The topic of suicide prevention has once again become a focal point of discussion following two more celebrity suicides. RIP Katie Spade and Anthony Bourdain. Whenever I hear the news of another suicide whether it was a friend, family member, colleague, or a celebrity, I always stop and think about what could have been done to prevent it from happening altogether. It especially hit me hard as a mental health counselor and as an individual who has had suicidal thoughts before.
I am not going to throw a bunch of numbers and statistics at you. I am rather certain that the audience is aware of how serious of an issue suicide is. I instead wanted to focus on the more practical end of things. I am talking about what to watch out for and the best course of action to help someone else or even yourself.
What to watch for:
Change in behavior. The once happy-go-lucky person you saw has since disappeared. What is left is a shell of that individual hollow from despair. Something just feels off and does not feel like themselves. They just seem down and have trouble finding pleasure in even the most basic of life’s activities. The motivation just is not there. Energy levels vary either from too much or too little sleep. Their appetite switches up, and they may appear to be gaining or losing a significant amount of weight. There may even be extreme mood swings. The smallest thing could set them off.
On the contrary, the behavioral change that catches some people off guard with suicidality is when the individual goes from down and out to positive and upbeat just before making an attempt. As a counselor, this is something I watch for too because often times an individual will feel a sense of relief after they make their decision to follow through on an attempt. They finally feel like they have a solution to life’s problems. It feels like the weight has been lifted off of their shoulders, as they near their end.
Isolation. People will often pull back from their loved ones. They want to be left alone. They feel like a burden on others and do not want to bring others down. Or they invite themselves into the pity party and neglect their support network. The individual allows their thoughts to ruminate into oblivion.
Depression. Until you experience a depressive episode, it is hard to explain how it can affect you. The overwhelming feelings of guilt, sadness, and melancholy make life feel bleh. Depression makes it difficult to even get out of bed. Even if you can muster up enough energy to do so, life feels like it is bitch slapping you to the point that it might not feel like it is worth going on. This is why it is often a contributor to suicidal ideation and is listed as one of the nine potential criteria to be diagnosed with clinician depression. All nine of these criteria are things to look out for.
Hopelessness. An even stronger indicator of suicidality is feelings of hopelessness. A person feels like a failure. They think that they are stuck and cannot press onward. Without any will to move forward, a person does not see the point of continuing with their life. If you hear someone stating things like “I give up” or “I don’t want to live like this anymore,” it could be a strong signal of suicidal ideation.
Lack of goal-oriented action. We have all been on auto pilot at some point. We just go through the motions of daily life. If an individual believes that they do not have a future, then why put forth the effort? They will sometimes still follow through on their basic responsibilities but struggle to make progress towards their bigger, long-term goals or lack thereof. The individual goes into robot mode and fulfills their duties but without any real purpose.
Cognitive narrowing. If you have ever seen a horse pulling a carriage, the horse usually wears blinders. This is to keep the horse focused on the path ahead and to keep it from panicking. Imagine this concept taking hold of your mind. The blinders go up, and you only see straight ahead. You cannot see the big picture and hone in on what is directly in front of you. In this case, the only solution one sees is to attempt suicide. Therefore, keep an eye out for someone talking in absolute terms like “always” or “never” because it usually means they are becoming more closeminded. They also will struggle to listen to others’ suggestions or will come up with an excuse when offered another resolution.
Trauma history. Trauma is heavily associated with negative feelings. It is not usually remembered for good reasons. Therefore, when these feelings arise, it feeds the monster. This is especially true when someone experiences the suicide of a loved one. Having born witness to its effects, it is fresh in an individual’s mind. It also helps to know if there are any significant dates coming up like anniversaries of deaths, divorces, breakups, etc. Individuals are more likely to attempt suicide or have suicidal ideation during these time periods.
Preparatory action. Suicide can be an impulsive decision, but there are times where someone will take steps beforehand. Some will write their “suicide note” ahead of time and even rewrite it. They give away treasured belongings that you would never imagine them giving up. Someone might even go out of their way to obtain their “weapon of choice” liking stashing pills or buying a gun.
Outright statements. People will sometimes come right out and say it bluntly. “I want to die” or “I want to kill myself.” These statements are to be taken seriously and not ignored.
Passive versus active: As a mental health counselor, I try to identify the type of suicidal thoughts an individual has in order to determine the best course of action. The thoughts fall under either “passive” or “active.” Passive suicidal thoughts are typically vague and reflect feelings of hopeless (i.e. “I can’t live like this anymore.”) The individual often does not have a specific plan or even intent to follow through on it. On the other hand, active suicidal ideation possesses specific details (“After this, I am going home and swallowing my bottle of pills.”) Both types of statements are meant to be taken seriously. Passive suicidal thoughts can sometimes be resolved through counseling, support, and simple problem solving. Active suicidal thoughts are an indicator of a crisis and professional help should be sought immediately.
Intent (How Serious Are They About It?)– This refers to how much purposeful thought an individual has put into their suicidality. I have worked with plenty of individuals who feel like they cannot go on with their current lifestyle but have no intention of actually following through on their thoughts. Others though have every detail laid out and are prepared to go through with it.
Means (Do They Access or Possess the Means to Follow Through?) – If someone tells me that they want to swallow an entire bottle of pills, I usually follow up and ask what kind, how many, and where they are. I usually call their primary support person then to remove the pills and to monitor their location and the amount being taken. If someone tells me that they plan on shooting themselves but they tell me that the gun is locked away in their father’s house thirty miles away, it is unlikely that they can complete any action. It would still require a phone call to their father or support person.
Lethality (How Dangerous/Fatal is Their Plan?)- To illustrate the spectrum on this, I worked with several young people who attempted suicide by taking ten to fifteen Tylenol. You can become extremely sick from ingesting that many, but it is highly unlikely to be fatal. Compare this to an individual who wants to shoot themselves with a gun for instance. There is much higher chance of death.
How to help:
Active listening. Just lending someone the space to open up and talk is extremely powerful. Knowing that someone is there and they are not alone helps more than anyone can imagine.
For more on active listening, check out my post at: https://caringcounselor.blog/2018/02/02/active-listening/
Expanding cognition. Try to get an individual to the point where they can listen to suggestions. Gently discuss alternative options to resolve their issues. Help them to see the bigger picture and what they might be missing out on. Assist them in taking the blinders down.
Problem solving. Often times people look to suicide while in a state of confusion and feeling lost. Coming up with concrete steps to address any unresolved issues can provide a momentary sense of comfort. Also, it helps to focus on short-term goals rather than long-term goals as not to overwhelm.
Setting goals. Cognitive narrowing also limits a person’s ability to see past the present moment. It fogs future-oriented thinking. Setting goals opens up those horizons and gives an individual something to look forward to. It also helps to instill a sense of hope when it is most needed.
Call, text, or chat with a professional screener. During my last bout with serious suicidal ideation, I called a hotline. I used my last bit of rational thought to call them because I was unsure who else I could call at 11:00PM on a Sunday night. I knew that there would be someone available though. I felt comfortable knowing a professional trained screener would be on the other end of the line to help me figure out my next steps.
For more information, call the National Suicide Prevention Hotline at 1-800-273-8255. They are available 24 hours a day, 7 days a week.
If you are too shy to talk, they have an online chat option. You can also text HOME to 741741 for the crisis text line.
Immediately go to local crisis screening center a call 911. If someone is having active suicidal ideation or is in imminent danger, seek help right away.
In regards to self-care, it is essential to have a crisis plan. Suicide prevention preserves the “self” for you to take care of.
-The Caring Counselor