If you or someone you know may be considering suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255 (En Español: 1-888-628-9454; Deaf and Hard of Hearing: 1-800-799-4889) or the Crisis Text Line by texting HOME to 741741.
If you know someone struggling with #despair, #depression or thoughts of #suicide, you may be wondering how to help.
Most Americans say that they understand that #suicide is preventable and that they would act to help someone they know who is at risk, according to a national survey conducted by the American Foundation for Suicide Prevention and the National Action Alliance for Suicide Prevention in 2018.
Yet many of us are afraid to do the wrong thing. In fact, you don’t have to be a trained professional to help, says Doreen Marshall, a psychologist and vice president of programs at the AFSP.
“Everyone has a role to play in #suicideprevention,” she says. But “most people hold back. We often say, ‘Trust your gut. If you’re worried about someone, take that step.’ ”
And that first step starts with simply reaching out, says Marshall. It may seem like a small thing, but #survivors of #suicide attempts and #suicide experts say, it can go a long way.
Simple acts of connection are powerful, says Ursula Whiteside, a psychologist and a faculty member at the #UniversityofWashington.
“Looking out for each other in general reduces [suicide] risk,” says Whiteside. “Because people who feel connected are less likely to kill themselves.”
And “the earlier you catch someone,” she adds, “the less they have to suffer.”
Here are nine things you can do that can make a difference
If You Need Help: Resources
For more help:
- Find 5 Action Steps for helping someone who may be suicidal, from the National Suicide Prevention Lifeline.
- Six questions to ask to help assess the severity of someone’s suicide risk, from the Columbia Lighthouse Project.
- To prevent a future crisis, here’s how to help someone make a safety plan.
1. Recognize the warning signs
Signs of suicide risk to watch for include changes in mood and behavior, Marshall says.
“For example, someone who is usually part of a group or activity and you notice that they stop showing up,” explains Marshall. “Someone who is usually pretty even-tempered, and you see they are easily frustrated or angry.”
Other signs include feeling depressed, anxious, irritable or losing interest in things.
Pay attention to a person’s words, too.
“They may talk about wanting to end their lives or seeing no purpose or wanting to go to sleep and never wake up,” says Marshall. “Those are signs that they may be thinking about [suicide]. It may be couched as a need to get away from, or escape the pain.”
According to the AFSP, people who take their own lives often show a combination of these warning signs.
And the signs can be different for different individuals, says Madelyn Gould, a professor of epidemiology in psychiatry at Columbia University who studies suicide and suicide prevention.
“For some people, it might be starting to have difficulty sleeping,” she says. Someone else might easily feel humiliated or rejected.
“Each one of these things can put [someone] more at risk,” explains Gould, “Until at some point, [they’re] not in control anymore.”
2. Reach out and ask, “Are you OK?”
So, what do you do when you notice someone is struggling and you fear they may be considering #suicide?
Reach out, check in and show you care, say #suicideprevention experts.
“The very nature of someone struggling with #suicide and #depression, [is that] they’re not likely to reach out,” says Marshall. “They feel like a burden to others.”
People who are having thoughts of #suicide often feel trapped and alone, explains DeQuincy Lezine, a psychologist and a member of the board of directors of the American Association of Suicidology. He is also a survivor of suicide attempts.
When someone reaches out and offers support, it reduces a person’s sense of isolation, he explains.
“Even if you can’t find the exact words [to say], the aspect that somebody cares makes a big difference,” says Lezine.
Questions like “Are you doing OK?” and statements like “If you need anything, let me know” are simple supportive gestures that can have a big impact on someone who’s in emotional pain, explains Julie DeGolier, a medical assistant in Seattle and a survivor of suicide attempts. It can interrupt the negative spiral that can lead to crisis.
The website for the #NationalSuicidePreventionLifeline has a list of do’s and don’ts when trying to help someone at risk.
Opposite Action — Tips from Survivors
From the suicide prevention site, Now Matters Now, this video offers examples of “opposite action,” a suicide prevention technique derived from dialectical behavior therapy. The technique guides people to choose actions that help them embrace life instead of withdrawing when they’re struggling with suicidal feelings.
3. Be direct: Ask about suicide
“Most people are afraid to ask about #suicide because they [think they] don’t want to put the thought in their head,” says Marshall. “But there’s no research to support that.”
Instead, she and other #suicideprevention experts say discussing #suicide directly and compassionately with a person at risk is key to preventing it.
One can ask a direct question like, “Have you ever had thoughts of #suicide?” says Marshall.
More general questions like, “What do you think of people who kill themselves?” can also open up a conversation about #suicide, says Gould. “Now they are talking about it when you might not have had the conversation before.”
4. Assess risk and don’t panic: Suicidal feelings aren’t always an emergency
Say a loved one confides in you that they have been thinking about #suicide. What do you do then?
“Don’t let yourself panic,” says Whiteside.
People often believe that a person considering #suicide needs to be rushed to the hospital. But “not everyone who expressed these thoughts needs to be hospitalized immediately,” says Marshall.
Research shows that most people who’ve had suicidal thoughts haven’t had the kind of overpowering thoughts that might push them to make an attempt explains Whiteside. In other words, many more people experience suicidal thoughts than take action on them.
But how do you know whether your loved one’s situation is an immediate crisis?
Whiteside suggests asking direct questions like: “Are you thinking of killing yourself in the next day or so?” and “How strong are those urges?”
For help with this conversation, psychiatrists at Columbia University have developed the Columbia Protocol, which is a risk-assessment tool drawn from their research-based suicide severity rating scale. It walks you through six questions to ask your loved one about whether they’ve had thoughts about #suicide and about the means of #suicide and whether they have worked out the details of how they would carry out their plan.
