One Therapist’s Thoughts on Suicide

September is both National Suicide Prevention Month and National Recovery Month.

Suicide. No one wants to talk about it, yet it is a reality that many of us will face by either having a friend or love one who suffers from thoughts of suicide or by struggling with it ourselves. The impacts of suicide ripple out and last for generations.

My father’s brother died by suicide when he was 5 days short of his 23rd birthday. I never met him and my father was only 17 at the time. My uncle, who had recently graduated from Yale, was in medical school at the University of North Carolina at Chapel Hill. He died while at the school, walking in the same places I would walk some 50 odd years later.

The wake of my Uncle’s death forever changed the lives of my father’s family. I don’t think it’s a coincidence that my grandfather would pass away the day after the anniversary of his death exactly 25 years later. You never get over that kind of thing.

There are few things that us therapists are allowed to break confidentiality for — child or elder abuse, supervision/ consultation purposes, court order, and threats to the safety of others or ones self. Talking to someone about suicide isn’t easy, but it’s important. Most of us fear that we will plant the idea in someone’s head by asking about it. This could not be further from the truth. If a person is struggling with suicidal thoughts, the thoughts were there long before you inquired about them.

On the day before World Suicide Prevention Day (September 10th), megachurch pastor and mental health advocate Jarrid Wilson lost his long battle with depression. On the same day, Dr. Greg Eels, who was the director of the Counseling and Psychological Services for the University of Pennsylvania, also died by suicide. Recent deaths of celebrities by suicide has catapulted the conversation into the mainstream media.

It’s an age-old story, “they had it all…what was so hard in their life?” Or, “they seemed so happy!” We’ve heard time and time again that one’s exterior doesn’t always match what’s going on inside. I think that’s what scares people most about suicide. Sometimes it seems like it can come out of nowhere.

Usually, however, it comes from somewhere. Usually there are signs, however subtle they may be.

The National Institute of Mental Health (2019) does an excellent job of laying out warning signs for suicide:

• Talking about wanting to die or wanting to kill themselves
• Talking about feeling empty, hopeless, or having no reason to live
• Planning or looking for a way to kill themselves, such as searching online, stockpiling pills, or newly acquiring potentially lethal items (e.g., firearms, ropes)
• Talking about great guilt or shame
• Talking about feeling trapped or feeling that there are no solutions
• Feeling unbearable pain, both physical or emotional
• Talking about being a burden to others
• Using alcohol or drugs more often
• Acting anxious or agitated
• Withdrawing from family and friends
• Changing eating and/or sleeping habits
• Showing rage or talking about seeking revenge
• Taking risks that could lead to death, such as reckless driving
• Talking or thinking about death often
• Displaying extreme mood swings, suddenly changing from very sad to very calm or happy
• Giving away important possessions
• Saying goodbye to friends and family
• Putting affairs in order, making a will

According to NIMH (2019), the best predictors for suicide are as follows:

• Prior suicide attempt(s)
• History of depression and other mental health conditions
• Family history of suicide
• Substance use issues
• Family history of a mental health or substance use disorders
• Family violence, including physical or sexual abuse
• Having guns or other firearms in the home
• Incarceration
• Being exposed to others’ suicidal behavior, such as a family member, peer, or media figure
• Medical illness
• Being between the ages of 15 and 24 years or over age 60

Suicide does not discriminate on age, race, ethnicity, or socioeconomic factors. Suicide is the second leading cause of death for young people ages 10–24. Individuals who identify as American Indian and Alaska Native adolescents and middle-aged persons have the highest rate of suicide, followed by White middle-aged and older adult males (National Institute of Mental Health, 2019). Additionally veterans and individuals who identify as LGBTQ+ are at an elevated risk of attempting suicide (National Institute of Mental Health, 2019).

With suicide rates increasing in the US, what’s the best way that we prevent suicide?

Contrary to popular belief, asking about suicide does not plant the idea in someone’s head, but it may save their life. Asking someone the question directly is the best way to do it. “Have you thought about ending your life?” Or even more directly, “are you thinking about killing yourself?”

DO NOT BE AFRAID TO ASK and try to not act shocked if someone shares that they are thinking about ending their life.

If they tell you that they are contemplating suicide:

1. Establish safety. Ask questions to determine if the person has a suicide plan or access to means to hurt themselves. If they have access to a gun, for example, and are seriously considering suicide it may be necessary to call the authorities to ensure a safe escort to the emergency department. If you are able, take action to remove any means that the person could hurt themselves with such as weapons or medications. Do not leave the person alone after they disclose thoughts to harm themselves. The goal is to put time and distance between the person and their chosen method.
2. Seek help immediately. If someone tells you that they are thinking of killing themselves, it is important to seek help immediately. Do not promise to keep their thoughts a secret. It’s better for them to be mad at you than for them to no longer be here.
3. Offer hope and support. Allow the person to express their feelings without judgments.

If someone is actively suicidal, call 911 or volunteer to go with them to the emergency department.

Connect a person to ongoing supports including:

• National Suicide Prevention Lifeline at 1–800–273–TALK (8255)
• Crisis Text Line (text HOME to 741741) available 24 hours a day, 7 days a week Deaf and hard-of-hearing individuals can contact the Lifeline via TTY at 1–800–799–4889.

The National Suicide Prevention Lifeline (listed above) provides 24/7, free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals. All calls are confidential and available to everyone. Their website is chock full of resources and can be found at https://suicidepreventionlifeline.org

One of the best things we can do is talk about this stuff. Talking about suicide is one of the most important ways to prevent it.

My parents did not shy away from talking about my uncle’s suicide, and I think their openness about it helped to save my life. When I first struggled with depression at 16, I had no idea what was going on in my head. When I began having thoughts about killing myself and started formulating a plan, I knew that I was in serious trouble. I was embarrassed to tell anyone what I was thinking, but I remembered the honest conversations my parents had with me years before about our extensive family history of depression. I remembered them saying to me, “if you ever start to feel the way Uncle Jay did, tell us. We won’t be mad or upset, don’t be afraid to tell us.”

I’m thankful they had the talk with me. I’m thankful they didn’t make me feel ashamed, and I’m thankful they sprung to action and got me help. I’m not sure if I’d be here typing this had they not been so proactive 15 years ago. My life is living proof that true and lasting recovery is real. There is hope.

Talking, listening without judgment, and taking immediate action saves lives. If you or a loved one is suffering with depression or other mental health struggles, contact a medical or licensed mental health professional. #Yourlifematters.

National Institute of Mental Health. (2019). Suicide in America: Frequently asked questions. Retrieved from https://www.nimh.nih.gov/health/publications/suicide-faq/index.shtml