This tiny book… and gold coin… and wrist band… represent, for me, the first ever immediate device outside of ‘a chat over a cuppa’ which can significantly impact on the terrible toil on our youth taken by the scourge of suicide.

As an intensive care specialist with forty years’ experience in managing botched up attempts at suicide and near (and not so near) suicide attempt victims, I have come firmly to the conclusion that the bulk of these attempts have little to do with chronic mental illness and more with ‘impulsiveness’, that sudden ‘need’ to end it all and rid oneself of being a burden to others.  Many have no recollection of the event after they recover from their, often horrendous, injuries.  Most are remorseful of putting everyone to so much trouble.

Suicide revolves around feelings of loss of self-worth, of loathing for life, of hopelessness, of ‘insurmountable’ debt (often a paltry few hundred dollars) and inability to see the light at the end of the tunnel.  That... and an impulsive temperament to stop the pain quickly and efficiently.  Sometimes, these intrusive thoughts are aggravated by catastrophising, of thinking that all is going badly all the time and of making mountains out of molehills.  Most are youngsters with not a great depth of interpersonal support – university students away from home, international travellers, those with internal conflicts (eg gender identity, sexuality), gambling and the biggest of all, debt.   I should know.  At age 25, my favourite brother, 10 months younger than I, ended his life by blowing his brains out for, to me, no good reason.  He was a risk taker, gregarious and outgoing and had no psychiatric history and did not abuse illegal substances.  He was taking a few tablets of Doloxene for headache; a medication which has since been banned, in all countries except South Africa and France, because it causes suicidal ideation as a side-effect.

This book goes straight to the heart of the problem.  It slows down, using a variety of immediately available devices, the imperative of immediacy and introduces to those wishing to end their existence the seed that there may be One Reason why suicide is a poor option and that there are other choices.  I wish my brother had the tiny book in his breast pocket and his coin-in-a-box in his trouser pocket.  I am convinced that he would be here with us if someone, including me, had the vision to give him these great tools.

The content of the pocket sized ‘book’ is mostly written by the ‘victim’ in the empty pages so it is eternally ‘personalisable’.  The coin, which is infernally difficult to get out of its polycarbonate shell, acts as both a talisman and a delaying tactic.  Both devices give a flicker of hope in the blindness of grief and ‘madness’ of wanting out from society regardless of consequences. 

Stuart O’Neill has been very clever in transmitting to others what worked in practice for him.  It takes someone who has been through the fire more than once to devise a plan as cheap, smart and simple as this.  When at the pointy end of ‘doing the deed’ there is no time for referral to the best psychiatrist in town or to calling the psychology team for an appointment.

Just One Reason (for not committing suicide right now... in this place… using these means…) by looking for One Reason to not commit suicide, to give life another try, to choose another plan, to find a better choice and to see that there is hope also empowers those around these people in the depths of their despair by being able to throw them a cheap safety line.  Handing One Reason and the Coin and wearing the wrist bands expresses in the language of the 2020s, that here is a buddy, a family member, an acquaintance, a school mate, a mentor, a partner who cares and is happy to offer support and to walk a short way along the journey out of pain, loss and despair.

Much like defibrillators in shopping centres and places of worship, these tools should be readily available in bulk everywhere… to teachers, to careers advisors, to youth groups, to counsellors and pastors, to mental health practitioners, to tertiary education facilities, to worksites and hospitals…

This is a book straight from the horse’s mouth.  It has not been written by some highfalutin academic professor of psychiatry but by one who understands suicide up close and personal.  We should all carry a copy in our First Aid Kit. 

Stuart O’Neill, Just One Reason is simply brilliant.  ‘It gets it’ and attacks suicide in its weak underbelly… that suicide and denying yourself of ever making another choice, ever, is never the solution.  We are deeply indebted for your insightful offering, to the people of our state and to all those who have lost all hope, a great resource.

At last, a ray of real practical wisdom towards ending suicide.  A tool that actually works rather than weak platitudes and the application of depression labels to the distressed.  JOR will save many lives. - Well done.

Stephen Gatt,

Professor, Anestesi e Reanimasi, Udayana University, Bali

Associate Professor, Anaesthesia, Critical Care and Emergency Medicine, University of New South Wales.