NWR's Mental Health Happy Hour Support Group
September 2018 Topic: Suicide Prevention & Awareness Month
If you or someone you know is in an emergency, call The National Suicide Prevention Lifeline at 800-273-TALK (8255) or call 911 immediately.
Suicidal thoughts or behaviors are both damaging and dangerous and are therefore considered a psychiatric emergency. Someone experiencing these thoughts should seek immediate assistance from a health or mental health care provider. Having suicidal thoughts does not mean someone is weak or flawed. According to the CDC, suicide rates have increased by 30% since 1999. Nearly 45,000 lives were lost to suicide in 2016 alone.
What to do when you someone
you know might be suicidal..
Some people believe, “If people are determined to kill themselves, nothing is going to stop them." This is not true. Again, most suicidal people don’t want to die; they want to stop the pain. The impulse to end it all, however overpowering, does not last forever. And proper treatment can eliminate suicidal symptoms. If you suspect someone is suicidal, the first and most important step is to engage that person, to connect with that person. They may have already “signed off” from the world. Your job is to reestablish communications. Talking helps ease the pain. Try to gage the gravity of the situation. Some people believe that, “talking about suicide may give someone the idea." This is not true.
You don't give a suicidal person morbid ideas by talking about suicide. Bringing up the subject and discussing it openly can give the person a great sense of relief. They don’t have to keep it a secret any longer, and this allows them to open up about the underlying issues. Treat all feelings, gestures and language seriously. Be non-judgmental. Accept the person’s feelings and don’t try to talk them out of those feelings.
- Don’t debate whether suicide is right or wrong, or feelings are good or bad.
- Don’t lecture on the value of life.
- Don’t give advice by making decisions for the person or telling them to behave differently.
- Don’t dare them to do it. Share your feelings of concern for the person. Offer hope that alternatives are available but do not offer glib reassurances or try to make light of the situation. It only proves you don’t understand. Offer empathy, not sympathy.
- Do not make a promise of secrecy. Saving a life takes precedence over confidentiality and loyalty. Ask who else knows.
- Do not ask if the person wants help but tell them you will help.
- Do not allow a rejection of help. Once you have connected with the person, do not leave them. You are their bridge back to life. Make it clear you will stick with them until they are connected with someone who can really help them. Encourage an anti-suicide pact.
- Get a commitment not to attempt suicide, even if it’s short term.
Take action. Remove means. Get help from persons or agencies specializing in crisis prevention and suicide prevention. Get immediate help for the person if they are really at risk of hurting themselves by calling 911. Finally, get help for yourself. Taking care of someone who is hurting and it can take its toll on you. Consider talking to a professional about the experience after it is over.
HOW TO GET HELP: There is a wide range of treatment available for suicidal behavior, including medications and “talk” therapies. The key is to get the person professional help as soon as possible. It is better to recognize a potential danger and have it addressed at an outpatient clinic than to wait until the only option is the Emergency Room.
If you know someone who has some of the risk factors above, a first step would be to find out whether the person has a “safety net” -- a caseworker or a school psychologist, for example. Many times, there are professionals who are already involved with the person. If not, then it is a matter of finding the right professionals and getting them involved. Your local NAMI affiliate can help. Call us at 1-800-950-3228 for your affiliate’s phone number and address.
The next step would be to contact these professionals and share your concerns. When speaking to professionals, remember that they might be limited by confidentiality rules in what they can tell you about the person, but they can and should listen to everything that you have to tell them. If you notice some warning signs, it is imperative to get the word out to as many people who can help as possible: not only to a mental health professional, but to anyone who can help: family, friends, teacher, doctor, clergy. Find the people the person will respond to and sound the alarm. Figure out the best way to intervene to get the person professional help and then do it. If you are dealing with someone who is in crisis, call your local crisis line. If there is immediate danger, call 911.
Know the Warning Signs
- Threats or comments about killing themselves, also known as suicidal ideation, can begin with seemingly harmless thoughts like “I wish I wasn’t here” but can become more overt and dangerous
- Increased alcohol and drug use
- Aggressive behavior
- Social withdrawal from friends, family and the community
- Dramatic mood swings
- Talking, writing or thinking about death
- Impulsive or reckless behavior
Is There Imminent Danger?
Any person exhibiting these behaviors should get care immediately:
- Putting their affairs in order and giving away their possessions
- Saying goodbye to friends and family
- Mood shifts from despair to calm
- Planning, possibly by looking around to buy, steal or borrow the tools they need to complete suicide, such as a firearm or prescription medication
Risk Factors for Suicide
Research has found that more than half of people (54%) who died by suicide did not have a known mental health condition. A number of other things may put a person at risk of suicide, including:
- A family history of suicide.
- Substance abuse. Drugs and alcohol can result in mental highs and lows that exacerbate suicidal thoughts.
- Intoxication. More than one in three people who die from suicide are found to be currently under the influence.
