- What can I do to help someone who may be suicidal?
Take it very seriously!
Myth: “The people who talk about it don't do it.” Studies have found that more than 75% of all completed suicides did things in the few weeks or months prior to their deaths to indicate to others that they were in deep despair. Anyone expressing suicidal feelings needs immediate attention.
Myth: “Anyone who tries to kill himself has got to be crazy.” Perhaps 10% of all suicidal people are psychotic or have delusional beliefs about reality. Most suicidal people suffer from the recognized mental illness of depression; but many depressed people adequately manage their daily affairs. The absence of “craziness” does not mean the absence of suicide risk.
“Those problems weren't enough to commit suicide over,” is often said by people who knew a completed suicide. You cannot assume that because you feel something is not worth being suicidal about, that the person you are with feels the same way. It is not how bad the problem is, but how badly it's hurting the person who has it.
- Remember: suicidal behavior is a cry for help.
Myth: “If a someone is going to kill himself, nothing can stop him.” The fact that a person is still alive is sufficient proof that part of him wants to remain alive. The suicidal person is ambivalent - part of him wants to live and part of him wants not so much death as he wants the pain to end. It is the part that wants to live that tells another “I feel suicidal.” If a suicidal person turns to you it is likely that he believes that you are more caring, more informed about coping with misfortune, and more willing to protect his confidentiality. No matter how negative the manner and content of his talk, he is doing a positive thing and has a positive view of you.
- Be willing to give and get help sooner rather than later.
Suicide prevention is not a last minute activity. All textbooks on depression say it should be reached as soon as possible. Unfortunately, suicidal people are afraid that trying to get help may bring them more pain: being told they are stupid, foolish, sinful, or manipulative; rejection; punishment; suspension from school or job; written records of their condition; or involuntary commitment. You need to do everything you can to reduce pain, rather than increase or prolong it. Constructively involving yourself on the side of life as early as possible will reduce the risk of suicide.
- Listen.
Give the person every opportunity to unburden his troubles and ventilate his feelings. You don't need to say much and there are no magic words. If you are concerned, your voice and manner will show it. Give him relief from being alone with his pain; let him know you are glad he turned to you. Patience, sympathy, acceptance. Avoid arguments and advice giving.
- ASK: “Are you having thoughts of suicide?”
Myth: “Talking about it may give someone the idea.” People already have the idea; suicide is constantly in the news media. If you ask a despairing person this question you are doing a good thing for them: you are showing him that you care about him, that you take him seriously, and that you are willing to let him share his pain with you. You are giving him further opportunity to discharge pent up and painful feelings. If the person is having thoughts of suicide, find out how far along his ideation has progressed.
- If the person is acutely suicidal, do not leave him alone.
If the means are present, try to get rid of them. Detoxify the home.
- Urge professional help.
Persistence and patience may be needed to seek, engage and continue with as many options as possible. In any referral situation, let the person know you care and want to maintain contact.
- No secrets.
It is the part of the person that is afraid of more pain that says “Don't tell anyone.” It is the part that wants to stay alive that tells you about it. Respond to that part of the person and persistently seek out a mature and compassionate person with whom you can review the situation. (You can get outside help and still protect the person from pain causing breaches of privacy.) Do not try to go it alone. Get help for the person and for yourself. Distributing the anxieties and responsibilities of suicide prevention makes it easier and much more effective.
- From crisis to recovery.
Most people have suicidal thoughts or feelings at some point in their lives; yet less than 2% of all deaths are suicides. Nearly all suicidal people suffer from conditions that will pass with time or with the assistance of a recovery program. There are hundreds of modest steps we can take to improve our response to the suicidal and to make it easier for them to seek help. Taking these modest steps can save many lives and reduce a great deal of human suffering.
WARNING SIGNS
Conditions associated with increased risk of suicide
- Death or terminal illness of relative or friend.
- Divorce, separation, broken relationship, stress on family.
- Loss of health (real or imaginary).
- Loss of job, home, money, status, self-esteem, personal security.
- Alcohol or drug abuse.
