This is from a talk I did for the Lewisville ISD on September, 15, 2011 at their CHOICES “Ask the Doctor” a community wide event.
SUICIDE is a Threat
Suicidal acts are frantic attempts at improving one’s life, not ending it.
D.J. Mayo, Psychologist
In most cases, suicide is a solitary event and yet it has often far-reaching repercussions for many others. It is rather like throwing a stone into a pond; the ripples spread and spread.
People choose suicidal acts when they see them as the best way of ending an unbearable situation or getting the changes they desire.
World Health Organisation
What do we worry for?
We worry for the one making the threat
The example I use for this talk was a male, so these points are written as ‘he’, but the person at risk could also be a ‘she’. The choice of how to kill one-self is also an example and could easily be a gun or pills.
Life, Death and Safety
- We’re worried – that he’ll follow through on the threat.
- We’re worried – that he’ll feel he has backed himself into a corner and has to follow through for people to take him seriously.
- We’re worried – that he might not understand that hanging puts quick, severe pressure on your neck, spine, air and blood flow in a way that will almost definitely damage the body a brain.
- We’re worried – that he doesn’t understand how quick it is, and that hanging doesn’t leave time for people to respond or rescue, nor does it leave time for him to change his mind.
Skills, Knowledge and Thought Processes
- We’re worried – that the person’s not thinking straight about how final death really is. Deep down they’re probably acting this way because they really want some kind of change, but they’ve lost hope
- We’re worried – that he can’t think straight, because anger, jealousy, alcohol or some other drug has broken down the things that normally keep him safe from dangerous impulses
- We’re worried – that he’s not thinking of ways to soothe himself or calm himself down.
- We’re worried – that he doesn’t have the skills to look inside himself, to recognize his needs or analyze his thought processes so that he could make changes to the way he’s doing things.
- He might have a need he can’t express. He might have pain he can’t communicate. And if he can’t tell us about it, we can’t help him. And while we’re dealing with the suicide threat, energy gets diverted from dealing with the ‘deeper’ needs.
Feelings and Pain
- Underneath all this, there might be poor self-esteem. The threats might be a reaction to feeling rejected or unloved. It might be coming out of anger about confusing or unjust circumstances. It might be an attempt to reach out in the midst of loneliness.
- Maybe he’s doing this because it’s hard to find actions that seem to have any noticeable effect on the world, and this is one of the few ways he’s found to make his presence felt, and because these actions meet this need, it becomes a bit like an addiction.
- Maybe this ‘flaring up’ is indicative of really low emotional resources, feeling deeply stressed, tired or drained.
- It’s hard for us to meet these deep needs when he’s doing things that create so much distress and isolation.
- It might come from the limited thought processes of young minds and experiences: they don’t know that ‘this will pass’.
- Maybe it’s part of youth trying to cope when they have been experiencing big or fast changes on a deep level. Like those that have taken place since 9/11.
- Or changes in the way the family is run and structured.
- It might be that these people do not know how to cope if they don’t get what they want.
- Maybe it’s a sort of crazed anxiety of losing love, especially if important connections are missing or broken, and it feels like you might be in danger of losing the ones that are left.
- Perhaps the threats are violence turned inwards, then radiating out to those who are closest.
Warning Signs of Suicide
- Talking About Dying — any mention of dying, disappearing, jumping, shooting oneself, or other types of self-harm.
- Recent Loss — through death, divorce, separation, broken relationship, loss of job, money, status, self-confidence, self-esteem, loss of religious faith, loss of interest in friends, sex, hobbies, activities previously enjoyed
- Change in Personality — sad, withdrawn, irritable, anxious, tired, indecisive, apathetic
- Change in Behavior — can’t concentrate on school, work, routine tasks
- Change in Sleep Patterns — insomnia, often with early waking or over sleeping, nightmares
- Change in Eating Habits — loss of appetite and weight, or overeating
- Fear of losing control — going crazy, harming self or others
- Low self-esteem — feeling worthless, shame, overwhelming guilt, self-hatred, “everyone would be better off without me”
- No hope for the future — believing things will never get better; that nothing will ever change
Other things to watch for—suicidal impulses, statements, plans; giving away favorite things; previous suicide attempts, substance abuse, making out wills, arranging for the care of pets, extravagant spending, agitation, hyperactivity, restlessness or lethargy.
Every person can help prevent suicide
Show You Care!
Often, suicidal thinking comes from a wish to end deep psychological pain. Death seems like the only way out. But it isn’t. Acknowledge the feelings they might be having, and that it’s okay to feel those things, or perhaps acknowledge your relationship to them, and that you care about them. Let the person know you really care. Talk about your feelings and ask about his or hers. Listen carefully to what they have to say.
- “It sounds like you’re angry (or jealous or something else), and it’s okay to be angry.”
- “I’m worried about you, about how you feel.”
- ”You mean a lot to me. I want to help.”
- ”I’m here, if you need someone to talk to.”
