‘When it is Darkest’: In conversation with Rory O’Connor

A common myth about suicide is that speaking about it might ‘plant the idea’ in someone’s mind. Rory O’Connor, Professor of Health Psychology at the University of Glasgow, has dedicated over 25 years of his life to suicide prevention research, seeking to combat this kind of harmful misconception that stops people reaching out for help. Rory’s new book, ‘When it is Darkest’, draws on his years of experience in suicide prevention, mental health and psychology, and takes a comprehensive look into the reasons behind suicide and how to support someone who is suicidal themselves. Rory spoke with Alex Harvey, Head of Digital & Development at Grassroots, about the challenges and triumphs of writing the book, what to do when worried about a loved one, and how our society looks at mental health.

How are you feeling today?

Feeling not too bad today, it’s the weekend and it’s been a long week so I’m looking forward to some down time.

Book cover: When it is Darkest: Why People Die by Suicide and What We Can Do to Prevent It. Rory O'Connor - International expert in suicide prevention.

What can you see out of your window right now?

I’m in my attic so I can see nothing out my window, but when I looked out the window earlier, it’s not a bad day in Glasgow. We’ve had decent enough weather and it’s forecast to be okay over the weekend so I’m pleased about that.

What makes you happy?

Spending time with my family and friends is at the top of my list. In respect of in-the-moment happiness, it’s when I’m playing tennis. I adore playing tennis, it’s really important for my mental health. It’s probably the one space where I’m totally engaged and not thinking about work or other issues going on.

What inspired you to write ‘When it is Darkest’?

I’ve been working in the field of suicide research and suicide prevention for about 25 years. When I got into the field, one of the books I read was by Mark Williams called ‘Cry of Pain’. I remember finding that really inspirational because Mark has this incredible ability to bring together really complex ideas but express them in a way which is accessible beyond the ivory tower of academia. I suppose in the back of my mind, even then I had this aspiration that if I continued to work in the field that maybe one day I could write a book which would be accessible to the general public about our understanding of suicide, and what we can do to prevent it. I’ve always had that in the back of my mind, but I suppose over the last four or five years I thought I had something to say. I thought the work that we’d done had made some small advances in understanding and provided a framework for the outreach work and public lectures that I’d been doing.

Some of what I was saying seemed to resonate with people who had lived experience of suicide – those who had been suicidal themselves, as well as those who’d lost loved ones to suicide. What I’d been thinking about over those intervening four or five years was how I could put together a book which would do what I try to do with my public lectures, which is try to communicate the science, a bit like what Mark Williams did all those years ago in 1997 when his book was first published.

I also wanted the book to be authentic and to bring my own experience, because the work that I do is influenced by my own experience with bereavement and my own mental health. So about 18 months to two years ago I had this “Eureka!” moment which I talk about in the book, that happened when I was on holiday. I thought of a way which I could bring together the personal with the professional which I hoped could reach out beyond academia. My motto in everything I do, is: ‘If I can help one person, that’s enough for me’. I’ve been delighted thus far by the feedback from people with lived experience of suicide, that what I’ve tried to do has reached them.

“We live in a world where people become so overwhelmed by pain that they see suicide as the only option… Suicide is not about ending your life but wanting the unbearable mental pain to end.”

Why is preventing suicide important to you?

Ever since I started my career in psychology I’d been fascinated by mental health. Even before that, since very early on, I’d been interested in trying to understand mental health and why people felt sad or were depressed and anxious. In terms of why it’s important, it’s just unbelievable the pain and suffering that underpins suicide. So if we can understand that we can hopefully try to alleviate that pain in order to prevent suicide. It’s such an incredible waste of somebody’s life, and not only is the pain and suffering an individual experiences awful, but also the devastation that is left behind with family and friends when somebody dies by suicide is just incredible.

We live in a world where people become so overwhelmed by pain that they see suicide as the only option. The reality that has become even more clear to me is that suicide is not about ending your life but wanting the unbearable mental pain to end. That mental pain can come from a whole range of places: from your distant past, early life trauma or disadvantage, as well as things going on in your life today. The whole combination of psychology, clinical factors, cultural factors, inequality – these are all huge issues which are at the heart of understanding suicide. It’s the leading cause of death in some age groups in men in the United Kingdom, three-quarters of all suicides are men. We need to do more to understand and prevent that.

