OPINION: Covid-19’s silent toll and why words matter

  • A 'silent' result of the Covid-19 pandemic is the increase in mental illness and suicide
  • Reaching out to someone who is struggling might save a life
  • Even though it is difficult, we should talk more, not less, about mental health, including suicide

The ultimate impact of Covid-19’s mental toll as a “double pandemic” may show up in suicide rates in 2020 and beyond, one report states. 

A survey in the USA shows that the increase of suicidal thoughts, called suicide ideation, is up from last year, with one in four young Americans now reporting suicidal thoughts.  The report states that these young adults, between 18 and 24, have “seriously considered” suicide in the 30 days preceding the survey. 

This year’s World Suicide Prevention Day (WSPD) as an awareness-raising campaign is therefore doubly important because of the Covid pandemic’s “silent toll”. The WSPD’s organising body, the International Association for Suicide Prevention (IASP), is a forum for academics, mental health professionals, crisis workers, volunteers and suicide survivors to “work together”, the theme around WSPD.

 In other words, we should talk more, not less, about mental health, including suicide.

And this is where you and I – we, the public – count. Our actions, and also our words count. We can all contribute to “working together”. Maybe even save someone’s life.

Empowering communities and individuals

The IASP says it is already seeing the consequences of Covid-19 on people’s mental well-being. As “we adapt to a world altered” by the virus, our levels of isolation, distress and anxiety increase. Yet, the need for physical distancing “should not impact our connections”. In other words, we should talk more, not less, about mental health, including suicide.

Referring to Mental Health Awareness Day next month on 10 October, the IASP says the “time is now to empower communities and individuals to attain the highest standard of health, which can only be achieved when their mental health and well-being are ensured, and their rights respected”.

President of the IASP, Professor Muraad Khan, emphasises that the impact of the virus over the past almost nine months has not only been on individuals’ physical health, but also their mental health. The International Covid-19 Suicide Prevention Research Collaboration (ICSPRC) involves researchers from 30 countries and “demonstrates collaboration taking place at an unprecedented pace”. The aim of the ICSPRC is to prevent and manage suicide and suicidal behaviours, including self-harm, specifically during the Covid-19 pandemic. 

According to the IASP, almost 800 000 people die by suicide annually, with about 75% occurring in low- and middle-income countries. The IASP estimates that for each death, approximately 135 people “suffer intense grief or are otherwise affected”. This means annually 108 million people are “profoundly impacted” by suicide.

For every suicide, 25 people make an attempt, with “many more” having “serious thoughts” of suicide. The reduction of suicide is, therefore, a “global imperative” and part of the Sustainable Development Goals to reduce one-third of premature deaths from non-communicable diseases through prevention and treatment – and, of course, to promote mental health and well-being. And this is our opportunity to help bring about change.

Indicators or mental ill-health

For all of us, individuals, families, communities, and society at large, this year’s WSPD is an “opportunity for the world to come together and begin redressing the historic neglect of mental health”. You can do so by reaching out – while still keeping your physical distance – when you realise someone has become quieter. Or maybe you pick up other signals that the person is struggling, such as that she or he is not looking after her- or himself properly, or has become more irritable, even with outbursts of anger.

A change in sleeping and eating habits – too much, or not enough – also indicates mental ill-health. The US Center for Disease Control says that besides the one in four young adults having suicidal thoughts, their report also indicates a “nation increasingly on edge” as the number of Americans with anxiety symptoms currently is three times higher than the same time last year.

If this is the case in the US, we can assume it is the same, or even worse, in our country, as also stressed by experts such as Professor Soraya Seedat, executive head of Stellenbosch University’s Department of Psychiatry.  The IASP says that we should not shy away from addressing situations where we can see someone is struggling.

Not saying anything while there are clear indications that the person is under tremendous psychological stress will not improve the situation. Of course, the problem is that there is still so much stigma attached to mental health that we are hesitant to broach the subject. But would you have kept quiet had you seen the person is suffering from physical discomfort? 

According to the IASP, one reason we are hesitant is because we do not know what to say. They stress it is important to know “there is no specific formula”. But empathy, compassion and genuine concern could prevent a tragedy. People also worry that they could worsen the situation. This is based on the “myth” that it “may instigate vulnerable individuals to contemplate the idea or trigger the act”.

