When Someone is Suicidal

When Someone is Suicidal or Expressing Suicidal Thoughts

So I’m going to start out today with a story. It was about, 10 years ago. I was meeting with this guy in his mid-40s, This was after the economy collapsed, and he was really struggling. He had lost his job. He was having financial trouble and marital struggles.

In part of the conversation, he said, “I just want to go to the beach. I wish I would drown.” I hear a lot of similar comments. Where a person is talking about not wanting to be here.

The question is, how much emphasis do you put on what is being said? How uncomfortable could it be for people? Are they really telling me something, or are they just expressing an emotion?

How do I Help Someone Who is Suicidal?

So today what we’re talking about when someone is suicidal and suicidal thoughts. What I’m going to do is I’m going to go through a number of things. Then I’m going to give you some statistics on it. Right now, we’re going to look at three things.

1. How do I assess if someone is actually suicidal?
2. How do I intervene?
3. How do I provide support when someone is suicidal?

These become very difficult topics for people to talk about. The reason why I’m sharing it with you is because you’d be surprised how common it can be. We’ve had this discussion over and over again. With mental health issues, people want to dismiss it or it’s an uncomfortable topic, so they don’t want to talk about it. But, when you don’t talk about it, that’s when things get worse.

So I’m going to put this qualifier in. Remember, when I share these videos with you, this is not a substitute for treatment. This is not to say, hey, if you follow these steps then you’ll have no issues. Or that you’ll be able to help someone through their stuff.

Really what I’m trying to do is provide information so you’re much more aware. When things are said or are done, you can kind of have a better understanding of what’s going on, and then how you might make choices going forward.

Suicide Statistics

Suicide is a very difficult one. So let me just start with a couple of statistics. We hear about homicides in the news all the time. However, there are twice as many suicides in the United States every year compared to homicides. So it’s two for one. So for every homicide you hear about, there were two suicides.

The question is why does the news not report this stuff? Now could it be that when it comes to mental health issues, no one wants to actually acknowledge that there is a serious issue.

• There are twice as many suicides as homicides in the US.
• Suicide is the 10th leading cause of death in the United States.
• What’s more remarkable is for those that are aged 10 to 34, suicide is the second leading cause of death.
• Women are shown to have more, or at least acknowledge more, suicidal thoughts than men, and have more attempts than men.
• But men are much more successful in completing suicides. And when I’m saying completing suicides, I mean that they die from their attempt.
• The highest rate of suicide is in middle aged Caucasian males.
• Young women, a hundred attempts will pretty much equals out to one completed suicide. So, with young women, multiple attempts. And when you factor them all together, a hundred attempts would equal one completed suicide.

So, a lot of people will say, hey, why is it suicide is not really mentioned much? How can I tell if someone’s suicidal or not? I will tell you, I have active involvement in every client that is thinking of coming to Nsight and every client who is here at Nsight.

The Importance of Good Mental Health Treatment

There are a lot of times we will take clients that other treatment facilities won’t take. They may have been in a psychiatric hospital on involuntary hold because they were a danger to themselves. I’m going to talk a little bit about that. That person will be released from the hospital, because you can’t hold someone in a hospital forever.

There are some treatment facilities that don’t want to treat that person because they think the client may be too high of a risk. Maybe the facility thinks the client is going to kill themselves. I think there are a lot of times that facilities are reluctant to see a client that struggles with suicidal thoughts. That makes it difficult for the person seeking treatment. I think the reluctance is the treatment facility does not understand what’s in front of them.

So I’m going to explain a little bit of this stuff. I’m going to put this qualifier on it. No matter how well you follow some of the steps that I talk about, please understand you cannot predict suicide. That would be like a heart doctor saying to somebody, I know exactly when you’re going to have a heart attack. They can’t do it.

Suicide is no different. You can’t predict it. However, you can see warning signs. Just because someone thinks about suicide, doesn’t mean they need to be in a hospital. You have to look at it like this; You can’t have someone spend their entire life in a hospital because they think about suicide.

Causes of Suicidal Ideation

So let’s talk about what could be causes or not. You’ll see a lot of times it runs in families. So is there a biological component? That hasn’t been shown yet, at least from the research I’ve done. But, we do know it does run in families. Cultural differences. I will share with you that in the United States, the native American, American Indian population and native Alaskans, have the highest rate of suicide of any culture. So there could be cultural factors.

So I’ll comment on a couple of diagnoses that we see a lot of suicide in. One would be major depression. So people that suffer from very severe depression can be at high risk for suicide. That doesn’t mean, just because you have depression, that suicide is going to be part of it. They can be totally separate.

We’ll look at suicide and ask, what do some of these people have in common?

• People who struggle with severe depression.
• People that struggle with bipolar disorder.
• Those who struggle with schizoaffective disorder.

Notice that with all three of these diagnoses, depression is part of it. But there may be other components. There may be individuals that have chronic pain and commit suicide, or attempt suicide. It may not have anything to do with depression.

So then we’ll ask, okay, well what is it?