What was the hardest thing for you about writing this book?

The hardest part for me was talking about my own personal experiences of bereavement. I talk about my close friend Clare who lost her struggle to live. As I say in the book, I remain devastated by her death and it changed me as a person, I hope for the better. It made me more compassionate and more understanding. That was really difficult, really emotional. I wrote most of the book in my attic, most nights and weekends in the latter half of 2020, and I shed a lot of tears over my own losses. Also I talk about my own struggles with mental health, and five years ago making the decision to go into therapy. I was experiencing an incredible sense of emptiness and loneliness, and it was me reflecting on those experiences and my own bereavements.

What I tried to do was sit down every night to write. I didn’t quite know what I was going to write. I had a few lines for every chapter and I would just wait to see what emerged. I’d think of people I’d met over the years through my research as well as public engagement work or documentaries I’d been involved in – they would tell me their stories and they were so often such powerful stories of pain and loss. Just reliving peoples’ pain together with my own personal experiences was tough, but certainly cathartic as well. I suppose I underestimated the emotional energy it would require me to write the book. I’m delighted that I have, but on reflection it was much more draining than I originally had thought.

“We need to recognise the fact that although we know that less than 30% of people who die by suicide are in contact with mental health services in the 12 months before they die – the question is why?”

What do you see as some of the biggest barriers to preventing suicide on a societal level?

We live in a society which is unequal, and those inequalities sadly are only going to get worse post-pandemic, and that really pains me. In our society, mental health and physical health are not on equal par. Although we have made some strides forward, we’re nowhere near where we should be. We’re still genuinely failing thousands of people every single day in this country because of long waiting lists.

Where there is evidence for treatments being effective, some of which I touch on in the book, people often don’t have access to those. There are waiting lists for child and adolescent mental health services which are over a year, when our young people are struggling so badly. I can think of countless examples of people who I know, and who have contacted me, whose loved one has attempted suicide and still cannot get access to the help and support that they need. That is an utter, utter disgrace.

In every part of the United Kingdom, the same problems are there, we need to prioritise mental health, but at the heart of it is tackling inequalities and stigma. We have made some strides forward in terms of destigmatising but we’ve still a long way to go. We need to look beyond clinical services and think of new ways to reach men in particular. We need to recognise the fact that although we know that less than 30% of people who die by suicide are in contact with mental health services in the 12 months before they die – the question is why? Is it because the services aren’t there? Or because when services are there they’re not tailored to the needs of the people who need them? Or is it the long waiting lists? Often waiting lists go down because people are so desperate that they have to go private, and the sad reality is that leads to even greater inequality, because the people who can’t afford to pay are the people who are dying across the country.

Rory (a fresh-faced looking pale man with smart white hair and round black glasses) sits in a desk chair. Some way behind him are a desk, computer, and a long bookshelf. Alex from Grassroots (A man with a smart red beard and short hair) listens as Rory talks.

“It’s not your responsibility to solve their problems, you’re there to support them and think about how you can work together to get them the help they need.”

If someone is worried about a friend or family member in relation to suicide, what advice would you give them?

In suicide prevention we can all have a role to play, no matter how big or small, and that’s important to recognise. It’s a complex problem to tackle and it’s putting all those jigsaw pieces together, some of which are small and some are bigger. In my book I talk about dispelling the myths around asking about suicide.

If you are concerned about a loved one or friend, please just ask directly. Of all the people I’ve encountered over the years who have been suicidal, when somebody has asked them whether they’d been thinking about ending their life, they’ve often felt an incredible sense of relief that somebody had noticed. Often there’s shame associated with someone who’s feeling suicidal, and a sense of worthlessness. They don’t think they’re worthy of somebody caring for them. In that moment of acute despair when they’re so overwhelmed by pain, any small flicker of light can help interrupt suicidal thoughts.

