Not Falling Over: Post 5: Barriers, Defences and a Plan of Attack

A series following a professional woman’s experience of reoccurring suicidal thoughts and what she does about them.

9 min readApr 10, 2023

TW: Suicide, Suicidal Ideation

In the past I’ve managed my ideation solely by having a cry, hunkering down and generally retreating from the world and whilst I still do this to some extent, I’ve also realised that I need to have better defences than that. After keeping three years’ worth of statistics and watching the steady rise in occurrences I’ve figured it’s not going to go away if I don’t take a more proactive approach and meet my ideation halfway — and this is what I’m attempting to do now but up to that point I’ve done other things which are more defensive and less about attacking it head on.

Over the years I’ve used a few apps and online resources to monitor and manage my feelings. Before my ideation ramped up in regularity, I would have occasional dips and I started to log these on an app called Catch It which not only allows the user to capture and record their mood but also incorporates some CBT (Cognitive Behavioural Therapy) elements which encourages some consideration and reflection into those thoughts. The app was created by the Universities of Manchester and Liverpool and I found it helpful and used it for some time but stopped when I thought I no longer needed it.

CBT was something I was familiar with already and whilst I had not been able to find any free resources at the time, I had worked through a copy of CBT For Dummies which I had picked up in a discount bookshop and which I found to be a really good starting point. Wanting more guided help, I’d looked for online courses but not found any UK ones which were free (although that may well have changed now) and I came across a free online course called Mood Gym which was developed by the Australian National University. I signed up and spent several weekends working through the exercises, some of which required a bit of practical homework during the week. Again, it felt like a good use of my time, and being able to unpick my overthinking and look at it objectively was helpful.

Since my autism diagnosis I am less convinced that CBT is the whole solution for me as there is some debate about its effectiveness in those who are autistic, and as I grow more aware of some of my differences in thinking I wonder how those would fit with CBT when my behaviour is often rooted in a neurological condition rather than down to anxiety or trauma. I’ve seen ‘adapted CBT’ being offered for neurodivergent people and I’m not against CBT but I’m also keen on trying to work out why the frequency of my ideation has increased and to try to spot any patterns or causes which might be there.

I use two apps to log this kind of information. The first which I’ve mentioned before is Streaks. It’s a really simple app that allows you to log good habits (or bad ones) or record things you want to keep track of. You can set it so it automatically counts each day unless you reset it, or you can create a task where you press a button whenever you do something. I use it for recording how many times I exercise, when I have a period (or increasingly don’t have one) and also for my ideation. This means when I’m in the depths of a difficult day I just have to press a button and not only can I keep track of how many times it’s happening per month or year, but I also have a useful list of exact dates which I can go back to.

I also log my moods and activities in more detail using another app called Daylio. I’ve been using it for several years and you can use it to journal your day, record activities and moods and keep track of how you’re feeling. It uses emojis so it’s really quick to use and you can personalise them for your own activities and feelings. I’ve set up my Daylio with different sections for sedentary and active tasks, hobbies and interactions with people (so texts, family calls, work interactions etc). My moods are also customised so I can capture days when I really feel happy, days that are just ok (which is most of the time) and the bad ones which range from Meh to Bad but also include emojis for ideation and panic attacks (I used to have panic attacks fairly often at one point).

I tend to use Daylio once a day without adding additional notes or photos so I end up with a very brief overview of the day which takes me seconds to complete — but you can use it throughout the day and add additional information. Daylio also provides handy charts showing you how you’re getting on (including an annual chart at the end of the year) so it can potentially collect a lot of information.

A slightly different kind of app I want to mention is the strange but rather wonderful video game that doesn’t feel like a game Kind Words. The idea is that you can post a short anonymous letter to the community or respond anonymously to others’ letters. It’s not a game where you can undertake prolonged correspondence as once you reply that’s the end of the transaction. I’ve never posted a letter but I have spent over 50 hours responding to others. Some might be asking you for music or movie recommendations but often users will be sharing their concerns or worries (no personal identifying information is shared). I try to respond with compassion and helpful suggestions and use Kind Words as part of my own mental health management. Sometimes I don’t use it if I’m struggling myself but when I feel like I’ve got the energy to help others, I do.

