Rights, Stigma and Suicide Prevention

Stories, signs to notice and what to do

The Meeting He Did Not Join

Daniel, thirty-four, a logistics supervisor in Nairobi, had been treated for depression for four months and was doing better. He had not told anyone at work. When a colleague joked in a meeting that a late client was 'mental, completely psycho,' the room laughed, and Daniel felt his face go hot.

He began skipping the weekly meeting. He told himself it was safer to say nothing. At night he thought, 'If they knew, they would think I was weak and unfit to lead.' The shame was heavier than the illness had been in some weeks. He nearly stopped his follow-up visits.

His manager, Wanjiru, noticed he was withdrawing. She asked him for a private chat and said, 'You have always done good work, and I want to know if there is anything I can do.' Daniel told her only a little: he was managing a health condition and needed an early finish twice a month for appointments.

She thanked him, said it stayed between them, and the next week quietly asked the team to stop using insulting words about mental health: 'That is not accurate, and it hurts people.' Daniel kept his appointments. The shame did not vanish overnight, but he stopped calling himself a failure and began to see that he had a health condition, not a character flaw.

How to recognise it

• Withdrawal from meetings, social events or responsibilities after hearing stigmatising jokes.
• Secrecy about treatment and fear of being judged or sacked.
• Self-critical thoughts such as 'I am weak.'
• Skipping appointments or hiding medicine because of shame.
• Casual insults such as 'mad', 'mental', 'psycho' being normal in the workplace.

What this story explains

This story shows stigma and self-stigma, and how respectful language, one supportive leader and a person's own choice about who to tell can reduce shame and protect care.

Probable root causes

• Myths and fear of the unknown about mental illness.
• Insulting language and jokes that make a workplace unsafe.
• No clear workplace policy on mental health.
• Cultural beliefs that treat mental illness as weakness or failure.
• Fear of discrimination in work or promotion.

What to do

1. Remind yourself that it is a health condition, not a character flaw.
2. Choose carefully whom to tell, and what to share.
3. Keep every treatment appointment despite the shame.
4. Speak up calmly about insulting jokes, or ask a manager to do so.
5. Talk to a trusted person or a peer support group.
6. Notice self-critical thoughts and challenge them.

Whom to consult

• Treating doctor or psychiatrist if shame is making you stop treatment.
• Counsellor or clinical psychologist for self-stigma and work stress.
• Human resources or a trusted manager for adjustments such as appointment time.
• Emergency service or hospital if hopelessness turns to thoughts of ending life.

Do and don’t

How to behave and communicate

• Manager: 'You have always done good work. Is there anything that would help?'
• Listen without asking for details they do not offer.
• Address a joke calmly: 'That is not accurate, and it hurts people.'
• Reassure: 'This stays between us.'
• Keep your tone respectful, not pitying.

What Farah Said at the Bus Stop

Farah, twenty-two, a college friend of Imran in Karachi, had been quiet for weeks. At the bus stop one evening she said lightly, 'You all would be fine without me.' Then she added that she had been giving away some of her books and writing goodbye notes. She laughed it off, but Imran did not.

His stomach dropped. He remembered what he had heard: take talk of death and goodbye seriously. He put his phone away, turned to face her, and asked, 'Farah, are you thinking of ending your life?' She was silent, then her eyes filled. She said yes.

Imran did not argue or panic. He said, 'Thank you for telling me. I am glad you did. I am not going to leave you alone tonight.' He asked whether she had anything at hand that she could use to hurt herself, and she said yes. Imran stayed with her while they asked her older brother to come and remove it safely.

They called the emergency number, and Farah was taken to the nearest hospital, where she was assessed kindly and a care plan was made. The next week, Imran went with her to the first follow-up appointment. Farah later said that being asked directly was what made it possible to say it.

How to recognise it

• Talk about death, being a burden, or not being around.
• Goodbyes, giving away belongings, or sudden calm after distress.
• Looking for ways to harm self, or having access to means.
• Withdrawal, hopelessness, or substance use after loss, trauma or severe stress.
• A joking tone around serious statements.

What this story explains

This story shows the suicide prevention steps from the chapter: take talk of death seriously, ask directly, do not leave the person alone, reduce access to means if safe, and call emergency services.

Probable root causes

• Depression, which can make life feel unbearable.
• Substance use or severe stress.
• Trauma, abuse or major loss.
• Isolation and feeling like a burden.
• Stigma that stops people from saying how bad things are.

