Suicide: after a suicide attempt

This information is a suicide prevention factsheet intended for people who have survived a suicide attempt and their whānau, family and friends.

You are not alone – you can get through this

Life after a suicide attempt may at first feel chaotic and without direction, but with time and the right support you can find your way back to a life filled with hope, connection and a new sense of purpose and meaning.

Getting your life back on track after attempting suicide is not easy. It takes time to recover, physically and emotionally. It's natural to have many feelings, thoughts and concerns. You might not know what to do or what to say.

This factsheet is a starting point for working through some of the questions that can come up after a suicide attempt. And it offers ideas about what may assist you in regaining a sense of control and getting back on track.

Immediate support

If you have just attempted suicide, it’s important to see a doctor or mental health worker at either a hospital or clinic to make sure your physical and mental health are both okay.

It’s important for you to see a medical professional as soon as possible, even if the attempt does not appear life threatening.

At the hospital

If you have gone to hospital, it can be a daunting experience. The waiting, the busy environment, and the lack of control over the situation can be unsettling.

The Ministry of Health has some good advice about what to expect and how to cope with a busy hospital environment.

At hospital, medical staff will look at any physical injuries first. After these have been treated, they will then arrange for a mental health worker to come and talk about what was happening before the attempt.

This assessment will look at:

• how your mood has been
• how you’ve been managing your day to day activities (e.g. work, family or whānau responsibilities)
• how your relationships have been going
• if you have been experiencing any major stresses.

This is really just a conversation to look at what has happened, why and if any current risks remain. Using the information from this discussion the health professional will assist you to make plans for the next few days and talk about what might be helpful in the coming weeks. They might also make appointments or recommend you make contact with an appropriate health service.

Seeing a GP

If you go to a local medical clinic, a family doctor (GP) will discuss your situation and determine if further medical tests are needed. Once they are satisfied there are no physical problems, they will talk more about what has been happening, what supports are available at home, and if there are any risks of further harm. They might also suggest going to see a counsellor.

The GP’s goal will be to put plans in place to ensure you have support over the following days and weeks. They will probably suggest you return for follow-up appointments to monitor how you are going and whether you have enough support.

The GP will probably encourage you to return for follow up appointments over the coming weeks, and will use these appointments to monitor how you are coping and whether you have enough support.

Consider involving others

Immediately after a suicide attempt you might find it hard to think clearly or remember details of conversations. You may also find it’s hard to talk about what has happened or to describe to others how you are feeling.

Consider involving someone you trust in conversations and meetings with the health professional. They can be a second pair of ears and provide extra information in discussions.

About confidentiality

You have the right to tell health professionals when you don’t want them to discuss your situation with others in your support network.

All health professionals are legally required to maintain their patient’s confidentiality but there are some exceptions. These include if:

• you have given permission to share your personal information
• they believe you may hurt yourself or somebody else
• they need to talk with another health professional about you and your treatment
• they are legally required to share your confidential information.

If you do not give permission for information to be shared, people supporting you can still give information to health professionals, as well as ask for advice and information about their role and what to expect, etc.

If you are 16 years or under it's important for a whānau member or carer to know what has happened so that they can support you. This does not mean that they will hear every detail of your conversations, but the health professional can provide them with information that helps them to support you and keep you safe.

If you’re unsure how confidentiality works, ask the health services staff to explain it to you and your support people so that everyone understands what information will and won’t be shared.

Before you go home

With the right support in place you should be able to go home. If you do not feel safe to return home, say so, and ask what other options are available. It can be helpful to write this information down so that you can refer to it again later. Often it can be hard to remember things when you are tired or stressed.

Before you head home make sure you have an understanding of:

• What you can do to make it easier to get through the next few days.
• What supports are available and useful to you when you return home.
• What you should do if you feel suicidal again.
• Names and contact details for counselling or other support services.
• Names and contact details for emergency services.

Health professional responses may differ

How a health professional responds to you will depend on their personal attitude towards suicide and their level of skill, confidence and comfort in responding to suicide attempts. Time pressures within the clinic or hospital may also affect the amount of time that they can spend with you.

Consider the advice that the health professionals offer you, talk openly about any worries that you have, and ask questions so you fully understand your options for moving forward.

If you do not feel safe to return home, say so and ask what other options are available.

In the short term – the first few days

The first few days after your suicide attempt are critical and will often raise a range of big issues and questions such as:

• What now?
• How can I be sure I will get back on track?
• How can I stay safe?

There are no clear-cut answers but there are several things you can do to make it easier.

