“When I drive to work in the morning, I keep imagining what it would be like if I drove off the road or into the oncoming traffic…” My friend admitted to me the obtrusive thoughts were getting stronger. “I desperately wanted to help, but I wasn’t sure where to begin… ”
My friend proactively reached out to a psychiatrist and enrolled in an excellent support program that provided weeks of ongoing daily therapy. However, there were dark weeks when suicide watch was a scary reminder to both of us that the impulsive, obtrusive thoughts of suicide are real. My friend chose me as a support person, and every day for months, we followed a safety-plan outlined by the therapist. I asked questions and listened to countless hours of confused thoughts that slowly took on hope and worked through pain. Together we fought for my friend’s life, following the sage advice of professionals but with the security of compassionate love and support.
When my friend and I first talked, I wish I had known more approaches for how to do more than just want to help. I now know that suicide and its comorbid conditions like depression and anxiety are NOT the person, but rather the thoughts going through their minds. I also learned that several helpful approaches can be taken to linking our loved ones to professional help while still providing love and support. Learning more about these approaches will enable you to support your loved ones as well.
In the United States, over 47,000 lives were lost to suicide in 2017. [i] Globally, nearly 800,000 people die from suicide annually – one person every 40 seconds. [ii] Suicide is also on the rise among young people. Since the mid 2000s, suicidal ideation, plans, attempts, and deaths have increased among 12- to 25-year-olds. [iii] Exact numbers vary depending on location, socio-economic status, education levels, or racial populations, but in general, half of suicide attempters die in their first attempt. [iv]
Who seems to be at greatest risk for suicide? Individuals whose depression began in adolescence are five more times likely to attempt suicide and have an increased risk of death by suicide. [v] Although many suicides have been linked with having mental disorders (like depression or bipolar disorder) at the time of death, half of deaths by suicide do not have a known diagnosed mental health condition. [v, vi] Other factors contributing to suicide can include relationship problems, substance abuse, or physical health problems, as well as money, job, legal, or housing stresses.
But suicide is so much more than raw statistics across the page in front of you. Suicide, attempted suicide, and suicidal ideations represent immense emotions, confusion, pain, uncertainty, guilt, apathy, hopelessness, desperation, and a plethora of other experiences and feelings.
Suicide is unfortunately a complex issue influenced by a myriad of risk factors. Numerous scientific explanations and prevention techniques exist. With the rise in suicide among adolescents and adults alike, understanding a healthy approach to talking about suicide with family and loved ones is an active step we can each take in combating this significant cause of death across the globe.
Mental health illnesses are tied with many suicide deaths, which means preventing suicides among individuals suffering from mental disorders is vital. Being able to recognize the hallmark symptoms of mental conditions is advantageous, as is realizing when loved ones exhibit changes in patterns and interests in order to help break barriers to seeking professional care.
HOW DO WE HELP?
Learn the Warning Signs.
Be aware of how to detect warning signs of suicide. The Center for Disease Control and Detection (CDC) recommends these identifiers: [vii]
Thinking or talking about or threatening suicide; seeking a way to kill oneself; increased substance abuse; feelings of purposelessness, anxiety, being trapped, or hopeless; withdrawing from people and activities; and expressing unusual anger, recklessness, or mood changes.
“Are you thinking about suicide?”, “Are you hurting?”, “How can I help?” are appropriate questions to ask someone without judgment and clear purpose. Asking how someone is doing in this way can allow them to open up to their emotional pain and open the door for help with their situation. Important elements of this step are listening to the reasons for their pain as well as their potential reasons to live. You can see many reasons why they should live; but it’s important for them to acknowledge reasons to keep living. Asking questions does not increase suicide or suicidal thoughts, but rather the acknowledgment and transparency about suicide can decrease suicidal ideation. [viii]
Next, we need to keep suicidal individuals safe. To do so, you need to find out their suicide plan. Has the individual harmed himself before you talked? Does he have a plan to kill himself? Is the plan detailed, specific? When is he planning on carrying out this plan? Does he have access to do what he is planning?
After these questions are answered, you will have a better idea of how imminent the danger is. The more detailed the plan, the higher their risk is to actually fulfill it. If you don’t know what to do next, suicide is imminent, or you’re facing an emergency, call the National Suicide Prevention Lifeline for help: 1-800-273-TALK (8255) and 911.
