Guest post by Lauren Graham, MA, LPC
Editor’s Note: This post is part of our Mental Health Series to coincide with National Suicide Prevention Month. You can read the first post in the series, Mental Health is Raging on Our College Campuses, here. For this article, we’ve invited professional counselor Lauren Graham to offer a pragmatic guide on responding to suicidal ideation within your life and ministry. Lauren is a member of an MBC church, where she and her seminarian husband used to lead the college/young adult group.
Not many things in this world can strike fear into our hearts quite like a loved one or someone we are ministering to sharing with us that they are experiencing suicidal thoughts. The reactions tend to range from panic to passivity, and we dread being in either of these camps. Life is precious, and many times, we really awaken to the gravity of a person’s humanity when their life is at stake.
The fear surrounding suicide is merited, as suicide is a serious and heavy issue. Yet I suspect that much of the fear comes from lack of education and training on how to help those who are at risk of suicide.
Suicide is an extensive topic. While we do not have the space to explore every facet of this issue, my hope is to provide you with some considerations to explore as you engage the people around you in this arena.
Be clear and direct about suicide.
If you have ever considered this topic before, you may have wondered if talking to someone about suicide will put the idea in their head to follow through. Thankfully, there is substantial evidence to conclude that myth is simply not true.
In fact, research supports that using clear and precise language when communicating with others about suicide is associated with better outcomes. For example, instead of asking, “Are you thinking of doing something reckless/stupid?”, ask “Are you thinking of killing yourself?” or “Are you thinking of ending your life?”
It can be nerve-wracking to ask such serious and direct questions, but we must remember that a person’s life is on the line. Adopting clear and direct language ourselves can help the person really consider the seriousness of their thoughts, feelings, and actions.
Be thorough in your evaluation.
An important nugget to remember when caring for someone who is facing suicidal ideation is that a suicide attempt or completion is rarely a result of one factor. There are usually many factors that contribute to a person’s decision to take their own life. This is vital to keep in mind because when we sit across from someone who is experiencing suicidal ideation, these factors not only give us a workable blueprint of how to respond to immediate needs but also clarify how to care for them in the long run.
When assessing for suicide risk, there are two types of factors that professionals look at to understand how to respond: risk factors and protective factors.
Risk factors include but are not limited to:
- Recent loss (death of a loved one, loss of financial stability, loss of status, etc)
- Recent increase of drug/alcohol use
- History of drug/alcohol use concerns
- Previous attempts of suicide
- Persistent, intrusive, and active suicidal thoughts
- Access to means for death (especially lethal means)
- Preparing for death (giving away belongings, writing goodbye letters, etc)
- Death of a loved one by suicide
- Lack of emotional regulation skills
- Poor concentration and/or high anxiety/panic
- Hearing voices (especially if voices are commanding suicide)
- Perceived level of stress is intolerable
- Unable to identify reasons to live
- Has a diagnosis of Major Depressive Disorder, Bipolar Disorder, Schizophrenia, Borderline Personality Disorder, or Antisocial Personality Disorder
- Excessive guilt and/or volatile mood swings
- Living alone or socially isolated
- Unmarried (Single, Divorced, Widowed, or Separated)
- Chronic health conditions or chronic pain
- Gender identity issues
- Current abuse/bullying
- Males over the age of 45 years old
- Veterans (especially if recently discharged)
- Past inpatient psychiatric admissions
- Lack of access to affordable health care
- History of trauma
Protective factors include, but are not limited to:
- Strong family and/or community support
- Able to cite reasons to living, has meaning and purpose in life
- Religious or cultural convictions against suicide
- Ability to tolerate emotional pain
- Positive coping skills for anxiety, stress, and emotional distress
- Strong connection to a romantic relationship
- Responsibilities to children or others
- Currently pregnant
- Little to no drug or alcohol use
- Effective and accessible health care
- Limited access to lethal means
These risk factors and protective factors provide us a tangible way to enter into someone’s suffering and be of emotional and practical support. The generally accepted method of mitigating suicide risk is by reducing the number and intensity of risk factors while working to build and/or strengthen a person’s protective factors. It is considered even more effective and imperative to involve the person who is suffering in an open and honest dialogue about these factors. This can help them to grow as an advocate for their own mental health, thereby increasing their ability to cope with emotional distress and build necessary skills needed to prevent suicide.
