How to Talk About Suicide With the Person You Are Worried About
Never agree to keep thoughts of suicide a secret. Sometimes instinct tells us we have to break confidentiality.
It’s better to have someone alive and mad at you than dead by suicide and you feeling that you missed an opportunity to help them keep safe. We recommend treating this subject and the people involved with respect, dignity and compassion and don’t keep it to yourself. Know who you can connect with as this work cannot be done alone.
You may, as a helper, experience thoughts and feelings that are uncomfortable. It’s OK to reach out.
Talking about suicide can provide tremendous relief and being a listener is the best intervention anyone can give. Talking about suicide will not cause suicide.
When experiencing intense emotions, the person will not be able to problem solve. It is not your job to fix their problems. Listen, care, validate and be nonjudgmental.
Questions to Consider when you’re concerned
Resource: “Supporting your loved ones” Mark Lukach, Tedx Talk
(The responses to the following questions will enable you to reflect back your concern to the person and/or communicate to a trained professional.)
- Are you thinking of suicide?
- Have you tried to end your life before?
- Have you been feeling left out or alone?
- Have you been feeling like you’re a burden?
- Do you feel isolated and or disconnected?
- Are you experiencing the feeling of being trapped?
- Has someone close to you recently died by suicide?
- How are you thinking of ending your life?
- Do you have the means to do this (firearms, drugs, ropes)?
- Have you been drinking or taken any drugs or medications?
- How have you been sleeping?
- Are you feeling more anxious than usual?
- Who can we contact that you feel safe and/or comfortable with?
For the helper:
- Are you noticing or have you noticed any dramatic mood changes?
- Changes in work behavior or school attendance/marks dropping?
- Does the person seem to be out of touch with reality?
How to Talk to Suicidal Callers
by Kevin Caruso
- If you ever receive a phone call from someone who is suicidal, there are several things that you will want to do:
- Listen attentively to everything that the caller says, and try to learn as much as possible about what the caller’s problems are.
- Allow the caller to cry, scream or swear. Suicidal feelings are very powerful, so let them come out.
- Stay calm, and be supportive, sympathetic, and kind.
- Do not be judgmental or invalidate the person’s feelings. Let the caller express emotions without negative feedback.
- After you have a good understanding of the caller’s problems, summarize the problems back to him or her. This helps to preclude misunderstandings and demonstrates to the caller that you are being attentive.
- Then ask the caller, “Are you feeling so bad that you are thinking about suicide?”
If the answer is yes, ask, “Have you thought about how you would do it?”
If the answer is yes, ask, “Do you have what you need to do it?”
If the answer is yes, ask, “Have you thought about when you would do it?”
Here are those four important questions in abbreviated form:
- Have what you need?
The reason for asking these questions is to assess the level of risk of suicide for the caller. If the caller answers yes to three or four questions, the risk is very high, and immediate treatment is necessary. Try to get the individual to call 911 or go to an emergency room.
If the caller answered yes to one or two questions, try to determine if immediate treatment is necessary. If you deem that it is, try to get the individual to call 911 or go to an emergency room.
At a minimum, you should try to get the individual to see a therapist and a medical doctor as soon as possible. Gently explain that he or she probably has clinical depression or something similar and thus has a chemical imbalance in the brain, and that this is a very common condition, but definitely needs to be treated.
Only let the person go when you are sure that he or she is not in immediate danger of suicide. And, again, before you let the person go, emphasize that it is imperative that treatment is received. It is not an option, it is a requirement.
Handling a Call from a Suicidal Person
By David L. Conroy, PhD.
- Be yourself. The right words are unimportant. If you are concerned, your voice and manner will show it.
- Listen. Let the person unload despair, ventilate anger. If given an opportunity to do this, he or she will feel better by the end of the call. No matter how negative the call seems, the fact that it exists is a positive sign, a cry for help.
- Be sympathetic, non-judgmental, patient, calm, accepting. The caller has done the right thing by getting in touch with another person.
- If the caller is saying Im so depressed, I cant go on, ask The Question: Are you having thoughts of suicide? You are not putting ideas in his head, you are doing a good thing for him. You are showing him that you are concerned, that you take him seriously, that it is OK for him to share his pain with you.
