Language Really Does Matter in Suicide Prevention - and the Angel is in the Detail!
Around #WorldSuicidePreventionDay2024, I published a series of posts about the language we use, and can use, and should use, and should avoid - because it can be harmful to people or stop us getting the suicide numbers down! - in our everyday conversations about #suicide & #SuicidePrevention, including in our advocacy & campaigning work, based on my extensive and intensive #research and the many exchanges I have regularly around language with my many collaborative partners.?
In the research I regularly carry out, via online focus groups and interviews, I listen to people who work in suicide prevention, including those with lived & living experiences of suicide; and I test out the language with groups of people not previously exposed to suicide who, in some cases, have never previously discussed the subjects of suicide or suicide prevention.?
I'm a Research Fellow and, for much of my professional research career, I've carried out research around language, including analysing everyday public discourse and social media conversations; developing campaign slogans
It's a professional passion, and it's a personal passion.?
And those who know me well will know that part of my OCE - Obsessive Compulsive Enthusiasm! - is a proud pedantry when it comes to language...and statistics as well!?
But all of this is 'coming from a good place' because I know how harmful a single word or phrase can be in certain circumstances with certain people, and how helpful the 'right' language can be.?
Many people often say "the devil's in the detail" which is very true.?
But it's also true to say 'the angel's in the detail'!?
Positive, Constructive Response and High Engagement
My series of posts - which, as well as reviewing the IASP led #WSPD2024 content, were timed to fit with the very helpful #LanguageMatters campaign being run by NSPA (the UK National Suicide Prevention Alliance) - were generally very well received with lots of positive, constructive engagement
Thank you everyone who contributed to that.?
There were a couple of criticisms of my analysis, or negative reactions to a couple of specific pieces of language I picked up on.
I cover these later in this article but I think (I might be wrong) they were from people who didn't follow the full series of posts and didn't read all my text and context and comments around those posts - they were reacting to specific language triggers - so this article is an opportunity to put everything into context and into perspective.?
The Detail
Here's a summary of the key points in those posts.?
Firstly, there are the key messages that emerged from previous phases of research prior to the #ZeroSuicideSociety #JoinTheDotsTour which made it onto the Towards Zero Suicide Society banners which travelled with me for my many educational talks across the M62 Corridor in June (in conference halls, libraries, cinemas, theatres, wellness centres, wellbeing cafes, sports stadiums, shopping centres, bars...!):?
Before getting deep into the issues around the language we use in everyday conversation on suicide, and language we use in campaigns about suicide prevention, I published a series of posts reviewing the #WSPD2024 content on the IASP (International Association for Suicide Prevention) website and the resources there.?
This included commenting on how the previous #WSPD 3-year theme of 'Creating Hope Through Action' had been helpful as a positive focus, finding its feet in Year 1 and becoming quite a rallying call by Year 3; and how the new 3-year theme for 2024-26 #ChangeTheNarrative is more open to interpretation - changing which narrative exactly, and to what precisely? - but will again go on a journey itself over its 3-year life.?
For my contribution to the debate, I focused on changing the narrative in our public conversation to challenge stigma and shame, and how we need to raise the bar in our ambition on suicide prevention.?
I focused on these two key points:
---
1) removing stigma and shame around suicide, and encouraging people to talk openly
2) raising the bar in our ambition on reducing the number of suicide deaths (and suicide attempts and plans) especially when everyone seems to agree that 'most suicides are preventable' but we don't seem to be very good at preventing most suicides!
Instead of translating 'most suicides are preventable' into strategies & plans for a minimum reduction of 50% in the suicide numbers, we have governments, advisory groups and lead advisors to government aiming very low with targets of 10% reduction in the suicide numbers at best.
Those fuelling and/or accepting low ambition often create and sustain a narrative with low ambition language like "we're doing the best we can" or "we're doing the best we can with available resources" or "if it wasn't for our efforts, the numbers would probably be higher" - none of these help us get the transformational change we need, with the suicide numbers on that downward trend #TowardsZeroSuicide.
I continued the analysis and prompts for discussion here:
...and here...
...which included this important text:?
2) Calls to 'prioritise' service A or B, area C or D, group E or F are part of the problem as well, so we must be very careful in our use of 'prioritise'.
