Mental health: Suicide, depression & brain injury
People with an acquired brain injury may be at
risk of suicide at some stage of their recovery process.
An Acquired Brain Injury can cause a sudden and lasting change
in a person's thinking, how they react to certain situations, their
work and how they relate to others. People who have experienced an
Acquired Brain Injury might have increased stress, greater
difficulty with relationships, difficulty managing their own
emotions, but fewer skills for dealing with these problems.
Even though the person may seem the same as they were before,
they may feel a disturbing sense of change in who they are. They
may also be more impulsive and may find it hard to consider other
perspectives or think differently about things. Without appropriate
support they may find themselves feeling isolated and helpless.
It is important to realise that because of these and other
factors, people with an Acquired Brain Injury might experience
feelings of depression and may be at greater risk of suicide. For
people who think about ending their lives, suicide may represent an
answer to what they feel is an otherwise unsolvable problem. The
choice may appear preferable to circumstances such as enduring
emotional distress or disability, which the person may fear more
It is particularly important for family members, friends and
those who care about the person to know the danger signs, know ways
of being helpful and know who you can turn to for advice or
Regognising the First
A suicide attempt is rarely made following a sudden or impulsive
decision. Rather, it is more common for individuals to shift
between the stages on a continuum which range from the initial
thoughts about suicide to committing suicide. The stages may be
bi-directional (i.e. a personal may move forward, return to an
earlier stage or no longer consider suicide as an option):
- Organising means
- Suicide attempt (intentional or subintentional)
- Commit suicide.
Some may engage in self-harming behaviour which has the potential
to lead to death while the actual goal is not to die. It is
important to be alert to cues that someone may be considering
suicide. Things to look out for are:
- If they make statements like 'It would have been better if I
had died' or if they make threats about committing suicide
- If they become very withdrawn or depressed
- If the person with Acquired Brain Injury has tried to commit
suicide before, you should particularly be aware of cues and try to
assist them to seek professional help.
There are various factors which indicate a higher risk of suicide
occurring. The brain injury survivor may have access to lethal
means and the development of a specific plan. Drug abuse, engaging
in extreme behaviour and catastrophic reactions to relatively mild
stress can also increase the risk factor. In some cases a final
crisis may act as a precipitating event.
How You Might Help
A person who is considering suicide desperately needs to know
that others care. Some suggestions on providing support
- Sometimes just being with a person is helpful, even if not
- Contact others who may be able to provide support
- Listen to what they are saying about themselves and their
- Avoid saying things like 'You should be grateful you are alive'
or 'You'll get over it'
- Tell them you are always willing to talk and that there are
others who care as well.
- Encourage them to stay in touch with friends or make new
- Make sure they are in touch with a local GP.
Interventions for individuals at high risk:
- Crisis intervention (levels may include immediate support e.g.
telephone counselling, referral to a psychiatrist, closely
monitoring the person or moving the person to a less stressful
- Medical/psychiatric treatment (including medication)
- Psychological therapy
- Mental health case management
- Linking into support systems (e.g. family and community
Specific crisis intervention strategies
The general aim is to lower the level of lethality or very high
risk of suicide by working to: a) increase the individual's
psychological sense of possible choices and b) to increase his/her
sense of being emotionally supported.
Strategies may include the following:
- Establishing rapport (e.g. 'I'm listening and I want to support
- Explore the person's perception of the crisis
- Focus on the immediate past (e.g. a recent significant event or
problem) and immediate future
- Develop options and a plan of action. Increase the options
available to the person and the number of people available to help
(professionals and family members)
- Arrange removal of the potential means of suicide where
- Encourage the person to develop a plan which includes resources
and support in the immediate future. Write down the steps of a
personal safety plan to be carried around by the person (e.g. in
- 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)
- Monitor their emotional state and establish a follow-up
- Try to involve appropriate people in the person's natural
It is recommended that people offering support to a distressed
individual avoid using the following techniques:
- False reassurance e.g. 'Everything will be fine, don't
- 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 is not that
- Probing or intrusive questioning (e.g. 'Why do you think your
girlfriend left you?'
A combination of the following techniques can be used to convey
- Active listening (nodding and minimal responses such as 'okay',
- Meaningful eye contact and supportive body language
- Reflection of feeling (e.g. 'You sound really upset', 'I can
see that you are frustrated')
- Reflection of content (e.g. 'It sounds like you want your
family to give you more space')
- Paraphrasing and summarising (e.g. 'At the moment you are
- Asking permission (e.g. 'I want to help you - can I come and
sit near you?').
Support for the supporter
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 well-being. Support for the person working with the
distressed individual may come in the form of debriefing from other
professionals. Relatives and friends may also benefit from seeking
professional help in order to express their feelings and receive
If You are Considering Suicide
If you are the person who has acquired a brain injury and you
are considering suicide, you should know that:
- You are not alone
- Most people think about suicide at one time or another.
Thinking about suicide does not mean that things can't get
- There may be physical issues caused by your Acquired Brain
Injury, and these physical issues may be causing you to feel as bad
as you do. It is important to get professional or medical advice to
help you deal with some of those physical problems.
- The crisis will pass
- Sometimes problems seem unbearable, but there are always things
you or others can do. If you have a brain injury, it might be
particularly hard to see your way through some problems. That is
why it is essential that you talk about your problems with someone
who can help.
- Others do care
- There are always people willing to help you work out your
problems. Don't be afraid to ask for help. Let family members,
friends, your local doctor or other professionals know how you
There are 24 hour services available. You can call Lifeline to speak with a telephone
counsellor, on 13 11 14 go to
your local hospital emergency department or call the Brain Injury
Association in your State.
References and further information
Many thanks to the Acquired Brain Injury Outreach Service
(ABIOS) for permission to adapt this information from one of their
brochures. You can visit their website at www.health.qld.gov.au/abios.