• Let other people assist you when it is possible.
• If you live alone, consider asking someone you trust to stay with you until things settle down. Alternatively, you might prefer to stay at their home for a period of time.
• Follow the advice of doctors and take any medication they have prescribed.
• Try to establish a routine with sleeping, meals and exercise.
• Keep appointments with counsellors and doctors.
• Remove things in and around the house that you could harm yourself with.
• Keep the use of alcohol and drugs to a minimum and preferably avoid them altogether. They can impair your judgment and make you feel worse.
• If people are trying to be helpful, acknowledge and respond to them. Although you may still not be in a space to talk in any detail, let them know you will talk more when you feel ready.
• If people from your support network are not available and you feel worried, unsure or suicidal again, consider calling a helpline or support service.

Using your support network

Surround yourself with people who you trust, who will listen to you without judgment and who you enjoy being with.

Different people may have different roles. For example:

• A parent or whānau member may help you feel loved and cared for.
• A friend may be great if you are feeling down and want to have a laugh or do something socially.
• A neighbour or work colleague might be a good person to talk about things other than your personal life (such as sport, current affairs etc.).
• A religious or community leader may help you to connect or reconnect with spiritual beliefs or community activities.
• A counsellor might be the best person to assist with strategies to deal with stress and coping.
• A 24 hour phone service may provide non-judgmental crisis support.

There is room for a whole range of people in your support network but make sure you identify at least one person you feel that you can talk with about how you are feeling.

Talking to others

You may or may not want to talk about what has happened or what led up to your suicide attempt. It's common to feel unsure, worried and even distressed about what to say to others.

When you are ready, it's important to talk about what has happened with people you trust. This allows others to be there for you and provides a chance to work out where to go from here.

It's important to start thinking about what you (and those close to you) will say to others. It can be useful to have a clear agreement about what should be shared and with whom. By sharing some information about what has happened you might also find that this helps to reduce gossip and speculation.

Often a short message about what has happened and how you are now coping is enough for most people. It could be something like, “Things have been really tough for me lately and I attempted suicide. I just wanted to let you know what I have been dealing with and that I am trying to get back on track.”

Learn from others – reading about other people who have managed difficult times can be inspirational.

There are many different types of support groups in New Zealand that you can also go to for assistance and to find someone to talk to.

Don’t be afraid to let people know what you need from them. It might be that you just want to be listened to, or that you would like to talk about something other than your suicide attempt.

Getting support from a health professional

A health professional can help to address the feelings or situations that led up to your suicide attempt. You can talk openly about what has happened and find new ways to cope with difficult decisions, experiences or emotions.

You might find sessions with a health professional useful to:

• sort through how you are feeling and why
• provide a different perspective
• link you in with other doctors or experts when necessary
• help develop new coping strategies.

Even if you don’t think it will be helpful to link in with a health professional consider having a couple of sessions to try it out.

Finding a health professional that you are comfortable with can take time. If you don’t feel comfortable with the first health professional you can talk to them about how you are feeling or you can try a different health professional. No matter what you decide it is important to keep trying.

Understanding medication

After a suicide attempt you may be prescribed medication to help improve your mood. Unlike antibiotics some of these medications take time to take effect; anywhere between 2 to 4 weeks. Sometimes medications can make you feel worse.

When starting a new medication you should have regular reviews with your doctor so they can monitor your progress and check for any side-effects. It’s also important to talk to your support network and doctor about how you’re feeling.

It may take several tries before you find a medication that suits you, so continuing to see the doctor while this is sorted out is essential. If you decide to stop taking your medication, it’s best to do so slowly, with supervision by your doctor.

Other support and guidance

If you seek support or guidance from alternative or complimentary practitioners, community or religious leaders, it is wise to tell them all about the other types of services or advice you are getting. They can then consider this information before deciding what other supports may be useful.

Common reactions – what you might be thinking or feeling

• There is no right or wrong way to feel following a suicide attempt. You can experience a range of feelings, and you might find that these feelings can change quickly and unexpectedly.
• You might feel exhausted, numb, remorseful or embarrassed. Or you might feel shame or guilt, worried about how your attempt has affected those around you.
• You might also feel angry about what has happened and find it hard to see any hope for the future. Alternatively you might be relieved and glad that you have survived but unsure about what happens now.

Understanding your own actions

You might not know why, or even if, you wanted to end your life. You might feel confused by what has happened. The reason for your attempt will perhaps become clearer as you work through your thoughts and feelings in the next few days and weeks.

Understanding why you attempted suicide and how this now affects you can take time, but it is an important step in finding your way back.