Hopelessness & Helplessness When it Comes to Suicidal Thoughts

Think about it like this. Hopelessness and helplessness. Those are two huge factors. So if I feel helpless, like no matter what I do, I can’t overcome whatever challenge I’m dealing with, that puts me at risk. If I’m hopeless. Hopeless that no matter what happens, my condition is never going to get better.

If I feel like I’m helpless to do anything. And, I feel like I’m hopeless that it will ever get better. Those two are major factors when it comes to suicide.

So I had to just put that out there. When you’re looking at an individual, let’s say a loved one, friend, family member, and you’re concerned about suicide. And you can look at, well they don’t seem depressed, but they’re reporting that they want to kill themselves. Are they hopeless and helpless? Are they in a situation that’s very difficult?

Assessing Someone Who is Suicidal – Suicidal Thoughts

So let’s look at a couple of other things. When it comes to assessing, how do you determine? So there’s four things that you should always look for.

One would be suicidal thoughts, and that’s the number one thing that this starts with. So I’m going to comment too. Think about suicidal thoughts. Just because someone has a suicidal thought, that’s not abnormal.

You can say, Jerry, that’s really weird. What part of normal would include thinking about suicide? Think about it like this. If I’m in a lot of pain, whether it’s physical or emotional, I could be really stressed out. It can be really bad anxiety. My brain starts to go through my coping skills. So there’s healthy coping skills, and not healthy coping skills. Well, one of the things a person might think is, if I wasn’t here, meaning I’m no longer alive, I wouldn’t be in this pain.So if you look at this on a continuum of coping skills, at the very end, suicide could pop up as an option.

That doesn’t mean I’m suicidal. That doesn’t mean I’m going to kill myself. It just means that popped up as one of my coping skills. Wow, if I wasn’t alive, I wouldn’t have to deal with this pain. Or I wouldn’t have to deal with whatever the distress is that I’m dealing with. So one suicidal thoughts.

Assessing Someone Who is Suicidal – Having a Conversation

Next, if I’m with someone, and I’m trying to determine what’s going on with them, I don’t want to avoid the conversation. People are very reluctant to talk about these kinds of thoughts. They may think if they tell you they have suicidal thoughts, you’re going to put them in a hospital. Or, you’re going to call the police. Personally, I want to listen. I may say, “So tell me what’s going on. Have you ever thought about suicide? Have you thought about not wanting to be here?”

They may say, yeah, I think about not wanting to be here, but that doesn’t mean I want to kill myself. But if someone acknowledges, yeah, I do think about killing myself. My next question would be, have you ever thought about how you would do it? Meaning do they have a plan?

So a lot of people never go that far. They may say, nah, I never thought about how I would do it. Or they could say, well, I might jump off the Golden Gate Bridge.

One of the things that I have to look at. If I’m in Nebraska and the Golden Gate Bridge is in San Francisco, what’s the feasibility of that plan? Is that just some random thought, like, oh yeah, I guess if I did it I would jump off this bridge

I’m trying to look at, is this a good feasible plan? Or, is it an expression of distress? Like I’ve thought about how I would do it. I would be much more concerned if they said, hey, I’m going to overdose on some pills I have in the medicine cabinet. I would ask, do you actually have those pills in there? Yeah. Okay. To me, that’s much more significant, than a plan that’s not feasible at this time. There would be a lot of effort to get from Nebraska to California.

Assessing Someone Who is Suicidal – Is There a Plan?

Third thing is this. So we have thoughts, we have a plan that I might do something. The third thing is means. That’s kind of what I was talking about. Am I near something? Do I have something? Do they have the actual means to do something?

So I could share with you that I’m suicidal. I have thoughts about it. I think I’m going to I want to shoot myself. I might ask, do you have a gun? No. Will they have access to a gun? No. I think I might buy one. Do you have the funds to buy one? No. Do you know how to do that? No.

So what I’m doing is gathering more information. It’s a lot different when you ask someone about their plan: Yes, I’m suicidal. I think about shooting myself. Do you have a weapon? Yeah, it happens to be in my car.

I’ve actually had people say this. There’s a huge difference between the two. I’m trying to assess where is their level of distress? Are they talking about this just in thought, as a coping skill, as a means to get out of certain pain? Trying to think about how I would not be in pain? Or, is this pretty well thought out, and I’m looking for ways in which to accomplish this?

Assessing Someone Who is Suicidal – Is There Intent?

The next thing is intent. This is the most important.

When people get put on involuntary holds, they will be evaluated by a mental health professional. If they have thoughts, they have a plan and they have means, the next thing is intent.

Yes, I intend to do this. Which is when I need to intervene. Intervening would be making sure that they are in a safe place. That would be an inpatient psychiatric facility that can handle clients that struggle with suicidal thoughts.

I’m going to tell you that most people that are in this amount of distress and think about killing themselves, wouldn’t be telling you all of this stuff if they had already made up their mind.

So in all of this conversation, I want to be very validating. I want to be very supportive. I want to be understanding. I want to pick what is the best place for me to intervene.

I’m going to tell you right now. If you’re ever confused about, always go with safety first. Take them to an emergency room. Have them evaluated or call 911. Don’t ever take risks thinking you can predict what they will do. By default, if there’s concern, I need to intervene in this way.