- If the answer is yes, you can begin asking a series of further questions: Have you thought about how you would do it (PLAN); Have you got what you need (MEANS); Have you thought about when you would do it (TIME SET). 95% of all suicidal callers will answer no at some point in this series or indicate that the time is set for some date in the future. This will be a relief for both of you.
- Simply talking about their problems for a length of time will give suicidal people relief from loneliness and pent up feelings, awareness that another person cares, and a feeling of being understood. They also get tired — their body chemistry changes. These things take the edge off their agitated state and help them get through a bad night.
- Avoid arguments, problem solving, advice giving, quick referrals, belittling and making the caller feel that has to justify his suicidal feelings. It is not how bad the problem is, but how badly its hurting the person who has it.
- If the person is ingesting drugs, get the details (what, how much, alcohol, other medications, last meal, general health) and call Poison Control. A shift partner can call while you continue to talk to the person, or you can get the callers permission and do it yourself on another phone while the caller listens to your side of the conversation. If Poison Control recommends immediate medical assistance, ask if the caller has a nearby relative, friend, or neighbor who can assist with transportation or the ambulance. In a few cases the person will initially refuse needed medical assistance. Remember that the call is still a cry for help and stay with him in a sympathetic and non-judgmental way. Ask for his address and phone number in case he changes his mind. (Call the number to make sure its busy.) If your organization does not trace calls, be sure to tell him that.
- Do not go it alone. Get help during the call and debrief afterwards.
- Your caller may be concerned about someone else who is suicidal. Just listen, reassure him that he is doing the right thing by taking the situation seriously, and sympathize with his stressful situation. With some support, many third parties will work out reasonable courses of action on their own. In the rare case where the third party is really a first party, just listening will enable you to move toward his problems. You can ask, Have you ever been in a situation where you had thoughts of suicide?
The most important pain-coping resource is the help of a trained mental health professional. A person who feels suicidal should get help, and get it sooner rather than later.
After a Suicide Attempt: What Now?
If you are suffering about the suicide attempt of your loved one, no doubt you’re confused as to the best course of action to take. What should you expect? What should you do? In fact, this is the most critical time – immediately after an attempted suicide. But, what, exactly should you do now?
The first thing to do is to ensure the person is stable. This will most likely require hospitalization, depending on the method of the attempted suicide and how life-threatening the situation is at the present. The suicidal person cannot be left alone during the days immediately following the attempt. They are not rational, and, contrary to popular belief that once they’ve tried to commit suicide and failed, they won’t attempt it again, the truth is that many times they are likely to try it again at some time in the future.
For some persons admitted to the hospital following a suicide attempt, the greatest risk is the first few hours after admission. If possible, stay with the person as long as possible during visiting hours while he or she is in the hospital. If you can’t be there for the duration, ask others to help spell you. The idea is to monitor what’s going on with your loved one. This means asking lots of questions of the doctors and nurses, helping to comfort your loved one, and getting help for him or her if needed.
Suicide prevention experts caution that the person who has already attempted suicide may try death by suicide while they’re in the hospital. For others, this risk is greatest when they return home from the hospital.
Again, make sure that the individual is not left alone nor has access to any means of making good on their intention to do themselves in. This means sweeping the house for any prescription and over-the-counter drugs, poisons, knives and sharp objects, ropes and cords and, especially, firearms. If your loved one has been living alone, it’s best if you take him or her into your own home – or move in with them – to ensure their immediate safety.
If medications are prescribed, make sure that the individual takes them as directed. Many of the medications will help to stabilize mood, especially depression.
Pay attention to your loved one’s diet. Make it a point that he or she takes vitamins and supplements as recommended by the doctor in order to build up strength that’s probably been depleted. Often times, the suicidal person has neglected themselves to the extent that they are seriously malnourished.
Let Them Talk
During the time after the suicide attempt is when you want to engage the person in conversation as much as possible. Let him or her talk – as long and as often as they wish. In your comments, it’s important not to be judgmental or critical of the person. That is counterproductive and will discourage any opening up. It’s also very important to show how much you love the person. He or she is most likely devastated, feeling incredibly lost, ashamed, guilty, fearful of the future, and afraid, most of all, that you will withdraw your love.
