ASIST | Applied Suicide Intervention Skills Training
Most people are horrified that a person they know and love, or even a stranger, would feel the urge to take their own life. For many of us, the desire to end one’s self is a profoundly incomprehensible thing as it is so far outside our own experience and our own understanding of life.
Have you ever thought about what you would do if someone, a friend, colleague, stranger, revealed how they were feeling to you? If someone hinted at “everything feeling pointless”, would you change the subject and hope for the best, tell them to cheer up, or investigate further? If a friend told you they “couldn’t see a way out”, would you rush to tell them how much you love them, how much their family loves them, how much their friends love them? Tell them how much they have to live for? List off the good parts of their life, as you see them? The urge to extract a person from the pain they are in can make us feel overwhelmed, panicked, helpless and desperate. And sometimes, unbeknownst to us, we are more often trying to extract ourselves from being in pain, rather than the other person. Although these are normal, human and empathic responses, intensive listening and understanding are key.
As part of my counselling and psychotherapy training I attended an ASIST (Applied Suicide Intervention Skills Training) course. It was facilitated by two kind, funny women, one from AWARE and one from the Samaritans. Although aimed at people who are in a caregiving capacity anyone interested can do the free, two-day workshop on suicide ‘first aid’. Anyone.
It is not psychotherapy or counselling training. In the workshop it was likened to giving a heart attack victim CPR. It doesn’t matter what your profession is, or what you think about heart attacks, or what you know about heart attacks, or if you have any previous heart attack experience, or if you’ve had a heart attack yourself. All that is crucial is the ability to provide CPR and first aid so that life is preserved until the ambulance gets there. It’s the same thing with ASIST. It is an on the spot intervention, not therapy. It is about intervening when it is revealed that a person is feeling suicidal, providing immediate support to keep the person safe in that moment, and until they can get further professional help.
The focus of the first day was on exploring our own attitudes and understanding the concerns of the person at risk. We learned (anonymously) that there were many people in the group who had either thoughts of suicide, or had attempted suicide at some point before in their lives. This insight helped to bring the reality of it closer to us. We broke into two groups and with the aid of a handbook, made note of our current attitudes and beliefs around suicide and our role in relation to a person at risk.
What struck me about this part was that no attitude or stance on suicide is ‘right’ or ‘wrong’, as such, but rather it is how we use our attitudes or beliefs that matter. It has no relevance to the person needing help what our beliefs are, what matters is that we are able to assist them in the moment and use our beliefs in a positive way. All attitudes and beliefs have advantages and disadvantages, and the workshop explores them all thoroughly. Rather than a lecture on suicide, the workshop works from what is already there in the trainees, and builds on that, through group work and discussion. We brainstormed what we thought could cause suicidal feelings and then the facilitators drew links between everything until we had an underlying theme. This kind of approach is empowering and confidence-building for the trainees. Each participant, along with being caring and motivated to help, brings a wealth of knowledge and life experience which enhances their own and everyone else’s learning.
On the second day, the workshop went on to discuss the Intervention Model, starting with the signs of suicide – the actions, feelings, thoughts and physical manifestations. These signs are called ‘invitations’ or signals a person is putting out to show they are feeling close to the edge.
Here is where a person can intervene, by asking the question “Are you feeling suicidal?” This can feel like an overwhelmingly heavy question to think, let alone utter. But the person at risk is very familiar with this notion and has thought deeply about it. We learned that asking the question will not plant a seed in a person’s mind, or encourage them to take action. It simply creates the space where he or she can feel accepted, heard and understood, without judgement.
The workshop continued through the different stages of the intervention model, finishing with helping the person to access further support. The temptation to rush a person at risk through the stages and into action towards a solution can feel very strong. It is natural to want to escape from the uncomfortable feelings that are evoked in us. It was invaluable to learn how to put our own feelings of urgency and panic to one side and stay with the person at whatever stage they are at, be calmly in their space with them.
We did role plays in the afternoon. They gave us a ‘real’ context for putting the intervention model into practice. At the end of the second day the facilitators gave us some resources to aid us in the future should we need the training. We were guaranteed that we would. In the weeks immediately following the two day workshop I had to call on the skills I’d learnt on two occasions, via a helpline I was working on. It wasn’t a coincidence. What has changed is that when I heard the ‘invitations’ or ‘signals’, I was able to recognise them for what they were, and ask the question “are you feeling suicidal?” rather than thinking ‘everyone says that sometimes’, or just letting it pass by, or feeling helpless and immobile. It was a privilege to be able to assist those people and be a brief port in a storm for them. It was humbling to hear “speaking to you saved my life” at the end of the call, and even two years later, I am feeling emotional recalling that moment. I cannot emphasise enough how powerful the training is. I felt confident in my ability to help and, moreover, I felt a new responsibility to help.
A relative passed away in the early hours of the workshop’s second day, which made working with themes of life and death all the more profound. It was a special experience to go directly from her bedside to be among people committed to preserving life where possible. It made that urgency feel all the more necessary. Death is an inevitable and natural part of life which we are helpless to prevent. Suicide is not inevitable, and we are not helpless. We can prevent it. We can arm ourselves with the tools and skills to intervene and assist when appropriate. It’s not just up to the person at risk to reveal how they are feeling, it’s up to us to be kind of the person they can reveal their feelings to.
It begins with you. Changing anything that we don’t like in the culture we live in starts with the individual. If you want to make a change against the staggering suicide statistics in this country, do this workshop. It’s humbling, it’s free, and it’s two days out of your life. It starts with you. Be the change.
