Back in my early days as a Beijinger, I taught a class full of wide-eyed youngsters. One of the boys in that class was a lively blond-haired boy whom I shall never forget. He was endearing and full of wit, with a cut-glass British accent that reminded me of home. As I was completing my first year of expat life he was completing his last. Months after our first encounter, he and his family relocated back to the UK and I never heard of him again. About half a decade later I learned that that boy had taken his own life; he was fourteen years old. 

Suicide is a bleak topic and one that is often spoken of in hushed tones. However, as with most taboo subjects, open discourse is empowering and can have life-changing ramifications. In recent years, there has been a heightened appreciation of the importance of a holistic approach to self-care. This trend has been reflected in the expat community, as awareness has grown that global relocation is amongst life’s most stressful events. Many employers have adopted comprehensive strategies to safeguard their employees’ mental wellbeing. But is this enough? How can we look out for the welfare of others? Might there be a way for us to prevent somebody we know doing the unthinkable? Just how can we offer assistance to a person we think might be suicidal?

Know the warning signs and take them seriously

According to mental health website HelpGuide, the best way to prevent suicide is to recognize the warning signs and know how to respond if you spot them. Warning signs may include an unusual focus on dying, suicide, or self-harm. This preoccupation might be alluded to, or directly expressed by talking or writing about these topics. Another warning sign is a person planning or looking for a way to kill themselves. This might be revealed by online searches, stockpiling medication, or acquiring potentially lethal items.

Another warning sign is hopelessness. Studies have found that hopelessness is a strong predictor of suicide. Feelings of hopelessness may be conveyed by referring to life or the current situation as “unbearable.” A person may also speak of having nothing worth living for. Talking about being a burden to others, using drugs or alcohol more often, withdrawing from friends or family, and neglecting personal care and appearance are all potential warning signs. It is essential to bear in mind that this list is not exhaustive, and that a suicidal person may not necessarily display all of these signs. 

Any suicidal talk or display of these warning signs should be taken seriously. Research has found that more than 75% of people who die by suicide did things in the weeks and months prior to their deaths to indicate to others the depths of their despair. A person expressing suicidal feelings needs immediate help. 

Speak to the individual about your concerns

If you suspect that somebody you know may be suicidal it is advised that you share your concerns with them. According to the National Suicide Prevention Lifeline and a host of other experts, asking the question “Are you thinking about suicide?” in this direct way does not increase suicidal ideas. On the contrary, this question can give the person concerned an opportunity to share their thoughts and feelings and really be heard. Asking this question directly can also be the best way of identifying if somebody is at risk.

After asking this question it is essential to let the person know that you care and that you are willing to listen to what they have to say. If they do decide to open up to you, be calm and listen even if you find their outpouring extremely negative and uncomfortable. The fact that they are willing to talk openly is a positive thing. Avoid offering quick-fix solutions, or trivializing their experiences and making them feel as if they need to justify their feelings of despair. Offer them hope that help is available, and that these suicidal feelings can pass. Don’t promise confidentiality. A life is at stake and you may need to speak to a mental health professional in order to get the suicidal person some help.

Respond quickly in a crisis

If somebody tells you that he or she is thinking about death or suicide, it is important to evaluate the immediate danger the person is in. Have they already done anything to try to kill themselves? Do they know how they would kill themselves? Do they have a specific plan? Have they decided when they will enact this plan? Do they have access to their planned method? Those at the highest risk of suicide in the near future have a specific suicide plan, the means to carry out the plan, a time set for doing it, and an intention to do it. If a suicide attempt seems imminent, call a crisis center or take the person to an emergency room. Remove potentially lethal objects from the vicinity and do not, under any circumstances, leave a suicidal person alone.

According to the Harvard T.H. Chan School of Public Health, “means reduction (reducing a suicidal person’s access to highly lethal means) is an important part of a comprehensive approach to suicide prevention.” A number of studies have demonstrated that when lethal means are made less available or less deadly, suicide rates by that method decline.

Help them connect

Do everything you can to get a suicidal person professional help. This will often necessitate being proactive. Do the necessary research, make the phone calls, escort them to appointments if needed. Rather than waiting for them to call you “if they need anything,” be the one to call or visit them. 

It is also extremely helpful to encourage someone with thoughts of suicide to develop a safety plan that clearly documents what they should do in times of crisis. The plan should set out steps which he or she promises to follow during a suicidal crisis. It can also include ways for them to identify if they start to experience severe thoughts of suicide. An important feature of a safety plan is a list of individuals to contact in an emergency. Identifying people that are trusted enough to call in times of crises can be lifesaving in and of itself. The process can also help develop the very important feeling of connectedness.

