Content warning: Discussion of mental health and suicidal thoughts  

On Wednesday I did something I have never done before: I went a morning tea with my team at work and we talked about mental health and suicide prevention. One of my colleagues organised it as part of R U OK day. We had an amazing and very open conversation. It was one of the best things I have been part of at work and I found it really helpful.

The thing that struck me about this meeting was how unusual it was. Most people don’t want to talk about mental health issues or suicide. This silence breeds more silence and tends to make people very reluctant to talk about these topics, even if they really need to.

Up until quite recently the accepted wisdom around talking about suicide and related issues was that you shouldn’t do it because it would somehow encourage people to act on any suicidal thoughts they may have. Also there was – and still is – a lot of stigma around suicide and mental illness, which means most people don’t feel comfortable mentioning they are having issues to those around them. This silence isolates people and makes them feel alone and helpless. 

I have had many issues in this space and feel it is really important to let people know they can have these conversations if they need to. In my own life, in addition to my autism, I have a diagnosis of atypical schizophrenia. This means I have had a lot of times in my life struggling with mental health issues and suicidal thoughts. In 2010 I was very unwell but for a variety of reasons I wasn’t seeing a psychiatrist or any other mental health clinicians. I had a GP who was lovely but their knowledge of mental illness was pretty limited. I told the GP I was struggling and she sent me to a psychologist who was not well-suited to me. I remember going in to appointments with a very self-destructive inner monologue and with the psychologist  having no idea what I was going through – because I chose not tell her! Despite having been out loud and proud autistic for many years it took me a lot longer to feel able to discuss my mental illness, apparently even to a psychologist. I felt I couldn’t share that I was having suicidal thoughts. I thought to myself “I am a public servant and a homeowner so how would that look?” I worried my work colleagues would somehow find out I was having those thoughts. I was too ashamed to talk about my illness or my thoughts. I imagine that I am far from alone in this experience.

In the years since then I have become a lot more able to talk about my mental health. I think it is essential to have these discussions. If nobody knows what you re going through then nobody can help. I remember wanting people to figure out how much I was struggling and for them to somehow spring into action to take away the misery and fear but of course that never happened. Nobody could read my mind! 

Autistic people can have significant issues in this space for a number of reasons:

• We have far higher rates of something called alexithymia than others do. Alexithymia is also called emotion blindness. It doesn’t mean a person has no emotions, rather it means they struggle to be aware of and / or articulate what they are feeling. If we don’t know we are having a hard time, how can we know to access assistance?
• Horribly we are still victimised, abused and bullied at very high rates. These things often lead to very low self-esteem and post-traumatic stress disorder, putting us at a far higher risk for mental illness and suicidal thoughts. 
• We so often get misdiagnosed and missed by mental health professionals. Clinicians may have a very limited understanding of autism. This means we often miss out on the tailored support we need which can be very frustrating and invalidating. Once again, these are risk factors, particularly if a person is in crisis and feels like nobody can understand or help them.
• The mask. Autistic people often mask ourselves in order to fit in and be socially accepted by others and survive in the wider world. This means that outwardly we are doing great despite what is actually going on. Once again, this can be a big risk factor.
• Many autistic people are socially isolated and disconnected meaning that we don’t have that protective factor against suicide that is knowing there are people who love and care for us.

Thankfully there are some useful strategies and protective factors that can be put in place to help address these issues. These include:

• Understanding that suicidal thoughts are something which need addressing and that it is best not to ‘go it alone’. Finding  someone to talk to is really important. For some people that will be a mental health professional such as a psychologist or counsellor but for others it will be a friend, partner or family member. Know that it is OK – and a very good idea – to discuss your thoughts and concerns with someone else.
• Know that accessing help – whatever that may be – is a good thing to do. I think it is a actually essential to access help in some form if you are having suicidal thoughts.
• There are some crisis services you can access although some are a bit patchy in terms of their effectiveness for autistic people. Lifeline in Australia has a 24 hour crisis phone line and also online real time chat with volunteer counsellors. I have found Lifeline to be very good in the past although they are not for everyone.  BeyondBlue also have a phone counselling service. There are also ‘official’ mental health crisis services. While some people report finding those unhelpful they can be useful to access as they can link you in with other mental health services if you need that. If you are concerned for your safety, emergency services can be contacted as well (ambulance etc). 
• If you are in crisis and fearful for your safety, one strategy I find helpful is to remind yourself that the intense period of crisis generally lasts for between 15 minutes to one hour. So you do not need to get through the rest of your life with these intense distressing feelings, just get through a short space of time.
• If you can, it can help to distract yourself when in crisis. This basically means engaging in an activity that will keep your brain occupied so you are not experiencing the height of the crisis. Distractions are different for each person – try one/s that work for you. 
• Being around people and / or pets you love and care for when having a crisis and having suicidal thoughts is a very good emergency strategy. Most people will not act on those thoughts when they are around others. It can be difficult asking someone to spend time with you but it even helps some people just going into a public place until the crisis passes and the impact of the thoughts lessens.

If you are in crisis or need assistance, contact for Lifeline in Australia is https://www.lifeline.org.au/about-lifeline/contact-us and their crisis phone line is 13 11 14