Someone you love is wrestling with suicidal thoughts. What do you do? Dr. Jade Wu's frank and empathetic advice will guide you.
I had a patient who lost her adult daughter to suicide many years ago. This patient was one of the kindest, most selfless people I knew. She was a loving mother and grandmother, a NICU nurse whose life’s calling was to take care of sick babies, and an insightful person who was always quick to pick up on other people’s feelings and needs.
After the tragedy, my patient would travel and discover things her daughter would have liked, which instantly reminded her of her loss. She would wonder, What if? What could she have done differently to prevent the suicide? It broke my heart to see her struggling to be strong for the rest of the family, whose lives were falling apart. Years later, the family is still trying to put the pieces back together.
This family is not alone. Suicide is the tenth leading cause of death in the United States, with almost 45,000 victims each year. That's approximately 123 Americans who die from suicide each day. Many more attempt suicide or have periods of time when they can’t shake thoughts of wanting to end their lives. I've seen many patients with these demons in their past. Some still struggle with suicidal thoughts. Some look upon their second chances with renewed appreciation for life. All of them are profoundly affected by these experiences with suicidality.
Suicide is the tenth leading cause of death in the United States, with almost 45,000 victims each year. That's approximately 123 Americans who die from suicide each day.
Suicide is a serious and complicated issue. It’s not always easy to see when someone is contemplating suicide, and there isn’t always a fool-proof, one-time fix. It’s often a taboo topic, and people are afraid to seek help or share their experiences because of the stigma associated with suicde. Fortunately, there are more and more resources to help those who are struggling, and to empower their loved ones with knowledge and tools.
Here are five important tips for family, friends, and other community members, and I hope to help open the dialogue for those who are feeling alone in their struggle with suicide.
#1 - Know the risk factors of suicidal thoughts
Risk factors are situations that make a person more likely to experience suicidal thoughts. Let's walk through them.
One major risk factor is having a mental illness. These mental illnesses include:
- Bipolar disorder
- Personality disorders
- Substance misuse
It is estimated that most people who complete suicide had an underlying mental illness, often undiagnosed. However, it’s important to know that not everybody who has committed suicide had a mental illness.
Even if you're confident that a loved one is completely free from mental illness, you should still take other signs of suicidality seriously.
This pattern may differ based on culture. In North America, about 12 percent of those who committed suicide did not have a mental illness. In East Asia, about 30 percent of people who committed suicide did not have a mental illness. So, even if you're confident that a loved one is completely free from mental illness, you should still take other signs of suicidality seriously.
Sexual/Gender Minority Status
Another major risk factor for suicide is sexual and gender minority status, especially for teens and young adults. Heterosexual individuals have a four percent chance of attempting suicide at some time in their life. Lesbian, gay, and bisexual individuals have an 11 to 20 percent lifetime risk, and transgender individuals have a staggering 30 percent lifetime risk of attempting suicide. The majority of sexual and gender minority people’s suicide attempts happen before they turn 21. This is a global public health crisis that we can’t ignore, and we can start by being aware that the LGBT+ people in our lives may be struggling in silence.
Lesbian, gay, and bisexual individuals have between 11-20 percent lifetime risk of attempting suicide, and transgender individuals have a staggering 30 percent lifetime risk.
Other Risk Factors
- Chronic illness
- Relationship loss
- Financial loss
- Exposure to suicide
- Sense of hopelessness
- Lack of social support
Other risk factors for suicide include having experienced trauma or abuse, currently suffering from chronic illness, and recently experiencing major relationship or financial losses. People are especially vulnerable if there has been exposed to suicide. That exposure may come from an event in their family, school, or even the media.
Common factors that ultimately tip the scales are a sense of hopelessness, isolation, and—importantly—a lack of social support.
#2 - Know the suicidality warning signs
When it comes to warning signs, which are more imminent signs that someone is contemplating or planning suicide, the clearest is when a person talks about wanting to die or mentions actively looking for a way to kill themselves. Often, when people are at the depths of their hopelessness, they talk about having no purpose, feeling trapped, being a burden to others, or being unable to bear their pain. You may also notice them withdrawing, using alcohol or drugs more, having more extreme mood swings, or being more reckless.
