Coping with COVID-19: Suicide Prevention
Most of us have experienced feeling burnt out, exhausted, and overwhelmed as we navigate the challenges of COVID-19. The risk of suicide, depression, hopelessness, and substance use is typically highest during the disillusionment phase of a disaster, and it’s what we’re seeing right now. Contrary to common belief, the greatest risk of suicide is during the spring, not winter. It’s important we learn how to talk about suicide and suicide prevention when people in our lives may be struggling.
In this episode of the Washington State Department of Health (DOH) podcast on coping with COVID-19, Kira Mauseth, PhD and Doug Dicharry, MD discuss suicide prevention with special guests Lizzie Cayden, MSc, CPP from the DOH Suicide Prevention Program Unit, and Jennifer Stuber, PhD at the University of Washington School of Social Work.
Suicidal thoughts are a common reaction to painful experiences
It is not uncommon for people to experience thoughts about suicide (suicidal ideation). Before the COVID-19 pandemic, about 1 in 20 adults and 1 in 10 teens reported having recent thoughts about suicide. Now, as the pandemic continues, we are seeing even higher rates. That doesn’t mean everyone thinking about suicide will plan, attempt, or die by suicide. But, it’s important to address what people are going through so they can get through it safely and feel supported.
Thoughts of suicide are usually not about wanting to end one’s life, but rather wanting to end one’s pain. Having these thoughts is a human response many people have when alternatives feel limited. For some, trauma may play a role. No matter the causes, we need to get comfortable talking about them to help people get the support they need and to eliminate stigma as a barrier to care.
Talking about suicide can save lives
Suicide and suicidal ideation can be difficult to talk about. Many people worry that if they share their suicidal thoughts, they may face judgement, disapproval, or repercussions. They may feel a sense of shame. It isn’t shameful to have thoughts of suicide, but it can still be hard to talk about. Disclosing thoughts of suicide takes a tremendous amount of courage.
When we don’t talk about suicide, we miss opportunities to provide help and connection to those who are struggling. There is a sense of isolation that comes with having suicidal thoughts. Talking about it can provide social support and help people feel less alone.
A common myth is that if you ask someone if they are thinking about suicide and they are not, you will cause them to think about it — this is not true. If you are worried about someone, asking them how they are feeling in a caring and compassionate way might save their life. Not all conversations will go well. People who are struggling may feel they need to hide what they are going through and may get defensive or angry. Still, it is important to reach out to loved ones who might be struggling to let them know you care and will be there when they are ready to talk. You can also suggest resources if they might feel more comfortable talking to someone else.
Coping strategies for difficult moments
If you have thoughts of suicide, it might feel like there are no other options. The good news is that the thoughts are temporary, and there are things you can do to cope until they pass.
Distraction — One of the most common strategies for coping with suicidal thoughts is distraction. Do something that takes your attention away from those thoughts. Take a walk, have a COVID-safe visit with a friend, engage in a hobby, or take a shower.
Hope — When you have suicidal thoughts, it can be hard to see other options for relieving the pain. Hope means knowing there are other options, even when your mind tricks you into believing you’ve tried everything. With hope, you can look for a different, more positive perspective on what the future might hold and remind yourself that you are more resilient than you are giving yourself credit for. One way to develop hope is by connecting with others whose lives have been touched by suicide and learn from their experiences.
Connection — Professional and social support are key to getting through difficult times, including times of suicidal thoughts. Connecting with someone who can sit with you, listen, and empathize can reduce feelings of isolation and shame.
If you are having thoughts of suicide, you are not alone. Lean on your support system and be open to telling others what you’re going through. It can take time for those difficult thoughts to pass, but using coping strategies can help get you through the most critical moments.
LEARN to support others
You can save lives in your family and community by knowing how to prevent suicide. The LEARN model can help you understand when someone may be at risk for suicide and how to connect them with help.
- Look for signs
- Empathize and listen
- Ask directly about suicide
- Remove dangers
- Next steps
Read more about each step in the LEARN model at the Forefront Suicide Prevention webpage.
It’s ok to ask for help
For many who are struggling, spending time with a caring friend can go a long way. But sometimes people need more support than a friend can give. Helplines offer counseling for those in crisis and are a critical resource for preventing suicide. People in distress can reach out to these helplines at any time:
For more national and local suicide prevention resources, visit Forefront Suicide Prevention’s Resources webpage. The DOH Suicide Prevention Program also has a list of hotline, text, and chat resources, which includes help for specific populations and regions.
