Why I'm Not OK With RUOK Day

I wasn't long into my tenure at Kotaku Australia; a few months, perhaps. It was the job I'd been working towards since primary school. And yet after the pieces had finally begun to fall into place, I found myself standing on a median strip, in the middle of a six-lane highway, one of the busiest in New South Wales.

I found myself standing there, wondering what would happen if I took a step forward into the path of the semi trailer passing by.

Obviously, RUOK Day is meant for people like me. Thing is, it's become the one day of the year I hate more than most.

If you didn’t know already, suicide has rapidly become one of Australia’s biggest killers. More than 2800 Australians were officially listed as having died from "intentional self-harm", the polite way of killing yourself.

If the number seems small, consider this: suicide is now officially the 13th most common cause of death in Australia, and the 10th most common cause of death for males.

And that's the amount of people who succeed. The Black Dog Institute estimates that around 21,000 in New South Wales alone try to kill themselves.

Just imagine how big the figure is for the whole country.

Chances are, if you haven't tried to kill yourself, you know someone who has, or you know someone who knows someone who has. If you're aged between 15-44, it's the leading underlying cause of death.

That's how common place suicide has become.

That's where things like RUOK Day emerge from.

Image: iStock

The principle behind RUOK Day is perfectly sound. In 1995, a son found himself growing up without a father. The son: Gavin Larkin, who became the founder of RUOK Day after being diagnosed with lymphoma.

Larkin's father, Barry, recorded some of his thoughts on audio tapes that Australian Story aired a few years ago. Anyone who's thought about suicide will be pretty familiar with willingness and ease at which your own mind sabotages itself.

"It's so easy to just slip into sadness and despair, and a chain of depressing or angry thoughts," Barry can be heard saying.

One of Barry's surviving sons later said "he ended up being isolated, and taking his life". And that's the point. If people aren't isolated, they're less likely to kill themselves.

And that's the main problem with RUOK Day.

Image: RUOK Day

A few years ago, in a previous office, someone wandered up to me in the kitchen and without thought, rhyme or reason, asked me if I was OK.

Rather than simply saying, "Sure, I'm fine", as office etiquette so often demands, I answered the question honestly.

I really didn't know if I was OK. Life wasn't terminal at that very second. But not that long ago, I wandered out to the balcony to hang up the washing and peered over the edge. What would it feel like if I hit the ground, I thought. I was completely fine only seconds before then — completely happy, in fact.

But that didn't stop my mind from being sabotaged. Because that's what it feels like: whenever things feel good, your brain tries to weigh the scales. Maybe that colleague really doesn't like you. Maybe someone is being deliberately incompetent to ruin your life. Maybe you should step into traffic.

There's no rhyme or reason to it all. So maybe I wasn't OK. I really didn't know. And I said as much.

Which is precisely the opposite thing you're supposed to do. You're not supposed to answer the question, because that's not socially acceptable. When RUOK Day rolls around and someone asks you if you're OK, it's not to start up a conversation about your mental health.

How do you even start a conversation about your own mental health in the middle of an office? And when someone starts, what the hell do you say? What can you say?

Image: iStock

What RUOK Day has become is an opportunity for people to ask a question. Being reminded of your connections, your friendships, what you have in this world, reduces the impulsion to leave it.

But the trick is to make an environment where people feel comfortable talking. The focus should be on getting the story told, not convincing someone to ask a question they're not prepared to hear the answer for.

This isn't to say that the day, and the foundation behind it, hasn't been of immense use. A friend on Facebook recently told a story about how they helped a close mate stop himself from "doing something stupid" after they asked if he was OK.

You can't put a price on time.

But the problem lies in what comes after the question. What happens after you get the response. That's why the question itself is so painful, almost offensive: because when you answer honestly, the questioner often has no answers.

And they're not supposed to. That's what psychologists, doctors, specialist services are for. But these days, even their capacity to help is diminished.

Jennie Hill recently pointed out how the increased awareness around suicide can actually be detrimental. If support services don't have the necessary resources to deal with the bottleneck of cases, it ends up feeding into the isolation and loneliness that so often becomes a precursor to suicide.

"Imagine if we had a day each year when we all went around asking cancer patients if they were “okay”, yet didn’t fund practical medical help for them or give them any hope," Hill wrote. "The idea is laughable, yet the analogy is real."

And as someone who feels like they've struggled, perhaps not as much as others — and that's another problem in and of itself — that's the irony of it all.

"Those of us who aren’t sick can pat ourselves on the back that we’ve done something good today, and go on with our lives."

Image: RUOK Day

I don't say this to be glib, or to shame or ostracise those who genuinely want to help. You can't fix something you don't understand.

