Stigma and perceived stigma are barriers to people seeking help for mental health problems in general (Corrigan 2004; Vogel et al 2009) and suicidal thoughts and urges in particular (Niederkrotenthaler et al 2014). Batterham et al (2013) found more than 25% of676 stafFand students at the Australian National University agreed in an online survey that people who ended their life by suicide were “weak”, “reckless” or “selfish”. The language used to describe suicide is often stigmatising which is unsurprising given that suicide was illegal for centuries in the United Kingdom and is considered a sin in many religions. According to one Gallup poll, 82% of Americans find suicide to be morally unacceptable, threads/whats-so-morally-wrong-with-suicide.207488/.

Many people who attempted suicide were sent to prison for this in the United Kingdom, and it took years of campaigning to realise that care, not prosecution, was needed. Suicide was finally decriminalised in the United Kingdom in 1961. It is imperative therefore that when we communicate with clients at risk of suicide, we use non-stigmatising language and applaud any steps they have taken towards help-seeking. There are a number of terms used in both public discourse and the suicide literature which are stigmatising such as “failed suicide attempt” (implying death by suicide is some kind of success). The term “committed suicide” is outmoded and stigmatising as it is associated with committing serious crimes. It is much clearer and less stigmatising to use the term death by suicide. The term failed suicide attempt should be avoided as it suggests that death by suicide is a success. I would also avoid the term “suicide gesture” as this is judgemental language and may dismiss the potential for actual risk even if the action was not intended to be fatal.

Stigma towards mental health is associated with negative help-seeking attitudes for people who are experiencing suicidal thoughts. However, it may not be the strongest barrier to them seeking help (Czyz et al 2013). In this online US study of 157 students, the most commonly reported barriers included the perception that treatment is not needed (66%), lack of time (26.8%) and preference for self-management (18%).

Myth: If you talk about wanting to end your life you probably wont do it.

Many people who end their life have told someone, most likely significant others, about their suicidal feelings in the weeks prior to their death. People may also deny having suicidal thoughts when last asked prior to their death or communicate their risk in more behavioural ways (Appleby et al 1999).

Myth: People who repeatedly harm themselves aren't a suicide risk.

A history of self-harm is an important risk factor for future suicide. It elevates the risk of suicide 50- to 100-fold within the year following self- harm (Chan et al 2016).

Myth: Talking about suicidal thoughts and feelings could make you more likely to act on them./Never ask a person if they are suicidal as this could put the idea in their head.

Evidence suggests that asking people about suicide does not increase their risk and may be beneficial (Gould et al 2005; Dazzi et al 2014; Blades et al 2018).

Myth: Media stories about suicide do not affect suicide rates.

When a famous person dies by suicide the rate increases at a statistically significant level (Cheng et al 2007).

Myth: Only people with a mental illness think about or attempt suicide.

Recent statistics indicate that more than half of deaths by suicide do not merit a psychiatric diagnosis (Stone et al 2018). Suicidal behaviour is not an illness but an expression of intense personal distress.

Myth: Suicide is selfish.

In fact, many people who end their life believe they are releasing others from a burden. The interpersonal-psychological theory of suicide (Joiner et al 2005) identifies perceived burdensomeness as a primary component of suicidal desire and a possible point of intervention for suicide prevention (see review by Hill & Pettit 2014). Joiner and colleagues (2002) analysed 20 suicide notes written by people who attempted suicide alongside 20 notes written by people who completed suicide. They found that, of five variables, the only statistical difference was that the notes of those who died by suicide included more detail about how they were a burden to others and society at large compared to those who attempted suicide.

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