I lost an ex-boyfriend to suicide in April.

We dated 10 years ago at a time when both of us spent far too much time in pubs. He was bipolar, drank a lot, suffered from depression and was haunted by an ex’s abortion.

If only I could have one more conversation with him, I wonder if I could have helped more?

He wrote many articles about his mental health struggles, repeatedly trying to make light of a darkness that was suffocating him.

The outpouring of tributes since the heartbreaking news broke includes frequent mentions of red wine, pizza, laughter … and turmoil.

The mix of mental health and alcohol as a coping mechanism is a common cocktail — but it’s often a deadly one.

If we know a friend is struggling with their mental health, what can we actually do? Should we really be accompanying them to the bar? How can we practically help complicated friends that we fear suicide is not if but when? And, how are we meant to manage the immense feelings of guilt after someone in our circle (and heart) decides they can’t take life anymore?

Psychologist Dr Lyn O’Grady says, “It’s important to understand that suicide is incredibly complex and has many different contributing factors. It doesn’t just happen suddenly. The very nature of bipolar is that there are periods of escalated behaviour and periods of more depressed behaviour.”

THE CONNECTION BETWEEN SUICIDE AND MENTAL HEALTH

“People suffering from mental illness are at a higher risk — but not everyone with mental health issues becomes suicidal,” Dr O’Grady says. “Mental illness can be successfully managed with good treatment if people are getting the help they need.

“Professionals can help individuals understand and manage their own mental illness. They will talk through what coping strategies someone is using and help to unravel that. Alcohol or drug use are common strategies because they offer short-term escapism. But often they are unhelpful and can escalate over time.

“Seeking out mental health support is so important. We are working very hard to reduce the stigma around mental health, but we also have to acknowledge ‘self-stigma’. Often people don’t want to face up to their challenges or aren’t honest with those around them about how bad things have become.”

IS IT A GOOD SIGN IF SOMEONE TALKS ABOUT THEIR STRUGGLE?

“As you have seen, someone who uses creative writing may be trying to make sense of what they are feeling, but it doesn’t guarantee that’s going to be enough,” Dr O’Grady says.

“Sometimes, people can be doing great things in one respect but choosing other behaviours that aren’t helping. People can also be quite compulsive, so they may seem as if they’re doing OK, but that spiral can happen fast.

“Chronic suicidality can go on for years; some people talk about first having suicidal thoughts as children. For others, the thoughts are more fleeting.”

WHAT CAN WE DO TO HELP?

“Look for changes in behaviour. If someone’s relationship ends or they lose a job and they’ve attempted suicide before, they are at a higher risk.

“Mental health professionals in Australia are working hard to offer better support to people after they have attempted suicide. If nothing’s changed when they leave hospital, then nothing has changed and they remain at high risk. Finding local support is crucial.

“Ultimately, it is up to the person to reach out. Much as you may want to, you can’t force someone to take those steps.

“Ask them if you can call a helpline together, do some safety planning so they know what to do if they feel in crisis, try to guide them to helpful resources.

“Encourage someone you’re worried about to talk. Try to help them find relaxation and fun that doesn’t involve alcohol, and don’t forget about your own self-care.”

AND WHAT ABOUT THE GUILT?

“Guilt is a perfectly natural part of suicide bereavement,” Dr O’Grady says. “Family, friends and health professionals around that person will all be thinking, ‘I wish I’d done this or that’.

“Don’t push those feelings away; sit with them and give yourself time to process them. It’s perfectly normal to feel like you can’t concentrate on anything else for a few days, even weeks, but if time goes by and it’s not getting any better, you may want to seek out some help for yourself.”

Don’t suffer in silence, if you need help, call Lifeline on 13 11 14, Mensline on 1300 78 99 78 or Suicide Call Back Service 1300 659 467. You can read more advice on understanding suicide and grief at Support After Suicide.

Corrine Barraclough is a freelance writer. Continue the conversation @TweetCorrineB