Suicide. It can be a scary word, even for mental health professionals. No matter your profession, you are likely to come across individuals who might be currently experiencing suicidal thoughts or have so in the past. You might have a co-worker or friend who has a family member who has attempted or completed suicide or is currently struggling with a crisis. It is the role of mental health professionals to be trained in this area; however, a basic knowledge of how to effectively intervene is beneficial for everyone. The following information outlines a few definitions and tips for addressing suicide and helping someone connect to the appropriate resources.
What does “in crisis” mean?
I would define “in crisis” as any situation where a person feels like their stressors outweigh their coping skills. What one person views as a crisis might be not even be seen by another as a problem. Being in crisis is not only the moment where the client is going to attempt suicide or about the “jump off a cliff” but it can be very subtle and can look differently for each person. A crisis could be due to external or internal stressors and might be expressed through various ways like anger, crying, or high anxiety. Walking alongside someone who is “in crisis” allows us the opportunity to help the person process emotions, use appropriate coping skills, and continue in recovery with more tools and recovery then they had before the crisis occurred.
Why is suicide such a scary topic to discuss?
One of the main reasons people are afraid to talk to someone about suicide is fear (Roush, Brown, Jahn, Mitchell, Taylor, Quinnett, & Ries, 2018). There are also many false beliefs attached to people who are experiencing suicidal thoughts. Some of them might include… “If I mention suicide they will do it… They really won’t do it if they are talking to me… If I ask about the plan, it will make them follow through.” And the big one…. “What if I say the wrong thing?” These are all false beliefs. All of these internal questions underline the fact that many people do not feel equipped, trained or confident in their abilities to address suicide.
“Asking questions about suicide does not make it worse. In fact, not asking questions does not allow you to respond in an educated and compassionate way resulting in a larger risk.”
Are there different “levels” of suicidal risk?
Thoughts of suicide can exist on a continuum. A person might be experiencing Passive Thoughts of Death such as thoughts about “not wanting to wake up, they would be better off if I wasn’t here, I wish I would get cancer and die….” These thoughts, while although not active suicidal thoughts, can be of concern and require you to take action (Interian, Chesin, Kline, Miller, St Hill, Latorre, & … Stanley, 2018). Other concerns that might come along with this type of thought process is seeing a change in functioning level. Change in sleep, appetite, isolating, decreased activities of daily living (ADL’s), increase substance use, and other risk-taking behaviors can all be of concern. If a person mentions any preparatory acts such as giving away of personal items, preparing for suicide (buying pills, rope), researching for ways to harm themselves, writing letters/suicide note or not being future-oriented, it is a cause for concern. Any statements regarding suicide or the above-listed things should be taken seriously. Even if someone says “but I wouldn’t do it,” you still should refer help them immediately get connected to a mental health professional. A person who has thoughts of suicide, a plan with access to means, and intent to kill themselves is at highest risk and should receive immediate intervention to ensure they are safe.
What do I say/ not say?
The most important step is that you ask about suicide and not be afraid to actually use the word “suicide.” Ask the person, “Have you had thoughts of suicide?” And if the answer is yes, “Do you have a plan of how you would kill yourself?” These questions are vital to know what level of risk a person might be experiencing. More in-depth questions will be needed, but depending on your role, your purpose might be to IDENTIFY and then guide the person to the next step to ensure there is a safe handoff to a social worker or other mental health professional. No one should leave a conversation with you after mentioning suicide without a plan being in place and you ensuring a connection has been made with a mental health professional. Lastly, it’s important to realize how you are asking the questions. Asking someone “you’re not going to kill yourself, are you?” can make someone defensive and decrease the chance they might be willing to share. It is important to show empathy, compassion, and allow someone to be open with their feelings.
Are there any pieces of training available?
One specific training available to anyone seeking additional training is called “Mental Health First Aid” ( https://www.mentalhealthfirstaid.org ). This training follows a few specific steps that are important to remember. Their acronym ALGEE follows a 5 step process in assisting someone in getting appropriate help:
A ccess for risk for suicide/harm
L i sten non-judgmentally
G ive reassurance and resources
E ncourage appropriate professional help
E ncourage self-help/ other support strategies
What about working with people in addiction?
Sometimes we ask “what came first, the chicken or the egg?” as it relates to addiction and mental health symptoms, and many times people might not know the answer. Someone who has been self-medicating for most of their adult life might not be used to experiencing emotions they have numbed and do not know how to handle them without high anxiety or stress. One of the biggest clinical risk factors for suicide is hopelessness. Someone without protective risk factors (family, support, work, pets, etc) can be at a greater risk. Any time of transition can also be a huge stressor for a person. Getting married or divorced, getting or losing a job, the death of a loved one, the birth of a child, pretty much anything that changes can add stress to your life. This also includes sobriety. Someone who is newly sober is having to function in a way that is new to them and actively focus on changing negative behaviors, habits, and thoughts. Lastly, addictions are often based on faulty thinking and the same thing can be said as a symptom for individuals who struggle with anxiety or depression. Anyone can suffer from an addiction and anyone can suffer from a mental illness. Neither is a respecter of persons.
How do I help support someone who is struggling?
An important universal truth is that we all want to know that we matter and that we are important. An important role in suicide prevention is a strong support system and a good follow up plan (Brodsky, Spruch-Feiner, & Stanley, 2018). Leaving it as the ‘elephant in the room’ might lead someone to think that the topic makes you uncomfortable and might detour them from bringing it up again if the crisis returns. Statements reaffirming the strength and resilience it took to be open and be honest about underlying issues is important.
You should immediately connect the person to a mental health professional so that a thorough risk assessment can be completed. The National Suicide Prevention Lifeline number is 800-273- TALK (8255) is a great resource that can connect you and the person in crisis to a trained professional and provide guidance to local resources in the area. In case of immediate crisis, contacting 911 or going to the closest emergency room might be the best approach. It is also wise to research local community resources before a crisis occurs so that you are prepared if a crisis does occur.
Just like in other areas of your professional work, the more training and practice you receive, the more confidence you feel in meeting the needs of someone in crisis. The risk of someone completing suicide can be greatly decreased by asking the appropriate questions, connecting them to appropriate professional services, and providing continued support as they focus on recovery.
Mental Health First Aid (2018). What You Learn. Retrieved from https://www.mentalhealthfirstaid.org/
Brodsky, Beth S., Spruch-Feiner, Aliza, & Stanley, Barbara (2018). The Zero Suicide Model: Applying Evidence-Based Suicide Prevention Practices to Clinical Care. Frontiers In Psychiatry, Vol 9 (2018), doi:10.3389/fpsyt.2018.00033/full
Interian, A., Chesin, M., Kline, A., Miller, R., St Hill, L., Latorre, M., & … Stanley, B. (2018). Use of the Columbia-Suicide Severity Rating Scale (C-SSRS) to Classify Suicidal Behaviors. Archives Of Suicide Research: Official Journal Of The International Academy For Suicide Research, 22(2), 278-294. doi:10.1080/13811118.2017.1334610
Roush, J. F., Brown, S. L., Jahn, D. R., Mitchell, S. M., Taylor, N. J., Quinnett, P., & Ries, R. (2018). Mental health professionals’ suicide risk assessment and management practices: The impact of fear of suicide-related outcomes and comfort working with suicidal individuals. Crisis: The Journal Of Crisis Intervention And Suicide Prevention, 39(1), 55-64. doi:10.1027/0227-5910/a000478
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