Content warning. This post talks about suicide, which may be triggering to some.
In the last week, the topic of suicide has been center stage, following the death of several public and beloved people. There’s been an outpouring of shock, sadness, and confusion, as people work to make sense of the tragic loss. In addition to the shock and sadness, there’s been a collective call to better understand the topic of suicide. We must create a culture where we can talk openly about difficult and painful things. A culture and a safe space for friends and family to share their hearts.
I’ve had several friends, readers, and clients reach out this week, wondering what they can do to be a part of this shift. To be better prepared to think about, empathize, and offer support to someone who is struggling. So that’s what we’re doing today. We’re talking honestly and openly about suicide. What you need to know, how you can cope, and how you can support those around you.
Suicide is often rooted in deep hopelessness. Imagine standing twenty yards away from a deep, dark hole. The hole is scary, and for a while, you’re far enough away, standing at a safe distance. But over time, the hole starts to get bigger, and you feel as if you’re being pulled toward it. Initially, you’re hopeful the hole won’t swallow you up. But over time, you begin to lose hope. You can’t see another outcome; you can’t see things getting better. The tiny spark of hope you once had is extinguished, and it feels like there isn’t an ounce of hope left. This is often how people who die by suicide feel. Completely and utterly hopeless, certain that things can’t or won’t get better. The thought of continuing to move forward seems daunting beyond measure. They feel trapped, and the pain feels unbearable. So much so that it feels as if there is only one solution to ease their suffering.
People who die by suicide often feel isolated and completely alone, no matter how many people are around them. As humans, when we’re in pain, the natural response is to isolate and withdraw. To pull away from others. We feel defective and broken, so no one could possibly understand, right? This withdraw is initially comforting, though is also creates a space for isolation and hopelessness to run wild. When we’re struggling, our brains trick us into thinking no one will understand, so the solution is to retreat. People are often surprised when celebrities and well-known figures, many of which seem to have large social networks, die by suicide. Being alone and feeling alone are two very different things.
Depression is common, as are relationship issues and financial problems. Suicide and depression are closely linked, meaning that many people who die by suicide have a history of depression. (Please note, this does not mean that everyone who has a history of depression feels suicidal.) Significant relationship problems and financial strain can also exacerbate suicidal thoughts, particularly when hopelessness starts to creep in.
Watch for warning signs. Suicide often comes with warning signs, and the common theme to most of the warning signs is change. Changes in mood, personality, motivation, irritability, spending, responsiveness, and priorities. It’s a little bit easier to spot changes that are more of a decline (ie mood is lower, motivation is lower, the person is responding less to texts), but sometimes these changes might be in the opposite direction. Change is often a sign something is shifting in our lives. So while change doesn’t always mean someone is contemplating suicide, it’s an indicator that something important might be going on. Take notice of changes in people you care about and ask about them.
While warning signs are often present, they’re not always obvious. If you know someone who has died by suicide, it’s important that you don’t use these warning signs as a way to blame yourself for what you “missed.” People who die by suicide are often incredibly loving and kind, and they often work hard to mask their pain, because they don’t want their loved ones to worry. Reflecting after someone’s death is healthy, yet we have to be mindful that this reflection doesn’t turn into blame and shame. If you’ve lost someone to suicide, and you find yourself dwelling on what you “missed,” it may be helpful to talk through this with a mental health professional.
Ask the question. If you’re concerned about someone in your life, if you’ve noticed recent changes, ask them if they are considering suicide. It can feel really uncomfortable to actually say the words, “Are you thinking about killing yourself? Have you thought about suicide?” but asking this question directly is critical. It can be life saving. Avoid using phrases like “end it all”, “hurt yourself”, or “do something crazy”, because these aren’t directly speaking to suicide. And many people who are suicidal would answer “no” to these questions, because they don’t see killing themselves as the same as any of these. Ask compassionately but directly.
You won’t put the idea of suicide into someone’s head. One of the reasons people are afraid to ask about suicide so directly is because they’re afraid that they’ll “put the idea into the person’s head.” Research has shown over and over that this isn’t how it works. You won’t “put suicide into someone’s head.” In the 12 years I’ve been asking this question to people, both in my professional life and in my personal life, I’ve never once had someone flinch, get offended, or think the question was strange. If the person is considering suicide, they often find this question to be a relief. Someone is finally speaking to their pain. If the person hasn’t thought of killing themselves, they’ll let you know and probably appreciate that if they ever are suicidal, you’re someone they can go to.
Listen. Listen. Listen. When someone tells you they’re considering killing themselves, it can be really hard to hear. And so often, your brain switches into problem solving mode, wanting to point out all the reasons they have to live or help them feel better. Resist this urge. It won’t help. Time and time again, people who are struggling say the most helpful and meaningful thing you can do is listen. Without judgment. Acknowledge their pain, and validate their struggle.
Ask about a plan. After you’ve listened (and listened some more), ask the person if they have a plan for how they’d kill themselves. Again, this might sound morbid or strange, but this can often give you important information about the person’s level of risk. The more thought out and specific the plan is, often the more concerning. As a psychologist, I’m trained in nuanced and subtle risk assessment, but you are not expected to do this. Talking openly about plans can provide relief for the person, who has likely been carrying this weight alone. It can also make them more open to seeking help, as they speak their pain and plan aloud.
Help them get connected with a mental health provider. It isn’t your job to be a therapist (unless, of course, you are a therapist). So don’t try to be one. Instead, encourage the person to get connected with a mental health provider. Ask if they have a therapist or psychiatrist. If they do, ask if they’ve told them about their suicidal thoughts. If not, ask if they would be open to it or if they’d like you to go to an appointment with them, so they can have support as they talk about how they’re feeling. If they don’t have a mental health provider, ask if they’d be willing to see one.
Sometimes it can feel daunting to think about the whole therapy process, so just focus on making that initial appointment. Offer to help them find a provider. Help them make the calls. Sit with them while they schedule or check on their health insurance. Sometimes the process of getting connected with a provider can feel overwhelming. Reduce their load by helping them with some the practical stuff. Send encouragement in the days leading up to their appointment. You might also offer to drive them or sit with them in the waiting room. All of these can offer support and accountability for the person, helping them to feel less alone. (If you’re looking to get connected or help a friend get connected with a mental health provider, you can find some helpful tips for doing that here.)
Follow up. If you’ve had this initial conversation with someone you care about, awesome job. It can be scary and uncomfortable to talk about suicide and struggling, but it’s so important. Don’t let the conversation end there. Follow up, check in, offer to sit with them, stay engaged. Being that vulnerable with someone can leave a person feeling raw, so check back in and keep listening.
Utilize the National Suicide Prevention Lifeline. If you or someone you know is considering suicide, contact the National Suicide Prevention Lifeline. They offer 24/7 free and confidential resources for people in distress, as well as their loved ones. You can call them at 1-800-273-8255 or use their online chat feature. They offer services in English and Spanish, as well as for individuals who are deaf or hard of hearing. If you’re feeling suicidal or concerned about someone who is or might be suicidal, reach out to the Lifeline. If you know someone who is having thoughts of killing themselves, encourage them to put this number into their phone so it’s available, should they need it.
It can be hard to talk about suicide. It can be scary to know where to start or if you’re saying the “right” thing. But saying something is important. You never know the difference it can make.
If you or someone you know is considering suicide, reach out the National Suicide Prevention Lifeline.