We ask people who are suicidal to stay — but what happens then?
If we are serious when we tell people to ask for help, then we must be willing to examine what happens when they do. File picture
We spend a lot of time telling people in crisis to reach out, ask for help and stay. We spend far less time talking honestly about what can happen when they do.
There is a question I have heard from people who have been through some of the darkest periods of their lives: “Would it have been easier if I had died?”
Sit with that for a moment.
How does somebody get to a point where they have survived a suicide attempt or a serious mental health crisis, reached out for help, started engaging with services, perhaps started addressing addiction, and then finds themselves wondering whether dying might have been easier than living through what came afterwards?
I don't ask that lightly. Some of the people I have known who struggled with their mental health are no longer with us. Some reached out. Some had contact with services. Some had families desperately trying to help them. Some tried more than once. They are not here now, and they cannot be allowed to disappear into statistics, awareness campaigns and annual conversations about suicide.
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I cannot know why any individual person died. Nobody standing on the outside of another person's life gets to reduce something as complicated as suicide to one event, one service, one relationship or one thing somebody should have done differently.
But complexity cannot become an excuse for looking away. If we are serious when we tell people to ask for help, then we must be willing to examine what happens when they do.
We have spent years telling people to reach out. Please tell somebody. Ask for help. Don't suffer alone. Stay. I agree with every word of that. What I have started wondering is whether we spend nearly enough time asking what comes next, because reaching out is not the end of the story. It is the beginning.
I have been on the other end of those phone calls. I have tried to help people navigate services and watched families try to work out where they are supposed to go. I have contacted organisations that sound, from the outside, like exactly the people you should contact, only to be told that mental health is not their area.
You contact somebody else, they direct you somewhere else, and that service has another remit again. Meanwhile, there is a human being sitting in the middle of all of this, and often a frightened family around them trying to work out what on earth they are supposed to do next.
I don't think the people answering those phones are the problem. Most are working within whatever remit they have been given, and many of the professionals genuinely care. The problem is what happens in the gaps.
Families end up holding all of the information together. They explain what happened yesterday to somebody seeing the person today. They repeat histories, follow up referrals, provide collateral information and try to work out what has actually travelled from one service to another. They do all of this while also trying to be a family. They shouldn't have to become an amateur crisis team because somebody they love is unwell.
People in crisis don't always look like people in crisis. Someone can be completely overwhelmed one evening and appear relatively calm the following morning. They can minimise what happened, feel embarrassed, desperately want to go home or genuinely feel better. The person a professional meets for half an hour may not look anything like the person their family saw six hours earlier. The whole picture matters.
Then there is what happens afterwards, and this is the part we talk about far less. The immediate crisis passes. The ambulance goes, the gardaí leave, the person leaves hospital and everybody gets to breathe out a little. Except the person still has to go home. They still have to wake up the next morning and live with whatever happened.
They may have relationships to repair, addiction to address, treatment to attend and consequences to face. They may have frightened people they love. They may have behaved in ways that caused genuine hurt. Recovery does not mean pretending none of that happened, and compassion does not mean removing accountability.
But those things are not mutually exclusive. You can have boundaries with somebody and still want them to recover. You can be angry about something they did and still recognise their humanity. You can say that behaviour was unacceptable without deciding that the person is now unacceptable forever.
We seem to struggle with holding those things at the same time, and that becomes particularly obvious when stigma and gossip enter the picture. If you live in a small town, you know exactly what I mean.
People know things. Someone saw something, somebody heard something, someone knows somebody who works somewhere, and somebody tells somebody else because they are “concerned”. Before long, the worst night of somebody's life has travelled considerably further than they have.
Someone else's medical information does not become yours to pass around simply because you happen to know it.
We often talk about stigma as though it is some enormous abstract problem belonging to “society”, but stigma is frequently much more ordinary than that. It is a WhatsApp message, a conversation at a counter, a story in a pub, a knowing look or a private detail repeated because “everyone knows anyway”.
Imagine trying to put yourself back together while wondering what the person serving you in the shop has heard about you. Imagine wondering what other parents know, what neighbours have been told or how far a story has travelled. Imagine knowing that something you are deeply ashamed of, frightened by or still trying to understand yourself has become interesting to other people.
Then think again about that question: “Would it have been easier if I had died?”
