Suicide prevention is an urgent and complex issue in mental health services. In the book Mindfulness and the Transformation of Despair: Working with People at Risk of Suicide, Mark Williams and his coauthors speak to fellow clinicians and researchers, acknowledging the crux of the condition: “Suicidal people are hardly ever certain that they want to die, but they certainly do not want to go on living in such pain…and our job is to help them find a way of living alongside the difficulties, making peace with despair, and giving them a chance to experience what it is like to come out on the other side of feeling so trapped.” Although Williams found evidence that mindfulness-based interventions may help those struggling with suicidal thoughts, to date, not many such programs exist.
A recent exception is The Suicide Prevention Through Mindfulness Training program, an eight-week pilot program held in St. John’s, Newfoundland. Conducted in May and June 2021, the program was offered by the Canadian Mental Health Association Newfoundland and Labrador (CMHA-NL) in partnership with Safer Mindfulness Inc. A follow-up support program for participants was also offered from late August to early October 2021. Mindfulness instructor and trainer Andrew Safer, author of Anxiety, Stress and Mindfulness, designed and led both programs, with input and support from a diverse team. Those steering the project development included a clinical psychologist, a social worker, a community support worker with ASIST (Applied Suicide Intervention Skills Training), and others. While the program didn’t include a formal research study, participants did answer evaluation questions during the first and last sessions, indicating positive results. For example, collectively, the participants rated the intensity of their suicidal thoughts as being more than 41% lower at the end of the program than their ratings at the beginning of the program.
You Don’t Have to Navigate This Moment Alone
Mindful talked with Andrew Safer, Founder of Safer Mindfulness Inc., about creating this program and teaching mindfulness skills to help people navigate suicidal thoughts without acting on them.
If you are experiencing suicidal thoughts, know that you don’t have to navigate this moment alone. Most importantly, and as difficult as it may be, talk to a medical professional or to someone you trust about how you’re feeling.
Andrew Safer also offers this simple mindfulness practice that can support you in shifting how you relate to thoughts. It may serve as an addition to any medication, therapy, or counseling you are receiving.
How Mindfulness Can Support Mental Health in Suicide Prevention
Mindful: How did this collaboration with the Canadian Mental Health Association Newfoundland and Labrador come together?
Andrew Safer: I presented to their board in 2016, and things developed organically from there. CMHA-NL received funding from the Department of Health and Community Services for running mindfulness training programs for people struggling with anxiety, depression, and addictions, which were delivered through this excellent collaboration.
We had a team from CMHA-NL including some who had helped with the Mindfulness for Depression training program that I led in 2020. We did some planning and included their input for the Suicide Prevention program. We discussed whether to include people who were suicidal in the same group with the people who were depressed, but not suicidal. Ultimately, we decided it would be better to work with the group at risk of suicide separately. Twenty-four people registered, and 13 (some of whom had been referred by psychiatrists and psychologists) attended the initial Suicide Prevention session. An average of 12 participants attended the sessions.
What did you research to prepare for creating the program?
I’m not an expert in helping people with suicidal thoughts specifically, although I do have some personal experience with suicidal thoughts dating back more than 30 years. I researched in Google Scholar, where I found there was evidence of benefit for this population. I actually did not find Mark Williams’ excellent book Mindfulness-Based Cognitive Therapy with People at Risk of Suicide until a week or two before the program started. So, although it wasn’t foundational in terms of the program’s design, it was still very helpful because our programs were, in fact, aligned in many ways. I took comfort in the fact that Williams had done this pioneering work, using strict research protocols. I hadn’t read anything by another mindfulness practitioner-teacher working in this field.
Considering the subject matter, clinicians might be intimidated at the thought of working with this population. But, once I saw the impact this approach can have, I found it hugely inspiring. As it turns out, mindfulness practice and techniques can be a really powerful method that people who are dealing with suicidal thoughts may benefit from, (along with regular support from mental health professionals).
What was your approach to mindfulness for this program?
There are different approaches to mindfulness meditation, such as breath awareness and mindfulness-awareness (more on that below), each having elements that are generally well suited to dealing with these types of mental health issues. Our foundational sitting practice includes the grounding elements of basic mindfulness practice—quite literally, placing attention on feet on the floor and seat in the chair. This is a gateway to grounding, and also to feeling connected to something bigger than oneself. That’s the beginning point.
Beyond that, we are orienting to the present moment, and working with the thought process: recognizing thoughts and returning to the present moment. In mindfulness-awareness, instead of maintaining an orientation to the body, we place the attention on the outbreath, so we’re welcoming a sense of openness or spaciousness. The habitual preoccupation with oneself—my problem, my anxiety, my story lines—gradually begins to give way to an awareness of “other.” One’s eyes are open during sitting practice. The fundamental practice of recognizing thoughts and coming back to the here and now, over and over again, provides an excellent method for developing a perspective on thoughts, and this can be very helpful for people with suicidal thoughts.
In addition, making friends with oneself is an integral part of the process. For many of us, a critical and judgmental voice is always running in the background of our experience. How much more so for people plagued with suicidal thoughts? With the teachings and practice of loving-kindness, they can begin to make inroads into self-kindness and appreciating themselves for who they are.
What were the outcomes? How do people te