Some of the reasons others have given for attempting suicide have included:

• The situation was so unbearable, I couldn’t think of an alternative.
• I felt trapped. There was no other way I could get away.
• I was just so agitated and completely on the edge all the time, I needed to do something.
• I felt overwhelmed and out of control.
• I needed to get help and let others know how desperate I felt.
• I felt like a failure and a burden. I just wanted to make it easier for those around me.
• I don’t know why I did it.

There is no right or wrong way to feel following a suicide attempt. 

A suicide attempt is often associated with intense psychological pain along with negative feelings that seem endless and impossible to escape from. Stressful life events may be the trigger for these feelings and can include:

• feeling alone, isolated and without any friends, family or whānau
• going through a difficult relationship breakup
• losing a job
• experiencing a financial crisis
• being bullied at work or school
• experiencing discrimination and isolation due to sexuality, gender identity, culture or disability
• going to court for legal matters
• experiencing drug and alcohol problems.

And sometimes there appears to be no obvious life events or experiences that have led to a suicide attempt.

Some mental health conditions and medications will also increase the likelihood of someone experiencing intense out of control thoughts and feelings, but attempting suicide does not always mean a person was experiencing a mental health problem.

People supporting you  –  what they may be thinking or feeling

It’s possible that people may be fearful of saying the wrong thing. Here are some things that could guide your conversations with them:

• Acknowledge and thank those who make contact.
• If you are unsure about what to say, thank them for their concern and let them know you are handling things as best as you can.
• If you find it comforting to have people with you let them know that you appreciate their support.
• Consider sharing how you feel and seeking support from those you trust and who care about you.
• If someone wants to talk about your suicide attempt and nothing else, let them know that it helps to talk about other things too
• If it’s not working for you, let them know what you need from them. For example:
• “What I need at this point is someone who can listen to me without telling me what I need to do.”
• “I’d really appreciate it if we could talk about other things at the moment. I just want to get my mind off it.”

Returning to work and study

Returning to your previous work or study is an important sign that you are getting back on track but it can be difficult to explain why you have been away.

It may be useful to discuss the possibility of:

• Flexible days or times in the initial return to work or study.
• The potential need to have time off to attend appointments.
• Initial reduced work or study load while you transition back.
• Flexible deadlines for work or study tasks.
• Identifying who else can support you in the work or study setting.

If you don’t have close relationships with the people you work or study with you may not want to talk about what has happened; you might want to keep your personal and work/study life separate. However, by letting someone know (such as managers, supervisors, study coordinators), you create opportunities to receive additional support.

By law, under the Human Rights Act, workplaces and teaching institutions are required to make reasonable adjustments to support people who have been or are unwell. Before returning to either work or study, you may wish to get advice, or find out about your rights and/or what supports are available from services such as:

• your workplace’s human resources department
• the Employee Assistance Programme provider or Student Counselling Service
• the Human Rights Commission
• the Ministry of Business, Innovation & Employment.

If thoughts about suicide return

It's common for suicidal thoughts to return after your suicide attempt. It’s not a sign you have failed or that you are not recovering. Recovery from a suicide attempt is about building strategies and confidence in managing thoughts about death and suicide if or when they return.

Some people find that their suicidal thoughts can return in response to situations of significant stress or tension. Often the hardest time to manage thoughts about suicide or death is in the period immediately after an attempt or after discharge from hospital. It’s important to make sure you have thought about how you will respond if you become suicidal again.

Many people find it is useful to prepare a safety plan. A safety plan is a series of steps that you follow if you start to feel suicidal again.

Often a health professional will work with you to develop a safety plan, but you can also do one yourself. It includes:

• Signs or triggers that tell you that you are becoming overwhelmed or suicidal.
• Strategies that you can use to help get through those times when the urge to end your life is greatest. This can be a combination of distractions and things that make you feel a bit better, such as talking to a good friend, going for a walk, watching a movie, having dinner with your family or whānau, prayer or karakia, etc.
• People you can talk to when you are struggling. This might include family or whānau members, friends, as well as doctors, counsellors, kaumātua, community or religious leaders.
• Professional services to contact, including services that are available 24 hours a day, such as crisis telephone support services, hospitals and Emergency Services.

Read more about coping with suicidal thoughts.

Looking after yourself

Having connections to other people and things you find important can protect you against suicidal thoughts or make it easier to manage if such thoughts return.

It is not uncommon for people to feel disconnected from life and those around them leading up to a suicide attempt. This can be a good time to reconnect with the things that are important to you. Work with people that you trust to help identify ways to reconnect with things you find meaningful. It can also be a time to discover new things that are important to you.