- Access to firearms.
- A serious or chronic medical illness.
- Gender. Although more women than men attempt suicide, men are four times more likely to die by suicide.
- A history of trauma or abuse.
- Prolonged stress.
- Age. People under age 24 or above age 65 are at a higher risk for suicide.
- A recent tragedy or loss.
- Agitation and sleep deprivation.
Can Thoughts of Suicide Be Prevented?
Mental health professionals are trained to help a person understand their feelings and can improve mental wellness and resiliency. Depending on their training they can provide effective ways to help. Psychotherapy such as cognitive behavioral therapy and dialectical behavior therapy can help a person with thoughts of suicide recognize unhealthy patterns of thinking and behavior validate troubling feelings, and learn coping skills. Medication can be used if necessary to treat underlying depression and anxiety and can lower a person’s risk of hurting themselves. Depending on the person’s mental health diagnosis, other medications can be used to alleviate symptoms.
It can be frightening and intimidating when a loved one reveals or shows signs of suicidal thoughts. However, not taking thoughts of suicide seriously can have a devastating outcome. If you think your friend or family member will hurt herself or someone else, call 911 immediately. There are a few ways to approach this situation.
- Remove means such as guns, knives or stockpiled pills
- Calmly ask simple and direct questions, such as “Can I help you call your psychiatrist?” rather than, “Would you rather I call your psychiatrist, your therapist or your case manager?”
- Talk openly and honestly about suicide. Don’t be afraid to ask questions such as “Are you having thoughts of suicide?” or “Do you have a plan for how you would kill yourself?”
- If there are multiple people, have one person speak at a time
- Ask what you can do to help
- Don’t argue, threaten or raise your voice
- Don’t debate whether suicide is right or wrong
- If your loved one asks for something, provide it, as long as the request is safe and reasonable
- If you are nervous, try not to fidget or pace
- If your loved one is having hallucinations or delusions, be gentle and sympathetic, but do not get in an argument about whether the delusions or hallucinations are real
If you are concerned about suicide and don’t know what to do, call the National Suicide Prevention Lifeline: 1-800-273-TALK (8255). They have trained counselors available 24/7 to speak with either you or your loved one.
Even if your loved one isn't in a moment of crisis, you need to provide support. Let her know that she can talk with you about what she is going through. Make sure that you are actively and openly listening to the things she says. Instead of arguing with any negative statements that she makes, try providing positive reinforcement. Active listening techniques such as reflecting feelings and summarizing thoughts can help your loved one feel heard and validated. Furthermore, reassuring your loved one that you are concerned for her well-being will encourage her to lean on you for support.
One of the best things you can do if you know or suspect that your loved one is contemplating suicide is educate yourself. Learning about suicide, what the warning signs are, and how it can be prevented can help you understand what you need to do as a member of their support system.
If Possible, Be Prepared
If your friend or family member has had suicidal thoughts in the past, it's a good idea to have a crisis plan just in case. This means that you'll need to work together to develop the best course of action if a crisis situation should occur.
Being Prepared for a Crisis
No one wants to worry about the possibility of a crisis, but they do happen. That doesn't mean you have to feel powerless. Many healthcare providers require patients to create a crisis plan, and may suggest that it be shared with friends and family. Ask your loved one if he has developed a plan.
A Wellness Recovery Action Plan can also be very helpful for your loved one to plan his overall care, and how to avoid a crisis. If he will not work with you on a plan, you can make one on your own. Be sure to include the following information:
- Phone numbers for your loved one’s therapist, psychiatrist and other healthcare providers
- Family members and friends who would be helpful, and local crisis line number
- Phone numbers of family members or friends who would be helpful in a crisis
- Local crisis line number (you can usually find this by contacting your NAMI Affiliate, or by doing an internet search for “mental health crisis services” and the name of your county)
- Addresses of walk-in crisis centers or emergency rooms
- The National Suicide Prevention Lifeline: 1-800-273-TALK (8255)
- Your address and phone number(s)
- Your loved one’s diagnosis and medications
- Previous psychosis or suicide attempts
- History of drug use
- Things that have helped in the past
- Mobile Crisis Unit phone number in the area (if there is one)
- Determine if police officers in the community have Crisis Intervention Training (CIT)
Go over the plan with your loved one, and if he is comfortable doing so, with his doctor. Keep copies in several places. Store a copy in a drawer in your kitchen, your glove compartment, on your smartphone, your bedside table, or in your wallet. Also, keep a copy in a room in your home that has a lock and a phone.
Psychiatric Advance Directives
You may also want to ask about a Psychiatric Advance Directive (PAD), which is a legal document that allows a second party to act on your loved one's behalf if he becomes acutely ill and unable to make decisions about treatment. The PAD is written by your loved one when they are currently ‘competent.’ It details the individual’s preferences for treatment should they become unable to make such decisions due to their mental health condition. Planning ahead can make a huge difference in your loved one’s treatment experience in the future.
