What You Need To Know To Help Someone Who is Suicidal
How would you respond if your friend told you that they were suicidal? If you’re anything like me the first time this happened, you’ll panic. In a wave of confusion, you’ll scramble to look for the answers on why your loved one wants to die. You’ll try to convince them that everything is okay. You’ll feel overwhelmed and out of your depth.
As a trained therapist, I have worked with hundreds of suicidal clients. I want to share with you how to help someone who is suicidal. This is a step-by-step guide to help you get your loved one the support they need. Please if at any point you feel overwhelmed supporting someone, call the professionals.
I wasn’t prepared when my friend reached out to me. My hope is that you will be after reading this guide. You’ll get resources on what to do so you’ll be ready. Your friend’s life could depend on it.
1) Be Curious Instead of Panicking
It’s easy to freak out when someone tells you that they want to end their life. Your thoughts will race as you try to figure out why someone is telling you this. You’ll question what you should do, and you’ll worry about screwing it up.
All this anxiety is normal and good. This is a high-pressure situation that requires your attention. You should feel anxious. It means you’re taking it seriously. However, if you dwell on your worry, you won’t be able to support the person you’re talking to.
Be Nonjudgmental Instead of Focusing on Anxiety — Adopt a Curious Approach.
You’ll need two things to do this: Suspending your judgment and asking a lot of questions.
Nobody wants to pour their heart out to Judgey McJudgerson. A sneer or an eye roll makes everyone mad. In a conversation with a suicidal person, you have to reserve all your opinions for another time. If you allow your judgments into the conversation, they’ll shut down the person you’re talking with.
Your job is to understand your loved one and hear what they’re saying. Your judgments and upset emotions will only get in the way. Your friend won’t be comfortable talking to you and won’t trust that you’re trying to help. Instead, you must listen with an open mind.
Ask Good Questions
A good way to not judge is to focus on asking open-ended questions. Open-ended questions can’t be answered with a “Yes” or “No.” They require explanations. Most will start with “How” or “What.” An example would be asking “How does this situation make you feel?” versus “Are you scared?” The former will cause me to open up more and share. The latter will get a one-word response.
As a general rule, avoid using “Why” questions. They unintentionally imply judgment. “Why would you want to kill yourself” implies that you disagree with the person. Even though you don’t agree, this will shut down the conversation. Instead, try “What is causing you to feel like you want to end your life?” It’s the same question but the focus is on the cause of the suicidal ideation and not the judgment.
It’s also important to note that by asking questions, you aren’t going to make things worse. Questions don’t put thoughts into people’s heads. This isn’t Inception. The questions you ask will only reveal what’s been hidden. At this moment, you’re a detective.
Finally, if you don’t know what to say in a conversation, it’s easiest to keep asking questions. It keeps the attention on the other person, shows that you care, and gives you time to plan your next steps. Questions are always a good fall back in a hard conversation.
2) Use Empathic Listening As You Ask Questions
Someone who is suicidal rarely wants to die. They just don’t want to feel the emotional pain anymore. Death feels like the only escape. As their emotional distress increases, their suicidal thoughts will increase too. A person in pain doesn’t think as clearly and their ability to understand themselves becomes difficult. Empathic listening helps a person to understand what’s going on within themselves.
“The gentle and sensitive companionship of an empathic stance…provides illumination and healing. In such situations, deep understanding is, I believe, the most precious gift one can give to another” — Carl Rogers — Founder of Client-Centered Therapy
If you want to help, you must practice empathic listening. It’s a type of listening that validates people’s feelings and soothes negative emotions. The premise is simple: adopt their perspective and see the world from their viewpoint. Imagine if you were them and what you would feel in their circumstances. That’s empathy.
Now before you tell me that you aren’t able to do this, I’m going to call bullshit. Everyone is born with Mirror Neurons. They’re neurons that are responsible for reading and understanding other people’s emotions.
If you were to watch a skateboarder fall and break their arm, you’d instinctively cringe in pain. Why? You weren’t the one who got hurt. Its because your mirror neurons fired off the sense of pain that the other person is feeling. At that moment you were empathic to the skateboarder. This shows that you can be an empathic listener too.
To be an empathic listener you’ll need to hear the emotion behind what is being said. Conversations tend to focus on facts and logic. Be a detective and search for the emotions that are in the subtext of the statements made. Ask yourself “If those circumstances happened to me, how would I feel?”
