Talking to someone who is suicidal

Talking about suicide is never easy. 

While you might want to help, it is important to first ensure that you are comfortable talking about it; if you’re not, it is bound to reflect in the conversation. If talking about suicide makes you feel uneasy, then it’s a good time for you to reflect and ask yourself why. Is the fear of saying the “wrong thing” stopping you? Then hopefully this document can serve as a comprehensive starting point. Beyond this, it is also suggested to read testimonials of survivors, to truly understand what it means to feel suicidal.

What pushes someone over the edge?

The thought of suicide is a consequence of feeling like there is no other option – that there is no other way out other than ending one’s life. It may sometimes come from a place of loneliness, a place of punishment, guilt and even pain.

Know that talking about suicidal thoughts rather than keeping it inside is a positive sign, because it means that the person is reaching out for help. They are reaching out for someone who can understand their pain. And reaching out always means that there is hope.

Hence when someone mentions that they feel suicidal, do not go into panic mode. Although it is completely natural for us to have this “default reaction”, understand that staying calm will help you think more clearly and to be actively present. If we equip ourselves with proper awareness and knowledge to deal with the situation, then we can trust ourselves to be better at providing support. Remember, all we need to do is to be there for the person on the other side. Because, that is all THEY need. But what does “being there” mean? It means to actively, whole-heartedly and truthfully pay attention to the person and to take them seriously.

Let us remember that contrary to the popular notion that talking about suicide can increase its risk, if the topic is addressed in a sensitive manner, it can encourage an individual to share their experiences and feelings.

Here are some myths and facts about suicide –

https://www.samaritans.org/how-we-can-help/if-youre-worried-about-someone-else/myths-about-suicide/

 

Assessing the level of risk

Assess the immediacy of acting on a suicidal thought. Does the person have a weapon nearby and can they end their life immediately (extreme risk)? Or are they calm and just talking about their suicidal thoughts as a way to share and reflect (mild risk)?

In the case of the former, understand that this extreme risk is driven by an intense feeling that “everything is too much to handle”. So try to lower the intensity of this feeling. Some de-escalation phrases are discussed below (re: Pt. 8 of “What should you say”). Engage the person in conversation, even if it is about the suicidal thought itself (given they want to speak about it; refer pt. 4 of “What should you say” below). Just keep the conversation going. And, when appropriate, calmly insert a suicide helpline.

In the latter case of mild risk, while the person shares these thoughts, please refrain from trying to “solve” or “fix” the problems causing those thoughts or an immediate attempt to “lighten” the mood. These efforts, although well-intentioned, may stagnate conversation. Pay attention to what the person needs through actively listening to them.

What does it mean to actively listen? It involves:

• Not trying to talk the person out of their thoughts or feelings.
• Not professing to understand a story that is not yet known.
• Not offering superficial reassurance.
• Not problem-solving.
• Not giving advice.

In some situations, it is helpful to plan a buffer – a “safety plan”, in case the person contemplates attempting suicide again. This is essentially a plan of action which consists of identifying one’s triggers (for increased awareness) and devising a set of internal and external coping strategies that can be used when needed. This plan enables them to have more control of the situation.

Please read more into this so that you can learn and maybe coordinate making such a plan with the person. 

Here are some links to read up more on what a “Safety Plan” is:

https://www.suicideinfo.ca/resource/safety-plans/

http://suicidesafetyplan.com/uploads/SAFETY_PLAN_form_8.21.12.pdf

https://www.nasmhpd.org/sites/default/files/SAMHSA%20SPI%20SMI%20PPT%20final_2.pdf

 

Safety plan template : https://www.getselfhelp.co.uk/docs/SafetyPlan.pdf 

What should you not say?

These are not meant to be a strict set of rules but rather guidelines that should be kept in mind while conversing with a person who is at risk.

 

• “Suicide is selfish/Think about what your family and friends will go through” – This just adds on to the guilt that the person is feeling because they already think they’re a burden. And in their distressed condition, they may feel that they would be freeing their friends/ family of this burden. How to use empathy here? Understand that it is normal for anyone in excruciating pain to just want to escape. Haven’t we all experienced being in pain and just wanting it to go away? Think about those times and try to grasp the pain the person is going through.

 

• “Suicide is cowardly”– This statement does nothing but add shame. It does not help the situation but instead can make the person feel judged and cornered.

 

• “You don’t mean that. You don’t really want to die.” – Often out of panic, we might say this to the person, but it can be really dismissive and invalidating of the person’s experience. At ANY circumstance, it’s always better to believe someone is suicidal rather than dismiss it, because even if there is a morsel of truth to it, taking the person seriously can avoid the danger.

 

• “You have so much to live for”– Although in some cases, this might convey a sense of hope, it is important to remember that the top reason someone resorts to suicide is because they DON’T think they have anything to live for. In such cases, this can communicate a lack of understanding of their feelings and situation.

 

• “Things could be worse”– Yes, things can be worse but pain cannot be compared. Pain is a SUBJECTIVE experience. Someone’s whole world can be crashing even if they are relatively “well-off’.

