How You Can Help Prevent Suicide

September is suicide awareness month. While every month is designated to draw attention to a worthy cause, September is different. People want to do more than observe; they want to help, which is likely an indicator of how many Americans have been impacted. This article discusses tangible steps you can take to help people in your life who are at risk of suicide.

First, it is imperative to point out that suicidal ideation is a medical emergency. Immediately involve a mental health professional if you are confronted with acute suicidality. No one should try to manage such a situation alone. It is important to arm yourself with information that will help you recognize who is at risk, what the warning signs are, and what to do when those warning signs arise. With this knowledge, you can be part of the solution to a devastating problem.

And devastating it is. Suicide is the 10th-leading cause of death in the United States and the second-leading cause among teens. According to a 2018 report released by the CDC, rates of suicide increased in 49 states over the past 15 years. More than half of those who died did not have a diagnosed mental illness. Women attempt suicide in greater numbers than men, but men die by suicide more often. However, that gap is closing. All told, about 45,000 Americans die every year by suicide. Forty-five thousand families are irreversibly changed, ravaged with grief, and left to wonder what could have been. Knowing what to look for can help make a difference.

Who is at greatest risk of suicide? People who are suffering from depression or posttraumatic stress are particularly vulnerable, but severe stress puts those who are unencumbered by mental illness in jeopardy. Specifically, crises involving relationships, finances, and health are frequent precipitants to suicide. Isolation and lack of social support are often implicated. For teens, academic pressure, bullying, and hostile home environments pose significant risk. Substance use is also a key contributor, estimated to play a role in 28% of suicides. All of these factors should be taken into account in determining when action should be taken. But the question remains – how to proceed?

The first step in suicide prevention is to listen carefully. Is someone telling you something that might indicate that they are considering suicide? At times a person may something as clear as, “I’m thinking about killing myself.” These statements must be taken seriously. That sounds self-evident; however, statements such as these are sometimes attributed to attention-seeking behavior. Family members of chronically suicidal patients will report, “I’ve heard him say that a million times. He doesn’t mean it.” In fact, any one of those statements could be an accurate representation of the individual’s mindset at the time and should trigger clinical intervention. Other statements may be more vague or indirect. “I can’t do this anymore.” “They’d be better off if I weren’t around.” “There’s nothing to look forward to.” These and similar statements characterize the hopelessness often associated with suicidal thinking and warrant further discussion.

The second step is to observe behavior. Does the individual look sad or down for long periods of time? This is different from being sad about a particular loss or specific event. Almost everyone feels appropriately sad at times; it’s part of the human experience. Clinical depression, or major depressive disorder, is a different matter entirely that can be addressed and ameliorated with treatment. Other signs to look for include protracted periods of irritability, social withdrawal, changes in sleeping and eating habits, and an inattention to what psychiatrists call activities of daily living, or ADLs – bathing, dressing, grooming, homemaking, work, and the like. Importantly, a variant of depression, bipolar disorder, sometimes referred to as bipolar depression, presents a potentially greater risk. People who are suffering from bipolar disorder can have fluctuating moods ranging from “very high highs to very low lows.” The lows present the risks attendant to major depressive disorder described above. During the highs, known as mania, the patient can progress from euphoria and sleeplessness to a state of dangerous impulsivity or even psychosis. This is a condition that generally requires hospitalization.

The third step is to take note of specific deliberate actions. Is a loved one stockpiling pills that could be used to overdose? Has the person recently purchased a gun? Is there a sudden increase in the use of drugs or alcohol? More subtly, has the person begun giving away possessions or spending time getting their “affairs in order”? These are all potentially evidence of a suicidal plan or intent.

All of this leads to the paramount question, “What can I do?”

Talk. Don’t be afraid to engage someone in a conversation if you observe any of the behavior or actions described above. You’re not going to give someone the idea to kill themselves for the first time by having a conversation. People who are suffering have already had these thoughts and may even wonder why no one expresses concern. You may try to gauge the degree of risk by asking specific questions.

1.     “Have you thought about killing yourself?” It’s OK to be direct. Remember, you’re not planting a seed. You won’t trigger suicidal ideation through inquiry. The person may be relieved to share their feelings and “get permission” to seek help.

2.     “Have you made a plan?” An affirmative answer to this question indicates a high degree of risk. General thoughts about death are concerning, but a specific plan suggests a more present danger. Having distinct thoughts about taking a bottle of pain pills or shooting or suffocating oneself requires immediate professional attention. If someone has taken steps to acquire these or other means in furtherance of suicide, the situation is much more emergent. Similarly, a particular time frame, such as this week, this month, right after the holidays, or a specific event, represents planning and intent.

3.     “How can I help you?” This simple, open-ended, nonjudgmental question could save someone’s life. People who are in the depths of despair have difficulty with even simple tasks. Appreciating your empathy, someone may ask you to help arrange an appointment with a doctor or drive them to the hospital. This is an important point that bears repeating – don’t try to solve the problem yourself. Professionals are equipped to deal with people who are at risk of dying by suicide, and it’s imperative to involve such an individual as soon as possible. Attempts to dissuade or minimize suicidality by saying such things as, “It’s not so bad, you have such a great job, you are so successful, this happens to everyone,” can make someone feel unheard and marginalized and ultimately have an unintended and opposite effect. Not everyone will be open to help. You may have to call 911 in an emergency. Sometimes people are afraid that they will anger someone or fracture the relationship by calling for emergency attention. This is understandable, but we don’t hesitate to do so if the medical emergency affects the heart or lungs. The brain deserves equal attention.

Additional Resources:

National Suicide Prevention Lifeline 1-800-273-TALK (8255) or text HELLO to 741741. Both services are free and available 24 hours a day, seven days a week. The deaf and hard of hearing can contact the Lifeline via TTY at 1-800-799-4889. All calls are confidential. You may also visit the following websites:

https://www.nimh.nih.gov/health/topics/suicide-prevention/index.shtml

https://suicidepreventionlifeline.org/

https://www.nami.org/get-involved/awareness-events/suicide-prevention-awareness-month