Tough Talk Made Better

World Suicide Prevention Day is held annually on September 10. The theme for 2024 is Changing the Narrative on Suicide to transform how we perceive this complex issue. It’s about shifting from a culture of silence and stigma to one of openness, understanding, and support.

If you are feeling like you have lost hope and are struggling to cope, if you are dealing with thoughts of suicide, or if you are worried about someone else, call or text 9-8-8 at any time.

One night a few years ago, Aja Sax found herself alone in her apartment and completely overwhelmed with suicidal thoughts. It wasn’t the first time she’d experienced this feeling, but it was, by far, the most intense.

“The few days leading up to my most serious episode, I lived with this feeling that I wanted to take my own life because I just couldn’t see things ever getting better,” she recalls. “I couldn’t imagine ever being happy again.”

Sax says she’s had bouts of depressive thoughts for as long as she can remember. She had asked her parents about getting professional help when she was 12 years old, only to have her concerns dismissed. “My father laughed in my face. And my mother said, ‘You’re so young, what could you possibly be depressed about?’”

As a young adult, when she confided in friends, she felt that many “invalidated” her feelings and suggested the answer for her was meditation or sunrise yoga. Fortunately, she also had support from people—online and in person – who took her seriously and seemed to know exactly how and when to check in with her. One even stayed with her through her worst night and helped her take action to seek help in the morning.

“Those online relationships saved my life,” she says.

Sobering statistics

According to the World Health Organization, globally, more than 700,000 people die by suicide every year. In most regions, youth suicide rates are higher than other demographics, including in Canada where suicide is the second leading cause of death among people aged 18-34—youth and young adults.

A key piece in addressing this epidemic and reducing suicide rates is steering conversations about suicide away from those that can create more harm and, instead, in the direction of the kind that Aja credits with saving her life. To that end, the Mental Health Commission of Canada (MHCC) recently launched #ChatSafe, a resource designed to change the way we talk about self-harm and suicide.

Developed by a suicide prevention team under the guidance of professor Jo Robinson at Orygen, an Australian research institute focused on youth mental health, #ChatSafe is the world’s first evidence-based set of guidelines designed to support peer-to-peer communication about suicide and self-harm between young people aged 12-25. There is an additional resource for caregivers, and both tools include comprehensive and straightforward guidelines to avoiding unsafe language, imagery, and emotional triggers when having conversations about suicide and self-harm.

“There are a lot of misconceptions when it comes to the way we intervene with people and some of that comes from the language itself,” explains Nagi Abouzeid, a member of the MHCC Youth Council who is currently pursuing a Master of Science in rehabilitation sciences at the University of Montreal. “There’s a section in the #ChatSafe guidelines that outlines unsafe language, such as ‘commit suicide’ as opposed to the safer phrase ‘dying by suicide’. People use this old terminology and don’t realize where it comes from.”

Language matters

Prior to 1972, when it was decriminalized in Canada, suicide was a criminal offence that people “committed,” and non-fatal suicide incidents could be prosecuted. Although the legal status changed over 50 years ago, the words “commit” or “committed” still link it to immoral behaviour, which can lead to feelings of shame. In turn, that can discourage folks in distress from seeking help.

One of the first people to draw attention to the role language plays in our perceptions of suicide was Toronto writer Doris Sommer-Rotenberg, who, in a 1998 issue of the Canadian Medical Association Journal, specifically called out the use of the phrase “commit suicide.” Driven by a wish to “keep alive the vitality” of her son, a physician in his thirties who died by suicide, as well as a desire to help prevent similar tragedies, she helped kickstart a movement to overhaul the language of suicide.

In addition, she campaigned for a research chair in suicide studies in her son’s name, Arthur Sommer Rotenberg, at his alma mater, the University of Toronto, which was the first of its kind in North America. “This fact, in itself, attests to the silence that has historically surrounded the issue of suicide,” she observed.

In 2016, Sommer-Rotenberg was awarded the Governor General of Canada’s Meritorious Service Medal for her work in raising awareness of the silence and stigma surrounding suicide. In the roughly 25 years since she wrote her editorial, silence has become less of a problem, thanks, in part, to social media. There’s still plenty of fine-tuning to be done when it comes to language, however.

“While social media can be a source of connectedness for young people, it can also pose a risk to the safety of young people,” explains Nitika Rewari, Director, Prevention and Promotion Initiatives at the MHCC. “So, it is our responsibility to support young people to have the right tools and knowledge they need so they can safely communicate online about suicide and self harm. #ChatSafe guidelines can help.”

Often, as was the case with Aja Sax from our opening paragraphs, well-moderated virtual forums can help members get support and sage advice from others with lived experience of suicide and self-harm. However, the digital mental health landscape is also home to some influencers, how-to suicide sites, and even big budget productions that can veer into unsafe territory.

“The Netflix series 13 Reasons Why was developed in a way that really highlighted some of the things that we say not to broadcast, for example, means by which people attempt suicide,” Rewari says, noting that the series tackles some of society’s most complex mental health topics, such as adolescent suicide, bullying, and problematic substance use. She says such topics, especially as they relate to suicide and mental illness, could be raised in a more safe, sensitive, and responsible manner to avoid stigmatizing suicide and to encourage viewers to seek or offer help when needed.

Useful tools

Although there’s still plenty of debate as to the cause of the increase in monthly suicide rates the month that series was released, one study in the United States established that it was associated with a significant increase in suicide among youth. The researchers concluded that “caution regarding the exposure of children and adolescents to the series is warranted.”

#ChatSafe guidelines make it easy for participants in threads and content creators to learn when to use trigger alerts and how to avoid unsafe imagery, themes, or terms, thanks to its extraordinarily clear and plain-spoken language.

“Something I really appreciate, as a youth, is the practicality of the suggestions,” says Alisha Haseeb, currently in the health sciences undergraduate program at McMaster University and a member of the MHCC Youth Council.

“The guidelines go beyond identification of best and unhelpful practices by offering concrete and actionable alternatives, while also providing insight into why certain methods of engagement and communication are more effective than others, which really shows that this is rooted in evidence-based practice and encourages us to make decisions that are reflective of our intentions.”

She adds: “I think that reading through these guidelines is a great way to just be mindful of the language that we’re using and also to be mindful of the impact that it has and what kind of messaging we’re sending.”

The accessibility is also owing to the methodology professor Jo Robinson used to develop #ChatSafe. The suicide prevention team at Orygen consulted a diverse range of people representing different cultures from regions around the world, taking it way beyond the usual peer review system that’s generally limited to other academics and research scientists.

“I think there is certainly a disconnect between the generation that is designing services and guidelines for young people, and the way in which young people actually engage with those services,” says Haseeb. “Something that gives me a lot of confidence in this resource is that it is co-designed by youth who had living or lived experience of self-harm or suicide or had supported someone who was self-harming or suicidal.”

That has also made it easier to adapt it for use in 14 countries outside of Australia, including South Korea, Nigeria, Finland, Brazil and, of course, Canada.

“I’m delighted to have collaborated with MHCC to release the #ChatSafe guidelines across Canada,” says Orygen’s Jo Robinson. “There’s never been more need to empower young people to talk safely online about self-harm and suicide, along with the parents and carers in their communities. Together, we hope to see a safer internet for young people and successful help-seeking for those at risk.”