Brain injury and suicide risks

An acquired brain injury (ABI) can cause sudden and lasting changes in a person’s thinking, how they react to certain situations, their work and how they relate to others. Brain injury can lead to an increase in stress, as well as difficulty in managing emotions and relationships. At the same time, brain injury adversely affects a person’s ability to deal with these challenges.

People might appear the same but nevertheless feel a disturbing sense of change within. Brain injury can cause people to be more impulsive and have trouble considering other perspectives. Without appropriate support this can lead to feelings of isolation and helplessness.

These are among the factors that cause depression and increase the risk of suicide among people with brain injury. Without support, a person in this situation might see suicide as an answer to seemingly unsolvable problems, such as enduring emotional distress or disability.

A suicide attempt is not usually made following a sudden or impulsive decision. Rather, it is more common for individuals to shift between stages on a continuum. These range from initial suicidal thoughts (ideation), to planning how (intent), to following through on a suicidal act. A person may move back and forth across these stages, progressing forward in severity or returning to earlier stages where suicide is no longer considered.

The broad stages include:

• planning
• organising means to attempt suicide
• attempting suicide (intentional or misadventure)
• suicidal act.

Initial signs to be aware of:

• statements such as ‘It would have been better if I had died’
• any threat about suicide
• behaviour that is very withdrawn or depressed
• a history of having attempted suicide in the past.

It is important to look for cues, particularly when a person has attempted suicide before, and assist the person to seek professional help.

• evidence of a specific plan
• drug abuse or extreme behaviour
• catastrophic reactions to relatively mild stress
• a crisis that precipitates the event.

A person who is considering suicide desperately needs to know that others care and that help is available. Sometimes just being with a person helps, even without talking. Simply listen to what the person is saying about themselves and their life. It’s reassuring for the person to know that you care and are always willing to listen and talk with them.

Encouraging them to reach out is also important. Counselling services and GPs can be a first port of call to provide support, but the person may need your help to engage with them.

Crisis intervention can include immediate support via telephone counselling, referral to a psychiatrist or close monitoring. Medical and psychiatric treatment is an option, including the use of medication, hospitalisation and psychological therapy. In the long-term, it is important that people are linked to support systems such as mental health case management.

These strategies aim to increase a person’s sense of choices available to them, and increase feelings of being emotionally supported:

• establish rapport, e.g. ‘I’m listening and I want to support you’
• ask whether the person has considered suicide
• if yes, have they made a plan
• explore the person’s perception of the crisis and what they can do right now to stay safe
• develop options and a plan of action e.g. going to GP to get a mental health care plan – increase the options available to the person and the number of people available to help (professionals and family members)
• suggest they call Lifeline Australia www.lifeline.org.au – 13 11 14 for 24/7 support
• arrange removal of the potential means of suicide, if this is possible
• try to increase the person’s investment in the future by involving them in small and meaningful activities, e.g. tasks around the house and garden
• try to involve appropriate people in the person’s natural support system
• if you are concerned for their welfare, call the emergency services on 000.

A combination of the following techniques can be used to convey support:

• active listening (nodding and minimal responses such as ‘okay’, ‘sure’)
• meaningful eye contact and supportive body language
• reflection of feeling, g. ‘You sound really upset’
• reflection of content, e.g. ‘It sounds like you want your family to give you more space’
• paraphrasing and summarising, g. ‘At the moment you are feeling overwhelmed’
• asking permission, g. ‘I want to help you – can I come and sit near you?’

Avoid these techniques when offering support to people who are distressed they will make the person feel as if you are minimising their distress, and potentially stop the person from seeking support in the future.:

• false reassurance, e.g. ‘everything will be fine, don’t worry’
• inappropriate use of facts, e.g. ‘You’ll recover from your brain injury within a year’
• confrontation, e.g. ‘It is time for you to accept that you will never walk again’
• minimising a person’s feelings, e.g. ‘come now, it’s not that bad’
• probing or intrusive questioning, e.g. ‘why do you think your girlfriend left you?’.

If you have an ABI and are considering suicide, you should know that you are not alone. Most people think about suicide at one time or another. Thinking about it does not mean things can’t get better. There is a lot of help and support available.

Brain injury causes physical issues that can lead to depression. It is important to seek medical and professional advice to help deal with these physical problems. The crisis will pass even when it feels like it won’t.

Don’t be afraid to talk about your problems with someone who can help. Let family members, friends, your doctor or other professionals know how you feel.

If you are in need of immediate support, 24/7 support is available by calling Beyond Blue on 1300 22 4636 (or visit them online at beyondblue.org.au) or Lifeline on 131114.

Working with or being close to someone who is at high risk of committing suicide can be extremely stressful. It is very important that people receive their own support and take care of their own emotional wellbeing. Relatives and friends may also benefit from seeking professional help to express their feelings and receive advice.

Organisations such as Lifeline www.lifeline.org.au or Suicide Call Back Service www.suicidecallbackservice.org.au, 1300 659 467 have resources for supporters.