Each year, more than half a million people around the world die from suicide, 30,000 of them in the United States. According to a recent study, you are more likely to die from suicide than homicide. Although this is a shocking fact, due to the taboo on speaking of suicide, not many discuss it until tragedy has already struck.
I remember the day that I heard the news of Robin William’s suicide a few years ago. That afternoon, I was facilitating a recovery group in an outpatient program in Northern California. There were about 30 participants in our group, at different levels of recovery. As we processed the news of William’s death, to my surprise, almost all of the participants spoke of their own current or past struggles with suicidal thoughts. You would not have been able to tell by looking at them that the thought of death was present in their lives, but as we talked about it openly, people felt more comfortable sharing it.
It is important to educate ourselves on this topic and learn how to support people who are struggling with suicidal thoughts. Here are some ways that you can provide support.
Recognize the Signs of Psychological Pain
Although no one can reliably predict suicidal behaviors, there are things that indicate that someone is in a heightened state of risk, such as struggles with depression, trauma, and/or substance abuse. Substance abuse and mental illnesses such as mood disorders and anxiety distort reality and increase feelings of worthlessness and hopelessness, in turn increasing the chances of suicide. Research shows that at the time of death, 95 percent of those who commit suicide are dealing with a mental disorder.
Mental disorders may have different presentations in different individuals. Some people struggle mainly with physiological changes such as sleep disturbances, agitation, concentration problems, and physical pain, while others might only experience feelings of shame, guilt, anxiety, panic, and anger. Regardless of the symptoms, whenever you notice a change in your loved ones that lasts more than a few days, it is important to take it seriously and reach out to them.
A few months ago, I began working with a teenage boy in my counseling practice in Torrance. He had been admitted to Torrance Memorial Hospital after his mother found him trying to hang himself in his bedroom. She told me that she had noticed that shortly after his parents’ divorce he appeared more withdrawn and blamed himself for the divorce. Although his mother said that she had witnessed these signs for several months prior to his attempt, she attributed them to the normal process of adjustment to divorce and did not seek support for him. It is common to label similar mental disorders as normal adjustments to stressors, but if we do so, we might lose the opportunity to save someone’s life.
Assess the Level of Risk and Act Accordingly
Not everyone that mentions suicide is at imminent risk. Most families that I work with either take a dismissive or alarmist approach to the suicidal ideation of someone they love. The alarmist group tends to overreact when they hear someone close to them mentioning suicide and take action that might discourage future openness to the topic. Unlike the alarmists, the dismissive group tends to make the opposite mistake. They tend to label suicidal ideation as manipulation and an attempt and controlling a situation.
The best approach is somewhere in the middle. Knowing the imminent risk factors for suicide can help you assess and handle the situation. According to recent research, there are certain static and aggravating variables that significantly increase someone’s likelihood of experiencing symptoms of suicidality. Some such baseline factors include family history of suicide, previous suicidal behaviors, and impulsivity. Additionally, if someone has recently been going through a stressful situation, such financial or interpersonal loss, a chronic health issue, or divorce, their chance of acting on their suicidal ideations multiples. If you know someone with baseline risk factors who has experienced a recent stressor, it is essential to reach out to them as soon as possible.
Be a Listening Ear
As you observe someone that you know is suffering, it is important to speak up and let them know that you are there for support. Sometimes just by listening you can reduce their burden and help them feel supported. Many people struggle with feelings of burdensomeness and lack of belonging in addition to their suicidal thoughts. By reaching out to them and showing your support, you might reduce that burden.
If they share with you that they are struggling with a mood disorder, you may ask whether they have thought of ending their life. Many people are hesitant to ask about suicidal thoughts, because they don’t want to put ideas into a loved one’s head; however, research shows that asking about it does not correlate with its increased likelihood.
Facilitate Appropriate Support
Ask whether they have any plans to end their life and how serious they are in following through with it. If they disclose to you that they are planning to act on their suicidal thoughts, you can encourage them to go to the emergency room, where they can get immediate support, or offer to call the local emergency psychiatric team. Many counties have designated professionals who make house calls and do assessment and intervention.
If your loved one does not appear to pose an immediate risk, offer to support them by researching psychologists or therapists specializing in suicide counseling. It is also important to leave them with a hotline number for a suicide crisis line in case the frequency of the thoughts increases.
If Asked, Offer Potential Solutions
Mental challenges, such as depression, trauma, and substance abuse, can impair problem-solving abilities. Many feel that there is no escape from their situation, which increases the feeling of hopelessness and risk of suicide. If this is what they are experiencing, help them see that no matter what their circumstances are, there are several solutions.
Start by asking them to tell you about their main problem and discuss several alternative plans for handling it. You may share with them how you or someone you know faced similar adversity and how the situation was resolved. Sometimes the first step toward a solution is the most challenging one. If that is the case, offer to support them to take that step. Frame their problem as a challenge, and if you know of similar challenges that they successfully navigated in the past, remind them of this.
Follow Up and Provide Resources
Though it is important to make initial contact, make sure you follow up with them a few days afterward. Gently remind them that you are there if they need support, and provide them with resources (e.g., contact information for a psychologist or psychiatrist, support groups, clinics, and legal services) that might be helpful for them. Ask them if they have taken the first step you discussed and, if not, whether there anything you can do to facilitate it.
Know Your Limitations
By reaching out and offering support, it is possible that you have reduced your loved one’s risk. For many people, knowing that someone truly cares for them and has their back alleviate their pain. However, no one can control what another person chooses to do. Unfortunately, even some of the most skilled psychologists that I have worked with through the years have lost patients to suicide. As I noted, there are numerous factors, such as genetics, childhood adversity, and others, that can increase the risk. All you are able to do is to reduce risk factors and foster a sense of hope and belonging.
If you feel stuck and are frightened by the potential risk of losing someone to suicide, I highly recommend you get support for yourself. I have worked with many people who have lost someone to suicide, and they often blame themselves for something that they do not have any control over.
Dr. Nazanin Moali is a clinical psychologist and depression therapist in Torrance who works effectively with a wide variety of adults and adolescents who have a range of emotional and behavioral issues. She utilizes a highly personalized treatment approach tailored to each of her patients, based on her years of experience and training at various hospitals, residencies, and clinics. Her clients come from Palos Verdes Peninsula, Manhattan Beach, Torrance, Hermosa Beach, Redondo Beach, and all parts of Los Angeles County.