Discussing suicide: How to support someone you’re worried about

Suicide rarely happens without a warning.  It is definitely not comfortable or pleasant when someone who you know and love talks about ending their lives.   You may feel uncomfortable and ask yourself, how and what can I talk to them about it?  The trick is simple:  Always allow the person the time and the space to talk.   It can make the person feel supported and understood.  It may eventually help them put things into perspective.

Watch

Look for the warning signs:  “This hurt will never go away unless I do something about it” could be a red flag.  In children and in youth, artistic expressions on themes of death, hopelessness, pain, and suffering; drawings where the body sizes of figures shrink over time may reflect the suicidal person’s sense of worthlessness. 

Although you cannot always predict suicide, here are a few other warning signs:

• Verbal statements like, “I wish I were never born” or “I wish I could sleep and never wake up”, “It doesn’t matter anymore; I am not going to here much longer anyway” could be warning signs.

• Social withdrawal; repeatedly asking to be left alone, refusing activities that the person once enjoyed doing.
• Increased use of alcohol, drugs or other substances.
• Getting personal affairs in order, making a will, giving away belongings and valuables, especially when there is no logical explanation to it.
• Obtaining means for suicide, chemicals, weapons, medicines
• Self-destructive behaviors, reckless driving, other harmful behaviors
• Talking about low self-esteem, hopelessness and worthlessness
• Saying goodbye to people as if they won’t be seen again or writing letters
• Sudden and/or extreme changes in sleeping and/or eating patterns
• Changes in work/school performances
• Changes in life situations:
• Major loss – in business/finances,  a loved one, home, pet, status, relationship
• Chronic illness
•  Natural calamities

Ask

• Choose a time and place where you can talk openly and easily, without getting interrupted.  Be prepared for a long conversation, make sure you do not have pressing commitments or appointments.   Choose a place that feels safe.   Choose a time or activity that you can do together if that feels more comfortable.  Sometimes it is easier to talk when you are out on a walk or a long drive or simply while watching TV together at home.
• Start the conversation.

Some of the simple conversation starters could be:

“I just had a terrible day at work; how was yours’s?”  Or “I noticed you have not been yourself lately, what’s wrong/ can I help? / Want to talk about it?”

• Be specific:  “Is everything okay at school/at work/at home?
• Be direct: “Have you been thinking about suicide?”  “Do you feel like life is not worth living anymore?”  And don’t worry.  Bringing it up doesn’t increase their chances on actually acting on it.

Listen

• Listen to the person’s struggles and feelings with empathy and let them know that you care about them.  Do not judge.  Be prepared to listen if it makes you uncomfortable or upset. Statements like, “I appreciate you telling me this, and how you’re feeling. Thank you for sharing this with me” helps develop trust and understanding.   Open ended questions helps keep the conversation going.
•   Let the person know that no matter what they have to say, it won’t affect your relationship.  You are there to help, to support them in what they are going through.  Let them know they are not alone in this. 
• Respect their feelings even if you feel they are not being logical.

What to say?

• “What’s causing you to feel so bad?” or “What has helped you in the past” or a simple “How can I help?” can go a long way.
• Offer reassurance
• Find out if they’ve already made a plan and how do they plan to implement it.   “Have you been thinking about how to kill yourself, or when?”  “Have you taken any steps yet?”  Asking this is extremely important.
• “Shall I call your therapist?”  Or “Do you want me to drive you to the doctor?”   A suicidal  person may not have the energy or motive to find help. You may not always be in a direct position to help.  Encourage them to seek a professional.  Offer help in setting an appointment.   Connecting them to a support group, crisis center, faith community, teacher or other trusted person may be extremely beneficial.
• Use terminology that is not stigmatizing.  If you are talking to the family member or a loved one of the person who died by suicide, make sure you use terms that emphasize respect and not stigma.  Sentences like “died by suicide” or ‘took his life”  or “attempted to take his life” are less stigmatizing than “committed suicide” or ’failed suicide attempt”.

What not to say

•  This is not a time to remind them of ‘what they’ve got going for them’ or “how selfish they are not to think of the impact of their actions on their family”
• “Don’t be over dramatic” “why are you trying to seek attention this way” “Grow up; don’t act immature” can do more damage than good.   Take them seriously and acknowledge the reasons they want to die.  They are not attention seeking.  They are seeking help.
•  “I am shocked.  How can you even think of this? “Is not going to help them when they are in a state of ‘impending doom’.
• “Be grateful for the things you have. ““Things could be worse” or “You have everything to live for”, definitely does not help either.
• Last but not the least, don’t make promises to keep their ‘suicidal intent’ confidential.   You cannot and should not keep it confidential but confide it to people who are in a position to help.

What’s next?

You have spent time with your friend who feels suicidal.  You have asked, you have listened and offered reassurance.  You have validated their feelings and said all the right things.  It’s now time for you to take your next steps:

• If you think you friend needs urgent help and has made his decision to end his life, call 911 or a local emergency number.   If the person is willing to accompany you, drive them to the hospital yourself.
• Do not leave the person alone even for a short period of time.
• Discourage them from drinking alcohol or using other elicit substances
• Encourage them to eat healthy and balanced meals
• Call a friend or family member for assistance if necessary
• Remove all harmful objects away from their reach if possible.

If you feel the person is not in immediate danger, but still needs help, share your concerns with a person who can help.  It may be hard to tell whether a person is actually contemplating suicide if they have not been completely open with you, and you may be afraid of taking action and being wrong.  But if a person’s behavior or actions raise red flags, the person may be struggling with some major issues, even if not considering suicide at the moment. Getting the person to the right resources may be the best course of action to take.

Key takeaways

If you know someone around you is suicidal, don’t play it down or ignore the situation.  Although you may not be absolutely responsible for someone’s safety, your timely intervention and support may help the person see another perspective Many people who kill themselves have expressed the intention at some point. You may worry that you’re overreacting, but the safety of your friend or loved one is most important. Don’t worry about straining your relationship when someone’s life is at stake.  Maybe you have just been given this unique opportunity to save a life.  Make it count!