It's common to hear calls for 'parity in mental health & physical health' but this is often interpreted by government & other institutions as shifting the balance in a fixed budget to allocate a higher % to #MentalHealth and correspondingly less to #PhysicalHealth which causes harm where poor mental health and poor physical health are inter-related.
People with long-term physical health issues are more likely to take their own lives!
I submitted a suggested theme for WSPD from our ZeroSuicideSociety model & framework...
"Everyone Must Be a Priority for Someone"
...which I believe we could unite around for transformational change in getting
Perhaps that can be the theme for 2027-2029, or maybe it can be at the heart of our conversations over the next 3 years to 'Change the Narrative on Suicide'?
My next post challenged the narrative from the IASP and WHO - the first line of its #WSPD2024 website - that:?
"Suicide is a major public health problem with far-reaching social, emotional and economic consequences".
My response included this text:?
This year + 2025 + 2026, the theme is #ChangeTheNarrative on suicide.
So which narratives do we want to change, and to what?
Interesting first line on the WSPD home page:
"Suicide is a major public health problem with far-reaching social, emotional and economic consequences".
For most people not working in 'the health system', 'public health' doesn't really mean anything.
For most people now working in suicide prevention due to their own lived experience, suicide is not just a 'public health' problem!
And for many of us who've lost people to suicide or experienced a suicide crisis, it's often better described as:
"a far-reaching social, emotional or economic problem that has (public) health consequences"!
Language is crucial in talking about such a complex & sensitive subject as suicide & suicide prevention.
#LanguageMatters as #NSPA put it this week.
Every word or phrase can be significant. Eg, when suicide is referred to as "a mental health crisis", we have a further problem because suicide is not just a mental health issue!
And when suicide is referred to as "a public health problem", it's a signal that this multi-factor, multi-perspective issue is being viewed through a particular lens.
Let's check the definition of 'public health':
> "The health of the population as a whole, esp as the subject of government regulation & support"
> "The branch of medicine dealing with public hygiene, epidemiology & disease prevention".
If we look at suicide prevention from a long-term historic perspective, there've been considerable benefits from viewing it through a #PublicHealth lens along with drawbacks, like the World Health Organisation avoiding studying the subject prior to 2014 as they said suicide wasn't a disease, so was outside its remit!
In more recent history, it's increasingly recognised that viewing suicide through a health lens is now a major part of the problem, with 'the health system' having little understanding of, influence over, or commitment to solving underlying drivers of suicides like poverty, discrimination, racism, homophobia, Islamophobia, injustice, job loss, domestic abuse, cyberbullying, social isolation, rural isolation, climate anxiety, failures in the criminal justice system, etc.
Also, Health/Public Health Depts struggle with the ground-up community solutions we need... ...and they're structurally & culturally dominated by a 'trade-off mentality' where they tend to identify and focus on 'priority groups', 'priority areas' or 'priority issues' as this is the model they've been trained in, and always worked in.
Once we step outside this restrictive, harmful, model in favour of a co-ordinated, collaborative approach
Then there was a post focusing on the briefing packs including specifically the briefing pack on National Strategies:?
which included this critique along with my personal and professional credentials:?
I have 44 years' Lived Experience of suicide.
I started working in suicide prevention in 2013 when I facilitated a global forum on 'Breakthrough Ideas for Suicide Prevention' which generated '10 Big Ideas'.
One of those 'Big Ideas' was a 'National Strategy' for Suicide Prevention.
It seemed an obvious thing to do; and that not having a National Strategy was a major barrier to getting the numbers down.
I was living in Australia at the time, and we didn't have a National Strategy, so there was a major drive to have one.
After a few years, views started to diverge about the value of a National Strategy because of lack of evidence of impact in reducing the suicide numbers, and also because of the process being systemically conservative.
If you 'bring everyone together' to agree any strategy, plan or target, there's a tendency to gravitate to the lowest common denominator, not high ambition or stretch targets!
Meanwhile, we had the first published National Suicide Prevention Strategy (NSPS) for England in 2012.
Within the previous NSPS for England, there was a low aspiration target to reduce suicides by 10% in 5 years...and the suicide numbers went up!
The latest NSPS didn't even include a target!
