Suicide prevention toolkit part one Our society is waking up to the fact that suicide is the biggest killer of young men. No longer a young man myself and for the first time since leaving school something other than suicide is more likely to kill me. Perhaps a heart attack, or an altercation with a punter in my local public house. It's something to celebrate because I have been particularly at risk as someone with bipolar. People with the condition are estimated to be 20 times more likely to take their own life than the general population. It being Suicide Prevention Month I would like to share with you my thoughts on suicidal ideation and how to prevent it. Rather than bombard you a hard to digest tips and techniques I'll serialise these in digestable and easy to retain chunks from today until this coming Friday. Firstly, what is suicidal ideation? I am sure there are suicides that occur due to a sudden perceived catastrophe such as a stockbroker realising a plunge in the FTSE has wiped out their holdings, or someone who's failed their A levels and has the immediate prospect of studying at the local agricultural college instead of university. But my experiences of suicidal ideation were far more sustained. It typically started with a slide over a number of weeks into depression, then deeper down to a point where my thinking became fixated on self-destruction. In this state, my mind seemed to focus exclusively on ways to take my life with an exhausting drip, drip, drip of repetitive suicidal thoughts. It was quite simply my brain telling me over and over again to kill myself. Sometimes the only relief was to consider different suicidal methodology and how comforting it would be not to exist anymore. This could go on for weeks and was exhausting. I think I should point out that the majority of the time I'm in a normal range of mood and these thought patterns were episodic. I haven't been affected for a number of years and I'm fine today. I think it is interesting to consider the first time I experienced these thoughts. I was 17 years old and still at school, recovering from my first manic episode that had thrown my academic life into disarray. It took 10 years for me to get a diagnosis of bipolar (about average) and I had no idea at the time why my erratic behaviour had damaged relationships with teachers and students alike. During the depressive episode that followed the mania, and which included suicidal ideation, I had no psychological tools to manage what I was experiencing. I concentrated on salvaging my A levels and in time was lucky that the extreme negative thought patterns subsided, despite a level of residual depression lingering for several years. So what stopped me? Probably the most important thing is the fact I grew up in a family. My Dad had bipolar so there were times when our lives were anything but stable, but we stayed together as a family despite some lean times. I consider that to be a strong protective factor. However, if a friend comes to you feeling suicidal, an observation about the benefits of stable family life isn't going to be much help. Are there practical things we can suggest beyond the usual, sound advice of going to a GP and calling a helpline if you're desperate? I believe so. There are protective thought patterns that I have developed that now enable me to beat suicidal ideation almost before it starts. When I was grappling with bipolar in the early noughties, I found a psychotherapist who specialised in Neuro-linguistic Programming (NLP), a branch of Cognitive Behavioural Therapy (CBT). A few sessions of NLP helped me establish a greater awareness of my inner voice and observe the way my mind told me all sorts of unhelpful messages. Developing an ability to spot self-sabotaging thought patterns, and to consider alternative ways to appraise myself and the world around me helped me significantly. I have since used the techniques I learned to develop a toolkit, which I apply when I spot the early warning signs of a manic or depressive episode occurring. There are specific things I do to prevent mania but I will focus here on techniques to prevent the depressive phase and suicidal ideation. My suicide prevention toolkit The anti-depression spanner set This consists of all the things I do to turn around a developing depressive episode - increasing exercise, coming off alcohol and coffee, telling my wife and trusted friends/colleagues that I'm at risk, and ensuring adequate but not excessive sleep. I apply the CBT techniques I have learned and pay more attention to my mental 'monitoring programme' that observes my thoughts and challenges irrational perceptions. Listening to 70s funk helps, rather than intensifying my low mood with someone like Leonard Cohen. Fresh air, sunlight and a good diet are also key. Antidepressant medication can be useful for some, but it can precipitate mania in people with bipolar and for that reason I don’t take it. The hammer of experience People who make attempts on their lives run a significant risk of completing on the second and future attempts. But this is where a key protective thought pattern can be introduced. I tell myself that I survived last time, so this state of mind is temporary and will pass. I've managed to get out of the hole before and will be able to do it again. Explaining this to someone who is suicidal is tough and they simply aren't going to comprehend easily. Their mind may be telling them that a perceived catastrophe or situation they are facing is final and can't be solved, and that the only logical way to deal with it is self-destruction. They may believe they will always feel this bad. If done sensitively, however, it is possible to plant the kernel of an idea of the eventual transitory nature of these thoughts. I'll be back with another instalment of the suicide prevention toolkit tomorrow. Before then feel free to share what you have read with someone who might need it. Jeremy Your donation will help provide a range of services offering the support people need, when they need it steering people away from suicidal ideation. You can make sure there's someone at the end of the phone to listen, a nearby group to share experiences, a 24-hour peer forum and more. Together, we can support the person behind the diagnosis of bipolar.