Understanding and Intervening With Suicide
The recent suicide of Robin Williams left many of us shocked, heartbroken, and confused. How could someone so funny and full of life be depressed enough to take such a drastic measure? In America, over 39,000 people commit suicide each year (Center for Disease Control and Prevention, 2012). That’s a staggering number that can leave many of us perplexed and wondering how so many can be experiencing such a dark depression without anyone noticing or intervening. Suicide can sometimes appear nonsensical and leave us thinking there were no warning signs. However, upon closer inspection that is often not the case. In fact, 50-75% of people who attempt suicide tell someone about their intention (American Foundation for Suicide Prevention, n.d.). Hopefully, the number of completed suicides will significantly decrease this upcoming year. In order for that to happen, we all must educate ourselves to recognize and appropriately intervene when someone we know may be suicidal.
The Signs of Suicide
Someone who is contemplating taking their life will often drop subtle clues in an attempt to see if others will notice their cry for help. Unfortunately, these clues often go unnoticed. Some common behaviors and warning signs that indicate suicidal ideation include:
· A previous suicide attempt
· Verbal threats such as “I wish I were dead” or “Life doesn’t matter anymore.”
· Significant behavioral changes such as an increase in risk-taking or an increase in becoming more reserved.
· Giving away possessions.
· An increase in alcohol or drug use.
· Increased isolation from others.
· Loss of interest in hobbies once enjoyed.
· Lack of interest in appearance.
· Change or loss in appetite or weight (Highlands Behavioral Health, n.d.)
This list is not exhaustive. For more warning signs please visit here. Take notice if you see any of these behaviors in your friends and loved ones. It can be difficult to confront such behaviors, but doing so can save someone’s life.
How To Intervene When You Suspect Someone is Suicidal
If you recognize any of these signs in someone, it is important to follow a few steps to get involved. To intervene effectively, one needs to do four things: ask, explore, disable, and resource.
First, ask about one’s suicidal intent. Do not shy away from asking this in a direct and clear way. It can surface a great deal of discomfort to think about asking such a bold question. However, you must step in if you think there is cause to be concerned. The best way to ask this question is directly and clearly. Do not downplay it or beat around the bush. Ask boldly. Some possible ways to do this include:
I have become concerned about you over the last few weeks, and I need to ask if you’re thinking about taking your life?
You have been in my thoughts this past week, and I’ve been uncomfortable by some of your recent comments. Are you thinking about committing suicide?
Many people balk at the thought of asking such bold questions, but being direct is important for a couple of reasons. First, clearly asking about someone’s suicidal intent externalizes the problem. When someone is in intense emotional pain, they tend to lack the ability to think about problems in a solution-focused way. Their problem solving typically becomes emotion-focused, which can lead to black and white, all-or-nothing thinking. When we are emotion-focused, our emotions can cloud our judgment and we have a greater tendency to make rash and illogical decisions.
In addition, directly asking about someone’s suicidal ideation can clearly communicate that you are actively responding to the signals or signs they have displayed either intentionally or unintentionally. Everyone desires to be noticed and cared about. When someone takes notice of our actions and comments, it sends a clear message that we matter and that others care about what we intend to do. Many think about taking their lives because they feel invisible and unnoticed. Directly asking questions can discredit the belief that no one notices or cares.
If you’re able to open the door of communication by asking, explore with them their reasons for dying and their reasons for living. If someone discloses they are feeling suicidal when you ask them about their intentions, simply ask them their reasons for wanting to take their life. You are not a professional therapist, so you do not need to respond to their reasons. It’s more important to simply listen. After listening thoroughly to their reasons for desiring to end their life, explore with them their reasons for living. It is rare that someone cannot find at least one reason for living. Maybe it is to take care of a beloved pet. Maybe it is to complete a project at work. Maybe it is to avoid causing pain to their friends and family. Everyone can find a reason for living. Help your person uncover their reason.