Therapy Should Be First on the List
Your loved one needs professional counseling by a licensed and certified therapist. This must be primary on the list of short- and long-term priorities. In addition to individual counseling, group therapy may be recommended. Make sure the person attends every counseling session. Don’t allow them to slack off, since therapy takes time to work – and it’s often difficult and painful for the individual. The tendency is to minimize the risk, saying “I’m okay now. I don’t need any more therapy.” Don’t buy into this. Push, gently, for continued therapy.
Regular medical checkups are also a good idea. Following the suicide attempt, physical and/or mental changes occur, and healing takes time. If drugs and alcohol were also part of the individual’s lifestyle, these conditions need treatment as well.
Make Important Lifestyle Changes
Obviously, things can’t go back to the way they were before. This often means a severe change of lifestyle, but not always. In any case, some things have to change. Where there was no counseling, there now has to be. The suicidal person will not “get better” on their own. The reason they got to the point of despair, enough to want to end their life, won’t just go away. The underlying causes may not even be known or acknowledged by your loved one. All this has to be dealt with, and the best person to help in the recovery is a professional therapist.
Through therapy, your loved one will begin to discover the reasons that led him or her to attempt suicide. Depression, anxiety, fear, shame, disgust and other emotions will surface that are very powerful and very difficult and painful to deal with. The therapist will suggest short- and long-term behavioral changes that will help your loved one to better adjust to life.
There is no miraculous pill that will quell suicidal thoughts. There isn’t any set time period during which the person will be healed. Every person heals on their own timetable. Healing can’t be forced, no matter how much you or your loved one wants it.
Exercise plays an important part in rebuilding a healthy physical body. You, and other family members and friends, can help by encouraging your loved one to engage in sports, running, hiking, swimming, working out, or any strenuous physical activity. Be sure that this vigorous exercise takes place a minimum of four days a week, and for 30 minutes to an hour each day. Exercise produces endorphins, the body’s natural feel-good chemicals, which help to reduce feelings of depression.
Be aware that many persons who attempted suicide become withdrawn. They don’t want to talk. They don’t want any contact with others, including anyone from the outside world. Respect that feeling, but do encourage your loved one to go out and participate in activities again as he or she is ready to. Make sure you’re not too pushy on this point, however, as that can be misconstrued and backfire. When they are ready, take them out to activities and events – but don’t go anywhere that’s too stressful. Your loved one won’t be ready for that for quite a while.
Be Alert for Suicide Warning Signs
After the suicide attempt, it doesn’t mean you’re home free – no matter how much your loved one tells you not to worry. Although some individuals do not exhibit any warning signs prior to an attempted suicide, about 75 percent do show one or more signs. You do need to be alert for any of the following warning signs of suicide – as they can occur anytime during the days and weeks after the initial attempt:
• Depression or sadness all the time – Note that suicide prevention experts say untreated depression is the number one cause of suicide.
• Talking or writing about death or suicide
• Writing a will
• Giving away possessions, especially those the person holds most dear
• Dramatic mood changes
• Change in eating or sleeping habits
• Loss of interest in activities – especially those previously enjoyable
• Poor work or school performance
• Abuse of drugs or alcohol
• Change in personality
• Withdrawal from family members and friends
• Feelings of hopelessness, being helpless or feeling trapped
• Demonstrating strong feelings of anger or rage
• Acting impulsively or recklessly
• Feeling excessive shame and/or guilt
If your loved one is in immediate danger, call 911 without delay. Suicide prevention lifelines are available 24/7 – so make use of them if your loved one needs to talk with someone urgently. click here for Crisis Lines
Things Not To Do:
- Let the person, especially adolescents, be in control of their medication upon release from the hospital. Dispense the medication(s) yourself.
- Ignore it and hope things just get better.
- Tell everyone this is a family business and keep it a shameful secret
- Focus all your attention on the suicidal child to the exclusion of the other children.
- Hover and monitor every action of the loved one, never allowing him or her a minute to themselves.
- Blame, the family member who made the attempt.
- Blame yourself.
- Think it will never happen again.
- Try not to make statements such as “How could you do this to me?” or “What on earth were you thinking?” or “Whatever made you do it?”
Things To Do:
- Remove all guns from the house and restrict access to lethal means as much as possible
- Suggest a session with the therapist for them and for the family/caretakers before leaving the hospital.
