Suicide is the 11th leading cause of death in the U.S., and the third leading cause of death for 15 to 24 year olds. Still, suicide remains a taboo topic, is highly stigmatized and is surrounded by myth and mystery.
One of the biggest — and most destructive — myths is that if you discuss suicide, you’re planting the idea in someone’s head, said Scott Poland, Ed.D, the prevention division director at the American Association of Suicidology and associate professor at Nova Southeastern University. Clinical psychologist and suicide expert William Schmitz, Psy.D., likens it to talking to someone who’s recently been diagnosed with cancer. By mentioning cancer, you’re not forcing the topic front and center. “If someone is diagnosed with cancer, it’s on their mind.” Bringing it up shows support and concern. Similarly, by talking about suicide, you show the person that you truly care about them. In fact, lack of connection is a key reason why people have suicidal thoughts; isolation contributes to and escalates their pain.
In general, it’s important to take any suicide thought or attempt seriously. But what does that mean and then where do you go from there? Because we talk so little about suicide, there’s little awareness about how to help. Dr. Poland emphasizes that people don’t have to suddenly step into a therapist’s shoes and counsel the person. But there are important ways you can help. Drs. Schmitz and Poland discuss the best ways below.
Take suicide seriously, and don’t minimize it.
When talking to a person you think might be suicidal, it’s critical not to dismiss what they’re saying. While this makes sense, we might minimize a person’s pain without even realizing it. Poland even sees this when training professionals on suicide prevention.
For instance, in a training example, if the person says, “My life is so terrible right now,” it’s usually met with reactions like “Oh, it’s not that bad” or “I know you’d never hurt yourself.” Even when the person mentions being overwhelmed, well-trained professionals dismiss the comments. For instance, they say: ‘Things were awful for me last semester, too, and I got through it. Let me help you with your studying.” Although help is being offered, this reaction still minimizes and discounts the person’s feelings and experiences. And both slam the door on communication.
Know the warning signs.
According to both experts, these are some of the warning signs to pay attention to: dramatic changes in behavior or weight; drinking more than usual; mood changes; anxiety; making hopeless statements about death and dying; and isolating or withdrawing, such as dropping out of activities. Ultimately, though, “trust your gut that something is not quite right,” Poland said.
The American Association of Suicidology also features an in-depth list of warnings signs. It’s designed to help professionals detect risk for suicide, but it may give you more information.
Approach the person.
If you notice one or several red flags, don’t hesitate to talk to the person. Again, the worst thing you can do is to ignore what’s happening. Poland suggested starting the conversation by saying something like: “’I’d like to talk to you a minute, I’m really worried, you seem like you’re a little down. Could we talk about that? I’m here to help.”
Also, during the conversation, consider your physical cues. You may be asking the person to share their feelings with you but your demeanor may indicate that you don’t really care, you’re rushing or you’re not open or fearful about hearing them.
Importantly, never agree to secrecy, Poland said. For instance, you can say, “I really care about you, I’m here to help, and I cannot promise to keep this a secret,” he said.
Some resources suggest asking the person if they have thoughts of hurting themselves. According to Schmitz, such questions are “rarely beneficial.” That’s because “When people walk around the topic of suicide [such as the question of hurting oneself], it can send the unintended message that it is not OK to discuss suicide.”
Also, he added that “for a lot of suicidal individuals, they have no desire to hurt themselves, they are striving to cease pain and want relief/death, and will often decide on the ‘least painful’ method of suicide in their ideations.”
Ask the person directly if they’re considering suicide, Schmitz said: “You know, John/Jane, a lot of people with (insert warning sign[s]), can have thoughts of suicide or of killing themselves, are you having any thoughts of suicide?”
“Too often we either don’t listen well or we say something that cuts off the conversation,” Poland said. But listening is one of the best ways you can help, both experts emphasized. Give the person the opportunity to tell you how they’re feeling and what they’re going through.
As Schmitz said, “We can have so much fear in talking about suicide [and] we’re so scared about saying the wrong thing, that we say nothing.” Speak from the heart. Anything that’s said genuinely and directly, he said, ultimately can’t be damaging.
Schmitz recalled working with a high-risk suicidal patient whose thoughts included killing himself with a gun. During one of their sessions, when talking about treatment, Schmitz unwittingly said to the patient, “we just haven’t found a magic bullet for this yet.” “Doc, ‘I’m not sure that’s the best analogy,” the patient responded, and they were able to laugh at the situation because of the connection they had.
“It’s not about the right four words or two sentences, it’s about the connection,” Schmitz emphasized. There are no magic words. What’s important is conveying empathy, concern and a willingness to help.
Help them eliminate access.
If the person discloses to you how they’re considering committing suicide, eliminate access to those means, Schmitz said. For instance, if they’ve had thoughts of using a gun and there are guns in the house, either get the guns out or get the person away from the home, he said.
Even if the person says in passing that they’re thinking about overdosing, it’s invaluable to see what kinds of medications are in the house and to talk about getting rid of them, he said. He added that you can tell the person, “I really care about you and I don’t want you to do something impulsive that you’ll regret.” This shows them that you genuinely care.
“The next critical message after connection and empathy is that [suicidal thoughts are] treatable and there is help,” Schmitz said. Numerous studies have shown that treatment can reduce the severity, duration and frequency of suicidal thoughts. Let the person know that they’re not alone, that others have experienced suicidal thoughts and go on to lead fulfilling lives after seeking treatment.
Help them get help.
When talking to the person, the key is to get them treatment right away. As Poland said, “this isn’t something we want to wait on,” even if it’s checking back with them later that day or the next day. Avoid assuming that things will be better the next day.
At their university, Poland encourages faculty members to walk students to the counseling center or call a provider together immediately after their talk. Together, the two of you also can call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), which is free, confidential and available 24/7. (Here’s more information.)
Call 911 in case of an emergency.
In addition to calling 911, stay with the person until emergency services arrive, Poland said. It’s vital not to leave a suicidal person alone. You can show support and compassion by saying things like “‘I’m going to be there for you,’ I’m going to visit you’ or ‘Who can I call for you,’” he added.
Unfortunately, suicide is largely misunderstood in our society. But there are many things you can do to help, including: paying attention to the warning signs, approaching the person, being direct and empathetic, truly listening and helping them find help right away.