How To Help Someone Who Is Suicidal

The most important step in helping someone who is suicidal is recognizing it. Several years ago, before my fiance, Dan committed suicide, I was pretty clueless about what the risks and warning signs for suicide really looked like. And for that reason I lost someone that I loved very much.

I had a stereotype firmly implanted in my head. It was an image of a person with their head hung low, tears falling from their eyes, a bottle of pills in one hand, a razor blade in the other. I imagined a person who had never really worked, due to a severely disabling, deep seated mental illness. I imagined they had been a burden on their family most of their lives, their illness being a source of constant disruption. This imaginary person would look at me with wild eyes. “I just can’t go on like this anymore,” they say, “I’m going to kill myself and then you’ll all be sorry.”

But Dan didn’t look anything like that image before he died, or before he attempted suicide three weeks before his death. He was the most financially, emotionally, and mentally sound person I had ever known. And I’m not exaggerating. I, in essence, stood in awe of him. I was kind of a mess when I met him and he literally AND figuratively picked me up and put me back on my feet. He fixed me. And I had no idea he was broken.

So, did I miss anything? Yes. Lots of things. I was a babe in the woods as far as suicide prevention and awareness. I don’t blame myself for not seeing anything before his suicide attempt. There were no warning signs. But afterwards,  when he came home from the hospital… I wish I had known then, what I know now. I simply didn’t realize how serious the situation was. To learn more about why people commit suicide, check out my past posts: Why Do People Commit Suicide? and They Don’t Want To Die. They Just Want Attention.

In order to help someone you think may be suicidal, first, recognize if the person is at risk for suicide. The following information is from The National Institute Of Mental Health:

What are the risk factors for suicide?

Research shows that risk factors for suicide include:

• depression and other mental disorders, or a substance-abuse disorder More than 90 percent of people who die by suicide have one, or both, of these 2 risk factors!
• prior suicide attempt
• family history of mental disorder or substance abuse
• family history of suicide
• family violence, including physical or sexual abuse
• firearms in the home, the method used in more than half of suicides
• traumatic life event such as divorce, or death of a loved one
• incarceration
• exposure to the suicidal behavior of others, such as family members, peers, or media figures.

Not everyone who experiences the above risk factors will attempt suicide. Here is a break down of how you can recognize the warning signs and what you can do to help.

The following information is from the wonderful blog Gemma Utting – Relationship Therapy. The original post that she wrote can be found here: Suicidal Friend? Please check her blog for lots of wonderful, helpful information – thanks Gemma! 

What has happened to the person recently?

• Have they ever attempted suicide before? The majority of people who commit suicide have attempted it before. This is the most serious warning sign! If I had just known how serious this one warning sign was, maybe I would have interacted differently with Dan after he was released from the hospital.
• Have they just ended a close relationship? Divorce or separation can feel like the death of a significant other to many people. They will need to go through the grieving process just as if their loved one had died.
• Has someone close to them just died? Grieving people need lots of support
• Have they lost a loved one to suicide? If the death of a loved one is due to suicide, the risk of suicide is the greatest!
• Have they had a recent “bad-news” medical diagnosis? This can be the scariest thing a person will ever face in their life.
• Have they been recently discharged from prison? Adjusting to the “outside” can be emotionally and mentally traumatic.
• Have they recently been financially devastated (could be through losing a job)?
• Have they had a recent publicly humiliating experience?
• Have they recently been in a war zone? The statistics for veteran depression, PTSD, and suicide are alarming!
• Have they been bullied? A common trigger for teen suicide.
• Have they recently “come out” as LGBT and been met with hostility? Another common trigger for suicide. 

What has the person been saying?

• “Nothing brings me pleasure any more.”
• “You’d all be better off without me.”
• “Life’s pretty pointless.”
• “I’m in so much pain.”
• “I can’t face another Christmas like this.”
• “It’s too late – I’ve nothing to live for.”
• “Nobody understands.”
• “I can’t face (people at work/my family/kids at school/etc.) again.”
• “This will all be over soon.”
• “I’m worth more to my family dead than alive.”
• “It’s hard to find the energy to even get out of bed.”
• “I just wish I could sleep all day.”
• “This is never going to get better/there is no hope.”
• Talking about stories of other people’s suicide in an apparent attempt to see what your reaction will be.

What has the person been doing?

