Saturday, March 29, 2008

What to do when someone is suicidal

Certainly, not everyone who has thoughts of suicide or talks about suicide actually attempts it. But most people who take their own life have expressed their intention at some time. That's why it's important to take any talk or threat of suicide seriously, especially when someone has depression or another mental disorder, is intoxicated, or is behaving impulsively or recklessly.

While it may not be possible to prevent all suicides, your active involvement may make a difference in saving a life. Learn effective, compassionate ways to intervene and guide someone toward professional help when he or she may be considering suicide.

Know who's at risk of suicide

Understanding who's at a higher risk of suicide can help prevent a tragedy. While you don't necessarily need to constantly monitor someone who's at higher risk, you may be more alert for possible problems. Factors that may increase someone's risk of suicide include:

  • Previous suicide attempts
  • Having a psychiatric disorder, such as depression, bipolar disorder, schizophrenia or personality disorders
  • Alcohol or substance abuse
  • A family history of mental disorders or substance abuse
  • A family history of suicide
  • Family violence, including physical or sexual abuse
  • Firearms in the home
  • A significant medical illness, such as cancer or chronic pain

You can't always tell when a loved one or friend is considering suicide. But here are some typical warning signs:

  • Talking about suicide, including making such statements as "I'm going to kill myself," "I wish I were dead" or "I wish I hadn't been born"
  • Securing the means to commit suicide, such as getting a gun or stockpiling pills
  • Withdrawing from social contact and wanting to be left alone
  • Dramatic mood swings, such as being emotionally high one day and deeply discouraged the next
  • Being preoccupied with death, dying or violence
  • Feeling trapped or hopeless about a situation
  • Increased use of alcohol or drugs
  • Changing normal routine, including eating or sleeping patterns
  • Engaging in risky or self-destructive behavior, such as using drugs or driving recklessly
  • Giving away belongings or getting affairs in order
  • Saying goodbye to people as if they won't be seen again
  • Developing personality changes, such as becoming very outgoing after being shy
Also, don't always expect to see warning signs of suicide. Some people keep their thoughts of suicide secret or deny having suicidal intentions even when directly asked. And many who consider or attempt suicide do so when you thought they should be feeling better — during what may seem like a recovery from depression, for instance. That's because they may finally muster the emotional energy to take action on their suicidal thoughts.

The best way to find out if someone is considering suicide is to directly but gently ask. Asking them won't give them the idea or push them into doing something self-destructive. To the contrary, your willingness to ask can decrease the risk of suicide by giving them an opportunity to talk about their feelings. If someone denies having suicidal intentions but you're still worried, continue to gently raise the issue.

You can ask open-ended questions about their feelings or specific questions about suicide. Here are examples of questions you can ask someone you're concerned about:

  • Are you thinking about dying?
  • Are you thinking about hurting yourself?
  • Are you thinking about suicide?
  • Have you thought about how you would do it?
  • Do you know when you would do it?
  • Do you have the means to do it?
  • How are you coping with what's been happening in your life?
  • Do you ever feel like just giving up?

If a friend or loved one is considering suicide, he or she needs professional help. Remember, it's not your job to become a substitute for a mental health provider. Also, don't tell him or her that you promise not to tell anyone. The safety of your friend or loved one is of the utmost importance. Don't worry about losing a friendship when someone's life is at stake. Besides, carrying a secret like this is a big burden for you emotionally.

If you believe someone is at imminent risk of suicide or harming himself or herself or has made a suicide attempt, don't leave the person alone. Call 911 or your local emergency services provider right away. If necessary, take the person to a hospital emergency department yourself.

If possible, find out if he or she is under the influence of alcohol or drugs or may have taken an overdose. You may have to remove items that could become weapons of self-destruction, such as guns, knives or pills. But don't put yourself in harm's way by doing so.

If the danger of suicide or self-harm isn't imminent, offer to work together to find appropriate help, and then follow through on your promise. Someone who is suicidal or has severe depression may not have the energy or motivation to find help on their own.

Ways you can help include:

  • Finding a qualified doctor or mental health provider
  • Taking him or her to appointments
  • Sorting through health insurance policies or benefit information

Many types of help and support are available to people considering suicide. If your friend or loved one doesn't want to consult a doctor or mental health provider, suggest finding help from a support group, crisis center, faith community, teacher or other trusted confidante.

There's no way to predict with certainty who will attempt suicide. And although you're not responsible for preventing someone from taking his or her own life, your intervention may help him or her see that other options are available to stay safe and get treatment.

Be supportive and empathetic, not judgmental. Listen to his or her concerns without interruption. Reassure him or her that help is available and that with appropriate treatment he or she can feel better about life again. Don't be patronizing by telling someone that "everything will be OK," that "things could be worse" or that "you have everything to live for."

Direct questioning, supportive listening and gentle but persistent guidance can help you bring hope and appropriate treatment to someone who believes suicide will offer the only relief.