Supporting a Person Whose Friend or Family Completed Suicide

How do I help someone who lost a friend or family to suicide?

In 2019, 400 lives were lost to suicide in Singapore, and suicide is the leading cause of death for those aged between 10 – 29 years old. 

There are at least 2 sides to every suicide: The person who took his or her life, and those left to grieve.

It can be challenging to support someone who has lost a family or friend to suicide. What should I say? What if I say something that only makes them feel worse? Should I even say anything? These worries are perfectly understandable. After all, many people struggle to talk about suicide. While we may feel awkward or uncomfortable when talking about suicide, this should not stop us from showing support and offering assistance.  

While it may be challenging, your support can make a real difference in helping a person through their loss. 

Supporting Those Affected by Suicide Loss: A Guide for Compassionate Responses

Here are 3 key areas that that we will cover below that will guide you in your efforts to support someone who has lost a friend or family member to suicide: Being a good listener, the do’s and don’ts of what to say, and warning signs to look out for. 

How do I be a good listener to a grieving person? 

One of the most helpful things you can do for a grieving person is to simply lend a listening ear. This means to sit with him/her and listen to their feelings in a non-judgemental manner without imposing your personal opinions. Do not try to problem solve either.   

ACTIVE LISTENING is a great way of doing so!  

While our conversation partner is still speaking, we often get caught up in trying to formulate our response. A consequence of this is that we end up failing to fully grasp and understand what the other person is trying to convey. Instead of trying to find the right words, it is more important to let the grieving person express themselves and share with you the nature of the loss. Here are some useful tips on being a good active listener to a grieving person: 

• Accept all feelings. Let him/her know that is okay for them to cry in front of you, break down, scream, or even laugh. They may be struggling with a whole array of new and even conflicting emotions like guilt, despair, blame, anger, and regret. These can be uncomfortable emotions, but it is better to let them out rather than bottling it up. Accept the emotions that they are experiencing and know that it will pass. There is no correct way to feel about loss. Ultimately, the person should feel free to express their feelings in a space that is free of judgement, argument, or criticism. 

• Silence is okay. Be prepared for moments of awkward silences. Do not force the person to speak if they are not ready to. Instead, be willing to be present and show that you are ready to listen when they are ready to speak. 

• Offer comfort without minimizing or trivializing the loss. Statements such as “It could be worse” do not help. Do not give unsolicited advice, claim to know what the person is feeling, or compare your grief with theirs. Such words are rarely helpful. Instead, let the person know that what they are feeling is okay and that it is a normal reaction to the situation.

What should I say to a grieving person? 

• Acknowledge the situation and check in on how the grieving person is feeling. Do not assume to know or understand how the person is feeling. Assumptions often worsen the situation as they invalidate a person’s intense emotions. Instead, start off by acknowledging the situation so the person knows that you are willing to openly discuss the loss they have experienced. Next, give them the opportunity to express their feelings. For example, “I heard that ___ died by suicide. I’m sorry to hear this happened and I’m here when you need me. How are you feeling?” 

• Reflecting and paraphrasing. This is a really useful way to show the grieving person that you are hearing their story! It helps to foster a better empathetic connection, which makes the person more comfortable in continuing to share their thoughts and emotions with you. For example, the person might say “I don’t even know where to start, everything feels terrible.” In response, consider saying something along the lines of “It sounds like you feel very overwhelmed and upset, this situation is taking an emotional toll on you.” See how you would be reflecting their underlying emotions back to them? 

• Do not use cliches or platitudes to comfort. We often feel compelled to comfort the grieving person by saying things such as “time will heal” and “they are in a better place now”. While it comes from a place of good intentions, such words can minimize the depth of the person’s pain, leaving them feeling misunderstood and more isolated. Instead, check on how they’ve coped so far and explore what resources they've tried so far. 

Samaritans of Singapore Hotline: 1800 221 4444 

Institute of Mental Health’s Helpline: 6389 2222 

Singapore Association of Mental Health Helpline: 1800 283 7019 

You can also find a list of international helplines here.