Talking openly about mental health and suicide prevention is essential, especially during natural disasters like a pandemic. It is normal to not feel ok right now. If you are worried about yourself or a loved one, talk to your healthcare provider or someone you trust to help you get support. For more resources on managing mental health during COVID-19, visit coronavirus.wa.gov/wellbeing.
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Check the state’s COVID-19 website for up-to-date and reliable info at coronavirus.wa.gov.
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Answers to your questions or concerns about COVID-19 in Washington state may be found at our website. You can also contact the Department of Health call center at 1–800–525–0127 and press # from 6 a.m. to 10 p.m. Monday, and 6 a.m. to 6 p.m. Tuesday — Sunday and observed state holidays. Language assistance is available.
- [Narrator] Welcome to a Washington State Department of Health podcast on coping with the impacts of the COVID-19 pandemic. And now your hosts for the show, disaster psychologist, Kira Mauseth, and child and adolescent psychiatrist, Doug Dicharry.
- Hi, everybody. Welcome to our show today, I’m Kira Mauseth.
- And I’m Doug Dicharry. Today we’re talking about suicide prevention and we have with us two special guests. First, Lizzie Cayden from the Department of Health’s Suicide Prevention Program. Welcome Lizzie.
- [Lizzie] Hi, good morning, thank you for having me.
- [Doug] Can you tell us a little bit about your work?
- [Lizzie] Sure, I’m the Suicide Prevention Program unit supervisor at the Washington State Department of Health. My team supports public health suicide prevention work for the entire state, as well as looking at suicide prevention across the full lifespan. So, we support several projects and initiatives, we do coordination for the state’s action alliance for suicide prevention, and a lot of data evaluation and support. We also complete publications like the state’s suicide prevention plan and are leaders for various tasks forces and other committees that support work across other agencies. So like the governor’s challenge at the Washington department of veterans affairs, task forces like agricultural industry suicide prevention and law enforcement mental health.
- [Kira] Great.
- [Doug] Great.
- [Kira] We’re really thrilled to have you here with us today, and we also have Jenn Stuber, who’s the director of Forefront Suicide Prevention at the University of Washington. Welcome Jenn.
- [Jenn] Good morning, thanks for having me here today.
- [Kira] Can you tell us a little bit about your work and the mission of Forefront?
- [Jenn] Yeah, Forefront was founded in 2012, actually it was founded in response to the law that was passed in 2011, that made Washington the first state in the country to require a suicide prevention training for all behavioral health providers. And we passed this law and as we know it’s much easier to pass a law than to implement a law, so Forefront was founded to really help support the state in helping to implement in scales, innovative evidence-based suicide prevention programming. And so, yes, the organization has been around for about seven years now and my role in it as director, I’m a person with lived experience in that I lost my husband to suicide in 2011 and that’s why I do this work every day because I believe we can make a difference.
- [Kira] That’s great, and as a provider and a clinician, I really appreciate that work, and that piece of our training in an ongoing way is such an important and vital work of how we support the community and the people that we work with. So great to have you here, for sure. We’ve been discussing lots of different sort of topics in previous podcasts and to lay the foundation for this discussion on suicide today I just want to sort of remind everybody that where we are in the disaster recovery and response cycle for COVID-19 as a pandemic is in this disillusionment phase. And the disillusionment phase, as we’ve mentioned before is usually the most difficult time in this recovery cycle for folks when it comes to symptoms and things that people might be struggling with psychologically. Most of us are feeling burnt out to some degree, really exhausted, tired. We’re kind of over this thing as we’ve talked about before and we really want to keep an eye out for risks related to suicide.
- [Doug] And we know that during this phase of any disaster, historically the risk for suicide, for depression, for hopelessness, for substance abuse — they’re really high at this at this point in any disaster.
- [Kira] So today on our show, we’re going to be talking about how to recognize warning signs, actions that you can take to help prevent suicide for yourself and someone you know within our communities and friends and family members. But first, we’re going to start by talking about understanding what really we mean when we’re talking about suicide prevention and get into a little bit more detail. So, the first thing, I guess, Jenn I’ll start with asking you, can you talk a little bit about how common it is for people to have suicidal thoughts? We also call that suicidal ideation. Is this a common thing or how does that look on a community level?
- [Jenn] It’s actually very common to the extent that we know that roughly one in 20 adults and roughly one in 10 adolescents — this is pre COVID — were having thoughts about suicide. Helping people understand that when you have thoughts about suicide, it’s really a way to try to address internally someone’s extreme pain that they’re going through. It’s not actually in the big picture really about wanting to end one’s life, it’s really about wanting to end one’s pain. And it’s extremely important for people to understand that this is a human response that a lot of people have, and we have to just get comfortable with having conversations about it, and helping people who were in this situation feel better connected and get them the supports that they need. And so with COVID we know that rates of ideation — at least based on surveys that are outside of Washington state — rates of ideation have increased, so more people are thinking about suicide, but again there are relatively large number of people thinking about suicide, and that does not mean that everyone’s thinking about suicide goes on to plan or attempt suicide or die by suicide. But it’s extremely important when someone is thinking about suicide to really try to address some of the things that are happening for that person so that it doesn’t get more severe.
