By Aileen Kim, MD
Part I of my educational series about suicide addressed how risk factors and warning signs for suicide can be recognized. In Part II of my educational series about suicide, I will address what a loved one of someone who may be suicidal can do to help.
The first step is speaking up. Speak about your feelings and observations. Ways to start a conversation about suicide:
"I have been feeling concerned about you lately."
"Recently, I have noticed some differences in you and wondered how you are doing."
"I wanted to check in with you because you haven’t seemed yourself lately."
Gather information about the situation.
Questions you can ask:
"When did you begin feeling like this?"
"Did something happen that made you start feeling this way?"
"How can I best support you right now?"
"Have you thought about getting help?"
Support the person who may be suicidal. Here are examples of what you might say that could help:
"You are not alone in this. I’m here for you."
"You may not believe it now, but the way you’re feeling will change."
"I may not be able to understand exactly how you feel, but I care about you and want to help."
"When you want to give up, tell yourself you will hold off for just one more day, hour, minute—whatever you can manage."
What if you’re not sure if someone you love is in immediate danger? The following questions can help you gather more information about the immediate risk for suicide:
Do you have a suicide plan? (PLAN)
Do you have what you need to carry out your plan (pills, gun, etc.)? (MEANS)
Do you know when you would do it? (TIME SET)
Do you intend to take your own life? (INTENTION)
People who answer “yes” to all four of these questions and have details in mind, as well as intend to take their life, are at very high risk of attempting suicide. Now, that being said, there are a lot of gray areas regarding answers to these questions. Negative answers to some or all of these questions do not guarantee someone is immediately safe from suicide. There are many other variables influencing immediate safety that these four basic questions do not address. The immediate risk of suicide may be unclear especially to someone who is not a mental health professional. Suicidal persons may not always be forthcoming even with those they trust and love, or be capable of thinking and communicating clearly when they are experiencing suicidal thoughts. For these reasons, if you are unsure or your intuition tells you the feedback from your loved one may not be accurate, ask a healthcare professional for advice.
Be yourself. Let the person know you care, that he/she is not alone. The right words are often unimportant. If you are concerned, your voice and manner will show it.
Listen. Let the suicidal person unload despair, vent anger. No matter how negative the conversation seems, the fact that it exists is a positive sign.
Be sympathetic, non-judgmental, patient, calm, accepting. Your friend or family member is doing the right thing by talking about his/her feelings.
Offer hope. Reassure the person that help is available and that the suicidal feelings are temporary. Let the person know that his or her life is important to you.
Take the person seriously. If the person says things like, “I’m so depressed, I can’t go on,” ask the question: “Are you having thoughts of suicide?” You are not putting ideas in their head, you are showing that you are concerned, that you take them seriously, and that it’s OK for them to share their pain with you.
Argue with the suicidal person. Avoid saying things like: "You have so much to live for," "Your suicide will hurt your family," or “Look on the bright side.”
Act shocked, lecture on the value of life, or say that suicide is wrong.
Promise confidentiality. Refuse to be sworn to secrecy. A life is at stake and you may need to speak to a mental health professional in order to keep the suicidal person safe. If you promise to keep your discussions secret, you may have to break your word.
Offer ways to fix their problems, or give advice, or make them feel like they have to justify their suicidal feelings. It is not about how bad the problem is, but how badly it’s hurting your friend or loved one.
Blame yourself. You can’t “fix” someone’s depression. Your loved one’s happiness, or lack thereof, is not your responsibility.
The content of this blog is intended as general educational material and is not a substitute for medical evaluation or advice in the context of a healthcare relationship. If you or someone you know is suicidal, call 1-800-273-8255 or seek immediate medical attention by calling 911.