Keep an eye out for warning signs 

It is not uncommon for a grieving person to feel depressed, angry, or disconnected from others. These emotions usually decrease in intensity over time. However, it might be indicative of a bigger cause for concern if the intense emotions don’t subside over time and the person does not appear to be capable of coping with the overwhelming emotions on a day-to-day basis. They may also display significant distress or impairment in social, occupational, interpersonal, or other important areas of functioning. Here are some other warning signs to look out for: 

• Extreme focus on the death 

• Talking about wanting to escape the pain / statements indicating they are considering ending their life 

• Withdrawal from others 

• Diminished experience pleasure from the things they used to enjoy 

• Feelings of hopelessness 

• A lack of concern for personal welfare or hygiene 

• Excessive consumption of alcohol or other substances 

• Trouble sleeping 

If you are concerned about a person in distress, it can be helpful to recommend that they see a psychologist. Let them know that it’s absolutely alright to seek out other additional help they may require.

Remember, everyone’s healing process is different, and healing takes time.

Sometimes, lots of time. 

Grief after losing someone to suicide can feel like a rollercoaster, but with support (from someone like yourself!), the ride can become significantly less scary. 

How to Encourage a Loved One to Seek Help

How can I help? What should I say?

Recognising Barriers to Seeking Help for Mental Health

One major obstacle to receiving help is that people who need help the most are usually the least likely to seek it. When we break an arm, we visit an orthopaedic; when we have a cavity, we visit a dentist – we understand that we can’t fix the problem by ourselves. However, this same understanding often doesn’t extend to mental illnesses. There can be various reasons for this, such as stigma, self-reliance, or not wanting to appear weak.   

Another key deterrent is a lack of insight. Many people simply don’t think that their distress is significantly impacting them or realize that they need help. As their loved ones, you may be the first ones to notice that something is amiss. You may find the person displaying a worrying change in their emotions, behaviors, or interpersonal relationships. Perhaps you notice your mother experiencing more intense fluctuating emotions and an inability to function in day-to-day life? Or maybe your best friend has become increasingly withdrawn and has been unable to care for themselves for a significant period of time? You care for these people, so it is understandable that you worry for their well-being. It’s hard to watch someone you care about struggle with their mental health, while knowing that there are intervention options that they can benefit from So, how can you encourage a loved one to seek help for their mental health?  

Overcoming Challenges to Getting Help for Mental Health

1. Approaching your loved one about their mental health concerns

Approaching the topic can be daunting. You will likely require quite some time and patience to persuade a person in need to seek the help he or she needs. A good place to start is by letting them know that you need to have an important conversation with them. 

Time and place is key. Avoid starting the conversation in a public space where others could overhear the conversation. Contrary to what is portrayed on TV shows, staging a large-group intervention does more harm than good. Instead, have the conversation when your loved one is relaxed, and undistracted and in a safe space. This makes the person feel more respected, in control, cared for, and willing to engage in a discussion. 

Use “I” statements and remain non-judgemental. Refrain from pointing fingers or using stigmatizing language. Tell your loved one “I’m worried about you”. Explain specific, objective areas of their behaviors that are concerning, such as “I noticed that you have been rather withdrawn lately and spend a lot of time in your room.”

Approach them from a genuine empathetic space, and not sympathy or judgement. Do not blame or guilt them for ignoring their well-being. Highlight your concerns and care for them as the reason you are having this conversation. If they share their troubles with you, do not discount their distress – it is not a personal weakness and their feelings are real. 

2. When they say “No” 

If your loved one responds with negative emotions like anger, remember that it is not directed at you (although it can sometimes be easy to feel that way!).

Manage your expectations. Not everyone will be immediately receptive to the idea of seeking help. After all, it is a serious thing to consider and your loved one likely needs some time to process and think about it. Don’t get disheartened though! Rather than shutting the door on the topic or forcing them into something they are not ready for, let your loved one know that you will approach them again in the future when they feel more prepared and that they can always lean on you if they would like a listening ear. 

3. Provide emotional and practical support 

The process of getting your loved one to seek help is a lengthy one.  

Continue supporting your loved one – lend a listening ear, validate and empathise with their feelings, ask what you can do to help, and simply be around for them. Be patient and remember to take care of yourself too.  

Being there for someone else can be taxing, so it’s important to ensure that you are taking care of yourself emotionally, mentally and physically too. It is encouraged to establish boundaries and take some time for yourself. By doing this, you model self-care for the person you are supporting! 

In addition to emotional support, practical support goes a long way too. When contemplating seeking help, an individual may get put off as they may not know where to start. This, in itself, can feel very overwhelming. Ask your loved one about their preferences regarding what kind of help they would feel comfortable with and help them to find a suitable therapist that fits their needs. Contact clinics on their behalf and research the specialities of various psychologists to determine a good fit. 

