What to say & do

[ Some brief sentence or two before the video ]

SAY

(to show you have noticed and care):

Whether at home, work or elsewhere, find a private space or call and say:

“You’ve had a lot going on lately with [INSERT WARNING/RISK FACTOR] (e.g, losing your job)”. This shows you have noticed.

Then show you care by saying something empathic and compassionate:

“This must be difficult. Anyone else going through this would also find it hard.” 

ASK

(about suicide directly):

“When people go through X (e.g. loss), they can have thoughts about ending their life. I am wondering, have you had any thoughts about suicide?”

 Some autistic people prefer you just asking straight out, “Have you had any thoughts about suicide”. 

 Autistic people often say “How do you know what I’m going through, you’re not autistic.” Creating a connection with that person tends to be more important than the words used. Use a calm, non-judgmental, non-pressured approach.

If yes, ask if they have thought about how/where/when and if they are finding it hard to not act on the thoughts.

If yes, keep them safe:

NOW: Get them to see a GP as soon as possible to set up a mental health care team and make sure they are supported until then. Do not leave them alone and remove anything they could use to harm themselves. If you cannot stay with them, call a friend or family member of theirs to help. If they can’t keep themselves safe that day, take them to hospital. Call 000 in an emergency or if they leave and you cannot contact them.

FUTURE: You can make a safety plan with them using BeyondBlue’s smartphone application: BeyondNow (Apple version: https://tools.toolle.com/au/tool/beyondnow-suicide-safety-plan/id1059270058 or Google Play version: https://play.google.com/store/tools/details?id=au.org.beyondblue.beyondnow). This app gives them a step by step plan of what to do if thinking about suicide with ideas on how to cope and who to contact.

If no, keep listening. You don’t have to fix it, just give them space to talk. If the person is not thinking about suicide, it can still be an opportunity to talk about why you were concerned about them and let them know you’re someone they can talk to if things get tough.  

Persons on the autism spectrum may find it harder to identify or express their feelings and emotions. You could ask if they would like to draw or write down how they are feeling or what they are thinking about. They may just need you to be with or near them. 

DO

(support and encourage help-seeking):

• Help book GP and/or counselling appointments and offer to go with them.

  • This is especially important if the person is autistic who may have anxiety and avoidance around making phone calls, communicating their needs, limited access to transport and support services, etc.

• Ask them what they need most right now.

• Encourage self-compassion and being kind to themselves.
  Suicide ideation can be a result of feeling like a failure, useless, worthless, etc.

• Ask them, if their best friend was in this situation would they call them ‘stupid’ and an ‘idiot’?
  Ask them what they would say instead and attempt to apply that to themselves.

• Encourage them to speak to family, friend, coach, chaplain, boss.

• Follow-up: check-in.

See more ideas below.

Tell them:

• They are valued.

• There is a lot that can be done to lift their overwhelm.

• The language needs to be suited to that person.  Make sure you are genuine in your encouragement. If they hear they are valued and it was said without meaning, they may interpret it as condescending and worsen their distress.  

KNOW

what NOT to say/ask/do:  

DON’T SAY:

• I know how you feel.

• Don’t worry so much.

• It’s not that bad.

• Just try…

• You should…

• Think of the positives.

• Others have it worse.

• Find the ‘silver lining’.  

• Calm down.

DON’T ASK:

• You’re not going to do something stupid are you?

• What have you got to be sad about?

• You are only …. years old. What do you have to be so upset about?

DON’T DO:

• Forget to check in or follow-up.

• Become too involved. Be their cheerleader or coach from the sideline.

• React strongly with shock, anger or frustration.

• Talk about methods or locations to suicide (this can increase risk).

Ask them if they have thought of ideas around these but don’t give them ideas.

 How to TALK & LISTEN:

Encourage Talking:

• What has been going on for you?

• How long have you felt this way?

• What has added to your stress lately?

• Language has to suit the person. Use their style of talking. 

How to Listen

Saying some of the below statements or something similar can be enough if there is no immediate risk. You do not need to fix the issue they are facing. Simply listening and validating how they feel can alleviate distress. What they need is to feel heard and noticed and that their concerns are valid. Then making sure they have ongoing support is important whether it is you, family or friends and/or professionals. It should not be a once-off check in:

• You seem overwhelmed.

• It makes sense you have been feeling hopeless.

• This must be difficult.

• I can see why you are feeling so low.

• This is hard and anyone else going through this would struggle too.

• I may not know how to help but I care and I am here.

• You are not alone.

• You are important and your life matters.

• I am here to listen.

• How can I support you?

• Language needs to suit the person. Use their style of talking, e.g., ‘I can see why you are pissed off’. 

LONGER-TERM support:

REDUCE STRESS

Reduce commitments and stressors where possible. Ideas:

• Drop a university subject.

• Take leave from work.

• Take a break from cooking and cleaning at home.

 Get disability support at university (e.g., more exam time, assignment extensions, exams alone in a room).

•  Make work days shorter.

•  Allow longer breaks at work.

• Reduce number of social activities per week.

 They may have already tried these without success.  For example, they may not get enough support at university, work may not allow the days to be shorter. See if there are ways to further advocate for them (e.g., GP, psychologist, psychiatrist, other allied health support and advocacy).  

INCREASE CONNECTION

Increase social support. Ideas:

• Join a community group: e.g., team sport, church.

• Join a club: book club, board games group, walking group.

• Join an online support group specific to stressors e.g.,

  • Facebook: search support groups for… ‘single mothers’, ‘divorced dads’, ‘transgender youth’, ‘sistergirls and brotherboys’, ‘veterans’

  •  Facebook: search support groups for… ‘being on the autism spectrum’

  • Join an NDIS or other social group: bowling, hiking.

  •  Identify and connect with local autism social groups or social groups in interest areas (e.g., photography, running, games…) 

INCREASE MEANING

Employment, volunteering, study.

Focus on these being a good match/fit with the persons strengths and interests.

Concrete and practical types of employment can be considered such as: Librarian, IT, science, data entry, working with animals, creative jobs (e.g., architecture, animator, video game design), accounting, routine types of work (customer check out person, restocking, packing, warehousing).

INCREASE ACTIVITY

• Sport and hobbies.

•  Find out their special interests and encourage looking up online or in-person interest groups or ways they can engage with these more (e.g., magazine subscriptions).  

IMPROVE HEALTH

• Improve diet, sleep, exercise.

• Reduce alcohol and drug use.

• Encourage sensory breaks and soothing to reduce overwhelm and exhaustion:

  • Noise cancelling headphones.

  • Place a lamp in each room at home for more soft lighting in the evening instead of main bright lights.

  •  See an Occupational Therapist for more ideas on personal sensory soothing.

 INCREASE ADVOCACY

•  If eligible, help them explore disability support options through the National Disability Insurance Scheme (NDIS) if they have not done so already.

•  Link them with a disability employment service to help them find purpose and meaning in a voluntary or employed position in a supportive environment.

•  If they are being bullied, take this seriously. If they are school aged, set up a meeting with the school and parents to discuss a plan to support the student. Help the student form more friendships at school through befriending activities. If an adult in a workplace or university, set up a meeting with their manager, HR manager, student counsellors, etc. to plan a way to support them.