Caroline Flack's death shows even outwardly confident people may need help – Michelle Scott

A friend who appears to be the 'life and soul of the party' could be most in need of help as people who struggle with depression or anxiety can try to create a façade of normality, writes Michelle Scott.

The late former Love Island presenter Caroline Flack seemed outwardly confident (Picture: Ian West)

Suicide by people in the public eye, such as the tragic loss of Caroline Flack at the weekend, is particularly shocking because celebrities may appear so outwardly confident, successful and sure of themselves.

This is part of the reason why it remains incredibly difficult to predict those most at risk of self-harm or suicide.

From my experience as a psychotherapist in Edinburgh, those who are struggling with low self-esteem, depression, anxiety or trauma will often isolate themselves from their friends and family because they have overwhelming feelings of shame.

The reflex to create a façade of normality leads to further feelings of disconnection and isolation because their friends don’t realise they are in trouble. Gradually the individual begins to believe they are abnormal. This negative belief system is incredibly difficult to disentangle.

For celebrities, as with all of us, there is a danger that we base our self-worth on the success of our career and relationships. Career setbacks are upsetting for everyone, but where this is played out in the full glare of the national media, there is nowhere to hide.

Equally, relationship problems can cause the individual to feel that they are unattractive and worthless.

Suicides by young people up 67% since 2010

For young people and adolescents, suicide is more likely than for people aged over 30 partly because young people are more impulsive. They may find it much harder to believe that their negative feelings will pass. They are also more likely to self-harm on an impulse. According to Office for National Statistics' figures, the number of people aged under 19 taking their own lives has risen by 67 per cent since 2010.

Working with young people in the first year of university, it is clear that this period of transition can be extremely unsettling. We see this across the university cities of Scotland – in St Andrews, Edinburgh, Glasgow and Aberdeen, young people are facing the same issues.

If you are already vulnerable or sensitive, the process of moving away from friends and family needs to be carefully managed. The stresses of exam preparation, making new friends, exploring relationships and sexuality, and ‘finding your tribe’ is a lot to take on board.

Even those who have a strong network of friends and family can find it difficult to access appropriate support. The problem is that friends and family don’t always know how to express empathy if they haven’t been in the same situation themselves.

The future can and will be better

For the person living those experiences, it is not helpful if other people tell them to “snap out of it” or “it’s not that bad”. It is far more helpful to be there with the patience to listen without judgement.

For some people, the pressure leads to addiction or other harmful behaviours.

People in a crisis need time and a language to be able to express their pain and then to take gradual steps towards recovery. It is incredibly helpful when others who have been in a similar place are willing to share their story publicly.

Healing begins when there is recognition that although there is something missing in life now, the future can and will be better.

Michelle Scott, of TRC Group in Edinburgh, specialises in long-term recovery from mental health problems