Also, the first line claimed "considerable progress since 2012" despite rising numbers.
Btw, the gross suicide numbers have risen by 25% since 2012 and we now have the highest suicide rate since 1999!
The IASP Outreach Briefing says:
"Matsubayashi & Ueda (2011) examined the impact of national strategies from 21 nations between 1980 and 2004. They found that suicide rates were reduced after governments initiated national strategies".
Academically interesting but, in the real world, 1980-2004 is ancient history.
What's the impact been in the past 20 years?
And since the pandemic?
When the NSPS for England was published last year, my summary was:
"Woeful in its low ambition; shameful in its spin; harmful in places; and, at worst, the Suicide Prevention Strategy that will prevent us preventing suicides".
I was asked to write a detailed critique of the NSPS, and the process used to develop this and other National Strategies, with how we can do better.?
And here's my critique of the National Suicide Prevention Strategy for England, 2023-2028:
Then the final post in the series around the IASP WSPD content:
Summarising my #WSPD2024 posts reviewing the detailed text, content & resources, I highlighted the importance of:?
> taking on board guidance and looking at resources from credible sources like the IASP, but not just following it sheep-like and not just copy & pasting it into your social media - which happens a lot, especially for content like 'Suggested Posts'!
> the importance of going beyond 'awareness-raising' into deeper education
> the need for systemic change not just surface changes; for culture change, for structural change, for transformational change
> the need to 'get outside of the suicide prevention bubble' and draw more people in to the conversation, especially those who have particular skills & experience in transformational change or can be a tangible part of the solution in some way
> how the term 'survivor' is ambiguous so should be used with care, including some people not liking being called a 'survivor' and preferring the term 'lived through a suicide attempt'
> problems with the use of 'prioritise' where this is used as it creates a competition; and
> the crucial need to collaborate not compete in suicide prevention
> not just saying 'Start The Conversation' as this can be traumatising, but 'Take The Training, Start The Conversation'?
I also added the link to my post-Tour report entitled 'Take the Training, Have a Conversation...about Suicide':?
My next post in the series emphasised some of these points already made and had a major focus on the crucial importance of making it clear that suicide is a MEANS of death not a CAUSE of death:?
This included reference to the podcast I'd recorded with Mick Coyle which strongly featured this point:?
In the next post, I reiterated why the language we use in suicide prevention really does matter, why it's crucially important for us to get it 'right' and not use words or phrases that we know can:
> create or compound stigma
> cause harm
> upset people bereaved by suicide
> cause further distress to those who've lived through a suicide crisis, or are living through a suicide crisis right now
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> stop us preventing suicides
> stop us getting the suicide numbers on a downward trend, towards zero suicide.
And there was a particular feature on the importance of not using the term "committed suicide" but instead using non-stigmatising, factual language like "died by suicide".?
Worth mentioning here that in the exchanges around these posts, I made the point about not "jumping down the throat" of those new to our world of suicide prevention if they use terms like "committed suicide" without understanding its adverse impacts.?
We need to be patient in our education process; and be kind and compassionate.?
In the next post, there was further recap and consolidation, and a feature on two pieces of language covered in our latest research that are problematic, along with further emphasising the importance of stating that suicide is a MEANS of death not a CAUSE of death.
In this post, I also commented on the downsides of using campaign slogans like #StandUpToSuicide which is problematic for the same sorts of reasons that calling suicide a CAUSE of death is damaging.?
This post stated:
1) Don't say "There's always hope" to someone in suicide crisis as they've usually lost all hope and don't believe 'there's always hope' so you can come across as uncaring, not listening, not understanding.
It's right up there with saying "God will protect you" to someone who's lost all faith in God!
At worst, the impact can be as bad as saying 'pull yourself together'...it can be harmful...it can tip people over the edge!
Please educate yourself about alternatives, inc saying things like "I'm hearing you say there's no hope and I just want to be with you right now"; "It sounds like everything's shit at the moment..."; and "do you want to talk or shall I just sit with you?".
2) Please don't say "the biggest risk to (young) people is (young) people themselves".
It's stigmatising.
It blames the (young) person.
It implies their suicide crisis is their fault!
