Depending on when this article is printed, the Netflix show 13 Reasons Why might be fresh in our minds or just something we Google to remind ourselves. Regardless of the timing, the topic of suicide is always current. I will neither glamorize nor vilify the show or suicide. As a psychologist, I am duty bound to protect life and to keep safe those who seek my service. It will be from that perspective that I address this issue.
Suicide is a profound act. One that ceases the life of a person who, for reasons we may never be able to comprehend, felt that their only way of removing themselves from the pain they experienced was to end their life. And this profound act is like a stone dropping into a body of water. Its impact causes ripples that will affect almost everyone around that person.
It can be very difficult for someone who has never experienced thoughts of suicide to understand how a person can end up in such a dark place and think of death as the only solution. In my work and in accounts from others who have worked with persons who have survived an attempt on their own life, I feel comfortable stating that most, if not all, people contemplating suicide don’t really want to be dead. They just want to stop whatever pain — whether physical, emotional or both — they are experiencing. Some of these persons come to their thoughts slowly over time and as a result of some form of illness (mental or physical) or chronic pain. Another group experiences a breakdown in their ability to cope with an event they experience as a rapidly evolving crisis and as a result often contemplate or act spontaneously to end their life. The last group is a group that may use the threat of suicide as a manipulation to get something.
Regardless which group a person belongs to, our responses need to be unambiguous and caring. If there is ever an indication that a person is contemplating ending their life, we should ask them about it in a direct manner. Yes, it can be scary to ask. No, asking will not give them the idea. And when we ask, we must ask specifically about the desire to be dead. For example, we ask, “Are you thinking of killing yourself?” We won’t ask, “Are you thinking of hurting yourself?” Why is this difference important? There are people who will interpret your question literally and will not equate hurt with kill. These people will answer that second question, “No,” but might actually be thinking, “No, I’m not going to hurt myself. I’m going to kill myself.” What we do next depends on the answer we’re given.
If the person we ask tells us they are contemplating suicide, we have a situation that requires immediate action. It becomes very important that the person is thoroughly assessed for their safety. The best place for this to happen is at a hospital. If it is safe for you to do so, you may transport the person to an emergency room for assessment. If it is not safe or you don’t feel safe bringing the person to the emergency room, contact public safety in your area and advise them of the situation. Public safety personnel, physicians and other medical personnel in hospitals are not only trained to complete the necessary assessment, they also can begin and/or enforce the process for admitting the person for treatment. Public safety can take an individual to a hospital against his/her will for further evaluation if they believe the person is a safety risk. The physician (or psychiatric social worker or nurse) can keep the person at the hospital if their assessment suggests that there is a risk for harm to self (or others) if the person is not kept at the hospital. It is important to remember that the information you have regarding the person’s behavior or statements is very important for both public safety and hospital staff. Do not dilute or “sugarcoat” what you have seen and/or heard. To do so risks the person you are concerned about not getting the appropriate help.
If the person we ask tells us they’re not contemplating suicide, our initial concern can be slightly lessened, but we need to check in with them and ask some follow-up questions. The first follow-up question we should ask is, “Have you ever thought of killing yourself?” If the answer is, “No,” we can relax a bit more but we should explain the reason for our concern and express our concern for the person’s safety. If the answer to the question above is “Yes,” then we also need to ask, “When was the last time you thought about killing yourself?” The response to this question will dictate our next step. Although we should remain concerned, the longer it has been since the last thought of suicide suggests there might be less risk. For example, risk for suicide would likely be higher for someone who had their last thought of suicide yesterday as opposed to three months ago. In these cases, refer the person to, and encourage him/her to follow up with professional assistance. The closer the last thought of suicide is to the moment you asked increases the urgency for getting assistance.
Talking about suicide can be difficult and can make us feel uncomfortable. But doing so can actually save someone’s life. Above all, if you ever have a concern for someone’s safety, act on it. Never leave them alone. Take them to help or call for help. And, as always, if you have any questions about this topic or want a confidential consultation or a counseling appointment, contact Psychological Services Bureau at (213) 738-3500.