Sunday November 29th was R U OK Day in Australia.
R U OK? (are you ok?) is an Australian national suicide prevention effort developed by an organization that seeks to reduce the rate of suicide by breaking the isolation and helplessness that characterizes people at risk to take their lives. This organization had its genesis from the death of Barry Larkin, a businessman and consultant who took his life in 1995; his three sons decided to introduce a conversation they never had the opportunity to have with their dad. Australians at work, home and among friends are now prompted to break the silence and ask 'are you ok'?
To help everyday people ask this not so easy question, R U OK? offers suggestions, which I paraphrase:
- Be open and receptive, take the lead and ask 'are you ok?'; convey that you have time to talk.
- Say something that suggests concern and opens the conversation, like 'I've noticed you have looked really stressed' or 'I understand this is a very tough time for you'.
- Listening is more important than telling. You need not know answers. Your interest and your seeking to end a person's isolation and aloneness is what counts
- Be hopeful, but not superficial. Periods of serious stress and depression can and do pass -- especially if someone feels that others care and that there is help they can get.
- Don't expect someone to cheer up, or get over it. Instead, suggest to a person who says 'no, I'm not ok' that there are ways to get better - which start with their taking one step at a time. Sometime that step is talking with others, taking better care of themselves, or speaking with a doctor or mental health professional.
In the United States, 31,000 people commit suicide each year. This does not count those who disguise their suicide in the form of an accidental death or where natural causes are attributed to what was an act of self-destruction. This is three times the homicide rate in this country. And the suicide rate is increasing, for the first time in a decade, especially among Caucasian women aged 40-64.
I recently heard about a man I had known, a very successful lawyer, who had suffered from depression. He was no complainer: the bigger the demand the more he was there to meet it. But a difficult financial time coupled with developing diabetes were the stressors that prompted his depression. The strain showed, at work and at home, but those that cared about him felt awkward; how could they say something to him, since it was he who always took care of everything and everyone? This story does not have a happy ending. He took his life, alone, in his car, far from home. Who knows if the outcome could have been different? But we do know that the mix of depression, health or financial problems, a personality that has difficulty asking for help, and no one daring to ask 'are you ok' can be a deadly combination.
For you to have the confidence to initiate an 'are you ok' conversation, you may need to know what to do if you uncover an immediate crisis. In Australia, and here in the USA, there are National Help Lines if you ask someone 'are you ok?' and then sense that person may be in imminent danger of doing something self-destructive -- and perhaps irrevocable. If you are not familiar with local services or who to turn to there is a National Suicide Prevention Hotline (1-800-273-TALK) in the USA. It is free, confidential, 24/7, and connected to crisis centers throughout the country.
We are entering the holiday season -- a time where many are not so merry and feelings of isolation often peak. One kindness we can offer friends, family, fellow students, or colleagues at work is asking 'are you ok'? This is a good time to ask and to take the time to listen. It may be the greatest gift of all.
The opinions expressed herein are solely my own as a psychiatrist and public health advocate.
Lloyd I Sederer, MD
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