- Depression. In the young depression may be masked by hyperactivity or acting out behavior. In the elderly it may be incorrectly attributed to the natural effects of aging. Depression that seems to quickly disappear for no apparent reason is cause for concern. The early stages of recovery from depression can be a high risk period. Recent studies have associated anxiety disorders with increased risk for attempted suicide.
Emotional and behavioral changes associated with suicide
- Overwhelming Pain: pain that threatens to exceed the person's pain coping capacities. Suicidal feelings are often the result of longstanding problems that have been exacerbated by recent precipitating events. The precipitating factors may be new pain or the loss of pain coping resources.
- Hopelessness: the feeling that the pain will continue or get worse; things will never get better.
- Powerlessness: the feeling that one's resources for reducing pain are exhausted.
- Feelings of worthlessness, shame, guilt, self-hatred, “no one cares”. Fears of losing control, harming self or others.
- Personality becomes sad, withdrawn, tired, apathetic, anxious, irritable, or prone to angry outbursts.
- Declining performance in school, work, or other activities. (Occasionally the reverse: someone who volunteers for extra duties because they need to fill up their time.)
- Social isolation; or association with a group that has different moral standards than those of the family.
- Declining interest in sex, friends, or activities previously enjoyed.
- Neglect of personal welfare, deteriorating physical appearance.
- Alterations in either direction in sleeping or eating habits.
- (Particularly in the elderly) Self-starvation, dietary mismanagement, disobeying medical instructions.
- Difficult times: holidays, anniversaries, and the first week after discharge from a hospital; just before and after diagnosis of a major illness; just before and during disciplinary proceedings. Undocumented status adds to the stress of a crisis.
Suicidal Behavior
- Previous suicide attempts, “mini-attempts”.
- Explicit statements of suicidal ideation or feelings.
- Development of suicidal plan, acquiring the means, “rehearsal” behavior, setting a time for the attempt.
- Self-inflicted injuries, such as cuts, burns, or head banging.
- Reckless behavior. (Besides suicide, other leading causes of death among young people in New York City are homicide, accidents, drug overdose, and AIDS.) Unexplained accidents among children and the elderly.
- Making out a will or giving away favorite possessions.
- Inappropriately saying goodbye.
- Verbal behavior that is ambiguous or indirect: “I'm going away on a real long trip.”, “You won't have to worry about me anymore.”, “I want to go to sleep and never wake up.”, “I'm so depressed, I just can't go on.”, “Does God punish suicides?”, “Voices are telling me to do bad things.”, requests for euthanasia information, inappropriate joking, stories or essays on morbid themes.
A WARNING ABOUT WARNING SIGNS
The majority of the population at any one time does not have many of the warning signs and has a lower suicide risk rate. But a lower rate in a larger population is still a lot of people - and many completed suicides had only a few of the conditions listed above. In a one person to another person situation, all indications of suicidality need to be taken seriously.
Crisis intervention hotlines that accept calls from the suicidal, or anyone who wishes to discuss a problem, are (in New York City) The Samaritans at 212-673-3000 and Helpline at 212-532-2400.
No suicide attempt should be dismissed or treated lightly!
Why Do People Commit Suicide?
A suicide attempt is a clear indication that something is gravely
wrong in a person’s life. No matter the race or age of the person; how rich or poor they are, it is true that most people who commit suicide have a mental or emotional disorder. The most common underlying disorder is depression, 30% to 70% of suicide victims suffer from major depression or bipolar (manic-depressive) disorder.
Warning Signs of Someone Considering Suicide
Any one of these symptoms does not necessarily mean the person is suicidal, but several of these symptoms may signal a need for help:
Verbal suicide threats such as, “You’d be better off without me.” or “Maybe I won’t be around.”
Expressions of hopelessness and helplessness.
Previous suicide attempts.
Daring or risk-taking behavior.
Personality changes.
Depression.
Giving away prized possessions.
Lack of interest in future plans.
Remember: Eight out of ten suicidal persons give some sign of their intentions. People who talk about suicide, threaten to commit suicide, or call suicide crisis centers are 30 times more likely than average to kill themselves.
What To Do If You Think Someone Is Suicidal
Trust your instincts that the person may be in trouble.
Talk with the person about your concerns.