• Have they given loads of stuff away lately?
• Have they bought something expensive like a boat even when facing financial hardship?
• Do they have wild mood swings from very low to very manic?
• Have they been suddenly “getting their affairs in order”, ie: increasing life insurance, writing wills, verbalizing who should get what, expressing how their funeral should be conducted, etc.?
• Are they overdoing drugs or alcohol?
• Are they reading about suicide?
• Did they suddenly go from being very depressed to seemingly happy over night? Many people become euphoric when the final decision has been made and they feel as if their pain is close to an end.
• Are they isolating themselves from others? not returning phone calls, emails, etc?
• Are they hoarding pills or buying weapons?

Any one of these alone isn’t enough to lead a person to suicide, but if you begin to connect the dots and have some inkling your friend is in deep emotional pain,

3 Things to remember!

• Very few people are 100% committed to ending their life. This means they will have mixed feelings: part of them just wants to end the pain, but part of them is scanning for any signs of hope and help. You’ll be speaking directly to that part of them that wants to live.
• Talking to your friend about suicide will not make them suicidal.
• You won’t get this wrong if you care.

What should you say:

Part 1 – Connect

• Ask for some time with your friend
• Tell them the things you’ve noticed about them that has you concerned
• Let them know you are worried about them and you care
• Ask them what’s going on
• Listen very carefully

Part 2 – Understand

• Work to understand all the things troubling your friend
• When you think he or she has said everything, ask “What else is troubling you”?
• Stay warm, empathic and attentive

Part 3 – Ask the 5 Questions

After the person has shared their feelings with you, it’s time to get specific. Ask each of the five questions below, pausing between each question to listen to the answers:

• “Are you thinking of killing yourself?”
• “How do you plan to kill yourself?”
• “Do you have what you need?”
• “Have you ever tried before?” If so, when and how?”
• “What’s the hurry? Why now?”

Part 4 – How “LETHAL” [to themselves] is your friend?

If your friend answers “Yes – I have been thinking about suicide actually” notice how the answers to the next four questions will frame what you do next in terms of how LETHAL their plan is.

You ask “How do you plan to kill yourself?”

• Low lethality response: “Well, you know, I wish I could just take a few too many pills one night.”
• High lethality response: “I plan to shoot myself.”

You ask “Do you have what you need?”

• Low lethality response: “I’ve got a few tramadol, but I guess I’d have to get a prescription for a whole lot more.”
• High lethality response: “Yes, I have a loaded gun in my house.”

You ask “Have you ever tried before?” If so, when and how?”

• Low lethality response: “Oh no – I’ve felt bad from time to time like this, but even though I talk about it – just as a way to feel like I could end the pain, you know – I’ve never tried anything.”
• High lethality response: “Yes. Took an overdose 6 months ago – ended up getting my stomach pumped since I didn’t take enough and my wife found me. This time I’ll make sure I finish the job.”

You ask “What’s the hurry? Why now?”

• Low lethality response: “I’m not sure why now – I’ve been slipping in to a lower and lower mood I guess, but come to think of it, I’d like to see my granddaughter’s Christmas play.”
• High lethality response: “Well, tomorrow is the 5th anniversary of my son’s death over in Afghanistan. I’ve never forgiven myself for pressuring him enlist. Told him he’d amount to nothing if he didn’t get some discipline. The wife left me over it. I told myself last year when she left me, that I couldn’t face that anniversary again.”

You get the picture right – the person who is thinking about maybe getting a prescription is not in the same urgency bracket at the second man – whose pain is exquisite, and whose means and time frame are immediate.

• If you are still not sure however, you can always ask: “On a scale of 1 to 10, where 1 is no way will you kill yourself any time soon and 10 is you don’t plan to see tomorrow, where are you?”

Part 5 – Take Action

Remember – you are talking to that part of this person who wants to believe there is hope for a future. Hope for the pain to pass. Even the broken father in the scenario above will have a small % of himself clinging to life.

If your friend’s plan is on the low lethality spectrum, let them know~

• You are very concerned.
• You care about them and want them to find more happiness.
• You know they have mixed feelings – part of them just wants to end the pain, and part of them wants to believe life can be good again.
• Erase the stigma! Let them know depression is a medical condition like any other, and can be treated with the proper medical care. Our society looks down on mental illness and as a result, many are ashamed to admit they have a problem.
• Ask them if they will commit to getting some help – seeing their local doctor, seeing a mental health specialist, talking with family, meeting with you again, etc.
• Elicit a promise from them that if they begin to feel more suicidal, they will contact you before committing suicide. It’s not a guarantee and certainly does not always work, but many times suicidal people will honor these kinds of promises.
• Continue to touch base with them on a regular basis until you are sure the crises is over. Be as straight forward and direct as ever. Depression can not be cured over night, and they will most likely need your direct support for a while to come.