Many experts agree that combating a person’s isolation and increasing their connectedness to others can help to prevent suicide. Thomas Joiner, a psychologist and leading expert on suicide, states that a sense of low belongingness (also known as social alienation) is one of two psychological states which when held simultaneously over a long period of time can result in a desire for death. Joiner defines a low sense of belongingness as the experience that one is alienated from others, and not an important part of a family, a circle of friends, or some other valued group. 

Expats are particularly susceptible to feelings of isolation and social alienation. Most expatriates move thousands of miles away from family and friends when they leave for another country. Some expats find that the stress of relocation, adjusting to new jobs and educational institutions, and the challenges of navigating a new culture accentuate their feelings of alienation and lack of connectedness. 

Follow up

After connecting a person experiencing suicidal thoughts with the support that they need, it is extremely important to follow up with them.  Leave a message, send a text, or give them a call. Following up can help the development of a feeling of connectedness. It also provides an opportunity to ask what else you can do to help. 

It is important not to commit to anything you are not willing or able to accomplish. If you are not in a position to be physically present with someone with thoughts of suicide, talk to them about what and who they think will be the most suitable sources of help.

Helping a person who might be suicidal ought not to be regarded as a task that is suited only for mental health specialists. Research has proven time and time again that there are things that every one of us can do to reach out to and support an individual struggling in this area. Small things so often can make big differences. For those of us who know people who are currently in the throes of this battle, or who have known individuals that died by suicide, it goes without saying that it is not your fault. Nobody has ultimate control over the actions of another. We don’t get to determine who lives and who dies. What we can do is educate ourselves and others so that we are all better equipped to be of assistance to a person who might be contemplating suicide.

Suicide Prevention Resources

Lifeline Shanghai
This helpline serves the English-speaking community with free, confidential, and anonymous emotional support via telephone 10am to 10pm, 365 days a year. Trained volunteers listen, help to provide another perspective, and connect callers with other support services. (021 6279 8990)

My3
This is a safety planning and crisis intervention app enables users to add the contact information for three people who can help them when they are experiencing thoughts of suicide. The app also allows users to construct a customized safety plan.

This post appeared in the beijingkids October 2018 Mental Health issue.
Photos: Adobe Creative Cloud, Kat Jayne via Pexels

Meet three professionals in charge of helping people of all ages, across the complete spectrum of psychological difficulties. We asked them questions that we thought would demystify the process for those seeking psychiatric and psychological treatment, and show that help with mental health-related issues shouldn’t only be considered when things are at their worst.

Dr. Esperanza Salinas

Dr. Salinas is a psychiatrist with Beijing United Family Hospital’s Psychological Health Center, and has over 11 years of clinical experience. Her interest areas are mental illness in the young adult population, and in the impaired professional population. When she’s not guiding her patients through a range of psychological issues, she also enjoys writing children’s books which also touch on these topics of mental health. 

Making that step towards getting treatment for mental illness can be a difficult one. Do you have any advice for people that are trying to decide whether or not this is right for them?
Salinas: There is a whole industry out there of coaches and life coaches, and I always get the feeling that people don’t usually have an issue consulting with them. I see what I do the same way. How do we make your life better? How do we make your life the fullest that it can be? There will be bumps and dips in anybody’s road, but how do we make these more manageable for you? There is a stigma with mental health, but I think if we start looking at this more from the perspective of life coaching and a perspective of overall well-being, it’s important to this more holistic approach. No one ever says, don’t go see the doctor for your yearly exam, why can’t it be the same way with psychiatry? Why not have that same type of attitude towards it? Just, general checkups to make sure that everything is OK.

How do you think a yearly mental checkup could be implemented?
Salinas: What we rely on quite a bit is our peers and our colleagues in primary and specialty care. Good doctors will be able to pick up if this individual has an anxiety or depressive disorder, and then may suggest to them to go see us. I think the harder anxiety disorders are more chronic and people find ways to live with them, and there can be a lot of resistance on letting that stuff go. We do know though that life does get easier and better when the anxiety lifts, or when people start addressing that in a different way.