In the short-term, this could mean:

• catching up regularly with friends, family and whānau
• spending time doing things you enjoy
• joining a group for something you have always been interested in.

In the longer-term, this could mean:

• thinking about work and whether it is fulfilling for you, or considering voluntary work
• thinking about study, such as courses at school or university
• taking a holiday to places that you have always wanted to see.

Other things to consider are:

• Lifestyle changes – choosing to live a physically healthier life. Eating a balanced diet, reducing alcohol consumption to a more moderate level, exercising a little each day and establishing a good sleep pattern can all be helpful.
• Look at what needs to be strengthened in the person's life to restore balance. Te Whare Tapa Whā is a way of thinking about this from a Māori perspective: each side of the wharenui needs to be strong in order to support the others. The four sides are te taha tinana (physical), te taha wairua (spiritual), te taha whānau (family) and te taha hinengaro (mental and emotional).
• Meditation and relaxation – making sure relaxation is built into your routine; breathing exercises, progressive muscle relaxation, meditation, mindfulness, yoga and tai chi can be good ways to do this.
• Interests and contributing – giving back to the community often helps our sense of purpose and connection with others. Think about what you used to find interesting or have been passionate about and join a relevant organisation.

The future

After a suicide attempt it can be hard to see what the future holds. It might help to see this time as a turning point; an opportunity for you to find your way back. You will still have ups and downs. However, by focusing on the potential for change following your darkest times, and accepting the assistance of others, you can create opportunities that offer hope and direction for your future.

This online resource was developed by bringing together the wisdom and experiences of people affected by suicide and combining it with what we know to be helpful. The people involved in the beyondblue project, Finding your way back,  talked about suicide being a part of their past, but that it was not going to define their future. They wished the same for you, that you can look to the future with a sense of hope and take a step towards the life you want to live.

 (Source: Finding your way back - a resource for people how have attempted suicide, (adapted to include NZ law and terms) with kind permission from beyondblue).

Supporting someone who has attempted suicide

In a crisis or emergency

If someone has just attempted suicide or you're worried about their immediate safety, do the following:

• Call your local mental health crisis assessment team or take them to the emergency department (ED) at your nearest hospital.
• If they are an immediate physical danger to themselves or others, call 111.
• Stay with them until support arrives.
• Remove any obvious means of suicide they might use (e.g. guns, medication, car keys, knives, rope).
• Try to stay calm and let them know you care.
• Keep them talking: listen and ask questions without judging.
• Make sure you are safe.

Supporting someone who is recovering after an attempt

To support someone trying to recover from a suicide attempt, be prepared to be there, offer support and stay involved. Recovery can take time.

 You might need to be prepared to have difficult conversations about what's going on in their life and how they are feeling.

• Keep talking to them and don’t avoid talking about suicide or the hard things in their life.
• Don't give up on them and try not to lose contact with them, even if it seems like they are ignoring you.
• Help them feel there is hope of things getting better – identify positive things in their life.
• If they don’t want to talk with you, ask other people you both trust to support them – friends, family or whānau members, youth workers or others
• Help them to access professional help, like a doctor or counsellor. You could offer to go with them or help them to make appointments. Let them know about free counselling services like Lifeline and Youthline and give them the contact details.
• Encourage and support them to do the things they enjoy, keep physically active and connect with others.
• Help them identify any ways they can change their lifestyle to restore balance. This might mean cutting back on alcohol or drugs, doing some exercise, making time for themselves, or getting enough sleep.
• Accept them for who they are and let them know you care.
• When they're ready, support them to make plans for their future, solve problems and set goals.

Self-care

Remember to take care of yourself when you are caring for others:

• Make sure you’re getting enough sleep, eating properly and exercising.
• Be kind to yourself, and take time out when you need to. Being in this situation can be very difficult, and you can’t do everything.
• Find someone you can talk to about this – a friend or family member you trust, or a counsellor.
• It's not helpful to blame yourself if someone close to you attempts suicide. 

How to build a support network

It’s important to involve others to help you and the person you're supporting – don't try to do everything yourself.

To build a support network:

• Ask the person you're supporting to tell you what they need, what works for them and who should be involved.
• Your support network might include cultural elders, religious leaders or community groups they're part of, as well as friends, family and whānau. It might include people who have been through something similar to the person you're supporting, and can share how they got through it.
• Bring the group together in a safe space.
• Talk openly and honestly about the situation.
• Talk to them about what they will do if they feel suicidal again, how they plan to keep safe, and how others can help with this.
• Develop a plan together to support the person – identify how different people can help. Get professional help if you need it. Talk to your local doctor, medical centre, community mental health team or counselling service.