 

• “Other people have problems worse than you and they don’t want to die”– True, but don’t you think the person has already considered this? Compared themselves and felt more shame and guilt that they couldn’t handle it while others could? In fact, this can make them feel like they’re broken or defective. Reality will then just seem like a sick joke.

 

• “Your problems can be solved/Your problems are temporary”– Although some problems may be temporary, there also exists problems that can be long lasting and all we can do is learn to cope with them in a better way. This statement just shows a blatant assumption which again may push the person further away, making them feel like you don’t understand their situation.

 

Here’s a link to read more – https://purplepersuasion.wordpress.com/2014/04/09/ten-things-not-to-say-to-a-suicidal-person/

If you feel you have already said something referring to those listed above, don’t panic. It’s okay. Just go back to the person and convey that you did not respond helpfully and apologise for it. Let them know that you want to understand better and that you will henceforth try your best to be a better listening ear, an ally, a buddy who will be there for them.

What should you say?

Please do not take this as a “script” to be followed word-by-word but try to grab the essence of what needs to be said. Also try to refrain from over-using the phrase “I understand” and instead use statements/ phrases that SHOW you understand. Ask yourself, “What can I say right now that will show the person that I understand what/how they feel and that I care about them?” The following statements are some examples for the same.

 

• “I appreciate that you told me about your suicidal thoughts. This must’ve been so hard for you”– Acknowledge and appreciate the person for opening up. This will reinforce them to talk about it more and to also reach out more in the future.

 

• “I’m sorry for all the pain and hurt that you are feeling. It must be eating you up inside to feel this way” – Use empathetic statements that show you understand how tiresome and burdening it can be to continue living with suicidal thoughts.

 

• “I know you feel scared, but I’m right here and we can talk about this” – Reassure the person that you’re here with them- real time. That you will be there to virtually “hold their hand” through the whole process.

 

• “If you’re comfortable talking about this, would you like to tell me what makes you want to die?” – Sometimes, talking about what makes one feel suicidal can serve to vent the frustration, increase engagement and help understand one’s triggers. Also keep in mind to use phrases such as “Are you okay with this?”, “Can we do this?”, “Are you comfortable with this?” to ensure that you are not pushing the person too much.

 

• “What can I do to help/ make you feel safe?”– It is always better to ASK someone about their needs first, instead of assuming. If they reply with a “I don’t know”, reassure them that it’s okay and you both can figure this out together.

 

• “It takes a lot of strength to decide to wake up and fight these painful thoughts everyday”– Acknowledge how difficult it is for someone who is suicidal to DECIDE (by using this word, you reinforce that they have a choice, that they can choose to live and work towards a better life) to continue living despite the difficulties they face.

 

• “Sometimes we can feel trapped by our thoughts- like there’s no way out. But you are not your thoughts. It can seem hard but don’t let them limit you from reaching out and seeking more options” – Again, try reinforcing the idea that there are still options out there.

 

• Some de-escalation phrases when they are threatening an attempt on chat- “I’m right here, although not physically, I’m listening and I’m here for you. We can take this one step at a time”. Ask them if they have anything that will cause them harm near them. If they respond with a yes, gently ask them if they can trust you and if they can listen to a small request. *Note: Emphasize on words/ phrases such as “small step”, “tiny request”, “just this one thing” because this makes what you ask sound achievable and is met with little resistance* Wait for their response and then ask them to put the instrument far away in a drawer or even under the mattress. Then gently try to calm them (if they are feeling overwhelmed) through grounding. 

Grounding is a technique that can be used to calm someone by increasing awareness of their senses – what they see, hear, smell and feel. This is also a great way to keep them engaged in conversation and to distract from the immediacy of a suicidal thought.

Once relatively de-escalated, you can ask them to lie down, drink some water or to eat something (mindfully pay attention to whether this is what they need) because the intensity of the emotions can make them feel tired and light-headed.

For more info on grounding and related exercises-

https://www.speakingofsuicide.com/2015/08/20/tips-to-calm-anxiety

 

• Follow up: Persistence is the key here. Dropping a message or giving them a call, can go a long way in reaching out to the individual. Even if you don’t talk on a regular basis, let the person know that you are there for them.

Highly recommend reading this article- https://www.speakingofsuicide.com/2013/06/06/how-would-you-listen-to-a-person-on-the-roof/

If you’d like to read the original sources/ inspiration of the above article, kindly look at these links

What Would You Say to the Person on the Roof? A Suicide Prevention Text- https://guilfordjournals.com/doi/pdfplus/10.1521/suli.31.2.129.21509

How Would You Listen to the Person on the Roof? A Response to H. Omer and A. Elitzur- 

https://guilfordjournals.com/doi/pdf/10.1521/suli.31.2.140.21518

Hopefully, this helps you feel a bit more confident about responding to mentions of suicide! Please reach out at engage@lonepack.org if you’d like to share some feedback on this or if you’d like to suggest improvements!