4. Offer to accompany them to seek professional help

Once your loved one is ready to seek professional help for their mental health concerns, you can suggest the possibility of accompanying them to see a clinical psychologist. Some people may feel scared of seeing a therapist alone, so it helps to offer to go with them until they are comfortable. You can sit in the waiting room during their first few sessions. Assure them that you won’t ask any questions about what was discussed during the session unless they wish to share.  

Educating them on what the therapy process entails might also help to ease any worries that they may have. We have a helpful resource on what to expect when coming for therapy that you might find useful!

You may also wish to arrange for a separate consultation with one of our clinicians to further discuss how you can provide support to your loved ones.  

5. Highlight their accomplishments 

Seeking help is one of the best steps that a person can take. It, however, is also one that requires great strength and courage. We’re often so focused on trying to improve ourselves that we may forget to acknowledge how far we’ve already come. Celebrate your loved one’s decision to go for therapy and the courage that it entails. Remember, simply choosing to seek help is half the battle won. Above all, assure them of your continued love and support throughout their mental health journey. 

How to Practice Mindfulness

What is Mindfulness?

How can I practice mindfulness in my daily life? Understanding mindfulness practice and its importance

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Mindfulness is about being present in your experiences in each moment, whether internal or external. Practising mindfulness is particularly important as too often we go about our days doing things automatically, or we get caught up in our worries, thoughts, or distractions, and fail to be fully immersed in our experiences.

There is no end goal or result in Mindfulness. Mindfulness is about being in the present moment. When we are not engaged in worrying about the past or future, the inadvertent result is that we are likely to feel calm.

Mindfulness can be practised with these simple activities that everyone already does on a regular basis.

Mindfulness Activities

1. Breathing 

1. Sit comfortably in your chair. You may wish to keep your eyes open or close your eyes.

2. Breathe. Pay attention to the air as it enters your nostrils and into your lungs.   

3. Is the air warm? Cool?  

4. Then breathe out through your mouth. Notice your chest and belly deflate as air leaves your lungs.  

5. Repeat these steps for 1 minute.

2. Walking 

1. Start walking. Being in a park or place with lush greenery helps. But it doesn’t matter if you do not have access to such places – wherever you are works just as well. 

2. As you walk, look around and observe your surroundings. There are colours that are dark, and there are colours that are light. Where are they placed within your field of vision? 

3. Breathe. Feel the temperature of the air – is it warm or cool? 

4. Touch your earlobes gently as you hear the sounds that are around you. Isolate a sound that you hear.  

5. Stop walking; close your eyes. Try and listen to that sound for a few moments. What do you hear? 

6. Open your eyes. As you look around your surroundings, observe whatever object your gaze lands on. Notice the level of detail of that object.   

7. Continuing walking. As you walk, what sounds do your footsteps make? Can you feel a breeze as you walk? 

8. Focus on making observations with your eyes, ears, skin, feet, nose:  

   • Where are you walking to? What’s around you? Are there any flowers? How many people are there around? What’s on the floor? Is the floor wet or dry? Is the weather sunny or cloudy? Are there any markings on the floor? Can you hear any sounds of nature despite being in a concrete jungle – are there birds? Which point of your foot lands first? Do you drag your feet? 

9. Notice the movements of your toes, feet, legs, arms, chest. Notice where your eyes wander to. 

3. Washing of Hands 

1. As you turn on the tap, put your hands under the running water. Remain still. Is the water cool or warm? 

2. Rub your hands slowly under the running water. Feel the water in between your hands as you rub, and how your palms touch each other as you rub to and fro. 

3. Listen to the sound of running water. How does the water sound as your hands go under the tap? 

4. Look at your hands: do you recognise the marks, scars, lines, nails? 

5. Focus on making observations with your eyes, ears, hands, palms:  

   • What is the colour of the soap? How would you describe its smell? What is the first action you do when you start washing your hands? Does the soap foam up? What colour does it become? Was the water warm or cold? What colour is your skin turning? Do you see the different shades of colour on your skin?  

4. Mindful Body Scans 

1. Lie on your back in a comfortable position. Face the ceiling or sky if you are outdoors. If you cannot lie down, you may wish to sit on a chair with your feet resting on the floor. 

