What else is important to know?
Getting someone professional help is critical. You don’t want to be in a situation where you are the lifeline for another human being. That is fraught with danger for that person and for you. Even if the person doesn’t kill themselves, they put you in an untenable situation that you’re not prepared for and will likely cause a great deal of anxiety for you. The best thing you can do is whatever you can to get that person into treatment. It may range from providing a suicide hotline number to actually calling the police and an ambulance to bring them to the emergency room, depending on the acuity of the circumstance.
What if someone has ongoing feelings of suicide?
Often, suicidal feelings can last a long time and be chronic. In addition to treatment, it’s important to create a safety plan. There should be a very clear, and preferably written, point-by-point plan of what a person will do if they feel suicidal. This is hopefully done in the context of treatment, but it’s important for the family to be aware of it whenever possible. The plan can include anything from providing a suicide hotline number to engaging in coping mechanisms they’ve learned as part of therapy, going to an ER, or calling a therapist, friend, or parent. Coping skills may include distracting behaviors, like walking around the block, taking a bath, or watching a funny movie — whatever seems to work for that individual. But a list of activities and steps that they are going to take before they act or harm themselves is useful and important.
Even if they are not suicidal in the moment, these feelings tend to recur. We should have the expectation that they’re going to feel this way again and help them anticipate the circumstances under which these thoughts or feelings are likely to emerge. A young adult with a history of becoming suicidal after they fail a test may not feel suicidal now, but might if they fail another test. Knowing the steps to take to help in the moment to get over the crisis is extremely important.
Is suicide an impulsive act?
Not always. Some people think about suicide for a very long time and plan carefully and basically make a decision that they feel is rational, although others would not agree, that their life is just not worth living. Others may be extremely impulsive, and the suicidal act may come at a moment of heightened emotion, in particular heightened anxiety and this sense of what we call psychic angst — pain in your being that just feels unbearable in the moment and may push someone to do something impulsively. Then, of course, there’s everything in between.
Can you predict who will take their life?
We cannot predict who is going to die by suicide. Most people who experience or exhibit warning signs don’t take their lives. There are many risk factors, but there is a lack of specificity in those risk factors. Many people get depressed or go through periods of hopelessness. For statistical reasons having to do with the relative infrequency of suicide and lack of specificity of any risk factor or group of risk factors related to suicidal behavior, it makes it impossible to predict who will die by suicide.
There is no blood test. There is no brain scan. There is no psychological test that can tell us if and when an individual will engage in suicidal behavior. We look for triggers and warning signs that have been associated with suicide risk in vulnerable individuals because it makes common sense to do so and can save lives. But in the end, we don’t know what is in the mind of that person who ultimately decides to take their own life. We don’t know that final thought because it’s never available to us. Because of that, there’s a certain degree of humility that I think all of us who work with people who struggle with suicidal feelings have to accept and understand.
Is there still a stigma around mental illness and suicide?
I think it’s getting better very slowly, but it is still a huge problem. Efforts of organizations like the National Alliance on Mental Illness are making an impact, and public figures coming out and sharing their mental health struggles helps too. But I think that the stigma remains a problem, particularly in some communities more than others. When there are cultural prohibitions or consequences to having a mental illness or getting treated for one, it makes it that much more difficult to access care.
Struggling with depression, anxiety, or having thoughts of suicide is not uncommon, yet many people seem to distance themselves from it — perhaps because it’s not the way that people want to see themselves. The sense of emotional well-being is so closely connected to who you are in the world. It’s different than if you have pneumonia or diabetes, if something happens to you — somehow the idea of mental illness isn’t viewed the same way, perhaps because it’s so closely aligned with a sense of self and identity — even though these are brain diseases.
How can people who have lost someone to suicide cope?
Be aware of your feelings and understand and accept the fact that you are going to have very strong feelings about what happened. That’s normal and appropriate, and you will need support. The extent of that support may be limited or may be extensive in terms of getting into therapy.
There is no constructive role for guilt or self-blame — there has already been one casualty, and we need not create any more. Feelings of guilt, loss, anger, and, of course, tremendous sadness are all natural feelings that can be dealt with and understood in the context of the circumstance.
If you are in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), or contact the Crisis Text Line by texting TALK to 741741.