But if you're going to ask someone, particularly without context, whether they're feeling alright, take it from me. Think about what the reply might be before asking the question.

And there's always the chance that someone — a colleague, a close friend, or a loved one — will end up telling you anyway, whether you're prepared or not.

There's a word for people in certain jobs and positions most likely to notice when people are at risk of suicide. They're called gatekeepers. They're typically people who are on the frontlines, such as nurses, paramedics, outreach workers, but they're also mothers, fathers, partners, teachers, sporting coaches.

According to the Breaking The Silence suicide prevention report, training and informing people in these sorts of roles is one of the best strategies for lowering suicide rates.

But it's not enough on its own. It's best applied when included as part of a community-wide initiative, something that increases availability of healthcare, while also reducing the stigma within that community and increasing the capacity for early intervention.

Of course, most of these options are dependent on knowing that someone is struggling in the first place. If they don't talk, if they continue to struggle in silence, then all the services in the world won't help.

And more often than not, healthcare services aren't helping either. The Black Dog Institute found 40 percent of people who attempted suicide and were admitted to hospital received no medical support afterwards.

People who try to end their lives once are the most likely to end their lives for good. And as Lifeline's report adds, most people who succeed tried to reach out for help:

Internationally, up to 83 percent of individuals who suicide have had contact with a primary care physician within a year of their death and between 50 and 66 percent within a month (Owens et al, 2009; Mann et al., 2005; Luoma, Martin, & Pearson, 2002; Andersen, Andersen, Rosholm, & Gram, 2000).
As Goldney (2008) points out ... a common theme among a number of studies maintains that mood disorders have often not been diagnosed in many of the individuals who have died by suicide. In instances where they had been, those people had often not received "adequate treatment for their depressive conditions" (Goldney, 2008, p.28).

Preventing suicide, clearly, takes a collective effort. It's a community wide approach; it involves your mother, your father, your friends, your colleagues, your workplace, your doctor, your hospital, your hobbies.

It's more than just a question. It's more than just one answer. It's an ongoing process that's bigger than a day; it's a problem that's bigger than a simple query over a cup of coffee.

What RUOK represents and what it symbolises is nothing short of pure goodwill. But the question needs to change. It's not about whether I'm OK, or whether your friends are OK.

It's about what you can do when I'm not. Are you prepared to listen? Are you prepared for the answer? And if someone reaches out for help, do they understand what to look for, what to say, what to do?

So often, they aren't. So often, services can't. That's why I'm no longer OK with RUOK Day, because it represents a problem that Australia wants to say it's solving, without fully putting in the measures necessary to fix it.

So stop asking if I'm OK. Just encourage me, and others who are struggling, to tell our story.

That's when we'll be OK, when we feel comfortable enough to speak, to reach out in our own way.


If you or someone you know is in need of crisis support or someone to talk to, contact the Lifeline Australia hotline at 13 11 14, the Suicide Call Back Service at 1300 65 94 67 or the Kids Helpline (for ages 5-25) at 1800 55 1800.


Comments

    I lie about it when I get asked because like you say - who wants to say 'no' in a crowded office with people you're not comfortable with? I've had two mental breakdowns, one of them almost at the stage of me being hospitalized for my own safety. I take medication (or did, I ran out and don't want to ask for time off to see my mental healthcare professional).

    I'm sure R U OK means well but honestly, I feel (in my workplace at least) the question is asked in jest, almost sarcastically.

      I made the mistake of admitting I was not OK at work.
      Now I don't have a job.
      Once the word got around that I had mental health issues, the management hierarchy couldn't get rid of me quick enough.
      So much for enlightened thinking about mental health.

    this was such a good article. I actually took the day off work on "R U OK" day so that I didnt have to reply or fake a "yeah im ok"

    I think it took a lot of guts to write this Alex. But I think you're way off base. Your poor experience does not reflect the positive outcome the day represents to me or to others. I have a lot of experience with suicidal depression. I've been to more funerals for suicides than any other type. I deal with its impacts on a daily basis. I know for a fact that RUOK day has helped people very close to me remember that they can talk to someone. And I know that the existence of such a day creates an opportunity for people to discuss these things--whether personally afflicted or not. And I read Jennie's piece on Medium this morning, and I think she's wrong as well. We don't fix Australia's unwillingness to talk about mental health issues by shutting down opportunities like this.

    I want to be asked if I'm ok. I want to ask those around me if they're ok. And yes, it's important to do that in a manner and situation that is appropriate and which provides the answerer with an opportunity to respond with 'no' and the discussion that follows. So for me, that means not asking the question on RUOK day necessarily. But I'll ask those people next time the opportunity arises, and I might not have ever thought to do that if it wasn't for the awareness provided by the concept of RUOK day.