If your friend’s plan is on the high lethality spectrum, let them know~

• You are very concerned.
• Erase the stigma! Let them know depression is a medical condition like any other, and can be treated with the proper medical care. Our society looks down on mental illness and as a result, many are ashamed to admit they have a problem.
• Tell them that even though it seems they are hell-bent on ending their lives, you know there is some small % of them that wants to live.
• Tell them you are talking to that part – even if it is only 2% of them.
• Tell that part you are taking them to the hospital right now.
• On the way, brainstorm for the names of any other beings on the planet who might be devastated if this person killed themselves – grand-kids, spouse, children, siblings, dear friends, dog… hunt for whatever you can that will connect this person to life.
• Remember – IF you’ve had this conversation it has clearly all been with the part of him or her who wants to live. If your friend wants to kill himself, he still can. Another day. Not on your watch.
• After the immediate crises is averted, continue to touch base with them on a regular basis. Be as straight forward and direct as ever. Depression can not be cured over night, and they will most likely need your direct support for a while to come.

Part 6 – Take Care of Yourself

• Whether your friend is successfully helped and ends up living a happier life, or completes suicide, you’ll probably need to talk about this with someone yourself. By all means use the resources listed in this post to get some help.
• Talk with your own trusted friend or family member, or join a support group. Helping a suicidal friend can be a traumatic experience, and many times there won’t be a happy ending.
• What ever the outcome, remember -

1. it’s not your fault
2. you did the best you could
3. you can no more cure your friend’s depression than you could cure her cancer
4. just like with cancer, or any other medical condition – even with the best care, sometimes depression is fatal

• If you are a survivor of suicide, or are grieving over any kind of loss, check out my past posts: Grief Is Not A Disease and Grief. Understanding And Surviving It.
• Bernadette and Amy have a great blog called Depression’s Collateral Damage which focuses on support for those who care for clinically depressed loved ones.

WHAT NOT TO SAY

Avoid the following ~

• “I know just what you mean.” You don’t, and it’s not about you just now.
• “Don’t worry – things will all work out.” Again, you don’t know, so don’t lie.
• “Suicide won’t solve any of your problems.” They aren’t looking to solve them, they are looking to end them.
• Cliche’s such as: “Suicide is a permanent solution to a temporary problem.” You will sound insincere, speak your own words.
• “You do it then – just go ahead and kill yourself!” Bluffs won’t make you feel good when they are carried out.
• “You’re so selfish to even consider suicide – you’ll just mess up your family.” Someone considering suicide is at the end of their rope, already strangled by guilt, and feeling un-entitled to pretty much even their next breath. Adding a guilt trip (however true this may be) will not help alleviate their mood of despair.
• “But you have so much to live for!” Again, you are not talking to a resourceful, rational being here.

Where to get help

• If you are in an emergency situation, call 9-1-1
• In the U.S. the National Suicide Prevention Lifeline  is available 24/7
• Here is a list of International Suicide Hotlines
• If the person is a friend from a social network, and you aren’t sure where they are located, check my post on How To Report Suicidal Content On Social Networks. There are links and instructions for the most popular networks. Your words and support are still just as important to them, so use all the same techniques and talking points to reach out and encourage them to get help. But if you are afraid for their lives, reporting them may become your last option.
• More resources can be found on my Resources/Support Page
• A stunning website devoted to helping you know how to help a friend in crises – Know The Signs.   Deena Siddle over at the wonderfully inspiring blog – One Woman Delivered  suggested this site. Thanks for sharing, Deena! 
• Here is another super link to the Helplines Resources Page at the billierard blog written by someone who struggles with depression and self harm. There are lots of resources for the UK and other international helplines. Thanks for you honesty in sharing your story, billierard, and reaching out to help others!
• If you know of other great hotline/support groups that aren’t listed here, please leave a comment!

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What do you think? Have you ever been suicidal? Have you ever helped someone who has? What is your advice to someone who is trying to help a friend in crises? Sharing is caring!