2. Breathe and be still. If you have to move or adjust your position from time to time, that is fine. As you breathe in and out, notice the rhythm of inhalation and exhalation and the way your chest rises and falls. You don’t have to change the way you breathe or hold your breath but remain aware of your breath as you continue to inhale and exhale. 

3. Now close your eyes. Bring your attention to your body and how it feels. The texture of your clothes against your skin, and the parts of your head, back and legs that rests upon the surface you are on. 

4. Imagine that you are outside of your body and looking at yourself. Look first at your toes. How do you feel as you look at your toes from the outside of your body? Now shift your gaze upwards as you work systemically from the bottom up: 

   • Your toes and the rest of your feet 

   • Lower legs and calves 

   • Knees 

   • Thighs 

   • Your pelvic region (buttocks, tailbone, pelvic bone, genitals); 

   • Abdomen; 

   • Chest; 

   • Lower back; 

   • Upper back (back ribs & shoulder blades); 

   • Hands (fingers, palms, backs, wrists); 

   • Arms (lower, elbows, upper); 

   • Neck, Face and head (jaw, mouth, nose, cheeks, ears, eyes, forehead, scalp, back top of the head); 

   • Lastly the “blowhole” located on the top of your head – imagine a point on head where air goes in and out like a whale’s blowhole. 

5. Mindful Conversations 

This last one is a group exercise. Mindful listening is an important skill as people crave but are seldom fully “heard” or “seen”. Mindful listening also offers us the opportunity to shift the focus from ourselves or own responses onto the person speaking. 

1. Gather around several of your friends and/or family. Sit together in a comfortable space (please observe safe distancing rules!). 

2. Think of one stressful event that you experienced recently. Take turns to speak and share what that stressful event was in the group. 

3. If you are speaking, speak without reservation or fear that anyone is judging you. If you are listening, listen intently without judgment or forming opinions.  

4. Notice your bodily sensations, your thoughts and the feelings that flash through your mind before, during, and after each person has spoken.

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General Tips for Mindfulness: 

1. Set aside a few minutes for each activity (at least 20 minutes for the group activity). This ensures you have sufficient time to fully immerse yourself in a mindful experience. 

2. During each activity, focus on at least 3 of your 5 senses (sight, taste, smell, touch, sound).  

3. Do not try to ‘push away’ unwanted thoughts or distractions 

4. Simply take cognisance or accept the thoughts or distractions that flash across your mind. 

5. Let whatever feeling or emotion you experience simply be. 

6. Then return your focus back into the experience of simply being mindful and aware of where you are. 

7. While it is normal to experience distractions during mindfulness activities, practise bringing your attention back onto the mindfulness exercise. Focusing on your senses helps with redirecting attention. With practice, you will be able to effortlessly redirect your attention onto an experience of your choosing. 

8. Remember to approach Mindfulness exercises in an open and non-judgmental way. Treat your experiences as they are, and acknowledge the distractions, thoughts or even judgments you may experience – these are normal and will arise from time to time. 

Survival Guide: The Holiday Season

As with the trains of the Deutsche Bahn, like clockwork, the holidays are upon us (again) this time of year. Many will be looking forward to the Christmas and New Year breaks; some will be bracing for the impending deluge of parties and festive foods, and yet others may take the opportunity to escape from the madness of it all (check out this handy guide on nearby destinations).

But some associate the holiday season with misery, stress or disappointment. And with good reason.  

Holidays are like a giant (salty) mirror that amplifies our daily struggles with loneliness, existential thoughts, or coming to terms with finances (yes, the holiday season can be expensive). Here are some techniques to help us enjoy the holiday season.

1.       Manage your expectations. Accept that there is no perfect way to enjoy a holiday. Nor does it have to be “as good as last year’s”. As circumstances change and evolve, and so too must our traditions and rituals. Cherish the important ones, but never at the expense of your mental well-being or your wallet. Be flexible about which traditions to change or hold on to. For example, Christmas or reunion dinners do not have to always be at the swankiest restaurant every year.

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2.       Schedule “Worry” Time. Especially in a group or larger setting, it may be hard to not worry about what may go wrong during the get-together. Common refrains include: “What if nobody likes the food I prepared?”; “Aunt May is going to talk about her son’s PSLE score and ask me how my daughter did…”; or “Grandma is going to nag about my weight.”

To control the frequency of worry, try this.

First, identify all the tasks or items that are within your “sphere of influence”; essentially, matters that you can do something about. Identify what needs to be done and complete those tasks. You’ll start to feel a whole lot better once you make a checklist and tick them off.