My defences for ideation are mainly how I manage when it’s happening. I’ve read some helpful books on suicidal ideation including Susan Rose Blauner’s How I Stayed Alive When My Brain Was Trying to Kill Me and Matt Haig’s Reasons to Stay Alive. I began to create personalised crisis plans which I would re-write in the back of each Moleskine notebook I used for my diaries before eventually downloading an app (yes, another one) on my phone called Stay Alive which has a number of resources on it including a personalised safety plan and a ‘Life Box’ where you can upload meaningful photos. One of the pictures in my Life Box is of a friend’s mother who I like and respect very much but who I think would be disappointed and saddened at me if I went.

Creating a crisis plan also allows you to think about the things that are helpful to do and to not do when you’re in a storm. For me, I find doing jigsaws therapeutic because my hyperfocus kicks in and I can sit at the dining table for many hours working away at one without doing much else. I don’t often do jigsaws unless I’m out of sorts and often I’ll pop my iPad on the table and find radio documentaries and podcasts to listen to whilst I’m doing it. If I listen to music, I’m careful about what I choose because music has a visceral effect on me and some songs that I love on good days will plummet me deeper into despair.

Sometimes I tell someone I know that I’m feeling very down but often I don’t. I appreciate that even telling someone on a good day about ideation is really hard because often it results in you having to manage their feelings when they get scared or worried that you’re about to kill yourself. Sharing is a good thing though if you can manage it.

And then I have my barriers. My barriers to exiting this life are my adult daughter, my closest friend and more recently my dog. The dog was only supposed to help me get out of the house every day and whilst she wouldn’t feel the heartbreak that my daughter would feel if I suddenly went, she wouldn’t have anyone to look after her and someone would have to rescue and rehome her. My dog has become a barrier, and for that I’m grateful.

My other barrier and last line of defence is linked to my autistic brain. I don’t do anything without researching and planning so whilst I can think of ways to end my life, I have deliberately not actively looked into any of them. And this means I do not have enough detail to actually undertake any method properly. This may sound like a flimsy barrier and one which could easily be breached — it’s only as strong as my willpower after all. But its strength is in the fact that when I’m feeling poorly I’m too discombobulated to start doing research and when I’m well I know not to do it. So far, it’s stayed strong.

All that leaves is my plan of attack. As someone who is very much peri-menopausal if not already there, I’ve been looking into the links between hormonal changes which are due to the menopause and suicidal ideation. It was something that my counsellor mentioned during one of our sessions but I had also read articles in the Guardian and on BBC News I did some Googling and watched an excellent webinar by Norfolk and Suffolk NHS Foundation Trust on the subject which included contributions from Dr Louise Newson, a menopause specialist who has also created a free app called Balance for tracking menopause symptoms. One of the incredibly helpful functions of the app is that it has a checklist of symptoms which you can fill in and bring with you when you go to see the GP so instead of spending half your appointment time answering questions you can give your GP the information upfront and take the conversation from there.

I did exactly this. It’s hard to get appointments at my practice but I got one the same day partly because I mentioned that I wanted to talk about my suicidal ideation and whether it could be linked to being peri-menopausal. I was given an appointment with a male GP which I wasn’t overly concerned about, but once there I found I had been swapped around and I had an appointment with a female trainee GP who was thorough and excellent and who was grateful for the Balance checklist I had brought with me. She clearly explained HRT (Hormone Replacement Therapy) to me before giving me a prescription for the type of HRT we agreed would be good for me to try. The doctor also gave me a referral to my local Access and Crisis Team and they called within a couple of days to arrange a telephone appointment the following week.

Mental health services have always been pretty stretched across the NHS and things are not improving. The crisis team appointment was absolutely fine but I was told there wasn’t a great deal they could do for me as I was managing my ideation so well and from the questions I was asked, it felt like they are mainly there for those who are currently in crisis and people who are particularly vulnerable. I was asked if I was under coercive control, if I owed money or if I had lent money, if I had issues with drugs or alcohol and if I had a criminal record. I answered no to all of these and the person I spoke to suggested that I could have some free CBT (to run alongside the counselling I pay for) and I could try antidepressants.

I’ve tried SSRIs once before and had such extreme side effects I stopped after the first tablet and whilst I understand that I could try a different type and they might be better, I feel like they’re really not for me. I don’t like feeling woozy and I’m sure there’s an underlying cause to my ideation which I can identify and mitigate without antidepressants. Looking at the data I’ve collected via my various apps I can see that in many cases, days of ideation have followed days of feeling burnt out and/or stressed or they’ve come when things like trips away have been cancelled at the last minute. It will take time to see whether the HRT has any effect but I’m hoping a combination of getting my hormones back to a better level and looking out for potential triggers and changing the way I respond to them might mean I can better manage or possibly avoid days of ideation altogether.