Would you say that part of the stigma of mental health is that many people don’t often view these illnesses with the same gravity as a physical illness?
Salinas: There are differences and there are similarities. I think we have historically and culturally looked at it as very different, but we are starting to learn more and more biological aspects of mental illness, and we have to view it more like diabetes or more like high blood pressure, where these are chronic illnesses that need chronic attention. We don’t necessarily see diabetes when a person walks into the room and we don’t normally see depression. We may see a broken arm, but biologically we are starting to understand depression and anxiety in a much more fundamental way to make it very similar to these other chronic illnesses. There still aren’t any blood tests or MRIs that can be used. What we rely on are our rating scales, inventories, clinical judgment, and clinical interviews to make diagnoses, and also to follow the illness through its progression or improvement.

Dr. Bojun Hu

Dr. Hu is a psychologist in Beijing United Family Hospital’s Psychological Health Department and has over 10 years of clinical experience practicing psychology. Before moving to China in 2016, she worked as a therapist in hospitals and outpatient mental health clinics in both the Boston and New York City areas. In her free time, she teaches yoga and collaborates with dancers and architects to create cross-disciplinary art installations. 

How do you work toward building trust with your patients?
Hu: Things that I do, and things that I think most therapists do, are basically, one, provide a time and space where people know that their concerns, no matter how insignificant they think they are, are significant here, because their feelings are probably related to all sorts of other things going on in their lives. I also do a lot of reflections, so you reflect back to people: “I think what I heard you say was this,” or “I imagine if you are experiencing this, you must be feeling this.” When you are able to be with people in their experience, it allows them to relax. It allows their bodies to relax, and they are more willing to open up and talk. 

Because we are human beings and we take comfort in predictability, is there a balance between talking about things that can be frightening for people and things that are more comfortable for them?
Hu: I think that’s a really important balance, particularly for people with trauma, because there is that feeling of insecurity or fear that can be pretty constant in their lives. A lot of what most therapists do is to establish this safety and comfort. That’s the priority. It is only within this safety and comfort, that someone is willing to look at things that scare them. Part of my professional experience is to read people, to notice when they’re feeling anxious, scared, or otherwise overwhelmed.  

What would you say the differences are between a wellness class and therapy with a psychologist?
Hu: There is a therapeutic frame and there are boundaries to this interaction that allows it to be safe, and we work within these boundaries of confidentiality, time limit, and therapist-client relationship. There are different boundaries in a wellness class. There are also things that are allowed in the therapy room that may be frowned upon in a class. So, you can yell in here if you want to, and as long as you feel safe we can talk through it and understand what that’s about. We can’t normally do that in a yoga class, as you are asked to contain outbursts.

Dr. Ru-Chi Yang and Dai Hu 

Dr. Yang is a licensed psychologist, a health service provider in psychology, and a registered play therapist-supervisor in the United States, and Hu is the General Manager of LIH Olivia’s Place and an occupational therapist. They explain to us the benefits of seeking help in an environment like Olivia’s Place that is specifically engineered with the needs of children in mind and ways that parents can take an active role during the treatment of their child. 

How do you begin to help kids take a more engaged role in their therapy?
Yang: This depends on age, but for younger children, it is still not easy for them to verbalize their feelings, so it is essential to use some playful intervention. You want to have a child build a feeling vocabulary. As they build a vocabulary for these feelings, they will later learn to verbalize these feelings. It is important to use interesting or fun ways to initiate this instead of just asking, “how do you feel?”

Hu: We are treating children with social or emotional problems. The older ones like to keep to themselves. So they don’t really talk to you that much in the very beginning. It is important to bring yourself down to their level and play by their side. You don’t just jump into the treatment. For some children, you will need to take about two or three sessions before you start with anything therapeutic. 

How are parents involved in this process of therapy?
Yang: A child’s stress becomes a parent’s stress. We encourage parents to provide positive attention to their child, such as scheduling a special playtime that is child focused. Parents are busy, and it’s very difficult to do it every day. It is also very important to give support emotionally. Listen to and ask your child about everything that has happened throughout the day. Listening will help the child to feel like the parents understand, and support them. Also, encourage the child to engage in social activities with their peers, this helps in dealing with difficult feelings too. 

Hu: Sometimes we feel, especially for psychological problems, that the child is a perfect reflection of the family. So you need to involve the family, otherwise, things won’t change that fast.

What makes Olivia’s Place unique among other child-focused therapy providers? 
Yang: In China, a lot of people need help but the number of professionals that can provide these services is low. We’ve been trained overseas and have a high standard, and not everyone has the same concept of legal ethical conduct or professional training to deal with some of the difficulties they say they can treat. 