When to call 911 or go to the ER
Do not leave suicidal persons alone until you get them to the ER or emergency personal arrive on the scene. No suicidal threat or comment is to be taken lightly. If a person exhibits any of the following signs, get help immediately:
- in the act of hurting or killing himself, has a weapon or other lethal means
- threatening to hurt or kill himself
- looking for ways to hurt or kill himself, talking about a plan to do so
- talking about death or suicide and is acting anxious or agitated
- talking about death or suicide and is intoxicated or “high” on drugs [ix]
After determining how to keep them safe, it’s important to be there for suicidal persons. This can be accomplished by physically being in the same place or providing emotional support by text or phone. If you’re not physically present, talk with them about who they can reach out to that can be there to be with them at a moment’s notice.
Help them get connected.
This is where support groups come in. Help your loved one connect with some sort of support group that provides ongoing support. This may include hospitalizations, partial inpatient programs, or group therapy programs to provide support and connection during moments of crisis. A way to help get your loved one connected is to create a basic safety plan that will associate them with professional help. It is imperative to communicate without judgment with the suicidal person and make this plan with a trained professional. Staying true to your word is vital. But don’t ever promise that you won’t help them seek help from the appropriate professionals. You can and will save lives because of being there for your loved one with unconditional love and support.
Once your loved one is connected to professional support, find out how they are doing. Studies show that following up with suicidal individuals may be important to preventing suicides, so please check in with your loved one consistently in the following months. [x]
Providing a non-judgmental, supportive approach to supporting your loved ones is important when the dangerous thoughts of ending life flash through their minds. Do not be afraid to ask the hard questions. Many of us may not be comfortable talking about things as personal as our very reasons or lack of reasons for living, but broaching this subject with careful vulnerability and without prejudice will save lives.
About the author:
Cami Martin, MPH, is the assistant director for the residential Nedley Depression & Anxiety Recovery Program and the assistant manager for Nedley Health Solutions (NHS) and Nedley Clinic.
*****[i] Suicide. (2019, April). NIMH. Retrieved May 22, 2019, from https://www.nimh.nih.gov/health/statistics/suicide.shtml [ii] Suicide data. (2018). WHO. Retrieved May 29, 2019, from https://www.who.int/mental_health/prevention/suicide/suicideprevent/en/ [iii] Twenge, J.M., Cooper, A.B., Duffy, M.E., Joiner, T.E., Binau, S.G. (2019). Age, Period, and Cohort Trends in Mood Disorder Indicators and Suicide Related Outcomes in a Nationally Representative Dataset. Journal of Abnormal Psychology. 2005–2017, Vol. 128, No. 3, http://dx.doi.org/10.1037/abn0000410 [iv] Isometsä E. (2014). Suicidal behaviour in mood disorders–who, when, and why?. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 59(3), 120–130. doi:10.1177/070674371405900303 [v] Weissman, M. M., et al. (1999). Depressed adolescents grown up. Journal of the American Medical Association, 281, 1707– 1713. http://dx.doi.org/10.1001/jama.281.18.1707 [vi] Suicide rates rising across the U.S. (n.d.). CDC. Retrieved May 22, 2019, from https://www.cdc.gov/media/releases/2018/p0607-suicide-prevention.html [vii] Suicide Among Youth. (n.d.). CDC. Retrieved May 22, 2019, from https://www.cdc.gov/healthcommunication/toolstemplates/entertainmented/tips/SuicideYouth.html [viii] Dazzi, T., Gribble, R., Wessely, S., & Fear, N. T. (2014, December). Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence? Retrieved May 23, 2019, from https://www.ncbi.nlm.nih.gov/pubmed/24998511 [ix] GET HELP NOW – Suicide Prevention App for Android and iPhone. (n.d.). Retrieved May 30, 2019, from https://my3app.org/get-help-now/ [x] Fleischmann, A. et al. (2008). Effectiveness of brief intervention and contact for suicide attempters: a randomized controlled trial in five countries. Retrieved May 30, 2019, from https://www.who.int/bulletin/volumes/86/9/07-046995.pdf