We tell people to stay alive, and then some of the people who do stay alive are made to feel ashamed of what surviving actually looked like. We should be deeply disturbed by that. Disgusted that somebody can survive the lowest point of their life and then have to survive our judgement of it too.
We are very comfortable with mental health when it comes with a nice slogan. It is much harder when it is messy, when somebody relapses, when addiction is involved, when somebody behaves badly, when their family is exhausted, when they don't recover in a straight line or when the person struggling is somebody we don't particularly like. That is when compassion is tested.
Nobody has to excuse harmful behaviour. Nobody has to stay in a relationship that is hurting them or become somebody else's counsellor. You don't even have to understand what another person is going through. But you also don't have to make their recovery harder.
If you cannot offer somebody support, offer them space. If you cannot understand their situation, offer them grace. And don't make the worst period of somebody else's life entertainment.
We also need to talk much more honestly about families. We tell families to recognise warning signs, act when they are worried and encourage people to seek help.
But what happens when they do all of that and they are still frightened? What happens when a family reaches the point of saying, “We cannot keep this person safe”?
There has to be somewhere for that responsibility to go. Families cannot stay awake forever. They cannot monitor another adult every hour of every day.
They cannot be expected to know whether someone is safe to be alone, whether a deterioration warrants another emergency call or whether this is the moment they should override somebody's wishes because they genuinely believe that person may die.
Families can also hold several conflicting feelings at once. They can love somebody and be furious with them. They can be frightened for them and frightened of them. They can desperately want somebody to recover while desperately needing a break themselves.
None of those things means they have stopped caring. It means these situations are complicated, which is precisely why our response to them cannot be reduced to telling people to “reach out”.
Reaching out is the start. What happens next matters just as much.
Ireland has done something important in changing the way we talk about mental health. People speak more openly. We recognise warning signs that previous generations might have ignored, and we repeatedly tell people that there is no shame in asking for help. But awareness on its own is not enough.
The next conversation has to be about what people actually find when they reach out. We need to talk about whether services connect with each other, what happens after discharge, who listens to families, what happens when somebody falls between different remits and how we treat people recovering from addiction or trying again after a relapse.
We need to talk about privacy, stigma, the casual cruelty of gossip and the enormous amount of responsibility families can quietly end up carrying.
We also need to talk about what happens when the immediate danger has passed, because recovery is not simply the absence of a crisis. Somebody being alive today does not mean they are suddenly OK.
Somebody leaving hospital does not mean their family can stop worrying. Somebody entering treatment does not mean the problem has been solved. Somebody having a relapse does not mean everything they achieved before it was meaningless.
And some of the people we told to reach out are no longer here.
I keep coming back to that. Because there are people alive today who are still trying. Maybe badly. Maybe imperfectly. Maybe for the second, fifth or 50th time.
But they are here. They stayed. And that matters. So now we have to think about what happens next.
If we are going to ask people to stay, then we have to support them in the staying. We have to make room for recovery that isn't neat or linear.
We have to allow people to make mistakes, take responsibility, get treatment, rebuild relationships and try again without deciding that the worst period of their life is who they are forever.
That does not mean removing consequences or pretending harm didn't happen. It does not mean families sacrificing themselves or anybody being expected to tolerate behaviour that hurts them. It means recognising that accountability and compassion can exist together, and that somebody trying to recover needs both honesty and humanity around them.
It means families being able to say, “I can't carry this anymore”, without that being interpreted as “I don't love this person anymore”. It means privacy still mattering when somebody is unwell.
It means recognising that surviving a crisis is not the same thing as recovering from one. And it means making sure that when somebody reaches out, there is actually somewhere for them to reach.
Most of all, it means looking at how we behave when somebody survives.
Because telling people to stay cannot be something we only mean at the point when we are afraid they might die. We have to mean it the next morning. We have to mean it when they come home from hospital.
We have to mean it when they enter treatment, when they relapse, when they try again, when they have difficult conversations and when recovery takes longer than everyone around them hoped it would.
“Would it have been easier if I had died?” Sit with that for a long time.
Nobody who survives a crisis should be made to feel that dying would have been easier than living through the judgment that followed. Now we need to stand beside them while they learn how to live again.
- Orlaith Dunleavy is a mother of two neurodiverse children with a particular interest in how systems and communities respond to people at their most vulnerable, shaped by a lifetime of personal experience supporting people through crisis.
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