Month: November 2018

Tough Conversations: How to Speak with Someone Considering Suicide

Posted on November 17, 2018 by - Blog, Resources

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If you think someone is in immediate danger, you can help by calling a local crisis center, dialing 911, or taking the person to an emergency room. While your own safety should be your first priority, experts do not recommend that you leave someone with a severe risk of attempting suicide alone.

If you or someone you know is experiencing a crisis, contact the National Suicide Prevention Lifeline at 1-800-273-8255.

This article does not substitute for the need for professional counseling or crisis support. This is a framework for how to approach a conversation with someone who may be considering suicide.

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It’s not easy to talk about suicide. It can be even harder when you’re having a discussion with someone you think might be considering suicide. The following article provides strategies for having that difficult conversation and suggests actions you can take to connect the person to professional resources.


Part One: A Few Things to Think About

 

Preventing suicide begins with understanding and looking for its warning signs, which may look different for different people. You can read more about warning signs here, but the biggest “red flags” include[1][2][3]:

Warning signs that someone might be considering suicide
  • Talking about or joking about harming themselves
  • Talking about having no reason to live or feelings of hopelessness
  • Writing or talking a lot about death and dying
  • Seeking out objects that could be used to harm oneself, including drugs and weapons
  • Talking about being a problem or a burden to other people
  • Drastic changes in mood
  • Noticeable increase in use of alcohol or drugs
  • Giving away possessions or saying goodbye to friends and family

Additionally, the National Institute of Mental Health identifies the following risk factors that increase the likelihood that someone will attempt suicide (full list here). Remember: these risk factors do not mean someone will attempt suicide. Any person can exhibit risk factors for suicide, and it is nearly impossible to predict when someone will act on suicidal thoughts.

Suicide risk factors
  • Previous suicide attempts
  • Depression and other mental health disorders
  • Substance abuse    
  • Family history of attempting suicide or mental illness, including depression and anxiety
  • Presence of firearms in the home
  • Exposure to others’ suicidal behavior—such as that of a family member, peer, or public figure
  • Lack of access to or experience seeking mental health resources
  • Perceived and real disconnection from close social circles (e.g., family), community practices, or spiritual/faith practices
  • Age and point of development (e.g., higher risk between ages of 15-34)

Another reminder: having a conversation with someone considering suicide does not “put the idea into their mind.” Research does not support a connection between asking about suicide and suicide attempts.[4] The fear of unintentionally encouraging someone to consider suicide keeps many people from talking about mental health needs. In fact, directly asking about someone about suicidal thoughts can be the best way to determine if someone is at risk of harming themselves.

 

Part Two: Having the Conversation

 

Talking about suicide is not easy, and there is no such thing as a perfect conversation. The important thing is that you demonstrate your care for that person. To do so, it is important to ask directly if they’ve considered suicide and offer ideas and personal commitment to getting them help.

Based upon the best available suicide prevention research, here are a few “do’s” for having a difficult conversation about suicide[5]:

When having a difficult conversation about suicide, DO…
  • Ask directly if suicide has been a consideration. Asking does not encourage the idea and may actually come as a relief to the person you’re talking to—a relief that someone has noticed a change in behavior and cares about how they’re feeling.
  • Share what you’ve noticed. Placing thought and focus on noticeable behaviors may be a good way to begin a conversation and uncover any suicidal thoughts. An example?
    “I’ve noticed that you’ve been joking about dying a lot recently, and it seems like you’re not around as much. I’m worried about you and how you’ve been feeling lately.”
  • Consider the relationship. Are you especially close, or do you interact less frequently? The kind of relationship you have with a person that may be considering suicide could change the context of your conversation. Additionally, the person you’re concerned about might know they need help or want to talk about their feelings but may not want to talk with you. In any case, remember that the conversation isn’t about you, but the person you’re trying to support and treat them with the utmost respect.
  • Share your story, if you have one. While it’s important to listen to what the other person is experiencing, sometimes it’s easier to talk about problems if someone else “goes first.” You don’t have to share your life story. But, if you’ve seen a therapist, struggled with depression, or know someone who has attempted suicide, sharing these experiences can be helpful and help establish trust. If you aren’t comfortable with sharing your story, you may look to connect through someone else’s story or through recent news about mental health or suicide.
  • Listen more than you speak. A person contemplating suicide will need support speak to the pain, challenges, and overwhelming circumstances they are facing. What does support look like? Focusing attention on the needs of the person you are speaking to. By training yourself to actively listen and avoiding leading questions (e.g., “Are you feeling sad?”), you can ensure that the person you are speaking with feels heard and able to express their feelings without judgment.
  • Acknowledge the person’s courage and offer support. As much as this conversation isn’t easy for you, it is certainly not going to be easy for them. In fact, this might be the first time the other person has talked about their feelings in this way or has admitted they’re struggling. Let them know that you appreciate their honesty and validate their feelings.