What to do

1. Take what the person says seriously, even if it is said lightly.
2. Ask directly and calmly: 'Are you thinking of ending your life?'
3. Stay with the person and do not leave them alone.
4. Remove access to anything that could be used to cause harm, only if you can do so safely.
5. Call the local emergency number or take them to the nearest hospital.
6. Keep emergency numbers written down and follow up after the crisis.

Whom to consult

• Emergency service or nearest hospital immediately if there is a plan, intent or attempt.
• Psychiatrist or family doctor for assessment and treatment afterwards.
• Clinical psychologist or counsellor for ongoing support.
• A trusted family member or elder to share the watching, so no one carries it alone.

Do and don’t

How to behave and communicate

• Say 'I am glad you told me. I am here with you.'
• Keep your voice steady and slow.
• Use their words and listen fully, with phone away.
• Avoid shock, anger or blame.
• Ask: 'What would help you stay safe tonight?'

The Room With the Latch

Kofi, thirty, had lived with schizophrenia for ten years in a village outside Kumasi. After his last relapse, his family, frightened by neighbours' talk, kept him in a back room with a latch on the outside. They said it was for his own good. He was fed there, and visitors were told he was away.

His younger sister, Abena, home from nursing college, saw the stained mat and the untouched medicine and was shaken. Kofi had stopped speaking. She said to her parents, 'A locked room is not a hospital. He is ill, not a prisoner, and illness is treatable.'

Her father was angry at first. Then Abena described what she had learned: that people with severe mental illness often recover a good deal with treatment and support, that community-based care is better than hiding, and that confinement, neglect or beating is harm, not culture. She asked a community health worker to visit.

The worker met Kofi respectfully, explained the options, and with consent arranged a clinic visit. Kofi, with support, restarted a care plan, attended a day group, and went back to helping with the family farm. The latch came off. His father later said, 'I thought hiding him was protecting him. It was only protecting us from talk.'

How to recognise it

• A person with mental illness kept confined, hidden or neglected.
• Family fear and neighbours' labels such as 'mad' or 'dangerous.'
• No treatment, poor food or hygiene, or physical punishment.
• The person is not asked about their own wishes or care.
• Shame and secrecy in the household.

What this story explains

This story shows the rights part of the chapter: community-based care, respect for consent and protection from abuse and coercion, and that locked starvation or confinement is harm, not culture.

Probable root causes

• Fear and myths about severe mental illness.
• Stigma and pressure from the community.
• Lack of accessible services or information.
• Exhaustion and helplessness in family carers.
• Beliefs that treat illness as shame or punishment.

What to do

1. Speak to the family calmly about what is happening and why they are afraid.
2. Share accurate information about treatment and recovery.
3. Ask a community health worker, doctor or trusted elder to visit.
4. Include the person in decisions and ask for their consent where possible.
5. Restore dignity first: food, washing, company, daylight.
6. If confinement, beating or starvation is happening, seek help outside the house immediately.

Whom to consult

• Community health worker or family doctor for a respectful first visit.
• Psychiatrist for diagnosis, treatment and a recovery plan.
• Social worker or a trusted community leader to support the family.
• Local emergency service or police if the person is being harmed or is in danger.

Do and don’t

How to behave and communicate

• To the person: 'You are not in trouble. I want to hear how you are.'
• To the family: 'You are frightened, and that is understandable. Let us find proper help.'
• Use plain words like illness, help, clinic.
• Avoid shaming parents; offer information and choices.
• Listen to the person's own wishes before deciding.

Sam Told Nobody at Home

Sam, seventeen, a pupil in Sydney, had told two friends that he was a boy, though everyone at home still used a different name. When he came out to his parents at dinner, his father walked away and his mother said it was a phase. The next day his things were moved. His phone was checked. Nobody asked how he was.

At school Sam grew quiet. He missed classes, and the teacher noticed marks on his arm. Sam said it was the only way to stop feeling so much. He felt rejected at home, harassed online and as though there was nowhere safe.

His school counsellor, Ms Patel, did not debate his identity. She said, 'Thank you for trusting me. I am glad you are here. What you feel is real, and you deserve care.' She explained that self-harm can be a way to cope with pain, and that it is still a reason for care.

She asked him directly about thoughts of suicide, and he said they came sometimes. A safety plan was made. With Sam's permission, Ms Patel invited his mother to a meeting and shared accurate information about the higher risk of self-harm when young people are rejected, and how affirming care helps. His mother cried, listened, and began using his name. It took time, but home became safer.