I remember doing an assessment with a sixth-grade boy who was hospitalized for his suicidal thoughts. When I visited him in the hospital, I asked him about his reasons for living. The reason he came up with: he wanted to finish the playground wars that were currently going on at his elementary school. We talked about the importance of his attendance at the playground wars and how his teachers and classmates would miss out if he could not participate in the activities and games he had committed to. Simply discussing the playground wars and the important role he had revitalized and reminded him there are things he enjoys that make life fun at times.
If a person gets stuck at this point, I have found asking the following question to be helpful:
Do you really want to commit suicide, or do you just want the pain to stop?
Such a question helps someone in intense emotional pain clarify his or her desires. Remember, when we are in emotional pain, our problem-solving tends to stay emotion-focused and irrational. Asking such a question forces someone to enter into a more solution-focused and rational stance separate from emotions. Stopping emotional pain is a solvable problem. Committing suicide is not. Help your loved one see the difference between these two options.
The third piece of intervention involves disabling any plans your loved one may have already made to end their life. If someone has expressed intent to take his or her life, you must ask another uncomfortable question:
How do you intend to kill yourself?
Asking such a question helps you know how to help them disable their plan. If they say they would do it by shooting themselves, then let them know that you must remove the guns from their house and keep them with you.
If they say they would do it by overdosing on medication, then let them know you will need to take their medications to lock up in a safe place.
Find the means they have thought of to take their life and disable the plan to decrease their likelihood of harming themselves.
The final piece to effectively intervene with someone suicidal is to offer resources. After helping them disable their plan, give them resources to reach out to when their thoughts become dark and suicidal again. If you feel comfortable, give them permission to call you over the next day until professional help can become involved. If you are uncomfortable with that, there are several hotlines and professional services in the Denver area that are valuable. Here are some I give out regularly:
- COMITIS Helpline: 303-343-9890 and http://www.comitis.org
- National Suicide Prevention Lifeline: 1-800-273-TALK (8255) and http://www.suicidepreventionlifeline.org
- Suicide.org: 1-800-784-2423
- National Hopeline Network: 1-800-442-HOPE (4673) and http://www.hopeline.com
- Denver Health Psychiatric ER: 303-602-7221
After you have completed these steps, it is imperative that you seek out professional help to intervene once you have verified suicidal intent. Call the police and a mental health professional to help assist you for the next steps.
Remember that growing in your awareness and skills to effectively notice and intervene when someone may be suicidal is incredibly important. Even if you can’t remember all of these steps perfectly, please remember this one important thing: be human.
Learn to be comfortable in the presence of pain.
Put down your phone. Be loving and attentive with the hearts of the people you know are depressed—and hug them or take their hand when they are courageous enough to talk about their very important pain. Physical human contact can penetrate suffering.
Make an effort to check in on your loved ones that you know are struggling. Even if they don’t answer their phones, go the extra mile to show you care. Make eye contact when they talk in mumbles. Practice the words “suicide” and “depression” so they roll off your tongue easily and effortlessly.
Cry with them.
Sit silently when you don’t know what to say. Don’t numb the awkwardness that human suffering can surface by simply muttering useless words that do not add anything valuable to the situation.
Being comfortable around suffering is a skill that will serve you well in the future; it will make you a better friend, spouse, and parent.
Not only will it make you a better person, it will also make you a more effective conduit to possibly save someone’s life.
American Foundation for Suicide Prevention. (n.d.). Risk factors and warning signs. Retrieved from http://www.afsp.org/preventing-suicide/risk-factors-and-warning-signs.
Center for Disease Control and Prevention. (2012). Suicide facts at a glance. Retrieved from http://www.cdc.gov/violenceprevention/pdf/suicide_datasheet_2012-a.pdf.
Highlands Behavioral Health. (n.d.). Family and friend’s guide to helping a loved one who is suicidal. Unpublished manuscript.