Sheep Veterinary Society
Division of the British Veterinary Association

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These speakers notes highlight some of the signs of distress and pointers to its resolution. The paper was presented at a recent Sheep Veterinary Society meeting and will appear in the Sheep Veterinary Society Proceedings to be published in April.

While originally addressed to a veterinary audience some of the information is considered relevant in the present crisis.

Using all the information that you know about the person ask yourself:

Has the person experienced any of the following:

• recent loss (loved one, pet, job)
• recent break up of a close relationship
• major disappointment
• change in circumstances (retirement, redundancy, children leaving home)
• physical or mental illness?
  

Have they:

• made a previous suicide attempt
• a history of suicide in the family
• begun tidying up their affairs (making a will, taking out insurance)?
  

Using visual clues - things to note

Are they:

• withdrawn
• low spirited
• finding it difficult to relate to others
• taking less care of themselves
• different in some way (unusually morose or cheerful)
• tearful, or trying hard not to appear upset
• more irritable
• finding it hard to concentrate
• less energetic and seeming particularly tired
• eating less (or more) than is usual?
  

Examples of things to listen out for

Do they talk about:

• feeling suicidal
• having no hope in the future, no point to their lives
• feeling worthless, a failure
• feeling isolated and alone
• sleeping badly, waking early or staying in bed
• losing their appetite or eating more than is usual?
  

 Issues to consider before getting involved

1. Ethical issues

• Confidentiality.
  

2.  Your own needs

• understand your own attitudes
• recognise your limitations
• make sure that you debrief with someone
• ring The Samaritans?
• personal security.

Six steps to effective support

1.  Be prepared to engage

The point is to foster trust and support, not provide a solution or tell them about your (or other people's) problems.

• remember that it takes a lot of courage to talk to someone about personal distress
• try not to take anger and resentment personally and retort in kind
• expect a degree of incoherence - it might be the first time that they are putting it into words.
  

2.  Ask relevant questions

Showing that you care is the most important consideration.

• prompt by asking open questions and let them have space to reply
• begin with the general, develop empathy and trust
• let the conversation move to the specific, you can often 'reflect' the messages that you are receiving
• if the conversation seems to be going in circles you may need to ask some specific 'open' questions to find out what is really the problem.
  

3.  Be aware of the risk of suicide

You cannot realistically assess the risk but bear it in mind.

• talking about suicide does not put the idea into someone's head
• in exceptional circumstances, you may have to consider taking immediate action e.g. removing the means.

4.  Identify the person's "Significant Other"

"Significant Others" can be beneficial helpers.

• never assume that you know who they are
• be especially cautious of family connections
• enlist their support only with permission
• you may become the "Other"
• the significance of a religious faith.
  

5.  Discuss strategies and review the options

Help the person feel secure enough to take the next step of co-operating with the help available.

• help them to draw up a personal support list
• seek an assurance that they will use it
• people who are hurting don't easily trust and starting another relationship takes time
• don't argue or coerce, make helpful suggestions
• the importance of personal recommendations.
  

6.  Keep in touch

Most suicides occur within three months of the beginning of "recovery".

• follow up to make sure that they are making progress
• you may be able to give practical guidance on forms, relief services, Royal Agricultural Benevolent Institution contact etc
• when a person is being helped by 'professionals', they still need a friend.
  

Spotting those at risk of suicide

80% of people who contemplate suicide give warning signs

Warning signs:

• usually occur in clusters, and
• over a significant period of time.
  

The likelihood of a person committing suicide depends on several factors including:

• particular events (e.g. loss, broken relationships)
• personal history (e.g. previous attempts, family history of suicide)
• personal characteristics (e.g. time of life, ability to cope and level of social support, illness)
• People who have talked about or written about suicide must be taken seriously.
  
  
  

The risk is extremely high if:

• there is a readily available lethal method, and the person has indicated their intention to use it (e.g. farmers with shotguns).
• the individual has set a deadline, such as an anniversary or birthday, and indicated that something significant will happen on that day.
• the individual is uncharacteristically tidying up 'loose ends' - putting their lives in order before ending it all.

Contacts

Plus build your own contacts including CAB, Relate, health workers, Agricultural Chaplains etc

The way forward for your practice:

• Draw up a list of contacts: your local support group or the Farm Crisis Network (http://www.farmcrisisnetwork.org.uk)
• Meet the people with whom you need to network e.g. chaplains, Citizens Advice Bureau
• Record distress cases
• Follow up personally
• Debrief with a colleague or The Samaritans (at any time)
• Identify the needs.