if that feels more comfortable. Being ignorant of the cultural differences of grief could cause undue conflict or misunderstanding in the workplace; however, showing compassion and acceptance will create connections and help in the moving forward phase. Here are a few considerations:

When the person returns to work:

  1. At the first opportunity, express your condolences (if you have not already done so).
  2. Make it as normal as possible. Try not to change your facial expression and tone of voice when speaking with your co-worker.
  3. Carry on with normal work routines. If you typically eat lunch together, continue doing so.
  4. Try to be sensitive in your conversation. If you are unsure what to say or how to treat them, acknowledge that, and ask them if they wish to discuss the loss, or instead wish to concentrate on workplace tasks. They will tell you what they need and don’t need, and you should respect their wishes.

The following examples illustrate things you should avoid saying when trying to support someone who has recently experienced a loss.

What not to say:

  1. “I know how you feel.” Each loss is different. You could, instead, ask how he or she feels, but only if you know they are okay with talking about the loss at work. Also, don’t share your own story of loss as a sign of empathy.
  2. “It’s part of God’s plan” or “It is God’s will.” This can make people angry and they may respond with, “What plan?” For some, religion may not come into play.
  3. “Call if you need anything.” They aren’t going to call. It is much better to offer something concrete, such as: “I have some free time, and if needed, I would like to come over and help where possible.”
  4. “He/she is in a better place now.” These clichés can be hurtful as circumstances may be of a sensitive and/or difficult nature.
  5. “It’s time to get on with your life.” We all grieve in our own way and our own time. It is not your place to suggest what length of grieving is warranted.

Stages of grief

We know now that there are five stages of grief that most individual tends to go through, but how those stages play out in a person’s life will be unique and probably full of nuance, involving emotions that come and go, in a seemingly cyclical fashion. (3)

The five stages of grief

  • Denial
  • Anger
  • Bargaining
  • Depression
  • Acceptance

People experience grief in many different ways, often in a unique mix of sadness, shock, anger, fear, or anxiety. Some feel numb, while others feel relief or peace after a loss.

Some can even feel removed from the world and disconnected from daily life, including work. In all of these cases, support is necessary to move on and forward.

In order to heal, you have to acknowledge the pain and allow yourself the opportunity to grieve. Unresolved grief can lead to complications such as depression, anxiety, substance abuse, and health problems. Exploring your feelings and thoughts through writing, painting, music, or other forms of creative expression can be a powerful way to help heal. And remember, crying is a natural way to help release the hurt.

Be aware that some coworkers may not have experienced a significant loss, and do not have the psychological tools or experience to support their peers. For them, it is vital to have an established plan for supporting their colleagues without becoming consumed by the situation.

How to move forward

Grieving a loss can sometimes feel endless and unbearable, and yet we eventually must return to some daily routines.

Although some of those routines may have changed, the need to work often remains constant. What happens then? Moving forward doesn’t mean forgetting; it’s merely making new connections so we can thrive. Being conscious of our distressing emotional thoughts can be the impetus to moving forward in our own lives, but how do we become the kind of support for a grieving colleague if and when required in their time of need? (4)

Through our work, we have found that employees have a dual responsibility. First is the responsibility to the employer; second is the responsibility to keep the work environment running like a healthy ecosystem, part of which is taking a reasonable amount of interest in the well-being of coworkers. Almost all of us will spend the better part of our working lives surrounded by people who are not considered to be our friends. While we may spend more time with them than with our family and/or social friends, the interactions are typically communal and on the surface, rarely run deep. Coworkers and supervisors are often at a loss as to how to react in the wake of a personal and significant loss. It’s difficult to know what to do or say, what not to do or say, and how long the uneasiness will last. (5)

We form well-intentioned comments out of care and concern, yet may convey unknowingly a lack of sensitivity to one’s grief experience. The bereaved may take this perceived reservation to mean that it’s time to ” snap out of” their sadness though they have little control over their emotions and may lack the ability to regulate their attention. Workers whose jobs take high concentration may experience distracting thoughts about the deceased and may make mistakes that they wouldn’t typically make.

Added to the intense emotions they are experiencing is anxiety about how employers and coworkers perceive them. A bereaved person may have a fear of further loss, of their job, perhaps compounding the sadness and anxiety they are already experiencing. These are two ways you can support a grieving colleague; it is wise to find a compassionate middle ground where supportive actions and giving space are in balance. While it may seem well-intentioned, saying, “ take your time” or “whatever you need” may be insufficient and may result in an uncomfortable void between colleagues.

Where existing relationships permit and while ensuring you respect the right to privacy, you may ask about the loss during the course of related conversations.

At the same time, it’s essential to remain respectful and aware of when the conversation becomes uncomfortable and the person is giving verbal and non-verbal cues of their need to stop the conversation. Grief counsellors suggest phrasing it authentically. For example, ” I don’t know what to say, but I care, and I’m here when you want to talk.

Remember that grief isn’t linear, and it can be quite complicated. Feelings, thoughts, reactions, and challenges related to this type of pain are very personal. These thoughts or feelings can sometimes seem at odds with each other, with the intensity of grief changing over time. On top of this, it is not uncommon to feel like the grieving has reached an end only to be derailed by an unexpected trigger. Holidays, for example, are known triggers because they hold so much emotion, nostalgia, memory, and familial pressure.

What can you do?

Different strategies can help you to learn to live more effectively with this experience.

  1. First, do not try to speed up your mourning, or the mourning of those around you. It is normal to need time to accept the loss.
  2. Do not hesitate to talk about your feelings or reactions with people who may be close to you. Ask them for help. If you talk about your feelings, you will likely recover faster from the loss.
  3. Be attentive to others experiencing the same loss. In this way, you will benefit from mutual support and understanding.
  4. Take care of your physical health. It is possible that your grief will cause stress and sickness. Consult your physician if you are worried about your health.
  5. Take time to reflect on other losses that you have suffered. You will likely discover similarities. This should normalize what has happened, and give you hope.
  6. Gradually resume your favourite activities, particularly those that energize you or ‘recharge your batteries.’ Develop new interests, make new friends.
  7. The loss of someone close to you is a painful experience. It often leaves us in a state of helplessness or confusion. Remember: it takes time to learn to live with such an experience. Also, remember that many resources are available, should you need help.
  8. If necessary, do not hesitate to call us. A professional from your Assistance Program can help you through your mourning period.

We all work through grief at our own pace. A workplace with a thoughtful and easy to follow a plan for dealing with pain over loss is going to have the best chance of mitigating bereavement-related losses while avoiding having grieving become problematic and disruptive. (6)

 

References:

1. The RSA. YouTube (2013) Source: https://www.youtube.com/ watch?v=1Evwgu369Jw&list=PLt7b6WnSW1ynvTqyu3l_WnAEMhMmwXYl

2. LivingMyCulture. (2019) Source: https://livingmyculture.ca/culture/

3. Kessler, David (2019) Source: https://grief.com/the-five-stages-of-grief/

4. What are Stuck Points in Grief? WYG (2019) Source: https://whatsyourgrief.com/what- are-stuck-points-in-grief/

5. Perreault, Yvette. (2011) Source: https://www.catie.ca/sites/default/files/When%20 Grief%20Comes%20to%20Work_e.pdf

6. When Grief Goes From Just Plain Miserable to Problematic. (2018) Source: https://whatsyourgrief.com/grief-goes-just-plain-miserable-problematic/