Reaching out: ways to help a loved one at risk of suicide

If you or someone you know is planning to commit suicide, contact National suicide prevention lifeline at 1-800-273-8255 (En Español: 1-888-628-9454; Deaf and Hard of Hearing: 1-800-799-4889) or Crisis text line texting the house at 741741.

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If you know someone struggling with despair, depression, or thoughts of suicide, you may be wondering how to help.

According to a national survey conducted by the American Foundation for Suicide Prevention and the National Action Alliance for Suicide Prevention in 2018, most Americans say they understand that suicide is preventable and that it is safe. they would act to help a person in danger to their knowledge.

Yet many of us are afraid of doing the wrong thing. In fact, you do not have to be a trained professional to help, says Doreen Marshall, psychologist and vice president of programs at AFSP.

"Everyone has a role to play in suicide prevention," she says. But "most people hold back." We often say, "Trust your instinct. If you are worried about someone, take this step. ""

And this first step starts with a simple touch, Marshall says. It may sound like a small thing, but survivors of suicide attempts and suicide experts say that can go a long way.

The simple acts of connection are powerful, says Ursula Whiteside, a psychologist and faculty member at the University of Washington.

"Looking at each other in general reduced [suicide] Whiteside. "Because people who feel connected are less likely to kill themselves."

And "the sooner you catch someone," she adds, "the less they have to suffer."

Here are nine things you can do that can make a difference.

1. Recognize the warning signs

The signs of suicide risk to watch for include changes in mood and behavior, says Marshall.

"For example, a person who is usually part of a group or activity and you notice that she no longer shows up," Marshall explains. "Someone who is generally quite calm and you see that he is easily frustrated or angry."

Other signs include feeling of depression, anxiety, irritation or loss of interest in things.

Pay attention to the words of a person, too.

"They can talk about wanting to end their lives or see nothing at all or sleep and never wake up," Marshall said. "These are signs that they can think of [suicide]. This can be defined as a need to move away from pain or escape pain. "

According to the AFSP, people who commit suicide often have a combination of these warning signs.

And the signs may be different for different people, says Madelyn Gould, professor of epidemiology in psychiatry at Columbia University, who studies suicide and suicide prevention.

"For some people, he may be having trouble sleeping," she says. Anyone else could easily feel humiliated or rejected.

"Each of these things can put [someone] more at risk, "says Gould," until at some point, [they’re] more in control. "

2. Reach out and ask, "Are you okay?"

So what do you do when you notice that someone is struggling and you are worried that he is planning to commit suicide?

Contact suicide prevention experts, register and be compbadionate.

"The very nature of a person struggling with suicide and depression, [is that] they will not reach out, "said Marshall. They feel like a burden to others. "

People who have suicidal thoughts often feel trapped and alone, says DeQuincy Lezine, a psychologist and board member of the American Association of Suicidology. He is also a survivor of suicide attempts.

When someone reaches out and offers support, it reduces the feeling of isolation of the person, he says.

"Even if you can not find the exact words [to say]the aspect we are concerned about makes a big difference, "said Lezine.

Questions like "Are you okay?" and statements such as "If you need anything, tell me" are simple gestures of support that can have a significant impact on a person who suffers from emotional pain, says Julie DeGolier, medical badistant at Seattle and survivor of suicide attempts. This can interrupt the negative spiral that can lead to a crisis.

The National Suicide Prevention Network website has a list of do's and don'ts when trying to help someone at risk.

3. Be direct: ask about suicide

"Most people are afraid to ask about suicide, because they [think they] do not want to put thought in their head, "says Marshall. But there is no research to support that. "

Instead, she and other suicide prevention experts say that it is essential to prevent suicide directly and compbadionately with someone at risk.

One can ask a direct question of the type "Have you ever had any ideas of suicide?" said Marshall.

More general questions such as "What do you think of people who kill each other?" can also open a conversation about suicide, says Gould. "Now they're talking about it, whereas you may not have had the conversation before."

4. Assess the risks and do not panic: suicidal feelings are not always an emergency

Suppose that a loved one confesses to you thinking about suicide. What are you doing then?

"Do not be frightened," said Whiteside.

People often believe that a person who plans to commit suicide must be transported to the hospital. But "all those who have expressed these thoughts do not need to be hospitalized immediately," Marshall says.

Research shows that most people who have had suicidal thoughts have not had the kind of dominant thoughts that might drive them to make an attempt, says Whiteside. In other words, many more people have suicidal thoughts than to act.

But how do you know if your loved one's situation is an immediate crisis?

Whiteside suggests asking direct questions such as: "Are you planning to kill yourself the next day or so?" and "How strong are these desires?"

To facilitate this conversation, Columbia University psychiatrists developed the Columbia Protocol, a risk badessment tool based on their research-based suicide severity rating scale. He guides you through six questions to ask your loved one if he has thought about suicide and how to do it, and whether he has elaborated the details of how he would execute his plan.

Someone who has a plan at hand is at high risk of acting – according to the Suicide Prevention Resource Center, about 38% of those who have developed a plan are trying to do so.

