09 _What to say, ask & do

Here are some simple things to SAY, ASK & DO, to help you navigate the response

  • First organise to catch up with the person (for example, invite them for a walk or coffee).

If the person is autistic, get a sense of how they like to communicate and mirror that style (i.e. texting; phonecalls; meeting in a park; during the morning as opposed to later in the day).

SAY (to show you have noticed and care):

 “You’ve had a lot going on lately with [INSERT WARNING/RISK FACTOR] (e.g, losing your job)”. This shows you have noticed.

Then show you care by saying something empathic and compassionate:

“This must be difficult. Anyone else going through this would also find it hard.” 

ASK (about suicide directly):

“When people go through X (e.g. loss), they can have thoughts about ending their life. I am wondering, have you had any thoughts about suicide?”

 

Autistic people may not understand the intent of your indirect questions, and may benefit from you asking directly, “Have you been thinking about suicide?”.

Autistic people often say, “How do you know what I’m going through, you’re not autistic.” Creating a connection with that person tends to be more important than the words used. Use a calm, non-judgmental, non-pressured approach. Something like, “Of course I can never understand what it’s like to be autistic or I can never understand what it’s like to be you – but I’m here for you, I hear what you’re saying, you’re going through a really tough time at the moment.”

If yes, ask if they have thought about how/where/when and if they are finding it hard to not act on the thoughts.

If yes, keep them safe:

NOW: Get them to see a GP as soon as possible to set up a mental health care team and make sure they are supported until then. Do not leave them alone and remove anything they could use to harm themselves. If you cannot stay with them, call a friend or family member of theirs to help. Ask if they can promise not to harm themselves for an hour, then for a day. If they can’t keep themselves safe that day, take them to hospital. Call 000 in an emergency or if they leave and you cannot contact them. Call Lifeline on 13 11 14 for advice and support.

FUTURE: You can make a safety plan with them using BeyondBlue’s smartphone application: BeyondNow (Apple version: https://tools.toolle.com/au/tool/beyondnow-suicide-safety-plan/id1059270058 or Google Play version: https://play.google.com/store/tools/details?id=au.org.beyondblue.beyondnow). This app gives them a step by step plan of what to do if thinking about suicide with ideas on how to cope and who to contact.

If no, keep listening. You don’t have to fix it, just give them space to talk. If the person is not thinking about suicide, it can still be an opportunity to talk about why you were concerned about them and let them know you’re someone they can talk to if things get tough.  

Autistic people may find it harder to identify or express their feelings and emotions. Mirror their communication style and their preferred medium where possible. You could ask if they would like to draw or write down how they are feeling or what they are thinking about. They may just need you to be with them, or near them.

DO (support and encourage help-seeking):

  • Help book GP and/or counselling appointments and offer to go with them.

 
  • This is especially important if the person is autistic who may have anxiety and avoidance around making phone calls, communicating their needs, limited access to transport and support services, etc.
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  • Identify autism trained or autistic professionals.
  •  Talk about what they might expect from support appointments, what sort of things to talk about or they may be asked.
  • Help them to find a rainbow friendly medical service: https://www.welcomehere.org.au

  • Ask them what they need most right now.

 

Some autistic people may benefit from physical comfort (i.e. hug) or other sensory input/touch. Some may benefit from less input. Ask the person what is helpful for them. Other suggestions include reducing noise (move away or give them noise cancelling headphones), reduce light (put down blinds, dim or turn off lights, give them a hat or sunglasses).

  • Encourage self-compassion and being kind to themselves. Suicide ideation can be a result of feeling like a failure, useless, worthless, etc.

  • Ask them, if their best friend or pet was in this situation would they call them ‘worthless’? Ask them what they would say instead and attempt to apply that to themselves.

  • Encourage them to speak to family, friend, coach, boss.

  • Follow-up with them and check-in. Once off support is not enough. People’s psychological distress is often ongoing and it means a lot to them if people check in again later. If this doesn’t happen it makes them feel forgotten and like others expect them to move on when they are still distressed.

  • Tell them there is a lot that can be done to lift their overwhelm.

 
  • Be a visible and loud ally.
  • Help them find LGBTIQA+ friendly services.
  • Learn about and celebrate diversity days: https://www.welcomehere.org.au/diversitydays 

KNOW what NOT to say/ask/do:

DON’T DO:

  • Forget to check in or follow-up.

  • Become too involved. Instead, be their cheerleader or coach from the sideline.

  • React strongly with shock, anger or frustration.

  • Talk about methods or locations of other suicides (this can increase risk).

    • It’s okay to ask them if they have thought about methods or locations but don’t give them specific details about other suicide methods or locations. 

DON’T ASK:

  • You’re not going to do something stupid are you?

  • What have you got to be sad about?

  • You are only …. years old. What do you have to be so upset about?

DON’T SAY:

  • I know how you feel.

  • Don’t worry so much.

  • It’s not that bad.

  • Just try…

  • You should…

  • Think of the positives.

  • Others have it worse.

  • Find the ‘silver lining’.

  • Calm down.

How to TALK & LISTEN: 

Encourage Talking

  • What has been going on for you?

  • How long have you felt this way?

  • What has added to your stress lately?

 
     Language has to suit the person. Use their style of talking and match their non-verbal communication.

