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There are also literary accounts of bleak, death-laden imagery in bipolar depression ( 7) and vivid mental imagery appears to be present in acute depressive and manic phases of bipolar disorder (cf., 8, 9– 12). He had a history of escaping the inpatient ward to try to reach this cliff, which was some distance from the hospital ( 3). To give a single example from our clinic, one male patient with bipolar I disorder reported persistent, intrusive vivid imagery of himself jumping from a certain cliff when suicidal. Flashforwards may be particularly important because the act of imagining future events has been found to be causal in predicting behaviour ( 6), and therefore could increase the likelihood of completing a suicidal act. These mental images of future suicidal acts have been termed flashforwards, to emphasize the analogy with imagery flashbacks to past trauma. Individuals with unipolar depression have been found to experience repetitive suicide-related images at the time they are most despairing or suicidal ( 3, 5).

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Suicidal patients may employ not only a narrative to reflect on suicide but also simulate in images how to complete it ( 3– 5). However, we know that cognitions in the form of mental images have a more powerful emotional impact than their verbal counterparts ( 2). The experience of corresponding mental imagery is not usually elicited at all. Asking about thoughts typically evokes a response about suicidal ideation in a narrative form. The assessment of suicide risk is arguably one of the primary skills we expect clinicians to acquire and when doing so, we ask questions such as “Do you have thoughts about killing yourself? do you have a plan?”. You can also contact them by email or post.Suicide is a major cause of death in the modern world and, of all the psychiatric disorders, bipolar disorder confers the highest risk of completed suicide ( 1).

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National telephone: 116 123 (this number is free to call).telephone: 028 9066 4422 (local call charges apply).The Samaritans offer a 24-hour telephone helpline: It offers immediate help over the telephone if you, or someone you know, is in distress or despair.

If you or someone you know needs help, you can telephone Lifeline free at any time. Lifeline is a crisis response helpline available 24 hours a day, seven days a week to people in Northern Ireland. If you want to talk about how you feel or how you deal with someone else's behaviour, you can speak to a friend, family member or your GP. If they're in immediate danger, telephone the police on 999. If you're caring for someone, there are support services that can help.

Find a mental health organisation in your area.

You can ask your GP or the GP out of hours service about the mental health crisis team for your area.

provide support and short-term help until another team is available or the help is no longer needed.

go to the accident and emergency department at your local hospitalĪll trust areas have a mental health crisis team with psychiatric nurses, social workers and support workers.

call your mental health worker if you have one.

make an emergency appointment with your doctor, or call your doctor's surgery out-of-hours service if the emergency is at night or the weekend.

If you don't have a care plan, or can't find it, you could: If you were or are being treated for a mental illness, you should have a care plan. If you have a care plan, there are names and numbers to contact in an emergency. Discussing suicide in an open, non-judgmental, sensitive, discreet and practical way can allow someone in crisis to know they aren't alone and help is available.

sudden sense of calm or appearing very upbeat following depressionĭon't avoid talking about suicide.

Suicide prevention begins with recognising warning signs that someone may be considering taking their own life. You could say: 'You are not alone and there are people who can help you out of this situation' or 'I will stay with you until you get help'. You could ask: 'Do you feel like harming yourself?' or 'Do you feel like ending your life?' Call for helpĬall for help and encourage them to look for help. Discuss suicideĪsking about suicide won’t put the idea in people’s heads. Show you care by asking saying something like: 'I’m worried about you and I want to help' . If you're concerned about someone, you could: Show you care It can be difficult finding the words to express what they are feeling. Someone who’s having suicidal thoughts may not ask for help, but that doesn’t mean they don’t want help and support.

Sharing a problem is sometimes the first step to recovery. You’re not alone talk to someone you trust. If your mental or emotional state quickly gets worse, or you’re in crisis or despair, it's important to get help quickly.

I want to kill myself