- [Kira] Right, absolutely. And Jenn, I really appreciate like really mentioning how common this actually is, even in times before COVID, right? Can you say a little bit, either you or Lizzie, about the stigma around… we have these ideas about what suicide means and understanding that it is more common than we might think and also not being so afraid of talking about it, maybe some of the risk factors associated with that?
- [Lizzie] When we’re talking about ideation, the piece that we sometimes don’t progress to talk to is this opportunity for disclosure as well, and that really does relate back to stigma or fear of social sanctions. And what’s unfortunate about that is you really often will miss out on an opportunity for prevention and intervention strategies as well as just general support. When you’re able to disclose thoughts of suicide ideation, you might be sharing something that you’ve never shared with anyone before, and that alone can be a really powerful experience, and it’s often missed because of stigma, or fear of stigma. That also is going to place barriers into being able to access appropriate levels of care and support that you might need and then also by disclosing, you also are inviting social support and you’re able to address the isolation and loneliness that might be felt with the ideation and not have to progress through that as much alone.
- [Jenn] I think it’s also really important to like tap into the myth here. There’s a myth that if you ask someone about suicide that you might actually make it worse and that you might actually put the idea in their head. And I think that’s something that I think is really important to talk about that that is not true, that is that is a myth and what’s really important for a person who’s thinking about suicide is that they aren’t isolated and alone in those thoughts. And so that asking about suicide in a caring and compassionate manner can actually reduce one’s risk for suicide.
- [Doug] Yeah, that can be a great relief to someone who has felt like they’re the only ones that are going through this, it can be a very isolating experience. We know by the way that veterans are at high risk for suicide and middle-aged men in particular. There are particular groups that are at higher risk and for some of these groups it’s very difficult for them to talk about any of this — that they feel it may be, for example, a sign of weakness if they bring it up or that they’re not capable of handling the problems themselves. So it is important to reach out to show that you care, to do it in a compassionate way, so that the individual feels supported.
- [Jenn] And just know that conversation may not go extremely well all the time, particularly if it’s the first time, if someone’s been really struggling and has been in internally holding on to this very, very big — what they perceive as a very very big secret and a very, very big shameful secret. It’s not shameful to have thoughts of suicide but that’s what people think, and so no one, you ask them, particularly some of the groups that you just mentioned, it may not go super well. There might be initially some defensiveness, some anger, but it’s really important to continue to come alongside that person and to let them know that you care and you are someone who can talk about this when they’re ready for it, if they want to.
- [Doug] Good point.
- [Kira] Yeah, another demographic group that I work with and that I think is worth mentioning here are young adults and teenagers. I think that consistent with the stigma conversation, I think a lot of parents are really uncomfortable with this and uncomfortable asking their kids and afraid to bring it up, to see how folks are doing. I don’t know — Doug, do you have any examples from your experience in working with kids about how parents can best support and ask about these things?
- [Doug] Well, yeah, the first step is just education, so that parents know the facts and are not afraid of what it is that they’re approaching and to have an open conversation. And, as Jenn said, you may need to circle around to this because teens can also be very defensive. For some people, I mean for many people, suicide is thought of as a solution to a problem that they’re having. And at first, they may feel like they’ve got it figured out, this is the way that they’re going to take, and it’s almost as if you’re interfering with their solution. And so it may take time to be clear that you’re there to support and to help, and to give them hope because people develop a sense, particularly with if they’re very depressed or anxious, may develop kind of a tunnel vision. They don’t see any other potential solutions at the time so you need to open it up. You need to talk about other options and that’s the best approach for parents.
- [Kira] Yeah, and sometimes getting folks through that critical time — it’s the pain that needs to go away.
- [Doug] You’re right.
- [Kira] And that perspective shift is really hard for folks sometimes. So Jenn and Lizzie, can you mention some, maybe some options that are available to help people cope with those feelings when people are in that really dark place, whether it’s a teenager or a young adult — what are some self-help strategies that folks can use that are effective and some things that people can do?