Some possible questions to explore in a conversation like this:
- After talking through the risk factors, what is your reaction towards your risk of suicide?
- Is there anything that you are willing to forgo for the time being in an effort to reduce your risk of suicide?
- What skills or practices do you already engage in that help you to cope with difficult thoughts and emotions? How can we strengthen those?
- What are your religious or cultural beliefs about suicide?
- What support systems do you have in your life?
(Note: Very rarely does someone have no support system. It might be hard to see initially, but usually there’s someone, whether it be a pet, a coworker, a distant loved one, or even the positive influence of a loved one who has passed on. Any support is worth exploring, regardless of how unconventional it might be.)
Be proactive, not just reactive.
Very rarely does a person wake up one day and decide to commit suicide out of the blue. There are usually warning signs, though they may be subtle. This is why I advocate for a proactive approach to suicide prevention, not just a reactive approach.
What does it mean to take a proactive approach? A proactive approach means that conversations around suicide and self-harm are regular, visited often, and are accepted as normal and positive.
Here are some practical examples of what this could look like:
- Check in regularly regarding their mental health, whether they seem fine or not
- Discuss mental health and suicide consistently, openly and without judgment
- Ask them about warning signs for suicide that you are noticing (see risk factors above)
- Encourage and support them in regular self-care like eating habits, hydration, sleep, social engagement, substance consumption, preventative medical care, rest,etc.
- Examine your own beliefs and language surrounding suicide and mental health in general
Responding to Imminent Suicide Crisis
On the other hand, how should you respond when you are faced with an immediate crisis situation? You should absolutely respond and act with diligence! If a person expresses imminent suicidal ideation to you, you should ask the person at risk direct questions about the following:
- Have they made a plan for death?
- Do they have access to those means for death or other lethal means of death?
- Have they made any previous attempts?
Absolutely consider the other risk factors listed above—remember, the more risk factors present, the more you should be concerned about the person’s safety. However, answering “yes” to any of the three questions above are big indicators that the person is in imminent danger. At this point, you should call 911 immediately or drive them to the hospital yourself. The hospital or EMT/paramedics will likely want a summary of the situation from you, so be prepared to offer that. It is always better to air on the side of caution when it comes to suicide. The person may be upset with you, but it is better for them to be upset than another valuable life be lost.
When someone is in crisis, we should obviously respond and act with diligence. However, in the long run, I believe with a proactive approach to suicide prevention, we can help keep people healthy or even keep symptoms from worsening.
Be committed to next steps and followup.
By pressing into an open and honest conversation about suicide, tangible steps for followup become more clear.
- Do they need to be connected to a community resource for immediate medical care?
- Do they need a ride to the hospital because the risk is so great?
- Do they need encouragement to reach out to friends and family members for support?
- Do they need your support in connecting with a mental health professional who can help them to build positive coping skills?
- Do they just need your warm, loving, and consistent presence?
Followup is vitally important because your concern for the person at risk can be a protective factor in and of itself. Your followup communicates empathy, genuine care, and compassion, which is what we all long for in this life.
You Can Help Others
Suicide can be a scary and intimidating matter to navigate, but building some foundational skills in interacting with a person at risk of suicide can increase your confidence in navigating these conversations with wisdom and discernment.
As always, never hesitate to reach out to a counselor in your area or a medical professional to assist you in helping the people in your life. You do not have to walk this road of helping others in isolation. Pull in your support as well as you walk this difficult journey with others.
Resources
Below are some resources to look into for further education on suicide:
Suicide Prevention Lifeline
1-800-273-TALK (8255)
*For Spanish Speakers: 1-888-628-9454
*For Deaf, Hard of Hearing, and/or TTY Users: Use your preferred relay service or dial 711 then 1-800-273-8255.
Crisis Text Line
Text “HELLO” to 741741
Veteran’s Crisis Line
1-800-273-8255 press 1
Text 838255
Local KS/MO Compassionate Ear Warmline
913-281-2251
4-10pm every night of the year
*Non-crisis peer-operated support line