Continue supporting and checking in with the person who was just in crisis, because sometimes the calmness can come from the sense of resolution a person who has made up their mind to commit suicide experiences.
When a crisis seems to have passed and your loved one is seeming more calm, it’s understandable to want to let out a big sigh and take a break from crisis management. And you should certainly take care of yourself! Just remember to continue supporting and checking in with the person who was just in crisis, because sometimes the calmness can come from the sense of resolution a person who has made up their mind to commit suicide experiences. The improvement in their mood or functioning may also be a “boost” in their ability to carry out a suicide attempt. So it’s important to keep communication open and supportive even after the worst of the storm seems to have passed.
#3 - Don’t be afraid to ask about suicidal thoughts
There is a fear, even amongst many professional mental health researchers and providers, that asking someone about suicide is going to “put the idea into their head” and increase their likelihood of feeling suicidal. This is not true.
Asking could reduce [suicide] risk. It helps by decreasing stigma and giving the person nonjudgmental permission to express their feelings.
If someone is at risk of having suicidal thoughts or urges, the idea of suicide will not be new to them. Asking them about it will not make them more suicidal. Instead, asking could reduce risk. It helps by decreasing stigma and giving the person nonjudgmental permission to express their feelings. You can only provide someone with resources and support if you know what they need.
How to have a conversation about suicide
Of course, it’s still difficult to start a conversation about suicidal thoughts, even if you're very close to someone. I certainly wouldn’t blame you for feeling hesitant. It took years for me to get comfortable with asking my patients. But once the taboo is broken, the conversation isn't as scary as you might imagine. Here's one way to broach the subject if you see warning signs:
“I noticed that you’ve been seeming really down lately. You mentioned that you feel like there’s no point to life. Do you have thoughts about not wanting to live?”
If they say yes, or if they have already more explicitly talked about wanting to die, you can ask about their intentions:
“When you say that you want to die, do you mean that you want to end your life? Does it ever feel so bad that you think about suicide?”
“Do you have a plan for when or how to kill yourself?”
Just remember that if someone answers yes [when you ask whether they're having thoughts of suicide], they were already feeling that way before you asked.
These questions can seem terribly scary to ask. What if the answer is yes? Just remember that if someone answers yes, they were already feeling that way before you asked. By starting this dialogue with them, you’re not making it worse. You’re providing an path to seeking help.
If you discover that someone you care about is suicidal, what next?
#4 - Provide support using empathy, not shame or guilt
If you’ve already started a conversation with someone contemplating suicide, that’s a good start! At this point, you may feel very tempted to immediately start problem-solving or putting emergency suicide hotline numbers into their phone. These are good steps to take, but first, remember that the person in front of you just opened up about the most painful, hopeless, and perhaps shameful feeling they’ve had. Take a moment to first acknowledge their feelings with empathy:
“I’m so sorry you’re feeling this way. It must be awful.”
You may be tempted to jump in with arguments about why they shouldn’t feel suicidal, emphasizing that their problems aren’t so bad, or that they would be hurting other people by committing suicide—anything to put a stop to their thoughts. But this approach can minimize the person’s pain and make them feel even more guilty and isolated. They feel this way because, to them, the problems they face do seem hopeless, at least right now.
Even if you don’t agree that the person's problems are hopeless, you can empathize with what they're feeling:
“I can see that you feel really hopeless. What a terrible feeling to have! I can’t even imagine.”
Don’t worry—you're not agreeing that their situation is hopeless. You’re not tacitly encouraging them to consider suicide by validating their feelings.
Shaming and guilting is not helpful because this simply shuts a door between you and the person opening up to you.
Similarly, shaming and guilting is not helpful because this simply shuts a door between you and the person opening up to you. It’s likely that they’ve already considered how hurtful their suicide would be to others. But when someone is at the depths of despair, anything may seem necessary to stop the pain. Shaming will only deepen those feelings of despair.