Once you think you’ve identified the emotion the other person is feeling, validate it. By validating their emotion, you communicate to that person that you’re with them. It shows your listening and that their feelings aren’t crazy. With validation, a person identifies how they’re feeling amid their emotional chaos. It unknots the mess of cords in their head. If done right, it’ll provide much needed emotional release.
How do you validate an emotion, you might ask? Make a statement about how you’d feel in similar circumstances. Take for instance when someone says they’ve had thoughts of ending their life for the last 3 months. You could say “That’s a long time,” but you’ll be missing the emotion. Validation would be “That must be exhausting to have that weighing on you for so long.” Do you notice the difference? The statement identifies an emotion underlying the facts.
The best part about validating statements is that you can’t go wrong with them. If you hit the correct emotion, the person will share more. If you miss the emotion, the person will usually correct you. They’ll see that you’re trying to understand and continue sharing. See, win-win.
3) Assess the Risk Level
Up until this point, I’ve been talking about how to have the conversation. Now I’ll focus on the goal of the conversation: Getting help for your friend. I’m going to keep this part simple as you’re most likely not a professional. All you’ll need to figure out is how emergent the situation is.
To start, you need to clarify if your friend is experiencing active or passive suicidal ideation. The former is when somebody wants to kill themselves, the latter is when they want to die. They hope that life takes them, but they aren’t planning their death. The distinction is subtle but the importance is critical.
To figure this out, ask them to clarify what they mean by feeling suicidal. Have they been experiencing thoughts of wanting to die or have they had thoughts about ending their life? If the thoughts are about wanting to be dead, then they are experiencing passive suicidal ideation. This isn’t an emergency but they’ll still need help.
Yet, if they have thoughts about ending their life, you have two more questions to ask: Have they had a thought about how they’d end their life? And what is the likelihood they’d do it? These questions help you to determine how far their plan has gone and their level of intent. Based on these questions, here are the ways that you should respond
If They Have Active Suicidal Ideation with Either a Plan or Intent:
This is an emergency. In no way should your friend be left alone. Instead, your goal will be to get them to a hospital, immediately. The hospital will assess your friend to determine what services they need. Your loved one will talk with therapists and a psychiatrist if admitted. They’d be evaluated for medications as well as receive group therapy.
Ideally, you’ll want to find a nearby psychiatric hospital and have your friend evaluated there. You’ll need to share what you know to the evaluators at the hospital. This will help them make an accurate assessment of the situation.
The ideal location for treatment is a free-standing psychiatric hospital. They’re less likely to turn away someone in a mental health crisis. Although not always fast, they’ll be able to evaluate your loved one quicker than an average ER. This means your friend will get the help they need faster. They’ll have less time to second guess their decision to seek help.
If there isn’t a nearby psychiatric hospital, your next best plan is to get them to a local Emergency Room. There they can be evaluated and sent to a psych unit for treatment. This process can be quite tedious, so expect to be with your friend for a while. ERs are notoriously slow for assessing psychiatric cases. Commonly, in an attempt to free up space, they’ll send people home even if they need care.
Another way to get your friend assessed is to call a suicide hotline. Each state should have a crisis line. There is also a national line that you should save in your phone: 1–800–273-TALK (8255). Crisis hotlines are staffed 24-hours a day with professionals who know how to assess the situation. They provide resources and referrals for non-emergent situations. Yet, if they assess the situation to be emergent, they can call the police and get help sent over. This is a good way of avoiding being the one to call the police if required.
However, if the person you are trying to help isn’t willing to talk to any professional, you need to call 911. This is the worst of options. Nobody wants to force someone into treatment. Yet, if you have to choose between your loved one killing themselves or them being mad at you but alive, I’d choose the latter option.
If you need to call the police, ask for a CRT-Crisis Response Team officer, or some variation of that. Many police departments have officers trained to respond to psychiatric emergencies. They are better equipped than your average officer to talk with people who are struggling. If the police respond to the situation, make sure to share your concerns with the officer. Sadly, I wouldn’t trust your friend to be honest about their suicidal thoughts. Meaning you’ll have to share if you want them to get help.
If They Have Active Suicidal Ideation But No Plan or Intent:
This is a serious situation although it isn’t emergent. Your best plan is to get your friend evaluated by a professional. This way you can ensure that they aren’t at immediate risk. I would plan to not leave loved one alone until they get some help. You want to make sure that they’re safe until they’re evaluated because most likely they’ll still need to be hospitalized.
