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Indian Health Service The Federal Health Program for American Indians and Alaska Natives

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How to Talk About Suicide

 

A man and woman talking.
It may not be easy to talk about suicide or respond to someone who brings the topic up in conversation. Across almost all cultures, and especially in Indian country where rates are higher than the general population, the subject of suicide carries with it the stigmas of depression and death, and the fear that just talking about it will make it happen. However, talking about suicide and listening to those who share suicidal thoughts or behaviors is an important tool that may be used not only to prevent suicide, but also to help those who have lost hope heal.

Warning signs and risk factors often provide signals that someone may be considering suicide. Warning signs are clues which can be subtle or obvious indications that someone may be thinking of ending their life. Risk factors are circumstances that may increase one's susceptibility to thoughts of suicide. If you see any warning signs and recognize any risk factors in someone, starting the conversation may save their life.

Suicide Warning signs may include: withdrawal from friends and family, talking about or preoccupation with death, expression of hopelessness or worthlessness, loss of interest in favorite activities, giving away needed or favorite possessions, and/or making arrangements to put affairs in order.

The following, adapted from “Know the Signs”Exit Disclaimer: You Are Leaving www.ihs.gov, from the California Mental Health Services Authority (CalMHSA), offers dialog that may be useful to health professionals, friends, and family of anyone who may be thinking about suicide.

Begin the Conversation

Before talking with someone you are concerned about, be sure to have suicide crisis resources available, including the National Suicide Prevention Lifeline number, 1-800-273-TALK (8255), and numbers and addresses of local crisis lines or treatment centers. Mention what signs prompted you to ask about how they are feeling. Mention the words used or behavior displayed that you or others have noticed in the person. This makes it more difficult for them to deny that something may be wrong. Say:

"I've noticed that you've mentioned feeling (hopeless, depressed, useless, like a burden, etc.) lately”

or

“You haven’t been spending time with your friends and have been sleeping a lot lately”

Next, ask directly about suicide. Talking about suicide does NOT put the idea in someone's head and often provides some relief for that person since it gives them a chance to open up. Asking directly and using the word "suicide" establishes that you and the at-risk person are talking about the same thing and lets them know you are not afraid to talk about it:

"Sometimes when people feel that way, they think about suicide. Are you thinking about suicide?"

or

"Are you thinking about ending your life?"

If the answer is "yes" to your direct question, remain calm, and don't leave the person alone until you get help. Listen to the reasons the person gives for considering suicide as an option. Affirm that you realize what they are considering, but bring up that they may have felt differently before (which suggests that they may feel different again), and emphasize that living is an option for them:

"I can imagine how tough this must be for you. I know you say you're unsure if you want to live right now. But have you always felt like you wanted to die? It’s possible you won't feel this way forever. " Let the person know you care, that you take their situation seriously, that you are genuinely concerned, and will do all you can in your effort to support them:

"I'm deeply concerned about you and I want you to know that help is available to get you through this. I can help you."

Assess Risk

After you have established that they are considering suicide, ask the person if they have access to any lethal means (medications, weapons such as knives or guns, etc.) Say:

"Do you have any weapons, drugs, or prescription medications here?"

If the answer is yes, work to remove these items from the person's premises. You may need someone else — a friend, family member or even law enforcement — to assist with this task. The Harvard School of Public Health’s “Means Matter” site Exit Disclaimer: You Are Leaving www.ihs.gov offers suggestions on removal of firearms from the home.

For non-professionals:

Develop a safety plan

Create a plan for keeping the person safe until you can get help. Ask the person what things (such as being in a certain place or having certain people around) will help keep them safe until they can meet or speak with a professional.

If it is an issue, ask the person if they will refrain from using alcohol and other drugs, or, if they can't or won't refrain, ask that they have someone who can monitor any use. Alcohol and drug use will lower inhibitions, change mood, cloud judgment, and may encourage a suicide attempt, and must be avoided, or at least watched closely:

“Will you promise you won’t use alcohol or drugs, or at least have someone with you if you do, until we can get help?”

Get a verbal commitment that the person will not act upon thoughts of suicide until they have met with a professional:

"Please promise me that you will not harm yourself or act on any thoughts of suicide until you meet with a professional."

Get help

Share the resources you have gathered with the person. Be willing to make the call, or to sit in on the call, to the National Suicide Prevention LifelineExit Disclaimer: You Are Leaving www.ihs.gov at 1–800–273–TALK (8255).  The toll-free confidential Lifeline is available 24 hours a day, seven days a week. Say to the person:

"You might not feel like going to talk to a counselor, but there’s a number we can call to talk to somebody right now. Maybe they can help if we call?"

Let them know that you are willing to go with them to see a professional when they are ready. If you feel the situation is critical, take the person to a nearby Emergency Room or walk-in psychiatric crisis clinic if they are willing to go. If not, call 911. Do not put yourself in danger; if at any time during the process you are concerned about your own safety, or that the person may harm others, call 911.

Things not to say

Do not say "You're not thinking about killing yourself, are you?" Don't ask the person about suicide in a way that seems like you want to hear the answer "no." A "no" answer just gives the person the opportunity to shut down the conversation, limits your ability to gain the person’s trust, and can end your chances of helping them.

Also, even if you are feeling upset and hurt, do not display anger, tell the person to do it, or tell them that you don’t care, as these are the most dangerous things you can say. A suicidal person may be looking for any confirmation that they are unwanted, a burden, or will not be missed, and negative words may push them to act.

And never promise secrecy. The person may say that they don't want you to tell anyone that they are suicidal. You may be concerned that they will be angry with you if you tell others, but when a life is at risk, it is more important to ensure their safety. Instead, tell them you care about them too much and that you will help them get the assistance they need.