It’s a Friday afternoon and I’m running late. The waiting room of our General Practice surgery is filled to bursting as I walk out to call my next patient, Brian (not his real name). He sullenly walks down the corridor to my consulting room without lifting his eyes from the carpet below. My words of greeting are not acknowledged as he sits down opposite me. The room is overwhelmed with silence. I ask how I can help. More silence. Brian dares a glance at me, before sheepishly telling me he was told to come in by his children. He is in his mid 50s with a balding head and sun-weathered skin. His children are in their 20s and 30s. He is divorced and lives alone. Brian wears a fluoro yellow and orange top and has rough hands that tell me he works in construction. After gentle probing, I hear about his friend who passed away 3 months ago from a heart attack. Brian is still grieving the loss of his friend, reflecting that it has hit him harder than he first thought. He finds himself fearful of the same fate. He isn’t sleeping and he feels drained constantly, with no motivation or energy to do anything. His children have noticed a change, despite their own busy lives, and so have his colleagues at work. Brian concludes by telling me that he wants to make sure his heart is ok. The heavy silence returns.

From here, our conversation can follow one of two paths. The first path is to let the silence hang over us before moving on and exclusively discussing his concerns over his heart and avoiding the messiness of discussing emotions. Alternatively, we could break the silence and address the proverbial elephant in the room by asking how he is really going – emotionally and physically. We take the path less travelled, as I ask Brian what his mood has been like. Slowly, tears well up in his eyes. He tells me he is anxious and afraid and doesn’t really know why. He tells me he feels like half the man he used to be, both at home and at work. He feels hopeless and alone. Brian says he drinks so that he can forget; or maybe he drinks so that he doesn’t feel the same weight of emptiness he feels when he’s sober. And finally, he tells me that he has thoughts about suicide… a lot of thoughts, in vivid detail, that terrify him.

Brian’s depression and his suicidal thoughts are unfortunately far from unique. In Australia alone, 3,027 people died from intentional self-harm in the year 2015. That means that approximately one person dies every 3 hours from suicide in Australia each and every day. For Australians aged 15-24 years, suicide accounts for a tragic 33.9% of deaths. Perhaps more alarmingly, it seems that suicide is on the rise, with suicide moving up to the 13th leading cause of death in Australia in 2015 compared to being the 14th leading cause in 2006. Suicide rates are also noticeably rising for the middle-aged (40-49 years) and elderly (80+ years) population groups. Suicide and other self-harm related deaths continue to be over-represented amongst the most vulnerable members of our society, including Indigenous Australians, the LGBTIQ community, those with mental health conditions and Australians living in rural and remote areas.

This information can have one of two effects on us. It can either desensitise us to the nearly inconceivable suffering a human being undergoes when the thought of living is equated to unending and pervasive pain. Or it can trigger empathy and a desire to see things change.

But how can things change? Silence and ignorance are the main enemies we fight in our battle against depression and suicide. We must become educated enough to recognise the factors that precipitate depression, and the warning signs that might indicate someone is having suicidal thoughts. We must be brave enough to raise our voices and ask the tough questions that will shed a light on how someone is truly feeling. We must be willing to step into a person’s life with love as they wrestle with terrifying existential questions, and be ready to offer a hand of hope, dignity and solidarity that encourages them to find meaning and purpose.  We must be wise enough to acknowledge that we are not immune from depression ourselves, and that we must therefore be willing to seek help if we find ourselves staring into the void. And we must be able to confidently know where we can turn to for extra assistance – whether it is Beyond Blue, Lifeline, your local community mental health worker or your local GP. 

After a couple more appointments, Brian agreed to commence antidepressant therapy and engage with a local psychologist under the government funded mental health care plan. Now Brian feels like himself again; he takes pride in his work, looks forward to his downtime with his friends, and feels closer and more connected to his children than he ever has. This isn’t because he started taking a ‘magic’ pill or because he spends one hour with a psychologist every so often. Rather, it’s because Brian recognized there was a problem and was brave enough to speak up and break the silence of depression. It’s because, when he did break the silence, he found himself surrounded by people who cared for him and supported him along his journey through the darkness. And after weeks and months of journeying, Brian knows he will never let the silence deafen him again.

If you, or someone you know is feeling the same pain and loneliness that Brian and many others have experienced, don’t stay silent – see your GP today to get help that is so readily available.