People in crisis have often been pushed into crisis by external forces, eg uncaring or incompetent managers; our broken #NHS; greedy #SocialMedia firms; #gambling companies; #Ofsted; #ThePostOffice;...
Without these external forces, they wouldn't be in suicide crisis.
With the right support around them, these (young) people pose no risk to themselves.
Molly Russell was not a risk to herself without global social media firms feeding her harmful content!
Let's stop blaming the person in crisis and making it worse by telling them they're a risk to themselves.
3) We must stop perpetuating the myth that suicide is a CAUSE of death when it's clearly a MEANS of death with many different underlying causes.
Trying to 'blame suicide' is one of the biggest barriers to getting the suicide numbers down.
We've even had some recent calls to #StandUpToSuicide (!) thus creating a false enemy to fight; and another distraction from our work to tackle the real 'enemies' - those underlying causes of suicide crisis.
Once again, it's unnecessary.
We don't need to inaccurately and inappropriately call suicide a CAUSE of death.
Rather than saying "Suicide is the main cause of death among...", just say "Suicide is the biggest killer of..." and explain that suicide is a MEANS of death not a CAUSE of death.
Thank you.
My final post in the series was just after attending the NSPA #LanguageMatters webinar on this specific subject of language in suicide prevention.?
It was a final summary of the key points I'd covered in the series, plus a response to a comment I'd had to my previous post from Mike McCarthy (more on this later in this article)
Negative Points, Criticisms or Misunderstandings - and My Response
Although there was overwhelmingly positive engagement with, and feedback on, my series of posts on all these nuanced language issues, there were some negative comments and criticisms, although I think (I might be wrong!) these were from people who didn't follow the full series of posts and didn't read all my text and context and comments around those posts; they were reacting to specific language triggers (again, that's how it came across).?
I say this because they'd had no previous engagement with any of my other previous posts, and just commented at the very end of the series.?
Putting aside 'background noise' (as I always try to do!) and the point being raised about whether I was being didactic or 'dictatorial' in saying 'Do say this, Don't say that' which I explained in several replies including this one...
===
Your point about taking particular care with people new to our world of suicide prevention is one I’ve made a few times, inc specifically - as it’s probably the most common example - not (there’s that word ‘not’!) jumping down someone’s throat when they, without understanding the impact of what they’re saying, tell someone they “must never use the term commit suicide”.
In our good practice guides, eg Samaritans Mindframe etc, we often have a list of things NOT to say with alternatives for what we SHOULD say.
I’ve followed this time-honoured structure, highlighting phrases that research is showing can cause harm, notably to people in suicidal distress & crisis.
This includes phrases that don’t harm people not in crisis but do harm people when they’re in crisis.
I’m putting it out there for information & education.
Obviously some will heed it, others not.
Guides are there as just that, guides, to be applied appropriately in actual conversations, where we can think about the person & context and suitably tailor.
One reply said “never discuss means of suicide”. One for more discussion!
===
- the two specific criticisms I received about the points I was highlighting were about two forms of words.?
And it was implied that I was criticising two particular organisations, although this was not the case; I was simply raising concerns about potentially harmful language that I'd seen used in the past 6 months - language that 'failed the research test'.?
Firstly, I highlighted that saying "There's always hope" is problematic because it can be harmful, indeed highly distressing, for someone who is experiencing a suicide crisis and believes there is no hope right now.?
The person in suicide crisis hears someone say "There's always hope" and hears someone they don't think is listening to them (and 'no-one listening' has often caused or exacerbated the crisis), someone who doesn't understand, doesn't care.?
It can be very damaging.?
In highlighting how widespread this phrase is, I included - as the best example I could think of - a screenshot of the Hub of Hope home page, which is an excellent support tool from the excellent Chasing The Stigma.
It's particularly stark there because it's the only text that appears on the page along with the search box.?
Btw, this is actually good practice for a help site to have minimal text and a prominent search box, but it puts added pressure on getting that one bit of text 'right'.?
It was suggested that I was "criticising Hub of Hope" and, to some extent, I was of course but only in raising valid concerns about that particular phrase.?
I very much value the Hub of Hope, I use the Hub of Hope every day, I promote it regularly, I asked Julia Waters to include it in her recent speeches to 1000s of teachers (which she did!), I want people to use it.?