Ask The Question
Don’t hesitate to raise the subject. Talking with young people about suicide won’t put the idea in their heads. Chances are, if you’ve observed any of the warning signs, they’re already thinking about it. Be direct in a caring, non-confrontational way. Get the conversation started.
- “Are you thinking about suicide?”
- ”Do you really want to die?”
- “Do you want your problems to go away?”
Challenge their Thinking
Challenge thinking is about letting them know that even though it’s okay to be feeling this way and you still care about them, it’s not okay to use the violence of threats or death that cause people so much pain. It’s also about helping them see that death won’t solve their problem
- ‘It’s okay to feel angry, but it’s not okay to kill yourself.’
- ‘I care about you, but I can’t give in to you when you act this way, so now I have to call someone here to keep you safe.’
- ‘How are you going to feel the respect and attention you’re looking for if you are dead? You’ll be gone forever.’
- ‘Do you really want to go away forever? You’ll leave a big hole of pain in your family and friends, who love you very much.’
The goal is to keep the person safe long enough to get to a time and place where there can be some good talking.
- Go for a drive. Take them to a place where they might calm down.
- ‘Go for a walk or drive him ‘round the community. Only drop him back home when he’s really tired. But still watch over him.’
- ‘Take him away from the thing that was making him angry.’
- ‘Go to a coffee shop.’ (laughter)
- ‘Or the beach.’ (more laughter)
- ‘Go to a place that’s safe for them but doesn’t facilitate their suicide fantasy, or give in to what they’re asking for.’
- ‘Sometimes the safest place might be the emergency room.’
After they calm down and get some slept, you can make connections, like with family or support workers. Then you can talk about it more.
- ‘Do something that makes him happy. Just ask them gently. You can listen to them. Get their story.’
- ‘Remind them about their family. People they care about. You can ask them, “What are the troubles in your life?”’
- ‘Ask them simple questions. Get them to think about what they are doing. Like, “How are you feeling when you say you want to kill yourself?” or “What are the things that make you feel this way?’
- Help them break it down, so they can see the process of when they do this, identifying emotional states and suicidal triggers.’
- ‘You can help them think about other things they can do when they feel this way again.’
After the crisis has calmed down never talk of suicide as a secret, even if they ask you to. It’s better to risk a friendship than a life.
Ideas of what to say:
- “I know where we can get some help.”
- ”Let’s talk to someone who can help.”
- “I can go with you to get some help.”
- “Let’s call the crisis line, now.”
Sometimes you can be the most help by referring your friend to someone with professional skills such as:
- Someone the person already has connections with.
- Trustworthy family member. Someone the young person has respect for Support working together with the family member. “Family is important to provide support. It’s a partnership: support working with family and vice versa.”
- Someone who can help build coping mechanisms and help them talk about their strengths.
- Connect with a mental health professional or someone who can follow-up separately with the person making the threat.
- Someone who can talk to the whole community about suicide.
- Anyone SAFE - “Sometimes, to keep them safe, there might be no one left to call but the police.”
What NOT to say
Here are some things about what would be unhelpful to say to someone thinking about killing themselves
- ‘Go for it.’
- ‘Make my day.’
- ‘Go ahead.’
- ‘I dare you.’
- ‘Here’s the rope.’
- Giving them a challenge so they feel they have to prove it, like, ‘You don’t really mean it’ or ‘I don’t believe you.’
- Saying something dismissive, like, ‘It can’t be that bad’ or ‘You always say that.’
- Saying something that might make them feel more angry or alone, like, ‘Who’s it going to hurt?’ or ‘No one cares.’
Do something now: Don’t assume that they will get better without help or that they will seek help on their own.
Acknowledge your reaction: It’s natural to feel panic and shock, but take time to listen and think before you act.
Be there for them: Spend time with the person and express your care and concern.
Ask if they are thinking of suicide: Asking can sometimes be very hard but it shows that you have noticed things, been listening, that you care and that they’re not alone.
Check out their safety: If a person is considering suicide it is important to know how much they have thought about it. Do they have a plan?
Decide what to do: What you decide to do needs to take into account the safety concerns that you have. Don’t agree to keep it a secret.
Take action: The person can get help from a range of professional and supportive people
Ask for a promise: if thoughts of suicide return, it is important for the person to again reach out and tell someone.
Look after yourself: It is difficult and emotionally draining to support someone who is suicidal, especially over an extended period.
FOR IMMEDIATE HELP CALL
2-1-1 – Local Suicide Intervention
800-435-7609 – National Teen Suicide Hotline
Book for Parents
“Chasing Happiness: One Boy’s Guide to Helping Other Kids Cope with Divorce, Parental Addictions and Death” by Chase Block; Foreword by Kay Sudekum Trotter, PhD – pages 75 – 81 have great suicide advice
“Helping Your Child Cope with Depression and Suicidal Thoughts” by Tonia K. Shampoo and Philip G. Patros
Dr Trotter also post regularly in her FaceBook fan page http://www.facebook.com/DrKaySudekumTrotter.