How to recognise it

• Minority stress: discrimination, rejection or hiding who you are.
• Withdrawal, missing school, and a drop in mood.
• Self-harm used to cope with emotional pain.
• Cyberbullying or harassment.
• Talk of hopelessness or not wanting to be here.

What this story explains

This story shows who is pushed further out, including gender minorities, and the chapter's point that care must be affirming, not a debate, and that self-harm in adolescents is a reason for care and a plan or attempt is a medical emergency.

Probable root causes

• Rejection by family, peers or community.
• Discrimination and bullying, including online.
• Hiding identity and constant fear of exposure.
• Pain that the young person cannot express in other ways.
• Lack of affirming adults or services.

What to do

1. Listen first and respond with respect, not debate.
2. Ask directly about self-harm and suicidal thoughts.
3. Make a simple safety plan together with the young person.
4. With permission, involve a trusted adult or parent and share accurate information.
5. Encourage affirming spaces: a supportive teacher, friends, peer group.
6. Treat any plan or attempt as an emergency and contact emergency services or the nearest hospital.

Whom to consult

• School counsellor or trusted teacher for first support.
• Family doctor, paediatrician or adolescent mental health specialist for assessment.
• Clinical psychologist who offers affirming care.
• Emergency service or nearest hospital if there is a plan, attempt or serious injury.

Do and don’t

How to behave and communicate

• Say 'I am glad you told me. You matter, and I am here.'
• Listen without judgement, and let him lead.
• Ask: 'Have you had thoughts of hurting yourself or ending your life?'
• Avoid arguing about the cause of identity.
• Keep your tone warm and steady.

The Words We Use After Ravi

Ravi, twenty-six, died by suicide in Bengaluru. His older brother, Kiran, was left with a house full of relatives and whispered questions. An uncle said, 'He committed a sin,' and an aunt asked what the family had done wrong. Kiran found himself saying only that Ravi had died of 'sudden illness.'

He could not sleep. He replayed every missed sign. He stopped answering friends' calls because he did not know what to say. At the funeral a cousin, Meena, put an arm around him and said quietly, 'I am so sorry. We do not have to say anything.'

In the weeks after, Meena kept visiting. She brought food, sat with him, and when he finally spoke of Ravi she used the words Kiran needed: 'Ravi died by suicide, and it was not your fault.' She also corrected a relative gently: 'We do not say committed. He was ill and in pain.'

Kiran later told Meena he was struggling to carry on. She asked him directly whether he had thought of ending his own life. He had, briefly. She stayed with him and helped him see a doctor the next day. A bereavement group helped. He said, 'The kindest thing anyone did was to say his name and not look away.'

How to recognise it

• Intense grief, guilt, anger or numbness after a death by suicide.
• Family secrecy, blame or shame.
• Replaying the last days with 'if only' thoughts.
• Withdrawal, sleeplessness and difficulty functioning.
• Increased risk of low mood or suicidal thoughts in the bereaved.

What this story explains

This story shows the power of respectful language, such as 'died by suicide' rather than 'committed', how stigma adds to grief, and that people bereaved by suicide need support and gentle checking for their own safety.

Probable root causes

• Sudden, unexplained and often shocking loss.
• Stigma, religious or cultural blame, and family secrecy.
• Self-blame and unanswered questions.
• Isolation because others do not know what to say.
• Pre-existing stress or depression in survivors.

What to do

1. Go to the bereaved and say you are sorry without needing perfect words.
2. Use respectful language and gently correct blame or jokes.
3. Offer practical help: food, errands, company.
4. Allow them to talk about the person for as long as they wish.
5. Ask directly if they are having thoughts of ending their own life.
6. Encourage professional or peer bereavement support when grief feels unbearable.

Whom to consult

• Family doctor if sleep, mood or functioning is badly affected.
• Counsellor or clinical psychologist experienced in grief.
• Psychiatrist if depression or thoughts of self-harm appear.
• Emergency service or nearest hospital if they are in danger.

Do and don’t

How to behave and communicate

• Say 'I am so sorry. It was not your fault.'
• Sit with silence and let them lead.
• Use gentle, steady tone and the person's name.
• Avoid 'at least' statements and religious blame.
• Ask: 'How are you holding up? Do you ever feel you cannot go on?'

This book is for education and general awareness. It does not replace diagnosis or treatment by a qualified professional. If anyone is in danger, contact your local emergency services.