- [Jenn] Well, I mean, number one, it’s a very good strategy — and again, I think it is really important to reach out to formal types of support, and I know we’ll talk about this later in the show — but some really important things is for people to understand that when they’re having those acute feelings around suicidal thoughts that they do dissipate, and for everybody, the range of time it takes for that to happen varies, but they do dissipate over time. So it’s important to kind of get through that critical time using some coping strategies. And one of the most common ones is distraction, and so literally putting your mind on something else that is something other than the very, very challenging thoughts that that person’s having that could be… and doing something, I mean, sometimes people are in a really really highly, emotionally dysregulated state so obviously it’s not the time necessarily to start doing math problems or reading a book, or for some people though that might be great, but distraction is like a key coping strategy, putting yourself in a different environment, perhaps going to stay with a friend or going to your well, part of the problem is you can’t really go to some of your favorite places but taking a walk distraction, some other things that like dramatic things you can do, like literally throw water on your face, go take a shower, cold shower, like those kinds of things can be really kind of helpful in terms of changing the negative kind of feedback loop that’s going on for that person.
- [Kira] Yeah, those are great suggestions for sure. As a clinician, I completely agree and a lot of that sensory input, like the temperature of the shower like you were mentioning the ice water, sometimes having those sensory inputs really do something neurologically that helps people get their thinking into a different place because of these critical moments that people have with regard to suicidal thoughts, for sure. Lizzie, do you have some other thoughts about coping skills that people might be able to leverage?
- [Lizzie] Yeah, I guess what I’m thinking about mostly is going back to the conversation around stigma and just the pure value of having somebody who is willing to be with you and empathize and listen, and really help to address that shame that comes sometimes with these feelings. When you’re already isolated, remaining isolated with these feelings can just kind of spin out into a really bad outcome, and so changing your physical environment like Jenn was mentioning or reaching out to a friend and just knowing that if somebody reaches out to you, you don’t have to solve the problem. There’s a huge value and benefit in just having somebody who is willing to stand next to you.
- [Kira] Yeah, absolutely. Having that ally, sort of an emotional ally, through whatever experience that that takes a lot of bravery, a lot of courage I think for folks and it can be, I think it’s undervalued. I think just being with someone like you said is probably something that we kind of collectively need to work on a little bit. Doug, do you have any other clinical perspectives that you’d like to share?
- [Doug] Yeah, just to follow up on Lizzie’s comments. It’s important to consider that if you’re this situation helping a person, as Lizzie mentioned, you don’t have to solve this problem but you can assist someone else with this issue. For example, getting additional help, getting them into treatment if it’s, if that’s indicated because there are treatments that are available and things like cognitive behavioral therapy, dialectical behavioral therapy. There are medications that are available if someone, for example, is not responding to treatment or if they’re in a severe depression. There are effective medications that we know that can help with suicide. But the important thing is if you’re helping someone and you feel like you’re a little over your head, it’s okay to reach out and you know how to encourage you to try to help them find the resources that they need to deal with this.
- [Kira] Yeah, absolutely. We talked a little bit earlier and sort of kept coming back around to this idea of hope for people and using hope as a way to get through a really dark moment, a really difficult potentially a temporary way of thinking with either a distraction technique or another coping skill, but coming back to this idea of hope. Are there any examples that any of you would like to share about having seen people leverage this idea of, it’s not going to be the same tomorrow, it’s not going to be the same next week. Something I can get through this this period to make it through the other side and to feel differently and leveraging that hope is actually what helps people navigate this difficult experience.
- [Jenn] So, I have numerous experiences with that. At Forefront, the organization was really founded based on lived experience of those who have had ideation, attempted suicide, or those who’ve lost people to suicide. And I’ve seen hope, bountiful hope, really that comes from the collateral beauty that occurs when someone who is engaged in that struggle, either because they’ve lost someone or because they’re in that struggle currently, when they engage with others who have been there. And so I think we really want to emphasize also in terms of coping the importance of peers and really trying to build community. And I think we have a ways to go in this state, we have some opportunities around building that kind of community, but I think that’s a really important piece that we need to be more aware of in the future, that peers coming alongside people in the context of… is a really key piece community support, social support from people who get it is really key. I’ve seen numerous examples of people who’ve been suicidal and who have recovered, seen numerous examples of people who’ve had suicide loss who thought they’d never get through it and who have actually gone onto build lives that are very beautiful. However, they will always struggle with that loss, so I’ve seen a lot of that very, very hopeful things.
- [Kira] That’s great. Lizzie, are there any examples that you would like to share about this? I really feel strongly that hope is one of the most powerful sort of tools that we have but it really is foundational to how people can feel positive and feel… It’s not the same thing as optimism, right? It’s just about looking for something different, for an opportunity for a connection. Not necessarily something cheery, just a different perspective rather than a negative one on what might be coming in the future. Do you have any thoughts about hope?
