As we discussed in Part 1 of this series, suicide rates increase around the holidays & during the Spring. You might notice someone exhibiting signs that they are feeling suicidal: *giving away treasured possessions
*increased self-harm, substance use
*changes in mood or behavior…etc.
Would should you do if you suspect a friend is suicidal? Answer: You talk with him. Myth: talking with a suicidal person about suicide increases the likelihood he will commit suicide. Fact: Talking with the suicidal person decreases the likelihood he will commit suicide. Reason: he is connecting with a caring third party.
Suicide occurs when a person feels two things: helplessness & hopelessness. When you reach out & talk with a suicidal person, you remove helplessness & hopelessness from the equation. You might think, “But, I wouldn’t have any idea what to say!” Here’s what you do: just ask question #1…
1. “Have you been thinking about suicide?”
This is a simple question. People won’t usually get upset when you ask, & people tend to be honest when they answer. There are two possible answers:
Answer A: “No. Not at all.” (this indicates there is no problem)
Answer B: “Yes.” (If “yes,” ask question #2, which continues your use of the suicide lethality checklist. This is designed to determine how serious the problem is. So, ask question #2…)
2. Was the idea of suicide just a fleeting thought, or have you been seriously considering it?
Answer A: “Fleeting thought.” (less to worry about; keep an eye on him)
Answer B: “Serious consideration.” (More to worry about. Ask question #3…)
3. Do you have a plan (how you would do it)?
Answer A: “No.” (A little less to worry about. Keep a very close eye on him; consider mental health treatment.)
Answer B: “Yes.” (You need to be worried. He is more serious if he has thought through how he will do it, so ask question #4…)
4. How do you plan to do it?
Take note of the method (i.e. handgun, medication overdose, hanging, etc. Now ask question #5 on the suicide lethality checklist…)
5. Do you have the means to carry out this plan at this time?
Answer A: “No.”
(this prevents the possibility of immediate self-harm, but only lasts until he acquires the means.)
Answer B: “Yes.”
Take away the means.
i.e. if he plans to OD on meds, take the meds. If he needs the meds, dole out the amount for each dosage at the time of each dosage; don’t let him have the whole bottle, at least until the crisis passes.
If he plans on using a handgun, take away all handguns until the crisis passes. (Ask where the gun is located. When you have it in your possession, ask, “Are there any other guns?” Take them all). If you can’t legally take possession of firearms, find someone who can.
If he plans to crash his car, take his keys, and stay with him until the crisis passes.
Ask final question #6…
6. “Have you attempted suicide before?”
Answer A: “No.” (slightly less concern; though this still represents a crisis situation).
Answer B: “Yes.” (Great concern. People who have attempted suicide before have demonstrated they are willing to commit suicide. Previous suicide attempts are one of the strongest indicators for a high level of suicide lethality in a given crisis situation.
The progression of questions on the suicide lethality checklist indicate how serious is the threat of suicide. As soon as the potentially suicidal person answers “no,” your questioning is done. As long as he keeps answering “yes,” you keep asking questions to determine just how serious is the situation. The more serious, the more quickly & seriously you have to intervene.
A suicidal person represents a real & immediate medical crisis. The lethality checklist determines how potentially lethal is the situation. Here’s how to determine the number. The range is 0-5.
Have you been thinking about suicide?
“No” = 0; “Yes” = 1
“Fleeting thought” = the lethality level stays at 1; “Serious contemplation” = 2.
“No plan” = lethality remains at 2; “Has a plan” = climbs to 3.
“Does not possess means to carry out plan at this time” = lethality remains at 3; “Has means now” = 4.
“Never attempted suicide before” = lethality stays same at 4; “Has attempted before” = lethality level is a 5.
The score gives you a way to gauge the situation. If the number is zero, you likely have nothing to worry about, and no further action is required. If the score is 1 (fleeting thought), almost anyone can experience this from time to time. It may not be a cause for concern. You might recommend the person talk with a mental health professional, if you feel this is warranted. If the score is 2 (serious contemplation, but no plan), the person should make an appointment to talk with a mental health professional, and you should monitor the person closely in the meantime to prevent him from harming himself. You might be justified in taking the person to the emergency room in some situations.
If the score is 3 or higher (has a plan), this a crisis situation that requires immediate intervention. You should consider taking the person to the emergency room, calling 911, or having the person call a suicide hotline, such as the following one, which serves the Chicagoland area: 630-482-9393. You may find a similar hotline in your area via the Internet or other appropriate source.
In addition to solving the immediate crisis, you should also help the level 3 (or higher) suicidal person seek ongoing competent mental health services to address the underlying issues that are causing the suicidal thinking and behavior.
Suicidal thinking & behavior represents a complicated situation. I have tried here to create a simple approach to assessing & helping those around you. Always use common sense & seek medical or mental health assistance whenever doing so seems prudent.
Many people are afraid to deal with a suicidal person. Don’t be. By arming yourself with this information, you have what it takes to reach out and help. If you don’t reach out, you might regret that forever. Even if you’re wrong in your assumption, & the person is not suicidal, he will be glad you cared enough to ask, rather than upset that you thought that about him. Always err on the side of caution, and ask, if you feel doing so is warranted. Trust your intuition about people. If you feel you should ask, then ask.
Thank you for taking the time to read this. In part 3 of this series we will look at some additional aspects of intervening with people who are suicidal.
This “Suicide-Prevention Series” brought to you by Slam Horse