Communication needs to include LISTENING.
Ask direct questions without being judgmental.
Determine if the person has a specific plan to carry out the suicide.
The more detailed the plan, the greater the risk.
Get professional help, even if the person resists.
Do not leave the person alone.
Do not swear to secrecy.
Do not act shocked or judgmental.
Do not counsel the person yourself.
The Statistics of Suicide
Suicide is the eighth leading cause of death in the United States, accounting for more than 1% of all deaths.
More years of life are lost to suicide than to any other single cause except heart disease and cancer.
30,000 Americans commit suicide annually; an additional 500,000 Americans attempt suicide annually.
The actual ratio of attempts to completed suicides is probably at least 10 to 1.
30% to 40% of persons who commit suicide have made a previous attempt.
The risk of completed suicide is more than 100 times greater than average in the first year after an attempt - 80 times greater for women, 200 times greater for men, 200 times greater for people over 45, and 300 times greater for white men over 65.
Suicide rates are highest in old age: 20% of the population and 40% of suicide victims are over 60. After age 75, the rate is three times higher than average, and among white men over 80, it is six times higher than average.
Substance abuse is another great instigator of suicide; it may be involved in half of all cases. About 20% of suicides are alcohol abusers, and the lifetime rate of suicide among alcoholics is at least three or four times the average. Completed suicides are more likely to be men over 45 who are depressed or alcoholic.
Preventing Suicide
Although they may not call prevention centers, suicidal people usually do seek help; for example, nearly three-fourths of all suicide victims visit a doctor in the four months before their deaths, and half in the month before.
Helping a Suicidal Person
No single therapeutic approach is suitable for all suicidal persons or suicidal tendencies. The most common ways to treat underlying illnesses associated with suicide are with medication, talk therapy or a combination of the two.
Cognitive (talk therapy) and behavioral (changing behavior) therapies aim at relieving the despair of suicidal patients by showing them other solutions to their problems and new ways to think about themselves and their world. Behavioral methods, such as training in assertiveness, problem-solving, social skills, and muscle relaxation, may reduce depression, anxiety, and social ineptitude.
Cognitive and behavioral homework assignments are planned in collaboration with the patient and explained as experiments that will be educational even if they fail. The therapist emphasizes that the patient is doing most of the work, because it is especially important for a suicidal person not to see the therapist as necessary for their survival.
Recent research strongly supports the use of medication to treat the underlying depression associated with suicide. Antidepressant medication acts on chemical pathways of the brain related to mood. There are many very effective antidepressants. The two most common types are selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs). Other new types of antidepressants (e.g. alpha-2 antagonist, selective norepinephrine reuptake inhibitors (SNRIs) and aminoketones), and an older class, monoamine oxidase inhibitors (MAOIs), are also prescribed by some doctors.
Antidepressant medications are not habit-forming. Although some symptoms such as insomnia, often improve within a week or two, it may take three or four weeks before you feel better; the full benefit of medication may require six to eight weeks of treatment. Sometimes changes need to be made in dosage or medication type before improvements are noticed. It is usually recommended that medications be taken for at least four to nine months after the depressive symptoms have improved. People with chronic depression may need to stay on medication to prevent or lessen further episodes.
People taking antidepressants should be monitored by a doctor who knows about treating clinical depression to ensure the best treatment with the fewest side effects. It is also very important that your doctor be informed about all other medicines that are taken, including vitamins and herbal supplements, in order to help avoid dangerous interactions. Alcohol or other drugs can interact negatively with antidepressant medication.
Do not discontinue medication without discussing the decision with your doctor.
If you or someone you know is contemplating suicide, call 1-800-SUICIDE (1-800-784-2433) or 1-800-273-TALK (1-800-273-8255).
National Mental Health Association
www.nmha.org
800-969-NMHA
800-SUICIDE. (1-800-784-2433)
www.hopeline.com
This will connect you with a crisis center in your area.
American Academy of Child and Adolescent Psychiatry
www.aacap.org
202-966-7300
American Association of Suicidology
www.suicidology.org
202-237-2280
Suicide Prevention Action Network USA
www.spanusa.org
202-499-3600
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