The quickest way to get evaluated is to call the Suicide Crisis Hotline. As I talked about above, it’s an easy way to ensure that your loved one is thoroughly evaluated. Either they’ll leave the conversation with resources or be referred to emergency services. Either way, you don’t have to second guess your judgment. Liability will be on the professional.
I would also encourage you to be on the call with the crisis line as well. You want to make sure your friend is being completely honest about their symptoms. Their tune can change if they fear they’ll be hospitalized. Allow them to do most of the speaking. If you feel like they aren’t sharing something important, you can encourage them to say more.
If the Person is Experiencing Passive Suicidal Ideation
This is the least concerning of the 3 options. Depending on your loved one’s circumstances, this could be normal for them. Some people live years with passive suicidal ideation. Although emotionally draining, it doesn’t mean that your loved one is in crisis. Yet, they’ll need outpatient services to help them manage.
The best way to help someone who has passive suicidal ideation is to get them connected with providers. Finding individual therapists can be awful. Finding psychiatrists or doctors that provide psychiatric medications is worse. Community mental health centers have both, but the wait to get in can be long.
The easiest place to start is PsychologyToday.com. It has a list of therapists and psychiatrists available. You can search by insurance and by zip code. You can narrow the field by preferences and therapeutic approaches.
Once you find good options, make calls with your loved one. It’s easier to talk to professionals when you know you aren’t alone. Emotional support can make it possible to hit the dial button on a phone.
If you don’t think once-a-week therapy is enough, try psychiatric hospitals. Many have Intensive Outpatient Programs — or IOPs. These programs provide group therapy, medication management, and individual therapy. Participants can expect to meet three times a week for three hours at a time. This option is a good pick if the person’s symptoms have been getting worse and fast.
SAFETY PLAN
If, however, they are unwilling to get any help, it’s time to safety plan. This is only an option for passive suicidal ideation, not active.
Many people are reluctant to get help because it involves being vulnerable. However, you can’t be the only person that knows about what is going on. It isn’t fair to you. That burden is too big to carry.
WHO ELSE CAN HELP
Instead of going it alone, talk about who else can be brought into the conversation. What other friends or family can support them? Can they go to church and talk to a pastor? Do they have a supportive significant other? Explore with them who is available. The more people they talk to, the less shameful their suicidal thoughts feel.
WHAT THEY PLAN TO DO TO GET BETTER
The next part of the plan is figuring out what the person is going to do to help themselves. They can’t tell you that their life sucks and leave it at that. They need to do something to help themselves. If you give them resources, then they need to pick what they’re going to do. Your safety plan should include concrete steps of what steps they’ll take. This can be reading self-help books, talking about it with others, or exercising. The more ideas, the better.
WHO TO TALK TO IF THINGS GET WORSE
Finally, talk about what they will do if things get worse. If the symptoms increase, who will they talk to about it? They should be given numbers to the suicide hotlines, mental health professionals, and psychiatric hospitals. Save the numbers in their phone to ensure they have them.
If you feel up for it, encourage them to reach out to you. You already know the background and the story. If their suicidal ideation is increasing, you know who to call and how to help.
4) Follow-Up
Have you ever bared your soul to someone, never to talk to them again? I have, it sucks. It feels embarrassing. You question why you shared and if you’re important enough to care about.
Don’t be that person.
Follow-up with your loved one. No matter where they go, reach out to them and find out how they’re doing. Talk to them about if things are improving and how you can support them. By following up you’ll help develop a closer relationship with them; you’ll show you’re trustworthy; most importantly you’ll make the suicidal thoughts feel less shameful.
Final Tip: Never Keep Secrets and Never Bargain.
Keeping it secret, doesn’t keep it safe. There are several times where people will ask to keep the conversation hush-hush. Or they will tell you that they’re being dramatic and don’t really need help. They’ll try to convince you not to reach out for support. Don’t keep it secret and always reach out for help.
In the worst-case scenario, if your loved one completes suicide. You don’t want to be the only person to know that they were suicidal. You’re liable. You don’t want to live with that guilt. You can’t keep this a secret, you need to get them help. If they told you that they are suicidal, then they are asking for help. They might change their mind but you can’t. You must follow through and help them. Remember they aren’t thinking clearly.
At the end of the day, a person who is suicidal is a person hurting. The hurt seems inescapable. It’s at these times we need to wrap our arms around them and carry them to safety. The pain is not permanent but suicide is. This means we have to do the hard work for those who struggle. We have to hold hope for them so that one day they can be happy again.
