"It's Either Do It or Die"

Background: The role of self-management of suicidality was investigated as part of a larger qualitative study of suicidality among people with experience of mental illness in New Zealand. Aims: To understand how people self-manage suicidality, why they self-manage, and the effects that self-management may have on suicidal thoughts and behavior. Method: Twenty seven people with experience of mental illness and suicidality were interviewed. A narrative thematic analysis was performed. Results: People had either drifted into self-management (while still using or instead of using mental health services) or chosen self-management because they were unhappy with mental health services, desired independence, or had difficulty accessing services. Self-management of suicidality included: using active ways to reduce, distract, and protect themselves from suicidal thoughts and feelings; practical ways of looking after themselves; reframing thoughts; getting to know themselves better; and peer support. Conclusion: Self-management of suicidality can encourage independence and resilience, a sense of citizenship, mutuality, and achievement.