How Talking About Suicide Can Help with Survival

Are you concerned about suicide?

Would you like tips on what to look for and how to talk about the subject?

Last week, the Partnership to End Addiction sent a helpful handout on suicide with some talking points that I thought would be important to pass along.

I wanted to share it with you as I know mental health issues with our kids are on the rise.

Suicide, like addiction, is a taboo subject that many feel uncomfortable discussing.

There are ways that you can intervene.

For example, you use CPR when dealing with a heart attack. With a crisis, QPR is an emergency response and can be a lifesaver.

The warning signs of a heart attack are:

• Chest tightness
• Pain in the arm or neck
• Sweating
• Collapse

The warning signs of suicide are:

• Clinical depression
• Statements of hopelessness
• Giving away prized possessions

There are actional steps for both of these situations.

With a heart attack, you begin CPR by clearing the airways, pushing with chest compressions, and start rescue breathing.

You begin QPR by first asking how the person feels, second, persuade by offering hope and help, and third, refer the person to someone who can offer help.

Here’s a video from the American Foundation for Suicide Prevention. Be sure to check out their website for more information.

Facts about Suicide

• If people in a crisis get the help they need, they will probably never be suicidal again.
• Asking someone directly about suicidal intent lowers anxiety, opens up communication, and lowers the risk of an impulsive act.
• Most suicidal people communicate their intent sometime during the week preceding their attempt.
• People who talk about suicide may attempt an act of self-destruction.
• Suicide is the most preventable kind of death, and almost any positive action may save a life.

Clues and Warning Signs 

The more clues and signs observed, the greater the risk.  Take all signs seriously. 

Direct Verbal Clues:

• “I’ve decided to kill myself.”
• “I wish I were dead.”
• “I’m going to end it all.”
• “If (such and such) doesn’t happen, I’ll kill myself.”

Indirect Verbal Clues:

• “I’m tired of life. I just can’t go on.”
• “My family would be better off without me.”
• “Who cares if I’m dead anyway.”
• “I just want out.”
• “I won’t be around much longer.”
• “Pretty soon, you won’t have to worry about me.”
• “If anything happens to me, call…”

Behavioral Clues:

• Any previous suicide attempts
• Acquiring a gun or stockpiling pills
• Co-occurring depression, moodiness, hopelessness
• Putting personal affairs in order
• Giving away prized possessions
• Sudden interest or disinterest in religion
• Drug or alcohol abuse, or relapse after a period of recovery
• Unexplained anger, aggression, and irritability

Situational Clues:

• Diagnosis of a serious or terminal illness
• A sudden unexpected loss of freedom/fear of punishment
• Anticipated loss of financial security
• Loss of a significant other, mentor, counselor, teacher
• Fear of becoming a burden to others

Question –>Persuade –>Refer

Here are some examples of a way to directly approach the topic with a question.

• “You know, when people are as upset as you seem to be, they sometimes wish they were dead. Are you feeling that way right now?”
• “You look pretty miserable; I wonder if you’re thinking about suicide?”
• “Are you thinking about killing yourself?”

These are questions that are not helpful:

• “You’re not thinking of killing yourself, are you?”
• “You wouldn’t do anything stupid, would you?”
• “Suicide is a dumb idea. Surely you’re not thinking about suicide?”

How to persuade someone to stay alive:

• Listen to the problem and give them your full attention.
• Remember, suicide is not the problem; only the solution to a perceived insoluble problem.
• Do not rush to judgment.
• Offer hope in any form.
• Create time and space (for suicidal thinking to subside; space from the plan)

Then Ask:

• “Will you go with me to get help?”
• “Will you let me help you get help?”
• “Will you promise me not to kill yourself until we’ve found some help?”

Refer your child to someone who can help.

• Suicidal people often believe they cannot be helped, so you may have to do more.
• The best referral involves taking the person directly to someone who can help.
• The next best referral is getting a commitment from them to accept help, then making the arrangements to get that help.
• The third best referral is to give referral information and try to get a good faith commitment not to attempt suicide.  Any willingness to accept help at some time, even in the future, is a good outcome.

Tips for Asking the Suicide Question:

• If in doubt, don’t wait. Ask the question
• If the person is reluctant, be persistent.
• Talk to the person alone in a private setting.
• Allow the person to talk freely.
• Explore their ambivalence – “I want to live/I don’t want to live” and remind them of their value.
• Give yourself plenty of time.
• Remember to have resources handy.

Suicide can be stigmatizing for families.

Here are some ways to talk about it that are less stigmatizing.

Words that not good to use are:

• committed suicide
• successful suicide
• failed suicide attempt
• completed suicide

Some better language is:

• non-fatal suicide attempt
• suicide attempt
• death by suicide
• died by suicide
• suicide

Suicide does not discriminate. Yet, some communities are affected more than others.

According to the National Survey on LGBTQ Young Mental Health 2020, “40% of LGBTQ respondents seriously considered attempting suicide in the past twelve months. More than half of the transgender and nonbinary. youth have seriously considered suicide.”

Facts from the American Foundation for Suicide Prevention

• There were approximately 100,000 teens (15-19 year-olds) suicide deaths over the 40 year period between 1975 through 2015, the most recent year covered by the study.
• Boys take their lives at 3-4 times the rate of girls. The suicide rate for teen boys saw a rise that peaked in the late ‘80s and early ‘90s, then lowered in the late ‘90s and early 2000s. This may be attributed to pediatricians increasingly taking on the role of treating depression. However, the rate has unfortunately been rising again since 2006.
• While the presence of a mental health condition may contribute to increased suicide risk, it is important to note that the majority of people who live with mental health conditions will not die by suicide.

Top 10 things that have been learned from research from AFSP

Resources

• Find a mental health provider. 
• Suicide Prevention Lifeline 
• Suicide Prevention Phone number – 1-800-273-TALK (8255)
• Crisis Text Line: Text TALK to 741 741
• Crisis Chat 
• Call for emergencies – 911 or 211 for Mobile Crisis Unit

To learn more, download the handout talking points to help you if you are ever faced with a loved one who is thinking about suicide. Also, download the Talk Saves Lives Brochure here. 

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