Suicide and self-harm: Breaking the stigma

They do not see the kind 26-year-old whose favourite things include her three cats and hopes to one day work with animals.

The scars on Shelly’s arms and legs are a result of years of self-harm. 

“Walking down the supermarket aisle, I’ve had parents snatch children away from me, they pull their kids behind them. But I’m not contagious, I’m not going to bite,” Shelly said.

Shelly, who wished for her surname not to be published, began self-harming at 10 years old after a series of traumatic events.

It started with punching walls and pulling out hair, but after an incident with an older school student, the harm escalated to cutting.

She was in year 11 when she first attempted suicide.

The turning point came after the tragic death of a close friend at the tender age of 19. Shelly took the first step on the long road to recovery by seeking therapy.

She has since been diagnosed with post traumatic stress disorder and borderline personality disorder, which she says has made her life an “unpredictable roller coaster”.

While she still self-harms, Shelly is focused on recovery, which includes attending weekly appointments with her doctor, psychologist and treating clinician. 

She is hoping to get a job next year, and is considering a career in vet nursing.

Living with mental illness is very isolating, especially when subjects such as suicide and self-harm can be thought as best avoided.

“Nobody ever wants to talk about it because who would want to – it’s dark, it is depressing,” Shelly said.

“For ages I just kept this locked away and just wanted someone to come up and say ‘you seem really depressed, can I help?’ and nobody did, everybody just ignored me.”

While Shelly believed society was starting to take mental health more seriously, she said there was still a great need for more education and awareness.

Last week, Ballarat Centacare’s information session on BDP was fully booked days in advance highlighting this demand.

Shelly said while many found mental illness harder to understand than physical, she wanted people to remember a person who self-harms does not choose to live such a life and there is always a story behind the suffering.

“There are a lot of things that have happened to bring me to this point,” she said.

“We all need to start being kind to one another and more understanding. We see an amputee walk down the street and we understand something horrific has happened to them, whereas people look at my scars and judge me.”

Feeling misunderstood and alone, Shelly wrote an open letter in February to explain what it felt like to live with her mental illnesses, to describe how debilitating it could be and to explain as best she could her actions.

More than 13,000 people read the online letter in the first two weeks. But what mattered most to Shelly was the change in attitude from the people around her.

“I just want others to know people who self-harm aren’t scary, we are not monsters, we are human beings,” she said.

HOW TO HELP

Shelly said people often tiptoed around the subject of her mental health, but not being able to talk about it made her feel even more alone.

“I think the general worry is that people are scared it will trigger us, when in reality, we just want to talk about it,” she said. 

“We want it out there because the more we talk about it the more truths come out and the myths go away.”

SANE psychologist Suzanne Leckie said mental health could be very difficult territory for friends, families, and employers to navigate, but it was important to remember help was always available.

“Even once you’ve trained in the mental health profession, those first few conversations involving someone thinking about suicide are still a bit frightening, so it’s a lot to expect people without that training to feel confident to do it well,” she said.

“People become quite frightened about saying the wrong thing and making things worse, so at the time of people’s greatest need sometimes they find people actually take a step back from them, which can end up with them feeling more isolated and distressed.”

Ms Leckie said the benefit of helplines was there was support 24 hours a day for those in need or family and friends wanting some guidance.

She urged loved ones, who were unsure of how to respond, to direct the person to the help and support available or recommend services.

But Ms Leckie said during these conversations, there was no harm in giving someone the space to talk and communicating concern.

“The more we are willing to talk about (mental health) the healthier people are because they feel less alone, less ashamed and that there is more concern and care out there for them,” she said.

“You can never go wrong by telling someone you’re really sorry they feel that way, you wish there was more you could do to help, but you want them to know that you genuinely care for them.”

Ballarat Sergeant Rick Nield says police attend the tragedy of suicide all too often, and it is always an “extremely emotional time” for members, let alone the family and friends

“I have been to numerous suicides, and I still remember the first who was a 16-year-old male and that was 26 years ago, it just doesn’t go away,” he said.

“Members get trained at the Police Academy in relation to how they are supposed to deal with a suicide, but until you have to attend one, you can’t and don’t know how you are going to react.”

Sergeant Nield said police needed to try to gain the trust of the person and negotiate with them.

The stress in the moment was “immeasurable”, and the thoughts after the event “indescribable”.

“How members cope is different to each individual person,” he said.

“It’s all about communication and talking during and especially after, because that’s when it impacts, after the event.

“It is when the member settles down and has time to think, when the adrenalin stops, that’s the difficult part.”

Sergeant Nield said police were no different to anyone else, they are human and do get emotional.  

But he said police now talk a lot more openly to each other about mental health issues and the health of members is an “extremely important consideration” by Ballarat Police Station Management.

The Police Welfare Services is used openly and often by members, along with outside referral agencies. 

“People in general are like a glass, you can fill that glass with water, sand or anything, but once its full it will overflow,” he said.

“I hope that it never gets to that stage for members of Victoria Police. That is why talking is so important.”

When police are called for help, a divisional van is dispatched with two members to assess the situation.

Sometimes the situation is different to the circumstances described, and police will offer services if required, and leave without any further action. 

But if the person has or is threatening self-harm, suicide or to hurt someone, under section 351 of the Mental Health Act, police can make an arrest and have the patient transported to hospital.