If you’re concerned about someone, please ask directly, as long as you are sympathetic and compassionate; don’t try to minimise the person’s pain to invalidate it. Try not to be dismissive and just respond as a human being, and say: ‘Actually, let’s work together and think about how we can get you the help and support that you need‘. We’re all guilty of thinking, ‘How can I solve that person’s problems?’ as a friend or family member. Whereas it’s not about that. It’s about just listening.

It’s not your responsibility to solve their problems, you’re there to support them and think about how you can work together to get them the help they need. I would also check with the person if they think they can keep themselves safe – that’s crucial in the moment. Encourage them to contact a GP or another organisation that can offer them professional help if that is required. But if somebody can’t keep themselves safe try to get them to agree that either they will contact a GP or they’ll allow you to do it on their behalf. Or if you think someone is at imminent risk of harming themselves always remember that there are the emergency services as that last resort if you are concerned.

In the book there’s a whole chapter on safety planning for yourself or for someone else. If you can get an understanding of safety planning, it helps you to think about what the warning signs are that a crisis may be escalating, and then what you can do to distract yourself or who you can contact, as well as keeping the environment around you safe. This is so that if you’ve thought of a particular means of suicide you can try to create as much distance – either physically or psychologically – from you and that method so that we can keep you safe.

We know for certain that in that moment of acute despair people think that life will never get better, that they would be better off dead and that their loved ones would be better off if they were dead. I have come across so many examples over the years where people recognise that they are so lucky to be alive, and we’re trying to help people through those moments of crisis so they then can, over time, live fulfilled lives. That’s the moment where you need to hold on, and if you’re a friend or family member, please reach out to support those around you.

You mentioned earlier that men are particularly at risk of suicide. What might work to solve this? Or is there any particular evidence you’ve seen of what might work well for men?

Colleagues of mine at Glasgow have led a programme called ‘Football Fans in Training’ over a number of years. It is focused on physical health as opposed to mental health, it’s trying to help men to lose weight. It’s an intervention programme that works with fans where support is given at a football club. It’s harnessing that area where men spend time. They’re not talking about weight loss programmes but about living healthily, which has been shown to be really effective for weight loss in middle aged men – the group of people in the UK most at risk of dying by suicide. And there’s lots of examples of football, rugby and cricket clubs, places where men can communicate and support each other, where it then moves to mental health.

It’s not going to therapy or treatment in that sense but it’s a place where they can communicate and support each other. We just need to think about going to where men are instead of us always expecting men to come to treatment or therapy. Then of course there’s digital, but we have to make sure that we evidence base it and evaluate those treatments that are provided by digital support. There is innovation going on there, but we just need to make sure it is joined up and that when we’re trying to develop these services and responses, that we ask men what they need. I don’t think we’ve done enough of that over the years. That’s changing in terms of the research community, because you have to really involve people with lived experience in all aspects of the research process and that can only improve treatment and support.  So, more of that, more innovation and looking beyond our traditional statutory services.

It was a real feat to write this book, it took you to a lot of different places and was very challenging in it’s own way. We all need support sometimes – where do you get yours?

IIt’s so important we look after our own wellbeing, and that’s not something I did particularly well in my younger days. I probably didn’t spend enough time trying to understand my own mental health or support myself. I’m very fortunate I have good family and friends who I can turn to for support and that’s really important to me, as well as playing tennis. As I mentioned earlier, tennis is such an important part of my life and I do running as well. Those things help me switch off. In the last five years I have gone to therapy once a week and that’s been really helpful for me to think about all aspects of my life – my professional and personal, the interplay between the two – and help me emotionally process things from my past as well as the day-to-day. Those things are all equally important in keeping me and my mental health in a better place.

Do you have any final reflections on writing the book?

Although the title of the book is ‘When it is Darkest’, what I hoped to try to convey, if you read the book in full, is a sense of hope – hope for people who are struggling, and also hope for people who sadly have lost someone to suicide. I’m trying to help people understand that they’re not alone and that there are lots of people going through this. Although that pain of bereavement will never end, it does get easier – there’s a different way of living, and that different way of living is much more manageable. I think that’s really what I’ve tried to convey – that sense of hope.

You can buy ‘When it is Darkest’ here.