How to Listen

You do not need to fix the issue they are facing. Simply listening and validating how they feel can alleviate distress. What they need is to feel heard and noticed and that their concerns are valid. Then making sure they have ongoing support is important whether it is you, family or friends and/or professionals. It should not be a once-off check in. Say things like,

  • I can see this is hard.

  • You seem overwhelmed.

  • It’s okay to cry.

  • It’s okay to be upset.

  • It makes sense you have been feeling down.

  • This must be difficult.

  • I can see why you are feeling so low.

  • I hear you.

  • This is hard and anyone else going through this would struggle too.

  • I may not know how to help but I care and I am here.

  • You are not alone.

  • You are important and your life matters.

  • I am here to listen.

  • How can I support you?

 
   Language needs to suit the person. Use their style of talking, e.g., ‘I can see why you are pissed off’.
    Ask about their interests.

GIVE THEM ALTERNATIVES TO SELF HARM:

  • Rip up paper

  • Play music loudly 

  • Eat a chilli 

  • Suck on ice

  • Talk about what is upsetting 

  • Clean something

  • Write a to do list

  • Take a break from responsibilities 

Ideas from autistic people to cope when distressed:

  • Creative activity: write, draw, paint

  • Video game

  • Sit with a pet

  • Talk to someone who understands 

  • Sit in nature 

  • Read favourite book

  • Watch favourite shows

  • Solidarity

Best ways to support autistic people who are distressed:

  • Give them enough time to think and respond – don’t rush them

  • Clear, direct communication 

  • Don’t force eye contact 

  • Don’t stop them from moving unless you really have to for safety (e.g., if banging their head, do not restrain them, place a pillow in the way)

  • Reduce stimuli (noise, bright lights)

  • Ask what they need: for you to move closer or further away, if they need a hug or for you to just sit near them.

LONGER-TERM support:

1. REDUCE STRESS

  • Reduce commitments and stressors where possible/relevant. Ideas:

    • Drop a university subject.

    • Support them with stable housing.

    • Work out financial stress.

    • Take leave from work.

    • Take a break from cooking and cleaning at home or decision making.

 
  • Get disability support at university (e.g., more exam time, assignment extensions, exams alone in a room).
  • Exposure therapy with a professional to build up tasks and build resilience can be helpful.
  •  Make work days shorter.
  • Allow longer breaks at work.
  • Reduce number of social activities per week.
  • They may have already tried these without success.  For example, they may not get enough support at university, work may not allow the days to be shorter. See if there are ways to further advocate for them (e.g., community support, peer support, GP, psychologist, psychiatrist, social worker, other allied health support and advocacy).

2. INCREASE CONNECTION

  • Increase social support. Ideas:

    • Join a community group: e.g., team sport.

    • Join a club: book club, board games group, walking group.

    • Join an online group with like-minded people or for support e.g.,

      • Facebook: search support groups for ‘single mothers’, ‘divorced dads’, ‘veterans’

 
  • Facebook: search support groups for ‘lesbian mothers’, ‘gay dads’, ‘non-biological parents’, ‘transgender youth’, ‘sistergirls and brotherboys’
 
  • Facebook: search support groups for ‘autistic adults’, 'adults with ADHD'
  • Join an NDIS or other social group: bowling, hiking.
  • Identify and connect with local autism social groups or social groups in interest areas (e.g., photography, running, games…)

3. INCREASE MEANING

  • Employment, volunteering, study.

 
  • Focus on these being a good match/fit with the persons strengths and interests.
  • Concrete and practical types of employment can be considered such as: Librarian, IT, science, data entry, working with animals, creative jobs (e.g., architecture, animator, video game design), accounting, routine types of work (customer check out person, restocking, packing, warehousing), bus driving
  • Become an advocate and help others
  • Volunteering at places like soup kitchens (Lentil as Anything, for example)
  • Join a Think Tank for an Autistic organisation or at disability services like Riding for the Disabled
  • Find places where you can grow in your identity, competency, autonomy and relatedness (Check out https://icannetwork.online and https://www.autismspectrum.org.au for ideas)
 
  • Become and advocate and support others, especially youth

4. INCREASE ACTIVITY

  • Sport, yoga and hobbies.

  •   Find out their special interests and encourage looking up online or in-person interest groups or ways they can engage with these more.

5. IMPROVE HEALTH

  • Improve diet, sleep, exercise.

  • Reduce alcohol and drug use.

 
  •  Find and follow passions and interests.
  •   Encourage sensory breaks and soothing to reduce overwhelm and exhaustion:
  •   Noise cancelling headphones.
  •   Place a lamp in each room at home for more soft lighting in the evening instead of main bright lights.
  •  See an Occupational Therapist for more ideas on personal sensory soothing.

   INCREASE ADVOCACY

  If eligible, help them explore disability support options through the National Disability Insurance Scheme (NDIS) if they have not done so already.

  Link them with a disability employment service to help them find purpose and meaning in a voluntary or employed position in a supportive environment.

  If they are being bullied, take this seriously. If they are school aged, set up a meeting with the school and parents to discuss a plan to support the student. Help the student form more friendships at school through befriending activities. If they are an adult in a workplace or university, set up a meeting with their manager, HR manager, student counsellors, etc. to plan a way to support them.

 Learning Auslan can also be a good way to communicate when someone has shut down or are burnt out and struggling to communicate.