- Get individual and family therapy
- Create scales for 3-5 emotions or thoughts such as loneliness, depression, or suicidal thoughts that can help gauge how he or she is doing and whether or not he or she needs your help.
- Family members need to be supported to deal with their own feelings/reactions. Reach out to trusted friends for help and encourage the rest of the family to do the same.
- Ask your mental health professonal for information on suicide and mental illness.
- Be gentle with yourself and remember to take care of yourself also.
- Try to make statements such as, “I’m sorry you felt that way and I wish I could have helped you,” or “I’m sorry I didn’t realize you were in such pain,” or” I can’t imagine how bad you must have felt,” or finally, “I want to help you, tell me what I can do to help you now.”
Making a Survivor Kit or Box:
Consider having your loved one make a survival kit or bos, where they can put music, pictures, poetry, anything that will help comfort them and respresent safety. If the attempt survivor believes it would be helpful, letters and objects to remind them of their value and the negative impact it would have if they killed themselves can be included. Then, whenever they are upset, they can go to the box and begin to focus on the moment and not the future.
Consider making hope cards, which are simply index cards. The attempt survivor and a supportive person sit down and write what causes them to feel suicidal on one side of the card and on the other side, they work together to create a list of things that can challenge or change these thoughts. For example , perhaps someone feels suicidal when they believe nobody cares for or loves them. On one side they may write, “unloved” and on the other side, they can list all the people in their life who do care about them and/or love them, such as parents, spouse, siblings, partner, friends, children, etc. The cards can be carried at all times and when these feelings come up the person can pull them out the stack of cards, read them and manage his or her feelings.
Resources and Help:
Keep yourself informed about things to do for your loved one. Helpful books and literature are readily available from a number of sources. The Feeling Blue Suicide Prevention Council is a non-profit community service organization serving Pennsylvania and the Tri-State Area. Their website contains a lot of helpful information and links. Here is a link to their booklet, “After an Attempt: The Emotional Impact of a Suicide Attempt on Families.” The booklet covers important Do’s and Don’ts, dealing with a traumatic event, what to say to the attempt survivor, ways the family can communicate their feelings, how an attempt affects spouses, siblings and parents, and additional resources.
The U.S. Department of Health and Human Services (HHS) National Suicide Prevention Lifeline has a downloadable booklet, “After an Attempt: A Guide for Taking Care of Your Family Member After Treatment in the Emergency Department.” The booklet covers what happens in the emergency department. First, there’s an assessment. The doctors determine any psychiatric or medical conditions present, determines if they are or have been treated, and if the suicidal thoughts or actions are the result of recent change or longstanding behavior. Next, the doctors seek to find out what the person did to harm themselves, and if there were previous attempts. They also ask if there are any current stressors, and/or anger in relationships. Doctors need to know what support systems there are, and who is or will be providing treatment, and what treatment programs are a good match for the individual and the family. The booklet further covers how you can help the emergency department, next steps after the emergency visit, what you need to know following the emergency department visit – how to keep your loved one safe, reduce risks, creating a safety plan, self care, moving forward and phone numbers for support groups.
The LifeLine Canada website has links to suicide prevention organizations and peer support organizations where you can find more resources and help throughout Canada, United States and Worldwide. Many of them have online libraries with downloadable publications, booklets and information to help family members following a suicide attempt by their loved one.
Should You Worry?
It’s natural to worry that your loved one may try another suicide attempt. But you can’t let this worry define you or derail your efforts to get professional help for him or her. You may also wish to undergo counseling yourself, to be better able to deal with the situation and feel better about helping your loved one on his or her journey to healing.
It’s important that you have your own support system in place. You can’t always be watching over your loved one, fearful that another attempt is imminent. This will just add to your stress level and make it impossible to maintain a serene environment. Get help around the house – whether that entails a friend or other family member coming over to be present while you take some needed away time, or while you work, or to transport your loved one to and from treatment or group meetings, or some other reason.
Remember that one of the most powerful emotions is love. The more you can show how much you love your family member that you nearly lost to suicide, the better off you both will be. Encourage other family members to be understanding, nonjudgmental and patient as well. It won’t be easy, and sometimes it may seem next to impossible. But your love and understanding will go a long way toward helping your loved one on the road to recovery.
From “After a Suicide Attempt: What Now?” : www.everythingaddiction.com