5. If it's a crisis, stay in the vicinity

So what happens if you have badessed the risk and are concerned that your loved one is in crisis? First, ask them to stop for a day or two, says Whiteside, while being "rewarding and kind".

The kind of intense emotions that can drive a person to act impulsively "usually disappears or becomes manageable in less than 24 or 48 hours," she says. If you can, offer to stay with them during this time, she adds. If not, help them find other immediate social support or medical help. They should not be alone in these times of crisis.

Ask them if they have any way to harm themselves and work with them to remove these objects from their environment. Research shows that removing or limiting access to means reduces the number of deaths by suicide.

Lifeline National Suicide Prevention offers this guide on the five things to do if someone around you is in imminent danger.

If you do not know how to help someone during a time of crisis, call the National Lifeline for Suicide Prevention, says Gould.

6. Listen and give hope

If the person does not run an immediate risk, it is always important to listen, for example survivors of suicide attempts like Lezine and DeGolier.

"The most important thing is to listen with an open mind, not to judge," says DeGolier.

"Do not tell a person what to do, they want to be heard, to make their feelings known."

The next step is to offer hope, says Whiteside. It's useful to say things like, "I know how strong you are, I've seen you overcome difficulties, I think we can overcome this together," she says.

He's one of Lezine's closest friends in college who did it during his suicidal phases, he says.

"On the one hand, she never lost confidence in me," says Lezine. "She always believed that I had a positive life possible and that I would achieve good things."

He says that his confidence in him prevented him from completely giving in to his despair.

"Have someone, a confidant who absolutely believed in a person [my] his ability to do something meaningful in life "has been instrumental in his recovery, he says.

7. Help your loved one develop a safety plan

When a person does not run the immediate risk of attempting suicide, it is the right time to think about the prevention of a future crisis.

"This is where we want to do adaptive help and adaptive search strategies," said Gould.

Suicide prevention experts advise people to develop what is called a safety plan, which, according to research, can help reduce the risk of suicide. It's a simple plan to know how to cope and get help when a crisis occurs. Typically, someone at risk and their mental health provider create it together, but a family member or friend can help you too.

The American Foundation for Suicide Prevention has a model for creating a safety plan. In particular, a list of triggers and warning signs of an impending crisis, people with whom they feel comfortable asking for help and activities that are needed, should be listed. they can do to distract themselves at these times – it can be simple, like watching a funny movie.

Security planning includes helping your loved one to make their environment safer. It's one of the most important steps in preventing suicide, Marshall said. This involves a conversation about mortal means.

"If you ask what kind of thoughts you have, they can tell you the way," she says.

If they do not communicate this information, it is worth asking them directly, she adds. Once they have explained the means they thought to use, we can discuss with them how to limit their access.

"The more time and space can be put between the person and hurting themselves, the better," Marshall said. "If it's a firearm owner, you can talk to him to make sure that he does not have easy access to a firearm." in case of crisis. "

8. Help them fight the mental health system

When someone is in urgent crisis mode, this is often not the best time to try to navigate the mental health care system, says DeGolier. But to avoid a future crisis, offer to help your loved one to consult a mental health professional to find out if the medications can help and to learn how to manage his mood and suicidal thoughts.

A kind of speech therapy called dialectical behavior therapy, or DBT, has proven effective in reducing the risk of suicide. It teaches people strategies to calm their minds and to distract themselves when suicidal thoughts return.

It can be difficult for a person with negative emotions to obtain and respect an appointment for mental health. Family members and friends can help, notes Whiteside.

"Know that it takes perseverance," she says. "You do not stop until you have an appointment with them, it may mean that you call 30 people until you find someone who is available." take a day off, go with them. "

Lezine says that he was fortunate to have the help and support of his friend in college when he was struggling.

"One of the things that was helpful to me … did she go with me [to my appointment], "he says. When you feel really depressed and feel as if you're importing less, you might not want to take time, or think it was worth it, or that I did not want to go through it. "

Many people do not go to their first appointment or do not follow up, he says. If a person holds you by the hand throughout the process, accompanying you to your appointments can prevent this.

"If someone is sitting with you, you can have eye contact, touch contact," says Lezine. "It makes a difference, giving you the impression that you have another person who cares about you."

9. Explore tools and online support

For those who have difficulty accessing mental health care, some evidence-based digital tools may also help.

For example, there is a smartphone app called Virtual Hope Box, which is modeled on cognitive-behavioral therapy techniques. Research shows that veterans who felt suicidal and used the app were better able to cope with negative emotions.

Whiteside and his colleagues have launched a website called Now Matters Now, which features videos with personal stories of suicide survivors talking about their own difficulties and how they overcame their suicidal thoughts. Survival and suicidal ideation histories have been shown to have a positive effect on suicidal individuals.

The website also contains videos that teach some simple skills, otherwise taught by a therapist trained to offer DBT.

These skills include mindfulness and rhythmic breathing, which involves breathing with longer expirations than inspirations. Whiteside explains that it can calm the nervous system. Likewise, a cold shower, splashing icy water on the face, or eye contact with someone may distract and / or calm the person who may immediately commit suicide.

Surveys show that people who visit the website and watch videos see their suicidal thoughts diminish in the short term, she says.