Let’s talk about suicide, and how to be there for each other.

How to ask compassionate and difficult questions when you are concerned about someone.

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Photo courtesy of Nicole Harrington.
Photo courtesy of Nicole Harrington.

A widely cited statistic from the Centers for Disease Control (CDC) is that suicide rates rose over 25% between 1999 and 2016. These climbing rates apply to both men and women, and across age, socioeconomic status, and racial groups.

This statistic often hits home when a famous person commits suicide. As a psychologist, it concerns me that when there is a high-visibility death by suicide, a call follows for greater access to mental health professionals. Undoubtedly, better access would save lives. But barriers – including inadequate screening and awareness, social stigma, poor insurance coverage, high treatment costs, and professional shortages – will take serious and ongoing efforts to address.

Additionally, the repeated refrain for greater access to mental health services has the unfortunate effect of reinforcing an inaccurate belief that as individuals we can’t make a difference. Even when someone is in extreme distress, feeling connected to others may stave off the despair that can tip over into suicidal thoughts and behavior.

Talking about suicide is initially uncomfortable, even frightening. Yet by learning to speak directly and compassionately about difficult emotions and experiences, including thoughts of self-harm, we can move beyond discomfort and provide much needed help. And research shows that acknowledging and talking about suicidal thoughts can actually reduce the risk of harmful behavior.

As a past clinical director in a research clinic for depression and suicidality, I have talked to hundreds of adolescents about self-harming thoughts – thoughts that were often a source of shame and isolation.These young people were relieved to hear that others would work together to find them help.

It is important to remember that people at risk for suicide are grateful for the offer of help. Unfortunately getting the necessary help often takes time and having people check in during this process is crucial. Following up to make sure that help has been received is critical to someone in crisis, who likely has limited emotional reserves to persist when help is not readily available.

If you know someone who may be at risk for suicide, it is not your responsibility to be an expert or to save them. What you can do, which is more important than you might imagine, is be open and supportive.

Verbalize what you notice that concerns you. For example, “You seem down or not yourself these days.”  “You seem to have withdrawn, are you OK?”  The very act of noticing can help offset the isolation or desperation that a person with suicidal thoughts is experiencing.

If someone says they are having a hard time, it helps to ask, “What is the hardest part of what you are dealing with?” If you worry that the person may do something self-destructive you can ask, “Does it ever get so bad that you think of hurting yourself?” “Has that happened recently?” 

It is not uncommon for someone, after sharing that they have had suicidal thoughts, to quickly add, “But I wouldn’t do it” or “I don’t really want to die but I want to be away from the pain”. If this happens, acknowledging the pain that led to the thoughts helps, for example,“I’m glad to hear that, but I am also sorry that you have been in such pain. Can I help you explore getting help?”

If someone tells you they made an attempt recently, or are actively thinking about it, you don’t have to be alone with this information. You shouldn’t be. You can offer to take the person to a hospital emergency room or call someone in their family. Others can help in removing access to lethal means like guns and medications. When it comes to immediate safety, keeping confidentiality takes a back seat.

If you feel unsure of what to do, be honest and sincere. “I care and want to help but I, myself, need help in understanding how. Is there someone you can think of to whom, together, we can reach out?”If the person is already seeing a clinician, ask permission to speak to her or him about your concerns.

Most importantly, let the person know you care, that you are there for them. Tell them that although they feel this way now, they won’t always.

Let’s move beyond calls for better access to mental health services and start a broader conversation about how to connect with each other in painful and difficult circumstances. As individuals and as a society we should not wait for institutions to become more responsive. Right now, let’s learn new ways to be there for each other.

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