In some cases, a person who is suicidal refuses to seek or accept treatment. They may engage in self-harm, risky behaviors and multiple suicide attempts. Oftentimes a person in this condition has a serious underlying mental illness that they refuse treatment for. Unfortunately, because they present such a significant danger to themselves, they may need someone else to make these decisions for them. A conservatorship is a legal relationship granted by a court that allows one person (the conservator) to make personal decisions for another (the ward), who has shown themselves to be unable to fulfill the basic requirements needed to protect their own health and safety. Unless otherwise specified, the conservator has all of the powers that a parent has over a minor, which would allow the conservator to direct the ward’s mental health treatment and suicide prevention measures.
Have a question? Someone else may have already asked it. Check out our list of frequently asked questions. 1-800-950-NAMI (6264) or firstname.lastname@example.org The NAMI HelpLine can be reached Monday through Friday, 10 am–6 pm, ET. HelpLine staff and volunteers are prepared to answer your questions about mental health issues including:
- Symptoms of mental health conditions
- Treatment options
- Local support groups and services
- Education programs
- Helping family members get treatment
- Programs to help find jobs
- Legal issues (the NAMI Legal Resource Service can connect individuals with attorneys in their area but does not have the resources to provide individual representation)
We are unable to provide counseling or therapy, cannot provide specific recommendations for things like treatment or do individual casework, legal representations or other individual advocacy. In the event of a crisis call, we will transfer callers in crisis or who express suicidal ideation to a national crisis line to provide further assistance.
What To Do In An Emergency or Crisis
No one wants to experience a crisis, but they do happen. Fortunately, there are people and organizations willing and able to help. Use these resources if you or someone you know is experiencing a crisis. It’s important to identify the correct options and seek help quickly in a crisis situation.
In An Emergency
If you or a loved one is in immediate danger calling 911 and talking with police may be necessary. It is important to notify the operator that it is a psychiatric emergency and ask for an officer trained in crisis intervention or trained to assist people experiencing a psychiatric emergency.
In A Crisis
National Suicide Prevention Lifeline – Call 800-273-TALK (8255) If you or someone you know is in crisis—whether they are considering suicide or not—please call the toll-free Lifeline at 800-273-TALK (8255) to speak with a trained crisis counselor 24/7.
The National Suicide Prevention Lifeline connects you with a crisis center in the Lifeline network closest to your location. Your call will be answered by a trained crisis worker who will listen empathetically and without judgment. The crisis worker will work to ensure that you feel safe and help identify options and information about mental health services in your area. Your call is confidential and free.
Crisis Text Line – Text NAMI to 741-741 Connect with a trained crisis counselor to receive free, 24/7 crisis support via text message.
National Domestic Violence Hotline – Call 800-799-SAFE (7233) Trained expert advocates are available 24/7 to provide confidential support to anyone experiencing domestic violence or seeking resources and information. Help is available in Spanish and other languages.
National Sexual Assault Hotline – Call 800-656-HOPE (4673) Connect with a trained staff member from a sexual assault service provider in your area that offers access to a range of free services. Crisis chat support is available at Online Hotline. Free help, 24/7.
Preparing For A Possible Crisis
Taking steps to prepare for the possibility of a crisis can help you act quickly, ease your mind and lessen the impact if a crisis situation does occur. Understanding the differences between mental health crisis services and how to access them are a vital step towards being prepared. Your local NAMI can help you locate these services in your community.
A crisis plan is a document that contains important information and outlines how to respond to a crisis situation. Many healthcare providers require patients to create a crisis plan that include:
- phone numbers of mental health professions, family members and friends
- a list of current prescription medications, doses and diagnosis
- any history of suicide attempts, psychosis or drug use history
- triggers and coping mechanism that have helped in the past
About the NAMI HelpLine
The NAMI HelpLine is a free service that provides information, referrals and support to people living with a mental health condition, family members and caregivers, mental health providers and the public. A well-trained and knowledgeable team of volunteers, interns and HelpLine staff will respond to your call or message. Many staff members and volunteers live with a mental health condition or provide care and support to a family member or friend. The HelpLine also has volunteer attorneys and legal interns who provide legal expertise or a referral to an attorney in your community.
How can I start a HelpLine at my NAMI Affiliate?
The NAMI HelpLine provides resources for NAMI Leaders to help with the start-up and operation of a NAMI State Organization or Affiliate HelpLine. Leaders can also contact the NAMI HelpLine manager for information and support.
- Capital Region NAMI office: 99 Pine Street, Suite 105, Albany, NY 12207
- American Foundation for Suicide Prevention Capital Region NY: email@example.com
Talk Space Online Counseling
Betterhelp.com Online Counseling
NYS Office of Mental Health - Find a Mental Health Program in your area