One of the scariest things you can experience is the fear that someone you know may be suicidal. When a friend, family member, or associate shows some of the warning signs for suicide, it’s essential to intervene and take action to get that person to the help they need. When someone is suicidal, they’re in a disassociated state in which they are experiencing extreme self-hatred. How can you lift a person out of this state? Below you will find steps showing what you can do to help a person who is in the midst of a suicidal crisis and put them in touch with the help they need.
1. Engage
Engage the person at risk in a personal way; let the person know you are paying attention and make the person feel accepted. Maintain eye contact. Let your personal reactions show on your face. Sit forward, lean toward the person, and don’t get distracted. For example, convey empathy, try to see and feel things from the person’s perspective.
2. Identify
Ask whether the person is thinking about suicide. Be direct but sensitive. It gives the person permission to talk about suicidal thoughts or plans.
3. Inquire
If the person is considering suicide, ask about their reasons. Reflect back in your own words what you are hearing to help the person feel that he or she is being understood. With understanding you can then work together to find ways other than suicide to resolve the situation.
4. Assess
Ask if the person has a plan. For example, “Have you thought of how you might kill yourself?” “Is there a gun in the house?” “How soon are you planning to do it?” Ask whether the person has attempted suicide before. If you have any doubts about the level of danger, err on the side of caution. In a situation where a person’s life is at stake, it’s better to do too much than not enough. You ask about where, when, and how they are planning on doing it, you are also looking for any positive things that light them up. You want to support any coping strategies that they show are working for them. And you might even ask them: “In the past when you felt bad, how have you dealt with it? What’s helped?”
5. Develop an action plan
This task involves you and the person at risk coming to an agreement and putting a plan into action to prevent the immediate risk of suicide.
Be specific: Be sure the person is able to play back the plan to you to show that he or she clearly understands it. You want to commit to doing things, and you want them to commit to doing things. Play the plan back to them, and make sure they are really understanding it. It’s important to provide structure for them; to make it simple, direct, and with structure, because people at risk are feeling fragmented. They feel like they’re coming apart—and you need to provide the structure.
Limit objectives: The action plan isn’t meant to be a total solution for all the person’s problems. Be realistic. Don’t make false promises or resort to phony statements.
Confirm the commitment: The person at risk agrees not to engage in any self-harming behavior for an agreed-upon time period. Ask the person to repeat the agreement out loud. Both of you will experience a feeling of relief. If you don’t experience a feeling of relief, get them to help immediately.
Develop crisis control: Make arrangements for emergency support if the steps of your plan for action can’t be carried out. For example, have the person or their parents call the local or national suicide hotline. Lastly, what you want to do is make a backup plan with them. What are they going to do if they get overwhelmed with suicidal thoughts or feelings between now and when you are going to do the next step of your plan or the next time you are going to see them? You want to make sure that they have both the local and the national hotline numbers so that 24 hours a day they can reach another trained person at the end of the line who can help talk them through it. You also want them to be able to contact you, but if they can’t get a hold of you, you want to make sure that they have those numbers.
Spell out the follow-up: After assistance is obtained, follow up to see how they are doing.
Lastly, it’s really important that we reach out and act kindly toward everyone in our lives, people we come across, and that we smile at people; you know, that we take the time to talk to somebody who looks distressed and ask them what’s wrong. Make the effort because some people are just waiting to be stopped, to be interrupted, to be helped. Go ahead and ask, it couldn’t hurt.
Go ahead and smile at somebody, it doesn’t take a lot for you, it doesn’t cost you anything. It could really save a life.
Helpful resources
If you or someone you know needs mental health services, information, or referrals in Santa Barbara County, call the 24/7 access line at 1-888-868-1649. Youth under 21 call 1-888-334-2777.
If you or someone you know is in crisis and may be considering suicide, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). English and Spanish counselors are available 24/7; press #1 for veterans services.
The California Department of Health Care Services offers a variety of suicide prevention tool kits focusing on schools, LGBT, and senior communities: www.dhcs.ca.gov/services/MH/Pages/BestPractices.aspx.
Psychalive.org has a suicide prevention advice page psychalive.org/category/suicide-prevention-advice/
In the aftermath of suicide: For those who have experienced a traumatic event, contact Santa Barbara Response Network (SBRN) 699-5608.
Lisa Firestone, Ph.D., is the director of research and education for The Glendon Association (glendon.org) and senior editor of psychalive.org. She is a clinical psychologist and a suicidologist, as well as author and trainer.
This article appears in Feb 4-11, 2016.