Through including this illustrative example, I was simply raising a specific point about the use of "There's always hope", and I suggested alternatives too, and alerted Hub of Hope.?
I also pointed out that it's problematic specifically for people in suicide crisis right now, and said that maybe those people wouldn't be using the Hub of Hope?
Maybe their key users might be those approaching crisis or struggling or trying to help others in crisis or struggling but not those people actually in crisis right now??
But I 'put it out there' for everyone to reflect on, which was the underlying purpose of the whole series of posts which, as you can imagine, has been quite some investment of time and careful thought on my part.
Standing Up To Suicide?
Standing Up For Suicide Prevention?
Standing Up For What You Believe In
Standing Up For What You Know Helps and Against What Can Harm
Secondly, I highlighted that the campaign slogan #StandUpToSuicide is problematic because it's ambiguous.?
In the research, people often react initially by saying "what does that even mean?" and are still not sure after a long deliberation.?
And it distracts people from what should be the primary focus on the underlying causes of suicide by making suicide itself 'a false enemy'.?
Suicide is the means by which people choose to end their lives in order to try and end their pain or escape from their crisis and the seemingly hopeless situation they feel trapped in.?
This situation is created by multiple causes and contributory factors, including by irresponsible and cruel governments, inspectorates like Ofsted, universities like Bristol, organisations like The Post Office, greedy social media firms deliberately causing harm online, betting companies feeding addiction, etc.?
If we want to frame an 'enemy to fight' (not language I find helpful btw), then these people are the real 'enemies', not suicide.
I've actually been flagging concerns with this slogan for some time, including in this post I published just after completion of our #ZeroSuicideSociety Humber-to-Mersey #JoinTheDotsTour, which had been a huge long conversation for 2 weeks and gave us a further opportunity to test language issues and impact:?
My fellow Co-Founder of the Baton of Hope, Mike McCarthy, replied to one of my posts to say the Baton of Hope uses this campaign slogan, and he explained why:
"Standing Up To Suicide means challenging the silence, refusing to accept the status quo and at the same time introducing practical change and promoting hope so that the idea that suicide is an inevitability is well and truly revealed for the falsehood that it is".
Unfortunately, despite agreeing wholeheartedly with every word following the slogan, I found the explanation as a justification for using the slogan confused, confusing, not at all convincing, and contradictory to the research.?
And I believe passionately that it's important to 'stand up' and say something if you think that any language is potentially harmful.?
What people and organisations then do in response is out-of-your-control of course, but I think we have a duty to try and educate each other and, especially, to flag any concerns or lessons learned or emerging research evidence.?
When I raised the issue in my series of posts about language - as a sub-point to the even more important point about making sure we all clarify that suicide is a MEANS of death not a CAUSE of death, to make sure we're all focused on the CAUSES - I wasn't previously aware that the #BatonOfHopeUK was wedded to this phrase, although I've since seen Mike on the screen with a Baton of Hope banner behind him with #StandingUpToSuicide on it!?
And, of course, Mike's reaction now makes more sense!
Anyway, to clarify, my original post wasn't intended as a criticism of any particular organisation, just raising concerns and highlighting the downsides for anyone using campaign slogans like 'Stand(ing) Up To Suicide'.?
Based on Mike's explanation, it sounds like what the Baton of Hope is actually asking us to do is 'Stand Up For Suicide Prevention' which is a call-to-action I could commit to 100%!?
Btw, the screenshot above is from The Jordan Legacy's 'One Voice, One Hope' webinar on Monday 23 September 2024.?
In this webinar, and the Chat, and the posts around it, with lots of fascinating exchanges, there've been calls for us all to be more collaborative, more supportive, more understanding, and more kind...
...whilst also being challenging in our shared mission of getting the (UK) suicide numbers on a downward trend #TowardsZeroSuicide by creating & sustaining a #ZeroSuicideSociety
As one of the originators of the drive towards a 'Zero Suicide Society' with our definition:
"a society that is willing and able to do all it can to prevent all preventable suicides"
- more information on what a Zero Suicide Society is and what it isn't here in this post -:?