      I think Alex made that point though: it is useful, but it would definitely be more useful if people had a better idea how to approach people.

      I definitely agree that RUOK is a force for good though.

      The point isn't to shut it down but for the day to evolve, become something else, something bigger. We're beyond asking the question. I think the national consciousness has reached that point now.

        Except we're clearly not beyond asking the question. Even comments here show that. It's apparently used as a joke by people in offices who think mental illness is worth joking about. That's not a fault of the day, that's a fault of the national consciousness.

        So I think the question still needs to be asked. But I think you raise a good point about changing how and where it's asked.

        I agree @joabyjojo. Perhaps R U OK day is mis-marketed as being about a simple question when in fact it's so much more?

        But it's not like they don't acknowledge and attempt to educate about the fact it's a bit bigger then an abbreviated sentence - see their website https://www.ruok.org.au/ask-a-mate?_rdr

        Last edited 09/09/16 5:45 pm

    the concept is fine, but all I've seen is light hearted attempts to make a joke out of asking RUOK.

    I can tell you at my low points, all I will ever say is 'I'm fine', and this day will not change that.

    I applaud the people behind this, because something is better than nothing.

      I agree to everything you said and can completely relate to your approach.

      Last edited 09/09/16 2:05 pm

    As someone who was in and out of depression for 16 years I can tell you that I am fully behind and support these days that draw attention to mental health issues. If I had someone ask me this question back then and if this day was as big as it is now when I was going through it, I would have loved to have people ask me.

    Even if there isn't infrastructure at the moment to support the calls/questions people have that result from these days, it highlights the fact that these departments/support groups need more funding. Without these days, they have no chance of getting it. Hopefully this changes in the future when the government can see what is the reality of what is happening with our society.

    Bring on more days like this I say. Society needs to know that this issue is huge and that then hopefully results in the stigma being reduced further and let's the sufferers know that they are not alone and there are those who will help them.

    Beautifully written and something I agree with. (Had a way less concise rant on Twitter yesterday. :P)

    Hey mate, I have absolutely no experience with depression other than talking with a close friend who suffers. On the other hand, I'm happy to listen if you ever want to talk at/to somebody and even though you might not be comfortable with me, I'll never actually know who you are so what does it matter, right?

    Get in touch if you want to chat.

    -J

    Nothing more I can add, totally sums up where I'm at with the idea.

    Very well said Alex AND those above! I can see that it might help some people, but having depression myself and having overheard / seen first hand how some people (including managers / former managers) discuss / gossip about even trivial details about other people certainly prevents me from giving an honest answer when asked "R U OK?"

      So, so true.

    Honestly I don't even do the standard "i'm good" for people asking how I am anymore. I'm not a miserable git telling everyone how awful life is, but I just kind of dodge it and ask how they are. Sitting on my break at work surrounded by RUOK posters, but life is hard, posters don't help, and neither does bringing crap to the workplace. Generally when people do offer help, they expect you to improve quickly with their help, otherwise they stop helping.

    Last edited 09/09/16 4:28 pm

    Hi Alex. It's not hard to hate things and be cynical when you're depressed, nor to fail to see the point of interventions like these. I'm sorry if your colleague was not prepared for your reality, but the next person to ask might be. I lost a friend to suicide and have had a year or two of wondering if I might join him. But I'm lucky that my circle of friends are practiced with depression (having lost more than one person to that black dog) and had no problem talking to me about it or checking in. It's not that way for everyone though and it's entirely possible that a great many people will have conversations that will save lives, because things like RUOK have made it more normal to do so. Maybe not your workplace, but somewhere.

    This is an extract from an email I sent around to my team a few years ago on RUOK Day, which was then (with my permission) circulated throughout our organisation. The feedback I got from it was pretty incredible.

    This isn’t for everyone. One of the problems with asking people if they’re OK is that they may say ‘No, I’m not.’. This can be quite confronting for some people, and they may not know what to do. THIS DOES NOT MAKE YOU A BAD PERSON! It is simply outside your area of experience. Remember, that by asking someone if they’re OK, you’re not offering to take on the role of their therapist. If you feel up to it, by all means listen to their problems, even offer advice. There are some tips for this here. If you don’t, try not to walk away or isolate the person. While the stigma of mental illness is not what it once was, too many people distance themselves from friends who have acknowledged that they’re sick because they don’t know what to do. Suggest they seek professional help – their GP is the best place to start. Then try to include them in things – social, professional, whatever – just as you did before you knew. If you ask me if I’m OK I might burst into tears. This isn’t a bad thing. I’m just really happy that you care. Just smile, give me a hug (or, as EEO policy suggests, pat me on the arm between the shoulder and the elbow) and carry on, knowing that you’ve really helped

    Last edited 09/09/16 5:20 pm

    I think before people go too much into the shortcomings of 'R U OK Day' they should pop over to the website and have a browse at the recommended approaches and tips and things to think about. Asking "R U OK" is just the first step. It's also listening. It's also exploring further if you think the person is just saying 'OK' without meaning it. It's thinking 'Am I the right person to ask this?'. If people glibly ask others in some sort of token sheep-mentality semi-joking manner, they're not acting in the spirit of the day.