Someone who has a plan at hand is at a high risk of acting on it — according to the Suicide Prevention Resource Center, about 38 percent of people who have made a plan go on to make an attempt.
5. If it’s a crisis, stick around
So what if you’ve assessed risk and you fear your loved one is in an immediate crisis? First, request them to hold off for a day or so, says Whiteside, at the same time being “validating and gentle.”
The kind of intense emotions that might make someone act on an impulse, “usually resolve or become manageable in less than 24 or 48 hours,” she says. If you can, offer to stay with them during that time period, she adds. Otherwise, help them find other immediate social support or medical help. They shouldn’t be alone at these times of crisis.
Ask whether they have any means of harming themselves at hand and work with them to remove those things from their environment. Research shows that removing or limiting access to means reduces suicide deaths.
The #NationalSuicidePreventionLifeline offers this guide to the five action steps to take if someone you know is imminent danger.
If you don’t feel confident about helping someone through a crisis period, call the National Suicide Prevention Lifeline, says Gould.
6. Listen and offer hope
If the person is not in immediate risk, it is still important to listen to them, say survivors of #suicide attempts like Lezine and DeGolier.
“The biggest thing is listening in an open-minded way, to not be judgmental,” says DeGolier.
“Don’t tell a person what to do. They’re looking to be heard, to have their feelings acknowledged.”
The next step is to offer hope, says Whiteside. It helps to say things like, “I know how strong you are. I’ve seen you get through hard things. I think we can get through this together,” she explains.
One of Lezine’s closest friends in college did just that during his #suicidal phases, he says.
“For one thing, she never lost faith in me,” says Lezine. “She always believed I have a positive life possible and I would achieve good things.”
He says her faith in him kept him from giving in to his despair completely.
“Having somebody, a confidante who absolutely believed as a person in [my] ability to do something meaningful in life” was instrumental in his recovery, he says.
7. Help your loved one make a safety plan
When a person is not in immediate risk of attempting #suicide, it’s a good time to think about preventing a future crisis.
“That’s where we want to make help-seeking and adaptive coping strategies a practice,” says Gould.
#Suicideprevention experts advise people to develop what’s known as a safety plan, which research has shown can help reduce suicide risk. It’s a simple plan for how to cope and get help when a crisis hits, and typically, an at-risk person and their #mentalhealth provider create it together, but a family member or friend can also help.
The #AmericanFoundationforSuicidePrevention has a template for creating a safety plan. It includes making a list of the person’s triggers and warning signs of a coming crisis, people they feel comfortable reaching out to for help and activities they can do to distract themselves during those times — it can be something simple as watching a funny movie.
Safety planning includes helping your loved one make their environment safer. This is one of the most important steps to preventing suicide, says Marshall. That involves a conversation about lethal means.
“If you ask what kinds of thoughts you’re having, they may tell you the means,” she says.
If they don’t volunteer that information, it’s worth asking them directly, she adds. Once they say what means they have thought of using, one can discuss with them how to limit their access to it.
“The more time and space you can put between the person and harming themselves, the better,” says Marshall. “If this is someone who is a firearm owner, you may talk with them to make sure they don’t have ready access to a firearm in moments of crisis.”
Understanding suicidal thoughts
This video from Now Matters Now explains what it’s like to experience suicidal thoughts, and how therapy can help people cope with them.
8. Help them tackle the mental health care system
When someone is in urgent crisis mode, it’s often not the best time to try to navigate the #mentalhealthcare system, says DeGolier. But to prevent a future crisis, offer to help your loved one connect with a #mentalhealthprofessional to find out whether medications can help them and to learn ways to manage their mood and #suicidal thinking.
A kind of talk therapy called dialectical behavior therapy, or DBT, has been shown to be effective in reducing the risk of #suicide. It teaches people strategies to calm their minds and distract themselves when the #suicidal thoughts surface.
It can be hard for someone who’s struggling with negative emotions to get and keep a #mentalhealth appointment. Family members and friends can help, notes Whiteside.
“Know that it takes persistence,” she says. “You don’t stop until you have an appointment for them. That may mean you call 30 people until you find someone who has availability. You take the day off from work, go with them.”
Lezine says he was fortunate to have had that kind of help and support from his college friend when he was struggling.
“One of the things that were helpful … was she went with me [to my appointment],” he says. “When you’re feeling really down and feeling like you don’t matter as much, you might not want to take time, or think that it’s worth the time, or feel like I don’t want to go through this.”
Many people don’t make it to their first appointment, or don’t follow up, he says. Having a person hold your hand through the process, accompany you to your appointments can prevent that.
“If somebody is sitting there with you, you can have eye contact, touch contact,” says Lezine. “It does make a difference, making you feel like you have another person who cares.”
9. Explore tools and support online
For those struggling to access #mentalhealth care, there are some evidence-based digital tools that can also help.
For example, there’s a smartphone app called Virtual Hope Box, which is modeled on cognitive behavioral therapy techniques. Research shows that veterans who were feeling suicidal and used the app were able to cope better with negative emotions.
Whiteside and her colleagues started a website called Now Matters Now, which offers videos with personal stories of suicide survivors talking about their own struggles and how they have overcome their #suicidalthoughts. Stories of survival and coping with #suicidalthoughts have been shown to have a positive effect on people at risk of #suicide.
The website also has videos that teach some simple skills that are otherwise taught by a therapist trained to offer DBT.
Those skills include mindfulness and paced breathing, which involves breathing with exhales that last longer than the inhales. Whiteside explains that this can calm the nervous system. Similarly, a cold shower or splashing ice water on one’s face or making eye contact with someone can distract and/or calm the person who is at immediate risk of taking their own life.
Surveys show that people who visit the website and watch the videos have a short-term reduction in their suicidal thoughts, she says.
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space. #http://bit.ly/JamesMentalHealthArticle