- [Lizzie] Absolutely, I think one of the key pieces that Jenn just mentioned is peer support, and sometimes what you need to get and keep hope in the interim of feeling like this is having that peer, is having that network and that community and that connection. One of the things with suicide is I think we often assume that because it’s a behavioral health outcome, it was always a behavioral health contributing factor and that can absolutely be the case — if you’re suffering with depression or schizophrenia or various other mental illnesses that have been linked to suicide outcome, that can be a factor and what’s important is to really go back to the critical protective factors we were talking about earlier, like social support and community and access to care and support. And social environments where stigma isn’t a barrier — these are things that can help contribute to and build up hope in the meantime. And then the other component of that is, if you are concerned about somebody who might be struggling — and we talked about this a little bit earlier — asking the question directly about are you considering suicide is not going to cause suicide. There are other contributing factors to suicide that go far beyond mental health. Substance use disorders, particularly alcoholism, is important to acknowledge and mention, but other contributing factors and risk factors, like physical illness and older age and socioeconomic factors and major life changes. If that’s like a financial loss or relationship change or job loss or the death of a family member — this is why a comprehensive approach to suicide prevention is so important to include and consider. And that value of having peers who can relate to where you are in that experience, because everybody’s experience is so unique, having somebody that you feel connection to who can both help with the shame and the stigma if it’s there and if it’s a component, but also just normalize your experience and be with you through it.
- [Kira] Yeah, I think that’s great. And I really love that hope and connection just happen to be some of the ingredients of resilience that we’ve talked about before, which brings it back together. I want to kind of move us along to talk about some resources and some options that are available for folks and whether that’s to have to get engaged with therapy in terms of more of that ongoing or deeper level trauma exploration and treatment or whether it’s more of a crisis management strategy. I know that Forefront has something called the LEARN model for suicide prevention. Is that something that you would be willing to share with us, Jenn?
- [Jenn] Sure, the LEARN model, I really love this model because it’s really applicable to everybody in our society and it has different layers that you can add onto it to kind of make it more clinical to add those clinical components. But LEARN is very similar to CPR in that it’s really what can everybody do to help prevent suicide. And so LEARN — L stands for look for signs, E stands for empathize and listen, A stands for ask directly about suicide, R stands for remove dangers, and N stands for next steps to care. And so those are really, I think, it’s a good pneumonic to kind of help the public and also, as I mentioned you can really adapt those LEARN steps to have a clinical application as well.
- [Kira] Yeah, well, I’m a big fan of acronyms. I can use them for all kinds of stuff, so I love that idea. Are there other ideas, Doug or Lizzie, about specific prevention steps or resources that that folks can engage?
- [Lizzie] Yeah, absolutely. When we talk about resources we’re so quick to jump to you can use this line or you can reach out to this particular organization, and those are still valuable and critical and they absolutely play a role in resources and suicide prevention. But following up on what Jenn said about the LEARN model, it’s just so important to highlight that everybody has a potential role in suicide prevention and this is not a situation that has to exist on its own separate from the rest of the community. There are things you can dol and that’s like helping to enhance your own protective factors or the protective factors in people that are around you who you care about and love and are connected to. Really critically if suicide risk is heightened at a particular amount of time it’s really critical to reduce access to potential means. And that might mean safe storage of whatever means somebody might be considering going about, because like Jenn mentioned, this will pass and so reducing access in the meantime just kind of buys you some additional time between that thought and that potential action. And most importantly in the LEARN model that I really like is not underestimating that value of empathy and what you might be able to offer as an individual. There are resources for next steps, there are all sorts of additional resources that you can tap into if you’re worried about somebody you care about. But sometimes just being that person in the interim who is there and cares can really be the difference between a bad outcome or an outcome of hope. So with that there is line support, we have the national suicide prevention lifeline at +1 800–273–8255 or the crisis text line at 741741. One of the really great things about the crisis text line in Washington state is it reaches some of our younger population. So more than half of our users in Washington state are age 25 or younger, and then additionally, interestingly in Washington more than half of our users on the crisis text line are also LGBTQ also primarily youth and young adults. And we do know that is a population that is a high risk for suicide. There are also national resources dedicated to vulnerable populations, and what I really like about that is you can get somebody on the line who really is going to understand your unique circumstances. I’ll give a couple examples but there are quite a few of them, if you call the National Suicide Prevention Lifeline and press 1, you will be connected to support for veterans, and then there’s things like the Trevor project which really supports youth and young adults who are LGBTQ.