    Also, it's not just a 'day'. It's a reminder to people that they should feel ok with asking this, and answering this, in a sincere and meaningful day *any day* of the year.

    R U OK? should be one of a thousand ways we say to each other 'I'm not sure if there's anything wrong, but we're all in this together, and i'm someone who cares enough not to fake it or ignore it if I think something's not right. If you don't want to talk, that's cool. But if you do, or you think you need help asking for help, that's cool too'

    R U OK day may not be for you. Maybe find what works. But if it works for even one person, i'm proud to be part of it.

    As a person dealing with fluctuating states of depression, how I am supposed to respond to this question from casual friends or acquaintances when my the people who I consider/ed my nearest and dearest haven't been able to handle it?

    I applaud the concept, it's far too casual for what could be a such a loaded response, and it's really only asked by do-gooders who, as good intentioned as they are, tend to be the type that you don't want invested in your personal business. That, and the wider insincerity around the question just makes me want to hide.

    TL;DR - "I'm fine."

    Sorry to hear that. Sincerely that is exactly why I say nothing when asked, Instead I make flippant excuse as to why I looked so worried or tired or whatever the signal I gave off was. No company wants the liability. Even without that you do not want your work associates to treat you differently. it only makes matters worse.

    So how do you deal with the sudden desire to step onto the bitumen?

    For me its a case of recognising that this is my mind playing chicken with me. If I step out I lose. I then back this up with knowing that if I do, there are people who actually want me around and I am being selfish in having those thoughts.

    Lastly I have come to terms as best as one can, that I am going to have these thoughts. I am going to wake up thinking those thoughts. I am going to transition from catching the bus to stepping out in front of it for no apparent reason. Because I have accepted that I am better prepared to win the game and not be the chicken.

    I think the problem is that there isn't a one size fits all approach to depression and suicide. Some people cope with depression by ignoring it, pretending it is not happening and being in complete denial. A question like 'Are you ok?' can help them stop and take stock of the situation and realise that they need help.

    Then there's other people who spend every waking thought and moment thinking about how they feel and how they can't change how they feel and how horrible they feel and those are the kinds of people that questions like that in casual situations don't help. They know they're not ok, they don't need reminders, they need to find ways to stop thinking so much and making themselves feel worse. I think the author is the latter kind of person and I can relate. When someone is working through something, often times they don't need to focus on their negative feelings but allow themselves to move past them and get out of 'the funk'.

    Maybe a better question is, 'how are you?' or 'how are you doing?' or 'how's it going?' . It's just a shame that most of these questions have just become phrases you say with no real meaning or intention, as I suspect 'RU OK?' is going to become without the support and change in attitudes the author talks about.

    I would really like to add something to this discussion. I want to start by saying I agree with @AlexWalker. I also disagree.
    Let me explain. I am the parent of a teenager with a mental ilness. He's not depressed per se, and isn't suicidal. But he is incapable of reasoning. He deliberately isolates himself from family and society in general. He has mild delusions and obsessive behaviours/thoughts. He is also prone to flying in to a rage over what are minor disagreements. Recently he assaulted my wife and I, requiring us to call the police, for the second time. He takes anti psychotic medication and anti depressants to control his mood and lessen the severity of the obsessions and delusions. They are significant dosages that seriously affect him so they have to be taken at night.
    My son is getting all the help he needs. He's consulting a doctor (psychiatrist) weekly and we are doing everything in our power to make his life manageable.
    And there is the problem. The emotional and psychological effort that this situation requires of us is immense.
    Both my wife and I have had to get assistance from mental health professionals as a result. This only began out of someone asking me if I was ok. I wasn't. I mean, I'm not.
    We have two small children at home as well that are exposed to his behaviour and outbursts. We feel totally impotent in relation to preventing them from being exposed to it. Most of the time it feels like I'm failing as a dad not being able to control the situation in my own house.

    Someone asked me if I was ok. I'm not. But I know I'm not alone in this battle we have with our son's illness. People care and want to know I'm looking after myself, because if I lose the ability to cope, my whole family falls apart.

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