...I always challenge and question and analyse and seek alternatives...always with the primary focus on how we can get the suicide numbers on a downward trend #TowardsZeroSuicide; and I do that through the 'Zero Suicide Society Transformation Programme' which I now run through a dedicated for-purpose business, Towards Zero Suicide CIC.
And please bear in mind that I'd raised concerns about the concept of 'One Voice' 2 months prior to The Jordan Legacy's 'One Voice, One Hope' webinar, and of course prior to Steve's announcement of the 'One Voice, One Hope' proposition.?
In the context of this week's new airing of these old discussion points, this post is definitely worth a read:
As I've said many times in the past, the concept of 'One Voice' is problematic because there are so many diverse (Lived Experience) Voices in the field of suicide prevention, and they should all be respected; and there should be greater equity and opportunities to hear new voices all the time, but I agree 100% with everything else in Mike's summary here...
"Standing Up To Suicide means challenging the silence, refusing to accept the status quo and at the same time introducing practical change and promoting hope so that the idea that suicide is an inevitability is well and truly revealed for the falsehood that it is".
...it's just the slogan that's a problem, because I know it can be harmful in shifting the focus away from the underlying causes of suicide.
A Healthy Perspective
Thankfully, this recent series of posts, exchanges and conversations around these posts has been largely very positive, with lots of highly constructive engagement, but it has been a bit bruising towards the end.
This is not because of any valid challenge to the points I've made - because I expect challenge and welcome challenge that's focused on the actual points I'm making based on the research - but bruising because of the way the criticism has been made and framed.?
One of the greatest hypocritical ironies I experience regularly in our field of suicide prevention (or is it ironic hypocrisy?!) is people telling me we all need to be kinder and understanding...whilst making ill-informed and unkind comments themselves!?
Let's try a kindness & compassion reset from today!
Let's Finish on a Positive!
Two phrases are good to think about when the red mist is rising:?
1) We're All In This Together
It's good to play the Ben Lee song of that name, featured in the film of the wonderfully collaborative #JoinTheDotsTour:?
2) We're All Coming From a Good Place
As we definitely were at the amazing #JoinTheDotsTour Launch Conference at The Baths Hall on Wednesday 12 June:
Paul Vittles FMRS FAMI FRSA is a Research Fellow, transformational change consultant and coach, counsellor, and person with lived and living experiences of suicide.?
Paul is Chief Facilitator for the Zero Suicide Society Transformation Programme, which was established in 2023 after publication of the ground-breaking report 'Moving Towards a Zero Suicide Society' (which Paul co-authored with Steve Phillip); he's the founder of Towards Zero Suicide CIC which now co-ordinates the Zero Suicide Society Transformation Programme; and he was Tour Director for the pioneering #JoinTheDotsTour from the Humber to the Mersey, 11-23 June 2024.?
Exploring the world we live in, finding the bits that suit our hopes & dreams.
5 个月I believe if a word, a sentence, a story that gets repeated repeatedly, and it can become the more populat belief. Gives hope and enables. Will be looking through your publication. So much to learn. Thank you.
Non-Executive Director and advocate for positive social change
5 个月It's great to see this strong advocacy and deep insight. Thank you for your contributions Paul.
Workplace Wonder Woman! ????♀? Award-Winning Inclusion Specialist Consultant for HR & Leaders. Keynote Speaker ??. 30+ Years of Lived Experience. Disabled, Neurodivergent & Surviving Cancer. Also Cat Crazy ??
5 个月"In more recent history, it's increasingly recognised that viewing suicide through a health lens is now a major part of the problem, with 'the health system' having little understanding of, influence over, or commitment to solving underlying drivers of suicides like poverty, discrimination, racism, homophobia, Islamophobia, injustice, job loss, domestic abuse, cyberbullying, social isolation, rural isolation, climate anxiety, failures in the criminal justice system, etc." I couldn't agree more Paul Vittles
Looking forward to seeing you Paul! We’re going to have to give you the honorary keys to Blackpool and Wigan ?? Sam Southern Claire Taylor ??
Suicide Prevention in Education, Employment & Health| Director, Mental Health, Princess Alexandra Hospital | Associate Professor at Griffith University, Australian Institute of Suicide Research and Prevention
5 个月Paul Vittles Really well written article Paul - love the way you make the powerful point that everyone must be a priority for someone