What we’re talking about is the different steps that people go through. So thoughts, plan, means and intent. I’ve worked with people where they say, hey Jerry, I have thoughts. I have a plan. I have means.

So my plan would be I’m going to overdose on these pills. They’re in my medicine cabinet and that’s how I would do it. But I’m going to tell you right now, I’m not going to do it, because I don’t want to. I’m just telling you. My brain has gone that far as thinking through it. But that’s not what I want to do.

So this is really where a mental health professional needs to make a very strong clinical decision. How do I continue to work with this individual? Are they safe? Are they contracting for safety?

Remember, as a mental health professional, or even a layman, I cannot predict. No different than a cardiologist can predict a heart attack. I’m going to have to default to safety if I have any concerns that go beyond the trust and working relationship I have with an individual.

I would also have to look at multiple attempts. What were the previous attempts? Where they serious? Were they significant? Were they by lethal means?

We may have a client says, oh yeah, I overdosed one time. I took three aspirin, and it said to only take one. I might ask if they needed medical attention there? There’s certain questions we would ask to see the lethality of the previous attempt. I’m going to share with you, the more lethal the attempt was, the greater the likelihood another lethal attempt can occur. So there’s a lot of factors that I’m trying to take into consideration as I’m doing this.

How Do I Intervene When Someone is Expressing Suicidal Thoughts?

How do I intervene? One, it may be validation and support. The suicidal thoughts can be an indication that person is in a lot of emotional distress, and they just want to be able to talk to someone and work through it.

So number one would be get them to outpatient therapy. Get them to see a psychiatrist. Medication could be beneficial to help increase their mood. Hopefully that may increase their feelings of hopefulness and that will help get them out of distress.

Psychotherapy can help them work through the issues that are causing conflict and can help improve their coping skills. If they have tried individual therapy and it doesn’t work, they may need more intensive treatment where they’re actually staying at a treatment center. Something more long term like several weeks as opposed to several days.

They might go to a place like Nsight. Where they would be receiving a lot of services like, group therapy, individual therapy, medication management and so forth. Things that are designed to help them transition back to their life. To help them get through the crisis that’s making things difficult.

Suicidal Thoughts – Providing Support

So the last thing I want to share with you all is support. I need to be supportive. I don’t want to avoid the conversation because avoiding it is just going to make things worse. Meaning the person’s not going to improve. They’re going to feel dismissed. They’re going to feel like their emotional needs aren’t being met, which makes me more helpless. They start think nobody wants to help them. There is no hope for me, and it’s over. I want to let them know that I do care about what it is that you’re saying. I want you to get better and be able to work through this.

At the start of the video I was telling you about a guy with significant emotional distress. Financial issues, marital issues, and career-related problems. He was unemployed and had no money. He was having constant conflict with his wife leading to a possible divorce. The guy was a middle aged, Caucasian male, and in a high risk population.

He had no history of previous attempts. Then he asks me, okay, did he actually indicate suicidal thoughts? Well, I would have to take them on what I believe to be true. If he’s saying like, hey, my thought is I’m going to go down to the beach and I hope I drown.

I have to look at it. This guy was a very good athlete. If his plan was a little bit more specific, meaning I’m going to swim out into the ocean. Not just swim out and hope the waves drown me. But, I’m going to just keep swimming until I can’t swim anymore. That would be a pretty significant plan. One that would warrant possible hospitalization. It’s one thing to just make a comment. It’s another thing to say, you know what I’m going to do? I’m going to just keep swimming and swimming as far as I can, knowing that I’ll get so exhausted when I’m far enough out, I’ll never make my way back in.

This is troubling stuff to talk about. I know that this is not an easy conversation, but I’m bringing this up for a specific reason. The reason is, it’s more common than people think. There’s also a tendency to dismiss individuals that say, “I feel suicidal.”

There is a tendency to say, “You’re just attention seeking.” I’m not negating that as a possibility. People may use this as a way of expressing emotional distress, but nobody picks that as their first line when they are just looking for emotional validation. It’s very extreme to say, “I’m going to kill myself”, just to get you to pay attention to them.

People will do that, but it’s a pattern of unmet emotional needs over and over again. So now I’m going to the extreme. While the risk may be lower,  for example, it may take a hundred attempts for one completion. I don’t want to have the person I’m working with to be that one completion. So I always take this stuff seriously. I’m supportive. I try to thoroughly assess. I tried to intervene in the best way possible. I want to do it in a way that does not hurt the person more. I want to let them know that they’re cared for and loved.

So I hope that makes sense to you. With all of these videos, if you like them, give them a thumbs up and share. If you don’t like it, give it a thumbs down, but also write a comment. Write what you didn’t like about it. If you don’t agree with what I’m saying, or you want to add additional something additional, please do so.

For mental health professionals, if you all comment on these videos, you may have different viewpoints, different perspectives, more stuff to share. The more everyone is involved talking about difficult subjects around mental illness, we de-stigmatize it. No different than physical illness. The overall goal is physical health here. Here the overall goal is emotional health.