Hu: Also, most parents don’t have the ability to differentiate. For example, when someone might have experienced a false version of play therapy, they might come here and say they’ve tried that even before experiencing Dr. Yang’s efforts. Dr. Yang is probably one of a few doctors in Beijing that are certified in play therapy. So we only use qualified and certified people. 

Mental Health Resources

Hospitals and Organizations

Raffles Medical’s Mental Health and Counseling Services
All ages. Staffed by experienced and internationally trained doctors and counselors, Raffles Medical is available to help you identify problems and provide individualized support. Daily 8am-8pm. Suite 205, Wing 1, Kunsha Bldg, 16 Xinyuanli, Chaoyang District. (6462 9112)

LIH Olivia’s Place
Kids. Olivia’s place has the expertise to conduct assessments related to learning problems, ADHD, Autism Spectrum Disorders, cognitive impairment, mental health concerns such as anxiety and depression, and challenging behavior. Mon–Fri, 9am-6pm. Sat, 9am-12pm. 13 Jiu Xian Qiao Road, Building 6-1, Second Floor, Chaoyang District. (6461 6283)

BJU’s Psychological Health Center
All ages. They provide consultation, assessment, and treatment for concerns ranging from mood disorders, relationship and parenting issues, loss and bereavement concerns, and educational and developmental needs. United Family New Hope Clinical Center, 9-11 West Jiangtai Road, Chaoyang District. (5927 7067)

The Learning Frontier
Kids. Located in Shuangjing, The Learning Frontier is dedicated to providing bilingual, personalized guidance, and support services for children and families residing in Beijing. Their team includes a variety of specialists focusing on mental health, education and learning, applied behavior analysis, and speech and language and occupational therapy to assist children. 4th Floor, No. 11 Dongbai Lu, Chaoyang District. (6775 3268)

Individual Therapists

Adel Andalibi, PhD
All ages. Andalibi uses mindfulness-based somatic psychotherapy, using the Hakomi method, somatic experiencing, movement therapy, metaphor, and narrative therapy. Group therapy is also available for parents and teens. The approach is respectful, playful, mindful, and gentle. (Phone/WeChat: 18321746409, adel@herespace.com)

Michelle Mope Andersson
Adults. Focusing on existential wellness, stress management, marriage, and family help, Michelle has been a pastoral counselor since 2005, and was a wellness and stress counselor for the UN in Pyongyang. (mopeandersson@yahoo.com)

Titi Hill
All ages. Hill specializes in a wide range of child and family issues including family breakdowns, family and peer relationship difficulties, anxiety, depression, low self-esteem, diversity issues, abuse, addiction, stress, bullying, bereavement, and transitioning. She has a Bachelor’s Degree in Integrative Counseling from the University of Surrey. RMB 950/50 min session. (186 1255 7824, info@beijingcounselling.com)

Leon Lee
Ages 13+. Lee became a certified counselor for positive and transcultural psychotherapy at the age of 25 and a certified psychotherapist at the age of 27. He has had his practice for 10 years and specializes in marital conflicts and psychosomatic symptoms. RMB 600/hr. (WeChat: leonptp)

David Blanco
Adults. Blanco is a clinical psychologist and psychotherapist specializing in individual and group therapy. Through personal development courses, Blanco helps families trying to overcome relationship difficulties or stress issues. His courses are primarily conducted in English and Chinese, but he also is a native Spanish speaker. (WeChat: baidaweiindonesia, davidblanco@qq.com)

Group Support

CandleX
Adults. CandleX offers mental health support, in English, to teenagers and adults living in Beijing. Both expats and Chinese nationals are eligible to receive this support. Their bimonthly support groups conducted in English help to create a community among people struggling with the effects of mental illness. (info@candlex.cn)

Beijing LGBT Center
The Beijing LGBT Center is a non-profit, community-based organization that empowers the Beijing lesbian, gay, bisexual, transgender (LGBT) community by providing social services and organizing advocacy programs. Their work seeks to further the LGBT movement, eliminate discrimination and achieve equality. Rm. 2606, Bldg B, Xintiandi Plaza, 1 Xibahe Nanlu Jia, Chaoyang District. (5903 3730, bjlgbt@gmail.com)

Beijing Mindfulness Centre
The Beijing Mindfulness Centre is dedicated to providing a safe and inspiring environment for learning and growth. They offer various mindfulness-based programs in English, Spanish, and Chinese, and individual coaching to the community. 44 Qian Yongkang Hutong, Dongcheng District. (6403 4923, hello@beijingmindfulness.com)