Stigmatised phrase

The IASP stresses that evidence suggests this is not the case. Offering support as well as a listening ear “are more likely to reduce distress as opposed to exacerbating it”. Not being judgemental can also “help restore hope”. This includes the way we speak. Words matter, especially with regards to mental health. A phrase that one may use without thinking is that someone has “committed suicide”.

It is as if this stigmatised, and indeed, old-fashioned phrase has been etched into our vocabulary. And exactly because of the stigma, many still “lean” on this “insensitive and outdated” expression. This is also why the Ithemba Foundation (ithemba means hope in isiXhosa) – founded to raise awareness around mental health and to support research – asks for “a change in tongue”.

Our words matter, and each of us can consciously decide how we talk about mental health, including suicide. Also: We can all become agents of change. This includes saying in a conversation in a non-confrontational way that it is offensive to use “commit suicide” in our so-called modern and more informed era. Saying someone has “committed suicide” is laden with blame and stigma and embeds the idea that it is a crime – even a sin. It ignores the fact that suicide is often “the consequence of an unaddressed” mental illness.

In the words of the executive director of Suicide Awareness Voices of Education (SAVE), Dan Reidenberg, mental health should be regarded in the same way as any other physical health condition. Just as someone did not “commit” a heart attack, but died of a heart attack, the phrase should be that someone died of suicide. By saying someone committed suicide “it further discriminates against those who lost their battle against a disease”.

Reidenberg says it is time to see suicide as “a dangerous by-product of a health condition that can – and should – be prevented”. Using “sensitive mental health vernacular” will help to eliminate negative stereotypes regarding mental health, says assistant professor Jacek Debiec at the University of Michigan.

Words have consequences

Research has shown that if stigma is present, people avoid seeking help. The language we use indicate “our system of values”, both conscious, and subconscious, and saying someone committed suicide also conveys “shame and wrongdoing” and does not capture “the pathology of the condition” that led to the person’s death. It may even imply that the person was “a perpetrator rather than a victim”.  

One can compare using inappropriate phrases concerning mental health and suicide with using racist phrases. Just as it is inconceivable to use racially offensive words, one should not use socially offensive ones. Using racist terminology is punishable by law, but we should also think about using socially offensive terminology concerning mental health and suicide. But that’s where all of us can make that difference by drawing people’s attention to such dated phrasing, also in a way that shows compassion and understanding.

Judgemental or degrading language simply adds to not recognising mental health illnesses. Words matter. And they have consequences. And all of us can be agents of change, starting right here and now with WSPD 2020.

While addressing the “silent” pandemic amidst the still raging global Covid-19 pandemic, as compassionate human beings, all of us can bring about change. Especially while being physically apart, we should make sure we stay socially connected.

Depression is a treatable disease and suicide a preventable tragedy. Please reach out, it could change the course of someone’s life.

*Lizette Rabe is a professor at Stellenbosch University, and founded the Ithemba Foundation to raise awareness of mental health and to support research. The 2020 Hope Hike and Hope Bike, Ithemba’s annual awareness raising event in October as Mental Health Awareness Month, will be a virtual event, which means anyone, anywhere, can make a difference. For information click HERE. 

For help and information:

Lifeline 24 hour crisis line: 0861 322 322.

Search for a mental health professional in your area: www.mentalhealthsa.org.za

SADAG: 24-hour helpline: 0800 456 789, 0800 567 567, or sms 31393 

1. https://www.nytimes.com/2020/05/19/health/pandemic-coronavirus-suicide-health.html?referringSource=articleShare.  

2. https://edition.cnn.com/2020/08/14/health/young-people-suicidal-ideation-wellness/index.html.  

3. https://www.iasp.info/.  

4. https://www.health24.com/Medical/Infectious-diseases/Coronavirus/opinion-covid-19-may-be-prudent-to-over-estimate-the-mental-health-consequences-of-the-virus-20200526-2?_sp=eb7ca85f-6e87-4668-83bf-b34f7847473d.1599471476056.  

5. https://www.huffpost.com/entry/mental-health-language-committed-suicide_l_5aeb53ffe4b0ab5c3d6344ab.  

6. www.ithembafoundation.org.za.

Image credit: Unsplash

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