Just as important as knowing what to do when talking with someone about suicide is knowing what not to do. Here are a few “don’t’s” for talking with someone who may be considering suicide[6]:

When having a difficult conversation about suicide, DON’T…
  • Focus on “fixing” or “saving” the person. Instead, think about your role as a supportive one if the person is not in immediate crisis. You may not be able to fully understand how they feel, but you share, at minimum, a common condition: being human.
  • Diagnose them. Instead of stating things such as, “I think you’re depressed,” try asking “How are you feeling?” For the person you are speaking with, this type of approach may feel less patronizing and gives them space to think about and share how they feel.
  • Argue with them. If they’ve been open with you about their feelings, saying things like “you have so much to be happy about,” or “you know it’ll hurt your family,” can make them feel guilty and not want to be honest with you. Again, it is important to focus on their needs first and foremost.
  • React harshly or in a very surprised way if they say that they have considered suicide. Communicate to them that you’re sorry they’ve experienced those feelings, that you’re sad to hear it, and demonstrate to them that you care about their well-being. A sense of surprise, shock, or shame may end a needed conversation. It can also stifle help-seeking behavior.
  • Promise confidentiality. Privacy and confidentiality are different. While you may not tell anyone about how the person is feeling, it may be critical to share this information with a mental health professional. In order to best support the person you’re speaking with, it’s best to avoid a situation in which you have to break a promise—and break their trust. Be clear about your responsibility as a bystander to help and support them to your best ability.

People are different and will respond differently to being asked difficult and personal questions. In any case, the purpose of the conversation is to check in with the person you’re concerned about. It’s important that you respect their boundaries if they’re not in immediate danger. If the person does respond that they have thought about suicide you can assess how immediate their risk is for suicide by asking the following questions:

  • Have you attempted suicide in the past?
  • Do you have a plan to harm yourself?
  • Do you have the means to carry out your plan? (e.g., access to pills or firearms)

Depending on their response, you may seek a variety of ways to help them find support they need. If someone is considering suicide, always seek to connect them with professional resources in your community. This can mean counseling, crisis lines, or behavioral health services.

If you suspect the person is in imminent danger—that they have specific plans to harm themselves—you can offer to drive them to a hospital or crisis center. You can also call 911 to get help. Do not leave them alone, but do not try to fend for yourself.

Regardless of what you do, be respectful of their concerns and make it easier for them to access mental health support. A person considering suicide is in a vulnerable position and should not be left alone.

 

Part Three: Next Steps

 

After listening to how the other person is feeling and assessing their risk for suicide (without diagnosing them), consider taking these actions:

  • Seek professional support through a therapist or campus counseling center. It can be encouraging to ask if they’re open to talking to someone or share your own experiences. You can also offer to walk them to a Counseling Center or therapist in your community to make an appointment. The goal is to be supportive and help them follow through with seeking help.
  • Make sure they know about the National Suicide Prevention Lifeline (1-800-273-8255). The Lifeline is made up of over 100 local crisis centers and available 24/7. In virtually any place, you can speak to someone who knows your home, the context of your life, and connect you with trusted resources in your community.
  • Ask the person what they think they need or what they think they should do.  Asking for their input can make the conversation seem less one-sided. Above all, this may give you a glimpse into the specific pains they face. Suicide is often considered as an escape from overwhelming circumstances or perceived and real feelings of entrapment. Knowing these pains can help you provide better support.
  • Remove potential threats from their path. Whether it is alcohol, drugs, or some form of weapon (e.g., firearm), do what is within your power to remove sources for self-harm. In some cases, this may not be something you can control. Regardless, it is important to work together with others to ensure they can’t access things that would result in suicide or self-harm.
  • Continue to follow up and show your support. Having one conversation isn’t likely to resolve suicidal thoughts for good. Suicidal thoughts can consume a person’s mind and is not driven by some small cause that can flutter away. After professional help has been sought, we would encourage you to continue checking in, asking the hard questions, and most importantly, offering hope.
  • Ensure you take care of yourself outside of this experience. Providing such intense, emotional support can take a toll on you. Make sure you take time for yourself outside of conversations and giving support. Connect with someone you can trust to talk about your experience, whether a family member or friend or a professional.

Having a conversation about mental health and suicide isn’t easy. It can be messy, non-linear, and very uncomfortable. No matter how difficult it is, the most important thing we can do to help someone is have a conversation.

The best way to prevent suicide is by talking about it, and by having a difficult conversation, you’re communicating that you care, that you are present, and that no one is alone. If you are struggling or know someone who might be struggling, consider having a conversation today.

Was this content helpful for you? Have you found other ways to help someone considering suicide? Share your thoughts with us here!

References:

[1] httpss://afsp.org/about-suicide/risk-factors-and-warning-signs/

[2] httpss://suicidepreventionlifeline.org/how-we-can-all-prevent-suicide/

[3] httpss://www.nimh.nih.gov/health/publications/suicide-faq/suicideinamericafaq-508_149986.pdf

[4] httpss://www.cambridge.org/core/services/aop-cambridge-core/content/view/FCAEE9E5BC840D76CF10AEBECD921AC9/S0033291714001299a.pdf/does_asking_about_suicide_and_related_behaviours_induce_suicidal_ideation_what_is_the_evidence.pdf

[5] Created based upon previous references.

[6] Assessed based upon previous references.

 

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