The much better alternative is to let them know you can see their pain, that you’re willing to listen, and that you care about them. Once you’ve made clear this unconditional support, you can start to help in a more hands-on way.
#5 - Connect your loved one with suicide prevention and other resources and prevent imminent harm
Perhaps the most immediately important thing to do is to remove imminent risks. For example, if they have a plan, in this moment, to end their life soon, you should call emergency services or take the person to the Emergency Department. If the person you are supporting has said that they plan to commit suicide using a specific method, you can help to limit their access to this method for now. Ask them if you can hold onto their weapon for safe-keeping, for example, or offer to drive them home.
Do keep in mind that you may not be able to remove every risky thing from their life, so it’s just as important to connect them with longer-term resources.
One great resource is the National Suicide Prevention Lifeline at at 1-800-273-TALK (8255).
One great resource is the National Suicide Prevention Lifeline at at 1-800-273-TALK (8255). Those who respond on this line are trained to provide immediate support to people in crisis. The website Save.org also has great information and links to excellent resources.
If the person you’re supporting does struggle with mental health or substance use, encourage them to establish regular care. When someone is having a hard time, they may not be in the right mindset to research an already complicated healthcare system. Simply by finding a local clinic and calling to learn about what they can do for your loved one could be a major help.
In addition to professional resources, you can help tremendously by connecting your loved one with everyday resources. The most important thing is for the person to have meaningful social connections. And it’s not just about dragging them to large gatherings—quality is more important than quantity. Spend time with them, introduce them to other good friends, encourage them to join groups that can provide support. For example, you could encourage a young LGBT+ person to join a school’s LGBTQ student union.
#6 - Take care of yourself
I cannot emphasize this enough. Those who die from suicide are not the only victims. People whose loved ones contemplate, attempt, or complete suicide also undergo an incredibly difficult experience. A recent study found that 48% of people have been exposed to another’s suicide at some point in their life, and that they are twice as likely as others to have depression or anxiety. They were also much more likely to experience suicidality themselves. If they were close to the person who committed suicide, they had a quadruple risk of posttraumatic stress disorder compared to people who have not been exposed to another’s suicide.
A recent study found that 48% of people have been exposed to another’s suicide at some point in their life, and that they are twice as likely as others to have depression or anxiety.
If someone close to you has attempted or completed suicide, make sure you have a strong support network. Talk with your family, friends, and any religous or other community leaders you feel close to. I would also strongly encourage you to consider getting mental health support, even if you're managing well. I have had very high-functioning people come into the clinic only because someone made them go. Then, during the appointment, they broke down into tears when they realize for the first time how much a loved one’s suicide still weighed on them.
If you’re currently supporting someone who is contemplating suicide or recovering from an attempt, don’t forget to check in with your own feelings and ask for help. It can feel like you're the only one who can help, especially if you're the person's parent, closest friend, teacher, or sibling. You may feel like you want to take on the responsibility all by yourself.
But remember that just by listening, empathizing, and offering your love, you are doing your best. Your support is a tremendous amount of help to the person suffering suicidal thoughts. Even as you offer yourself, talk with them about bringing others into their support network. Let them know their other resources.
Meanwhile, get your own needs met. Don’t neglect your own nutrition, exercise, rest and sleep, social engagement, and the things that fulfill you. It’s okay to do things that make you laugh. After all, part of how you can help is by showing that there is goodness and hope in life.
Today’s topic is heavy and complicated. There's so much we cannot control, but knowledge is empowerment. I hope you'll consider these 5 tips for suicide prevention:
- Know the risk factors and warning signs so you can be aware of when your help may be most needed
- Ask directly if you suspect someone may have suicidal thoughts, which will reduce their risk
- Provide empathy first and foremost, and don’t use a shaming or dismissive approach to talking someone out of suicide
- Let your loved one know about resources, and know that they may not be capable of following through on seeking professional help right now
- Make sure to take care of yourself through this difficult time.
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