Lifeline Shanghai
Lifeline Shanghai serves the English-speaking community with free, confidential, and anonymous emotional support via telephone from 10am to 10pm, 365 days of the year. Though they are located in Shanghai, the operators are available to talk to anyone in China. (021 6279 8990)

This post appeared in the beijingkids October 2018 Mental Health issue.
Photos: Min An via Pexels, senjinpojskic via Pixabay

Navigating the stresses that come with living in China – the traffic chaos, the nonchalance in the face of near-death experiences, the murderous troposphere, and the occasional mass food scare – is no easy feat. But the strains that we so often embrace can also be compounded by anxieties that arise from being far away from home, having to navigate one of the world’s hardest languages, learning the ropes of a significantly different culture, and trying to find suitable treatment in a country with a growing but still stigma-bound understanding of mental health.

Mental health awareness in China has grown considerably in the past decade but as you would expect, resources remain largely local-focused, which along with denial, apathy, and not knowing when to seek professional help, can all work together to impede our efforts to get better. Dr. Chou Yuwen, a trained psychologist at Beijing United Family Hospital, states that behaviors are considered detrimental and in need of treatment when they “start to affect [a person’s]daily functioning such as work, study, and home life for a period of time.” Unfortunately for many, the warning signs may not be so obvious.

Qin Xiaojie, founder of NGO CandleX, which specializes in providing psychological support for sufferers of anxiety, depression, and bipolar disorder (with which she herself is diagnosed), states that the first step to getting help is acceptance: “you have to find a way to know that it’s okay to struggle and feel bad – it’s part of being human. The second point is to understand that there are options out there. Usually, if someone is suffering from depression, they have a tunnel effect where there appear to be no other options and the tunnel seems endless.”

To that end, Qin Xiaojie suggests that should you find yourself in a bind, “try to be open and explore, find support, and don’t carry [the burden]all by yourself – talk to your friends, talk to your parents, but also be aware that they might not react in the way that you expect them to, and if that’s the case, what do you do then to deal with that possibility.” She also suggests making a “crisis plan” for if your mental health deteriorates, an effective way to engage friends in reducing your own exposure to personal risk as well as aid recovery from an episode that may otherwise be impeded by trauma, circumstance, or anxiety. In this regard, a certain level of self-awareness is key to putting you on the right track to recovery given that it may require a drastic adjustment of your lifestyle or habits; perhaps you’re in a bad relationship or a job that’s not suitable for you, maybe you drink too much or don’t put time aside to cultivate ways to unwind.

Qiao Miao, a student counselor at Peking University, describes how many of the students that he sees lack hobbies, a byproduct of their competitive and all-encompassing university education. Just as someone who works all the time, or not at all, may not have an activity to take their mind off of their problems, Qiao often simply prescribes “finding something that you can fall in love with, something that when you’re doing it you can get into the flow, can focus on it alone, and are able to forget the passage of time.”

One factor that all three interviewees agree on is that the best way to combat mental health issues from developing in the first place is to be compassionate to yourself. Such self-maintenance can take many forms but you should start by tending to your body and mind, particularly by eating well, sleeping well, and getting regular physical exercise. Additionally, take a moment to be mindful of how you feel and assess the underlying causes. Finally, build habits that allow for downtime, perhaps coupling them with practical goals that will help you to manage stress more effectively.

As China’s middle class becomes increasingly self-sufficient amid an uncertain future, the acknowledged importance of mental health upkeep continues to grow, psychologists playing the role of priest to China’s atheist, capital-driven masses. As a foreigner in China, the best thing you can remember is that should problems arise, home is never too far away and that there is always help available here – you just have to ask for it.

Mental health resources

CandleX
Mental health support group every second and fourth Thursday of the month, 7.30-9pm (donation-based). www.candlex.cn

Beijing United Hospital 
9-11 West Jiangtai Road, Chaoyang District. Psychological Health Center: 5927 7067; 24-hour ER hotline: 5927 7120. www.beijing.ufh.com.cn

LifeLine Shanghai
Accepts China-wide calls for year-round free, confidential, and anonymous emotional support, 10am-10pm. 021 6279 8990; www.lifeline-shanghai.com

This article first appeared in the Jan/Feb 2018 issue of the Beijinger.
Read the issue via Issuu online here, or access it as a PDF here.

More stories by this author here.

Email: tomarnstein@thebeijinger.com
WeChat: tenglish_

Image courtesy of Thomas Sauvin/Beijing Silvermine