Suicide calls in civil enforcement

As a call handler working in civil enforcement, you will deal with a wide variety of people and issues. It's impossible to predict the precise nature of a call before responding to it. Most of the time, calls are normal, but from time to time, a call handler may experience calls from people who make a statement of intent to self-harm or take their own lives by suicide. Declarations of this nature can cause distress for both the caller and the call handler.

Suicide is the intentional act of taking one’s own life. A suicide attempt is when people harm themselves with the goal of ending their life, but they do not die. Avoid using terms such as “committing suicide,” “successful suicide,” or “failed suicide” when referring to suicide and suicide attempts, as these terms often carry negative meanings, instead say took their own life or tried to take their own life.

Possible contributing factors

Stressful life events (such as the loss of a loved one, legal troubles, or financial difficulties) and interpersonal stressors (such as shame, harassment, bullying, discrimination, or relationship troubles) may contribute to the risk of someone attempting to take their own life. Negative thoughts or actions of this nature are a sign of extreme distress and an indicator that someone needs help. Talking about wanting to die is not a typical response to stress, so calls of this nature should be taken seriously and need immediate attention.

People can have a range of ‘negative self-harm feelings” – some might talk about wanting to go to sleep and not wake up or wanting all the bad things to go away. It’s common for people in difficult situations to have these thoughts, but that does not necessarily mean they want to end their life.

One person might see taking their own life as one possibility among several; another might feel it's the choice they want to make and have a plan of how to do it.

How to prepare for a call

The distress is best managed by being prepared (your own and theirs) and knowing in advance how to respond to calls of this nature. It's important to be clear that if a caller states they may take their own life or self-harm, they may well do so and our procedures and actions must be organised around that assumption.

For the call handler concerned, the key to responding effectively is to plan ahead, so you know what to do before someone makes such a declaration. Systems, procedures, and responses need to be in place and ready to apply to ensure an appropriate response.

Sometimes people take their own life impulsively in moments of crisis with a breakdown in the ability to deal with life stresses, such as financial problems, relationship break-ups, or chronic pain and illness. In addition, experiencing conflict, disaster, violence, abuse, or loss and a sense of isolation are strongly associated with this behaviour.

By far the strongest risk factor for someone contemplating ending their life is a previous attempt. While everyone’s experience is different, there are a number of simple, positive things you can do as a call handler to make a huge difference to someone at risk.

• Show concern
• Help the person feel connected and valued

What to look for

Knowing what to look for, and having the skills and confidence to have a conversation and provide support, can lessen the likelihood of someone trying to end their own life. Some callers may say they intend to self-harm or kill themselves as a threat or a tactic to evade payment or to make you believe a case should be returned because of their mental state. Others will mean it.

It is very hard to distinguish between the two and especially on the telephone. For this reason, all declarations must be taken seriously. If you ever receive a phone call from someone who is suicidal, there are several things that you should do:

• Listen attentively to everything that the caller says
• Allow the caller to cry, scream or swear. Suicidal feelings are powerful, so let them come out
• Stay calm and be supportive, sympathetic, and kind
• DO NOT assume that you know what the underlying problem is
  

Being uncritical is critical

The last thing someone needs is to feel judged.

Never deny or trivialise a caller’s feelings, by saying things such as:

• "You’re not thinking of doing anything stupid, are you?" (This would indicate that you were trivialising the caller’s perception of their mental state. This is very real and serious for the caller, even if you think it’s not – they are not stupid).
• Pull yourself together!
• I know how you feel!
• You think you’ve got problems. You should have my life! (Remember it's about them not you)
  
  Do use supportive expressions, such as:
• Take your time. You’re doing really well
• I can see this is really hard for you
• The way you feel is not your fault
• How can I help? What do you want me to do?

You might feel unsure about what to say, but the main thing is to be calm and non-judgmental. You don’t need to solve their problems or understand ‘why’. Don’t be afraid to ask directly if they are thinking of taking their own life. Asking the question does not increase the person’s risk, but their response will help you understand how they are feeling.

Your role is to provide reassurance

If someone tells you they’ve thought about or attempted to take their own life, it’s important not to let any preconceived ideas you may have get in the way of listening openly. You may be shocked or find it hard to understand, but your role is to provide reassurance and offer support. Be aware of the person’s journey to get to this point and how difficult the conversation is likely to be for them. Talking about taking your own life takes courage – acknowledge this and thank the person for being honest with you.

Call handlers are not counsellors, your interaction with the caller who will probably be a complete stranger will be very short, and there will be little opportunity for repeated contact. Put more simply, it's extremely difficult in some cases to gain trust and give a ‘quality’ response to a caller within a pre-defined time period.

The use of scripts for conversations with callers minimises call handler control and should be avoided wherever possible. Scripted conversations will be perceived as fake, they’ll lack intonation, emotion, and delivery. Call handlers should be equipped with the knowledge to deal with the range of queries likely to be encountered which gives greater opportunity for them to use more of their skills to deal effectively and safely in these situations to achieve the best outcome.

If someone is in imminent danger

If you think the caller is in imminent danger of harming themselves, use a signalling system to summon support and trigger procedures to alert the emergency services whilst maintaining contact with the caller.

Remember, if a life is in danger, it is an emergency. Don’t be scared, it’s the right thing to do. You must get help and you will not be in trouble

When dealing with calls of this nature, give the caller time to express themselves, even though you may feel anxious.

Don't skirt around the topic. You can find yourself tiptoeing around the subject because you’re scared of saying the wrong thing. There's still a taboo around talking about taking your own life, which can make it even harder for people experiencing these feelings to open up and feel understood.

Direct questions like 'Are you having negative thoughts?' or 'Have you felt like you want to end your life?' can help someone talk about how they're feeling. The reason for asking these questions is to assess the level of risk for the caller. If the caller answers yes to any of the questions, the risk is very high, and immediate intervention is necessary.

Is it safe to ask if someone wants to take their own life?

Asking someone if they're planning to end their life may not feel like the right thing to do, but in fact, professionals do recommend asking direct questions. Some people worry that this might indirectly encourage the person to act on their feelings, but in reality, research has shown that speaking openly decreases the likelihood of the person acting on their feelings.

Keep the caller talking and DO the following:

• Take their statement seriously

Listen carefully and clarify. Check your understanding of what has been said. Suspend all activities you are carrying out

• Summon a colleague

Workplace procedures must be in place and you must know how to summon support from a colleague who will act as your support partner

• Gather information

Make some assessment on the degree of risk. Remain calm – this will help the caller gain perspective of the situation.

Clarify and confirm that the caller has said they intend to take their own life

Determine if they’ve had previous attempts and if they’re receiving treatment. Find out any plans the caller has to carry out their declaration, when it is planned for and if they have the means to do it

• Establish

If the caller has any contact with health care services, or a community -based healthcare professional, or if they have a carer or person who looks after them

• Find out

Has self-harm action already been taken, e.g. have tablets of something else been taken, have they cut themselves badly, or if they are in a position of danger where self-harm could be actioned easily e.g. next to heavy traffic, at height or near a river or lake

• Record information

Include location or any plans to go elsewhere – this will be of vital importance when you inform the emergency services

Emergency services

If the caller is distressed and is in immediate danger, summon the emergency services. You do not need consent to do so.

Only let the person go when emergency services or a health care professional, carer or family member has arrived and you’re sure that the caller is no longer in immediate danger. A person thinking of taking their own life may not ask for help, but that doesn't mean that help isn't wanted. People who take their lives don't want to die—they just want to stop hurting.

Hopefully, calls of this nature will be rare but remember be prepared and if the worst happens it’s not your fault!