Then tell yourself this: “there are always going to be things that are not within my influence. I am going to allow myself to worry about it, for no more than 10 minutes. But after these 10 minutes, I shall leave my worries for my tomorrow self to grapple with” (or similar words… but you get the idea).

The intent of this Cognitive-Behavioural Therapy (CBT) tool is to compartmentalise and contain worries that are not within your control to a designated period during the day, thereby freeing up your “head space” for important, relaxing or fun activities. This tool has been found to be clinically effective in managing worries.

3.       Social Support. Social support is a powerful tool for stress relief. Interpersonal communication among family members allow us to take each other’s stands and think of how we can help each other. At the same time, it also prevents misunderstanding from arising. For example, gift exchange may be a tradition, but it could be a stressor for one who is going through a financial difficulty. If getting a present for everyone in the household is going to cost a hefty amount, talking to your family member ahead of time about your situation is going to help. This is to seek their understandings and maybe adjust the tradition according to needs. Gift exchange can be changed to “secret santa” such that everyone has to only buy one present.

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4.       Coping with Unexpected Situations. Things do not always go in our favour (or similar sounding words to that effect), said Murphy. Plans often go awry.

However, it may be (mathematically) easier to adjust the way you handle emotions than to change the way others react. For example, you can’t control the people who make you angry, but you can control your anger and what you do with it. Here are some ways to cope with anger or stressful situations:

Ψ Emotion-focused coping: Reduce negative emotions (i.e. anger, fear, anxiety, aggression, depression, humiliation) by practicing meditation or by writing them in a journal. Another way could be to picture said others as cartoons while they are spewing offensive things: it takes some of the hurt away.

Ψ Problem-focused strategies: Remove or reduce the cause of the stressor through problem-solving. In time of stressful situations, think calmly of how to change the situation.

5.       Reframe your thinking. As with any social setting involving more than one person, there will be many situations, interactions, and verbal and non-verbal cues that make us susceptible to distorted patterns of thinking (eloquently described in Mandarin as 胡思乱想).

The first step in identifying maladaptive thoughts is to develop an awareness when you start to recognise the patterns of thinking induced negative or stress-inducing patterns of thinking. For example, “They must be gossiping about me”, “Why are they looking at me like this? Is it because I am fat?”, “She is boasting about her son again, I must not lose” and so on. The second step is to challenge those thoughts. Are the things you're telling yourself even true? Also, what are some other ways to interpret the same set of events? Which ways of seeing things serve you better? Instead of seeing things the way you always have, challenge every negative thought, and see if you can adopt thoughts that fit your situation but reflect a more positive outlook.

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6.       Avoid conflicts. Sometimes, what is needed is just to walk away. Walk away from your triggers by excusing yourself: “after hearing what you said, I need to defecate” or call a trusted friend to rant.

If an argument is occurring between two persons (and one of them is not you), avoid taking sides. During this season especially, monitor your alcohol intake and keep a clear head about you. Listen if you are called upon to do so but do not share confidential or private titbits with another.

Keep conversations light and optimistic. If you know the person you are talking to is a fervent Trump supporter, don’t provoke that person by invoking the good name of the 44th President of the United States.

7.       Just say no. The easiest the express but the hardest to do. If large gatherings cause you great amounts of stress, it is okay to say no. Just say no. Offer to catch up with those you wish to individually or in smaller groups. Or spread or defer your engagements over a longer period of time. There is no stipulation that says you must visit ALL of your family and friends during the actual holiday period.

8.       Absent family members. Keep in mind that some family members may not be able to attend because of various reasons such as illness, service in the military, studying abroad, financial burden or other reasons. Acknowledge their absence by including them.

If a beloved family member has died, do not ignore or minimise the loss. Be truthful about your feelings and share stories about your loved one. It can be cathartic for family members to mourn together in this way.

9.       Make decisions based on goals, relationships or values. Establish a set of values that you strongly believe in. Then rank your priorities and relationships and make decisions based on them. For example, if controlling your spending has been an issue, make a budget plan and stick to it. If you are a family-oriented person, make more time for your family instead of packing your holiday schedule with colleagues or friends. If you believe that the way you have organising your time is not going to work, change it.

Practising mindfulness and interpersonal effectiveness skills will improve your ability to cope in social situations. Developing an honest understanding of yourself and your emotions, and focus on living in the present.

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