Sergeant Nield said about 60 to 70 per cent of the time police and the patient ended up here. 

Police then wait for a mental health clinician or doctor to make an assessment and a decision is made as to whether the person is placed into care or released.

By 10am on Friday, two police units were at the Base Hospital emergency department with mental health patients. 

Sergeant Nield said the vans could be at the hospital for 10 minutes or two to three hours, it depended on how busy the department was and the priority jobs. 

“All of a sudden our three vans on the road is now down to one, this unit is doing all other jobs required by police in the Ballarat area until the units are relieved from the hospital,” he said. 

But there might not be another mental health call for the rest of the shift, the day, or week.

Sergeant Nield said the introduction of a PACER (Police And Clinician Emergency Response) unit would take the pressure off resources, with the patient assessed first at the home rather than using a divisional van and ambulance to take them straight to hospital. 

He said the assessment in the home would result in three possible outcomes – no further intervention required, the clinician completes an assessment order, or the person does need to be taken into care, Ambulance Victoria is called and the person is transported directly to the Queen Victoria Building.

The hope is to have the unit start operating in December.

Sergeant Nield said the people police came in contact with ranged from teenagers through to 80 year olds.

He said if the patient was the person who phoned, nine times out of 10 they would be cooperative, if the person was affected by drugs or alcohol, they were generally less cooperative.

“Every job that police attend is different and therefore has to be taken on its merits because it can turn quite quickly from one situation to another,” Sergeant Nield said.

If someone comes across self-harm or a suicide attempt, Sergeant Nield said to call triple zero and explain the situation.

“If you feel comfortable, go up and say, ‘how are you going, do you want some help?’ If you don’t, just keep an eye on them and if the person walks away, even if you follow from a distance and give updates of where you are, so the police can get there and then speak to the person,” Sergeant Nield said. 

“But I certainly wouldn’t be putting myself in a dangerous situation, because you don’t know the person’s real mental health, you don’t know whether or not they have any weapons, whether or not they have the propensity for violence, if they are affected by drugs and/or alcohol.”

Sergeant Nield urged people who were feeling flat or low to not be afraid of talking to someone. 

“This is as simple as talking with family, friends, Lifeline, Beyond Blue, your GP just to name a few. Just talk to somebody.”

Ballarat Health Services provides mental health services across the Grampians region, including Bacchus Marsh, Ballarat, Ararat, Stawell and Horsham. 

In each team is specialist trained staff catering for all age groups, ranging from birth right up to elderly.

BHS MH operations director Michael Fryar said there was 300 staff spread across the regions and age groups.

“We provide services 24 hours, seven days a week, and, depending on the urgency of the treatment required at the time, different responses will be made,” he said.

Mr Fryar said one part of the referral system was through the emergency department at Ballarat Base Hospital.

“A percentage of people come through in an urgent or crisis situation, and we lead the state in being able to respond, get appropriate treatment and have people exit the emergency department,” he said.

Community staff are also available to see people at home or in one of the offices across the region for assessment and treatment.

Mr Fryar said while the need for mental health services was increasing, the services available had increased incrementally over the past few years to help meet demand.

As for the impacts of dealing with crisis situations, Mr Fryar said there were “very comprehensive and robust” supervision and support services built into the organisation’s mental health services to help staff.

“I think the main thing is the level of training, professionalism and expertise that our staff have,” he said.

“We are very fortunate to have a great group of staff and they are experts at what they do, it puts them in a good position to be able to respond to this type of work quite routinely.”

The Hospital Outreach Post-suicidal Engagement (HOPE) program has been designed to provide holistic support to help individuals, carers and families identify factors and build strategies to reduce the risk of suicide.

The state government program, currently being trialed, offers an intensive response during the period of risk or vulnerability in the months after a suicide attempt. Individuals are supported for up to three months after being discharged from hospital.

The trial is running at St Vincent’s, The Alfred and Frankston hospitals, but will also start at Geelong, Maroondah and Wangaratta hospitals this year, with service models and recruitment in progress.

On Wednesday Minister for Mental Health Martin Foley visited St Vincent’s Hospital to talk about the program.

“Every year, suicide takes more than twice as many lives as the road toll – there is no single cause or solution and it is not a disease for which there is a cure,” Mr Foley said.

“However, with understanding, a multipronged approach, and a government committed to working with the whole community, we can reach out, provide support and continue the work to get people the help they need.

“Suicide is a tragedy that has a devastating impact on families and loved ones and we need to ensure we are doing what we can to provide a service system that meets their needs.”

Meanwhile, Ballarat Health Services’ Mental Health Service took time during Mental Health Week to thank and acknowledge the work of its consumer advisory committee.

CAC chair and consumer consultant Amanda McCartney said a lived experience of mental illness could make a positive contribution to the way public mental health services were delivered.

“Current and past consumers of our service area continuously asked to contribute feedback and suggestions for improvement,” she said.

“Being a formal part of the advisory committee means this feedback is utilised in a constructive and significant manner, the consumer voice is used as a driver for the way services plan and implement their care.”

For 24/7 support, contact:

Lifeline 13 11 14

Beyondblue 1300 224 636

Suicide Callback Service 1300 659 467

Emergency Services 000 (Triple Zero)

MensLine 1300 789 978

Kids Helpline 1800 551 800